Award Title: NIHR Global Health Research Group on stroke at King's College, London
Funder: Department of Health and Social Care

Abstract: Stroke is now the leading cause of death and disability from non-communicable disease in Africa._x000D_
Stroke is experienced earlier in life than in developed countries, affecting working parents with_x000D_
devastating financial consequences for families. In the UK, coordinated multidisciplinary care with_x000D_
national quality improvement initiatives, supported by the applicants, have significantly reduced the_x000D_
number of strokes and their impact. Sierra Leone is classified as a ‘Least Developed Country’ by the_x000D_
Organisation for Economic Cooperation and Development and as a ‘Heavily Indebted Poor Country’_x000D_
by the International Monetary Fund. There is no dedicated stroke unit and physiotherapists are not_x000D_
trained in Sierra Leone. The programme will improve the outcomes for patients and families in Sierra_x000D_
Leone following stroke within 5 years. It will bring together UK world leading stroke research and care_x000D_
expertise with an existing award-winning research and clinical partnership within Sierra Leone. The_x000D_
huge advantage of having an established partnership ‘King’s Sierra Leone Partnership’ (KSLP), is that_x000D_
administrative, governance and ethical review structures exist to manage the programme. Poor_x000D_
information is a barrier to good research and clinical practice. Stroke registers have demonstrated_x000D_
their value as a research and quality improvement tool in developed countries. The programme will_x000D_
collect the high quality data on stroke illness, care provision, needs and outcomes required to improve_x000D_
health care systems. There are an estimated 1,000 acute stroke admissions per year in Connaught_x000D_
and 34 Military hospitals. Research questions, particularly those around disability, quality of life and_x000D_
feasibility will be co-produced with service users and families. The applicants are very experienced in_x000D_
patient, carer and public involvement (PCPI). A service user led reference group works with the_x000D_
research team in South London and inputs at every level. The investigators will work together with_x000D_
stroke survivors and families to improve research and care processes. Wider stakeholder_x000D_
engagement will be built in and mirror existing successful quality improvement models in Sierra_x000D_
Leone.  Plans to set up a stroke care pathway and stroke unit are underway already. Research training will be delivered at all levels_x000D_
including Good Clinical Practice (the international ethical, scientific and practical standard to which all_x000D_
clinical research is conducted). The model will build on partnerships within the UK and Sub Saharan_x000D_
Africa, namely stroke unit development support from Ghana. Community engagement with stroke survivors and their families will be a core part of the activity. _x000D_
The applicants are experienced in training and have many awards and positions of authority_x000D_
recognising their skill. Dame Caroline Leigh Watkins is a nurse and has used many innovative ways_x000D_
to train allied health professional research and stroke care skills. Professor Rudd as National Clinical_x000D_
Director for Stroke and previous President of the British Association of Stroke Physicians has_x000D_
developed stroke as a specialty and leads the national multidisciplinary guideline group and nation_x000D_
quality improvement audit for stroke. The project proposal is to build on an existing partnership and_x000D_
create a platform for further research. Strengthening the health system will aim to improve patient and_x000D_
family health within 5 years. The approach will be to work together in equal partnerships with PCPI_x000D_
input and respect for diversity and inclusion principles.

