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Advanced Neurology Stroke care in sub-Sahara Africa

creating an overarching collaborative partnership among private insurance companies to compete for services,
Policymakers, Payers, Partners in health-care promotion, thereby providing more options for patients and
Providers of health care, and Patients. A synergistic, eventually leading to cost containment. Payers should
overlapping, and counter-balancing system approach is work collaboratively with other 5 Ps to enhance health
summarized pictorially in Figure 3 and detailed below: benefits for the poor. They should also play a major
(i) Policymakers: At both federal and state or local levels, role in incentivizing providers for high productivity,
policymakers need to increase the health-care budget efficiency, and efficacy and provide regular feedback
to a minimum of 15% stipulated in the 2001 Abuja to policymakers on matters affecting service delivery
Declaration Summit. However, reaching this spending to patients.
target is just the first step. Ensuring that the allocated (iii) Partners in health-care promotion: Health-care
budget is resourced optimally, timely, and executed partners should create evidence-based clinical
flawlessly, while minimizing wastefulness is equally guidelines for primordial, primary, and secondary
important. Targeted health-care spending should prevention of stroke. They should promote research
prioritize the following: and public education on stroke prevention and the
(a) A national health insurance scheme designed to importance of seeking acute stroke treatment, with the
benefit less well-to-do citizens goal of reducing the incidence, prevalence, and burden
(b) Research funding to academic public and private of stroke. Novel stroke leadership organizations such
research institutions on stroke as the African Stroke Organization can fulfill this
(c) Establishing an agency to conduct epidemiological role with support from the federal, state, and private
surveillance of stroke incidence, prevalence, sectors. Other federal health-related agencies, such
mortality, DALYs, and risk factors as the Center for Disease Control, can be created or
(d) Creating incentivized pathways for privatizing expanded to assume the role of health-care promotion
aspects of stroke care services, such as monitoring and maintenance.
outcomes and supervising acute care and (iv) Providers of health care: Health-care providers are
rehabilitation centers. at the forefront of both acute and rehabilitation care.
A feedback system between the policymakers The availability of clinical guidelines will help stroke
and the payers, partners, providers, and patients care providers which create unique care pathways
should be established to promote service for their patient population that are evidence based,
optimization and quality assurance projects. leading to early and accurate diagnosis, treatment, and
(ii) Payers: Establishing a universal national insurance prognostication. The goal is to reduce mortality and
health coverage scheme may promote and attract morbidity, as well as disease prevalence. For example,
establishing minimum stroke units for acute stroke
patients has been shown to reduce complications
Policymakers
(federal & state) and mortality associated with stroke, and this setup
Epidemiological is feasible even in resource-challenged environments
surveillance, funding,
insurance, health common in many SSA countries.
policy, (v) Patients: Patient education to promote accountability
and research
for their health is key and requires collaborative efforts
from health-care partners, payers, and providers
alike. Targeted education that considers cultural and
Payers
Providers educational backgrounds, language, gender, religion,
Clinical pathways, Patients Create incentives for
education, research, Accountability providers to promote and other geopolitical factors affecting learning will be
productivity,
and stroke care efficiency, and most effective. Given the diversity within and among
units set up
efficacy SSA countries, decentralizing planning for patient and
community engagement at state and local levels will
yield the best outcome.
Partners Finally, no single nation or entity will have all the
Research, guidelines, answers or get everything right at the onset. Best practices
education,
monitoring, and from across the subcontinent and elsewhere should
certification be sought out and emulated. For example, Algeria,
Figure 3. Overarching concept of the “5 Ps” collaborative partnership to Botswana, Lesotho, Kenya, Morocco, Senegal, and South
advance stroke care in sub-Saharan Africa. Africa have increased their fiscal flexibility by adopting

Volume 3 Issue 2 (2024) 13 doi: 10.36922/an.2804