Building Sustainable Neurosurgical Systems in Developing Countries (2025-2026)

Background

Neurosurgical systems in low- and middle-income countries are often plagued by insufficiencies in the workforce, training, technology and data. This translates to low clinical coverage, research outputs and training opportunities.

Strained neurosurgical systems reflect suboptimal health systems which lack in all aspects of the World Health Organization’s health system building blocks. Ethical issues in allocating resources, distributing the neurosurgical workforce and optimizing care compound these challenges.

In Uganda and Nigeria, broader health system deficiencies are especially apparent in subspecialties such as neurosurgery. For example, Uganda has only one neurosurgeon per 2 million people. Such deficiencies in workforce, training and infrastructure 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 adopt public and population health approaches to optimize available resources, reduce inequities and address the vast unmet need for neurosurgical care.

Project Description

Building on the work of previous teams, this project aims to develop evidence-based, culturally appropriate health interventions to address deficiencies in neurosurgical systems. An international team of Duke students and faculty and international students and faculty from Uganda and Nigeria will perform work specific to each of those countries, including systematic literature reviews and research on an array of neurosurgical system components.

Team members will review the draft neurosurgical strategic development plans created by previous teams; collaborate with stakeholders to create and pilot a global framework for sustainable neurosurgical system development; conduct a feasibility study of this framework in Nigeria and Uganda; and implement various public and population health strategies to address neurological issues of public importance. Some team members will travel to Uganda and Nigeria in Summer 2026 to collaborate in implementation.

Anticipated Outputs

Policy briefs on Ugandan and Nigerian neurosurgical systems; quantitative and qualitative data to inform interventions; abstracts for presentation at conferences; manuscripts for peer-reviewed journal publication; public health advocacy and educational materials on various neurological conditions

Student Opportunities

Ideally, this project team will include 2-4 graduate students and 6-8 undergraduate students. Interested students may come from disciplines such as pre-health, medicine, nursing, global health, population health, public policy, biomedical engineering, ethics, data science and statistical analysis. Applicants should possess cultural sensitivity and a desire to help build sustainable health systems in resource-limited areas. Students should have – or want to build skills in – research development, qualitative and quantitative data analysis, and manuscript writing.

Duke and international students will collaborate to develop the research and intervention protocols, apply for Duke and International IRB approval, develop study tools (e.g., interview guides, surveys), and collate and analyze the data.

All team members will learn about neurosurgical systems in low- and middle-income countries and research the challenges that perpetuate inequities in neurosurgical care. Students will learn global health research methodologies; gain experience with research development; increase cultural competency; participate in preparation of abstracts, presentations and manuscripts; and receive mentorship from a multinational and multidisciplinary team.

Graduate students will gain leadership experience by managing subteams, participating in conferences and leading project implementation at study sites.

Some students will travel to Uganda and Nigeria in Summer 2026.

Timing

Fall 2025 – Summer 2026

• Fall 2025: Participate in team meetings, discussions and presentations; continue project development and iterative refinement
• Spring 2026: Submit Duke and international Institutional Review Board application; perform pilot data collection, analysis and tool refinement
• Summer 2026 (optional): Travel to Uganda and Nigeria for project implementation; collate and analyze data; prepare abstracts, presentations and manuscripts

Crediting

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

See earlier related team, Building Sustainable Neurosurgical Systems in Developing Countries (2024-2025).

 

_{Image: Previous team members pose with partners on Zoom, courtesy of Alvan Ukachukwu}