Speeding implementation in cancer: The National Cancer Institute's Implementation Science Centers in Cancer Control.

The National Cancer Institute's Implementation Science Centers in Cancer Control (ISC3) Network represents a large-scale initiative to create an infrastructure to support and enable the efficient, effective, and equitable translation of approaches and evidence-based treatments to reduce cancer risk and improve outcomes. This Cancer MoonshotSM-funded ISC3 Network consists of 7 P50 Centers that support and advance the rapid development, testing, and refinement of innovative approaches to implement a range of evidence-based cancer control interventions. The Centers were designed to have research-practice partnerships at their core and to create the opportunity for a series of pilot studies that could explore new and sometimes risky ideas and embed in their infrastructure a 2-way engagement and collaboration essential to stimulating lasting change. ISC3 also seeks to enhance capacity of researchers, practitioners, and communities to apply implementation science approaches, methods, and measures. The Organizing Framework that guides the work of ISC3 highlights a collective set of 3 core areas of collaboration within and among Centers, including to 1) assess and incorporate dynamic, multilevel context; 2) develop and conduct rapid and responsive pilot and methods studies; and 3) build capacity for knowledge development and exchange. Core operating principles that undergird the Framework include open collaboration, consideration of the dynamic context, and engagement of multiple implementation partners to advance pragmatic methods and health equity and facilitate leadership and capacity building across implementation science and cancer control.

Action for Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials-Is Africa the Answer? Report From a Satellite Session of the Accelerating Anti-Cancer Agent Development and Validation Workshop.

Patients of African ancestry are not well-represented in cancer clinical trials despite bearing a disproportionate share of mortality both in United States and Africa. We describe key stakeholder perspectives and priorities related to bringing early-stage cancer clinical trials to Africa and outline essential action steps. Increasing Diversity, Market Access, and Capacity in Oncology Registration Trials-Is Africa the Answer? satellite session was organized at 2021 Accelerating Anti-Cancer Agent Development and Validation Workshop. Panelists included representatives of African Organization for Research and Training in Cancer, Uganda Cancer Institute, Uganda Women's Cancer Support Organization, BIO Ventures for Global Health, Bill & Melinda Gates Foundation, the US Food and Drug Administration, Nigeria's National Agency for Food and Drug Administration and Control, Bayer, and Genentech, with moderators from ASCO and American Cancer Society. Key discussion themes and resulting action steps were agreed upon by all participants. Panelists agreed that increasing diversity in cancer clinical trials by including African patients is key to ensuring novel drugs are safe and effective across populations. They underscored the importance of equity in clinical trial access for patients in Africa. Panelists discussed their values related to access and barriers to opening clinical trials in Africa and described innovative solutions from their work aimed at overcoming these obstacles. Multisectoral collaboration efforts that allow leveraging of limited resources and result in sustainable capacity building and mutually beneficial long-term partnerships were discussed as key to outlined action steps. The panel discussion resulted in valuable insights about key stakeholder values and priorities related to bringing early-stage clinical trials to Africa, as well as specific actions for each stakeholder group.

Building Capacity in Implementation Science for Cancer Prevention and Control Through a Research Network Scholars Program.

Building capacity of researchers and practitioners in the dissemination and implementation (D&I) of evidence-based interventions is greatly needed to improve cancer prevention and control. A diverse workforce trained in D&I science is critical for improving cancer outcomes and reducing cancer-related health disparities. The US Centers for Disease Control and Prevention's (CDC) Cancer Prevention and Control Research Network (CPCRN) Scholars Program aimed at training students, researchers, and practitioners in D&I for cancer prevention and control launched in 2021. The purpose of this paper is to describe the creation of the training program, curriculum, and evaluation plans, and to present the baseline results and lessons learned. CPCRN investigator and partner input and formative interviews (n = 16) with assistant professors, postdoctoral fellow, doctoral and undergraduate students, and a program manager guided development of the program. Twenty of 24 applicants were accepted into the inaugural year of the program. The majority of accepted scholars identified as female (80%) and were graduate students (50%). Thirty-five percent were of racially diverse backgrounds. Most self-rated their previous D&I experience and competencies at a beginner level. The multi-step approach used for development of this training program and lessons learned will be helpful for others collaborating on preparing the research and practice workforce in D&I science.

