Understanding the Extent and Impact of Barriers to Neurosurgical Service Delivery in Sub-Saharan Africa

Team profile by Ena Oboh and Zoey Petitt

Low- and middle-income countries (LMICs) account for a significant percentage of the global burden of neurosurgical disease. However, there is inadequate access to neurosurgical services due to insufficient workforce, infrastructure, equipment, funding, policy effort and prioritization. This past year, our team was focused on identifying ways to build sustainable neurosurgical systems in LMICs.

In the fall semester, we studied neurosurgical systems in Nigeria and Uganda through the lens of the WHO health system building blocks framework. We worked in two subteams of 12 students each, which included Duke graduate and undergraduate students and international students from Nigeria, Uganda and the Democratic Republic of the Congo. 

Each week, the sub-teams reviewed existing literature to understand a different aspect of the neurosurgical system, completed a paper and presented a summary of the key findings. The students also received didactic lectures from Duke faculty and international experts in the field, covering such topics as neurosurgical disease burden, service delivery, workforce and training, infrastructure/equipment/technology, health financing, data management and leadership and governance. 

At the end of the semester, each subteam created a National Neurosurgical Strategic Development Plan (NSDP) based on the National Surgical, Obstetric and Anesthesia Plan (NSOAP) framework. Each subteam also proposed potential research projects that could address challenges in the neurosurgical system that were identified throughout the semester.

In the spring semester, each subteams chose a research topic after receiving feedback from Duke faculty and collaborating partners in Nigeria and Uganda. Both subteams chose to focus on studying the presence, extent and impact of barriers to neurosurgical service delivery in sub-Saharan Africa (SSA) with the aim of answering the following research questions:

1. What are the specific barriers to optimal neurosurgical service delivery in SSA? 
2. What is the magnitude and impact of these barriers at individual, hospital and health system levels in SSA? 
3. What generalizable interventions can be implemented at individual, hospital and health system levels to alleviate these barriers?

This research project will be conducted in six SSA countries (Nigeria, Uganda, Cameroon, Democratic Republic of the Congo, Senegal and Zimbabwe), and will utilize a mixed-methods approach involving a quantitative survey of neurosurgical providers and patients/caregivers, and a qualitative interview with neurosurgical providers. While three Duke students will travel to Nigeria and three to Uganda to collect data alongside our international student team members in those countries, our collaborators in the remaining four countries will lead data collection efforts there. We plan to collect data from June through August 2023, with data analysis and dissemination in successive months.

Building Sustainable Neurosurgical Systems in Developing Countries

Poster by Morayo Abbey-Bada, Glory Agun, Lordstrong Akano, Joy Buchi-Ahiabuike, Nikhil Chaudhry, Eugene Cho, Rishi Chilappa, Olaoluwa Dada, Larrey Kamabu, Alice Kateregga, Olalekan Kolawole, Rose Nantambi, Paula Njeru, Arsene Daniel Nyalundja, Ena Oboh, Samuel Olawale, Glory Olowojoba, Yesel Trillo Ordonez, Taye Owoputi, Zoey Petitt, Heather Raslan, Katherine Reddy, Isha Shah, Joseph Mary Ssembatya and Keying Sun