Over 100 million people in the world have experienced stroke, most of them live with long-term disabilities, loss of employment and the mounting out of pocket costs associated with additional health, rehabilitation and support needs. With the global burden falling almost entirely on the poorest communities, those who have the least are not only most at risk, they are also the least likely to access preventive care; least likely to receive acute care, and least likely to receive rehabilitation and long-term community support. For the few who can eke the costs of care out of their household purse, in the poorest households this comes at the expense of food or their children’s education.
Opportunities to support more equitable health outcomes exist at every stage of the stroke patient pathway. In terms of prevention, low-cost interventions, including access to screening, diagnostics would help identify the biggest contributors to stroke, while access to low-cost medications to manage leading risk factors such hypertension, diabetes and high-cholesterol would more than half the rate of stroke. With an ROI of US$10 for every $1 invested stroke prevention is a fundamental way governments can reduce their NCD burden.
Acute stroke treatment is another area where adequate UHC has the potential to save lives, transform patient outcomes and deliver health for all. Access to diagnostics to identify stroke enable fast treatment which in turn reduces long-term treatment while access to thrombolysis and mechanical thrombectomy are recommended by WHO, but even in countries with highly developed healthcare systems, access is limited and inequitable. Globally only 7% of patients for whom thrombectomy would be effective, receive this life-changing treatment.
Evans Nyembega was working as a pharmacist in Kenya when he had a stroke, lack of access to diagnostics and financial barriers to healthcare were devastating for him- physically, financially and emotionally. ‘The first problem I encountered with stroke treatment was diagnosis which took too long. The cost of treatment is also prohibitive as the drugs are very expensive and I could not afford this. I had a problem in remembering things like the time to take drugs because I suffered cognitive challenges, so I needed a caregiver permanently. I lost gainful employment resulting to abject poverty.’
It is not only in low-income settings where stroke patients face inequitable access to care and high out of pocket costs. Canadian, Lara Kaufman was 41 when she had her stroke, she needed physical and occupational therapy beyond the 12 weeks allotted under her government healthcare program, but ‘had to pay out of pocket tens of thousands of dollars over the years in private rehab. This rehab was necessary to recover.’ She says ‘It's unacceptable that anyone must pay out of pocket in Canada. Many people do not get the rehab they need to get back to work and so they don't get back to work and need government assistance. Also, many people who don't have access to physical therapy end up needing hip or knee replacements because they fall or walk improperly and so they go back into the healthcare system. The same goes for mental health.’
On International UHC Day we say there can be no ‘Health for All’ without inclusion of stroke prevention, treatment and rehabilitation in UHC. We join the call for governments to
- Make universal health coverage and financial protection for health a national priority!
- Adopt and implement laws to shield people from impoverishing health costs.
- Allocate budgets for an affordable package of essential health services.
- Establish national public health schemes that cover health costs for the entire population and are financed by national taxes.
- Minimize or eliminate user charges for those most in need, including individuals with low incomes or chronic conditions.
Governments: financial protection for health is on you!
Visit https://universalhealthcoverageday.org to find out more and to support the 'Health for All' call.
#UHC #UHCday #HealthForAll #strokeprevention #stroketreatment #strokerehabilitation #lifeafterstroke
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