Fundación Neumológica Colombiana 30 años de una institución con espíritu / Fundación Neumológica Colombiana 30 years of an institution with spirit

Hablar de la Neumología moderna en Colombia y de la Fundación Neumológica Colombiana es hablar de Darío Maldonado Gómez. Nacido en Pamplona, Norte de Santander, llegó a Bogotá siendo un adolescente, cuando sus padres se vieron obligados a salir de su ciudad natal hacia la capital, con todos sus hijos, producto de la violencia encendida a finales de la década de los 40´s. Con el ejemplo de su padre, Darío Maldonado Romero, médico que se especializó en la lepra y consagró sus esfuerzos al desarrollo de políticas de salud pública. Así, con la ambición de aprender y apropiar la ciencia, el arte y el humanismo que sustentan la medicina, ingresó a la Universidad Nacional en Bogotá y obtuvo su título de médico en 1959. Su ánimo de aprender y de poder ofrecer siempre las mejores opciones a sus pacientes, lo llevaron pronto a Chicago y Milwaukee, Estados Unidos, donde, en la década de los 60´s, se entrenó en Medicina Interna y Neumología con el profesor Gordon Snider, pionero y figura de la Neumología moderna en el mundo.

Talking about modern Pulmonology in Colombia and the Colombian Pulmonary Foundation is talking about Darío Maldonado Gómez. Born in Pamplona, Norte de Santander, he came to Bogotá as a teenager, when his parents were forced to leave their hometown for the capital, with all their children, as a result of the violence inflamed at the end of the 1940s. With the example of his father, Darío Maldonado Romero, a doctor who specialized in leprosy and devoted his efforts to the development of public health policies. Thus, with the ambition of learning and appropriating the science, art and humanism that sustain medicine, he entered the National University in Bogotá and obtained his medical degree in 1959. His desire to learn and to always be able to offer the best options to his patients, they soon took him to Chicago and Milwaukee, United States, where, in the 1960s, he trained in Internal Medicine and Pulmonology with Professor Gordon Snider, pioneer and figure of modern Pulmonology in the world.

[João de Barros Barreto: a builder of the organizational debate on health in Brazil]. / João de Barros Barreto: um construtor do debate organizacional em saúde no Brasil.

The article explores João de Barros Barreto's ideas and proposals for the field of the organization of health services in Brazil. Based on the proposal of the Capanema Reform (1937-1941), the text reveals the context of the formulation of the so-called district health model in Brazil historically, focusing on its logic, conceptual and theoretical principles and resources employed. The conclusion drawn is that Barros Barreto's professional career, contextualized in a specific scenario of ideas, state agenda and organizational perspectives, contributed decisively to the constitution of modeling achievements of relevant organizational arrangements in the trajectory of Brazilian public health.

O artigo explora ideias e propostas de João de Barros Barreto para o campo da organização dos serviços de saúde no Brasil. A partir da proposição da Reforma Capanema (1937-1941), o texto constrói historicamente o contexto da formulação do chamado modelo distrital em saúde no Brasil, com foco em sua lógica, bases conceituais e teóricas e recursos empregados. Conclui-se que a trajetória profissional de Barros Barreto, contextualizada em um cenário específico de ideias, de agenda de Estado e de perspectivas organizacionais, colaborou decisivamente para a constituição de realizações modeladoras de um arranjo organizacional importante na trajetória da saúde pública brasileira.

João de Barros Barreto: um construtor do debate organizacional em saúde no Brasil / João de Barros Barreto: a builder of the organizational debate on health in Brazil

Resumo O artigo explora ideias e propostas de João de Barros Barreto para o campo da organização dos serviços de saúde no Brasil. A partir da proposição da Reforma Capanema (1937-1941), o texto constrói historicamente o contexto da formulação do chamado modelo distrital em saúde no Brasil, com foco em sua lógica, bases conceituais e teóricas e recursos empregados. Conclui-se que a trajetória profissional de Barros Barreto, contextualizada em um cenário específico de ideias, de agenda de Estado e de perspectivas organizacionais, colaborou decisivamente para a constituição de realizações modeladoras de um arranjo organizacional importante na trajetória da saúde pública brasileira.

