The Current State of Neurosurgery in Nepal

Introduction: Five billion people worldwide lack access to essential surgical care despite surgical conditions accounting for one-third of the global burden of diseases. This burden is heaviest in developing countries like Nepal, where disparities in access to surgery for neurosurgical disorders stem from health system failures including an inadequate neurosurgical workforce, lack of requisite neurosurgical equipment, and challenges in perioperative care.

Methods: To characterize the current state of neurosurgery in Nepal, we searched PubMed using the term "Neurosurg* AND Nepal" and reviewed the bibliometric and literature trends of neurosurgery-related publications in Nepal over time. We also queried publicly available databases like the WFNS workforce map, the Global Atlas of Medical Devices (GAMD), the World Bank’s databank, and the database of the Institute of Health Metrics and Evaluation.

Results: Literature search yielded 390 results as of October 20, 2022. The number of relevant articles nearly doubled from 14 to 25 between 2015 and 2016. More than 150 articles were published in 2021 and 2022. The WFNS 2016 neurosurgery workforce map reports a neurosurgeon density of 0.166-per-100,000-population in Nepal vs. 0.130-, 0.270-, and 0.806-per-100,000-population in Bhutan, India, and China, respectively. The GAMD reports 11 radiotherapy apparatuses and 12 specialized hospitals in Nepal as of 2022. Between 2000 and 2019, mortality from non-communicable diseases like stroke, cancer, and falls has increased.

Conclusion : Access to neurosurgery in Nepal is a challenge that severely interferes with patients’ surgical care. Inadequate neurosurgical workforce and equipment hinder the capacity to perform neurosurgery. This study highlights opportunities for advancing neurosurgical capacity development and health equity in Nepal, especially as the country enters the final eight years of the UN’s global agenda for sustainable development by the year 2030.