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The field of global surgery has gained attention since the publication of the Lancet Commission landmark report in 2015. The authors estimated that 5 billion people worldwide do not have access to safe, affordable surgical and anesthesia services. The paper “Global Neurosurgery: The Unmet Need,” published in 2016, launched the modern global neurosurgery era by advocating for the system-level thinking and programs required to address limited neurosurgical care in low-resource settings. At present, many individuals, academic institutions, governmental agencies, and nongovernmental organizations (NGOs) are involved in the global neurosurgery movement. These include the Program in Global Surgery and Social Change at Harvard Medical School, Duke Global Neurology and Neurosurgery, Weill Cornell Tanzania Neurosurgery Project, CURE Children’s Hospital of Uganda, and the Virtue Foundation in Mongolia. Nonetheless, as global neurosurgery efforts continue to expand, it is essential to align global neurosurgery activity in order to prevent duplication of effort. In 2019, the World Federation of Neurosurgical Societies (WFNS) established the Global Neurosurgery Committee (GNC) to promote access to safe, affordable, and timely neurosurgical care worldwide. The GNC initially included five primary objectives – Amplify, Align, Advance, Assimilate, and Advocate – with the sixth objective, Communication, added in 2021. In this manuscript, we provide an update on the Align objective team.

Background Every year, there are an estimated 22.6 million new neurosurgical consultative cases worldwide, of which 13.8 million require surgery. In 2016, the global neurosurgical workforce was estimated and mapped as open-access information to guide neurosurgeons, affiliates, and policymakers. Here we present a subsequent investigation for mapping the global neurosurgical workforce for the year 2018 to demonstrate the replicability of prior data collection methods as well as show any changes in workforce density. Methods We extracted data on the absolute number of neurosurgeons per low and middle-income countries (LMICs) in 2016 from the database of the global neurosurgical workforce mapping project. The estimated number of neurosurgeons in each LMIC during the year 2018 was obtained from collaborators. The median workforce densities were calculated for the year 2016 and the year 2018. Neurosurgical workforce density heat maps were generated. Results We received data from 119 countries (response rate 86.2%) and imputed data for 19 (13.8%) countries. 78 (56.5%, n=138) countries had an increase in their number of neurosurgeons, 9 (6.5%) showed a decrease, while 51 (37.0%) had the same number of neurosurgeons in both years. The pooled median increased from 0.17 (IQR=0.54) in 2016 to 0.18 (IQR=0.59) in 2018. Conclusions Overall, the density of the neurosurgical workforce has increased from 2016 to 2018. However, at the current rate, 80 (58.0%) LMICs will not meet the neurosurgical workforce density target by 2030.

As progress is gradually being made toward increased representation and retention of women in neurosurgery, the neurosurgical community should elevate effective efforts that may be driving positive change. Here, the authors describe explicit efforts by the neurosurgery community to empower and expand representation of women in neurosurgery, among which they identified four themes: 1) formal mentorship channels; 2) scholarships and awards; 3) training and exposure opportunities; and 4) infrastructural approaches. Ultimately, a data-driven approach is needed to improve representation and empowerment of women in neurosurgery and to best direct the neurosurgical community’s efforts across the globe.