Abstract The article explores João de Barros Barreto's ideas and proposals for the field of the organization of health services in Brazil. Based on the proposal of the Capanema Reform (1937-1941), the text reveals the context of the formulation of the so-called district health model in Brazil historically, focusing on its logic, conceptual and theoretical principles and resources employed. The conclusion drawn is that Barros Barreto's professional career, contextualized in a specific scenario of ideas, state agenda and organizational perspectives, contributed decisively to the constitution of modeling achievements of relevant organizational arrangements in the trajectory of Brazilian public health.

Threshold effect of government subsidy, corporate social responsibility and brand value using the data of China's top 500 most valuable brands.

An increasing number of firms have begun to attach importance to corporate social responsibility (CSR) to obtain sustainable strategic advantages in the competitive market. On the basis of nonlinear perspective, panel data of A-share listed companies in the ranking list of China's Top 500 Most Valuable Brands in 2012-2018 and Hansen panel threshold regression technology were adopted. With government subsidy and CSR being threshold variables, the internal mechanism about the influence of government subsidy and CSR on brand value was explored. Results show that the following. (1) CSR has a significantly inverted U-type threshold effect on brand value. (2) Government subsidy facilitates CSR with diminishing marginal utility. (3) When a difference exists in the strength of government subsidy, the influence of CSR on brand value presents a significant N-type law. Furthermore, threshold regression method was used to innovatively explore the complex nonlinear relationship among government subsidy, CSR, and brand value. This relationship has a significantly practical significance for listed firms for weighing the business decisions regarding the input of CSR and brand value, as well as subsidy policies for enterprises by the government.

Community health care workers in pursuit of TB: Discourses and dilemmas.

Community-led tuberculosis (TB) active case finding is widely promoted, heavily funded, but many efforts fail to meet expectations. The underlying reasons why TB symptom screening programs underperform are poorly understood. This study examines Nigerian stakeholders' insights to characterize the mechanisms, enabling structures and influences that lead programs to succeed or fail. Eight focus group discussions were held with Community Health Workers (CWs) from four models of community-based TB screening and referral. In-depth interviews were conducted with 2 State TB program managers, 8 Community based organizations (CBOs), and 6 state TB and Leprosy Local Government supervisors. Transcripts were coded using Framework Analysis to assess how divergent understandings of CWs' roles, expectations, as well as design, political and structural factors contributed to the observed underperformance. Altruism, religious faith, passion, and commitment to the health and well-being of their communities were reasons CWs gave for starting TB symptom screening and referral. Yet politicized or donor-driven CWs' selection processes at times yielded implementers without a firm grounding in TB or the social, cultural, and physical terrain. CWs encountered suspicion, stigma, and hostility in both health facilities and communities. As the interface between the TB program and communities, CWs often bore the brunt of frustrations with inadequate TB services and CBO/iNGO collaboration. Some CWs expended their own social and financial capital to cover gaps in the active case finding (ACF) programs and public health services or curtailed their screening activities. Effective community-led TB active case finding is challenging to design, implement and sustain. Contrary to conventional wisdom, CWs did not experience it as inherently empowering. Sustainable, supportive models that combine meaningful engagement for communities with effective program stewardship and governance are needed. Crucially effective and successful implementation of community-based TB screening and referral requires a functional public health system to which to refer.

Ligas acadêmicas na educação médica: uma análise institucional sob a visão dos orientadores / Academic leagues in medical education: an institutional analysis under the guiding view

Introdução: As ligas acadêmicas de medicina (LAM) surgiram no Brasil no início do século XX como reuniões de alunos, na necessidade de combate à alta prevalência dos agravos de saúde pela tuberculose e pela hanseníase. Na década de 90, a criação de novas LAMs permitiu um ambiente de discussão e prática de atividades em área de saúde de interesse de um conjunto de alunos e foi, assim, ganhando cada vez mais espaço na formação médica. Todavia, ainda são poucas as evidências científicas que discutem as finalidades e contribuições das LAMs durante a graduação, seja do ponto de vista do aluno ou do orientador. Objetivo: Estudar o perfil das ligas acadêmicas do curso de medicina de uma instituição de ensino da cidade de Juiz de Fora ­ MG. Material e Métodos: Trabalho de natureza descritiva e transversal que teve como instrumento de pesquisa questionário estruturado com 12 perguntas fechadas, previamente definidas, que foi respondido pelos orientadores das LAMs. Resultados: Em 2018, havia na instituição 36 ligas oficialmente constituídas com 37 orientadores. Quanto a frequência de encontros, os mesmos são majoritariamente mensais (78,4%) e 78,4% contam com a participação dos orientadores. Quanto à participação científica, 70,3% fazem discussão de artigos científicos, 62,2% possuem práticas extra-curriculares, 10,8% realizaram projetos de extensão e 13,5% têm trabalhos vinculados ao Programa de Iniciação Científica. Ressalta-se que a percepção dos orientadores é que 56,8% dos alunos participam para pontuação em programas de residência médica. Finalmente, 89,2% consideram o modelo de gestão adequado. Conclusão: A percepção dos orientadores é importante para a análise das ligas de forma a garantir melhorias principalmente para a educação e extensão. Somente com a descrição e estudo da situação atual será possível imprimir sugestões e avanços nessa questão, que já é tema central dentro da educação médica.

