THE Ministry of Health is contemplating adding thrombolytic therapy treatment to the list of medical subsidies provided by the National Health Fund (NHF) in response to the prevalence of strokes (cerebrovascular disease) among the population and increasingly in younger people.
Health Minister Dr Christopher Tufton says stroke is now the leading cause of death in Jamaica, resulting in 82 deaths per 100,000 population in 2019 and amounting in more deaths, from January 2020 to December 2021, than COVID-19. Last year 2,400 out of 7,300 stroke patients died from the disease.
Dr Tufton says part of the assessment of increasing targeted stroke health care and treatment would have to include discussions with the NHF. Currently the cost of thrombolytic treatment for stroke patients is prohibitive and is only offered limitedly by the University Hospital of the West Indies (UHWI). Thrombolytic therapy is a treatment which breaks up the clot in the blood vessel which causes a stroke.
"There would be a cost analysis done to determine what it would cost in a given year. It's an expensive set of drugs. There is an alternative, but still expensive, so we're going to be looking at that and having a conversation around that, so that [NHF subsidy] is very possible as part of the overall response to helping to control and to restore stroke victims to normal activity. We will look at it, but it has to be done in the initial stages, with some sort of cost assessment," the minister told the Jamaica Observer on Thursday from Sao Paolo, Brazil, where he is attending the World Health Organization 2022 Global Stroke Alliance meeting, along with eight other ministers of health from 25 countries attending the forum.
Describing the situation as a "growing avalanche of acute stroke in Jamaica", Dr Tufton advised the meeting that in 2018 stroke deaths in Jamaica reached 13.62 per cent of total deaths in the country."This age adjusted death rate is 65.41 per 100,000 of population and ranks Jamaica 100th in the world," he said.
The health minister pointed out that with 20 strokes occurring daily, one-third of which are fatal and most survivors left with disability, loss of income, and financial burden to families — an estimated two per cent of the country's gross domestic product — there remains significant unmet needs for stroke care and treatment in Jamaica."Given the lack of acute stroke care facilities, the health-care system provides little current ability to modify outcomes when a stroke occurs," he said.Dr Tufton pointed out that deaths from the disease exceed deaths from violence and traffic accidents combined.
He noted that, although the majority of strokes occur beyond age 50, between 10 and 15 per cent of cases present in patients 18 to 50 years old, and onset tends to be among younger people in low- and middle-income countries, accounting for 19 to 30 per cent of strokes.Compounding Jamaica's problem is limited access to hospital rehabilitation. Only one private institution offers inpatient rehabilitation, and none of the island's hospitals currently have a speech or occupational therapist, which means patients are forced to seek those services privately at high costs.Jamaica's delegation in its presentation to the meeting reported that only the University Hospital of the West Indies has a neuro trained physical therapist, and is currently recruiting speech and occupational therapist. It was noted that there are only four specialist outpatient centres specifically geared at stroke rehabilitation, only one of which is in a public facility. Furthermore, the majority of stroke care is done by non-specialists or general internists, with the Kingston Public Hospital and UHWI having two on-staff neurologists each. Dr Tufton said the plan is to have three dedicated stroke-care units established at three major hospitals – the UHWI, Kingston Public Hospital, and Cornwall Regional Hospital in St. James, in another year, working with the Jamaica Stroke Alliance, as a matter of urgency.
"Our commitment, given the nature of the impact, personal impact, health impact, economic impact on the population, is to invest at the prevention level in terms of managing the risk through information and education, through some of the things that we are already doing." Among those he pointed to were legislative measures taken to control the use of tobacco, policy to eliminate transfat consumption, and a sodium baseline study."All of these are linked directly to increasing cases of hypertension and diabetes, which are the large risk factors for strokes. We also have to deal with the curative and treatment and rehabilitation," he said.Dr Tufton added that the dedicated stroke centres will, therefore, focus on the gamut of prevention and treatment measures. He said the checklist for the centres includes now hard-to-access CT scanning."We already have met up to 60 per cent of the requirements to establish and be certified as a dedicated stroke centre. There are some training that is required, dedicated nurses who can be retrained…what we are going to be doing is working on the other 40 per cent," he explained. Costing for the setting up and outfitting of the centres has not yet been finalised.