. 2019 Sep 9:6:100059.

doi: 10.1016/j.wnsx.2019.100059. eCollection 2020 Apr.

Task-Shifting and Task-Sharing in Neurosurgery: An International Survey of Current Practices in Low- and Middle-Income Countries

Faith C Robertson^{1

2}, Ignatius N Esene³, Angelos G Kolias^{4

5}, Patrick Kamalo^{6

7}, Graham Fieggen⁸, William B Gormley^{1

2

9}, Marike L D Broekman^{10

11}, Kee B Park¹²; Collaborative Working Group

Collaborators, Affiliations

Collaborators

Collaborative Working Group:
Jeffrey Rosenfeld, Naci Balak, Ahmed Ammar, Magnus Tisel, Michael Haglund, Timothy Smith, Ivar Mendez, Jannick Brennum, Stephen Honeybul, Akira Matsumara, Severien Muneza, Andres Rubiano, Gail Rosseau, Tariq Khan, Basant Misra, Gene Bolles, David Adelson, Robert Dempsey, Peter Hutchinson, Abenezer Aklilu, Abigail Javier-Lizan, Adil Belhachmi, Ahtesham Khizar, Alexandru Tascu, Ali Yalcinkaya, Aliyu Baba Ndajiwo, Alvan-Emeka Ukacjukwu, Amit Agrawal, Amit Thapa, Ana Cv Silva, Armin Gretschel, Arvind Sukumaran, Atul Vats, Bakr Abo Jarad, Balgopal Karmacharya, Bipin Chaurasia, Boon Seng Liew, Carlos A Rodriguez Arias, Claire Karekezi, Cohen-Inbar Or, Danjuma Sale, Davendran Kanesen, Djula Djilvesi, Evarsitus Nwaribe, M Elhaj Mahmoud, Mian Awais, Sanjay Kumar, Amos O Adeleye, Manish Agarwal, Menelas Nkeshimana, Sunday David Ndubuisi Achebe, Walid El Gaddafi, Ece Uysal, Eghosa Morgan, Elubabor Buno, Emmanuel Sunday, Esayas Adefris, Fayez Alelyani, Felipe Constanzo, Gabriel Longo, Ghulam Farooq, Goertz Mirenge Dunia, Gyang Markus Bot, Hamisi K Shabani, Harch Deora, Hassan Almenshawy, Hazem Kuheil, Igor Lima Maldonado, Ionut Negoi, Irfan Yousaf, Jafri Malin Abdullah, Jagos Golubovic, Khalil Ayadi, Kriengsak Limpastan, Luxwell Jokonya, Mirsad Hodzic, Mohamed Kassem, Mohammed Al-Rawi, Muhammad Tariq, Mykola Vyval, Naci Balak, Nidal Abuhadrous, Nikolaos Syrmos, Osaid Alser, Paul H Young, Petra Wahjoepramono, Prabu Rau Sriram, Rafik Ouchetati, Recep Basaran, Ritesh Bhoot, Robson Amorim, Rosanda Iliƒá, Saman Wadanamby, Samuel M Fetene, Sanjay Behari, Satish Babu, Tariq Khan, Trung Kien Duong, Tsegazeab Laeke, Ulrick S Kanmounye, Vladimir Komar, Ipe Vazheeparambil George, Zahid Hussain, Lynne Lourdes N Lucena, Hugues Brieux Ekouele Mbaki, Ken-Keller Kumwenda, Djvnaba Bah, Ibrahim E Efe, Dickson Bandoh, Yunus Kuntawi Aji, Thomas Dakurah

Affiliations

¹ Harvard Medical School, Boston, Massachusetts, USA.
² Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.
³ Neurosurgery Division, Department of Surgery, University of Bamenda, Cameroon.
⁴ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom.
⁵ NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.
⁶ University of Malawi, College of Medicine, Department of Surgery, Blantyre, Malawi.
⁷ Stellenbosch University, Centre for Medical Ethics and Law, Cape Town, South Africa.
⁸ Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.
⁹ Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁰ Leiden University Medical Center, Neurosurgery, Leiden, Netherlands.
¹¹ Department of Neurosurgery, Haaglanden Medical Center, The Hague, Netherlands.
¹² Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 32309800
PMCID: PMC7154228
DOI: 10.1016/j.wnsx.2019.100059

Task-Shifting and Task-Sharing in Neurosurgery: An International Survey of Current Practices in Low- and Middle-Income Countries

Faith C Robertson et al. World Neurosurg X. 2019.

