Neurosurgical training in Africa. Part 2: Challenges and solutions for equitable access to neurosurgery

Equitable access to neurosurgery remains a critical challenge in East Africa, due to the shortage of specialists and the lack of structured training programmes. In this second part, the "Equip, Treat, and Educate" (ETE) model, developed by the NED Foundation, is analysed to promote sustainable neurosurgical training in resource-limited settings, in collaboration with COSECSA. A series of innovative initiatives with educational and social impact are also presented.

A retrospective review of the NED Foundation's activities between 2008 and 2024 was conducted, with special emphasis on actions carried out at the NED Institute in Zanzibar. The analysis included clinical data, training programmes, institutional cooperation, and outcomes associated with the ETE model, which is structured into three levels of increasing complexity.

During the analysed period, the NED Institute attended to more than 30,000 patients and performed 2537 free surgeries, with hydrocephalus being the most frequently treated condition. In parallel, more than 30 medical and nursing training courses were organised. In addition, thirteen key educational initiatives are proposed to strengthen local capacities, including practical workshops, surgical simulations, mentorship, rotational placements, international exchanges, scholarships, online training, and the development of open resources. These actions can enhance training quality, promote talent retention, and strengthen professional networks in the region.

The ETE model, in conjunction with the educational initiatives promoted by the NED Foundation and COSECSA, constitutes an effective and replicable strategy for strengthening neurosurgical training in low-income countries. This approach drives local professional development and enables progress towards more accessible, equitable, and sustainable neurosurgery.