Improving stroke care in Ghana: a roundtable discussion with communities, healthcare providers, policymakers and civil society organisations

Abstract

Even though there have been advances in medical research and technology for acute stroke care treatment and management globally, stroke mortality has remained high, with a higher burden in low- and middle-income countries (LMICs) such as Ghana. In Ghana, stroke mortality and disability rates are high, and research on post-stroke survival care is scarce. The available evidence suggests that Ghanaian stroke survivors and their caregivers seek treatment from pluralistic health care providers. However, no previous attempt has been made to bring them together to discuss issues around stroke care and rehabilitation. To address this challenge, researchers from the Institute of Advanced Studies, University College London, in collaboration with researchers from the African Centre of Excellence for Non-communicable diseases (ACE-NCDs), University of Ghana, organised a one-day roundtable to discuss issues around stroke care. The purpose of the roundtable was fourfold. First, to initiate discussion/collaborations among biomedical, ethnomedical and faith-based healthcare providers and stroke patients and their caregivers around stroke care. Second, to facilitate discussion on experiences with stroke care. Third, to understand the healthcare providers’, health systems’, and stroke survivors’ needs to enhance stroke care in Ghana. Finally, to define practical ways to improve stroke care in Ghana.

Perceptions of health professionals on structure and process of stroke rehabilitation in Ghana

“…Community-based rehabilitation includes the social and family support in rehabilitation, which in turn, provides the necessary physical, emotional and spiritual support needed by the patient (Wasti et al 2021). This study as well as that of Sanuade et al (2021) recommend the introduction of home and community-based stroke rehabilitation in Ghana to help minimise the complications of stroke as well as to reintegrate patients back into their previous life.…”

“…Therefore, stroke patients in these facilities did not have access to the services of these HCPs showing a limitation in their rehabilitation, which could affect their outcome as also reported by Ameh et al (2017). Similar studies conducted in Ghana revealed the unavailability of some HCPs for stroke rehabilitation especially the allied health professionals, which included occupational therapists, speech therapists and clinical psychologists (Baatiema et al 2017b;Sanuade et al 2021; names deleted to maintain the integrity of the review process).…”

“…The stroke unit system of rehabilitation has been adopted internationally, especially by HICs with good success rates (Christian et al 2016;Gould et al 2011;Ras 2009). However, LMICs such as Ghana are yet to adopt this stroke unit system of rehabilitation as there is only one stroke unit in Ghana as recorded in this study and previous studies (Baatiema et al 2017a;Sanuade et al 2021). The first and only stroke unit in Ghana was established in January 2014 in collaboration with a health team from Wessex in the United Kingdom (UK).…”

“…As stated by some of the TH participants, limited bed capacity was one of the reasons why some stroke patients were also rehabilitated in the general medical wards, indicating that only a small percentage of Ghanaian stroke patients were able to access the stroke unit. Sanuade et al ( 2021 ) reported that the limitation in bed capacity for stroke rehabilitation in Ghana sometimes delayed the start of the rehabilitation and this tend to affect the outcome of rehabilitation negatively.…”

The structure, processes, and outcomes of stroke rehabilitation in Ghana: A study protocol

“…Ghana has a vibrant pluralistic healthcare system made up of both mainstream biomedical (conventional) and complementary (herbal) health systems, which are all involved in stroke care and rehabilitation ( 59 ). In many rural and semi-urban areas in Ghana, most patients with stroke tend to use complementary medicine treatment either exclusively or in parallel with conventional medicine ( 40 , 60 ) for varied reasons ranging from faith and cultural congruence to accessibility, cost, and belief that these approaches are safe ( 40 , 61 , 62 ).…”