EHS-COVID (9) Stroke systems of care in low-income and middle-income countries: challenges and opportunities (3)

2 November, 2020

Management of stroke in low income countries requires a system that has its base in the community and its apex in the referral hospital. A poor patient with stroke is managed in the near-by hospital by a medical officer. If the family is rich; by a specialist in a higher level hospital. The challenge is short hospital stay, usually because the family cannot afford long stay or the medical officers over-look the long process of rehabilitation. When the patient is stable, they are discharged through the rehabilitation unit (if it exists) who request the patient to make monthly visits to the physiotherapy clinic. Many patients do not return and live a poor quality of dependent life and face early death.

Kisizi hospital in South-West Uganda provides a continuum of care through Community Level Rehabilitation. The stroke patient and any other patient who requires long-term rehabilitation are referred home through the rehabilitation unit (physiotherapy and occupational therapy - no speech therapists yet). Important to note is the rehabilitation personnel are key cadres who contribute to the discharge decision unlike in many settings where this is decided by the doctors. The patient is linked to a Community Based Rehabilitation worker who visits the patient in their home once a week to encourage activities of daily living and reintegration in family and community. A patient whose progress is unsatisfactory is visited by the physiotherapist. This system ensures continuity and is less costly for the family. The main challenge is it has not yet been incorporated in the community insurance scheme which only covers hospital based services.

Alice Nganwa

HIFA profile: Alice Nganwa is Executive Director at WIND Consult Limited in Uganda. Professional interests: Promote equity in development that includes marginalized people and addresses less popular but important development issues such as prevention of road traffic crashes, domestic violence, occupational safety, school health, healthy ageing and minimizing alcoholism and other addictions. windconsultug AT