Rita Melifonwu

Ashoka Fellow
rita_melifonwu_headshot.jpg
Nigeria
Fellow Since 2017
This description of Rita Melifonwu's work was prepared when Rita Melifonwu was elected to the Ashoka Fellowship in 2017 .

Introduction

Rita is reducing stroke prevalence in Nigeria by engaging stroke survivors, caretakers, medical professionals and policy makers to build stroke awareness, prevention, and treatment capacity across Nigeria. Her organization, Stroke Action Nigeria, is designed to guide the nation in taking action, strengthening capacity, advancing policy, and engaging in partnerships to reduce stroke prevalence in Nigeria.

The New Idea

Rita is reducing stroke prevalence in Nigeria by engaging stroke survivors, caretakers, medical professionals and policy makers to build stroke awareness, prevention, and treatment capacity across Nigeria. Her organization, Stroke Action Nigeria, is designed to guide the nation in taking action, strengthening capacity, advancing policy, and engaging in partnerships to reduce stroke prevalence in Nigeria.

She is changing public perception of stroke, reducing caregivers’ burdens, and enhancing stroke survivors’ support to reintegrate back into the society. She is working towards having 90 percent of Nigerians be aware of stroke risk factors and also positioning Nigeria to have a national stroke registry and strategy.

Rita is redefining stroke treatment and management in Nigeria and positioning medical personnel with the right resources and tools to help stroke patients through their treatment and become reintegrated into society. She is positioning Nigerians to increase their quality of life by reversing the incidence of non-communicable diseases in Nigeria, arming the country with the resources and tools to tackle the incidence and burden, and prevent future cases from occurring. She developed a holistic approach which equips individuals and their communities with the information and resources that put them in charge of their own health.
Rita has equipped Nigerians for early detection, reversal, or to completely halt incidences through innovative solutions that overcome political, economic, clinical, and technological barriers. Rita is demonstrating that, with appropriate organization, public awareness campaigns, funding, and access to medical equipment and treatment, it is possible to provide effective care, even in remote areas, and make a real difference in people’s lives.

Starting with stroke, she is fostering an environment where there is better understanding on how to prevent stroke, hypertension, and cancer. She does this by encouraging government support and guiding healthcare professionals to enhance the quality of life for stroke survivors.

The Problem

Stroke is a non-communicable disease with significant socioeconomic consequence worldwide. According to a release by the World Health Organization (WHO), stroke accounts for 10.8 percent of mortality and 3.1 percent of disease burden worldwide. There is an epidemiologic and demographic transition of diseases in most developing countries with increased risk for cardiovascular diseases. Globally, there were an estimated 16 million new cases of stroke and 62 million stroke survivors in 2005, with deaths from stroke accounting for 9.7 percent of all global deaths. This number is expected to increase to over 23 million new stroke cases and 7.8 million stroke deaths by 2030 in the absence of a significant global public health response.

It has been projected that by the year 2030, about 80 percent of all stroke cases will occur in low and middle income countries of the world. A recent review on global stroke cases showed that, while there is a decline in stroke incidence in developed countries, most developing countries are experiencing a rise in stroke incidence of about 100 percent.

Nigeria, the most populous black nation in the world, stands to risk the further straining of its resources as a result of the increasing prevalence of stroke and other cardiovascular diseases due to epidemiological transition. The current prevalence of stroke in Nigeria is 1.14 per 1000 while the 30-day case fatality rate is as high as 40 percent. Management of the disease is largely conservative as there are no specific stroke prevention or management programs in the health system. Despite Nigeria's strategic position in Africa, the country is greatly underserved in the healthcare sector. Access to medical healthcare is still very expensive. Additionally, there is a lack of health seeking behaviour by Nigerians, there is a lack of awareness about the risk factors of stroke, and there are few medical practitioners focused on stroke treatment. There is also a lack of after-stroke care both for caregivers and patients.

The Strategy

Rita is building awareness and capacity for stroke prevention and treatment in Nigeria. Using a citizen network of “stroke ambassadors” across the country, she creates awareness, educates about prevention, and provides preventive and after-stroke care at affordable prices. She also integrates stroke care into existing medical care facilities and works with the government to develop national policy for stroke care in Nigeria.
Rita recruits doctors, nurses, stroke survivors and their caretakers, and others passionate about addressing stroke care in Nigeria as stroke ambassadors, who become the drivers of change in their own regions. Ambassadors, who go through a one-day training program followed by ongoing training through video chat, are paid a small stipend per day of work they dedicate to the cause. The ambassadors recruit their own regional teams and design their own strategies to build awareness and treatment options in their regions. While the design is up to the ambassadors, there are several strategies that the network uses.
The stroke ambassadors work with hospitals where they identify stroke patients and become friends with them and their caregivers. With this befriending model, the stroke ambassadors provide free medical checks, free exercise activities and carry out routine visits to stroke patients and their caregivers in the hospital. They train family members who are caregivers to be able to take care of stroke patients in the right way and help them heal faster and also allow for easy reintegration back into their former lives.

The stroke ambassadors also carry out free community outreach programs to build awareness. They reach out to community organizations, such as churches, mosques, and marketplaces, to host outreach sessions where people can learn about and get tested for risk factors. At these sessions, the stroke ambassadors and their collaborators take weight and blood pressure to do a preliminary assessment of risk for the participants and refer them for blood tests if risk is high.

The stroke ambassadors are also trained to become exercise leaders. At a cost lower than physical therapy, ambassadors offer home visits to stroke survivors to teach basic exercises that help them recover and get their lives back.

