Despite the significant progress made in developing effective, safe, and cost-effective medicines that enhance the quality of life of individuals with neurological disorders, these medicines remain largely inaccessible.
A new WHO report, Improving Access to Medicines for Neurological Disorders, sets out the barriers that prevent access to these essential medicines, and presents a framework for action to address these challenges.
"The impact of neurological disorders can be significantly decreased and quality of life improved, if people living with these disorders are provided access to the essential medicines they need," says Dévora Kestel, Director or WHO's Department of Mental Health, Brain Health and Substance Use. "However, most people with neurological disorders struggle to access the treatment they need for their conditions because these medicines do not reach them or are too expensive."
Neurological disorders are the leading cause of disability and over 80% of neurological deaths and health loss occur in low- and middle-income countries. The treatment gap (the difference between the number of people with a condition and those receiving appropriate treatment) for neurological disorders is extremely high, exceeding 75% in most low-income countries and 50% in most middle-income countries.
Evidence shows that the treatment gap for epilepsy, for example, can reach 90% in low-income countries – that means that 9 out of 10 people living with epilepsy do not receive the care and treatment they need.
Barriers to accessing medicines for neurological disorders
Using epilepsy and Parkinson disease as tracer conditions, WHO published a report that sets out the complex and inter-linking challenges that prevent access to treatment for neurological disorders, including:
- poor health financing and the high cost of drugs, leading to high out-of-pocket spending costs that increases the risk of financial hardship for individuals living with neurological disorders and their families;
- insufficient public awareness of neurological disorders, inadequate healthcare infrastructure and lack of healthcare provider training on neurological disorders, combining to create barriers to accessing appropriate care, including diagnosis and treatment; and
- lack of appropriate selection of essential medicines at the national level and regulatory hurdles also contribute to inaccessibility of essential medicines for the treatment of neurological disorders.
These challenges are further compounded by existing health inequities, disproportionately affecting populations in low- and middle-income countries, individuals living in poverty, rural areas, and other vulnerable groups, creating a fundamental obstacle to achieving universal health coverage.
WHO report provides a framework for action
The report offers a framework for stakeholders to step up multi-level, multi-sectoral action and address the many barriers impeding sustained access to essential medicines for neurological disorders. The proposed actions address multiple areas across the health system, including policy and regulatory environments, health infrastructure and education systems. The report also emphasizes the importance of engaging with individuals with lived experience and the power of collaboration at country, regional and global levels, as well as among stakeholder groups.
"Actions proposed in this report have clear synergies with the WHO Roadmap for access to medicines, vaccines and other health products. With the proposed approach for neurological medicines, we have a robust set of actions and a clear way forward to improve access to these essential medicines," says Christophe Rerat, Senior Technical Officer in the Medicines and Health Products Division, WHO.
Supporting countries to improve access to medicines for neurological disorders
This report is an important tool in the implementation of the Intersectoral global action plan on epilepsy and other neurological disorders (IGAP) 2022–2031, which is supporting countries to scale up access to the essential medicines and technologies needed to manage neurological disorders by 2031.
Some countries are already taking significant steps to address these challenges. In Ghana, neurological disorders such as epilepsy and Parkinson disease have been prioritized. The recent update of the national essential medicines list and standard treatment guidelines included several medicines and clinical guidance for treatment of neurological disorders.
In the United Republic of Tanzania, a national coordination committee for epilepsy and other neurological disorders is being established to provide technical support to policymakers. The country's Medical Stores Department is conducting special procurements of medicines for neurological disorders in order to address the lack of access. Significantly, the United Republic of Tanzania's National Health Insurance Fund package 2024, now includes several medicines for neurological disorders, including epilepsy and Parkinson disease. These actions represent a major step towards ensuring more people living with these disorders can access the treatment they need.
