Dear Editor,
Africa confronts a significant global neurosurgery challenge, which is anticipated
by a workforce density of African neurosurgeons that is a lot higher than recommended.
It depicts that there exists a substantial imbalance in the distribution of the surgical
workforce, resulting in significant geographic gaps in healthcare access across the
continent. This challenge can be attributed to numerous factors, encompassing insufficient
healthcare planning, limited resources, inadequate support for the local training
of neurosurgeons, and unfavorable conditions that hinder neurosurgeons from practicing
effectively within the region. These challenges often result in neurosurgeons trained
in Europe or elsewhere choosing not to return to their home countries (El Khamlichi,
2001). African countries, as a collective, face a substantial deficiency in the advancement
of the field of neurosurgery. Countries on the continent of Africa, like other low-
and middle-income countries (LMICs), bear the heaviest burden of unmet neurosurgical
healthcare needs, which underscores the need for a concentrated emphasis on neurosurgery.
The continent contends with a heightened incidence of conditions like traumatic brain
injuries, cerebrovascular diseases, epilepsy, and neuroinfections, all of which demand
specialized surgical interventions. Neurosurgery assumes a pivotal role in mitigating
the distress of patients affected by these ailments, rendering it an indispensable
specialty in our healthcare landscape.
Another pivotal factor is the harsh reality that, in low-income countries, individuals
afflicted with neurosurgical conditions often lack the financial resources to access
medical care for themselves. As a result, they frequently present at very advanced
disease stages, making treatment more complex and contributing to higher levels of
morbidity and mortality (Corley et al., 2019). One of the causes of the increased
burden on healthcare in Africa is the constrained availability of specialized medical
services, especially in remote and underserved regions. Neurosurgical practice is
significantly reliant on the accessibility of surgical equipment, particularly in
low- and middle-income countries (LMICs) where resources are constrained. The absence
of prompt access to imaging tools results in delays in surgical interventions and
unfavorable patient outcomes (Servadei et al., 2018). Furthermore, in addition to
expanding the neurosurgical workforce, substantial efforts are required to establish
the necessary infrastructure that enables African-trained neurosurgeons to effectively
operate and advance their careers in the field of neurosurgery. These obstacles are
even more challenging due to the highly specialized nature of neurosurgery, which
depends on a complex network of interconnected processes. This network includes neuroimaging,
neuro-anesthesia, specialized operating room requirements, dedicated nursing care,
and rehabilitation services. Furthermore, the scarcity of practicing neurosurgeons,
the inability to incorporate neurosurgical training into existing surgical education
programs because of a lack of equipment and resources for diagnostic imaging, and
an insufficient surgical infrastructure that limits the capacity of the few available
neurosurgeons to provide comprehensive care all exacerbate the challenges. The dearth
of neurosurgical infrastructure is exacerbated by a lack of resources and a culture
of poor maintenance. This combination further obstructs access to neurosurgical services
(Aderinto et al., 2022).
The provision of neurosurgery necessitates a sufficient quantity of highly trained,
well-equipped, and highly motivated neurosurgeons. Numerous African-trained neurosurgeons
seek opportunities abroad, largely driven by the challenges mentioned above. This
“brain drain” phenomenon exacerbates the already limited availability of specialized
medical professionals within the continent. However, several other factors make this
practice challenging in Africa, including the geographical isolation of many communities,
bureaucratic obstacles, political instability, frequent socioeconomic fluctuations,
and elevated levels of poverty and illiteracy within rapidly expanding populations
(Sader et al., 2017). The shortage of funding for healthcare, primarily driven by
the lack of governmental commitment to health financing, in conjunction with the elevated
poverty rates in Africa, amplifies the deficiency in access to specialized post-operative
care (Aderinto et al., 2022). In certain countries, millions of citizens are deprived
of access to neurosurgical care, and this predicament arises from insufficient governmental
advocacy for neurosurgery rather than solely economic constraints. The insufficiency
of neurosurgeons, neurologists, and other essential medical personnel constitutes
a significant hindrance to the provision of effective neurosurgical care. Training
programs for these specialists are often lacking, and retaining them within the continent
poses a considerable challenge. When compared to more developed regions, an acute
scarcity of neurosurgeons in numerous African nations and a substantial disparity
in neurosurgical proficiency are observed. The need of the hour is that medical students
and residents of Africa must undergo comprehensive training via observership and fellowship
programs in developed countries and acquire expertise in this field of neurosurgery.
They must have the ultimate goal of returning to Africa and actively participating
in the enhancement of neurosurgical capabilities within African healthcare systems.
It would create a significant impact by bringing specialized neurosurgical care closer
to those who need it the most (Agarwal et al., 2013; Lartigue et al., 2021; Deora
et al., 2020; Javed et al., 2023). The practice of neurosurgery relies on continuous
research and innovation. The lack of neurosurgical research significantly hinders
the advancement of neurosurgery, a situation notably evident in countries across Southeast
Asia and Africa (Lartigue et al., 2021; Deora et al., 2020; Javed et al., 2023; Chaurasia,
2023a, 2023b; Chaurasia et al., 2023). However, the restricted resources and infrastructure
in Africa impede the development of new techniques and technologies, thus impeding
progress in the field. There is a need to implement initiatives like establishing
collaborative partnerships between institutions in high-income countries (HICs) and
low- and middle-income countries (LMICs) (Chaurasia, 2023c; Farooq et al., 2023).
It would incentivize researchers to conduct and publish research that enriches the
global neurosurgery literature within LMICs, resulting in opportunities for capacity-building
(Servadei et al., 2018).
The difficulties in the practice of neurosurgery in Africa are multifaceted and deeply
ingrained. These challenges are not isolated; they are interconnected and amplify
one another.
In summary, the practice of neurosurgery in Africa confronts substantial challenges
arising from resource constraints, insufficient infrastructure, and cultural factors.
Nevertheless, through collaborative endeavors involving governments, medical practitioners,
and the global community, it is possible to tackle these issues. By bolstering investments
in healthcare, education, and research, we can enhance access to neurosurgical care,
alleviate the burden of neurological conditions, and pave the way for a brighter future
for our continent.
Declaration of competing interest
None.