Predicting endoscopic activity recovery in England after COVID-19: a national analysis.

BACKGROUND: The COVID-19 pandemic has led to a substantial reduction in gastrointestinal endoscopies, creating a backlog of procedures. We aimed to quantify this backlog nationally for England and assess how various interventions might mitigate the backlog. METHODS: We did a national analysis of data for colonoscopies, flexible sigmoidoscopies, and gastroscopies from National Health Service (NHS) trusts in NHS England's Monthly Diagnostic Waiting Times and Activity dataset. Trusts were excluded if monthly data were incomplete. To estimate the potential backlog, we used linear logistic regression to project the cumulative deficit between actual procedures performed and expected procedures, based on historical pre-pandemic trends. We then made further estimations of the change to the backlog under three scenarios: recovery to a set level of capacity, ranging from 90% to 130%; further disruption to activity (eg, second pandemic wave); or introduction of faecal immunochemical testing (FIT) triaging. FINDINGS: We included data from Jan 1, 2018, to Oct 31, 2020, from 125 NHS trusts. 10 476 endoscopy procedures were done in April, 2020, representing 9·5% of those done in April, 2019 (n=110 584), before recovering to 105 716 by October, 2020 (84·5% of those done in October, 2019 [n=125 072]). Recovering to 100% capacity on the current trajectory would lead to a projected backlog of 162 735 (95% CI 143 775-181 695) colonoscopies, 119 025 (107 398-130 651) flexible sigmoidoscopies, and 194 087 (172 564-215 611) gastroscopies in January, 2021, attributable to the pandemic. Increasing capacity to 130% would still take up to June, 2022, to eliminate the backlog. A further 2-month interruption would add an extra 15·4%, a 4-month interruption would add an extra 43·8%, and a 6-month interruption would add an extra 82·5% to the potential backlog. FIT triaging of cases that are found to have greater than 10 µg haemoglobin per g would reduce colonoscopy referrals to around 75% of usual levels, with the backlog cleared in early 2022. INTERPRETATION: Our work highlights the impact of the pandemic on endoscopy services nationally. Even with mitigation measures, it could take much longer than a year to eliminate the pandemic-related backlog. Urgent action is required by key stakeholders (ie, individual NHS trusts, Clinical Commissioning Groups, British Society of Gastroenterology, and NHS England) to tackle the backlog and prevent delays to patient management. FUNDING: Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) at University College London, National Institute for Health Research University College London Hospitals Biomedical Research Centre, and DATA-CAN, Health Data Research UK.

Capacity building for cancer prevention and early detection in the Ugandan primary healthcare facilities: Working toward reducing the unmet needs of cancer control services.

BACKGROUND: In 2018, approximately 60,000 Ugandans were estimated to be suffering from cancer. It was also reported that only 5% of cancer patients access cancer care and 77% present with late-stage cancer coupled with low level of cancer health literacy in the population despite a wide coverage of primary healthcare facilities in Uganda. We aimed to contribute to reducing the unmet needs of cancer prevention and early detection services in Uganda through capacity building. METHODS: In 2017, we conducted two national and six regional cancer control stakeholders' consultative meetings. In 2017 and 2018, we trained district primary healthcare teams on cancer prevention and early detection. We also developed cancer information materials for health workers and communities and conducted a follow-up after the training. RESULTS: A total of 488 primary healthcare workers from 118 districts were trained. Forty-six health workers in the pilot East-central subregion were further trained in cervical, breast, and prostate cancer early detection (screening and early diagnosis) techniques. A total of 32,800 cancer information, education and communication materials; breast, cervical, prostate childhood and general cancer information booklets; health education guide, community cancer information flipcharts for village health teams and referral guidelines for suspected cancer were developed and distributed to 122 districts. Also, 16 public and private-not-for-profit regional hospitals, and one training institution received these materials. Audiovisual clips on breast, cervical, and prostate cancer were developed for mass and social media dissemination. A follow-up after six months to one year indicated that 75% of the districts had implemented at least one of the agreed actions proposed during the training. CONCLUSIONS: In Uganda, the unmet needs for cancer control services are enormous. However, building the capacity of primary healthcare workers to integrate prevention and early detection of cancer into primary health care based on low-cost options for low-income countries could contribute to reducing the unmet needs of cancer prevention and early detection in Uganda.

