India is the second most populated country in the world with majority of population being rural. Although the economy has been growing at a rapid pace, the per capita expenditure on health, family welfare, water supply and sanitation in recent years has been dismally low. The health services provided by the government are totally free or highly subsidized for the poor and needy. The rapidly emerging private health sector with health insurance facilities is affordable to only a small section of the population.

It is estimated that with a population of more than 1 billion, there are about 6–10 million people living with epilepsy in India, accounting for nearly one fifth of the global burden. The challenge of meeting the needs of the people with epilepsy in a developing country like India is a daunting task for every one involved in the planning and delivery of health care. In a country like India with diverse cultures, castes and low literacy; various myths and misconceptions about epilepsy that exist among the people further add to the societal disease burden and treatment gap. Developing countries such as India need to develop alternative strategies to reach out to the needy people living with epilepsy in different parts of such a vast country. The best approach in a country like India with limited resources for health-care would be to encourage “private-public participation.” There is an urgent need to have a separate National Epilepsy Control Programme (NECP) in countries like India. In order to be successful, the proposed NECP must be an initiative of the government and should work in collaboration with the health care providers in the private sector and non-governmental organizations.

India is the largest country in the Southeast Asian Region of the World Health Organization (WHO) with an estimated population of more than 1 billion living in an area of 3287.3 thousand km² with the population density being 325 per km². The majority of the population is rural, with only 27.8% living in urban areas. India has 35 states and union territories accounting for 593 districts, 5,161 towns, and 593,643 inhabited villages as of March 31, 2001.⁸ The majority of the population as per the 1991 Census was young, with 37.8% being in the 0- to 14-year and 55.5% in 15- to 59-year age group. The national literacy rate for 2001 was 65.5%, with males (75.96%) having a better literacy rate as compared to females (54.28%).

The combined national crude birth rate for 2002 as per the sample registration system of the Registrar General of India was 25.0, the crude death rate being 8.1 and the natural growth rate of 16.9 per 1,000 population. The average annual exponential growth rate of the population is calculated to be 1.96%. The gross per capita net national product at current price for 2003–2004 was estimated to be about U.S. $463 (INR 20860, 1 U.S.$ = INR 45.00). Only 3.97% of the total expenditure in the budget was allocated to the Health, Family Welfare, and Indian System of Medicine and Homeopathy (ISM & H) for the 10th 5-year plan (2002 to 2007). The per capita expenditure on health, family welfare, water supply, and sanitation during 2002–2007 will be about US $2.53 per year.⁸

The primary and secondary health care in the government sector is delivered through a vast network of subcenters (SCs; one SC for about 5,000 population and manned by health workers); primary health centers (PHCs; one PHC for 30,000 to 50,000 population); and taluk hospitals/community health centers (CHCs; one CHC for 100,000 population) that are under the administrative control of district hospitals (DHs; one DH for 1.5 to 2 million population). The tertiary health care is provided by hospitals attached to medical colleges, apex institutions, and super-specialized centers. Government health services are totally free/highly subsidized for the poor and needy. A rapidly emerging private health sector, in the absence of government health insurance to the majority, is affordable to only a small section of the population. Though allopathy (modern medicine) takes care of the majority, traditional systems of medicine also are widely used in the country.⁶

There were 189 medical colleges (during 2000–2001) and 185 dental colleges (2003–2004) imparting education and health care facilities in the modern system of medicine. In addition, there were 431 colleges providing training and health care facilities in the ISM&H, with the maximum being in Ayurveda (209) followed by homeopathy (180), Unanai (36), and Siddha (six). There were 15,393 hospitals as of January 1, 2002, with 914,543 hospital beds (of all types) accounting for 89 hospital beds per 100,000 population. In addition to the hospitals, there were 137,311 SCs, 22,842 PHCs, and 3,043 CHCs on March 31, 2001. There were 605,800 medical doctors registered with the Medical Council of India as of December 31, 2002, at the rate of 59 doctors per 100,000 population. In addition, 839,862 nurses and midwives were registered with the Nursing Council of India as of March 31, 2003.⁸

