Article outlines workforce shortages, systemic barriers, and policy strategies affecting neurosurgical care worldwide

Access to safe and timely neurosurgical care remains limited in most parts of the world. In a correspondence published in the Chinese Neurosurgical Journal, the authors examine persistent global inequities in the neurosurgical workforce and access to care. Drawing on existing workforce data and international policy frameworks, they highlight a growing mismatch between neurosurgical demand and available expertise, particularly in resource-limited settings.

Neurological disorders contribute to nearly nine million deaths globally each year, and an estimated 22.6 million new cases require neurosurgical attention annually, of which approximately 13.8 million require surgical intervention. Despite this burden, access to safe and timely neurosurgical care remains limited for more than two-thirds of the world’s population, particularly in low- and middle-income countries (LMICs). This gap has increasingly been recognized as a major global public health concern.

A new article, published on November 20, 2025, in the print and online versions of the Chinese Neurosurgical Journal, authored by researchers from Kandahar University, led by Dr. Ehsanullah Alokozay, discusses global neurosurgical workforce shortages, systemic barriers, and policy strategies shaping access to care worldwide.

A central challenge identified is the global shortage of trained neurosurgeons. Current estimates suggest a deficit of approximately 23,300 neurosurgeons worldwide, with the most severe shortages concentrated in Africa and Southeast Asia. Many countries remain below the minimum workforce target of 0.5 neurosurgeons per 100,000 population, a level widely regarded as necessary to meet essential neurosurgical needs. If current trends persist, more than half of LMICs are projected to miss this benchmark.

“The correspondence emphasizes that increasing workforce numbers alone will be insufficient to address these gaps. Structural barriers continue to limit training, retention, and career progression, particularly in LMICs,” highlights Dr. Alokozay. Limited access to advanced training, insufficient funding, lack of structured mentorship, and significant work–life imbalance—reported by approximately 87–90% of early-career neurosurgeons—are commonly cited challenges, particularly in LMICs. These factors contribute to burnout and undermine long-term workforce sustainability.

Beyond structural limitations, persistent inequities related to gender and race further constrain workforce development. Disparities in career advancement highlight the need for more inclusive professional environments that support retention and leadership development. According to the authors, addressing these inequities is essential for building a resilient neurosurgical workforce capable of meeting rising global demand.

To reduce disparities, the authors point to policy-level and system-level strategies that embed neurosurgical care within broader health planning. Integration of neurosurgical services into National Surgical, Obstetric, and Anesthesia Plans is highlighted as a key recommendation, aligned with priorities outlined in the Boston Declaration 2025. Such integration allows workforce development and service delivery to be aligned with long-term national health strategies.

Global policy initiatives, including the World Health Organization’s Intersectoral Global Action Plan on epilepsy and other neurological disorders, further reinforce the importance of integrating neurological and neurosurgical care into primary health systems. Alignment with these frameworks supports coordinated investment, accountability, and evidence-based decision-making.

Telemedicine is also presented as a complementary approach to expanding access to neurosurgical expertise. Remote consultations, virtual training, and postoperative follow-up have shown potential to reduce travel burdens and improve continuity of care. However, the authors note that infrastructure limitations, regulatory challenges, and workforce capacity constraints remain significant barriers in many LMICs.

The correspondence concludes that closing gaps in global neurosurgical care will require sustained investment, evidence-driven policy reform, and coordinated global collaboration. “Strengthening the neurosurgical workforce, addressing systemic barriers, and embedding neurosurgical services within broader health frameworks are identified as critical steps toward achieving equitable access to care worldwide,” concludes Dr. Alokozay.

Reference
Title of original paper: Addressing global disparities in neurosurgical workforce and access to care
Journal: Chinese Neurosurgical Journal
DOI: 10.1186/s41016-025-00419-1


About Kandahar University
Kandahar University is a public higher education institution in Kandahar, Afghanistan, established in 1990 under the Ministry of Higher Education. It offers undergraduate and postgraduate programs across disciplines, including medicine, engineering, agriculture, law, economics, education, and computer science, serving as a key academic hub in southern Afghanistan.


About Dr. Ehsanullah Alokozay from Kandahar University

Dr. Ehsanullah Alokozay is a medical academic and researcher affiliated with the Faculty of Medicine, Kandahar University, Afghanistan. His scholarly work focuses on clinical medicine and global public health, with particular attention to healthcare access and workforce disparities in low-resource settings. He has contributed to peer-reviewed international journals, including correspondence and research articles addressing maternal health outcomes and neurosurgical workforce inequities. Through his research, Alokozay highlights structural gaps in healthcare delivery in Afghanistan and comparable regions, aiming to inform policy discussions and strengthen evidence-based medical practice in resource-limited health systems.


Funding information
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.