HEADS UP 2024: Policy Efforts to Improve Equitable Access to Acute Stroke Care Globally.

Stroke is a leading cause of death and disability worldwide, particularly affecting low- and middle-income countries. Despite the benefit of stroke units and advancements in treatments such as intravenous thrombolysis and mechanical thrombectomy, achieving equitable access to these interventions remains challenging because of disparities in resources, infrastructure, and trained personnel. Additionally, the lack of awareness about stroke symptoms and the absence of organized pre-hospital care leads to delayed arrivals at hospitals equipped for treatment and postponed transfers to specialized centers. Moreover, insufficient secondary prevention strategies and rehabilitation services increase the chances of recurrent strokes and long-term disability. Despite the proven cost-effectiveness of treatment, the associated costs pose a substantial barrier to accessing timely care in low-resource countries. To reduce disparities and enhance global stroke care, confronting these challenges requires comprehensive strategies, including government policies, strong political commitment, and improved health care infrastructure using innovative financing. To address these issues, various initiatives aim to enhance accessibility to stroke care, including the World Stroke Organization Implementation Task Force, which includes support for implementing services, training programs for health care professionals, and telemedicine to extend stroke expertise to underserved areas. At the same time, the Certification of Stroke Centers Program promotes quality in care delivery, and the Global Stroke Alliance promotes international collaboration, joining stroke specialists and government representatives to establish national plans for stroke. This paper examines disparities and barriers to access, outlines current efforts to implement public policies in low- and middle-income countries, and proposes a step-by-step approach with concrete implementation strategies.