Introduction: The academic leagues of medicine (LAM) emerged in Brazil at the beginning of the twentieth century as student meetings, in order to combat the high prevalence of health problems caused by tuberculosis and leprosy. In the 1990s, the creation of new LAMs allowed for an environment of discussion and practice of health activities of interest to a group of students and was thus gaining more and more space in medical education. However, there is still little scientific evidence to discuss the purposes and contributions of LAMs during undergraduate studies, either from the student's or the advisor's point of view. Objective: To investigate the profile of academic leagues by the medical course of an educational institution in the city of Juiz de Fora - MG. Material and Methods: This study has a descriptive and cross-sectional nature and had as its instrument a structured questionnaire with 12 previously defined closed questions, which was answered by the LAM advisors. Results: In 2018 there were 36 officially constituted leagues in the institution with 37 mentors. As for the frequency of meetings, they are mostly monthly (78.4%), and 78.4% have the participation of counselors. As for scientific participation, 70.3% discuss scientific articles, 62.2% have extra-curricular practices, 10.8% have Extension Projects and 13.5% have papers linked to the Scientific Initiation Program. It is noteworthy that the perception of counselors is that 56.8% participate for scoring in medical residency programs. Finally, 89.2% consider the management model appropriate. Conclusion: Guidance perception is important for league analysis in order to ensure improvements especially for education and extension. Only with the description and study of the current situation will it be possible to print suggestions and advances in this issue, which is already a central theme within medical education.

Physical Fitness and Body Composition in 8-10-Year-Old Danish Children Are Associated With Sports Club Participation.

Larsen, MN, Nielsen, CM, Ørntoft, CØ, Randers, M, Manniche, V, Hansen, L, Hansen, PR, Bangsbo, J, and Krustrup, P. Physical fitness and body composition in 8-10-year-old Danish children are associated with sports club participation. J Strength Cond Res 31(12): 3425-3434, 2017-We investigated whether physical fitness and body composition in 8-10-year-old Danish children are associated with sports club participation. The study included 423 schoolchildren, comprising 209 girls and 214 boys, of whom 67 and 74%, respectively, were active in sports clubs. Yo-Yo intermittent recovery level 1 for children (YYIR1C), balance, jump and coordination tests, together with dual-energy X-ray absorptiometry, were used to determine exercise capacity and body composition. Children active in sports clubs had better (p < 0.05) YYIR1C (33%, 767 ± 26 vs. 575 ± 29 m), 20-m sprint (3%, 4.33 ± 0.03 vs. 4.48 ± 0.04 seconds), coordination (6%, 68 ± 1 vs. 72 ± 1 second), and balance test performances (9%, 19.3 ± 0.5 vs. 21.2 ± 0.7 falls·min) and lower fat mass index (16%, 3.8 ± 0.1 vs. 4.5 ± 0.2 kg[fat]·m) than children not active in sports clubs. Ball game players had better (p < 0.05) YYIR1C (38%, 925 ± 39 vs. 671 ± 28 m), 20-m sprint (4%, 4.25 ± 0.03 vs. 4.42 ± 0.04 seconds), and coordination test performances (5%, 65 ± 1 vs. 69 ± 1 second), along with higher (p < 0.05) lean body mass (5%, 24.00 ± 0.22 vs. 22.83 ± 0.25 kg) and whole-body BMD (2%, 0.90 ± < 0.01 vs. 0.88 ± <0.01 g·cm) compared with children active in other sports. The study showed that 8[FIGURE DASH]10-year-old Danish children engaged in sports-club activity, especially ball game players, have better exercise capacity and superior body composition compared with children not active in sports clubs.