While the primary and secondary health care facilities may at the most provide only the basic health care, some of the private and government hospitals and institutions now are providing “state of the art” facilities often at a fraction of the cost that needs to be paid in the hospitals in the developed nations. Although still not adequate, there has been a phenomenal growth in the health care sector in the last few years, especially in the private sector. The private health insurance agencies also have begun to play a role in the country, though not in a big way. Distribution of these health care facilities leaves much to be desired, and despite the fact that many parts of the country may still be without adequate health care facilities, medical tourism is projected to be a major revenue-earning industry in the next few years.

India being a land of contrasts, mental health care is provided by a multitude of trained and untrained personnel that include neurologists, neurosurgeons, psychiatrists, physicians, pediatricians, those trained in the ISM&H, and a large number of health and non–health care personnel (registered and unregistered medical practitioners, religious heads, and even faith healers). In urban areas for most people with epilepsy who receive treatment, the expert care is provided mainly by the neurologists and neurosurgeons, though primary care is delivered by family physicians, pediatricians, and internal medicine experts.

The challenge of meeting the needs of people with epilepsy in a developing country like India is a daunting task for everyone involved in the planning and delivery of health care. The limited resources and lack of adequate trained manpower complicates the problem further. At present there are about 800 trained neurologists and 1,300 to 1,500 trained neurosurgeons in the country. The paradox of a country like India is that as per the president-elect of the Association for Indo-American Neurologists, there are 600 to 700 neurologists of Indian origin in the United States (personal communication).

A high-powered committee set up by government of India, the Technology, Information, Forecasting, and Assessment Council (TIFAC), examined the technology and manpower requirement for the year 2020. The needs in the discipline of neurology were also assessed by the TIFAC. Assuming even a modest ratio of one neurologist for 200,000 population as against 8,000 in Italy and 18,000 to 50,000 in the United Sates, India would require ≥5,000 neurologists as against the present strength of <1,000 neurologists. Even if a hundred trained neurologists were to be added to the pool annually, giving allowance for outward movement from the country, it would take at least half a century to achieve the goal. A further confounding problem is the distribution of neurologists, because major proportions gravitate to metropolitan cities and big towns, leaving almost 70% of the population in the rural areas deprived of specialists’ care. Thus, there is an urgent need to reconsider and conceptualize alternative strategies to organize services at the peripheral, regional, and apex levels, as recommended by the TIFAC.⁶

Many studies based on well-accepted methods, valid screening and diagnostic tools, and case confirmation methods have been conducted to identify epilepsy in the community in an inexpensive way in different parts of India. Population-based neuroepidemiologic studies conducted in different regions have shown that epilepsy constitutes nearly a third of all neurologic disorders. The prevalence of epilepsy varies from 2.5 to 11.9 per 1,000 population.^{2,3,5,6,7,9,10,11,12,13,14} In the Bangalore Urban Rural Neuroepidemiological (BURN) survey, a task force project supported by the Indian Council of Medical Research (ICMR) covering a population of 102,557, a prevalence rate of 8.8 per 1,000 population was observed, with the rate in rural communities (11.9) being twice that of urban areas (5.5). Epilepsy was found to be the second leading neurologic problem in both urban and rural populations, next only to vascular headache.⁷ Based on these data and information emanating from various studies, it is estimated that in India (with a population of more than 1 billion), there are about 6 to 10 million people living with epilepsy, accounting for nearly one fifth of the global burden.^{2,3,5,6,7,9,10,11,12,13,14} Though most of the epidemiologic studies in India estimated prevalence of epilepsy, one study from Yelandur has provided incidence data.¹⁰ Accordingly, 50 new cases per 100,000 population are added annually, giving an additional burden of 500,000 new-onset epilepsy cases every year in India.