Essential Neurosurgical Facilities and Equipment Needed to Address Neurotrauma in Low and Middle Income Countries

In 2015, the Lancet Commission summarized the surgical burden and accessibility of surgical services worldwide. The Low- and Middle- Income Countries (LMICs) are especially at risk due to low proportion of neurosurgeons to neurosurgical disease. A tremendous need to establish hospitals and facilities that are properly equipped and staffed for neurotrauma is necessary to meet this burden. Without proper investment and intervention, LMICs will continue to have tremendous economic loss and profound disability and death. Evaluation of current facility deficits in LMICs is necessary to adequately address global neurotrauma burden. We define “referring hospital” in our research as the third-level hospital per the World Health Organization (WHO)/World Bank definition and the level 2 or 3 hospital per the World Federation of Neurosurgical Societies (WFNS) definition. Using the WFNS/ WHO/ Program in Global Surgery and Social Change Global Neurosurgical facility database, we assessed the country-wide 4-hour access to referring hospital for LMICs, which were then grouped into three categories: \u3e=80%, \u3c80% and \u3c60% access. Using the National Surgical Obstetric and Anesthesia Plan guideline as a working framework, evidence was gathered from literature search and expert opinion regarding key elements such as facility geographic distribution, referral patterns, and essential equipment. Currently, the WFNS neurosurgical facility database only has complete data for 70 countries among 195 countries in the world. 34 countries meet the requirement of 80% or more of the population lives within 4 hours of a WFNS level 2 or 3 facility. 6 countries had between 60-80% of the population living within 4 hours of a WFNS level 2 or 3 facility and 30 countries have less than 60% of the population living within a WFNS level 2 or 3 facility. Based on extensive literature search and expert opinion, in order to scale up neurotrauma care in LMIC\u27s, facilities should be evaluated to meet minimum requirements of having a CT scanner, essential neurosurgical equipment, and intensive care units capable of delivering neurotrauma care. Countries should have at minimum, 80% of the population living within 4 hours of a neurotrauma facility. It is recommended to investment in biomedical engineering with a focus on innovative solutions in low resource settings Telemedicine can be used to bridge physical distance and knowledge gaps for e-consultation, education, and collaboration between neurosurgeons in different settings