WFN and WHO Update

At the 150th session of the World Health Organization Executive Board on 27 January 2022,  the draft Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders (IGAP) was approved. The draft IGAP will be presented to the WHO Member States at the World Health Assembly in May 2022 for a vote on adpotion.

Strategic objectives and global targets of IGAP

Strategic Objective 1
Raise policy prioritization and strengthen governance

Global target 1.1

75% of countries will have adapted or updated existing national policies, strategies, plans or frameworks to include neurological disorders by 2031.

Global target 1.2

100% of countries will have at least one functioning awareness campaign or advocacy programme for neurological disorders by 2031.

Strategic Objective 2
Provide effective, timely and responsive diagnosis, treatment and care

Global target 2.1

75% of countries will have included neurological disorders in the UHC benefits package by 2031.

Global target 2.2

80% of countries will provide the essential medicines and basic technologies required to manage neurological disorders in primary care by 2031.

Strategic Objective 3
Implement strategies for promotion and prevention

Global target 3.1

80% of countries will have at least one functioning intersectoral programme for brain health promotion and the prevention of neurological disorders across the life course by 2031.

Global target 3.2

The global targets relevant for prevention of neurological disorders are achieved, as defined in:

– the NCD-GAP;

– Defeating meningitis by 2030: a global road map; and

– Every newborn: an action plan to end preventable deaths.

Strategic Objective 4
Foster research and innovation and strengthen information systems

Global target 4.1

80% of countries routinely collect and report on a core set of indicators for neurological disorders through their national health data and information systems at least every three years by 2031.

Global target 4.2

The output of global research on neurological disorders doubles by 2031.

Strategic Objective 5
Strengthen the public health approach to epilepsy

Global target 5.1

By 2031, countries will have increased service coverage for epilepsy by 50% from the current coverage in 2021.

Global target 5.2

80% of countries will have developed or updated their legislation with a view to promoting and protecting the human rights of people with epilepsy by 2031.

 


Resolution WHA 73.10 for the Development of an Intersectoral Global Action Plan (IGAP) on Epilepsy and Other Neurological Disorders. 2022 – 2031.

By Kimberly Karlshoej* on behalf of Alla Guekht, Wolfgang Grisold, Sam Wiebe, Helen Cross, Julie Hall, Martin Brodie, Mary Secco, Jo Wilmhurst, Michael Brainin, Claudia Trenkwalder, David Dodick, and Bill Carroll

First published in World Neurology: Sept/Oct 2021, Volume 36, No. 4
*Kimberly Karlshoej is strategy and program director for the WFN


It was a landmark event when on Nov. 12, 2020, the WHO Executive Board accepted the recommendation of the World Health Assembly (WHA) to adopt Resolution WHA73.10. This resolution called for the development of an Intersectoral Global Action Plan (IGAP) to tackle epilepsy and other neurological disorders through comprehensive actions to detect, prevent, care, treat, and rehabilitate people with epilepsy and other neurological disorders, as well as ensuring their social, economic, educational, and inclusion needs.

The WFN has long been involved with neurological activities with the WHO, which include a first edition of the Atlas: Country Resources for Neurological Disorders 2004, Neurological Disorders: Public Health Challenges 2006 and the second edition of the Atlas: Country Resources for Neurological Disorders 2017, to mention a few. The resolution to develop an IGAP is also momentous in that neurological disorders are overtly recognized by the WHO Member States in line with the Global Burden of Neurological Disorders (2018) finding of them being the leading cause of disability-adjusted-life-years and the second leading cause of death.

The resolution is in large part due to the efforts of the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE) supported strongly by the WFN who, with several member states led by the Russian Ministry of Health, convinced the WHA that epilepsy was a public health emergency.  In the lead up to Resolution WHA 73.10, member states recognized the burden of epilepsy and the synergies with many neurological conditions, especially access to both services and support for such conditions was insufficient, especially in low- and middle-income countries. The vote to address the problem with the call for the IGAP was unanimous. The WFN has a unique opportunity to contribute to the development of the IGAP.

