Stroke patient care and challenges

By Dr Sudarsan Mandal

India has made great strides in the medical field, and our advanced healthcare and highly trained doctors are on par with the best in the world. India is one of the most popular medical tourist destinations in the world. Foreign Tourist Arrivals (FTA) to India on medical visa in 2016 and 2017 were estimated at 4.27 lakh and 4.95 lakh respectively, representing a growth of 15.9%. AIIMS New Delhi, the peak institute for advanced medical studies and healthcare facilities, was established in 1956. Since then, 24 more such institutes have been added. As of June 2022, 19 institutes were operating with another 5 expected to be operating by 2025. However, we are a country of 1.38 billion people and challenges exist in last mile delivery.

According to 2019 World Health Organization (WHO) records, there is one doctor for every 10,189 people in the world [PA1] while the ratio recommended by the WHO is 1:1000. Additionally, we face the challenge of “double burden of disease”, or the prevalence of communicable diseases and a surge in non-communicable diseases (NCDs), or “lifestyle” diseases such as diabetes, stroke brain, hypertension, kidney, liver and heart disease. . Nearly 50% of spending on inpatient beds is spent on lifestyle-related diseases, as highlighted in a report by the India Brand Equity Foundation (IBEF), that this has increased the demand for specialist care.

NCDs have an impact on health, labor productivity and economic growth. Given the propensity of COVID-19 to overrun NCD patients with low immunity, improved outcomes are imperative. Additionally, the United Nations 2030 Agenda for Sustainable Development also recognizes the threat of NCDs to sustainable development and proposes to reduce premature mortality from NCDs by one-third by 2030.

According to the WHO – NCD India – 2018 profile, NCDs are estimated to account for 63% of all deaths in the country. India recorded 6.9 lakh deaths with 11.7 lakh cases of stroke according to “The Global Burden of Disease Study 1990-2019”. According to India Health of Nation’s Report-2017, stroke, a major NCD, is responsible for 3.5% of Disability Adjusted Life Year (DALY). It is the fifth leading cause of disease burden in India, according to ICMR’s India Health of the Nations States Report, 2017. One in six people are at risk of having a stroke. According to a Lancet study “Coping with the Global Burden of Stroke, 2021”, 70% of strokes and 87% of stroke-related deaths and DALYs occur in low- and middle-income countries ( PRFI).

The most common type of stroke is ischemic stroke, which accounts for almost 87% of all strokes in India and is caused by a clot or other blockage in an artery in the brain. The other 13% of strokes are hemorrhagic strokes caused by bleeding from an aneurysm in the cerebral artery. The incidence of strokes can create lifelong disability for the patient, weaken resources and societies, dissipate potential and increase the burden on caregivers. However, it is crucial to note that in some cases, stroke can be effectively treated with intravenous thrombolysis and mechanical thrombectomy (MT) with a good chance of recovery. Prompt treatment is crucial in strokes, as it kills around 2 million brain cells in less than a minute. Complications can vary depending on the type of stroke and whether you are able to successfully receive treatment. Even a blockage in a small blood vessel can lead to paralysis, speech problems, visual impairment, loss of bladder and bowel control, coma, or death. Until recently, all treatments were performed by open surgery. But currently, mechanical thrombectomy (MT), performed under the guidance of cath labs (catheter labs), within 4.5 hours of stroke incidence, yields favorable clinical outcomes (Tawir & Muir, 2017 ).

The increase in stroke cases and the recent pandemic upheaval have demonstrated the need for improved healthcare delivery. Meeting the challenge involves both raising awareness to prevent such incidents and improving infrastructure. The government is raising awareness for healthy living with various programs like Fit India, Yoga Day Celebrations, No Tobacco Day, etc. Maintaining a healthy lifestyle, avoiding smoking and alcohol, monitoring blood pressure and diabetes, including physical activities in daily routines, and reducing sodium in the diet are important to minimize risk factors.

Infrastructure also needs to be improved. With only 2,300 neurologists and 1,800 neurosurgeons, and only 1,400 cath labs, many patients struggle to access proper healthcare in time. Resources should be allocated for primary prevention, rehabilitation centers, speech therapy centers, family support for the management of sick patients, increased catheterization laboratories and diagnostic centers, and surveillance increased disease. Silos need to be broken down in health care so that physicians from diverse streams can share a patient’s story. The National Digital Health Mission launched in 2020 will integrate healthcare and digitally connect practitioners to patients by giving them access to real-time health records.

Indians were the sixth highest private spenders on health among low- and middle-income countries (Castor and Mohanty, 2018). Nearly 70% of health care is managed by the private sector, leaving only 30% managed by the public sector. Public-private partnerships can increase the density of care, contribute to the creation of more catheterization laboratories and also reduce costs for patients in the long term. A Hub and Spoke model works very well in better ecosystem creation.

Prime Minister Ayushman Bharat Jan Arogya Yojana (PM-JAY) aims to provide access to free and affordable health services to vulnerable populations. In the revised Health Benefit Package (HBP 2.2), TM was included for stroke patients and approximately 400 intervention rates were revised.

Health care was highlighted as a priority area in the 2022 budget. A 137% increase in health spending was announced in the 2021 budget. Budgeted central and state government spending on the health sector reached 2.1% of GDP in 2021-22, up from 1.3% in the previous fiscal year, according to the Economic Survey 2021-22. A new program, Pradhan Mantri Atmanirbhar Swasth Bharat Yojana was announced in March 2021, to spend Rs 64,180 crore over the next 6 years focusing on three areas, namely, preventive, curative and wellness care. be. Since 2017, NITI Aayog has been committed to establishing the Health Index as an annual systematic tool to improve outcomes in states and UTs. This will provide a comparative analysis of regional health outcomes, so that timely measures to strengthen infrastructure can be taken.
Greater penetration of cath labs and training of nurses in remote areas will improve last-mile delivery.

Stroke victims often suffer from a disability and therefore face mental health problems. Increased awareness of healthy living, access to timely and affordable health care and rehabilitation facilities will go a long way in relieving some of the pain of stroke patients. Hopefully the decision to increase the number of colleges and the increase in healthcare spending will contribute to better outcomes.

(The author is Deputy Managing Director of Dte. GHS, Department of Health and Family Welfare. The views expressed are personal and do not reflect the position or official policy of

About Antoine L. Cassell

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