``We are not afraid anymore ...'' Capturing the most significant change of the Leprosy Friendly Village approach in North Sulawesi, Indonesia

Objectives: To document significant changes brought about by a 5-year community based approach for leprosy elimination in Indonesia called: ‘The Leprosy Friendly Village Approach’ (LFV).
Methods: Education sessions on leprosy were delivered consistently and regularly on a long-term basis to health workers and the community involving influential commu-
nity members (ICM) to promote a positive attitude towards leprosy. An evaluation was performed using the Most Significant Change (MSC) technique. In-depth interviews
(IDIs) were conducted with policy makers and program managers, Health Centre (HC) staff, community members, including ICM and persons affected by leprosy. Focus
group discussions (FGDs) were conducted with HC staff and community members.
Results: Twenty-eight respondents were interviewed. Four FGDs with health workers and community members were conducted. The most significant change among health
workers was better knowledge, involvement and a more positive attitude towards leprosy. The most significant change in the community was less discrimination and
fear of leprosy, more referral of suspects to HCs and better community integration of persons affected by leprosy, who perceived less stigma and better acceptance from
the community. There was a decreasing trend in the annual number of new leprosy patients from 33 to 11 between 2012 and 2017
Conclusion: Delivering information on leprosy in a consistent, positive and regular manner on a long-term basis, involving health staff and ICM contributes to decreasing stigmatization. Adequate exposure to information on leprosy helps to improve knowledge and attitude towards leprosy, which contributes to early case finding and a
reduction in the number of new leprosy patients.