Medical Student SUNY Downstate College of Medicine
Introduction: Since its independence from India in 1947, Pakistan has struggled with global debt, corruption, constant regime change, and a decades-long war against terrorism. The socioeconomic consequences of this history stymied the advancement of health equity in Pakistan, especially in regard to surgical care. We sought to better understand the determinants of access to neurosurgical care in Pakistan by assessing the evolution of neurosurgery in this South Asian lower-middle-income country.
Methods: We queried the PubMed/Medline database to review and perform bibliometrics on the existing literature addressing neurosurgery in Pakistan. We also performed an ecological study of Pakistan’s neurosurgical disease burden by collecting relevant population health data from the databases of the World Bank and the Institute of Health Metrics and Evaluation. Finally, we conducted personal interviews with key informants to better understand the context and landscape of neurosurgery in Pakistan.
Results: Pakistan’s neurosurgical workforce has demonstrated rapid growth over the last two decades, with approximately 450 neurosurgeons, i.e. a neurosurgeon-per-100,000-population density of 0.114. However, the neurosurgeon distribution is limited to developed cities, creating accessibility barriers for patients from rural areas, especially those with brain and spine trauma, who have to travel long distances for care. Government-sponsored social welfare initiatives, such as the free health insurance scheme, help mitigate the financial burden of neurosurgical visits and procedures across provinces. With a majority of the population being under the poverty line, access to complex neurosurgical care for diseases such as neurotrauma, stroke, and brain tumors, is limited. Furthermore, the slow development of pre-hospital care contributes to the increasing number of deaths due to neurotrauma.
Conclusion : While the development of neurosurgery in Pakistan has made great strides in providing equitable neurosurgical care, the historical and contemporary impact of Pakistan’s sociopolitical and economic contexts represent important challenges to the continued development of neurosurgical capacity.
