Abstract
IntroductionNeurosurgical equipment donation from high-income countries (HICs) to low-and-middle income countries (LMICs) exists. However, there is currently no published literature on whether there is a need for neurosurgical equipment donations or how to design equipment donation programmes that meet the needs of LMIC neurosurgeons. The primary aims of this study were to explore: (1) the need for the donation of neurosurgical equipment from the UK and Ireland to LMICs within the African continent, and (2) the ways through which neurosurgical equipment donations could meet the needs of LMIC neurosurgeons.MethodsThis was a qualitative study using semi-structured, one-on-one, audio-recorded interviews. Purposive sampling was used to recruit and interview consultants or attending neurosurgeons from Ireland, the UK and LMICs in Africa in a continuous process until data saturation. Interviews were conducted by members of the Association of Future African Neurosurgeons during March 2021. Qualitative analysis used a thematic approach using open and axial coding.ResultsFive HIC and 3 LMIC neurosurgeons were interviewed. Five overarching themes were identified: (1) inequality of access to neurosurgical equipment, (2) identifying specific neurosurgical equipment needs, (3) importance of organisations, (4) partnerships between LMIC and HIC centres, and (5) donations are insufficient in isolation.ConclusionThere is a need for greater access to neurosurgical equipment in LMICs. It is unclear if neurosurgical equipment donations are the optimal solution to this issue. Other solutions that are not linked to dependency need to be explored and executed. Collaborative relationships between LMICs and HICs better ensures that neurosurgical equipment donations meet the needs of the recipients. These relationships may be best created within an organisation framework that has the logistical capabilities of coordinating international equipment donation and providing a quality control measure.
Highlights
Neurosurgical equipment donation from high-income countries (HICs) to low-and-middle income countries (LMICs) exists
Our study identified the potential for mis-matched donations resulting from a lack of understanding of recipient needs; a phenomenon that has been identified to be an issue in equipment donations for other subspecialties [30]
There is a need to reduce the shortage of neurosurgical equipment in LMICs if neurosurgical care is to improve
Summary
Neurosurgical equipment donation from high-income countries (HICs) to low-and-middle income countries (LMICs) exists. Of the 13.8 million individuals requiring neurosurgical care each year, more than 80% are located in low-and-middleincome countries (LMICs) [1] Despite their disproportionate neurosurgical needs, LMICs have significantly fewer human resources, funding and infrastructure to meet them compared to high-income countries (HICs) [2, 3]. The WFNS GNC mapped global access to neurosurgical infrastructure using a three-tier categorisation and geographic information systems: Level 1 facilities have the resources to provide basic macroneurosurgery; especially emergency neurotrauma care; Level 2 facilities provide basic microneurosurgery in addition to macroneurosurgery; and Level 3 facilities provide advanced microneurosurgery in addition to basic microneurosurgery and macroneurosurgery [7] This mapping project revealed that most LMICs do not have enough neurosurgical facilities to cover their entire population [7]. Karekezi et al evaluated the impact of African neurosurgeons whose training had been sponsored by the WFNS and found that restricted access to neurosurgical equipment limited the neurosurgeons’ service delivery in their home countries [9]
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