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

Abstract Background As nearly 23,000 more neurosurgeons are needed globally to address 5 million essential neurosurgical cases that go untreated each year, there is a growing interest in task-shifting and task-sharing (TS/S), delegating neurosurgical tasks to non-specialists, 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. Methods 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, emailing lists, and social media platforms. Country-level data were analyzed by descriptive statistics. Results The survey yielded 127 responses from 46 LMICs; 21 countries (45.7%) reported ongoing TS/S. The majority of TS/S procedures involved emergency interventions; the top three being burr holes, craniotomy for hematoma evacuation, and external ventricular drain. A majority (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%), maintenance of certification (9.4%), or receive remuneration (4.2%). Conclusion 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 elevate the level of TS/S care while continuing to increase the specialist workforce.