Localities are areas of common culture that may be larger or smaller than countries. Activities on locality or national fronts support change in individual countries.

Current priority localities and countries

In a vertically-integrated programme in each country, Lifting The Burden will:

1. work with people and agencies locally;
2. measure the headache burden;
3. raise awareness of it amongst those who can cause change;
4. put in place, and test, locally-appropriate health-care solutions.

This replicates, at local levels, the Campaign's three stages.

Wherever knowledge is insufficient of the scale and scope of the local burden attributable to headache, new epidemiological studies will be undertaken to fill that gap. Unless the problem is known and understood, effective solutions to it cannot be proposed.

Studies have been completed in Georgia, Russia, India and China and are underway in Ethiopia, Zambia, Pakistan and Saudi Arabia.

People contributing to these activities

New epidemiological studies conducted on national or locality fronts not only produce knowledge for action on those fronts but also contribute to the estimate of global burden.

Awareness initiatives persuade governments and other health-service policy-makers, health-care providers, people directly affected by headache and the general population that, on clear evidence, headache must have higher health-care priority. They are needed to gain commitment, based on recognition of need for change, to working for change.

Interventions may range from beachheads through planned learning exercises to full demonstrational projects.

The strategy for effective intervention first and absolutely requires local champions. Second it requires agreement upon the desired and achievable objectives - which should be based on local needs assessment - and upon local priorities.

Desirable is early contact with WHO Regional Offices and national WHO Representatives and/or collaborating centres.

The headache health-care model

Evaluating the effects of change is the not-quite-final step. Lifting The Burden must measure the effect of its interventions. Ideally, although it is methodologically challenging, this is done in terms of reductions in population burden attributable to headache.

The final step is to revise, if evaluation indicates that they should be, and re-apply the modified interventions in plan-do-study-act cycles using standard management of change methodology.

Then they can be rolled out across the locality or country.