Expanding and Enhancing Food and Nutrition Education in New York City Public Schools: An Examination of Program Characteristics and Distribution.

To expand their capacity, many schools partner with food and nutrition education programs (FNPs). Public policies and funding can support FNPs, but comprehensive data on the organizations that run FNPs, their program characteristics, or distribution across schools did not exist in NYC. This study aims to help local education and health agencies assess the characteristics of food and nutrition education in schools, as well as to measure progress implementing school policies and practices. A cross-sectional study on NYC FNPs was conducted during the 2016-2017 school year. Survey data on organizations and the FNPs they operate were collected. Data on schools in which FNPs operate were gathered. To determine distribution of FNPs across schools and by school demographics, the database of FNPs in schools was combined with a publicly available database of NYC schools. In 2016-2017, 40 organizations operated 101 FNPs in 56% of NYC public schools. These FNPs varied by goals, content, activities, location, and populations served. Information on these variations can help policymakers, advocates, funders, and schools expand school-based food and nutrition education. To ensure equitable access, more coordination, investment, and collaboration are needed.

Building Capacity for Logic Models and Evaluation Planning Using Canoe-building Concepts.

Non-communicable diseases (NCDs) are the leading causes of death in the United States Affiliated Pacific Islands (USAPIs); US Centers for Disease Control and Prevention funds programs for prevention and control of diabetes, tobacco use, and related chronic disease conditions. To build USAPI programs' capacity in evaluation and surveillance, we held in-person and virtual trainings on evaluation planning and logic models that were tailored with traditional canoe-building themes to be relatable and memorable. Evaluation results suggest the efforts were effective at translating concepts. Additional tools and technical assistance reinforced concepts and resulted in quality evaluation plans. Culturally tailored evaluation tools can be useful and should be developed with population representatives.

Capacity Building of Gynecologists in Cancer Screening Through Hybrid Training Approach.

Training health care professionals (HCPs) is one of the most challenging and key factors for the success of a cancer screening program. In order to make this onerous task possible, a hybrid training model, combining the online knowledge-sharing tool of ECHO (Extension of Community Health Outcomes) and in-person training, was proposed by the National Institute of Cancer Prevention and Research (NICPR). The main aim of this article is disseminating our experience on the effectiveness of this hybrid model in training health care providers in cancer prevention. A group of gynecologists was trained using a structured curriculum in cervical and breast cancer screening through a 14-week online course, followed by a three-day in-person training (group A). To analyze the effectiveness of this model, a group of gynecologists who were not part of the online course were enrolled for face-to-face training (group B). All the participants were offered pre- and post-training questionnaires and a pictorial quiz. Group A participants had 60% and 40% more knowledge in cervical and breast cancer screening, respectively, compared with group B before the in-person training. Though group B demonstrated a 51% increase in knowledge post-training, group A performed 26% better than group B in the pictorial quiz-demonstrating better knowledge acquisition. This hybrid training model, when employed in capacity building in cancer screening among gynecologists, works very effectively in improving knowledge and skill set in cancer screening. This can be a potent tool for the government for efficient training of HCPs in cancer screening.

Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.

BACKGROUND: Building capacity in research funding organizations to support the conduct of pragmatic clinical trials is an essential component of advancing biomedical and public health research. To date, efforts to increase the ability to design and carry out pragmatic trials have largely focused on training researchers. To complement these efforts, we developed an interactive workshop tailored to meet the roles and responsibilities of program scientists at the National Cancer Institute-the leading cancer research funding agency in the USA. The objectives of the workshop were to improve the understanding of pragmatic trials and enhance the capacity to distinguish between elements that make a trial more pragmatic or more explanatory among key programmatic staff. To our knowledge, this is the first reported description of such a workshop. MAIN BODY: The workshop was developed to meet the needs of program scientists as researchers and stewards of research funds, which often includes promoting scientific initiatives, advising prospective applicants, collaborating with grantees, and creating training programs. The workshop consisted of presentations from researchers with expertise in the design and interpretation of trials across the explanatory-pragmatic continuum. Presentations were followed by interactive, small-group exercises to solidify participants' understanding of the purpose and conduct of these trials, which were tailored to attendees' areas of expertise across the cancer control continuum and designed to reflect their scope of work as program scientists at NCI. A total of 29 program scientists from the Division of Cancer Control and Population Sciences and the Division of Cancer Prevention participated; 19 completed a post-workshop evaluation. Attendees were very enthusiastic about the workshop: they reported improved knowledge, significant relevance of the material to their work, and increased interest in pragmatic trials across the cancer control continuum. CONCLUSION: Training program scientists at major biomedical research agencies who are responsible for developing funding opportunities and advising grantees is essential for increasing the quality and quantity of pragmatic trials. Together with workshops for other target audiences (e.g., academic researchers), this approach has the potential to shape the future of pragmatic trials and continue to generate more and better actionable evidence to guide decisions that are of critical importance to health care practitioners, policymakers, and patients.

