Private healthcare initiatives in developing countries – Building sustainable neurosurgery in Indonesia and Pakistan

INTRODUCTION: Severe global shortages in neurosurgery, surgery, and healthcare in general have been documented, especially in low- and middle-income countries (LMICs). RESEARCH QUESTION: In LMICs, how do we expand both neurosurgery and overall healthcare? MATERIAL AND METHODS: Two different approaches to improving neurosurgery are presented. Author EW convinced a private hospital chain that neurosurgical resources were important throughout Indonesia. Author TK established a consortium (Alliance Healthcare) to obtain financial support for healthcare in Peshawar, Pakistan. RESULTS: The expansion over 20 years in neurosurgery (throughout Indonesia) and in healthcare (for Peshawar and Khyber Pakhtunkhwa (KP) province, Pakistan) is impressive. In Indonesia, neurosurgery centers have expanded from one in Jakarta to over 40 throughout the islands of Indonesia. In Pakistan, two general hospitals, schools of medicine, nursing, and allied health professions, and an ambulance service have been established. Recently US$11 million has been awarded to Alliance Healthcare by the International Finance Corporation (the private sector arm of the World Bank Group) to further expand healthcare infrastructure in Peshawar and KP. DISCUSSION AND CONCLUSION: The enterprising techniques described here can be implemented in other LMIC settings. Three keys to success both programs utilized: (1) educating the community (population at large) of the need for surgery in particular to improve overall healthcare; (2) being entrepreneurial and persistent in seeking the community support and the professional and financial support needed to advance both neurosurgery and overall healthcare through the private sector; (3) creating sustainable training and support institutions and policies for young neurosurgeons.