Table 2.

Details of Task-Shifting and Task-Sharing Training Programs Where Respondents Noted that Neurosurgical Task-Shifting and Task-Sharing Was Occurring in Their Respective Countries

Country	TS/S Provider Type	Ministry of Health Endorsed (Subjective)	Standardized Training	Length of Training Required	Location of Training	Method of Training	Who Leads Training	Comments
Belarus	GS	Unsure	No	–—	—	—	—	—
Cameroon	GS	Yes	No	—	—	—	—	—
Democratic Republic of the Congo	GS	No	No	Not standardized	Not standardized	Not standardized	NS	They have to seek permission from consultants for every operation
Egypt	Not available	Yes	No	2–3 years	Referral hospitals	Clinical experience		Minimal cases/emergencies can be performed by uncertified NS
Ethiopia	GS	Yes	No	1 month; 3 months	Teaching hospital	Clinical experience; assist emergency surgery	NS	They perform the surgeries in district hospitals and/or where NS are unavailable, and when patients are unable to be referred because of financial reasons or rapid deterioration
India	GS	No/Unsure	No	Unstructured not allowed	—	—	—	TS/S is variable, practiced in few institutions, or in rural practice. Not regulated. It depends on the senior neurosurgical consultant covering the region
Indonesia	GS	Yes	Yes	1–2 months	NS unit, all centers	Part of general surgery training	NS	General surgeons have autonomy to perform emergency neurosurgery such as burr-hole evacuation of epidural hematoma in remote areas in which referral to neurosurgeons is time consuming or impossible
Kenya	GS	No	No	—	—	—	—	—
Malawi	GP, NPP	Yes	No	—	—	—	—	A neurosurgeon is not always available to supervise them but they are encouraged to consult if in any case they are in doubt or it is beyond their scope of training or experience. All complicated cases within their scope must be referred. All cases outside their scope must be referred
Malaysia	GS	Yes	Yes	3 months	NS center	Part of general surgery training	NS	No formal training program available, GS must obtain endorsement by the head of department in each hospital (for hospitals without NS)
Morocco	GS, GP, NPP	No	No	3 months	France	Observation; clinical experience	NS	—
Namibia	GS, GP	Unsure	No	—	—	—	—	They perform burr-hole and ventriculoperitoneal shunts. Mostly alone (without supervision)
Nigeria	GS, GP	Yes	Yes	3 months; trauma surgery training only	NS unit; trauma surgery	Observation/hands-on for highly motivated; part of GS training	NS; trauma surgeons	No task shifting, but task sharing practiced and encouraged, mostly in rural areas with no NS supervision. Only resuscitate, then refer to NS. Such providers do personally refer patients they are unable to handle or with resultant complications from their procedures to trained NS
Pakistan	GS	No	No	2 years	Postgraduate medical institute	Local curriculum authorities	—	TS/S is practiced in teaching hospitals with cover and in private practice groups. I know of those who have almost completed their training but unfortunately could not clear their exit exams [but still perform NS]
Philippines	GS	No	No	3 months	Government teaching hospital	Direct supervision on rotation	NS	Basic emergency trauma procedures that are lifesaving for exigency purposes
Sri Lanka	GS	Yes	No	6 months	Same hospital as GS training	Clinical experience	NS	—
Sudan	GS, GP	No	Yes (only for board-certified NS)	TS/S training unclear	—	—	—	Traditionally refer to advance NS trauma center. TS/S not allowed apart from burr hole in remote area for lifesaving surgery. We have a specialized local board (for clinical approval)
Tanzania	GS, GP	Unsure	No	Not specified	Local hospital	Assist in surgery	—	Training of uncertified neurosurgeons happens accidentally/not planned. When one meets an interested trainee, it occurs briefly and unsupervised. No one is sure whether the actual neurosurgery practice continues after the training
Thailand	GS	Unsure	Yes	3 months	University hospital	—	NS	—
Zimbabwe	GS	No	No	—	—	—	—	—

TS/S, task-shifting and task-sharing; GS, general surgeon; NS, specialist neurosurgeon; GP, general practitioner; NPP, nonphysician provider.