Sustainable development requires productive populations

Michael Alan Hamlin

Posted on February 2, 2012

I spent much of last week in Puerto Princesa, which with a population of about 210,000, is the Philippines most sparsely populated of 38 independent cities not controlled by the province—Palawan in this case—where they are located. Politics explains the independent classification. Puerto Princesa residents don’t vote for the governor to ensure that the interests of rural residents are fairly represented, and not overshadowed by those of the urban community.

At least that’s the theory.

Instead, Puerto Princesa elects an omnipotent mayor. Although residents don’t elect the governor, the provincial capital offices are located in the sleepy city, an irony not missed on many. On an everyday level, the Rule of Law appears to work in Puerto Princesa. Drivers follow traffic laws and are considerate to other drivers. The city isn’t modern, but it is clean. I saw no garbage or litter on the streets. And policemen actually pay for their meals at roadside eateries.

Observing the state of law and order wasn’t the reason I was in Puerto Princesa, of course. My purpose was to help out with the management of the 1st Leprosy Stakeholders Symposium: Towards a World without Leprosy. The symposium was conducted to build the consensus and commitment among Department of Health officials necessary to carry out a “last mile” initiative to completely eradicate leprosy in the Philippines.

Whenever I mention that this leprosy treatment-focused meeting took place in Palawan, people assume the venue was chosen because nearby Culion—a small municipality in the northern extreme of the province—was a leprosarium when the Philippines was an American commonwealth. But the symposium’s sponsors principally wanted the event to take place outside Metro Manila so delegates and international speakers alike could see more of the Philippines.

(Disclosure: My firm was engaged by the sponsor to manage the symposium.)

The decision appeared to pay off. Delegates and speakers alike found Puerto Princesa both quaint and delightful. They also enjoyed the French bread and Vietnamese Bahn pho—flat rice noodles in soup—brought to Palawan by about 1,500 would-be refugees fleeing Vietnam’s communist government in the 1980s. Although the United States eventually granted most refugees asylum, some preferred to remain in their new home.

But serious business was discussed at the symposium. The incidence of leprosy has plunged in the Philippines since the 1900s when Culion was only known as a leper colony. According to Department of Health (DOH) secretary Enrique Ona, M.D. there were 38,570 registered leprosy patients in the Philippines in 1986, or 7.2 per 10,000 Filipinos. By the end of 1998 it was 0.9. Much of reason for this dramatic reduction is attributable to a public-private partnership that existed long before that term was popularized.

The World Health Organization (WHO) and the Novartis Foundation for Sustainable Development (NFSD) worked with DOH to provide what is called Multidrug Therapy (MDT) to patients at no cost. Worldwide, similar partnerships have helped cure some five million people. “Two decades ago, leprosy was a public health problem in 122 countries,” Dr. Klaus Leisinger, NFSD chairman, told symposium delegates last week.

“Today the disease has been eliminated as a public health problem in most countries, including the Philippines.” However, he cautioned, “While the Philippines has made tremendous progress in leprosy control, the battle has not yet been completely won. There are still pocket areas in the country where new leprosy cases are being identified.” Part of the reason, tragically, is because leprosy has become so rare that neither doctors nor the public recognize it.

NFSD continues to make MDT available at no cost to patients, and the first dose eliminates the disease’s capability to transfer from one individual to another. But if doctors and infected Filipinos don’t recognize the symptoms of the disease in its early stages, medication won’t be prescribed or taken. Another hurdle to complete eradication is the lingering social stigma attached to this hideous disease.

“Achieving elimination requires a continued, concerned effort by all stakeholders to take leprosy elimination to the next level: establish leprosy-free zones in the country by 2015,” Dr. Leisinger said, challenging the delegates. Leisinger wants to see concrete, actionable plans for improving awareness and identification of leprosy, as well as alternatives for alleviating social pressures that result in patients hesitating to seek professional care.

The WHO-NFSD-DOH partnership shows how effective public-private initiatives can be. But it’s important to understand why this one is so important. It’s important because productive populations enable sustainable development. Sick populations aren’t productive.

(Michael Alan Hamlin is the managing director of TeamAsia and a Manila-based author. His latest book is High Visibility: Transforming Your Personal and Professional Brand. Write him at and follow him on TwitterFacebook and LinkedIn. Copyright © 2011 Michael Alan Hamlin. All Rights Reserved.)

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