Developing, Promoting, and Sustaining Palliative Care Across Central Eastern Europe: Educating Nurses to Be Leaders Is a Critical First Step.

Worldwide, health care is becoming more complex and multifaceted. Nurses, who spend more time at the bedside or out in the community with patients and their families than any other health care professional, need leadership-building skills in order to navigate these challenging times. New guidelines focus on interprofessional and holistic care, emphasizing the importance of building leadership skills and abilities. The World Health Organization and the European Association for Palliative Care have shown interest in influencing the development and implementation of palliative care services globally, given the increasingly aging population, the growing incidence of cancer, and the human immunodeficiency virus/AIDS epidemic. Despite challenges in developing leadership skills in nurses throughout Central and Eastern Europe (CEE), visionary nursing leaders throughout these countries have taken the opportunity to develop the Transformational Palliative Nursing Leadership Program, which has been designed to improve the leadership abilities of palliative care nurses throughout CEE countries. The purpose of the Transformational Palliative Nursing Leadership Program education is to equip palliative care nurses with the ability to promote, develop, and sustain this specialized care in CEE countries or any other part of the world.

POETIC (Program for Enhanced Training in Cancer): An Initial Experience of Supporting Capacity Building for Oncology Training in Sub-Saharan Africa.

BACKGROUND: Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals because of insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries. METHODS: In its initial year, 2018, the Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of seven fellows for 3-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants prior to arrival and upon departure; additionally, three participated in semistructured interviews. RESULTS: Five themes emerged from the qualitative data: expectations of POETIC, differences between oncology in the U.S. and in sub-Saharan Africa, positive elements of the program, areas for improvement, and potential impact. Fellows identified several elements of Western health care that will inform their practice: patient-centered care; clinical trials; and collaboration among medical, radiation, and surgical oncologists. From the quantitative data, feedback was primarily around logistical areas for improvement. CONCLUSION: POETIC was found to be feasible and valuable. The results from the pilot year justify the program's continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future research will report on the expansion of the program and follow-up with former participants. IMPLICATIONS FOR PRACTICE: This work presents a novel model for fellowship exchange between lower- and higher-resourced areas. The program is a short-term observership with tumor boards and didactic teaching sessions incorporated. By attracting oncologists who aim to practice in their home countries, it facilitates international collaboration without contributing to the preexisting lack of medical professionals in low- and middle-income countries.

"If you understand you cope better with it": the role of education in building palliative care capacity in four First Nations communities in Canada.

BACKGROUND: In Canada, there is a growing need to develop community-based, culturally appropriate palliative care for Indigenous people living in First Nations communities. The public health approach to palliative care, which emphasizes community-based initiatives, is especially relevant in First Nations communities because care is grounded in their distinct social and cultural context. Central to the public health approach are educational strategies that strengthen communities' capacity to care for their vulnerable members as they die. This paper presents community-based research conducted with First Nations communities in Canada that aimed to assess and address local palliative care educational needs to improve community capacity in palliative care. METHODS: Participatory action research (PAR) was conducted with four First Nations communities in Canada over a six-year period (2010-2016). The research occurred in three phases. Phase 1: focus groups, interviews and surveys were employed to assess community specific needs and resources. Phase 2: recommendations were developed to guide the PAR process. Phase 3: educational resources were created to address the identified educational needs. These resources were implemented incrementally over 4 years. Ongoing process evaluation was employed, and revisions were made as required. RESULTS: Educational needs were identified for patients, families, community members and internal and external health care providers. A wide and comprehensive range of educational resources were created to address those needs. Those culturally appropriate educational resources are available in a very accessible and useable workbook format and are available for use by other Indigenous people and communities. CONCLUSIONS: This research provides an example of the public health approach and offers implementation strategies around palliative care education. This paper contributes to the international literature on the public health approach to palliative care by presenting a case study from Canada that includes: conducting a culturally appropriate assessment of educational needs, creating recommendations, facilitating development and implementation of educational resources in the community to improve community capacity in palliative care.

