Expanding Neurosurgical Access in Kenya: The Makueni Experience

Abstract

Background: Following a neurosurgical camp by the Brain Tumor Association of Kenya in June 2023, a significant burden of untreated neurosurgical disease was identified in Makueni County. In response, the County Government employed a full-time neurosurgeon in February 2024, enabling a sustained neurosurgical service. The program has evolved into a regional operative hub, serving Makueni and referrals from neighbouring counties including Machakos, Kitui, Kajiado, and the Coastal Region. Efficient adaptation of available resources has facilitated timely access to operative care closer to patients’ homes. Objective: To review operative neurosurgical workload, outcomes, and systemic challenges during the establishment of a county-based neurosurgical service, and to highlight its regional impact. Methods: A prospective review of all neurosurgical operations performed from March 2024 to October 2025 at Makueni County Referral Hospital was conducted, documenting procedure type, demographics, referral origin, postoperative outcomes, and early complications. Logistical and systems-level challenges encountered throughout implementation were recorded. Results: A total of 71 operations were performed: trauma (45/71; 63.4%), hydrocephalus (11/71; 15.5%), other cranial/spinal procedures (11/71; 15.5%), and tumors (3/71; 5.6%). Most patients demonstrated postoperative improvement (68/71; 95.8%) and mortality was low (3/71; 4.2%). Patients originated predominantly from Lower Eastern and Coastal Regions, reflecting Makueni’s increasing role as a regional neurosurgical access hub. Initial challenges included theatre staff unfamiliarity with neurosurgical workflow and hesitancy toward operating on neonates and elderly patients, which improved with growing experience, communication, and education. Conclusion: County-level investment and specialist leadership have demonstrated that decentralized neurosurgical care is safe and effective in a devolved health system. This model improves equitable access, reduces referral burdens, and builds long-term neurosurgical capacity, offering a scalable framework to enhance neurosurgical care in underserved regions of Kenya and sub-Saharan Africa.