Ilep: en el camino hacia un mundo sin lepra / No disponible

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Orígenes de la cooperación sanitaria internacional / No disponible

Desde la aparición de las primeras pandemias de cólera en la tercera década del siglo XIX tuvieron lugar una gran cantidad de Conferencias Sanitarias de muy diversa índole. Debido a la importancia económica de las epidemias y a las regulaciones que afectaban al comercio internacional, la diplomacia impulsó el nacimiento de la salud pública y sustituyó las ramas por la negociación. De este modo, las potencias coloniales europeas perpetuaban su dominio sobre los cinco continentes y establecían medidas de control sanitario global. Esa fue la dimensión sanitaria de la génesis del comercio internacional. Reuniones de expertos sobre higiene y demografía, fiebre amarilla, cólera, tuberculosis, enfermedades venéreas, dieron paso a otras sobre las gotas de leche y la alimentación infantil, y auspiciaron los inicios de la estadística sanitaria y epidemiológica internacional. Tras el precedente de la Cruz Roja Internacional, al iniciarse el siglo XX, este movimiento sanitario internacional culminó con la fundación de la primera institución con sede permanente en París: l’Office Intérnational ed’Higiène Publique (1907). Su papel en los conflictos bélicos, las grandes catástrofes y crisis sociales, y la difusión de información sanitaria fue muy limitado, pero marca un precedente en la cooperación sanitaria internacional. Tras la Gran Guerra, la gran catástrofe demográfica y sanitaria, la hambruna y la epidemia de gripe de 1918 impulsaron, tras el Tratado de Versalles, la creación de la Organización de Higiene de la Sociedad de Naciones. Por aquellos años, la filantropía internacional se había difundido ampliamente por Europa y América de la mano del International Health Board de la Fundación Rockefeller, y la colaboraciónentre ambas organizaciones en aspectos como la lucha contra las enfermedades infecciosas (malaria, tuberculosis, venéreas...), la higiene rural, las deficiencias nutricionales, o los estándares de salud marcaron un referente internacional para las políticas de salud pública y el avance de la medicina social. Ambas impulsaron las Escuelas de Sanidad y los Institutos Nacionales de Higiene, así como la formación de expertos en salud pública y su permanente intercambio de información. A comienzos de los años 1940, la Segunda Guerra Mundial cambió el panorama e impulsó la creación de la ONU y el reforzamiento de un cooperativismo internacional que tenía en su dimensión sanitaria uno de los principales elementos de estabilización. Primero el UNRRA y más tarde la FAO y la OMS sustituyeron a las organizaciones anteriores y abrieron la cooperación sanitaria a la participación de las ONGs, en un contexto histórico bien distinto: el de la Guerra Fría y la descolonización (AU)

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O paradigma dualista da hanseníase controle ou eliminação: o período crítico de 2000 a 2005 / Leprosy dual paradigm control or elimination: the critical period 2000-2005

INTRODUÇÃO: Uma das realidades atuais da hanseníase a nível do coletivo consiste na ação simultânea de órgãos oficiais e organizações não governamentais seguindo eventualmente estratégias diferenciadas. A presente comunicação visa contribuir para com tal questão, revendo alguns aspectos marcantes de respectiva evolução contemporânea. MÉTODOS Aplicação das técnicas de revisão bibliográfica e análise textual, enquanto metodologias conteudísticas, a dados primários de acervo circunstancial de publicações específicas em circulação aberta. RESULTADOS Os desencontros sucessivos demarcados entre ambos os setores explicitam-se no referente ao objetivo a ser atingido pela luta contra a doença, se seu controle ou sua eliminação. CONCLUSÕES Novas perspectivas de ações conjuntas são buscadas agora quando, mais realisticamente, se retoma a prioridade do controle da endemia e se contemplam, de fato, seus determinantes sociais.

INTRODUCTION One of the main tendencies of leprosy worldwide is the simultaneous action of non governmen-tal organizations and official agencies operating eventual different strategies. This paper aims to contribute to such question focusing on some outstanding aspects of re-spective contemporary evolution. METHODS Application of bibliographic review and contents analysis techniques to primary data from a circumstancial set of open circula-tion specific publications. RESULTS Successive disagree-ments registered between both parts refer to the ob-jective to be attained by the fight against the disease, if control or elimination. CONCLUSIONS New perspec-tives of jointed actions are being searched for now when priority on endemics control is more realistically assumed and social determination is been really considered.

