Improving access to care for people with epilepsy through Domestic Health Visitors in Lao PDR (DHeVELoP program)
To commemorate International Epilespy Day, this blog introduces the DHeVELoP Program, currently underway in Lao PDR.
Epilepsy is one of the most common neurological diseases in the world. 70-80% of people with epilepsy (PWE) receiving an appropriate treatment could have a normal life1. However, a large majority do not receive this appropriate treatment or do not receive treatment at all (treatment gap of more than 70% in many countries).
In Lao PDR, epilepsy is seen as a communicable disease and believed to be caused by a ‘bad spirit’. This misconception leads to stigmatization and discrimination of PWE. There is poor access to treatment for PWE. Around 50,000 PWEs are estimated in Lao PDR, only 10% of them have access to treatment. In addition, other challenges have been highlighted: the poor knowledge of epilepsy of the health workers, the low availability of antiepileptic drugs (AED) (especially in remote areas). An intervention is urgently needed to improve the access to treatment for PWE and we are searching for the most cost-effective strategy. We would like to share our work that is currently ongoing in three rural districts of Vientiane capital (one intervention district, Pakgnum and two control districts, Naxaithong and Sangthong).
The network of primary health care facilities is considered a grassroots-level network and covers all districts and communities in Lao PDR. The DHeVELoP program is an intervention study that aims to test the effectiveness of domestic health visitors (DHV) approach conducted by primary health care staff to improve access to treatment and care of PWE. The DHeVELoP program received funds from Grand Challenges Canada, funded by the Government of Canada, to develop our "bold idea with big impact in global health". Our program is co-funded by Sanofi.
DHV have four main missions: education campaigns for general population, identification of suspected cases of epilepsy, follow-up of PWE in the community and creation of micro-franchises. We have already completed the preparation phase providing the basic knowledge on epilepsy for health workers, and ensuring availability of antiepileptic drugs and information education and communication tools in the study area. In November 2014, the intervention was launched officially.
During the baseline evaluation, 6 PWEs were under treatment in the district hospital in the intervention zone as well as 6 in the control zone. To date, the DHV have successfully visited the identified villages once each month as planned. They have identified 36 suspected cases of epilepsy and referred these cases to district hospital for diagnosis confirmation. 5 more PWEs are under treatment and now 11PWEs are under follow-up by DHV in the community.
The intervention will be continued until April 2016. We expect to improve the skills of health workers, increase the number of PWE under treatment in health facilities and improve their compliance to treatment. Also, our expectation is to reduce the stigmatization, and improve the economic and social life of PWE.
The cost-effectiveness of this intervention will be evaluated using epidemiological and social indicators at the end of the project. This intervention could be a model for scaling-up ata national level and eventually for other countries that are in the same situation.
1 Josemir W. Sander, ‘The Use of Antiepileptic Drugs--Principles and Practice’, Epilepsia, 45 Suppl 6 (2004), 28–34
Related Innovation: The DHeVELoP Program