. 2019 Sep 9:6:100059.

doi: 10.1016/j.wnsx.2019.100059. eCollection 2020 Apr.

Authors

Collaborators

Collaborative Working Group:
Jeffrey Rosenfeld, Naci Balak, Ahmed Ammar, Magnus Tisel, Michael Haglund, Timothy Smith, Ivar Mendez, Jannick Brennum, Stephen Honeybul, Akira Matsumara, Severien Muneza, Andres Rubiano, Gail Rosseau, Tariq Khan, Basant Misra, Gene Bolles, David Adelson, Robert Dempsey, Peter Hutchinson, Abenezer Aklilu, Abigail Javier-Lizan, Adil Belhachmi, Ahtesham Khizar, Alexandru Tascu, Ali Yalcinkaya, Aliyu Baba Ndajiwo, Alvan-Emeka Ukacjukwu, Amit Agrawal, Amit Thapa, Ana Cv Silva, Armin Gretschel, Arvind Sukumaran, Atul Vats, Bakr Abo Jarad, Balgopal Karmacharya, Bipin Chaurasia, Boon Seng Liew, Carlos A Rodriguez Arias, Claire Karekezi, Cohen-Inbar Or, Danjuma Sale, Davendran Kanesen, Djula Djilvesi, Evarsitus Nwaribe, M Elhaj Mahmoud, Mian Awais, Sanjay Kumar, Amos O Adeleye, Manish Agarwal, Menelas Nkeshimana, Sunday David Ndubuisi Achebe, Walid El Gaddafi, Ece Uysal, Eghosa Morgan, Elubabor Buno, Emmanuel Sunday, Esayas Adefris, Fayez Alelyani, Felipe Constanzo, Gabriel Longo, Ghulam Farooq, Goertz Mirenge Dunia, Gyang Markus Bot, Hamisi K Shabani, Harch Deora, Hassan Almenshawy, Hazem Kuheil, Igor Lima Maldonado, Ionut Negoi, Irfan Yousaf, Jafri Malin Abdullah, Jagos Golubovic, Khalil Ayadi, Kriengsak Limpastan, Luxwell Jokonya, Mirsad Hodzic, Mohamed Kassem, Mohammed Al-Rawi, Muhammad Tariq, Mykola Vyval, Naci Balak, Nidal Abuhadrous, Nikolaos Syrmos, Osaid Alser, Paul H Young, Petra Wahjoepramono, Prabu Rau Sriram, Rafik Ouchetati, Recep Basaran, Ritesh Bhoot, Robson Amorim, Rosanda Iliƒá, Saman Wadanamby, Samuel M Fetene, Sanjay Behari, Satish Babu, Tariq Khan, Trung Kien Duong, Tsegazeab Laeke, Ulrick S Kanmounye, Vladimir Komar, Ipe Vazheeparambil George, Zahid Hussain, Lynne Lourdes N Lucena, Hugues Brieux Ekouele Mbaki, Ken-Keller Kumwenda, Djvnaba Bah, Ibrahim E Efe, Dickson Bandoh, Yunus Kuntawi Aji, Thomas Dakurah

Affiliations

¹ Harvard Medical School, Boston, Massachusetts, USA.
² Computational Neuroscience Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.
³ Neurosurgery Division, Department of Surgery, University of Bamenda, Cameroon.
⁴ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, United Kingdom.
⁵ NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.
⁶ University of Malawi, College of Medicine, Department of Surgery, Blantyre, Malawi.
⁷ Stellenbosch University, Centre for Medical Ethics and Law, Cape Town, South Africa.
⁸ Division of Neurosurgery, Department of Surgery, University of Cape Town, Cape Town, South Africa.
⁹ Department of Neurological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
¹⁰ Leiden University Medical Center, Neurosurgery, Leiden, Netherlands.
¹¹ Department of Neurosurgery, Haaglanden Medical Center, The Hague, Netherlands.
¹² Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.