Presently, Rita has built a network of 28 stroke ambassadors in 4 states in Nigeria and established two wellbeing clinics in Abuja and Onitsha. She recruits influential individuals such as the Obi of Onitsha to become stroke ambassadors to help with the other aspects of her strategy: policy change and change in the medical profession.

In addition to her citizen based ambassador strategy, Rita also engages policymakers at the national level to develop a comprehensive national stroke policy. She signed a Memorandum of Understanding (MOU) with the Federal Ministry of Health (FMOH) to collaborate in mitigating strokes and developing quality stroke care in the country. In 2015, Stroke Action formed an alliance with the Medical Association of Nigerians Across Great Britain (MANSAG) to collaborate with pushing the MOU implementation. As a result of this, the Nigerian Stroke Reference Group (NSRG) was inaugurated.

The NSRG is made up of experts in Nigeria and in the Diaspora, stroke survivors, caregivers, and key stakeholders in the prevention and management of stroke and its effects. The principal objective of the NSRG is developing a National Stroke Strategy that encompasses the principles of prevention, acute management, stroke rehabilitation, long term care and support for survivors and caregivers. Establishing a National Stroke Registry is also one of Rita’s goals. Additionally, she hopes to educate and conduct stroke trainings for healthcare professionals and advise the FMOH on stroke services in Nigeria.

One of the key objectives of the MOU is the Life After Stroke Centre being piloted presently in Abuja and Onitsha. The state governors are supposed to share lessons from the pilot and replicate the model in their states.
The Life After Stroke Centre promotes stroke awareness and prevention, community re-integration, functional rehabilitation, stroke education and training, and helps stroke survivors and their caregivers to ‘cope’ with their lives post-stroke.

In the Life After Stroke Centre, Rita recruits retired public health directors, part-time doctors, and nurses. She developed a membership health plan where members have access to free medicine and can pay for medical tests and physiotherapy at a subsidized rate. Members who pay 18000 Naira per year have access to information on risk factors and healthy living but pay for the tests required while the members who pay 28000 Naira get free access to non-invasive tests for a period of one year. There are 51 members of the centre in Onitsha and 350 in Abuja currently accessing the services.

Her vision is to replicate the Life After Stroke Centre model through Social Franchising. This will enable a ‘pilot’ to be undertaken and the outcomes developed into a ‘business in a box’ which will facilitate transfer of knowledge and experience to potential Social Franchisees. The Social Franchisees will be health and social care professionals (Doctors, Nurses, Physiotherapists) and stroke survivors and caregivers who wish to operate their own stroke support organizations. Potential Social Franchisees will be given the right – but also the obligation – to operate ‘community based’ franchised stroke support organisation as a business, according to the franchisor’s concept. The Social Franchisee, for a fee, will use the franchisor’s name and trademark, know-how, business methods and techniques, way of working and other rights. The Social Franchisee receives support, training, and the further development of the concept.

Stroke patients that were adversely affected when they started at the Life After Stroke Centre are no longer in wheelchairs as a result of the exercise training that the stroke ambassadors give them, they are able to do things on their own gradually, and eventually take their lives back.
Ultimately, Rita aims to integrate stroke management and care into the healthcare system in Nigeria. As such, she is working with hospitals to have Stroke Action teams based at the hospitals. She also conducts monthly educational sessions for medical practitioners and partners with the World Federation of Neurologists to do free trainings for doctors and nurses. She is talking with the head of the school of nursing in Abuja about piloting training within the curriculum there. She has also written a stroke handbook so that medical practitioners have the procedure for stroke treatment and management on hand, as well as the technique needed to manage stroke survivors and help them overcome the burden.
Rita is presently talking to people in Ghana and Kenya about replicating her model in their countries. Additionally, while Rita is focused on stroke care, she believes her model is applicable to other non-communicable diseases and is helping peers in the health sector to launch similar strategies for other diseases. Rita herself is exploring what can be done about dementia as a result of the link it has with people who have suffered stroke.

The Person

As a small girl in Enugu State, Rita went to visit her friend’s father in the hospital. He had suffered a stroke and could not walk or talk. Feeling sad about this, she started looking into charities working on stroke and she was directed to a social home in Enugu where she started volunteering her services with people living with disabilities. This work led her to become an advocate in her school for people with disabilities and she started recruiting peers to volunteer with her, as well.

Rita became a teacher; but, during a temporary stay in the United Kingdom, she learned that they had a shortage of nurses there. She decided to stay and become a nurse. She became known in her hospital for being focused on changing practices for the better. Indeed, she won an award for changing practices on how nurses can use evidence-based research to improve care. While working at a hospital in a predominantly white community, staff would often direct black patients to her ward. She first felt she was being marginalized; but, then she saw it as an opportunity when she started recognizing a pattern that black and minority ethnic people had more risk factors for stroke than their white counterparts. As she worked with stroke patients, Rita’s passion intensified. She told her boss that she wanted to start a stroke unit in her hospital. When she was told that there was no money, Rita wrote to then Prime Minister Tony Blair and shared her dream of starting a stroke unit. He responded that he had forwarded her letter to the Ministry of Health, which subsequently encouraged her to apply for the U.K. Department of Health’s 1999 Mary Seacole Nursing Leadership Award. Winning the award allowed her to conduct research and led to her starting Stroke Action UK, through which she started mobilizing volunteers to help stroke survivors and their families. Ultimately, the work of Stroke Action UK led to a national stroke strategy for the UK and became the prototype for Stroke Action Nigeria.

In 2012, Rita’s aunt in Nigeria suffered a stroke. Rita became interested in the services available to stroke patients in Nigeria and realized that Nigeria had no agenda for stroke patients. This prompted her to relocate back home to Nigeria and start Stroke Action Nigeria.