• Muhammad Shakir, Syeda Fatima Shariq, Hammad Atif Irshad, Aly Hamza Khowaja, Izza Tahir, Ali I Rae, Radzi Hamzah, Saksham Gupta, Kee B Park, and Syed Ather Enam.
• Section of Neurosurgery, Department Aga Khan University Hospital, Karachi, Pakistan; Centre of Oncological Research in Surgery (COORS), Juma Research Laboratories, Aga Khan University, Karachi, Pakistan.
• World Neurosurg. 2024 Oct 1; 190: 399407.e3399-407.e3.

BackgroundLow- and middle-income countries (LMICs) often struggle to provide adequate neurosurgical care due to poor governance and institutional efforts, making access to care difficult. Therefore, our review of literature aims to identify gaps in government, national, and institutional efforts to combat barriers to neurosurgical care of brain tumors in LMICs, to inform future policy and action planning.MethodsA comprehensive literature search was conducted using PubMed, Scopus, Google Scholar, and CINAHL without language restrictions from inception to October 20, 2022. After screening and data extraction, a thematic analysis based on the National Surgical, Obstetric, and Anesthesia Plan (NSOAP) systematically identified and classified notable themes, which were then quantified and presented as percentages.ResultsA total of 12 studies were included in the final analysis. The review highlighted some of the barriers to providing surgical care of brain tumors in LMICs, including political instability (14%), inadequate national budget for health care (43%), poor government support (14%), lack of support of hospital management (14%), and no coverage under national insurance plans (14%). Strategies that can be implemented to address the barriers include strengthening the local health system (17%), advocating for health ministry support (33%), developing national treatment guidelines (17%), making neurosurgery a part of the national surgical plan (17%), fostering collaborations across various levels of government (17%), changing national insurance policy to include neurosurgical care (17%), and advocating for more resources and changes in global care (33%).ConclusionsEffective governance plays a critical role in addressing challenges as it shapes the availability of resources and policies that affect the quality of care provided. Our study outlines key challenges and strategies reported within literature in an attempt to drive government attention and thereby policy to support the neurosurgical care of brain tumors, particularly in the developing world.Copyright © 2024 Elsevier Inc. All rights reserved.

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