Healthcare service provided for headache patients in selected African countries: a cross-sectional survey of clinician perspectives.

BACKGROUND

Headache disorders represent a major global health burden that is highly prevalent across the continent of Africa; however, they remain underdiagnosed and inadequately managed. The objective of this study was to evaluate the availability, accessibility, and organizational structure of headache care services across African countries and to detect major challenges and barriers to optimal care from the perspective of headache-treating clinicians.

METHODS

Countries were chosen using a stratified sampling strategy based on World Bank income classification [low-income countries (LICs), lower-middle-income countries (LMICs), and upper-middle-income countries (UMICs)] to ensure balanced representation across economic strata. Within each stratum, eligible neurologists were identified through national neurology societies and indexed publications. Of 120 invited clinicians from 40 countries, 73 neurologists from 28 countries responded (response rate 60.8%). Participants were invited to fill out a structured online questionnaire to assess the healthcare system structure (including workforce capacity, healthcare system characteristics, and diagnostic infrastructure), availability of the essential and newer headache medications, and perceived barriers to optimal care in their countries.

RESULTS

Significant discrepancies were observed in workforce capacity, defined as the reported number of neurologists per country ranging from 10 (IQR: 4.75-34.5) in LICs to 200 (IQR: 97-700) in UMICs (p < 0.001). Access to headache care was limited in LICs, where 50.0% (6/12) of respondents reported a 3-4 week waiting list for elective neurological consultations, while 41.7% (5/12) reported a similar 3-4 week waiting time for imaging (p = 0.028, 0.012). Self-medication was universal (100%). Structural barriers were highest in LICs, including limited neuroimaging (91.7%) and financial constraints (83.3%). Essential medications (according to WHO (World Health Organization) and International Headache Society (IHS) practice recommendations) were relatively more reimbursed in LMICs/UMICs; however, innovative therapies (gepants, ditans, and calcitonin gene-related peptide (CGRP) mAbs) were not reimbursed across all settings.

CONCLUSION

Headache care across African countries is facing substantial inequities in human resources, workforce capabilities, and access to proper care. Addressing these challenges requires fostering the healthcare systems, training of non-specialist healthcare providers, expanding insurance coverage, and increasing awareness of headache disorders in health policy to enhance patient outcomes.