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Objective: An adequate healthcare workforce characterizes high-quality health systems. Sustainable domestic neurosurgery training is critical to developing a local neurosurgical workforce in low- and middle-income countries (LMICs). This study evaluated how neurosurgical training is delivered in Ethiopia, provides a historical narrative of neurosurgery training in the nation, and proposes future educational opportunities., Methods: A mixed-methods design consisting of a semi-structured interview and a comprehensive survey was used to acquire data. The interview participants included neurosurgery program directors and faculty involved in resident education. The survey was sent to all current neurosurgery residents in Ethiopia., Results: Ethiopian neurosurgical service began in 1970, and neurosurgical education started in 2006 with the establishment of the Addis Ababa University (AAU) residency program. The survey response rate was 86%, with 69 of 80 eligible neurosurgery residents responding. Most respondents were male (93%), aged 20-25 years (62%), and enrolled in the AAU program (61%). The oldest medical schools affiliated with tertiary hospitals were the top feeder institutions for neurosurgery training. Seventy-one percent of respondents worked for more than 60 hours/week, and 52% logged at least 100 cases annually. Survey responses demonstrated a critical need to establish subspecialty training and harmonize the national training curriculum., Conclusions: The history of Ethiopian neurosurgery training exemplifies how global neurosurgery efforts focused on capacity building can rapidly expand the local neurosurgical workforces of LMICs. Opportunities for neurosurgical education require initiatives promoting a subspecialized, diverse workforce that attains both the clinical and academic proficiency necessary for advancing neurosurgical care locally and globally.

Background: Neurosurgery is a rapidly developing specialty in Ethiopia. Previous global neurosurgery studies have highlighted the need for synchronizing workforce increase with improving quality, access, and capacity to provide neurosurgical care., Objective: To evaluate Ethiopia's neurosurgical system and highlight the critical interventions required for the sustained development of Ethiopian neurosurgery as part of a high-quality health system (HQHS)., Methods: A comprehensive survey was sent to all practicing neurosurgeons. Public databases on Ethiopian census reports and current road infrastructure were used for spatial analysis of neurosurgical access., Results: The survey response rate was 90% (45/50). Most respondents were men (95.6%), aged 30 to 40 years (82%), who worked at national referral hospitals (71%). The reported annual caseload per practicing neurosurgeon was >150 cases for 40% of urban and 20% of rural neurosurgeons. Head and spine neurotrauma and tumors were the most common neurosurgical indications. Computed tomography scanner was the most widely available diagnostic equipment (62%). 76% of respondents indicated the presence of postoperative rehabilitation care at their institutions. Thirteen percent and 27% of the nation lived within a 2-hour and 4-hour driving distance from a neurosurgical center, respectively., Conclusion: The results highlight the need for vital improvements in neurosurgical capacity to sustain progress toward HQHS. Promoting sustained development in all components of HQHS can be achieved by diversifying the workforce and training residency candidates committed to practicing in underserved regions. Additional strategies might include establishing a national registry for neurosurgical data and implementing policy changes conducive to improving perihospital care and other health system components., (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)