Interpersonal and systemic factors in initiating, developing and maintaining collaborations between European neurosurgical departments and institutions in low-resources settings: A qualitative study

Brain and Spine, vol. 5, pp. 104303

Abstract

Introduction: Neurosurgical care in low- and middle-income countries faces persistent challenges, including insufficient infrastructure, lack of trained surgeons, and limited access to sustainable training programs. Collaborative initiatives with high-income countries aim to address these gaps. However, in-depth studies of European-led partnerships and the interpersonal and systemic factors underpinning their success remain limited. Research question: What are the most salient interpersonal and systemic factors relevant to the a) initiation, b) development, and c) maintenance of effective and sustainable collaborations between European neurosurgical departments and institutions in resource-limited settings? Material and methods: We conducted a prospective qualitative study using semi-structured interviews with fourteen matched neurosurgeons-seven from European centers and seven from LMIC institutions-engaged in such collaborations. Data were collected virtually between May and August 2024. Transcripts were analyzed thematically to identify major themes, which were coded and categorized. Results: Twelve themes emerged, grouped into three stages: a) initiation: trust and personal connections, systematic planning and foundations, local context and needs, institutional and government support; b) development: capacity building and skills development, academic and research growth, challenges to development and adaptation; c) maintenance: sustainability and independence, resources and logistical support, communication and continuous commitment, outcome measures and accountability, and challenges to maintenance and advices for continuity. Discussion and conclusions: Findings highlight recurring interpersonal and systemic dynamics central to successful long-term partnerships. This study provides context-specific, real-world insights into their practical execution. Future efforts should focus on developing targeted recommendations to strengthen global neurosurgical collaborations and address inequities in access to care.

Authors 16

1. Nicolò Marchesini corresponding Aachen

   Leiden University Medical Center · Azienda Ospedaliera Universitaria Integrata Verona · European Association of Neurosurgical Societies

   Affiliation as printed

   Department of Neurosurgery, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy

   Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium

   Leiden University Medical Center (LUMC), Leiden, the Netherlands

2. Vicki Marie Butenschoen

   European Association of Neurosurgical Societies · Technical University of Munich

   Affiliation as printed

   Department of Neurosurgery, Technical University Munich, School of Medicine, Munich, Germany

   Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium

3. Andreas Kyriacou Demetriades

   NHS Lothian · Edinburgh Royal Infirmary · European Association of Neurosurgical Societies

   Affiliation as printed

   Department of Neurosurgery, Royal Infirmary Edinburgh, NHS Lothian, Edinburgh, United Kingdom

   Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium

4. Said Idrissa Ahmada
   Affiliation as printed

   Department of Neurosurgery (NED Institute), Mnazi MMoja Hospital, Zanzibar, Tanzania

5. Thomas Kapapa

   Universität Ulm · University Hospital Ulm

   Affiliation as printed

   Department of Neurosurgery, Ulm University Hospital, Ulm, Germany

6. Patrick Dongosolo Kamalo

   Ministry of Health · Queen Elizabeth Central Hospital

   Affiliation as printed

   Blantyre Institute of Neurological Sciences, Department of Neurosurgery, Queen Elizabeth Central Hospital, Ministry of Health, Blantyre, Malawi

7. Pablo González-López

   University of Alicante · Hospital General Universitario de Alicante Doctor Balmis · European Association of Neurosurgical Societies

   Affiliation as printed

   Department of Neurosurgery, Hospital General Universitario Alicante, Alicante, Spain

   Department of Optics, Pharmacology and Anatomy, University of Alicante, Alicante, Spain

   Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium

8. Rupavathana Mahesparan

   Haukeland University Hospital · European Association of Neurosurgical Societies

   Affiliation as printed

   Department of Neurosurgery, Haukeland University, Bergen, Norway

   Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium

9. Ondra Petr

   Innsbruck Medical University · Universität Innsbruck · European Association of Neurosurgical Societies

   Affiliation as printed

   Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

   Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium

10. Wilco C. Peul
    Affiliation as printed

    Department of Neurosurgery, University Neurosurgical Center Holland, UMC | HMC | HAGA, Leiden, The Hague, the Netherlands

11. Nicephorus Boniface Rutabasibwa

    Muhimbili Orthopaedic Institute

    Affiliation as printed

    Department of Neurosurgery, Muhimbili Orthopaedic Institute (MOI), Dar es Salaam, Tanzania

12. Ellianne J. dos Santos Rubio

    Curaçao Medical Center · European Association of Neurosurgical Societies

    Affiliation as printed

    Department of Neurosurgery, Curaçao Medical Center, Willemstad, Curaçao

    Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium

13. Abenezer Tirsit

    Addis Ababa University

    Affiliation as printed

    Division of Neurosurgery, Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia

14. Jake Timothy

    Leeds General Infirmary · European Association of Neurosurgical Societies

    Affiliation as printed

    Department of Neurosurgery, Leeds General Infirmary, Leeds, United Kingdom

    Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium

15. Enoch Ogbonnaya Uche

    University of Nigeria

    Affiliation as printed

    Division of Neurosurgery, College of Medicine, University of Nigeria Nsukka, Ituku, Enugu, Nigeria

16. Magnus Tisell

    European Association of Neurosurgical Societies · University of Gothenburg

    Affiliation as printed

    Department of Neurosurgery, University of Gothenburg, Gothenburg, Sweden

    Global and Humanitarian Neurosurgery Committee, European Association of Neurosurgical Societies (EANS), Brussels, Belgium