The regional outreach programme of the International Headache Society: A WHO-IGAP oriented programme to improve access to care for headache patients in sub-Saharan Africa

Introduction

The partnership between the International Headache Society (IHS) and the Disease Relief through Excellent and Advanced Means (DREAM) programme, which was part of the Regional Outreach Programme (ROPE), represents an innovative educational approach, as illustrated in Martinelli et al.'s article published in Cephalalgia Reports (1). The article shows that it is possible to meaningfully improve headache education in sub-Saharan Africa (SSA) by building on task shifting with non-specialist care providers to promote neurology at the primary care level. The article also suggests collaborating with local entities (e.g., NGOs) to implement effective bottom-up tactics. This approach could empower a substantial proportion of the primary healthcare workforce and improve access to higher-quality care for large sections of the population.

Lessons learned from this experience must inform future initiatives aimed at fostering sustainable empowerment of the healthcare workforce in SSA and other low-income countries.

The IHS strategy should be structured around the following key areas.

Ensuring sustainability

All educational interventions should be founded on sustainability. To achieve a lasting impact, future efforts must focus on empowering local healthcare workforce to train subsequent cohorts. Providing them with the necessary educational resources, mentorship, and ongoing support is crucial to strengthening their role in headache care. Within the IHS-DREAM initiative, the process was successful, with the local non-physician clinicians (NPCs) involved showing a high level of commitment and the ability to prepare and deliver high-quality presentations under the lecturers’ mentorship.

Integrating digital and continuous education

To improve knowledge retention and application of skills, in-person refresher courses, periods of shared work in the field with mentors, and hybrid learning models could be explored. Incorporating telemedicine, online refresher courses and remote mentorship programmes could help to bridge gaps in continuing medical education and ensure that clinical officers are kept up to date with the latest best practices in headache medicine. This educational methodology has been successfully used in the DREAM programme since 2002 in other healthcare areas (2,3).

Policy and guidelines

The IHS promoted the definition of guidelines and practical recommendations that could also be applied in developing countries (4–6).

Although the recommendations are designed to be used in various contexts, barriers to implementation may arise. Therefore, we must advocate for better access to medications (7). Education alone is not sufficient if essential medications remain inaccessible. The availability of headache medications, ranging from simple analgesics to novel migraine-specific drugs, varies greatly around the world (8). Actions are needed to improve the availability of effective drugs in many countries to ensure the adequate management of people living with headaches. Future initiatives should work towards including headache treatments in national essential medicine lists to ensure that trained providers can implement effective treatment strategies (7).

We should advocate for the inclusion of headache disorders in national health policies, encourage research into the burden of headaches and promote interdisciplinary collaboration.

Expanding the model

The success of the IHS-ROPE programme provides a replicable framework for future initiatives in other low-resource settings. Expanding this model to other countries, including non-English-speaking ones, that face a similar shortage of neurologists, can improve access to headache care and ensure that patients receive appropriate management, closer to their communities.

To achieve this, other initiatives, with a wider reach, are already underway within IHS strategy under the impulse and coordination of Prof. Rami Burstein. These will target larger populations of healthcare workers and patients, also outside Africa. Stay tuned to learn more in due course!

Global collaboration is essential for the effective promotion of headache medicine, in line with the World Health Organization's (WHO) Intersectoral Global Action Plan (IGAP) on epilepsy and other neurological disorders (2022–2031) (9). The success of the ROPE initiative discussed in the manuscript by Martinelli et al., as well as all the above strategies, depends on the ongoing commitment and collaboration of the IHS, other neurological scientific societies, academic journals, policymakers and healthcare organisations (10). These groups must work together to amplify the voices of underserved populations. These initiatives have the potential to transform headache management in resource-limited settings by reinforcing training, expanding reach and drug availability, leveraging technology, and advocating for better access to care, ensuring a sustained and scalable impact. Prioritising equity in neurological care can improve health outcomes and uphold the fundamental principle of health as a human right.