Collantes Me V, Zuñiga Y H, Granada C N, Uezono D R, De Castillo L C, Enriquez C G, Ignacio K D, Ignacio S D, Jamora R D
Department of Neurosciences, College of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.
University of the Philippines, Manila, Philippines.
Front Neurol. 2021 Aug 17;12:665086. doi: 10.3389/fneur.2021.665086. eCollection 2021.
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.
中风仍然是菲律宾致残和致死的主要原因。评估中风护理的现状、所需资源以及卫生政策和项目中的差距，对于有效降低与中风相关的死亡率和发病率至关重要。本文旨在利用世界卫生组织卫生系统构建模块框架，描述菲律宾的中风护理系统和网络。为整合现有的分散在许多一般政策中的关于中风及其危险因素的国家法律和政策，菲律宾卫生部将预防和管理中风的国家政策框架制度化。尽管进行了政策改革，但政府融资覆盖范围仍然有限。在药品获取方面，政府于2016年启动了中风药品获取计划（MAP），向全国选定的政府医院提供了1000多瓶重组组织型纤溶酶原激活剂（rTPA）或阿替普酶补贴。然而，由于缺乏神经成像设备和支持提供上述药物的有组织护理系统，卫生部停止了该计划。尽管资源有限，但中风诊断和治疗设施更多集中在城市地区，主要是在私立医院，那里自费支出普遍存在。这些获取障碍也反映了当前中风人力资源的现状，即医学专家（如神经科医生）在位于城市地区的少数三级和培训医院工作。与此同时，没有建立统一的国家中风登记处，因此，确定当地中风负担仍然是一项挑战。中风病例报告系统缺乏集中化和碎片化，导致依赖医院记录或基于社区的中风调查数据，这可能无法准确描述该国的实际中风发病率和患病率。基于这些差距，确定了针对系统方法——治理、融资、信息系统、卫生人力资源和药品的具体建议。
