Our results suggest that task-shifting headache care to nurses through capacity-building can reduce the headache treatment gap in settings where there are no physicians or headache specialists. This is similar to results from other studies assessing the role of nurses in the provision of headache care(8–12). In African countries such as Cameroon, there is a stark difference between the number of people with headache disorders who need treatment and those who do not(6, 20, 21). This difference, known as the treatment gap, is even wider in rural areas where there is a critical shortage of physicians. Despite continuous efforts made by these countries to grow the healthcare workforce in rural areas, the number of physicians is still very low. Primary headache disorders such as tension-type headaches and migraines are one of the most common reasons why people seek medical attention in rural areas of Cameroon(3, 4). Addressing the headache treatment gap in rural areas in resource-limited settings is critical to mitigating headache-associated disability, which can significantly lower productivity. The evidence from our studies suggests that task-shifting headache care can be an effective strategy to reduce the treatment gap in resource-limited settings.
Task-shifting or delegating medical responsibilities from highly trained professionals to less specialized healthcare workers is a globally recognized strategy for addressing shortages in healthcare workforce especially in resource-limited settings(22). It has been used successfully to expand the delivery of healthcare services for diseases such as HIV/AIDS care, non-communicable diseases and mental health treatment(22–25). As frontline healthcare providers in many rural communities, nurses are well-positioned to take on the diagnosis and management of common primary headache disorders, particularly in areas with limited access to specialized neurological services. Though conducted in developed countries, several studies have shown that headache-trained nurses can accurately diagnosed and treat primary headache disorders such as migraine and tension-type headache with treatment outcomes comparable to those of patients managed by a neurologist(8–11). The European consensus recommendations on the role of nurses in headache emphasises on the need to see nurses not merely as assets for better care but rather a necessity, based on the multiple important roles and responsibilities they fulfil in the treatments(12).
A 2022 review on the barriers to headache care in low- and middle-income countries identified task-shifting headache care to nurses as a feasible strategy to reduce the headache treatment gap in low- and –middle income countries(20). While task-shifting headache care to nurses holds promise, it is not without its challenges. Careful consideration must be given to the appropriate scope of practice, supervision, and referral mechanisms to ensure the quality and safety of care. Also, the roles and responsibilities of nurses must be clearly defined while adequate training, mentoring, and support must be provided. Additionally, there may be low buy in from physicians or other healthcare providers who may be reluctant to cede their responsibilities.
To address these challenges, a comprehensive approach to task-shifting is required, one that involves not only the training and support of nurses but also the engagement of policymakers, physicians, healthcare administrators, and the broader community. Careful planning, robust monitoring and evaluation, and a commitment to continuous quality improvement will be essential to ensure the long-term sustainability and effectiveness of task-shifting initiatives for headache care. Furthermore, task-shifting must be accompanied by broader efforts to strengthen the overall healthcare system, including the improvement of supply chains, and enhanced referral and information-sharing networks. Moreover, the long-term sustainability of such programs will depend on the availability of adequate resources, including a reliable supply of headache medications and continued investment in the training and support of the nursing workforce.