’Correspondence
Addressing Africa’s outrageous neurosurgeons
deficit: what could the problem be?
Andrew A. Wireko, MBBSa,*, Pearl O. Tenkorang, MBChBb, Jyi Cheng Ng, MDc, Lian David, MBBSd,
Rohan Yarlagadda, BSe, Toufik Abdul-Rahman, MBBSa,b, Vladyslav Sikora, MD, PhDa, Arda Isik, FEBS, FACS, MDf
Dear Editor, of practice[4]. Furthermore, complex cases and unexpected com-
Approximately 66% of the global population requires essen- plications necessitate highly trained neurosurgeons[4]. A scarcity
tial surgical care, with an unmet need putting a strain on of experienced neurosurgeons endangers patients and may
healthcare systems worldwide[1]. Neurosurgery crucially saves discourage communities from seeking neurosurgical care[4].
lives by intervening with complex and often treatment-refractory The interest in neurosurgery as a career path has grown in recent
cases of the central nervous system that can have far-reaching years; Dada et al.[5] reported that∼7%ofAfrican final yearmedical
consequences. The world is undeniably suffering from a severe students expressed an interest in the specialty. However, their
shortage of neurosurgeons, with recent statistics indicating that career success is hampered by several factors, including insufficient
there are only ∼49 940 neurosurgeons worldwide[1]. The number exposure to neurosurgical procedures, a lack of training opportu-
of neurosurgeons is further disproportionately distributed across nities, stringent application requirements to name a few. As a result,
the globe, with African countries bearing the brunt of the burden. themajority of medical students are unmotivated to pursue a career
Neurosurgical diseases in Africa are said to account for 15% of all in neurosurgery[5]. In general, neurosurgical residency demon-
neurosurgical diseases worldwide[2], but as of 2020, there were only strates residents taking complete responsibility for patient care.
1165 neurosurgeons on the African continent to meet this demand. Aspirants are unaware of the prerequisites, costs, and availability of
[6]
Even within Africa, there is an inequitable distribution of neuro- training opportunities . Mentors may also be unwilling to assist
surgeons,with 756out of 1165neurosurgeons located inNorthAfrica, and could be unavailable. There is scant information provided on
and the remaining 409 neurosurgeons located in Central, East, and the training program’s length of training, curriculum, and available
[6]
West Africa combined. The 409 neurosurgeons in those three African resources . For the aforementioned reasons, most African
regions equate to one neurosurgeon for every 2.2 million people[3]. residents do not consider neurosurgical training inAfrica, and those
Many African nations have attempted to address neurosurgi- who do begin eventually give up.
cal care deficits in several ways. Countries such as Malawi, In a rapidly modernizing world, African countries are unable
Mozambique, and Uganda have launched non-physician to compete with developed countries in terms of retaining health
neurosurgical training programs with the goal of training professionals, paralleling the migration of the most capable and
nonphysicians to perform life-saving surgeries including intelligent citizens to high-income and developed countries.
neurosurgery[4]. This initiative appears to have ameliorated the Inadvertently, Africa strengthens other countries’ healthcare
surgical workforce shortage and augmented neurosurgical systems through the loss of its exceptionally skilled healthcare
care[4]. Nonetheless, nonphysician surgeons are significantly professionals to these other nations. Several factors contribute to
limited in their training, and they are unable to meet the needs of the widespread emigration of African healthcare workers to
neurosurgical patients with conditions beyond their scope various developed countries. While economic pressures greatly
influence most African healthcare worker’s decisions to migrate,
a b there are several other factors. Subpar healthcare systems,Sumy State University, Sumy, Ukraine, University of Ghana Medical School, Accra,
Ghana, cFaculty of Medicine and Health Sciences, University of Putra Malaysia, insufficient training opportunities, day-to-day security issues, and
[7]
Serdang, Malaysia, dNorwich Medical School, University of East Anglia, Norwich, other factors are among them . In fact, the facilities in Africa are
UK, eRowan University School of Osteopathic Medicine, Stratford, New Jersey, USA mostly substandard, with a heavy workload and a high patient
and fDepartment of General Surgery, Istanbul Medeniyet University, Istanbul, Turkey load[7]. As a result, most African health workers believe they are
This manuscript has been peer reviewed. underpaid in comparison to what they would earn in these
Sponsorships or competing interests that may be relevant to content are disclosed at developed countries for even less work.
the end of this article. The appalling neurosurgeon-to-patient ratio in Africa may
*Corresponding author. Address: Zamonstanksya 7,3, Sumy 40007, Ukraine. result in the tragic loss of countless innocent lives. As a result, we
Telephone: +380632725660; E-mail address: andyvans36@yahoo.com (A.A. seek global attention to address Africa’s shocking neurosurgeon
Wireko).
shortage. Global partnerships, collaborations, and training pro-
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. This is an
open access article distributed under the terms of the Creative Commons grams should be well established to provide well-structured and
Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is standardized neurosurgical training in Africa. This could ensure
permissible to download and share the work provided it is properly cited. The work that quality training is delivered equally across the continent and
cannot be changed in any way or used commercially without permission from the limit the number of upcoming neurosurgeons who are trained in
journal. developed countries. This is due to the fact that the majority of
International Journal of Surgery (2023) 109:1808–1809 those who travel for such international training are reluctant to
Received 24 October 2022; Accepted 16 November 2022 return home due to the high quality of exposure they receive.
Published online 16 March 2023 African governments should also prioritize their healthcare sys-
http://dx.doi.org/10.1097/JS9.0000000000000048 tems and allocate funds for the establishment of modernized
1808
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Correspondence. International Journal of Surgery (2023)
healthcare facilities, particularly neurosurgery facilities in tertiary Research registration unique identifying number
hospitals to facilitate local neurosurgical training, as well as equip (UIN)
the hospitals with modern neurosurgical devices to provide safe
and effective neurosurgical care. African health institutions may Not applicable.
also invite international experts to train and mentor neuro-
surgical trainees in Africa. Furthermore, neurosurgeons should be
adequately compensated to avoid skilled personnel emigration Guarantor
due to financial issues. Most importantly, African neurosurgical
associations should be able to assist aspiring neurosurgeons in Andrew A. Wireko.
pursuing a lifelong career in neurosurgery through mentorships,
advocacy, and neurosurgery-focused career programs.
References
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1809
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