Written history of leprosy in Sri Lanka dates back to Dutch era in eighteenth century. Dutch gained governance of the western coastal areas and the Jaffna Peninsula of Sri Lanka in 1658, after they vanquished Portuguese .They held these areas until 16 February 1796 after that those areas fell into British hands. During years of Dutch rule over the country, they have introduced the Roman-Dutch Law, printing to Sri Lanka and construction of the Leper Asylum at Hendala, a few miles North of Colombo near the mouth of the Kelani River.
The construction of Leprosy Asylum was funded by the famous Dutch East India Company or VOC (Vereenigde Oost-Indische Compagnie).Construction of the Leper Asylum at Hendala was completed in 1708 under Dutch Governor Hendrick Becker and it is still exists today as the Hendala Government Leprosy Hospital. It is probable that this asylum was the first of its kind in the East.
During the British era they took control of the coastal provinces of the country. Thus the administration of the leprosy asylum came under the British military. But in 1858, British started the Civil Medical Department, following this the asylum administration was undertaken by Civil Medical Department in 1868. The Lepers Ordinance was established in 1901 by the British government. With that segregation of leprosy patients was made compulsory. A second leprosy asylum was set up on the island of Mantivu off the eastern coast of the country in 1920. Now it is under the local health authority in the Eastern Province.
In 1930s, Director of Medical and Sanitary Services had started leprosy surveillance in the country to measure magnitude of the diseases spread. It was conducted during 1931. It was the first leprosy surveillance conducted in the country. The Medical Secretary of the Empire Leprosy Relief Association Dr. R. G. Cochrane had given recommendation on its control and he had visited the country several times.
In 1954, the World Health Organization (WHO) helped Sri Lanka in implementing Dr. Cochranes' recommendations. Those recommendation were institutional segregation of active cases, rehabilitation of discharged patients, a special children’s home for leprosy patients, a special home for crippled leprosy patients, employment of suitable leprosy cases in leprosy hospitals in place of attendants, Lepromin testing, BCG vaccination, treatment of suitable patients in local hospitals and dispensaries and in their homes, providing a leprosy specialist (a pathologist with experience in bacteriology), and an occupational therapist.
With assistance of WHO in July 1954, Senior WHO Officer in the Leprosy Project Dr. B. C. Malhotra, visited Sri Lanka as a consultant, and end of same year occupational therapist was also available. With support of all of them Sri Lanka Health department started the Anti Leprosy Campaign in 1954. The Campaign was established as a centrally controlled body to plan implement, coordinate and evaluate leprosy control activities in the country. Thus domiciliary treatment of non-infective leprosy patients began.
In 1955, leprosy campaign established a Leprosy colony at Uragaha in the Southern Province for Rehabilitation of the patient. In this, leprosy patients were trained for agricultural work, textile center work and occupational activities. The Urgaha was closed in 1963 due to the villagers objecting to its further continuance in the area.
Public Health Inspectors- Leprosy Control (PHI- LC) were appointed (one for each district) as a district level disease controlling health workers in 1970. They were trained to implement the field programme of the Campaign and they were actively involved in conducting clinics in villages, contact tracing, default tracing and public educational programmes. After 1977 compulsory admission of patients to the leprosy hospitals under the provisions of the Lepers Ordinance was discontinued. At that time under the administration of the Anti Leprosy Campaign (ALC) there were two Leprosy Hospitals at Hendala and Mantivu, a Central Leprosy Clinic at Room 21 National Hospital Colombo, and 25 PHIs in the districts.
In 1983, Multi-drug Treatment was introduced under the advice of WHO. Financial and material support for MDT was given by Leprosy Relief Work Emmaus, Switzerland. With the MDT treatment, Sri Lanka achieved 100 percent coverage of all the registered patients. Admission to the two Leprosy Hospitals had been completely stopped since the introduction of MDT in 1983. But the transmission of the disease had not been effectively interrupted as expected.
In 1990, Anti-Leprosy Campaign lunged the social marketing campaign to make a real difference to the leprosy situation in Sri Lanka. In that program, targets were to de-stigmatize leprosy, create an awareness of the early signs of the disease, and encourage patients to seek treatment by self-referral. This was funded by Sahib-Geigy Leprosy Fund, later known as Novartis Foundation for Sustainable Development (NFSD). Leprosy Relief Work Emmaus joined this in 1989. As a consequence Sri Lanka was able to reach the WHO Elimination Target of less than one case per 10,000 population, in 1995.
In 2001, leprosy control activities was integrated to the General Health Services. After that all health institutions of Sri Lanka were provided with adequate stock of MDT blister packs. Earlier it was available only with the leprosy clinics conducted by ALC and some of the skin clinic at the teaching hospitals before integration. For surveillance and control activities Regional epidemiologists (RE) were trained at district level.