Bombay Lerpsy Project- Una ONG modelo / No disponible

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Introducing operations research into management and policy practices of a non-governmental organization (NGO): a partnership between an Indian leprosy NGO and an international academic institution.

This paper reports on a partnership between LEPRA, a non-governmental organization (NGO), and the London School of Hygiene and Tropical Medicine (LSHTM) to explore the feasibility and appropriateness of incorporating operations research into the management and decision-making of a leprosy NGO. A pilot study in Orissa was used to determine the advantages and disadvantages of introducing operations research to assist in decision-making and programme implementation within the organization. The results highlight the difficulty and complexity of the process, but point to several important themes: partnership, changing perspectives, use of time and priority-setting, identification of gaps in systems, and building institutional and personal capabilities. The results of the study provide support to encourage NGOs to become actively involved in research. Because of their work and service to local communities, NGOs have the opportunity to collect information about the perceptions, resources and constraints of individuals, families and the communities themselves in accessing appropriate care. Their proximity to communities gives them a feeling of responsibility for ensuring that this information is translated to the district, national and ultimately international level. This will help to ensure the creation of appropriate infectious disease control policies that support the needs of patients. 'Outside' academic institutions can help NGOs to facilitate this up-stream flow of information from the local to the national and international level, to help to ensure that international disease control policies are appropriately serving local communities.

[Cooperation between an NGO and "host" states in the control of leprosy in Latin America]. / A cooperação entre uma ONG e os Estados "anfitriões" no controle da hanseníase na América Latina.

The proliferation of nongovernmental organizations (NGOs) can be considered the result of the inability of the current democratic system to perform all the tasks desired by its citizens. Although NGOs often do quite positive work, they tend to diminish governmental power and are capable of interfering in the internal affairs of other countries. In this context, there are efforts to control their activities, and this control can produce both negative effects (blocking the defense of human rights) and positive ones (correcting the lack of coordination in the work by NGOs). NGOs working with the control of leprosy have a long history of cooperation with "host" states in Latin America. In the worst cases they work in a vacuum left by the state. In a country like Brazil, where the government prioritizes the control of Hansen disease and community participation in the political process - NGOs generally work "in harmony" with national authorities. The most useful contribution to state efforts has been the technical and financial support for training health personnel, supervision, and awareness-raising campaigns. Thus, the NGO becomes "quasi-governmental" in performing its tasks.

A cooperaçäo entre uma ONG e os Estados "anfitriöes" no controle da hanseníase na América Latina / Cooperation between an NGO and host states in the control of leprosy in Latin America

A proliferaçäo das Organizações Näo-Governamentais (ONGs), pode ser considerada como um resultado da incapacidade do sistema democrático atual de desempenhar todas as tarefas desejadas pelos seus cidadäos. Embora que as ONGs muitas vezes realizem um trabalho bastante positivo, elas têm uma tendência de diminuir o poder governamental e säo capazes de interferir nos assuntos internos de outros países. Neste contexto, observam-se esforços de controlar as suas atividades e este controle pode resultar em efeitos negativos (bloqueio da defesa dos direitos humanos) e efeitos positivos (correçäo da falta de coordenaçäo no trabalho das ONGs). ONGs ativas no controle da hanseníase têm uma história longa de cooperaçäo com Estados "anfitriöes" na América Latina. No pior dos casos, trabalham num vácuo deixado pelo Estado. Num país como o Brasil - onde o Governo dá prioriade ao controle da hanseníase e à participaçäo da comunidade no processo político - as ONGs trabalham geralmente de um modo "harmônico" com as autoridades nacionais. A contribuçäo mais útil aos esforços estaduais tem sido o apoio técnico-financeiro à capacitaçäo do pessoal de saúde, à supervisäo e às campanhas de conscientizaçäo. Assim, a ONG torna-se "quase-governamental" na execuçäo das suas tarefas

A cooperação entre uma ONG e os Estados anfitriões no controle da hanseníase na América Latina / Cooperation between an NGO and \"host\" states in the control of leprosy in Latin America

