Global Programme to Eliminate Lymphatic Filariasis ... - libdoc.who.int

26Annual Report on Lymphatic Filariasis 2003Chapter 1 Progress of the Global Programme to Eliminate Lymphatic Filariasisonly medical but also social, environmental, economicand psychological factors. It has been realized that, inorder to understand fully the issues related to disability,it is necessary to define and analyse certain basicconcepts regarding the development of the disabilityand its implications. Previously, the use of terms suchas “disability”, “impairment “ and “handicap” to describethe different states associated with various diseases hadnegative connotations.The WHO International Classification of Functioning,Disability and Health (ICF) provides a better, more coherentview of different aspects of health from a biological,individual and social perspective. It provides a balancebetween the medical and social models of disability: themedical model views disability as a problem directlycaused by disease, trauma or other health conditions,which requires medical care in the form of individualtreatment by professionals. In contrast, the social modelsees disability as a matter of full integration of the individualinto society and prescribes social action to makethe environmental modifications necessary for the fullparticipation of disabled people in all areas of social life.Several meetings took place between 2002 and 2003,involving a number of partners from different partsof the world, to produce a framework for action andto establish basic principles on disability. The first,an informal consultation held in WHO headquarters,Geneva, in November 2002, considered the draft “Basicprinciples and a framework for action for the preventionof LF-related disabilities”. Pilot projects were then setup in Brazil, Burkina Faso, Dominican Republic, Haiti,India, Sri Lanka and Zanzibar, United Republic of Tanzania,to gather information on the management of lymphoedemaand devise strategies for information-sharingand community sensitization. In follow-up to certaincountry field experiences, a four-part training packageon prevention of disability associated with LF was developed,field-tested and finalized (see the next section onTraining and capacity-building).In November 2003, a joint UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training inTropical Diseases (TDR) and WHO Programme to EliminateLymphatic Filariasis Workshop on Prevention of DisabilityAssociated with Lymphatic Filariasis was held inColombo, Sri Lanka. The workshop enabled LF programmemanagers to become fully acquainted with WHO’s basicprinciples and the framework for action on the preventionof LF-related disabilities as well as to formulate protocolsfor pilot projects on community-based self-care forprevention of LF-related disability. The workshop wasattended by officers from LF national programmes andresearch sectors of the WHO South-East Asia Region.In 2003, a pilot project was launched in Zanzibar, UnitedRepublic of Tanzania, to test a new strategy aimed atincreasing access to surgery at district hospital level forsufferers of uncomplicated hydrocele, in line with therecommendations of the Informal Consultation on SurgicalApproaches to the Urogenital Manifestations of LymphaticFilariasis. A survey was carried out on hydroceleprevalence, which showed there were 1530 suffererswho could have surgery at district level. Because thesouthern districts of Pemba and Unguja had the highestprevalence (205 and 225, respectively), it was decided toimplement the project in those two districts and operationsare expected to start in March 2004.Another pilot project began in July 2003 in two districtsof Madagascar, Manakara and Mananjary, in collaborationwith the Italian nongovernmental developmentorganization Reggio Terzo Mondo. The aims of theproject are to assess the training package that has beendeveloped on community home-based prevention of disabilityassociated with LF, indicators for monitoring therelevance of the disability sub-management, and thefeasibility of expanding this care management model toother chronic diseases present in the districts. Preliminaryresults should be available at the end of 2004.Following a series of meetings at WHO headquartersduring 2002 and 2003 among officers of the Classification,Assessment, Survey and Terminology unit, theDepartment of Measurement and Health InformationSystems (HFS/CAS) and the Programme to Eliminate LF(CPE/CEE), it was decided to develop an assessment toolfor country use comprising the WHO Disability AssessmentSchedule (WHODAS) and a simplified version of theICF Checklist. The tool will be tested initially in BurkinaFaso, Madagascar, Sri Lanka and Zanzibar, United Republicof Tanzania, in 2004. It is anticipated that some of thepartners of GPELF will collaborate in these efforts.