On Locality and National Fronts

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 priorities in selecting localities and countries reflect opportunity as well as need.

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 among 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 principal objectives.

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

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.

Studies have been completed in Ethiopia, Zambia, Morocco, Pakistan, Saudi Arabia, Georgia, Russia, India, Nepal and China, are underway in Guatemala, Peru and Kuwait, and in planning in Nigeria, Uganda, Sri Lanka and Mongolia.

Awareness initiatives use knowledge to 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 to working for change founded on full recognition of the need for change.

Effective interventions are likely to be based on the headache service organizational model

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 in plans for intervention is early contact with WHO Regional Offices and national WHO Representatives and/or collaborating centres.

Capacity-building of doctors, especially in primary care, is a necessary part of most interventional projects and requires integrated educational initiatives.

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 the interventions, if evaluation indicates that they should be, and re-apply the modified interventions in plan-do-study-act cycles using standard change-management methodology.

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



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