Brazil has high rates of leprosy case detection, especially in the northern and west-central areas of the country. Effective decentralisation of routine treatment for leprosy has gathered pace since the year 2000 and this has improved access for patients, leading to a peak in new case detection in 2003 and a gradual decline thereafter. This is in parallel with specific government programmes aimed at poverty reduction. Disability prevention and surveillance for drug resistance remain important tasks within the leprosy control programme, in which six key referral centres lead the way.