The Lancet: Stroke rehabilitation in low-income and middle-income countries: a call to action

30 October, 2020

This week's Lancet (31 October) has a review on stroke rehabilitation in LMICs. This is a massive issue of inequity of access to essential services. As the authors point out in the full text: 'The proportion of people with stroke who access rehabilitation is very low in LMICs, and access is confined largely to the acute period within 7 days of stroke.' Below are the citation, summary and a comment from me.

CITATION: Stroke rehabilitation in low-income and middle-income countries: a call to action.

Prof Julie Bernhardt et al.

Published:October 31, 2020

DOI:https://doi.org/10.1016/S0140-6736(20)31313-1

SUMMARY

The WHO Rehabilitation 2030 agenda recognises the importance of rehabilitation in the value chain of quality health care. Developing and delivering cost-effective, equitable-access rehabilitation services to the right people at the right time is a challenge for health services globally. These challenges are amplified in low-income and middle-income countries (LMICs), in which the unmet need for rehabilitation and recovery treatments is high. In this Series paper, we outline what is happening more broadly as part of the WHO Rehabilitation 2030 agenda, then focus on the specific challenges to development and implementation of effective stroke rehabilitation services in LMICs. We use stroke rehabilitation clinical practice guidelines from both high-income countries and LMICs to highlight opportunities for rapid uptake of evidence-based practice. Finally, we call on educators and the stroke rehabilitation clinical, research, and not-for-profit communities to work in partnership for greater effect and to accelerate progress.

Comment (NPW): Reading the full text, the paper emphasises common barriers to rehabilitation relating directly to lack of availability and use of reliable healthcare inforamtion:

'1. Poor understanding among clinical leaders (eg, chief medical officers, doctors), health planners (eg, health ministers, hospital directors, insurance company leaders), and patients about the role of rehabilitation interventions on impairment, activity, and participation (eg, return to work), thereby undervaluing rehabilitation delivery in service planning.

2. Misleading cultural beliefs about stroke and the historical use and availability of traditional medicine, which might include some traditional practices.11, 12

3. Absence of rehabilitation in many standards of care, clinical practice guidelines, and care pathways and protocols.

4. Insufficient skilled workforce to deliver rehabilitation and scant access to standardised stroke educational programmes...'

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