Cohesion between Research Literature and Health System Level Efforts to Address Global Neurosurgical Inequity: a scoping review

Abstract Introduction Research output on global neurosurgery (GNS) has exponentially grown in recent years. As research efforts grow, we must first analyze how the current body of GNS literature fits into the macroscopic schema of systems-based policies. The aim of this study was to identify and categorize GNS research based on health system domains. Methods PubMed, CINAHL, and EMBASE were searched for GNS literature published from 1999 to 2019. Then health system domains were defined and itemized based on publicly available documents from the Program in Global Surgery and Social Change (PGSSC). This items chart was subsequently used to categorize the GNS literature into health system domains. Results A total 63 manuscripts were determined to focus on a health system-domain. Of these, 6 manuscripts focused on multiple domains, yielding an adjusted total of 70 manuscripts. Overall, the most represented health system domain was Service Delivery (21 manuscripts), followed by Workforce (19), Infrastructure (15), Financing (12) and Information Management (3). A total of 30 LMICs were represented across all manuscripts. In addition, the first author was affiliated with an institution from a high-income country for 71.4% of the manuscripts. Conclusion This review highlighted the pressing need for more research into Information Management in the context of GNS. In addition, health system-focused GNS literature only represented 20% of all LMICs (30/143). Lastly, the trends in authorship should be noted, as many ethical (and practical) issues may arise if there is a disconnect in the objectives of the authors and the neurosurgeons in LMICs.