A proliferação das Organizações Não-Governamentais (ONGs), pode ser considerada como um resultado da incapacidade do sistema democrático atual de desempenhar todas as tarefas desejadas pelos seus cidadãos. Embora que as ONGs muitas vezes realizem um trabalho bastante positivo, elas têm uma tendência de diminuir o poder governamental e são capazes de interferir nos assuntos internos de outros países. Neste contexto, observam-se esforços de controlar as suas atividades e este controle pode resultar em efeitos negativos (bloqueio da defesa dos direitos humanos) e efeitos positivos (correção da falta de coordenação no trabalho das ONGs). ONGs ativas no controle da hanseníase têm uma história longa de cooperação com Estados "anfitriões" na América Latina. No pior dos casos, trabalham num vácuo deixado pelo Estado. Num país como o Brasil - onde o Governo dá prioriade ao controle da hanseníase e à participação da comunidade no processo político - as ONGs trabalham geralmente de um modo "harmônico" com as autoridades nacionais. A contribução mais útil aos esforços estaduais tem sido o apoio técnico-financeiro à capacitação do pessoal de saúde, à supervisão e às campanhas de conscientização. Assim, a ONG torna-se "quase-governamental" na execução das suas tarefas.

A study of relapse after MDT in a district in West Bengal, India.

A study was undertaken to estimate the magnitude of the problem of relapse and to identify factors responsible for relapse in leprosy units that were delivering MDT in Purulia District of West Bengal. From records patients were classified as "Relapse" or "Not relapse". "Not relapse" patients were selected by simple random sampling from the Surveillance Register and were matched according to age, sex, and the leprosy control unit. 128 cases ("Relapse") and 128 controls ("Not relapse") were interviewed in the clinic using a pre-tested questionnaire. Details of methods to identify and confirm relapse were circulated to all reporting units for ensuring uniformity and reliability. NGOs covered 42% of the population, while the State Government covered the remaining. The patients had been followed up after completion of treatment for a period of two years in PB leprosy and for five years in MB leprosy. The study revealed that the relapse rate was 1.71/1000 person-years for original PB cases and 0.76/1000 person-years for original MB cases. The study also showed that history of contact with an active leprosy patient and irregular treatment led more PB cases to relapse than control cases. All patients with an initial BI of 3+ relapsed with a BI of 1+ or 2+.

Lessons in integration--operations research in an Indian leprosy NGO.

Since the Alma Ata Declaration in 1978, health systems supporting the treatment and control of infectious diseases like leprosy and tuberculosis have been encouraged to 'integrate' into the primary health care structure within countries. Now, more than 20 years later, countries are still grappling with the concept of integration and looking for ways to achieve it. This study reports findings from a leprosy/Tuberculosis/AIDS awareness pilot project conducted by LEPRA India, a leprosy non-governmental organization (NGO), between 1996 and 2000 in Koraput district, Orissa. The project addressed the issue of integration on two levels. On the one hand LEPRA used the context of the project to explore ways in which to integrate TB services into their existing leprosy control structure. On the other hand, lessons from the pilot study were intended to help the organization find ways of linking with the government health care structure. Following a 'qualitative approach', this operations research project assessed the perceptions of communities and providers about leprosy and tuberculosis services. Providers across the spectrum of this plural healthcare system were asked to provide comment on developing stronger networks with each other, with NGOs and with government, while patients and communities were asked to describe the resources available to them and the constraints they face in accessing health care in general, and for leprosy and TB in particular. LEPRA staff from top management to the outreach workers were also approached for their views. Patients and communities noted that physical access to treatment was a major constraint, while the existence of local providers and family support structures facilitated health and health care. Providers expressed a willingness to collaborate (with LEPRA and the government), but lacked training, adequate staff support and the appropriate equipment/technical resources. Also lacking were adequate information campaigns to inform the public about these diseases and their treatment. This information has provided LEPRA with an understanding of how they might best fill gaps in the existing system and therefore assist in the process of integrating services in their own organization and through the primary health care structure. To achieve this aim, LEPRA will increasingly become involved in developing relationships and partnerships with government in the delivery of training and services and in infrastructure development.

NGO and state: co-operation between a leprosy relief association and other institutions in South America.

In a structured questionnaire format, the German Leprosy Relief Association (GLRA) interviewed its representatives in two Federal states of Brazil and four other Latin American countries about the distribution, between itself, the state and other institutions of a) responsibility for funding and b) implementation of activities, in relation to leprosy control. Wherever the political commitment was given, GLRA's role could be reduced to the highly effective support of the government structure in well-defined areas, most particularly in staff training, health education and eventually in programme supervision. This public-private partnership under the umbrella of the host government sustains a small, but important specialized leprosy component whilst routine services are well integrated into the general health system.