Promoting smoking cessation in China: a foot-in-the-door approach to tobacco control advocacy.

INTRODUCTION: The Chinese government's implementation of the MPOWER policies and compliance with the WHO Framework Convention on Tobacco Control requirements has been slow. We used the 'foot-in-the-door' approach to promote tobacco control advocacy through capacity building of healthcare leaders, and establishment of smoking cessation clinics in Guangzhou and Beijing (two of the largest cities in China). METHODS: This collaborative pilot project involved the University of Hong Kong and three major hospitals in Guangzhou and Beijing. A steering committee conducted the smoking cessation training workshops starting from April 2006, and set up three smoking cessation model clinics during August 2006 to October 2008. We followed up the trained health care professionals (HCPs) in 2014 and 2015 to assess their impacts on tobacco control beyond smoking cessation. RESULTS: We emphasized the importance of the general tobacco control atmosphere during smoking cessation training of 139 HCPs to motivate them to engage in tobacco control advocacy. In addition to enhancing their knowledge and skills in cessation, the HCPs were then involved in the establishment of three in-hospital smoking cessation clinics and served as smoking cessation counselors since June 2008. Moreover, they ventured outside the clinics and the community to publicize smoking cessation. Their effort has contributed to smoke-free legislation, better surveillance on smoking and media advocacy on tobacco control in China. CONCLUSIONS: The training and establishment of smoking cessation clinics could serve as a means to motivate and empower HCPs who could contribute to broaden tobacco control policy in China.

A framework to build capacity for a reflex-testing program for Lynch syndrome.

PURPOSE: Lynch syndrome (LS) is the most common inherited cause of colorectal cancer. Although testing all colorectal tumors for LS is recommended, the uptake of reflex-testing programs within health systems has been limited. This multipronged study describes the design of a provincial program for reflex testing in Ontario, Canada. METHODS: We recruited key stakeholders to participate in qualitative interviews to explore the barriers and facilitators to the implementation of a reflex-testing program. Data were analyzed in an iterative manner, key themes identified, and a framework for a proposed program developed. RESULTS: Twenty-six key informants participated in our interviews, and several themes were identified. These included providing education for stakeholders (patients, primary care providers, surgeons); challenges with sustaining various resources (laboratory costs, increased workload for pathologists); ensuring consistency of reporting test results; and developing a plan to measure program success. Using these themes, a framework for the reflex-testing program was developed. At a subsequent stakeholder meeting, the framework was refined, and recommendations were identified. CONCLUSIONS: This study identifies factors to ensure the effective implementation of a population-level program for reflex LS testing. The final product is a prototype that can be utilized in other jurisdictions, taking into account local environmental considerations.

Strategies for coaches' development in a football club: a learning organization

Abstract Aim: The aim of this study was to identify the strategies adopted in a football club to support coaches' development. Methods: Eight coaches and four technical coordinators from a Brazilian elite club participated. After transcribing data from semi-structured interviews with coaches and technical coordinators, they were analyzed using the QSR Nvivo 9.2 software. Results: Three support schemes and their respective pillars of action were identified: a) Mentoring and meeting - Assistance among coaches, discussions with coaching staff, and free theme meetings; b) Incentive for continuing education; c) Club Pillars - Club goals, continuity of coaches, evaluation of coaches. Conclusion: Data allowed us to identify the important contributions of this Club in continued ongoing coach development. Moreover, we may characterize the Club as an authentic learning organization due to the promotion of a safe work environment that stimulates coaches' engagement in the Club's organizational culture and enables adequate communication and the constant update through courses and meetings.

