The Need for a Neurosurgical Equity Index for Accountability and Action

Profound inequities exist in neurosurgical access to care, limiting progress toward universal health coverage. Although current mapping and indicator-based approaches have provided essential visibility, they remain fragmented and often measure isolated components of health systems without integrating the overall context of need and capacity. This Perspective proposes the development of a Neurosurgical Equity Index (NEI), a pragmatic, equity-sensitive framework designed to capture both the supply of neurosurgical resources and the demand imposed by disease burden. The NEI aims to give a holistic understanding of neurosurgical systems and guide policy, investment and accountability. The NEI is structured around six domains: Workforce Capacity, Burden of Disease, Infrastructure and Perioperative Capacity, Access and Financial Protection, Outcomes and Safety, and Research, Training and Inclusion. Each domain will incorporate a limited number of globally available indicators, coordinated with the Lancet Commission on Global Surgery, and the World Health Organisation. Indicators will be normalised, weighted and aggregated using geometric-mean methods consistent with established composite-indicator science. By integrating multiple dimensions of equity into a single, reproducible metric, the NEI framework provides a holistic tool for identifying actionable gaps in neurosurgical systems. The index will be co-governed with low- and middle- income country (LMIC) colleagues in order to make sure of legitimacy, local relevance and ethical oversight. Pilot implementation is proposed across diverse regions to evaluate feasibility and refine the methodology, establishing the foundation for annual global equity reporting.