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Table 3 Constraints in implementing a community-based epilepsy program

From: Comprehensive management of epilepsy in onchocerciasis-endemic areas: lessons learnt from community-based surveys

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
  1. CDTI Community-directed treatment with ivermectin, AED Anti-epileptic drugs, CHW Community health workers