A developing country (or a low and middle-income country (LMIC), less developed country, less economically developed country (LEDC), or underdeveloped country) is a country with a less developed industrial base and a low Human Development Index (HDI) relative to other countries.
However, this definition is not universally agreed upon. There is also no clear agreement on which countries fit this category.
A nation's GDP per capita compared with other nations can also be a reference point.
Access to neurosurgical care is limited in low-income and middle-income countries (LMICs) and marginalized communities in high-income countries (HICs). International partnership represents one possible means of addressing this issue. Insights from surgeons in HICs have been explored, but data from LMICs' counterparts are scarce. We aimed to study the perspectives of neurosurgeons and trainees from LMICs regarding global neurosurgery (GN) collaborations and interests, motivators, and challenges in participating.
An online survey was conducted targeting neurosurgeons and trainees from LMICs. The survey explored demographics, previous experiences, ongoing activities, interests, and barriers related to GN activities. Data were collected between July 2022 and December 2022 and analyzed.
Responses involved 436 individuals. The most represented region (25%) was sub-Saharan Africa, and most respondents were male (87.8%) aged 35-49 years. Interest in GN was high, with 91% after its development. Most respondents (96.1%) expressed interest in training, professional, or research experience in HICs, but only 18.1% could cover the expenses. A majority (73.2%) strongly agreed to return to their home country for work after HIC training. Ongoing HIC-LMIC partnerships were reported by 27.8% of respondents. Clinical exposure emerged as the most relevant motivating factor (87%), while financial concerns, lack of opportunities, and lack of program support were identified as important barriers. Funding and dedicated time were highlighted as the most crucial facilitators.
Understanding the perspectives of neurosurgeons and trainees from LMICs is essential to expanding HICs-LMICs collaborations and improving access to neurosurgical care worldwide. Financial support and targeted interventions are needed to address barriers and promote equitable partnerships in GN 1).
In December 2016 in Bogotá Colombia, a group of neurosurgeons recognized the massive deficit in neurosurgical care, particularly in a developing country, and called upon the leaders of organized neurosurgery to take action. From this meeting the final version of the Bogotá Declaration on Global Neurosurgery was released, after a series of subsequent revisions and additions from leaders in the field at various society meetings across the world. The declaration was the first of its kind to acknowledge the massive deficit in global neurosurgical care and also place responsibility onto our own professional community to create collective and unified efforts to improve access to neurosurgical care.
With subspecialty surgical care often unavailable to poor patients in developing countries, short-term brigades have filled a portion of the gap. Here, we prospectively assessed cost-effectiveness of a pediatric neurosurgical brigade to Guatemala City, Guatemala.
Data were collected on a week-long annual pediatric neurosurgical brigade to Guatemala. Disability Adjusted Life-Years (DALYs) averted were the metric of surgical effectiveness. Cost data included brigade expenses, as well as all costs incurred by the local healthcare system and patient families.
During the mission, 17 pediatric neurosurgical interventions were performed. Conditions suffered by these patients would result in 382 total DALYs. Using conservative values of surgical effectiveness, procedures performed averted 138.1 DALYs. Although all operative and post-operative costs were covered by the visiting surgical team, patients spent an average of $226 USD for pre-operative workup, travel, food/lodging, and lost wages (range: $36-$538). The local healthcare system absorbed a total cost of $12,910. Complete mission costs were $53,152, for a cost-effectiveness of $385 per DALY averted.
This is the first study evaluating cost-effectiveness of a short-term neurosurgical brigade. While surgical intervention is acknowledged as playing a crucial role in global health, subspecialty surgical care is still broadly perceived as a luxury. Although providing care through local surgeons is undeniably more efficient than bringing in foreign medical teams, such care is not universally available. This study argues that volunteer neurosurgical teams can provide high-complexity care with a competitive cost-effectiveness profile 2).