Introduction

The history of neurology dates back to the sixteenth century. This academic discipline however, developed in a systematic way over the period of time from an observational science to a systematic way of approaching the nervous system and possible interventions to deal with neurological diseases.¹

In today’s era of medical advancement, neurology has emerged as a super speciality of medicine ranging from acute care such as Stroke, Brain tumours, Head and Spinal injuries to long term care such as Alzheimer’s disease, Parkinson’s disease and Epilepsy.¹ With wealth of subspecialities and medical treatments, neurology is one of the most important, albeit complex clinical areas for Hospitals and Health systems to manage,¹ representing perhaps the widest range of any medical speciality.²

The purpose of this article is to review the neurological resources available in terms of number of neurological beds, number of neurologists, neurosurgeons, neuropae- diatricians and neurological nurses at the global level.

Availability of Neurological Beds at global level

A neurological bed is defined as a hospital bed maintained only for use by patients with neurological disorders on a continuous basis. Very few reports are available (16 countries from the European region) describing the availability of neurological beds. These beds should be located in public or private neurological hospitals, general hospitals or special hospitals for elderly people or children.³

In terms of population coverage, only 0.9% of people have access to more than one neurological bed per 100000 population globally. The median number of neurological beds per 100000 varies widely across regions. 0.003 in Africa and South -East Asia, 0.15 in Eastern Mediterranean, 0.17 in America, 0.26 in Western Pacific and 1.71 in Europe.

The median number of neurological beds per 100000 population across different income groups of countries also varies. 0.01 and 0.02 for low income and lower middle income countries, respectively, while the numbers are 0.18 for higher middle income countries and 0.07 for high-income countries.

Number of Neurologists at the global level

Neurologists are essential to deliver comprehensive neurological care. They are also important for providing training, support and supervision to nurses, other paramedical staff and primary health care providers in neurological care.

In terms of the population covered, 25% have access to more than one neurologist per 100000 population worldwide.3 The median number of neurologists per 100000 population also varies widely across regions. 0.03 in Africa, 0.07 in South-East Asia, 0.32 in the Eastern Mediterranean, 0.77 in the Western Pacific, 0.89 in the America and 4.84 in Europe.

Most of the countries in Africa and South-East Asia, 89% in Eastern Mediterranean, 67% in Western Pacific, 50% in America and 7% in Europe have less than one neurologist per 100000 population.³

In total, 85318 neurologists are reported to be available in 106 countries across the world. The median number of neurologists is 0.91 per 100000 population (interquartile range 0.18-4.48) globally.

Number of Neurosurgeons at global level

Neurosurgeons complement the services provided by neurologists, most importantly to provide surgical services for neurological conditions. They provide expert care at secondary and tertiary level for neurosurgical emergencies such as head trauma and haemorrhage and also surgical care for conditions such as space occupying lesions. In some places, neurosurgeons also provide care for people with neurological disorders. Training of general surgeons in neurosurgical emergencies is important in settings where it is not possible to have enough neurosurgeons at primary and secondary levels.

A total of 33193 neurosurgeons are reported to be available across the world. The median number of neurosurgeons is 0.56 per 100000 populations. (Interquartile range 0.07-1.02) globally.³

The distribution of neurosurgeons across regions is variable. The median number of neurosurgeons per 100000 population is 0.01 in Africa, 0.03 in South-east Asia, 0.37 in the Eastern Mediterranean, 0.39 in the Western Pacific, 0.76 in the America and 1.02 in Europe.

Number of Neuropaediatricians at the global level

Neuropaediatricians is a specialist (neurologist or paediatrician) who has atleast one year of recognized subspecialist training in Child Neurology.

It is also important to build the capacity of paediatricians who have a special interest in Neurology so that they can manage neurological diseases more effectively.

The median number of Neuropaediatricians per 100000 population is 0.10(interquartile range 0.01-0.42) at the global level. The median number of Neuropaediatricians per 100000 population varies widely across regions. It is 0 in Africa, 0.003 in South-east Asia, 0.06 in the Eastern Mediterranean, 0.08 in the Western Pacific, 0.12 in America and 0.47 in Europe. 87.8% of the countries have less than one neuropaediatricians per 100000 population. In fact, 23.5% of the countries do not have any Neuropaediatricians.³

In terms of population covered, more than one Neuropaediatricians per 100000 population is available for only 2.4% of the population. The median number of Neuropaediatricians per 100000 population across different income groups of countries also varies. It is 0.002 for low-income countries, compared to 0.25 for high-income countries. Even among high-income countries, only 7.7% of them have access to more than one Neuropaediatrician per 100000 population.

