Building Sustainable Neurosurgical Systems in Developing Countries (2023-2024)


Neurosurgical systems in low- and middle-income countries are often plagued by an insufficient workforce, training, technology and data. This translates to low clinical coverage, research output and training opportunities. Strained neurosurgical systems reflect suboptimal health systems lacking in all aspects of the World Health Organization health system building blocks. Ethical issues in allocating 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 three million people; Nigeria’s ratio is one to 1.6 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. There is a need to optimize available resources to reduce inequities and address the vast unmet need for neurosurgical care.

Project Description

In the short term, this project aims to develop culturally appropriate research plans and interventions to fill gaps identified in individual health system components. Team members will review the drafted neurosurgical system strategic plans developed for Nigeria and Uganda by a previous team and collaborate with stakeholders and policy-makers in both countries to validate and implement these plans. 

Duke students will be divided into teams with students from around the world to perform country-specific tasks such as creating a literature review on the various neurosurgical system components, which will be submitted as short papers. The team will collaborate to develop the research/intervention protocol, apply for Duke and international Institutional Review Board (IRB) approval, develop study tools (interview guides, surveys, etc.), implement the study, and collate and analyze the data under the direct supervision of the faculty team leaders.

Duke and international faculty will host a series of workshops covering various aspects of the neurosurgical system, emphasizing personal experiences in under-served environments. In subsequent years, the project will continue to develop and implement health policy/system-building research or interventions to focus on different health system components.

Anticipated Outputs

Policy briefs on Ugandan and Nigerian neurosurgical systems; quantitative and qualitative data for Duke and partnering international institutions; abstracts for presentation at Duke and outside conferences; manuscripts for peer-reviewed journal publication; strategic development plan for building sustainable neurosurgical systems

Student Opportunities

Ideally, this project team will include 2-4 graduate students and 6-8 undergraduate students. Applicants should value a multidisciplinary and transcultural approach to healthcare and have awareness of the role of improved neurosurgical care on other aspects of the health system. Helpful skills include cultural sensitivity, humility and competence; research protocol and study tool development; qualitative and quantitative data analysis; manuscript writing; and project management.

Interested undergraduate applicants will likely be from such disciplines as prehealth studies, global health, public policy, biomedical engineering, ethics and data science. Interested graduate students will likely be studying medicine, nursing, global health, statistical science, public health, public policy and/or ethics.

Team members will learn global health research methodologies; gain experience with project development, study tool development and IRB application; learn to prepare abstracts, posters, conference presentations and manuscripts; collaborate in developing national plans for building sustainable neurosurgical systems; and receive mentorship in global health and global neurosurgery from a multinational and multidisciplinary faculty team.

In Fall 2023, this team will meet on Thursdays from 8:30-10 a.m. in Trent Hall Room 038B.

Some students will have the opportunity to travel to Uganda and Nigeria for six weeks during Summer Term I in 2024 and will work approximately 10 hours per week.


Fall 2023 – Summer 2024

  • Fall 2023: Workshops and seminars; team discussions, presentations and short papers; project development and iterative refinement
  • Spring 2024: Duke and international IRB application; pilot data collection, analysis and tool refinement
  • Summer 2024 (optional): Project implementation at sites in Kampala, Uganda and Ibadan, Nigeria; data collation and analysis; preparation of project deliverables (abstracts, presentations and manuscripts); project evaluation


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

This Team in the News

Meet the Winners of the 2024 Bass Connections Student Research Awards

See earlier related team, Building Sustainable Neurosurgical Systems in Developing Countries (2022-2023).

Graphic of stylized flags of Nigeria and Uganda inside the outlines of their respective countries.

Team Leaders

  • Anthony Fuller, School of Medicine-Neurosurgery
  • Alvan-Emeka Ukachukwu, School of Medicine-Neurosurgery

/graduate Team Members

  • Paul Aramanda, Business Administration-MBA, Health Sector Management
  • OyinOluwa Adaramola, Global Health - MSc
  • Yesel Trillo-Ordonez, Global Health - MSc
  • Jonathan Kennedy, Global Health - MSc

/undergraduate Team Members

  • Sara Valencia, Neuroscience (AB)
  • Heather Raslan, Neuroscience (BS)
  • Diya Patel
  • Julian Orrego
  • Manashwee Ghimire, Biology (BS)
  • Nina Dao, Evolutionary Anthropology (BS)
  • Eugene Cho, Biology (BS)
  • Rishit Chilappa, Neuroscience (BS)
  • Conor Bohrer, Religion (AB)

/yfaculty/staff Team Members

  • Timothy Dunn, School of Medicine-Neurosurgery
  • Michael Haglund, Duke Global Health Institute|School of Medicine-Neurosurgery

/zcommunity Team Members

  • Mulago National Referral Hospital
  • University College Hospital, Ibadan, Nigeria
  • Mbarara Regional Referral Hospital (MRRH)
  • Temitayo Shokunbi, University of Ibadan, Nigeria