# Governance and policy in global neurosurgery: a scoping review of national and international efforts

## TL;DR

This paper reviews how governments and organizations shape global neurosurgery policies to improve access and reduce disparities.

## Contribution

The study maps governmental stakeholders and their roles in advancing global neurosurgery through policy and funding.

## Key findings

- WHO is the most cited organization guiding global neurosurgical policy.
- National Ministries of Health are key in developing country-specific neurosurgery policies.
- International partnerships improve access in low-resource settings.

## Abstract

Governmental organizations play a key role in making Global Neurosurgery timely, safe, and accessible. They are essential in decreasing disparity and improving outcomes through informing policy, funding, and resource allocation. The Boston Declaration aims to promote collaboration between high-income and low- and middle-income countries in addressing these challenges and realizing more equitable access to neurosurgical care worldwide. To identify and map key governmental stakeholders in Global Neurosurgery, emphasizing their roles in policy development, funding, resource allocation, research support, capacity building, advocacy, and international cooperation in addressing unmet neurosurgical needs. We employed a mixed-methods approach, analyzing the roles of governmental organizations in neurosurgery. A comprehensive literature review was conducted using PubMed, Embase, and Global Index Medicus. Sources included Ministries of Health and National Institute of Neurological Disorders and Stroke (NINDS) websites, annual reports, social media, and world health organisation (WHO) documents. Inclusion criteria covered governmental organizations and health policy institutions; non-governmental organizations and those without documented impact were excluded. WHO was the most frequently cited organization (25%) guiding global neurosurgical policy. National Ministries of Health (23%) were pivotal in developing policy based on country-specific needs. Centers for Medicare and Medicaid Services were cited in 18%, reflecting their funding role in the U.S., while military health systems (7%) were accountable for trauma care. International partnerships, though less frequent (5%), played vital roles in improving access in low-resource settings. Government agencies like the WHO, Ministries of Health, and Centers for Medicare and Medicaid Services (CMS) advance Global Neurosurgery via policy, financing, and service provision. This underscores the urgent need for sustained collaboration, implementation teams, and accountability to achieve long-term equity.

The online version contains supplementary material available at 10.1007/s10143-025-03914-2.