'Wala kaming alam sa stroke care' (we don't know anything about stroke care): experiences of care providers delivering stroke rehabilitation care in the Philippines.
Leggat F, Buckingham S, et al. • Global health action • 2026
National, community, and individual level barriers including geography, finance, resources, politics and knowledge continue to foster stroke rehabilitation inequities across the Philippines, while community-based rehabilitation offers a practical bottom-up solution to improving the knowledge and wellbeing of stroke survivors in the interim.
Key Findings
Results
Care providers across multiple Philippine regions reported profound lack of knowledge about stroke rehabilitation, encapsulated by the statement 'wala kaming alam sa stroke care' (we don't know anything about stroke care).
17 participants across five regions were interviewed between June and September 2024
Participants included care providers with professional or voluntary community healthcare service delivery roles
The devolved and fragmented healthcare system was identified as a key challenge to upskilling and education of those delivering stroke services
Limited knowledge of stroke rehabilitation was linked to reduced quality and delivery of care in local communities
Results
Three high-level themes were constructed from the qualitative data: inequitable stroke care and rehabilitation services, barriers to the provision and access of stroke services, and desires, needs and opportunities for improvement.
Study used a qualitative descriptive design involving semi-structured interviews
Data were analysed using reflexive thematic analysis
Forming part of the Tulong, Ugnayan ng Lingap At gabaY (TULAY) project
Recruitment spanned five regions of the Philippines
Results
Multiple levels of barriers — national, community, and individual — were identified as contributing to stroke rehabilitation inequities across the Philippines.
Barriers identified included geography, finance, resources, politics, and knowledge
The devolved healthcare system was described as challenging for consistent stroke service delivery
Acute stroke care was noted to be prioritised while rehabilitation remains undervalued
Rising stroke prevalence and healthcare inequalities were described as presenting a concerning outlook for the Philippines
Results
Community-based rehabilitation initiatives, built together with stroke survivors and cognisant of local contexts, were identified as a promising solution to improve post-stroke outcomes in the Philippines.
Traditionally multi-level approaches (e.g. national, community) were noted to offer solutions to enhancing stroke rehabilitation
Community-based initiatives were highlighted as a practical 'bottom-up' solution given the devolved healthcare system
Government action, prioritisation, and policy formation were identified as necessary to mandate stroke rehabilitation services nationally
Community-based rehabilitation was framed as an interim solution while policy-level changes are pursued
Discussion
The devolved and fragmented healthcare system in the Philippines creates particular challenges for standardising stroke rehabilitation education and service delivery across local communities.
The devolved system was identified as a barrier to upskilling those delivering stroke services
Fragmentation of the healthcare system was linked to variability in the quality and delivery of care
The study noted that rehabilitation remains undervalued within the existing healthcare structure
Experiences of care providers delivering stroke rehabilitation are described as under-researched prior to this study
What This Means
This research explores what it is like to be a healthcare provider delivering stroke rehabilitation care in the Philippines, a country where stroke rates are rising but rehabilitation services remain underfunded and undervalued compared to emergency stroke treatment. Researchers interviewed 17 care providers — including both professional and community volunteer health workers — across five regions of the Philippines, asking about their experiences, challenges, and ideas for improvement. The central finding was that many care providers feel they know very little about how to support stroke survivors through rehabilitation, a problem driven by a fragmented, decentralised healthcare system that makes it hard to train and educate workers consistently across the country.
The study found that barriers to good stroke rehabilitation exist at multiple levels: nationally (government policy gaps and political issues), at the community level (geographic isolation, lack of resources), and at the individual level (financial hardship, limited knowledge). Because responsibility for healthcare in the Philippines is devolved to local governments, the quality of stroke rehabilitation services varies enormously depending on where someone lives. This means that stroke survivors in rural or underserved areas may receive little to no rehabilitation support, deepening existing health inequalities.
This research suggests that while national government action and formal policy changes are ultimately needed to mandate stroke rehabilitation services across the Philippines, community-based rehabilitation programmes — designed with input from stroke survivors themselves and adapted to local contexts — offer a practical, grassroots way to improve care in the meantime. The findings point to an urgent need for investment in training community health workers, better resource allocation, and policy reform that treats stroke rehabilitation as a priority rather than an afterthought.
Leggat F, Buckingham S, Ong A, Kent B, Santos N, Teves A, et al.. (2026). 'Wala kaming alam sa stroke care' (we don't know anything about stroke care): experiences of care providers delivering stroke rehabilitation care in the Philippines.. Global health action. https://doi.org/10.1080/16549716.2026.2682047