Nepal Leprosy Trust addresses the problem through five approaches:

• Leprosy services: In southeast Nepal, NLT built and now operates the Lalgadh Leprosy Services Centre (LLSC). LLSC is operated in affiliation with the Nepali government. It is believed to be the busiest leprosy centre in the world. LLSC provides: examination and diagnostic services; in- and out-patient services; treatment of complications; reconstructive surgery; Prevention of Disability (POD) or self-care treatment and training; foot care; physiotherapy; and the follow-up of defaulting MDT patients. People affected by leprosy receive all treatment, housing, food and drugs free of charge.

• Empowerment: The Stigma Elimination Project (STEP) helps leprosy-affected people access micro-credit, address illiteracy, advocate for rights, and carry out development projects in the community. The Self-Care Training Centre provides residential training to help affected people participate in family and community life. The 41 regional self-help groups increase independence, status and security.

• Capacity Building: A training centre trains community health workers in leprosy identification and control. Leprosy-affected people in self-help groups help with leprosy detection and control work.

• Community Awareness: The programme alerts people to early symptoms, raises awareness of curability, treatment and rights, and spreads knowledge of the lack of infectiousness after treatment. Educational dramas, videos and puppet shows are used. They help increase new case detection.

• Income generation: A sheltered workshop for leprosy-affected people in Kathmandu produces leather goods, as well as other handicraft items. Other self-help groups carry out similar work. There are 200 active projects currently. Other poor people are also helped to develop trades and projects.

Programmes also include other disabled or disadvantaged people, such as destitute women and children, or people with HIV/AIDS. They are often found when a leprosy-affected family member attends a self help group.

NLT Nepal runs the local operations with contributions from volunteer expatriates. The local management is helped by NLT UK with organisational management, report writing and target setting for donor relations, and with future strategy development as leprosy declines in importance. (NLT Ireland also raises funds.) The Centre is developing considerable expertise in skin diseases and disabilities. It is planned that this will become its focus as leprosy declines in prevalence. The time scale of leprosy development is 5-30 years which means that there will be future leprosy cases incubating for some time that have yet to show symptoms.