When the World Health Organization released its first Global Report on Neurology 2025, the findings were stark: an estimated 3.4 billion people—around 42% of the world’s population—were found to be living with at least one neurological disorder, with diseases of the brain and nervous system identified as the leading global cause of illness and disability.
Behind these headline figures lies a more complex reality in Africa, where nearly four-fifths of the global neurological burden is borne by countries with the fewest neurologists, laboratories, and research networks. Non-communicable neurological conditions such as epilepsy, Parkinson’s disease, and dementia have been increasingly recognised as a quiet but accelerating threat to public health and social development across the continent.
The report highlighted a dramatic workforce gap. Africa was found to have just 0.04 neurologists per 100,000 people—roughly one specialist for every 2.5 million citizens—a ratio 227 times lower than that recorded in Europe. African neuroscience research was shown to account for only 3.8% of global health publications, and only one country on the continent was identified as having formal government funding dedicated specifically to brain-health research.
On the service side, 46% of surveyed African countries were reported to have integrated neurological disorders into their universal health-coverage packages, but in practice the effective continental figure was estimated to be closer to 23%. Patients and families were found to shoulder most of the financial burden, with out-of-pocket payments covering 58% of neurological medicines—the highest rate worldwide.
“These indicators reveal a structural imbalance in how the world’s health resources are allocated,” said Mohamed Salama, professor of global health and human ecology at the American University in Cairo. Africa, he argued, is “paying the price for the absence of rigorous epidemiological studies that could have guided preventive policies.”
Salama noted that dementia rates have been reduced in some European countries, including the UK, through early-risk interventions and long-term population tracking. Africa, by contrast, “has remained unable to implement similar approaches because of data scarcity and weak institutional frameworks.”
For him, the challenge was said to extend beyond funding alone. “The bottleneck is also regulatory and organizational,” he said. “An integrated neurological-care system in Africa can only be built through a long-term project demanding knowledge, political will, and sustained national investment.”
Against this backdrop, Zambia’s new National Neurology Training Programme has been presented as a regional model for capacity-building, with a shift marked away from reliance on overseas training.
Ehab El-Refai, professor of neurosurgery at Cairo University, described it as “a pioneering experiment aimed at addressing the severe shortage of neurological specialists.” The programme has been designed around intensive, targeted instruction, enabling competent clinicians to be trained more rapidly.
El-Refai compared it with successful partnership models, such as the joint fellowship established between Cairo University and Germany’s University of Greifswald, through which neurosurgeons are trained in advanced techniques. What distinguishes Zambia’s initiative, Salama added, is its emphasis on sustainability through a “train-the-trainer” approach, whereby graduates are organised into national networks capable of mentoring future cohorts.
“This is how local knowledge is multiplied,” he said.
Epilepsy remains one of Africa’s most prevalent neurological disorders. Eight in ten people with epilepsy are estimated to live in low-income countries, yet three-quarters are reported to receive no appropriate treatment, despite the availability of inexpensive essential medicines.
The Epilepsy Pathway Innovation in Africa (EPInA) initiative has been identified as a potential turning point. Community awareness, early diagnosis, and hospital-based care have been linked within a single continuum. Health-care workers are trained to recognise early seizure symptoms and to use mobile-phone applications through which episodes are logged and data are shared with clinicians.
“This practical approach goes beyond medicine,” said El-Refai. “The social stigma that has prevented many patients from seeking help is directly addressed.”
Sustained government commitment and domestic funding were emphasised as essential if pilot projects are to be transformed into durable public-health policies. The incorporation of artificial-intelligence tools to collect and analyse patient data, El-Refai added, could accelerate drug development and allow treatments to be better tailored to African contexts.
Despite chronic underfunding, Africa’s neuroscience landscape has begun to show signs of momentum. New collaborations among universities in Kenya, Tunisia, and Zambia have been associated with increased research output. The establishment of a continent-wide database of neurological diseases, Salama argued, would serve as a “cornerstone for evidence-based policymaking,” replacing today’s heavy reliance on external estimates.
With greater local financing and cross-border research integration, Africa’s scientific landscape could be transformed within a decade, he believes, driven by a new generation of researchers studying the continent’s diseases within their own contexts and languages.
The WHO report also underscored that Africa’s neurological burden is not purely clinical. Brain-health outcomes have been worsened by air pollution, heavy-metal exposure, malnutrition, and extreme heat, while droughts, conflict, and mass displacement have further disrupted health services and medication supply chains.
“For brain health, the environment matters,” Salama said. The integration of environmental risks into prevention strategies, he argued, offers the most realistic path towards addressing root causes.
Only a third of African countries are currently reported to allocate a dedicated budget line to neurology, yet signs of change are emerging. Local training programmes, regional initiatives, and growing support from the WHO are laying the groundwork for what has been described as a continental renaissance in brain health.
The prioritisation of non-communicable neurological disorders within national health agendas, Salama said, “could deliver measurable improvements within five to ten years.” El-Refai agreed, but added that lasting progress will depend on neurology being embedded within medical education and continuous training, while being linked to national research funding and public-health planning.
