Christian Medical College, Ludhiana

North India’s first rural Centre-of-Excellence for Stroke and Neurological diseases

Health care access

Establishing a high-quality, affordable, treatment, public health research, teaching, and training facility, specializing in Stroke care, and allied neurological disorders for rural and underserved communities

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Lead Organization

Christian Medical College, Ludhiana

Ludhiana, State of Punjab, India

http://www.cmcludhiana.in

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Rising stroke incidence in India, disproportionately affects rural inhabitants and is the leading cause of both death and disability. The burden of disease far outstrips the availability of medical infrastructure, and skilled human resource to provide timely and efficient, acute, rehabilitative and preventative services. We propose to establish a state of the art, Centre of care, learning, and health research for stroke and allied neurological diseases in a population-dense region of rural Punjab. This "hub" of Neuroscience excellence will provide specialist consultations to "spokes" of affiliated mission hospitals, and government-primary (PHC), and community health centres (CHCs), in remote locations, via teleneurology. It will undertake capacity building through training programs for emergency physicians, specialists, non-specialist medical doctors, nurses, and physiotherapists, in low resource setting, and utilize task shifting to non-physician health-workers to educate the public, evaluate at-risk subjects, recognize warning signs, and decide on appropriate course of action for optimum outcomes.

Problem Statement

Rural India is besieged by an epidemic of neurological disorders like stroke, epilepsy, dementia, and traumatic brain injuries (TBI). In this disease cluster, stroke is the leading cause of death in rural Indians, with a case fatality rate of 27-42%, and a contributor to severe disability. Only 20% of patients suffering from stroke will ever go back to work. With 70% of the country’s population residing in rural areas, the struggle to achieve health equity, is impeded by :a) Insufficient numbers of qualified and specialized health workers in remote and rural areas-India has the lowest number of physicians per 10,000 population among BRIC countries, and b) Large imbalances in practitioner and medical infrastructure density. Nearly 60% of hospitals, and 80% of doctors are in urban areas, serving only 28% of the population. Individuals residing in rural communities have a higher incidence of stroke due to a lack of awareness of contributing factors, inability to afford secondary prevention drugs, lack of access to routine stroke treatments, and greater post-stroke disability due to limited rehabilitation workforce and resources. Use of teleneurology to ensure access to consultation and care in rural areas has emerged as an effective Stroke System of Care. India takes the top spot amongst 148 countries in terms of affordability of Information and Connectivity Technology (ICT). The implementation of a specialized-treatment Hub in rural Punjab connected to hospitals/clinic-Spokes across India, when paired with ICT presents an effective model well networked for expanding comprehensive stroke care optimising use of technology.

Solution Overview

Our solution will broadly impact a large population by improving a) Rural healthcare infrastructure and b) Undertaking capacity-building through training, recruitment, and retention of health workers in these areas. 2) Mid-level health workers with an enhanced scope of practice can provide vital health-service delivery particularly in areas with a shortage of doctors, while efforts are made towards scaling-up the production of physicians, and nurses. CMC-L trained ASHA workers, enabled with telemedicine to keep in touch with physicians at the HUBS, will visit villages across Punjab, and ensure cost-effective, quality healthcare access. 3) Using Tele-stroke units, we can provide round the clock to access to neurological experts for brain imaging evaluations, and patient consultations at various tertiary care centres.4) Stroke-surveillance, interventional, and outcomes research in rural populations, is sorely needed to inform effective national policy on stroke care. Studying the health and health-seeking behavioral patterns of villagers visiting the proposed facility, will aid in the design of effective care methods.The proposed facility will serve the states of Punjab, Haryana, Himachal Pradesh, Rajasthan, and Jammu & Kashmir, where an estimated 16 million people with neurological disorders do not have access to quality care. Stroke services will also be accessible to Ludhiana district-population-3.5million. Our program will particularly target tribal populations in Jharkhand, Rajasthan, and Jammu & Kashmir where primary care centre shortfalls are the highest in the nation. Patient-oriented benefits will include reduction in catastrophic health expenditures, stroke-related deaths, greater functional improvements in stroke survivors, and greater disease awareness.

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