How Direct Relief and Boehringer Ingelheim Brought Advanced Stroke Treatment to 30 Low-Income Countries Around the Globe – Direct Relief

Report on a Global Partnership to Combat Stroke and Advance Sustainable Development Goals

Executive Summary

A multi-stakeholder partnership involving Direct Relief, Boehringer Ingelheim, the World Stroke Organization (WSO), and national health ministries has successfully distributed over 37,000 vials of the life-saving stroke medication alteplase to 30 low- and middle-income countries. This initiative directly addresses critical global health disparities and makes significant contributions toward several United Nations Sustainable Development Goals (SDGs), most notably SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 17 (Partnerships for the Goals). The program provides a scalable model for strengthening healthcare systems and ensuring equitable access to advanced medical treatments.

Advancing SDG 3: Good Health and Well-being

Stroke is the second leading cause of death globally and a primary contributor to disability, posing a significant obstacle to achieving SDG 3. The burden is disproportionately high in developing nations. This program directly supports SDG Target 3.4, which aims to reduce premature mortality from non-communicable diseases.

• Global Stroke Burden: The World Stroke Organization reports that 87% of stroke-related deaths and 89% of disability-adjusted life-years (DALYs) lost occur in low- and middle-income countries.
• Therapeutic Intervention: The donation of alteplase, a thrombolytic agent that dissolves blood clots, provides a critical intervention to reduce the risk of death and long-term impairment following an ischemic stroke.
• Patient Outcomes: Early reports from recipient facilities, such as the Centre Hospitalier Universitaire de Brazzaville, indicate revolutionary improvements in stroke management. The first four patients treated were evaluated as either completely symptom-free or functionally independent post-treatment, demonstrating a direct positive impact on health outcomes.

Fostering SDG 17: Partnerships for the Goals

The success of this complex distribution effort exemplifies the power of multi-stakeholder partnerships as outlined in SDG 17. The collaboration leveraged the unique strengths of each organization to overcome significant logistical and clinical challenges.

• Corporate Partner: Boehringer Ingelheim donated the medication and provided crucial support through its Angel’s Initiative.
• Non-Profit Implementer: Direct Relief managed the complex logistics, established a new distribution network, and ensured compliance with rigorous international standards.
• Global Health Organizations: The World Stroke Organization (WSO) assisted in identifying qualified medical facilities capable of administering the treatment.
• Governmental Bodies: National ministries of health in 10 countries partnered to manage and arrange in-country distribution, aligning the program with national health strategies.

Reducing Inequalities in Healthcare Access (SDG 10)

The initiative fundamentally addresses the global health inequalities targeted by SDG 10. By focusing on nations where advanced stroke care is scarce or non-existent, the program works to ensure that access to care is not determined by geography.

• Targeted Distribution: The program delivered alteplase to 38 healthcare partners across Africa, Asia, and the Caribbean, including in countries like Chad, the Democratic Republic of the Congo, Papua New Guinea, and Syria.
• Building New Capacity: For six of the first 13 surveyed recipient institutions, this donation marked the first time they had ever received a supply of alteplase, effectively establishing new nodes of advanced stroke care.
• Equitable Access: The program’s stated goal is to move closer to a world where the best medical innovations reach everyone who can benefit, directly aligning with the principle of reducing inequalities within and among countries.

Program Implementation and Health System Strengthening

Beyond the immediate donation, the program was structured to build long-term, sustainable capacity for stroke care, a core component of strengthening health systems under SDG 3. Administering alteplase requires a high level of medical infrastructure and expertise, and the program actively worked to build this capacity.

1. Facility Vetting: Partner hospitals were required to have advanced diagnostic capabilities, including MRI or CT scan equipment, to properly diagnose stroke type.
2. Protocol Development: The Angel’s Initiative, a non-profit by Boehringer Ingelheim, helped create “stroke-ready hospitals” by providing online training and assisting staff in adopting proven, rapid-response treatment protocols.
3. Network Expansion: Direct Relief established new relationships with top academic hospitals and ministries of health, creating a durable pipeline for future donations of specialized medicines.

This initiative has demonstrated that donating and distributing highly specialized medicines in resource-limited settings is feasible and serves as a catalyst for long-term healthcare system strengthening.

Analysis of the Article in Relation to Sustainable Development Goals

1. Which SDGs are addressed or connected to the issues highlighted in the article?

1. SDG 3: Good Health and Well-being

   The article is fundamentally centered on health. It discusses the treatment of stroke, a major non-communicable disease (NCD), which is the “second leading cause of death” among such disorders. The entire initiative of donating and distributing the medicine alteplase aims to improve health outcomes, reduce mortality and disability from strokes, and enhance the well-being of patients like Mick Dhom Mayenga, who was able to regain his mobility and support his family.

