• Maria M Santos, Mubashir M Qureshi, Karol P Budohoski, Halinder S Mangat, Japhet G Ngerageza, Karsten Schöller, Hamisi K Shabani, Micaella R Zubkov, and Roger Härtl.
• Center for Global Health, Weill Cornell Medicine, New York, New York, USA; Department of Neurosurgery, Muhimbili Orthopedic/Neurosurgical Institute, Dar es Salaam, Tanzania.
• World Neurosurg. 2018 May 1; 113: 425-435.

AbstractAs the second of 3 articles in this series, the aim of this article is to provide readers with an understanding of the development of neurosurgery in East Africa (foundations), the challenges that arise in providing neurosurgical care in developing countries (challenges), and an overview of traditional and novel approaches to overcoming these challenges and improving health care in the region (innovations). Recognizing the challenges that need to be addressed is the first step to implementing efficient and qualified surgery delivery systems in low- and middle-income countries. We reviewed the major challenges facing health care in East Africa and grouped them into 5 categories: 1) burden of surgical disease and workforce crisis; 2) global health view of surgery as "the neglected stepchild"; 3) need for recognizing the surgical system as an interdependent network and importance of organizational and equipment deficits; 4) lack of education in the community, failure of primary care systems, and net result of overwhelming tertiary care systems; 5) personal and professional burnout as well as brain drain of promising human resources from low- and middle-income countries in East Africa and similar regions across the world. Each major challenge was detailed and analyzed by authors who have worked or are currently working in the region, providing a personal perspective.Copyright © 2018. Published by Elsevier Inc.

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