Scaling-up filariasis lymphoedema management into the Primary Health Care System in Kerala State, Southern India - an example of equity in healthcare.

Abstract Background: Lymphatic filariasis remains one the world’s most debilitating parasitic infections and is a major contributor to poor health in many endemic countries. The provision of continuing care for all those affected by this infection and its consequences is an important component of the United Nations’ Sustainable Development Goals. The World Health Organization’s recommendation for achieving this goal is for countries to integration their lymphedema care into the primary health care system. Methods:To fulfil the WHO recommendation for providing care for all those affected with lymphoedema caused by lymphatic filariasis, selected health care providers from each of the endemic districts in Kerala participated in intensive training sessions endorsed by the State’s medical administration. The six training sessions included appropriate self-care information and the development of individual plans for each participating institution to provide instruction and care for their lymphoedema patients. The learning achieved by attendees was assessed during the training sessions by pre- and post-training testing. The number of lymphoedema patients receiving care and instruction from the post-training activities of each participating institution was assessed from local records, six months after the conclusion of the training sessions.Results:One hundred and eighty-four medical personnel (91 doctors and 93 staff nurses) from 82 medical institutions were trained which quickly led to the establishment of active lymphoedema clinics providing the essential package of care (EPC) for lymphoedema patients at all the participating institutions. Six months after the training sessions the number of previously unidentified lymphoedema patients registered and receiving care at these clinics ranged from 296 to almost 400 per clinic, with a total of 3477 new patients receiving training in the EPC during this period.Conclusions:Generalist health personnel, when appropriately trained, can provide quality lymphoedema care in public health settings, and that patients, when provided services close to their home, are willing to access these services. This approach is a feasible strategy for integrating long term care for LF patients into a national health system, and is a clear example of moving towards equity in health care for the medically underserved, and thus successfully addresses a major goal of the global program to eliminate lymphatic filariasis (GPELF).