Building Sustainable Neurosurgical Systems in Developing Countries (2022-2023)


Neurosurgical systems in low- and middle-income countries (LMICs) are plagued by inadequate specialist and ancillary workforce, training, resources, technology and data. This translates to low clinical coverage, research output and training opportunities. Deficient neurosurgical systems reflect suboptimal health systems lacking in all aspects of the World Health Organization health system building blocks. Ethical issues in allocating meager resources, distributing the neurosurgical workforce and optimizing care compound these challenges.

Uganda and Nigeria are countries where broader health system deficiencies reflect on medical subspecialties, such as neurosurgery. Uganda has a ratio of one neurosurgeon to 3.7 million people, while Nigeria’s ratio is one to 1.9 million. Such deficiencies in neurosurgical workforce and training are seen in the other health system components, with significant inequities in the distribution, availability and affordability of neurosurgical services.

Project Description

This project team will assess the existing neurosurgical systems in Uganda and Nigeria, in relation to global standards. This will contribute to the long-term goal of creating a comprehensive plan for developing and sustaining neurosurgical systems in LMICs. 

Through a series of lectures and workshops presented by Duke and international faculty, team members will explore various aspects of the neurosurgical system, emphasizing personal experiences in underserved environments. Country-specific tasks will include literature review and research on the various neurosurgical system components, which will be presented by the team and submitted as short papers.

Team members will conduct research on the neurosurgical system in both countries based on the WHO health system building blocks framework. The final product will be a plan for developing sustainable neurosurgical systems with an emphasis on optimizing available resources and mobilizing relevant stakeholders. They will collaborate on developing the research protocol, submitting for Duke and international Institutional Review Board approval, developing study tools (interview guides and surveys), implementing the study, and collating and analyzing the data. 

Subteams will collaborate to evaluate their research findings for similarities, differences, challenges and adaptations within the neurosurgical systems. This will lead to the development of a combined template for building and strengthening sustainable neurosurgical systems in LMICs, as well as other deliverables, including abstracts, posters and manuscripts. 

Anticipated Outputs

Country reports on Ugandan and Nigerian neurosurgical systems; focused neurosurgical system interventions; abstracts; conference presentations; peer-reviewed manuscripts; national plans for building sustainable neurosurgical systems in LMICs

Student Opportunities

Ideally, this project team will be comprised of 4 graduate students and 6 undergraduate students. Interested graduate students will likely be from health and policy-related fields, including medicine, nursing, global health, statistical science, public health, public policy and ethics, and undergraduate students should be studying global health, public policy, biomedical engineering, ethics, data science, nursing and/or prehealth. 

Existing skills in research protocol and survey development, cultural sensitivity and competence, qualitative and quantitative data analysis, manuscript writing, and project management are particularly valuable. Students should be interested in transcultural and multidisciplinary experiential learning, research development, manuscript writing or pursuing medical studies with focus on global health and global surgery.

Graduate and undergraduate students will learn about neurosurgical systems in LMICs and the challenges that perpetuate inequities in neurosurgical care. They will have the opportunity to gain experience with project development, study tool development and IRB application through transcultural, transnational, multidisciplinary research. They will learn to prepare abstracts, posters, conference presentations and manuscripts. Students will receive mentorship in global health and global neurosurgery from a multinational and multidisciplinary faculty team.

Additionally, graduate students will gain leadership skills through student team management, project implementation and data collection at study sites, and internal and external presentations. They will interface between student groups and project faculty and participate at Duke and non-Duke conferences.

Duke and international students will collaborate on assignments, project development and implementation and project deliverables. All team members meet once weekly for 90 minutes and students will have an additional weekly meeting for 60 minutes. In Fall 2022, the team will meet on Thursdays from 9:00-10:30 a.m.

A graduate student may be selected to serve as the project manager.

Selected students may have the opportunity to travel to Kampala, Uganda and Ibadan, Nigeria in late spring and/or early summer 2023.


Fall 2022 – Summer 2023

  • Fall 2022: Lectures and workshops on neurosurgical systems in LMICs; team discussions, presentations and short papers; literature review on neurosurgical systems in Uganda and Nigeria
  • Spring 2023: Project protocol development and iterative refinement; Duke and international IRB application; pilot data collection, analysis and tool refinement; travel to project sites in Uganda and Nigeria
  • Summer 2023 (optional): Project implementation; data collation and analysis; development of a neurosurgical plan for LMIC health systems; preparation of project deliverables; project evaluation


Academic credit available for fall and spring semesters; summer funding available


Image: Aerial view of Ibadan city in Nigeria, by International Institute of Tropical Agriculture, licensed under CC BY-NC 2.0

Nigerian city.

Team Leaders

  • Timothy Dunn, Arts & Sciences-Statistical Science
  • Anthony Fuller, School of Medicine-Neurosurgery
  • Alvan-Emeka Ukachukwu, School of Medicine-Neurosurgery

/yfaculty/staff Team Members

  • Michael Haglund, Duke Global Health Institute|School of Medicine-Neurosurgery
  • Jeffrey Moe, Fuqua School of Business
  • Osondu Ogbuoji, Duke Global Health Institute

/zcommunity Team Members

  • The National Postgraduate Medical College of Nigeria (NPMCN)
  • The Nigerian Ministry of Health
  • West African College of Surgeons (WACS)
  • Nigerian Academy of Neurological Surgeons (NANS)
  • The Ugandan Ministry of Health
  • The College of Surgeons of East, Central, and Southern Africa (COSECSA)
  • The Neurosurgical Society of Uganda
  • Temitayo Shokunbi, University of Ibadan, Nigeria