Table-II.

Major barriers hindering the uptake of surgical rehabilitation for leprosy neuropathy in Pakistan and evidence-based strategies to overcome them.

Barrier Category	Specific Barriers	Potential Interventions / Solutions
Health-system limitations	Absence of surgical units within leprosy control programs; poor referral pathways	Integrate reconstructive surgery into National Leprosy Control Programme; create regional referral hubs in Sindh and KP
Human-resource gap	Lack of trained reconstructive and peripheral-nerve surgeons	Initiate short-term fellowship programs with African or Nepali centers; include nerve decompression training in surgical curricula
Financial constraints	Limited government and NGO funding for post-MDT disability care	Establish public–private partnerships; allocate dedicated rehabilitation budget lines
Awareness & stigma	Patients unaware that surgical options exist; social stigma discourages care-seeking	Nationwide awareness through media, community health workers, and rehabilitated patient ambassadors
Post-operative follow-up	Weak rehabilitation and physiotherapy linkage	Introduce community-based rehab follow-up programs; tele-rehab for rural patients
Data & monitoring	No national registry or surgical outcome tracking	Develop a digital leprosy disability and surgery registry; periodic outcome audits