Manpower gap: An important barrier against reduction of the treatment gap of epilepsy

We read with interest of the authors’ experience from Nepal and that they rightly point out the urgent need to bridge the manpower gap in this country. This gap is disturbingly high, not only in Nepal but in most other low-income countries (LICs) and is the most common direct cause of the diagnostic and treatment gaps in the management of epilepsy. The authors are also right to call for the training of people other than neurologists. However, the question which ‘‘other’’ people should be trained is also tricky because it is not just neurologists, but also less specialized doctors, nurses, and midwives who are lacking and who are also unequally distributed. Most LICs have fewer healthcare staff (doctor, nurse, or midwife) than the 2.3/ 1000 recommended as a millennium goal. Thus, there is an inevitable need to find ‘‘newer resources’’ who may serve as service-providers. We are working toward solving this issue of manpower in two Asian countries, namely Cambodia and Laos by working along with the department of access to medicines of Sanofi (France) and other partners. We have engaged primary health center (PHC) staff to provide a trained, home-based, professional epilepsy care. There are several reasons why PHCs and their staff can productively contribute to fulfill service-gaps in LICs. PHCs are the most fundamental part of a country’s healthcare system. Thus, their engagement may directly strengthen a country’s healthcare system as well as ‘‘truly decentralize’’ the distribution of core professional services. It is recently noted that implementing medical care at the primary level is crucial to improve the treatment gap and adherence among PWEs. PHCs are already in place in LICs and working and have staffs employed by the government. Most PHCs are staffed by a low and mid-level workforce and are an equivalent of a medical assistant but already provide variety of health services to the population with minimal expert support. PHC staffs are a ‘‘local resource’’, known to the population, which may help build a closer patient–healer relationship. Unlike other strategies (e.g. organizing regular visits from external experts), engagement of PHC staff may remove long