Ahead of World Stroke Day, WHO Urges Stronger Stroke Care Across South-East Asia

On Thursday, a day ahead of World Stroke Day, Poonam Khetrapal Singh, the World Health Organization's Regional Director for South-East Asia, issued a statement from New Delhi that opened with a stark imbalance. By WHO's estimate, about 70 percent of strokes and 87 percent of stroke-related deaths occur in low- and middle-income countries. The 87 percent figure also covers disability-adjusted life years, a measure that counts years lost to illness and disability as well as to death.

Singh said WHO will keep helping every country in the region choose and apply what it calls "best buy" interventions, meaning measures that reduce stroke risk and widen access to quality stroke services. She framed the region's commitment as covering prevention, treatment, management and rehabilitative care for people left disabled by stroke.

She argued the region has a foundation to build on. In recent years, she said, South-East Asia has made significant progress on two flagship priorities: preventing and controlling noncommunicable diseases and reaching universal health coverage. All countries continue to carry out multi-sectoral NCD action plans while expanding NCD services at the primary care level, in line with the 2016 Colombo Declaration. On tobacco, India, Nepal, Maldives, Thailand and Timor-Leste are among the world's top 10 countries for the largest graphic warnings on cigarette packaging. The region is also promoting physical activity, healthy eating and action on harmful alcohol and substance use, even as it responds to the pandemic. Singh added that higher taxes on unhealthy products could change behaviour and also raise money for health budgets, including services that prevent, detect and treat stroke.

The most concrete piece of the statement concerned a stroke care improvement programme that WHO supports across several countries. By the end of this year it will have finished its second year. It aims to strengthen stroke management and referrals by developing and training multidisciplinary teams of doctors, nurses and rehabilitation therapists. The first year of implementation began in April 2021 with Bhutan, Maldives, Myanmar and Timor-Leste. The programme has since been extended to Nepal and Sri Lanka.

Singh set out four interventions that she said could bring immediate progress anywhere in the region. The first is building stroke prevention and detection into primary-level health services. She said community interventions, e-health, appropriate medication and lifestyle changes can prevent at least 50 percent of stroke events. Public familiarity with the FAST method, which stands for Facial drooping, Arm weakness, Speech difficulty and Timely emergency service, could further reduce stroke's incidence and impact.

The second is strengthening pathways of care from primary level through rehabilitation, using a hub-and-spoke model to find and close gaps, with particular attention to fast-track referrals and emergency stroke services. The third is making essential stroke medicines available to everyone. Thrombolytics and other stroke drugs are now on WHO's Essential Medicines List, and Singh said they should be added to national lists. The fourth is adopting high-impact innovations, notably virtual capacity building and tele-networking within and between countries to build skills and share knowledge and resources.

Singh also said countries should use the COVID-19 response as an opening to improve health and well-being, make health systems more efficient and support social and economic growth. She closed by repeating WHO's commitment to help countries lower stroke incidence, improve detection and treatment, and widen access to rehabilitation, calling a fairer, healthier and more sustainable region "ours to achieve." What to watch next is whether governments actually put stroke medicines on their national essential lists and fold these steps into national plans.