Integrating neurology in community healthcare in sub-Saharan Africa: experience and outcomes of the 7-year partnership between the Italian Society of Neurology and the DREAM program.

Sub-Saharan Africa (SSA) has 1.3 billion people, 2.1 billion by 2050; the life expectancy has increased so the burden of non-communicable diseases (NCD) has almost reached that of communicable diseases. In SSA NCD neurological diseases rank at the top: stroke is a leading cause of death, and there are more than 20 million persons with epilepsy (PWE); 75% PWE lack proper treatment. Hospitals are few and under-resourced with a persistent neurologist shortage, hence the majority of neurologic patients seek care at primary care level: improving access to care for neurologic diseases at primary care level is a strategic objective of the WHO-Intersectoral Global Action Plan. HIV, highly prevalent in SSA, increases the burden of neurologic conditions and the United Nations-WHO called to integrate HIV and NCD-neurologic diseases at HIV primary care centres. At this level much of the care to neurologic patients is delivered by non-physician clinicians (NPC) whose education in neurology is insufficient. The Italian Society of Neurology (SIN) established a partnership with the DREAM program, a sub-Saharan Africa primary care program treating chronic diseases as HIV and other diseases since 2002, whose successful intervention model can be applied to epilepsy and other neurologic conditions. So far, the partnership trained more than 430 local healthcare workers, over 2,800 people with epilepsy receive regular care at 14 DREAM centers, more than 4,000 epilepsy teleconsultations have been performed by Italian neurologists along with more than 1,200 electroencephalograms reports thanks to a tele-neurology platform. In addition, SIN started an education course to young Italian neurologists to provide them knowledge and tools on SSA primary care, a step forward to build a globalized neurology.