title: Assessing Barriers to Neurosurgical Care in Sub-Saharan Africa: The Role of Resources and Infrastructure.
abstract: BACKGROUND
  Quantitative estimates of surgical capacity and infrastructure and perceived care limitations in low-resource countries are essential baseline measures that can provide strategies for improving access to surgical care. Information about these barriers in Africa is scarce, particularly with respect to neurosurgery. We conducted a survey to better understand the unmet surgical need and resources available for the care of neurosurgery patients in Sub-Saharan Africa.
  
  
  METHODS
  Using SurveyMonkey, we administered a neurosurgery-specific survey to neurosurgery attending surgeons and residents in Sub-Saharan African countries. Key outcome measures included workforce, access to imaging modalities and instruments, volume and breakdown of neurosurgical cases, and perceived limitations of care.
  
  
  RESULTS
  We obtained a 41% survey response (129/314 sent). In addition to the expected large gap in workforce between low- and high-income countries, we found a dramatic paucity of neurosurgical resources in Central Africa, whereas specific pockets in West and South Africa have better neurosurgical care. Access to neuroimaging was not a major limitation in Sub-Saharan African countries. The most commonly perceived limitations of care included infrastructure, anesthesia/nursing availability, wait times, and strength of training.
  
  
  CONCLUSIONS
  This large survey defines important self-perceived limitations to care within neurosurgery and highlights the importance of infrastructure and allied professions in this role. A clear understanding of areas of focus will enable a more efficient and sustainable response to the limitations in surgical care in low-resource areas.
authors: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Elie
authors: E
authors: Sader
authors: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Philip
authors: P
authors: Yee
authors: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada. Electronic address: mojgan.hodaie@uhn.ca.
authors: Mojgan
authors: M
authors: Hodaie
mesh_terms: D017954:Africa South of the Sahara; D001509:Bed Occupancy / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006280:Health Workforce / Q000706:statistics & numerical data; D006801:Humans; D059906:Neuroimaging / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data*
keywords: Africa; Barriers to care; Global surgery; Neurosurgery education; Resource and care