Letter: Commentary: The Importance of Increased Funding Opportunities to Empower Global Neurosurgeons From Low-Middle Income Countries.

Abstract

To the Editor: We were encouraged by the article from Rolle et al1 on increasing funding opportunities for global neurosurgeons from low- and middle-income countries (LMICs) as a first step to ensuring global equity, and we aimed to present additional solutions through large-scale collaboration which involves multilateral, multinational efforts. We will further expand on these avenues and discuss potential limitations and their alternatives. Although programs and initiatives have made great strides in curtailing the global burden of disease, LMICs have disproportionally benefited from neurosurgical advancements, and most countries have minimal to no neurosurgical capacity to care for their inhabitants.2,3 Furthermore, Sub-Saharan African countries have some of the lowest public share of healthcare funding and consumption expenditure per capita, representing approximately 4.95% of gross domestic product (GDP) as of 2019.4 Broadly, 2019 percentages of healthcare funding and consumption expenditure per capita are stratified as the following: lower middle-income countries (3.71% GDP), low-income countries (4.47% GDP), LMICs (5.33% GDP), middle-income countries (5.33% GDP), and upper middle-income countries (5.85% GDP).4 Comparatively, in 2019, high-income countries spent 12.53% of their GDP bolstering healthcare systems.4 These limited resources in LMICs are in sharp contrast with the exorbitant costs of treatments, with the unaffordability of care remaining a limitation to global neurosurgeons improving health outcomes for vulnerable groups. Evidently, as of 2021, the average life expectancy for those born in more developed countries was 76 years for men and 82 years for women, compared with 64 years for men and 68 years for women in least developed countries.5 A key strategy in empowering global neurosurgeons must remain addressing current management issues in organizational behavior and operations. In the medical field, this translates to better prioritizing limited resources and cutting expenses to allow global neurosurgeons the financial ability to improve healthcare systems across the globe. To that aim, better investigations should be made to assess at once public and private sector involvements in resource allocation of medical services. After all, increasing global preparedness and addressing deficiencies in global crisis response to preserve human health should begin with an honest reflection on the ways in which acquired funding is spent. For example, although advancements in robotic engineering have enabled healthcare teams to treat challenging cases with precision and accuracy with minimal complications and improved outcomes, the health infrastructure in most LMICs cannot accommodate the costs required to operate or maintain such equipment. Case in point, the CorPath GRX Robotic System (Corindus, A Siemens Healthineers Company) platform, which was both granted approval by the United States Food and Drug Administration and shows great promise as a tool in the neurosurgeon's armamentarium, costs on average $500 000, and the disposable cassette adds an additional $559 per procedure.6 Rolle et al1 believed that everyone deserves access to quality healthcare. We agree with the authors and think that increasing funding for global neurosurgeons could be coupled with providing them with the resources and capacity to provide the best care. Therefore, increasing funding could also be manifested in the form of free educational programs, paid health systems strengthening projects, sponsored surgical camps, and allocated budgets from health ministries to continually maintain hospitals and clinics.7 Leveraging existing partnerships between neurosurgery departments in high-income countries, as the authors have noted, can prove effective in empowering global neurosurgeons. In addition to efforts from Harvard Medical School as detailed by Rolle et al,1 the department of neurological surgery at Vanderbilt University School of Medicine represents a dynamic and growing initiative toward that aim, with international partner sites including Bangladesh, Ethiopia, Ghana, Kenya, Malawi, Nigeria, Pakistan, Peru, South Africa, Sri Lanka, Tanzania/Zanzibar, Uganda, and Zambia.8 Additional large medical centers with dynamic global neurosurgery initiatives include Duke University School of Medicine Center for Global Surgery and Health Equity and the University of Pennsylvania School of Medicine Global Surgery Group.9,10 Treating diseases of the nervous system and its coverings in developing countries is especially challenging because of the high prevalence of economic instability for providers and patients alike. Increasing funding for global neurosurgeons will equip leaders in LMICs with the tools to maximize finite resources, enabling them to provide quality healthcare to the largest number of people and reduce disparities in the most needed areas. We thank Rolle et al1 for their valuable addition to the global neurosurgery movement.