Strengthening the Participation of Persons Affected by Leprosy in Health Services A Case Study of The Implementation of Who Guidelines in Busia County, Kenya

Abstract

William Okedi*, Caroline Wakoli, Johnstone Eyinda and Mary Asoyong

Background: Leprosy remains a public health challenge in several regions of Kenya, with Busia County reporting a disproportionately high burden. Despite the existence of comprehensive WHO guidelines aimed at promoting the inclusion and participation of persons affected by leprosy (PALs) in health services, practical implementation remains limited in resource-constrained and decentralized health systems.

Objective: This case study aims to assess the current state of participation of PALs in Busia County's health services and explore how WHO guidelines can be effectively implemented to strengthen their inclusion in health system structures and service delivery processes.

Methods: The study employed a mixed-methods approach, combining qualitative interviews with PALs, healthcare providers, and health managers, with a review of existing health service data and policy documents. Key informant interviews and focus group discussions explored the perceptions, challenges, and facilitators of participation. Data was analysed thematically and triangulated to identify systemic gaps and opportunities for improvement.

Results: The study has documented barriers and enablers of PALs' participation in health service delivery. It has identified strategies for enhancing inclusion and provided recommendations for the practical application of WHO guidelines within the county health system. Findings will inform policy dialogue and guide health system strengthening initiatives targeting neglected tropical diseases (NTDs) and marginalized populations.

Significance: This case study contributes to the evidence base for participatory health governance in the context of leprosy and other NTDs. It offers practical insights for county health authorities, civil society, and international partners seeking to implement inclusive, rights-based approaches to health service delivery in Kenya and similar settings.

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