Notice how appallingly bad this is; measuring 'care' NOT RESULTS. Totally useless.
Business 101: If you don't measure it it is not important, so obviously stroke results are not important.
“What's measured, improves.” So said management legend and author Peter F. Drucker
The latest here:
Current State of Stroke Care in the Philippines
ME. V. Collantes1*, 
Y. H. Zuñiga2, C. N. Granada3, D. R. Uezono4, L. C. De Castillo1, C. G. Enriquez1, K. D. Ignacio1, S. D. Ignacio5 and R. D. Jamora1- 1Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
- 2University of the Philippines, Manila, Philippines
- 3Department of Health, Manila, Philippines
- 4College of Public Health, University of the Philippines, Manila, Philippines
- 5Department of Rehabilitation Medicine, College of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines
Stroke remains the leading cause of disability and death in the Philippines. Evaluating the current state of stroke care, the needed resources, and the gaps in health policies and programs is crucial to decrease stroke-related mortality and morbidity effectively. This paper aims to characterize the Philippines' stroke system of care and network using the World Health Organization health system building blocks framework. To integrate existing national laws and policies governing stroke and its risk factors dispersed across many general policies, the Philippine Department of Health (DOH) institutionalized a national policy framework for preventing and managing stroke. Despite policy reforms, government financing coverage remains limited. In terms of access to medicines, the government launched its stroke medicine access program (MAP) in 2016, providing more than 1,000 vials of recombinant tissue plasminogen activator (rTPA) or alteplase subsidized to selected government hospitals across the country. However, DOH discontinued the program due to the lack of neuroimaging machines and organized system of care to support the provision of the said medicine. Despite limited resources, stroke diagnostics and treatment facilities are more concentrated in urban settings, mostly in private hospitals, where out-of-pocket expenditures prevail. These barriers to access are also reflective of the current state of human resource on stroke where medical specialists (e.g., neurologists) serve in the few tertiary and training hospitals situated in urban settings. Meanwhile, there is no established unified national stroke registry thus, determining the local burden of stroke remains a challenge. The lack of centralization and fragmentation of the stroke cases reporting system leads to reliance on data from hospital records or community-based stroke surveys, which may inaccurately depict the country's actual stroke incidence and prevalence. Based on these gaps, specific recommendations geared toward systems approach - governance, financing, information system, human resources for health, and medicines were identified.
Introduction
The Philippines is an archipelagic nation with over 7,100 islands divided into three major island groups - Luzon, Visayas, and Mindanao, with its capital Manila located on the largest island Luzon (1). With over 109 million Filipinos living in the country, its population is generally young, with almost 40% belonging to the age group below 19 years old and only 5% are aged 65 and above (2).
From 2009 to 2019, stroke remains the second leading cause of death and one of the top five leading causes of disability in the Philippines (3). The true stroke prevalence is uncertain, but reported estimates vary between 0.9% (2005) (4) to 2.6% (2017) of the population (5). Based on types of stroke, seven out of 10 cases are diagnosed as ischaemic while the other three are considered hemorrhagic (4). Thirty six percent (36%) of the total stroke deaths are not attended by any medical personnel (6).
The Philippines' Local Government Code of 1991 has resulted in the devolution of different health services in the country, transferring the management of health systems from the national level to the provincial, city, and municipal level or the local government units (LGUs) (7). Thus, health outcomes varied from one LGU to another. Coping to the new responsibilities that came with devolution posed a challenge to some LGUs, leaving some health facilities poorly equipped and staffed, thereby affecting the quality of health services.
Contributing further to this challenge is the country's archipelagic nature, making health services delivery even more difficult. Geographically isolated and disadvantaged areas have limited access to health facilities. Added to this burden is the migration of health professionals to other countries searching for better wages, compromising the health care delivery (8). These health system challenges can compromise stroke care of the country, negatively affecting the outcomes of the patients and are reflected in the national data.
In resource-limited settings like the Philippines, reporting comprehensive documentation of the current state of stroke care and identifying existing gaps and challenges can support the prioritization of measures to reduce the country's stroke-related mortality and morbidity. This paper aims to characterize the stroke care system in the Philippines using the World Health Organization (WHO) building blocks of the health system framework (9).
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