Neurologists are unevenly distributed around the world. In many regions, especially outside major cities, waiting for specialist care for every routine epilepsy decision would leave large numbers of people untreated. Primary-care epilepsy programmes and task-sharing models are one response to that reality.
WHO states that most people with epilepsy can be diagnosed and treated at primary health-care level without sophisticated equipment, provided clinicians are appropriately trained and there are clear referral pathways for more complex situations.
What task sharing means
Task sharing moves defined parts of assessment, prescribing and follow-up to trained non-specialist health workers. It does not mean that specialist expertise is unnecessary. The aim is to use scarce specialist resources where they are most needed while making effective routine care available closer to where people live.
What primary care can often do
- recognise common seizure presentations and important mimics
- take a structured seizure history, including witness information
- start and monitor commonly used antiseizure medicines under national guidance
- discuss adherence, side effects, safety and reproductive considerations
- identify uncontrolled seizures and refer appropriately
- provide ongoing follow-up and prescriptions closer to home
What still needs specialist pathways
Diagnostic uncertainty, suspected epilepsy syndromes, drug-resistant epilepsy, complex pregnancy issues, severe medication reactions, prolonged video-EEG, advanced neuroimaging and epilepsy surgery assessment all require specialist input. Task sharing only works safely when referral remains possible.
What WHO programmes have shown
WHO’s Programme on Reducing the Epilepsy Treatment Gap has been implemented in Ghana, Mozambique, Myanmar and Viet Nam. The model expanded the skills of non-specialist health-care providers and strengthened community-based access. WHO reported that treatment coverage in Ghana rose from 15% to 38% over four years, while project sites in Viet Nam saw the treatment gap reduced by 38%.
Training alone is not enough
Poorly supported task sharing can create new problems, including misdiagnosis, inappropriate treatment or delayed referral. Effective programmes need training, supervision, decision support, reliable medicine supply, referral networks and health-information systems. Moving responsibility without those supports is not the same as strengthening care.
Why community links matter
WHO’s epilepsy programmes have also used community groups, volunteers and local awareness work to reduce stigma and encourage people to seek care. This matters because treatment gaps are not caused by workforce shortages alone. Fear, misinformation and social exclusion can keep people away from health services even where services exist.
The balance to get right
Good task sharing expands access without lowering standards. The goal is not to replace neurology. It is to build a tiered system in which routine epilepsy care can be delivered locally, while people with complex or uncontrolled epilepsy can move efficiently to specialist services.
Sources
WHO — Epilepsy
WHO — Improving the lives of people with epilepsy: technical brief
WHO — Pilot studies help close the epilepsy treatment gap
WHO — Epilepsy fact sheet
Evidence checked: September 2026.