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

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-inc...

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Published in:	World neurosurgery: X Vol. 6; p. 100059
Main Authors:	Robertson, Faith C., Esene, Ignatius N., Kolias, Angelos G., Kamalo, Patrick, Fieggen, Graham, Gormley, William B., Broekman, Marike L.D., Rosenfeld, Jeffrey, Balak, Naci, Ammar, Ahmed, Tisel, Magnus, Haglund, Michael, Smith, Timothy, Mendez, Ivar, Brennum, Jannick, Honeybul, Stephen, Matsumara, Akira, Muneza, Severien, Rosseau, Gail, Khan, Tariq, Misra, Basant, Bolles, Gene, Adelson, David, Dempsey, Robert, Hutchinson, Peter, Aklilu, Abenezer, Javier-Lizan, Abigail, Belhachmi, Adil, Khizar, Ahtesham, Tascu, Alexandru, Yalcinkaya, Ali, Ukacjukwu, Alvan-Emeka, Thapa, Amit, Gretschel, Armin, Sukumaran, Arvind, Vats, Atul, Jarad, Bakr Abo, Karmacharya, Balgopal, Chaurasia, Bipin, Liew, Boon Seng, Karekezi, Claire, Or, Cohen-Inbar, Sale, Danjuma, Kanesen, Davendran, Djilvesi, Djula, Nwaribe, Evarsitus, Mahmoud, M. Elhaj, Awais, Mian, Adeleye, Amos O., Agarwal, Manish, Ndubuisi Achebe, Sunday David, El Gaddafi, Walid, Uysal, Ece, Morgan, Eghosa, Buno, Elubabor, Sunday, Emmanuel, Constanzo, Felipe, Longo, Gabriel, Farooq, Ghulam, Dunia, Goertz Mirenge, Bot, Gyang Markus, Shabani, Hamisi K., Deora, Harch, Almenshawy, Hassan, Kuheil, Hazem, Maldonado, Igor Lima, Negoi, Ionut, Yousaf, Irfan, Abdullah, Jafri Malin, Golubovic, Jagos, Ayadi, Khalil, Limpastan, Kriengsak, Hodzic, Mirsad, Kassem, Mohamed, Al-Rawi, Mohammed, Tariq, Muhammad, Vyval, Mykola, Abuhadrous, Nidal, Syrmos, Nikolaos, Alser, Osaid, Wahjoepramono, Petra, Basaran, Recep, Bhoot, Ritesh, Amorim, Robson, Iliƒá, Rosanda, Wadanamby, Saman, Behari, Sanjay, Babu, Satish, Duong, Trung Kien, Laeke, Tsegazeab, Kanmounye, Ulrick S., Komar, Vladimir, George, Ipe Vazheeparambil, Hussain, Zahid, Lucena, Lynne Lourdes N., Ekouele Mbaki, Hugues Brieux, Kumwenda, Ken-Keller, Bah, Djvnaba, Bandoh, Dickson, Dakurah, Thomas
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-04-2020 Elsevier
Subjects:	Capacity Global health Global neurosurgery LMIC Original Task-sharing Task-shifting Workforce Global health Global neurosurgery Task-sharing DRC TS/S Capacity MOH LMIC Workforce Task-shifting DRC, Democratic Republic of the Congo LMIC, Low- and middle-income country TS/S, Task-shifting and task-sharing MOH, Ministry of Health
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Summary:	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. 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. 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%). 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2590-1397 2590-1397
DOI:	10.1016/j.wnsx.2019.100059