Advancing access to emergency care for traumatic brain injuries in Indonesia: a national program integrating...

Severe shortages and geographic maldistribution of neurosurgeons continue to limit timely access to life-saving neurosurgical care in low- and middle-income countries, with Indonesia representing a particularly acute example due to its archipelagic geography, prolonged transfer times, and rising burden of traumatic brain injury and stroke. To address delays in emergency care in districts without neurosurgical coverage, Indonesia has launched a nationally endorsed neurosurgical task-sharing initiative in which selected general surgeons are trained to perform a restricted set of emergency cranial procedures under continuous neurosurgical oversight. This article describes the rationale, regulatory framework, and educational design of this national pilot program, initiated in late 2025. Developed collaboratively by the Ministry of Health, the Indonesian College of Neurosurgeons, and the Indonesian College of Surgeons, the program integrates formal ministerial authorization, defined eligibility criteria for hospitals and surgeons, and a three-phase competency-based training pathway. Training includes simulation-based education using virtual reality and locally produced three-dimensional printed cranial models, intensive supervised operative experience at accredited neurosurgical centers, and real-time tele-proctored emergency surgery in district hospitals. The operative scope is deliberately limited to decompressive craniotomy for epidural and subdural hematomas and decompressive craniectomy for selected hemorrhagic and non-hemorrhagic stroke. As implementation has only recently begun, clinical outcome data are not yet available. This manuscript is a descriptive account of one nation's plan to address limitations in access to care for common, life-threatening neurosurgical conditions. Future studies will describe governance, competency assessment, and prospective outcome monitoring of this novel program.