Vol. 5, Issue 1, Part A (2023)

Background: There is a huge treatment gap for neurological, neuropsychiatry, neurodevelopmental and neurodisability disorders’ (altogether called brain disorders-BDs) care in low-Middle Income Countries (LMICs) like Pakistan. The provision of cost-effective and efficient measures to combat these disabling problems has become exigent for low-income countries. This makes a call for using the existing primary health care (PHC) structure to address the needs of the vast majority of the population, especially in hard-to-reach locations. 
Aim: The aim of this paper was strengthening and extending the existing systems of urban charity primary care to deliver free multidisciplinary and interdisciplinary health services for BDs in a hard-to-reach district along with addressing demand-side and supply-side barriers and enablers concurrently. 
Methods: In 2009, we started monthly brain health outreach program (BHOP) for geographic accessibility, availability, affordability and acceptability of paediatric brain health services in District Bhakkar, a hard-to-reach district in South Punjab- Pakistan. Since then we have been continuing monthly camps in different locations of Bhakkar city and its four Tehsils. We did collaboration with existing free urban primary health care in 2019, adjacent to DHQ Hospital Bhakkar where different neurology subspecialty camps are done on different designated week days for each subspecialty in every month in addition to our rotatory camps in different locations of district Bhakkar. Two newly joined consultant paediatric neurologists were asked to review about diagnostic gap (DG), treatment gap (TG), antiepileptic drug adherence gap (Ad. G) being blind of the purpose of this analysis. 
Results: To date there is no health facility for brain disorders in the whole district. Over the passage of time, we built simple core team then multidisciplinary teams of paediatric neurologists, adult neurologists, adult’s psychiatrists, neurodisability consultants, behavioral and occupational therapist offering different neurology subspecialty services. All employees working in this center are local; we have trained them; they are acting as key informants and are very useful for removing stigma of brain disorders especially among females. More than 3000 epileptic patients are registered in this free community centre. Impact evaluation upon the management of childhood epilepsy showed that younger the age, worst was the management status: DG decreased from77.7% to 3.2%, TG decreased from 89.2% to 4.2%, Ad. G decreased from 66.1% to 13.2%. 
Recommendations: A collaborative network between stakeholders in the public and private sector, as well as non-governmental organizations with the help of relative visiting brain subspecialists from tertiary care facilities are required that promotes and provides brain health care in hard-to-reach districts. 
Conclusion: Integrating brain health into primary care services is a critical, affordable, and cost-effective approach to delivering services for people living in financially deprived hard to reach locations, but requires contribution of brain subspecialists from the tertiary care facilities