Number of Neurological Nurses at global level

Neurological nurses are important members of the team that provides comprehensive neurological care, training and supervision. In countries where no formal training facilities exist for neurological nursing, general nurses should be trained to provide specific neurological care.

A total of 54693 neurological nurses are reported to be available worldwide. The median number of neurological nurses is 0.11 per 100000 population (interquartile range 0-1.66) at the global level.

The median number of neurological nurses per 100000 population varies widely across regions. It is 0 in Africa, 0.005 in South-East Asia, 0.13 in the Eastern Mediterranean, 0.14 in America, 0.32 in Western Pacific and 2.43 in Europe.

At the global level, 71% have access to less than one neurological nurse per 100000 population. 39% have no neurological nurses. In terms of population covered, more than one neurological nurse per 100000 population is available for 36.4% of the population.

Regionally, most of the countries in Africa and South-East Asia, 90% in America and South East Asia, 90% in America, 87.5% in Western Pacific, 71.4% in Eastern Mediterranean and 41.9% in Europe have less than one neurological nurse per 100000 population.

There are more neurologists than neurological nurses in many of the countries (the ratio of neurological nurses to neurologists is less than one globally).⁴

Conclusion

An important neurological resource is the availability of hospital beds for neurological disorders. Designated neurological beds, though not essential are an important indicator of the level of organization of neurological services in a country. The median number of neurological beds available is 0.04 per 100000 population globally. In terms of population covered, only 0.9% have access to more than one neurological bed per 100000 population. Neurological beds are particularly deficient in the Africa and South-East Asian regions. The median number of neurological beds per 100000 population in low-income countries (0.03) is much lower than in high income countries (0.73). Separate neurological hospitals may be desirable, but a neurological inpatient facility as a part of general hospital is, however, needed to provide comprehensive neurological management.^3,4

The median number of neurologists is 0.91 per 100000 population at the global level. This deficiency is particularly evident in the Africa, South-East Asia, Eastern Mediterranean and Western Pacific regions. In terms of the population covered, only one quarter has access to more than one neurologist per 100000 population. The median number of neurologists per 100000 population is also much lower for low-income countries (0.03) compared with high-income countries (2.96). Recommendations regarding the required number of neurologists in a country are available from countries in the European region and the regions of the Americas, varying between 1 and 5 per 100000 population. The number of available neurologists in low-income countries is very much lower than any of these recommendations.³

The availability of other types of highly specialized personnel is also limited, with median numbers for neuropaediatricians and neurosurgeons being 0.10 and 0.56 per 100000 population respectively. Again, this deficiency is particularly evident in Africa, South-East Asia, the Eastern Mediterranean and the Western Pacific. In terms of population covered, more than one neuropaediatrician and neurosurgeon per 100000 population are available for only 2.2% and 15.1% of the population respectively. Such a situation is particularly evident in low-income countries, with only 0.02 neuropaediatrician and 0.03 neurosurgeons available per 100000 population.

Neurological nursing does not exist as a speciality in 41% of the countries at the global level. Three quarters of the countries at the global level have access to less than one neurological nurse per 100000 population. The median number of neurological nurses is 0.11 per 100000 population. While training for neurologists is being pursued, specialised neurological nursing training has been neglected even in the developed countries.3

Acknowledgement

I sincerely thank RD Birla Smark Kosh for supporting research studies for PhD.

References

1. Haugh R. “The Complex Business of Neurosciences”, Hospital and Health Networks, 2002: pp 24-30.
2. Brinker T, Gnack U. “From Neuroscience Service Center to Integrated Neuro Care”. Electromedica 68 - neuro 2000: pp52-58.
3. Atlas Country Resources for Neurological Disorders 2004-World Health Organization (Geneva), World Federation of Neurology (London).
4. The World Health Report 2003- Shaping the future, Geneva, World Health Organization, 2003.
5. Herzig R, et al. “The current availability of neurological inpatient services in post communist central and eastern European countries”, Neuroepidemiology, 2003.