PMID: 32309800
PMCID: PMC7154228
DOI: 10.1016/j.wnsx.2019.100059

Abstract

Background: Because nearly 23,000 more neurosurgeons are needed globally to address 5 million essential neurosurgical cases that go untreated each year, there is an increasing interest in task-shifting and task-sharing (TS/S), delegating neurosurgical tasks to nonspecialists, particularly in low- and middle-income countries (LMICs). This global survey aimed to provide a cross-sectional understanding of the prevalence and structure of current neurosurgical TS/S practices in LMICs.

Methods: The survey was distributed to a convenience sample of individuals providing neurosurgical care in LMICs with a Web-based survey link via electronic mailing lists of continental societies and various neurosurgical groups, conference announcements, e-mailing lists, and social media platforms. Country-level data were analyzed by descriptive statistics.

Results: The survey yielded 127 responses from 47 LMICs; 20 countries (42.6%) reported ongoing TS/S. Most TS/S procedures involved emergency interventions, the top 3 being burr holes, craniotomy for hematoma evacuation, and external ventricular drain. Most (65.0%) believed that their Ministry of Health does not endorse TS/S (24.0% unsure), and only 11% believed that TS/S training was structured. There were few opportunities for TS/S providers to continue medical education (11.6%) or maintenance of certification (9.4%, or receive remuneration (4.2%).

Conclusions: TS/S is ongoing in many LMICs without substantial structure or oversight, which is concerning for patient safety. These data invite future clinical outcomes studies to assess effectiveness and discussions on policy recommendations such as standardized curricula, certification protocols, specialist oversight, and referral networks to increase the level of TS/S care and to continue to increase the specialist workforce.

Keywords: Capacity; DRC, Democratic Republic of the Congo; Global health; Global neurosurgery; LMIC; LMIC, Low- and middle-income country; MOH, Ministry of Health; TS/S, Task-shifting and task-sharing; Task-sharing; Task-shifting; Workforce.

PubMed Disclaimer

Conflict of interest statement

A.G.K. is supported by the National Institute for Health Research (NIHR) Global Health Research Group on Neurotrauma. The Group was commissioned by the NIHR using Official Development Assistance funding (project 16/137/105). The views expressed in this article are those of the authors and are not necessarily those of the United Kingdom National Health Service, NIHR, or the United Kingdom Department of Health.

Figures

**Figure 1**
An ideal task-sharing model divided into three phases of training, practice, and maintenance of providers.

**Figure 2**
Cartographic depiction of where low- and middle-income countries survey respondents were located.

**Figure 3**
World Health Organization Regions of survey respondents.

**Figure 4**
Complexity of procedures performed by neurosurgeons and task-shifting and task-sharing providers. (A) Who performs neurosurgery at the country level. (B) The reported complexity of surgeries performed according to provider level. The x-axis reflects the number of responses.

**Figure 5**
Types of procedures performed by task-shifting and task-sharing providers.

See this image and copyright information in PMC

References

1. Burton A. Training non-physicians as neurosurgeons in sub-Saharan Africa. Lancet Neurol. 2017;16:684–685. - PubMed
1. Bartelme T. Beacon Press; Boston, MA: 2017. A Surgeon in the Village: An American Doctor Teaches Brain Surgery in Africa.
1. World Health Organization . World Health Organization; Geneva: 2008. Task Shifting: Global Recommendations and Guidelines.
1. Meara J.G., Leather A.J., Hagander L. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Surgery. 2015;158:3–6. - PubMed
1. Mullan F., Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007;370:2158–2163. - PubMed

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Task-Shifting and Task-Sharing in Neurosurgery: An International Survey of Current Practices in Low- and Middle-Income Countries

Collaborators

Affiliations

Task-Shifting and Task-Sharing in Neurosurgery: An International Survey of Current Practices in Low- and Middle-Income Countries

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources