A mixed-methods evaluation of neurosurgical care in the public sector in Peru

Background In Andean Latin America, an estimated 60% of the population is without access to surgical care. Neurosurgical conditions are a leading cause of disability and mortality. The purpose of this study was to perform national evaluation of neurosurgical services within the Peruvian Ministry of Health (MINSA), which provides healthcare to over 70% of the population. Methods This cross-sectional, descriptive study included site visits at MINSA facilities between 2019 to 2020. A quantitative survey of hospital resources was administered and semi-structured interviews with neurosurgeons were conducted. Hospital characteristics were descriptively summarized, and a qualitative analysis using grounded theory was performed in Nvivo software. Results A total of 25 (93%) of 27 facilities were visited nationally. Twenty recorded interviews were conducted and identified 170 neurosurgeons, resulting in 1 neurosurgeon to 172,835 patient population. Hospitals in Lima had mean higher numbers of hospital beds, operating rooms, and access to post-operative recovery, but over 42% (n = 5) reported greater than 4 hours to reach the operating room for emergent surgery once the patient was determined to need a neurosurgical intervention after arrival at index hospital. Twenty-eight percent (n = 7) lacked access to computed tomography scanner, and 76% (n = 19) lacked access to magnetic resonance imaging. Significant themes influencing access to neurosurgical care were lack or poor maintenance of basic materials, equipment and supplies, inadequate healthcare infrastructure, and poor financial prioritization. Consequently, delays to life-saving intervention and poor patient outcomes were common occurrences. Conclusion This study serves as a baseline evaluation of neurosurgical capacity for MINSA facilities. Context-specific factors were identified to help inform future interventions and policy decisions for neurosurgical preparedness.