2. SDG 10: Reduced Inequalities

   The article highlights a significant health inequality, stating that the “overwhelming majority of the global stroke burden – 87% of deaths and 89% of disability-adjusted life-years (DALYs) lost – occurs in low-income and low-middle-income countries.” The program directly addresses this by providing advanced, life-saving medicine to people in these regions who “otherwise would have no access to them.” The goal is to ensure that “geography no longer determines access to care,” thereby reducing health disparities between countries.

3. SDG 17: Partnerships for the Goals

   The success of the initiative described in the article is entirely dependent on a multi-stakeholder partnership. It details the collaboration between Direct Relief (a non-profit organization), Boehringer Ingelheim (a private pharmaceutical company), the World Stroke Organization (WSO), Angel’s Initiative (a non-profit initiative), and national ministries of health. This partnership mobilizes and shares resources, knowledge, and expertise to achieve the health goals, exemplifying the spirit of SDG 17.

2. What specific targets under those SDGs can be identified based on the article’s content?

• SDG 3: Good Health and Well-being

  • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article directly addresses this target by focusing on the effective treatment of stroke, a leading NCD, with the medicine alteplase. The program’s goal is to dissolve blood clots, “reducing the risk of long-term impairment” and death, as evidenced by the positive outcomes of the first patients treated.
  • Target 3.8: Achieve universal health coverage, including access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines for all. The donation of alteplase provides access to a critical and effective medicine in 30 low- and middle-income countries. The article notes that for six of the recipient institutions, this was the “first time they had received a supply of the medicine,” directly contributing to increased access to essential healthcare.
  • Target 3.c: Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries. The article mentions that the “Angel’s Initiative… provided online stroke training courses to recipients” and helps create “‘stroke-ready hospitals’ by helping hospitals adopt and drill staff in proven stroke treatment protocols.” This is a clear example of strengthening the capacity and skills of the health workforce.

• SDG 10: Reduced Inequalities

  • Target 10.2: By 2030, empower and promote the social and economic inclusion of all, irrespective of disability. By providing treatment that allows stroke survivors to avoid or recover from severe paralysis, the program enables their social and economic reintegration. Mick Dhom Mayenga’s story, where he feared being unable to provide for his family but was later able to walk and lift heavy objects, illustrates how the treatment prevents disability from becoming a barrier to economic inclusion.

• SDG 17: Partnerships for the Goals

  • Target 17.16: Enhance the global partnership for sustainable development, complemented by multi-stakeholder partnerships that mobilize and share knowledge, expertise, technology and financial resources. The article is a case study for this target, describing a partnership between Direct Relief, Boehringer Ingelheim, the WSO, and Angel’s Initiative. They collectively mobilize resources (37,000 vials of medicine), expertise (identifying capable hospitals), and knowledge (stroke care training) to support developing countries.
  • Target 17.17: Encourage and promote effective public, public-private and civil society partnerships. The initiative is a clear example of a public-private-civil society partnership. It involves Direct Relief (civil society), Boehringer Ingelheim (private sector), and collaborations with “national ministries of health that managed or helped arrange distribution in 10 nations” (public sector).

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Indicators for SDG 3 Targets

  • For Target 3.4: The article implies progress can be measured by a reduction in mortality and disability from stroke. Specific indicators mentioned or implied are:
    • Patient outcomes post-treatment: The article reports that the “first four patients to be treated were all evaluated post-treatment as either completely symptom-free or remaining functionally independent.”
    • Reduction in Disability-Adjusted Life-Years (DALYs): The article cites the 32% rise in DALYs lost to stroke from 1990-2021 as a key problem the initiative seeks to reverse.
  • For Target 3.8: Progress is measured by the availability of essential medicines.
    • Quantity and reach of medicine distributed: The article explicitly states the donation of “more than 37,000 vials of alteplase to 38 healthcare partners in 30 countries.”
    • Proportion of health facilities with access to the medicine: It is noted that for “six…institutions…Direct Relief’s donation was the first time they had received a supply of the medicine.”
  • For Target 3.c: Progress is measured by the strengthening of healthcare systems.
    • Number of healthcare staff trained: The article mentions the provision of “online stroke training courses to recipients.”
    • Number of hospitals with enhanced capacity: The program helps create “‘stroke-ready hospitals’,” which is a direct measure of capacity building.

• Indicators for SDG 10 Targets

  • For Target 10.2: Progress is measured by the functional ability of individuals post-treatment.
    • Rate of functional independence among stroke survivors: The recovery of Mick Dhom Mayenga, who went from being “completely paralyzed on his left side” to being able to lift over 20 lbs and walk freely, serves as a qualitative indicator of restored independence and capacity for economic inclusion.

• Indicators for SDG 17 Targets

  • For Target 17.16/17.17: Progress is measured by the scale and effectiveness of the partnership.
    • Number and type of partners involved: The article names the key partners: Direct Relief, Boehringer Ingelheim, World Stroke Organization, Angel’s Initiative, and national ministries of health.
    • Volume of resources mobilized: The donation of “more than 37,000 vials of alteplase” is a quantifiable indicator of mobilized resources.

4. Summary Table of SDGs, Targets, and Indicators

Source: directrelief.org