60 Years of Raj Pracha Samasai with the success of leprosy elimination according to the royal initiatives, 1957-2020

Abstract

The main objective of this evaluative research was to evaluate the success of the leprosy elimination of the leprosy control project according to the royal initiatives from 1957 to 2020 in achieving the targets of the World Health Organization (WHO) and Thailand by using the CIPP model. The data were collected during July-December 2020. The results indicated that the leprosy control and elimination projects had been expanded since 1957 in line with the royal initiatives on the leprosy control, health education and public relations, disability prevention and rehabilitation, and disease control in migrant workers. Overall leprosy elimination program had the satisfactory results. It was able to eliminate the leprosy as a public health problem since 1994, 6 years before the target set by the WHO. The number of new cases had steadily decreased to just 119 cases in 2019. In 2020, the number of new cases was 89, the rate of new cases with grade 2 disability was less than 1 (0.1) per million population and no new children cases with grade 2 disability were detected. In addition, there were 374 districts (40.3%) and 2 provinces (2.6%) that did not detect a new leprosy case for 10 consecutive years. These situations indicated achievement of the sustainable leprosy elimination and leprosy-free goals of Thailand and the World Health Organization (WHO) in 2020. However, the overall proportion of new cases with grade 2 disability at the national level did not decrease, reflecting a delay in case detection. However, when analyzing only in districts with epidemiological indicators where there was the intensive case detection, it was found that the trend of proportions of new cases with grade 2 disability was dropping, while it was increasing in districts without epidemiological indicators. Thus, there is need for a suitable strategy for new case finding under low leprosy situation in areas without epidemiological indicators. In migrant population, there was a need to develop strategies for detecting cases early in order to prevent further transmission in Thailand and develop a system for patients to consistently receive medications. From the assessments of contexts, input factors, processes and outputs, it was found that they were appropriate, except for the input factors with a problem on shortage of personnel with expertise on the leprosy, which needed to accelerate personnel capacity building in health service system at all levels continuously. In the overall image of leprosy elimination according to the royal initiatives from 1957–2020, it was considered that it well succeeded according to the royal initiatives and royal wishes, and Thailand was expected to become leprosy-free, which is a goal of the World Health Organization (WHO) in the future. The royal genius and grace of His Majesty King Rama IX, Rama X and Chakri dynasty were therefore a critical success factor in the sustainable leprosy elimination and leprosy-free goals of Thailand.