Improving hypertension control and stroke care in Madagascar by strengthening the health system along the care cascade
Situation:
Madagascar has a population of 31 million inhabitants with a life expectancy at birth of 65 years. Stroke is the leading cause of hospital mortality and disability, with an estimated prevalence of hypertension at 36% as the most important risk factor. With only 20 neurologists and 5 neurosurgeons in the country, the high burden of stroke is alarming.
Objectives:
Reduce the burden of stroke in Southern Madagascar (Anosy, Atsimo-Andrefana) through prevention, treatment and rehabilitation
- Sub-Goal 1: Improving community-based stroke care.
Indicator 1: Increase knowledge of stroke signs and symptoms as well the practice of community-based stroke rehabilitation.
- Sub-Goal 2: Improving referral systems for patients suffering from hypertension and stroke.
Indicator 2: Number of successfully referred stroke patients to hospitals.
- Sub-Goal 3: Strengthening hypertension and stroke care across the care cascade.
Indicator 3: Number of successfully implemented stroke units and number of trained health workers and community health workers in the project area.
- Training and equipping community health workers (CHWs) for community-based stroke care, including regular blood pressure monitoring, awareness campaigns on stroke signs and risk factors, and basic stroke rehabilitation.
- Establishment of a robust CHW-led referral system connecting communities, health centers, and hospitals, including the provision of ambulance services for medical emergencies related to hypertension and stroke.
- Comprehensive quality improvement along the care cascade, based on the guidelines of the World Stroke Organization, including equipment provision and continuous training for medical personnel.
- Piloting and evaluation of a community-based savings groups to sustainably ensure affordability and availability of antihypertensive medications, thereby significantly reducing financial barriers for patients.
- Conducting targeted research and evaluation measures, systematically capturing knowledge, attitudes, and practices regarding hypertension and stroke in rural Madagascar to ensure the long-term effectiveness of interventions.
The project will strengthen the local and national health system in terms of improving prevention, treatment and rehabilitation of stroke by establishing stroke-ready centres for acute treatment and rehabilitation, raising community awareness and risk factor screening. Additionally, community purchasing groups will be piloted and evaluated with the goal, to create sustainable self-sufficient reduction of hypertension as a risk factor. Furthermore, the education of medical personnel will benefit the health care system long term, while the accompanying research findings can be used to guide further projects.
The project is innovative as it establishes for the first time in the region an integrated, community-based care cascade for hypertension and stroke patients. Notably, CHWs play a pivotal role not only in prevention and acute care but also in basic stroke rehabilitation—a unique approach in Madagascar. Another significant innovation is the introduction of community-based savings groups for the sustainable financing of medication, which previously did not exist in this form. The close integration of research, practice, and local policy ensures sustainable knowledge transfer and structural improvements in the healthcare system over the long term.
