The Role of Neurosurgeons in Policy Development: Addressing Unmet Neurosurgical Needs in Low-and-Middle Income Countries

Abstract

Introduction:
Global Neurosurgical (GNS) publications can be classified into two broad categories: 1) clinical research and 2) public health research. To date, most papers and manuscripts have been clinical in nature. However, over the past 5 years, the focus of GNS manuscripts have changed dramatically. A recent scoping review identified public health-oriented GNS manuscripts from 1999 to 2019 and categorized them by the WHO’s six Health System domains (service delivery, workforce, infrastructure, financing, information management, and governance). The objectives of this follow-up study include: 1) updating the literature search done in the scoping review and 2) discussing the importance of comprehensive policy recommendations.

Methods:
We searched three databases – PubMed/MEDLINE, CINAHL, and EMBASE – for GNS literature published from June 2019 (the end of previous search date) to December 2020. Afterwards, a title & abstract screening was conducted.

Results:
A total of 246 references were found across the three aforementioned databases. After the title & abstract screening, 68 GNS manuscripts were identified. Although a full-text review was not conducted, this cursory search supports the notion that the GNS community is now shifting towards a more holistic, health systems-oriented approach.

One limitation to this search method is the exclusion of commentaries and policy briefs that discussed governance within GNS. For example, the study excluded the Comprehensive Policy Recommendations that have been released by the Program for Global Surgery and Social Change (PGSSC). The first set of recommendations were about head and spine injuries. The second set of recommendations – published at the end of 2021 – focused on policy related to the management of Spina Bifida and Hydrocephalus.

Discussion:
The Comprehensive Policy Recommendations clearly highlight how neurosurgeons can influence policy development and implementation. While these publications are a step forward, it is not enough. Moving ahead, the GNS community should: 1) widely disseminate the document to all, 2) selectively distribute the document to Ministries of Health, and 3) conduct more policy-focused research. To adequately address the unmet neurosurgical needs in LMICs, collaboration is paramount. It is time for neurosurgeons to think beyond the operating room.