Neurological care is forgotten in Africa

*Common neurological disorders

If the World Health Organisation’s (WHO’s) dream of a Universal Health Coverage (UHC) means “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship,” then African governments must rethink the way they look at neurological care across the continent.

And if UHC means that health must cover the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course, then Africans who need neurological care are being shortchanged.

The WHO also notes that, to achieve UHC, the  delivery of these services requires that health and care workers with an optimal skills mix at all levels of the health system, who are equitably distributed, are adequately supported with access to quality assured products, and enjoy decent work. Unfortunately, this is not the case across the continent when it comes to neurological care.

In fact those seeking neurological care are not protected from the “financial consequences of paying for health services out of their own pockets,” in order to reduce “the risk that people will be pushed into poverty because the cost of needed services and treatments requires them to use up their life savings, sell assets, or borrow – destroying their futures and often those of their children,” as the WHO would like to see.

Anyone who has needed neurological care in Africa will notice that these services have virtually been relegated to the background. Some people may argue that health issues generally, have not been properly tackled on the continent. But we cannot simply continue to live taking people’s lives for granted. It is also true that African countries are facing financial constraints, but with careful planning, there should be provision made for every sector of healthcare.

Perhaps, it is because those in the political class have the privilege of travelling abroad for treatment, for this reason, they  do not care so much about the ordinary people. It is also for the same reason that hospitals are built and what is needed to make these facilities work are not put in place.

In Ghana,  for instance, most public hospitals do not have well-equipped facilities for imaging and patients are forced to use privately owned laboratories for testing and scanning, which are very expensive. The sad part of the story is that these private facilities are mainly in the capital. So, those who live in the rural areas, may not have the opportunity to be properly diagnosed. It is no wonder that rural dwellers prefer prayer camps for conditions that could be better managed in hospital settings.

It has also been  shown that, because very little is being done to train personnel as well as equip medical facilities to cure those who suffer from neurological  conditions, those who need care across the continent, just leave everything to God. In fact, if you  do not have the money to support the expensive laboratory tests and scans, then, God save you!

A neurological condition is any health issue that affects the brain, spinal cord and/or nerves. Because these systems control your mind and body,  these conditions can affect the way you think and feel as well as interact with the world.

These conditions include, stroke, neonatal encephalopathy (brain injury), migraine, dementia, diabetic neuropathy (nerve damage), meningitis, epilepsy, neurological complications from preterm birth, autism spectrum disorder, and nervous system cancers.

In a news release last month, the World Health Organisation (WHO) said, neurological conditions are now the leading cause of ill health and disability worldwide. The overall amount of disability, illness, and premature death (known as disability-adjusted life years, DALYs) caused by neurological conditions has increased by 18 percent since 1990.

The WHO said over 80 percent of neurological deaths and health loss occurs in low- and middle-income countries, and access to treatment varies widely: high-income countries have up to 70 times more neurological professionals per 100 000 people than low- and middle-income countries.

Sadly, these conditions are killing some people because  laboratories are not well equipped to do the right tests,  and  in some cases, the facilities just exist in name. So, a headache that may be the underlying factor for a serious neurological condition, may not be detected. Thus, it  is possible that a patient reporting to a deprived health facility may not be properly investigated, and so will end up being  pumped with pain killers for a long time, and then, death will come for him/her.

It is against  this background, that a  study, “Assessment of the Neurosurgical Capacity in Ghana: Challenges and Opportunities on the Ghanaian situation,” which was published by the World Neurosurgery in November 2022, can be said to have given an insight into  how neurological care is not meeting the needs of the people.

The researchers said Ghana has only 25 neurosurgeons in 11 hospitals that serve the population with a neurosurgeon-to-population ratio of 1:1,240,000 working under constraints that include limited access to equipment (e.g., CT and MRI scanners) and infrastructural support (e.g., ICUs, neurocritical care).

They said improving  neurosurgical care in Ghana, as in other LMICs, will require a concerted effort by neurosurgeons, neurologists, intensivists, anaesthesiologists, nurses, rehabilitation specialists, and health care administrators. Unfortunately, these professionals do not exist in their numbers to provide effective care.

The study said there are only 25 neurosurgeons that serve 31 million inhabitants with a ratio of 1:1,240,000 and eight neurosurgical trainees from two training programmes. In addition, access to neurological care  is available in only four of the 16 regions in the country, implying that inhabitants from 12 regions (75%) do not have access to neurosurgical care at all. This is astounding, as these regions account for almost half of the population of Ghana.

In Nigeria, the situation is not different. Three years ago, the Punch newspaper said, the country had only 97 neurosurgeons to cater for the medical needs of the country’s  population, estimated to be over 200 million. This is a far cry from at least 2,000 neurosurgeons that should reasonably serve the population, experts say.

Nigerian experts say it takes an average of seven to eight years to qualify as a neurosurgeon after medical school. They said the reason neurosurgeons are scarce is because in most Nigerian hospitals, there are no  facilities for them to work and it takes a longer time to train one. Besides all these, the job is so demanding that neurosurgeons have no time for extracurricular activities or family; training is very hard and difficult. The surgeries they perform are very delicate, difficult, and take a long time.

The researchers of the study on Ghana said their work involved a 19-item survey questionnaire that was developed to assess the nature of neurosurgical care in the country. They then conducted semi-structured interviews either virtually or in person with consultant neurosurgeons and trainee neurosurgeons between November 8, 2021, and January 20, 2022.

With no available  database of consultant neurosurgeons and trainees, these individuals were identified via personal and professional networks (e.g., Ghanaian Association of Neurological Surgeons)

There were 25 consultant neurosurgeons and eight neurosurgical trainees (from two training centres) identified at 11 hospitals in Ghana totalling a workforce density of one neurosurgeon per 1,240,000. Most neurosurgical centres were located in Accra, the capital. Almost half of the population did not have access to a hospital with a neurosurgeon in their region.

Of hospitals, 82 percent had in-house computed tomography and/or magnetic resonance imaging scanners. In the operating room, most neurosurgeons had access to a high-speed drill (91%) but lacked microscopes and endoscopic sets (only 64% and 36% had these tools, respectively).

There were no neurointensivists or neurological intensive care units in the entire country, and there was a paucity of neurovascular surgeries and functional neurosurgical procedures.

This gloomy picture, painted by the study on Ghana, and from what was said about Nigeria, two countries in the West Africa region that show some form of leadership, indicate that neighbouring countries may be in dire situations. The problem may be due to the fact that policy makers do not really understand what neurological care is all  about. It does look also that the long time that it takes to train professionals in this field has made it unattractive. It means that there should be some change of heart by policy makers to improve the situation.

In fact, we do not need to wait anymore as many people are suffering silently because of this neglect of the sector. 

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