Pilot Use of a Novel Tool to Assess Neurosurgical Capacity in Uganda

World Neurosurg. 2017 Dec;108:844-849.e4. doi: 10.1016/j.wneu.2017.08.045. Epub 2017 Aug 18.


Introduction: There is a significant burden of unmet surgical need in many low- and middle-income countries (>80% in parts of Africa). This need is even larger for specialties such as neurosurgery. Surgical capacity tools have been developed and used to assess needs and plan for resource allocation. This study piloted a new tool to assess neurosurgical capacity and describes its use.

Methods: A surgical capacity tool was adapted to assess neurosurgical capacity. An expert panel of neurosurgeons and researchers reviewed the Surgeons OverSeas PIPES (personnel, infrastructure, procedures, equipment, and supplies) assessment and added additional items essential to perform common neurosurgery procedures. This tool was then piloted at 3 public hospitals in Uganda and each hospital was given a score of neurosurgical capacity. At 1 hospital, 3 respondents were asked to answer the survey to assess reliability.

Results: The hospital with the largest neurosurgery caseload and 5 neurosurgeons scored the highest on our survey, followed by a regional hospital with 1 practicing neurosurgeon. The third hospital, without a neurosurgeon, scored the lowest on the scale. At the hospital that completed the reliability assessment, scores were varied between respondents.

Conclusions: NeuroPIPES survey scores were in keeping with the number of neurosurgeons and respective caseloads of each hospital. However, the variation in scores between respondents at the same hospital suggests that adaptations could be made to the tool that may improve reliability and validity. The methodology used to create NeuroPIPES may be successfully applied to a variety of other surgical subspecialties for similar assessments.

Keywords: Neurosurgery; Sub-Saharan Africa; Surgical capacity; Uganda.

MeSH terms

  • Developing Countries*
  • Health Services Needs and Demand*
  • Health Workforce*
  • Hospitals, Public*
  • Humans
  • Neurosurgery*
  • Neurosurgical Procedures
  • Operating Rooms / standards
  • Operating Rooms / supply & distribution*
  • Pilot Projects
  • Reproducibility of Results
  • Surgical Equipment / standards
  • Surgical Equipment / supply & distribution*
  • Uganda