UK Stroke Forum 2025 | Core principles required to be a leader in stroke care in low- and middle-income countries

Now, just from my journey, how I can summarize it is that being a leader in low- and middle-income countries requires a set of skills or core principles. And I can summarize them into six components. One, it’s all about being adaptive and flexible because your resource constraint so you need to work with what you have at your disposal you don’t have the leverage of preferring something preferences and all that so you need to work with what you have. Secondly it’s more about creating relationships and trust so leading with influence rather than using titles positions or hierarchy. I didn’t have positions. I still don’t have any positions at the moment, but it’s just building trust and motivating your team. Thirdly, it’s about being multidimensional. It will require you to become a clinician with good knowledge. At the same time, you need to be a researcher. You need to be an advocate and implementer as well. Fourthly, it will require you to be cross-cutting you need to be able to navigate systems. From my experience working with implementation studies it required me to navigate working with hospital directors management level also lobbying with policy makers at the level of the ministry of health coordinating local teams but above all balancing this while working with international partners because they also have their goals expectations and timelines. So you need to be able to accommodate all of that in a sync and balance in a way that doesn’t compromise any of the two areas. The other thing is progress or success is very incremental. It takes time. So sometimes you can be disappointed on the way, but it’s a cumulative effect, and you should look at the vision. You should have a purpose and try to celebrate every tiny victory. And then lastly is building resilience, because in resource-limited settings, the major things that we see are barriers and challenges. So you need to find loopholes within the challenges and the barriers to be able to find opportunities to improve care. I didn’t have any titles, I still don’t, but I believe that I’ve been able to contribute something to my community. So these are some of the things that I would recommend in anybody who’s trying to build a leadership journey in low-middle income settings. And the last thing which I thank people around me is I’ve been able to partner with so many institutions. At the moment, I am currently partnering with the University of Leicester, where I’m doing my PhD program, which is supported by the UK government through the BRC NIHR scheme. I’m doing a PhD focusing on stroke medicine, particularly looking at intracerebral hemorrhage and ischemic lesions in this population. But one of the chapters also looks at intracerebral hemorrhage in the Tanzanian cohort. So you can see that it’s an opportunity for me to further strengthen my stroke foundation, but also a deeper understanding of the mechanisms of stroke at a deeper level. But it’s also given me an opportunity to strengthen my scientific skills together with my leadership skills, which are very pertinent in improving systems, particularly in our country. And these priorities align clearly with the national priorities in our country. So it basically promotes bi-directional learning. So what I can say for international partners who are trying to link with low- and middle-income colleagues is to ensure that partnerships invest in people, because at the end of the day, it’s more rewarding in that way. So in summary, my journey shows how powerful data evidence is by working with international partners, but also committed teams, which can really transform stroke care even in low-resource settings.

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