The epilepsy treatment gap is often described as a difference between high-income and lower-income countries, but major inequalities also exist inside countries. One of the most persistent is the divide between rural and urban communities.
WHO states that the treatment gap is substantially higher in rural than in urban areas in many low-income settings. The reasons are not simply a shortage of neurologists. Distance, transport, medicine supply, local workforce, cost, stigma and referral systems all interact.
Why distance changes care
A specialist appointment may require hours of travel, an overnight stay or a day away from paid work. Those costs recur for follow-up visits, prescriptions and tests. Even where consultation itself is inexpensive, transport and lost income can make regular care difficult to sustain.
Diagnostic technology is usually concentrated in cities
EEG, MRI, prolonged video-EEG, specialist paediatric neurology and epilepsy surgery assessment tend to cluster in larger hospitals and urban centres. That does not mean every person with epilepsy needs advanced testing, but people with diagnostic uncertainty or drug-resistant epilepsy may face a particularly long route to specialist assessment.
Medicine supply can be less reliable
Rural clinics and pharmacies may carry fewer antiseizure medicines or experience more frequent stock interruptions. A treatment plan is only useful if the medicine can be obtained consistently. When supply is unreliable, people may be forced to switch products, travel farther or miss doses.
Workforce and training matter
WHO’s 2025 Global status report on neurology documents profound workforce inequalities between countries and notes that specialist services are often concentrated in urban areas. In places with few neurologists, primary-care clinicians frequently manage epilepsy. This can work well when staff have appropriate training, supervision, medicines and referral pathways.
Primary care can narrow the gap
WHO has long promoted integration of epilepsy care into primary health care. Its programmes in countries including Ghana, Mozambique, Myanmar and Viet Nam showed that training non-specialist providers and strengthening community-based care can increase treatment coverage. The exact model needs to fit the local health system, but specialist scarcity does not make improvement impossible.
Rural does not mean one thing
Rural communities differ enormously. Road networks, conflict, geography, wealth, medicine supply, language, local beliefs and distance to referral centres all affect access. Rural residence should therefore be understood as one marker of possible disadvantage rather than an assumption that all rural care is poor.
Why this matters
If people in one region can access diagnosis, medication and specialist review while people in another cannot, the same neurological disorder can produce very different outcomes. The rural–urban treatment gap is therefore a health-system issue as much as a medical one.
Sources
WHO — Epilepsy fact sheet
WHO 2025 — Global status report on neurology
WHO Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022–2031
WHO — Epilepsy and primary-care response
Evidence checked: September 2026.