Epilepsy in Primary Care in Sub-Saharan Africa

Authors: Prof. Massimo Leone

Editor's Choice
World Neurology | Article posted on August 15, 2025

Link: https://worldneurologyonline.com/article/epilepsy-in-primary-care-in-sub-saharan-africa

A neurologist's perspective and experience with the DREAM program.

In 2022, the World Health Organization (WHO) released the Intersectoral Global Action Plan (IGAP) on epilepsy and other neurologic disorders. One of its main goals is improving access to care for people living with epilepsy (PLWE), particularly in low- and middle-income countries where about 80% of these patients live.

Integrating epilepsy in primary care in sub-Saharan Africa and partnership for IGAP. The map shows DREAM centers integrating treatment for epilepsy, HIV and other diseases. Different levels and strategies for the intervention of the partnership in 2023, 2024, and 2025 are shown in the pictures. Click image to enlarge.

Sub-Saharan Africa has 1.3 billion inhabitants. The estimated number of PLWE in the region exceeds 20 million, but there is only one neurologist for every 2 million people.

The majority of PLWE in Sub-Saharan Africa are managed in primary care facilities by nonphysician clinicians (NPCs) whose education on the disease is insufficient. More than 75% of PLWE have little or no access to treatment. The Sub-Saharan African population is expected to double by 2050, as is the number of PLWE.

IGAP calls for improved access to care for PLWE, particularly at the primary care level. Actions to meet this need are urgently needed. Increasing (and improving) the number of primary care services for PLWE and improving education to NPCs are two key steps toward addressing this issue.

In 2020, an epilepsy program in Sub-Saharan Africa was started in primary care centers through the Disease Relief Through Excellent and Advanced Means (DREAM) program. This was in partnership with the C. Besta Neurological Institute, Instituto de Ricovero e Cura a Carattere Scientifico (IRCCS) Milan, the Italian Society of Neurology, and Global Health Telemedicine (GHT).

Integrating epilepsy in primary care in sub-Saharan Africa. Some activities and events in 2023 and 2024. Click image to enlarge.

Since 2002, the DREAM program has delivered care for HIV/AIDS patients in Sub-Saharan Africa. It is now active in 10 Sub-Saharan African countries with 50 primary care centers. This includes 28 laboratories with molecular biology. DREAM is part of the national public health systems in these countries.

Among the main achievements of DREAM is a long-term suppressed viral load in 95% of HIV patients in the program. All health care personnel are local, and the involvement of community health workers greatly contributes to the high retention rate. In all DREAM centers, HIV management is integrated with noncommunicable diseases. This is in accordance with the UN-WHO 2011 directive to fight the double burden of the diseases.

Italian neurologists considered DREAM a reliable platform to deliver care to PLWE in Sub-Saharan Africa, and an education and training program for local NPCs was started. So far, 20 in-person teaching and training courses on epilepsy and other highly prevalent neurologic diseases such as stroke and headache have been delivered to more than 300 primary health care workers. Each course is followed by periods of shared work on the ground and training on the job in Malawi, Central African Republic, Mozambique, and the Democratic Republic of Congo.

Three video electroencephalograms have been installed. More than 1,100 EEG recordings have been sent to epilepsy specialists in Italy through the GHT telemedicine platform. Sub-Saharan African clinicians have sent more than 3,400 teleconsultation requests to Italian neurologists. More than 2,600 PLWE are regularly treated at the 14 DREAM centers where epilepsy care is now delivered.

In addition, the Italian Society of Neurology started a teaching and training program for neurology residents. It includes periods of work at primary care centers in Sub-Saharan Africa under the mentorship of senior expert neurologists.

In conclusion, our long-term epilepsy program and partnership is enhancing cooperation between neurologists and primary health care NPCs. This approach contributes to increased and improved access to care for PLWE in Sub-Saharan Africa. •