Neuromodulation in African Health Systems: Barriers, Opportunities, and Future Directions

Neuromodulation includes a spectrum of therapeutic interventions that have transformed the management of neurologic and psychiatric conditions globally. Africa bears a disproportionate burden of neurologic diseases, yet remains underrepresented in neuromodulation research and clinical practice. This review aimed to synthesize the available evidence on neuromodulation practice and research across African health systems, identify key barriers and opportunities, and propose future directions to expand equitable access.

A literature search was conducted across PubMed, Scopus, Web of Science, Embase, and African Journals Online from inception to March 2026, combining neuromodulation modality terms with African country and regional identifiers. A narrative synthesis approach was adopted, organized thematically by modality, and supplemented with an analysis of barriers, opportunities, and future directions.

Electroconvulsive therapy (ECT) is the most practiced neuromodulation modality in Africa, but it is delivered inconsistently, with unmodified ECT still being practiced in some countries owing to resource constraints. Deep brain stimulation programs exist in only four to five countries, principally in Algeria, Egypt, Morocco, South Africa, and Tunisia, and serve a minute fraction of the eligible patients. Evidence for the use of transcranial magnetic stimulation in Africa is sparse and is largely confined to North and Southern Africa. Transcranial direct current stimulation (tDCS), despite being suitable for low-resource settings, is almost absent from African literature. Vagus nerve stimulation, spinal cord stimulation, and peripheral nerve stimulation are undocumented across the continent. African populations are excluded from global neuromodulation clinical trials. Barriers identified include severe neurologic workforce shortages, prohibitive costs of devices and procedures, inadequate infrastructure, the absence of national regulatory frameworks, cultural stigma, and systemic underrepresentation in research. Opportunities include piloting tDCS as a practical, low-cost option, pending African-specific feasibility and efficacy data; telemedicine-enabled remote neuromodulation delivery; deliberate inclusion of African sites in international trials; carefully governed task-sharing with allied health workers; and development of regional centers of excellence.

Neuromodulation remains largely absent from the published record on African health systems, despite the continent's growing burden of neurologic diseases. This reflects the available evidence rather than a definitive absence of clinical practice. Addressing this equity gap requires sustained investment in African-led research, workforce development, regulatory frameworks, and international research partnerships.