EHS-COVID (3) Stroke systems of care in low-income and middle-income countries: challenges and opportunities

30 October, 2020

COVID is conspicuous by its absence in this otherwise comprehensive review in The Lancet (31 October 2020). The paper does not even mention COVID or coronavirus. I invite HIFA members to share any observations on the impact of COVID on essential health services for people with acute stroke - and their long-term rehabilitation.

CITATION: Stroke systems of care in low-income and middle-income countries: challenges and opportunities

Jeyaraj D Pandian et al.

The Lancet, October 31, 2020

DOI:https://doi.org/10.1016/S0140-6736(20)31374-X

SUMMARY: The burden of stroke is higher in low-income and middle-income countries (LMICs) than in high-income countries and is rising. Even though there are global policies and guidelines for implementing stroke care, there are many challenges in setting up stroke services in LMICs. Despite these challenges, there are many models of stroke care available in LMICs — eg, multidisciplinary team care led by a stroke neurologist, specialist-led care by neurologists, physician-led care, hub and spoke models incorporating stroke telemedicine (ie, telestroke), and task sharing involving community health workers. Alternative strategies have been developed, such as reorganising the existing hospital infrastructure by training health professionals to implement protocol-driven care. The future challenge is to identify what elements of organised stroke care can be implemented to make the largest gain. Simple interventions such as swallowing assessments, bowel and bladder care, mobility assessments, and consistent secondary prevention can prove to be key elements to improving post-discharge morbidity and mortality in LMICs.

Best wishes, Neil

Coordinator, WHO-HIFA Collaboration: HIFA project on Essential Health Services and COVID-19

https://www.hifa.org/projects/essential-health-services-and-covid-19

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages in collaboration with WHO. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org