WSC 2025 | The Tanzania Stroke Project: improving acute stroke services in Tanzania

The Tanzania Stroke Project is the first national project that was launched in our region to introduce acute stroke services in the country. Now this was a multi-stakeholder involvement project which consisted of members from the Ministry of Health who endorsed the need for improving acute stroke services in the region. It was also a collaborative effort involving international stakeholders from the World Stroke Organization. But as a former scholar of the World Stroke Organization Future Stroke Leaders program, I also received a seed grant to support the implementation of the introduction of good stroke services in our region. We also had support from the hospital directors from the two of the largest referral hospitals in the country, so we had the national hospital called the Muhimbili National Hospital, which is within the hub of the city within Tanzania. We also had a second tertiary hospital within the northwestern part of Tanzania called Bugando Medical Center. The other component that made this activity possible, or the project possible, we also had a collaborative effort from local teams within the country. And so we had a national task force, a Tanzania Stroke Task Force. We worked together to introduce acute stroke services. So we had phase one of the project, which was initiated in 2023, up to 2024, where we introduced acute stroke services in the region using a three-tier implementation strategy, developing comprehensive stroke registries within the region to help us track real-time data and address the magnitude of the disease, so that we know which areas we need to improve. The second strategy was capacity building by promoting training of our stroke multidisciplinary teams. We conducted both virtual but also on-site mentorship training. We were blessed with a visit by Dr Sheila Martins, who visited us in August last year and provided extensive hands-on training to our stroke multidisciplinary teams. And the third strategy was developing acute stroke protocols and pathways, standardized and evidence-based but tailored to our local needs and realities, to have a structured continuity of care to promote acute stroke services. So within that time, we were able to launch acute stroke units within those two largest referral hospitals in the country. It was the first milestone for our country. Each center dedicated eight beds within the general medical ward. And for phase one, we were able to treat 35 patients. And then this was later scaled up to phase two of the project, which started in 2024, 2025. We had support, additional support from the World Stroke Organization and Meds Therapeutics. And we also had continuous support from the Ministry of Health and our local teams in Tanzania. So within phase two, we followed a similar approach, but this time we expanded the services, including an additional large tertiary hospital in northern Tanzania called the Kilimanjaro Christian Medical Center. So we strengthened our initial efforts. Apart from establishing a stroke unit in the new site, we also further continued with capacity building, but also strengthened surveillance of the existing registries. And one important component was community advocacy. We were able to implement community advocacy and healthcare worker sensitization. And how we did this, we translated the FAST acronym for community advocacy events to promote early recognition of stroke symptoms and signs. We were able to translate this to a Swahili acronym called UPESI for Swahili-speaking countries such as ours. And we used the UPESI acronym to widely spread it, disseminate it to our community members through media engagements, but also we did screening events last year. It was very impactful, and we believe that these changes or efforts that we’re doing will later on translate to better patient care. Now, based on the phase two project, we see that there was a significant improvement in the process indicators in terms of the number of swallow screens that were performed in phase one compared to phase two. We went from zero to 100% and it remained stable. We improved in terms of providing early physiotherapy, secondary prevention medications that were given. Everything scaled up and we saw significant improvement. But there are still gaps that need to be addressed. There are few speech and language therapies available in the country. So we still need to address that by training nurses to continue with the swallow screen. But even post-swallow screen assessment, we see that there’s a high proportion of patients who come in with aspiration pneumonia. So this means that we still need to continue to have continuous trainings to our teams, but also scale up the trainings to lower healthcare facilities, because that seems like it’s the point of contact for most patients who are arriving with a stroke, to empower them to be able to deliver structured care and standardized care that will help improve outcomes in our country.

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