India Needs a Faster Pathway from Stroke to Treatment
- Oct 29, 2026
- 3 minute read
Gaurav Vyas
For a person experiencing a stroke, what happens in the first few hours can shape the years that follow. The difference may be between returning to an independent life and living with long-term disability. Yet this does not depend only on whether an effective treatment exists. It also depends on whether symptoms are recognised quickly, appropriate medical help is sought, the right hospital is reached, imaging happens promptly and treatment decisions are made without avoidable delay.
For India, the scale of this challenge is considerable. The country recorded approximately 1.25 million new stroke cases and *773,000 stroke-related deaths in 2021. But equally important are the numbers that reveal the access gap. India has only around 500–600 stroke** units for a population of 1.4 billion, predominantly in urban areas. Only about one-fourth of Indians have access within an hour to a centre capable of intravenous thrombolysis, while around one-fifth have similar access to a centre capable of endovascular thrombectomy.
These numbers point to a fundamental reality: India’s stroke challenge is as much about time and geography as it is about medical capability.
A stroke in a metro and the same stroke in a district town may begin identically, but the journeys that follow can be very different. One patient may reach a hospital with imaging and specialist capabilities directly. Another may first travel to a local facility, wait for an assessment, be referred elsewhere and then travel again for advanced care. The National Stroke Action Plan cites the mean time to reach hospital after stroke onset at around 14.6 hours*** and identifies pre-hospital delay as a major barrier to early treatment.
If India wants to improve stroke outcomes, therefore, the opportunity is not confined to what happens inside a specialist centre. We need to make the entire journey to appropriate care faster.
The clock effectively starts at home. A family must first recognise the warning signs of a stroke and understand that immediate medical attention is critical. Simple tools can help: FAST stands for Face drooping, Arm weakness, Speech difficulty and Time to seek emergency medical help, while BEFAST adds sudden problems with Balance and Eyes or vision. Yet the National Stroke Action Plan identifies poor recognition of warning signs and low awareness of emergency response as important contributors to delayed arrival. Building greater public familiarity with these warning signs, alongside better awareness of emergency services and where to seek appropriate care, therefore remains an essential first step.
But awareness alone cannot compensate for a fragmented care pathway.
Once a suspected stroke patient enters the health system, the next question is not simply how quickly the patient reaches a hospital, but whether the patient reaches the right level of care. In a time-critical condition, arriving quickly at a facility that cannot provide the necessary diagnostic or treatment capability can still mean losing valuable time through secondary referral.
This is particularly important in a country of India's size. We cannot assume that every community will have immediate physical access to every level of specialist stroke care. The more practical objective should be to ensure that patients can enter a coordinated network in which different levels of the health system know their role and can move patients efficiently between them.
That begins with making more hospitals stroke-ready. District hospitals and other appropriately equipped facilities can provide initial assessment, imaging, stabilisation and treatment, while being linked to advanced centres for patients who require a higher level of intervention. India’s Stroke Action Plan calls for primary stroke-care units in district hospitals, with 24-hour imaging and the ability to provide thrombolysis, linked to advanced stroke centres.
It also makes a compelling case for stroke mapping. A national mapping system that identifies stroke-ready facilities by location and capability could help emergency responders and referring clinicians determine where an individual patient should be taken. The Action Plan envisages hospitals being categorised by capabilities including intravenous thrombolysis, endovascular treatment and rehabilitation, with this information connected to emergency services and digital systems.
The next step is to connect these facilities so that they function as networks rather than islands. Hub-and-spoke pathways can allow smaller hospitals to undertake initial assessment and management while connecting with comprehensive centres for specialist expertise and advanced intervention. The Action Plan itself recommends developing referral pathways between smaller stroke-ready hospitals and larger hospitals with the required facilities and expertise for endovascular treatment.
Here, technology becomes valuable not as an end in itself, but as a means of compressing distance. In a country where specialist expertise cannot physically be present everywhere, information and expertise must be able to travel faster than the patient. Telestroke can connect clinicians with specialist expertise remotely, while digital sharing of imaging and clinical information can support quicker consultation and referral decisions. AI-enabled imaging can further support rapid image interpretation and help prioritise urgent cases.
There is an equally important opportunity inside hospitals. Speed should become a measurable dimension of quality. The Stroke Action Plan sets benchmarks including door-to-physician within 10 minutes, initiation of CT or MRI within 20 minutes, intravenous thrombolysis within 60 minutes and door-to-puncture within 90 minutes. These targets recognise a simple truth: infrastructure matters, but so does the speed with which that infrastructure works for the patient.
India has made significant advances in its ability to diagnose and treat stroke. The next challenge is to connect those capabilities around the patient.
On World Stroke Day, we should therefore broaden how we think about access. It is not enough to ask how many hospitals, scanners, specialists or advanced interventions are available. We must also ask how quickly a person experiencing a stroke, whether in a large city or a smaller district, can reach the care they need.