As the first step, the WHO published a discussion paper. The WFN as a “non-state actor” (NSA) in official relations with WHO presented its comments on the draft discussion paper in both virtual and web-based consultations.  To do this, the WFN first joined with the ILAE, IBE, and the International Child Neurology Association (ICNA) to formulate comments on epilepsy and other neurological disorders, both adult and children, to match the intent of the IGAP draft discussion paper.

Second, the WFN formed a separate group with members of the Global Neurology Alliance (GNA) to advocate a stronger voice for neurological conditions. This group was selected by WFN President William Carroll to reflect the conditions that contributed most to the Global Burden of Neurological Disorders. The group comprised immediate past presidents of the International Headache Society (IHS: David Dodick), World Stroke Organization (WSO: Michael Brainin) and the current President of the Parkinson’s Disease and Movement Disorders Society (MDS: Claudia Trenkwalder) together with Alla Guekht, Wolfgang Grisold, and Kimberly Karlshoej from the WFN. Alla Guekht was indispensable in these meetings through her knowledge of the WHO. The WFN contributions to the WHO discussion plan were made jointly with the ILAE, IBE, and ICNA and jointly with the WSO, MDS, and IHS.

As social, biological, and environmental determinants mediate all experience, including responses to stress, and impact on brain development and brain health from pre-conception to end-of-life, the WFN emphasized in its submission the need for countries to prioritize brain health in their policies. New strategies for both brain health promotion and disease prevention across the life course need to be implemented at national levels.

Addressing the costs of health care, and reducing the current treatments gaps, especially in low resource settings was also emphasized.

Finally, the WFN stressed the importance of addressing stigma, exclusion, and discrimination of people with neurological disorders in its submission.

These general comments as well as many specific ones on the discussion paper were submitted to the WHO April 10 and were published with the other submissions as consolidated comments by WHO. The WHO then developed the first draft of the Intersectoral global action plan on epilepsy and other neurological disorders (IGAP) based on the input received. This document outlines the scope, vision, goal, and strategic objectives as well as specific actions for Member States, the WHO Secretaria, and international and national partners.

Further consultation on this draft document began during July 2021, and the WFN worked with the same two groups: first, the ILAE and ICNA, and second, the WSO, IHS, and MDS. Central to these submissions was to make the first draft more evenly balanced in its intent. Instead of recommending epilepsy as the entry point for all interventions in the implementation of IGAP, essentially a hierarchical approach, the WFN joint submissions recommended that implementation be undertaken with prioritisation determined by member states as either epilepsy with neurological disorder(s), neurological disorder(s) alone, or epilepsy alone depending on the member states needs and abilities. The WFN and its partners remained fully supportive of the need for a specific global action plan for epilepsy within IGAP. The outcomes of these consultations will serve as input for the WHO Secretariat to prepare a revised draft of IGAP that will be submitted for review at the 150th session of the Executive Board in May 2022. •


Wolfgang Grisold at the 150th session of the WHO Executive Board

The World Federation of Neurology (WFN) fosters quality neurology and brain health worldwide through its 6 Regional Associations and 123 Member Societies.  The WFN has a long history of working collaboratively with WHO at global, regional, and national levels.

The WFN wishes to congratulates the WHO secretariat for their diligent work on this excellent draft of the Intersectoral Global Action Plan on Epilepsy and other Neurological Disorders, and for the outstanding work done in incorporating many suggestions made during the consultations with the WFN and other Non-State Actors. As neurological disorders are a leading cause of morbidity and mortality worldwide, the WFN strongly encourages Member States to adopt this global action plan that promotes access to care and treatment for people living with neurological disorders, aims to prevent the development of neurological disorders and promotes and prioritises brain health throughout the life course.
Prof. Wolfgang Grisold, WFN President