Human resource challenges in leprosy control: A cross-sectional study in southwest border area of China

BACKGROUND: Leprosy remains a neglected tropical disease and major global public health challenge, particularly in developing countries with severe healthcare workforce shortages hindering control. The southwestern border, represented by Yunnan Province, is a core endemic area. A comprehensive assessment of its leprosy workforce is critical for achieving elimination. METHODS/RESULTS: In October 2024, a cross-sectional census survey evaluated 423 Leprosy prevention and control personnel across all 129 counties in Yunnan Province, China. These counties were categorized into high (I), moderate (II), and low (III) endemicity areas based on their leprosy burden. Distinct workforce patterns emerged among 423 personnel, Category I areas exhibited the highest proportion of personnel aged 30-39 years (37.5%), along with the continuing education participation (78.5%), the highest full-time employment rate (52.5%), and strongest prescription protocol awareness (72.5%). Category II areas featured the oldest personnel profile (35.0% aged ≥50 years),with a moderate positive correlation between age and years of service (r = 0.58), highest continuing education participation (78.8%). In contrast, Category III areas had the highest proportion under 30 years (20.5%), and highest proportion of personnel with Bachelor's degrees or higher (69.9%) lowest full-time employment rate (38.4%), highest compensation dissatisfaction (38.4% "below average"), and lowest intention to leave (8.2%). Pervasive workforce aging existed (at least 30% of personnel ≥50 years in Category II and III) and widespread technical gaps (>75% Category III areas lacked essential lab skills). Part-time staffing was common (47.5%-61.6% across categories). Despite over >90% of personnel in these three categories rated their compensation as "average or below", compensation and career challenges were most acute in Categories I and II. CONCLUSIONS: The Yunnan leprosy workforce shows strengths, notably high continuing education participation (78.5%) and balanced clinical/preventive staffing. However, it faces significant challenges, workforce aging, shortage of highly qualified personnel, and limited lab capacity. Urgent intervention measures are needed to revitalize the workforce, enhance training, and strategically allocate resources to expedite the achievement of leprosy elimination.