Stroke remains among leading causes of death in Philippines
MANILA, Philippines – Stroke is a medical emergency that occurs when blood flow to a part of the brain becomes blocked or a blood vessel in the brain bursts and causes brain cells to die from lack of oxygen. It puts one who suddenly suffers a stroke in a serious condition that requires fast action and medical intervention.
Fortunately, stroke is preventable and treatable if you catch it early and the patient gets attended to by a competent medical professional and has access to necessary treatment facilities and medicines.
The situation is not always ideal. The necessary medical intervention has to be done within a 4.5-hour timeframe or any life-saving effort might be a lost cause. It is always a race to reverse the medical condition — or even just to stop the stroke from progressing and eventually save a life that hangs in the balance. But the painful truth is that there are many factors that cause delays in the delivery of necessary medical intervention, especially in the provinces.
In the Philippines, stroke remains as one of the leading causes of death, particularly in the Ilocos Region. To address this problem, government leaders, healthcare institutions, and stroke experts from across Region 1 recently convened to explore ways to strengthen stroke care pathways and improve patient outcomes in the Ilocos Region.
There is an urgent need for continued action by government, healthcare institutions, and communities to strengthen prevention, treatment, referral, and rehabilitation services to help patients be able to access timely and appropriate care.
While advances in stroke treatment have improved outcomes for many patients, there still remains many challenges related to timely and equitable access to stroke-ready facilities, public awareness, availability of specialists to handle stroke cases as they come, travel times from remote communities, and fragmented referral systems.
According to regional health data, stroke has consistently ranked among the leading causes of mortality in Region 1 in recent years. In La Union alone, stroke has been identified as a major cause of death over the past three years, highlighting the significant burden of stroke on patients, families, communities, and the healthcare system.
"Stroke is not only a major health problem. It also places a significant financial burden on patients, families, and communities," said Dr. Ivy Ico of the Provincial Department of Health Office – La Union.
She added: “While progress has been made in strengthening healthcare delivery, opportunities remain to further enhance referral pathways, specialist availability, public awareness, and integrated stroke management."
Coordinated fight
These challenges and opportunities were the focus of a recent multi-stakeholder roundtable discussion organized by UHC Watch and supported by Boehringer Ingelheim. The event brought together representatives from regional and local government health agencies, healthcare institutions, professional societies such as the Stroke Society of the Philippines, local government units, and other stakeholders to explore practical approaches to strengthening stroke care across the region.
Participants emphasized the importance of translating Department of Health (DOH)’s National Policy Framework on the Prevention, Control and Management of Acute Stroke into coordinated local action through stronger collaboration and partnerships and more integrated systems of care.
“Reducing the burden of stroke requires addressing the entire continuum of care, beginning with prevention and community recognition of stroke symptoms, followed by organized emergency medical services, pre-hospital transport, timely acute hospital treatment, rehabilitation, and long-term support and secondary prevention,” said Dr. Cristina Macrohon-Valdez, immediate past president of the Stroke Society of the Philippines.
Time is of the essence
For many stroke patients in Region 1, access to timely treatment remains a challenge,
As patients from remote municipalities spend two to four hours of travel time to get to the nearest facilities capable of providing specialized stroke care. Thus, they often miss the critical treatment window of 4.5 hours, during which life-saving interventions can be successfully administered.
At this time, only a limited number of Acute Stroke-Ready Hospitals are available to serve patients in La Union, many of whom are referred from smaller healthcare facilities that do not have specialized stroke services.
"Many patients arrive beyond the critical treatment window because of delayed recognition of symptoms, long travel times, and challenges in referral pathways and coordination," said Dr. Mary Grace Fabia-Mistica, MD, FPNA, Stroke Program Head of the Ilocos Training and Regional Medical Center (ITRMC) Brain and Spine Center and the La Union Medical Center (LUMC).
She added: "Some families still mistake stroke symptoms as a temporary episode of high blood pressure or initially seek treatment at home. Every delay can affect a patient's chances of survival and recovery."
As the healthcare professionals during the recent roundtable discussion pointed out, however, after the necessary emergency treatment shall have been done, stroke patients still have to face a number of challenges. These include access to neurologists, rehabilitation providers, and long-term follow-up services, which are not readily available in certain regions and provinces, particularly in geographically isolated communities. This reinforces the importance of coming up with a more coordinated approach to stroke care.
Stroke care more accessible
To help address these challenges, stakeholders are advancing the development of StrokeLiNCS LU (Stroke Linking Institutions for Network Care toward a Stronger La Union), an initiative that seeks to strengthen coordination among healthcare facilities and support a more integrated stroke care pathway through a Hub-and-Spoke model.
The model aims to establish clearer referral pathways among healthcare facilities, improve coordination between hospitals, and facilitate the timely transfer of stroke patients to facilities equipped to provide specialized care for patients with this medical condition.
Under the system, designated hub hospitals such as the ITRMC, which is a major government tertiary hospital located in San Fernando, La Union, and the LUMC, which is a Level 2 tertiary provincial hospital located in Agoo, La Union, would provide advanced stroke services, while spoke facilities would focus on early stroke recognition, initial stabilization, and rapid referral.
Through standardized protocols, pre-notification systems, workforce development, telemedicine support, and a shared stroke registry, stakeholders hope to reduce treatment delays and improve continuity of care from emergency response through rehabilitation. They hope to ultimately improve outcomes for stroke patients throughout the province.
"The model does more than move patients," Dr. Mistica said. "It helps to bring expertise closer to where patients are. By reducing delays and creating faster, more coordinated referrals, we can improve outcomes and help save more brain function when every minute counts."
Government response
The initiative aligns with DOH’s National Policy Framework on Acute Stroke, which seeks to establish integrated stroke systems of care under the Universal Health Care Act.
According to Dr. Ico, the framework envisions a continuum of care spanning prevention, acute treatment, rehabilitation, and long-term recovery, supported by stronger healthcare provider networks, data systems, training programs, and financing mechanisms.
Recognizing stroke as a major health concern in the province, the Provincial Government of La Union and local stakeholders are now working to strengthen referral systems and integrate dedicated stroke pathways into the upcoming version of the LU-Health Care Provider Network Referral Manual.
The province has also incorporated plans for a Level II General Hospital and a Neurological Rehabilitation Center within the proposed La Union Medical Hub, which is expected to complement existing stroke services and expand rehabilitation capacity in the province.
RELATED: BEFAST: How to recognize stroke
