Table 3.
Constraints in implementing a community-based epilepsy program
| Aspect | Possible constraint | Proposed solution |
|---|---|---|
| Decentralizing epilepsy care | Shortages in AED availability | Advocacy to prioritize onchocerciasis-endemic areas for AED delivery; work with multiple AED suppliers; advocacy with pharmaceutical firms to provide free/subsidized AED in endemic areas. |
| Remote communities very far from health centres | Institute regular mobile clinics during which the nurse reaches out to remote communities. Can be coupled with other public health activities such as immunization, and maternal & child health services. AED could be transported monthly from the clinic to the village by the CHW. | |
| Community awareness programs | Resistance by certain institutions (schools, churches, jobsites) to provide a platform for sensitization | Education of stakeholders about the importance of epilepsy sensitization in their respective institutions |
| Difficulty in conveying the message in a contextual and convincing manner | Qualitative research could identify root problems and how to best address them | |
| Evaluation and monitoring | Lack of qualified persons | Use simple reporting forms (see Additional file 3); Train more volunteers into CHW |
| Epilepsy-related events not reported in some health systems. | Propose an epilepsy reporting form to be used in health structures in onchocerciasis-endemic areas | |
| Strengthening onchocerciasis elimination programs | Insufficient public funds for bi-annual CDTI or alternative strategies | Advocacy to stakeholders about the importance of onchocerciasis elimination; make use of unpaid village volunteers for CDTI. |
| Sub-optimal ivermectin intake by the population | Sensitization of the population about the importance of ivermectin to prevent epilepsy; better timing of distribution campaigns (avoid periods of intensive farming activity with high probability of meeting empty houses during distribution) | |
| Sustainability of the program | Possibility of the program being closed after sometime due to lack of interest and/or resources | - Advocacy for stakeholders to include epilepsy programs among priority interventions in onchocerciasis-endemic regions - Integrate the national onchocerciasis and epilepsy programs to share resources and reduces waste |
| Administrative bottlenecks and corruption | - Involve high ranking local elites who value the village and the populations |
CDTI Community-directed treatment with ivermectin, AED Anti-epileptic drugs, CHW Community health workers