Tríada oscura de personalidad, satisfacción laboral y cinismo organizacional: un modelo estructural / Dark Triad of Personality, Job Satisfaction and Organizational Cynicism: A Structural Model

Resumen Se analizó el impacto del cinismo organizacional sobre las relaciones entre la tríada oscura (maquiavelismo, narcisismo, psicopatía) y la satisfacción laboral, en una muestra de 343 trabajadores argentinos. Se plantearon hipótesis sobre relaciones directas e indirectas que fueron probadas mediante análisis de ecuaciones estructurales. Los resultados confirmaron que la tríada predice el cinismo (maquiavelismo: ϒ = 0.39, p < 0.01; psicopatía: ϒ = 0.22, p < 0.01; narcisismo: ϒ = 0.14; p < 0.05), y que el cinismo mediatiza completamente las relaciones entre la tríada y la satisfacción laboral (maquiavelismo: z = -4.51, p < 0.001; psicopatía: z = -3.24, p < 0.001; narcisismo: z = -1.78, p < 0.05). Se discuten las implicancias prácticas de los hallazgos y se sugieren nuevas líneas de investigación futura.

Abstract The impact of organizational cynicism on the relationship between dark personality traits (Machiavellianism, narcissism, and psychopathy) and job satisfaction was analysed. It was study a sample of 343 Argentinean workers. Hypotheses on direct and indirect relationships were tested by structural equation modelling. The results confirmed that the dark triad predicts cynicism (machiavellianism: ϒ = 0.39, p < 0.01; psychopathy: ϒ = 0.22, p < 0.01; narcissism: ϒ = 0.14; p < 0.05); and that cynicism fully mediates the relationship between the dark side and job satisfaction (machiavellianism: z = -4.51, p < 0.001; psychopathy: z = -3.24, p < 0.001; narcissism: z = -1.78, p < 0.05). Practical implications of findings are discussed and new lines for future studies are suggested.

Development of tailored feedback reports on organizational capacity for health promotion in African American churches.

Standard community-engaged research methods involve reporting research findings back to study participants. Project HEAL is an implementation trial conducted in 14 African American churches. This paper reports on a strengths-based approach to reporting Project HEAL organizational capacity data back to church leadership, through use of individualized church reports. Pastors in each church completed a church organizational capacity assessment. The study team, including community partners representing church leadership, co-created a channel and content to disseminate the capacity data back to Project HEAL church leaders. This consisted of a 4-page lay report that included the church's capacity scores, and recommendations for future evidence-based health promotion programming matched to their capacity. The study team was able to meet with nine of the 14 churches to review the report, which took an average of six and a half weeks to schedule. The individualized church reports were well-received by pastors, who expressed an intention to share the information with others in the church and to sustain health promotion activities in their organizations. Though the individualized reports were embraced by the pastors, it is unknown whether this process will result in sustainable health promotion in these organizations without further follow-up.

Pediatric neurosurgical bellwether procedures for infrastructure capacity building in hospitals and healthcare systems worldwide.

PURPOSE: Quantifying the global burden of pediatric neurosurgical disease-and current efforts addressing it-is challenging, particularly in the absence of uniform terminology. We sought to establish bellwether procedures for pediatric neurosurgery, in order to standardize terminology, establish priorities, and facilitate goal-oriented capacity building. METHODS: Members of international pediatric neurosurgical and pediatric surgical societies were surveyed via the Research Electronic Data Capture (REDCap) platform. Among 15 proposed neurosurgical procedures, respondents assigned numerical grades of surgical necessity and selected hospital-level designation within a three-tiered system. A procedure was considered a bellwether if (a) the majority of respondents deemed it necessary for either a primary- or secondary-level hospital and (b) the procedure was graded at or above the 90th percentile on a continuous scale of essentiality. Data were compiled and analyzed using Stata software. RESULTS: Complete responses were obtained from 459 surgeons from 76 countries, the majority of whom practiced in a tertiary referral hospital (88%), with a primarily public patient population (64%). Six bellwether procedures were identified for pediatric neurosurgery: shunt for hydrocephalus, myelomeningocele closure, burr holes, trauma craniotomy, external ventricular drain (EVD) insertion, and cerebral abscess evacuation. Few differences in bellwether criteria designations were observed among respondents from different World Health Organization regions and World Bank income groups. CONCLUSIONS: The six bellwether procedures identified can be used as markers of infrastructure capacity at various hospital levels, hence allowing targeted neurosurgical capacity-building in low-resource settings in order to avert disability and death from childhood neurosurgical disease.