Developing an Endovascular Neurointervention Training Program in Urban Tanzania: A SWOT Analysis and Recommendations

Introduction: Many countries, including Tanzania, have limited access to endovascular neurointervention and often have no fully trained endovascular neurointerventionalists. We present a needs assessment and recommendations for implementing a local endovascular neurointervention training program at two leading training hospitals in Tanzania: Muhimbili National Hospital (MNH) and Muhimbili Orthopaedic Institute (MOI).

Methods: Small groups and individual discussions were held with key stakeholders at MNH and MOI to identify the current state of patient healthcare, who may benefit from endovascular neurointervention, and the long-term goals for development of this service. Themes from these interviews were identified and used to inform a strengths, weaknesses, opportunities, and threats analysis.

Results: The ministry of health, departmental and leadership support for this initiative, the current wide referral base of patients with hemorrhagic cerebrovascular pathologies to MNH and MOI, and the recent successful development of a sister program for interventional radiology using a similar model are all key strengths and opportunities of the internal environment at MNH and MOI and in the Tanzania health system. Much of the necessary infrastructure is already in place, including biplane and single-plane angiography suites, 24-hour access to radiology, intensive care units, and operating rooms, and a busy cerebrovascular neurosurgery service. Weaknesses and threats include lack of public awareness, unreliable consumable pipeline, and inadequate numbers of trained staff, and a limited ischemic pathology referral base with no current national stroke program in Tanzania.

Conclusion : Tanzania has no fully trained endovascular neurointerventional providers, despite a significant burden of cerebrovascular pathologies. Current efforts to develop a system for stroke care and the recent success in bringing interventional radiology to Tanzania have created the momentum necessary to build a local endovascular neurointerventional training program. This program will be developed based on a previously described model and will focus on training local providers within their home environment to allow for continuity of patient care. The current strengths and opportunities of this environment will be leveraged to overcome the weaknesses of and threats to the program.