[[Global neurosurgery]] seeks to provide [[quality]] neurosurgical [[health care]] worldwide and faces challenges because of historical, socioeconomic, and political factors. To address the shortfall of essential [[neurosurgical procedure]]s worldwide, dyads between established neurosurgical and developing centers have been established. Concerns have been raised about their effectiveness and ability to sustain [[capacity]] development. Successful [[partnership]]s involve multiple [[stakeholder]]s, extended timelines, and twinning programs. 

Lippa et al. outlines initiatives and challenges within the neurosurgical [[community]]. The [[narrative review]] aims to provide a practical tool for colleagues embarking on clinical [[partnership]]s, the Engagements and assets, Capacity, Operative [[autonomy]], [[Sustainability]], and [[scalability]] (ECOSystem) of care. To create the ECOSystem of care in global neurosurgery, the authors had multiple [[online]] discussions regarding important points in the practical tool. All developed tiers were expanded based on logistics, clinical, and [[education]]al aspects. An online search was performed from August to November 2023 to highlight global neurosurgery partnerships and link them to tiers of the ECOSystem. The ECOSystem of care involves 5 tiers: Tiers 0 (foundation), 1 (essential), 2 (complexity), 3 (autonomy), and 4 (final). A nonexhaustive list of 16 neurosurgical partnerships was created and serves as a reference for using the ECOSystem. Personal [[experience]]s from the authors through their partnerships were also captured. 
They propose a tiered approach for capacity building that provides structured [[guidance]] for establishing neurosurgical partnerships with the ECOSystem of care. Clinical partnerships in global neurosurgery aim to build autonomy, enabling independent provision of quality healthcare services
((Lippa L, Cadieux M, Barthélemy EJ, Baticulon RE, Ghotme KA, Shlobin NA, Piquer J, Härtl R, Lafuente J, Uche E, Young PH, Copeland WR 3rd, Henderson F Jr, Sims-Williams HP, Garcia RM, Rosseau G, Qureshi MM. [[Clinical Capacity]] Building Through [[Partnership]]s: Boots on the Ground in [[Global Neurosurgery]]. Neurosurgery. 2024 Aug 26. doi: 10.1227/neu.0000000000003129. Epub ahead of print. PMID: 39185894.))