Lay Abstract: KCL GLOBAL HEALTH STRATEGY_x000D_
King’s is a global top 20 university and the ‘King’s Strategic Vision 2029’ is ‘to make the world a_x000D_
better place’. KCL has strengths in biomedical and allied health profession education and research,_x000D_
KCL recognised a need to cohere its global health (GH) activities, with a solid base and plan for_x000D_
investment and growth. The new King’s GH Institute (KGHI) is a focal point for King’s GH_x000D_
researchers, a mark of the institutional commitment, and provides expertise in research and education_x000D_
for the wider university. The inclusion of Kings Centre for Global Health within the School of_x000D_
Population Health and Environmental Sciences supports the strategy by bringing expertise together._x000D_
The strategy is “to focus on high value partnerships, where there is good research infrastructure and_x000D_
established collaborations with KCL that can be broadened and deepened; but also committing to_x000D_
long-term research capacity building with less developed partners with important need and potential”._x000D_
Our iBSc in GH, Public Health and MScs in GH, Global Mental Health, and GH and Social Justice_x000D_
attract 160 students annually. KCL plays a leading role in the South London CLAHRC (King’s Centre_x000D_
for Implementation Science coordinates implementation and QI research across health themes), and_x000D_
in two NIHR BRCs (GSTT/ KCL and Maudsley; clinical informatics and translational medicine). The_x000D_
School of Public and Environmental Health hosts the NIHR Statistics lead, the London Research_x000D_
Design Service, the CTU and the CRN. KCL hosts world leading research and clinical expertise that_x000D_
addresses all of the United Nation Sustainable Goal 3 targets, including non-communicable disease._x000D_
In line with the UK aid and international development strategy, the plan is to deliver outstanding_x000D_
applied global health research for the direct and primary benefit of patients, families and the public._x000D_
The focus of the work is the improvement of the management of non-communicable disease using_x000D_
stroke care in Sierra Leone as a model._x000D_
PARTNERSHIPS, STAFFING, FACILITIES, NETWORKS AND SUPPORT._x000D_
This application will build on an award winning partnership with Sierra Leone, King’s Sierra Leone_x000D_
Partnership (KSLP). King’s College, London (KCL) have invested in KSPL with in country academic_x000D_
and support staff. The Freetown team of 15 includes Dr Daniel Youkee (Country Director) , an_x000D_
education manager as well as five clinical academics, 2 research coordinators , 2 nurses and_x000D_
research support staff (operations manager, IT, finance, communications). In London, Dr Andrew_x000D_
Leather directs the partnership with help from skilled operations, partnership, financial and logistics_x000D_
support staff. KSLP actively support education through the College of Medical and Allied Health_x000D_
Science (COMAHS) and has strong government links._x000D_
The 2014-2015 Ebola epidemic has driven a renewed national and international commitment to_x000D_
strengthen weak health systems and led to ongoing redesign of the national strategic health plan,_x000D_
offering a vital opportunity to develop evidence based stroke clinical and preventative care in Sierra_x000D_
Leone and across the sub-region. We aim to develop centralised stroke services in Freetown and_x000D_
establish a stroke unit at Connaught Government Hospital and a stroke team at 34 Military Hospital._x000D_
The recent establishment of a national emergency services telephone hotline, a new ambulance fleet_x000D_
and the training of a new paramedic cadre provide a key opportunity to implement centralised stroke_x000D_
services in Freetown._x000D_
The work will widen the partnership to include world leading stroke researchers and clinicians (Wolfe,_x000D_
Rudd, Langhorne, Sackley, McKevitt, Watkins, Legg), scientists (Peacock, Fox Rushby) and other_x000D_
networks (World Congress of Physical Therapy, Lancet Neurology Commission for stroke in LMIC,_x000D_
Global Burden of Disease Collaboration (cardiovascular), the INDEPTH network, the European Stroke_x000D_
Organisation). The ‘vision’ is to establish a co-produced novel interdisciplinary research program,_x000D_
build research capacity and strengthen stroke care services._x000D_
KCL is supporting this application with a £100,000 towards PHD (or equivalent research training) and_x000D_
reducing overheads by £300,000, thus contributing £400,000 to the award._x000D_
CAPACITY AND CAPABILITY STRENGTHENING AND SUSTAINABILITY._x000D_
The programme will build on existing infrastructure and partnerships and will develop a platform to_x000D_
support further research and clinical quality improvement. It will incorporate methods that have_x000D_
produced step change in the care of stroke in the UK and learn from health systems change research_x000D_
experts based in Sierra Leone and in the NIHR KCL ASSET Global Health Unit. The programme will_x000D_
provide high quality epidemiological and health economic data, evidence based adapted guidelines,_x000D_
and staff training._x000D_
The programme will facilitate on-going projects such as the creation of a Stroke Unit in Connaught_x000D_
hospital with advice from Akpalu (Accra, Ghana). Once the Stroke Unit is established the project will_x000D_
develop a stroke team at 34 Military Hospital, to underpin the creation of a second Stroke Unit_x000D_
(beyond the lifetime of the study). The clinical pathways will strengthen the health system and we will_x000D_
provide stroke care training to the staff. The team has established expertise and resources plus_x000D_
knowledge of access to other opportunities, such as the stroke physician training programme run by_x000D_
the European Stroke Organisation (bursaries to LICs). In parallel, Sackley (Head of Academic_x000D_
Physiotherapy at KCL) will work with the College of Medicine and Allied Health Sciences (Freetown),_x000D_
Quartey (Ghana) and the World Congress of Physical Therapy to finalise the development of a BSc_x000D_
Physiotherapy._x000D_
The project will establish ‘research ready’ governance and ethical processes to support a research_x000D_
able work force The research infrastructure in KSLP will be strengthened through the appointment of_x000D_
research ‘network’ staff and the delivery of basic training such as GCP, consent and data_x000D_
management skills. A cadre of clinical (medical) academics will be developed through mentoring and_x000D_
access to Masters modules in research methodology, enabling at least one person to register for a_x000D_
PhD. More innovative approaches will be used for AHP clinical academics such as, funded_x000D_
secondments, online Masters of Public Health modules, internships, small bite research training and_x000D_
clinical networks with support from UK, Ghana and Rwanda AHP academics._x000D_
The programme will deliver sustainable change through research and clinical capacity and capability_x000D_
improvement. Patient, family and public engagement will lead into quality improvement in stroke_x000D_
services will be underpinned by changes in structure, management and monitoring of stroke disease._x000D_
Stroke guidelines and audit (mirroring the successful RCP Stroke Guidelines and UK Sentinel Stroke_x000D_
National Audit Programme) will be introduced towards the end of the programme. Evaluation of these_x000D_
interventions will take place in the next phase (i.e. beyond the lifetime of this award).

Research Activity Codes: 7.3 MANAGEMENT AND DECISION MAKING;8.5 RESOURCES AND INFRASTRUCTURE (HEALTH SERVICES)
Health Categories: STROKE