Global Child Neurology Capacity Building Through the Child Neurology Society International Affairs Committee: From Needs Assessment to SMART Action Goals

Abstract

Background

Child neurology in low- and middle-income countries (LMICs) faces persistent disparities in workforce capacity, subspecialty training, and structured mentorship. To address these gaps, the Child Neurology Society International Affairs Committee (CNS-IAC) launched a 2-phase initiative to identify regional needs and develop SMART (Specific, Measurable, Achievable, Relevant, Time bound) goals and action plans.

Objective

To identify educational and clinical priorities of child neurologists practicing in LMICs and translate these findings into region-specific SMART goals and action plans.

Methods

A mixed method study was conducted in 2 phases. Phase 1 (2024) used a de novo Qualtrics survey reviewed by the international child neurology experts. The survey assessed 12 clinical domains, preferred educational resources, and open-ended needs. Phase 2 (2025) consisted of structured regional working groups at the CNS Annual Meeting, where participants codeveloped SMART action plans through facilitated discussion and iterative refinement.

Results

A total of 48 clinicians from 18 LMICs contributed to phase 1 of the initiative. During phase 1, 29 clinicians completed the online survey and 19 participated in the in-person discussion session, with 2 individuals participating in both activities. Thirty-nine participants participated in the structured regional working groups and developed regional SMART goals. General child neurology and epilepsy were the most common areas of interest. Respondents highlighted limited access to standardized curricula, mentorship, and subspecialty training. SMART plans emphasized adaptable education, leadership development, and sustainable implementation.

Conclusions

The CNS-IAC model provides a practical, scalable framework for moving from needs assessment to regionally driven action to strengthen child neurology capacity in LMICs.

Keywords

Child neurology global health education LMICs SMART goals needs assessment capacity building

Introduction

Child neurology in LMICs continues to face disparities in access to diagnostic tools, specialized training, and professional mentorship.¹ Although advances in neurodiagnostic, neurogenetics, and neurorehabilitation have expanded rapidly in high-income settings, these improvements have not been universally accessible. Existing reports highlight shortages of trained child neurologists, limited exposure to subspecialty care, restricted availability to essential diagnostic tools such as neuroimaging, electrophysiology, and inadequate opportunities for structured mentorship and research collaboration in many LMICs.^2–4 These challenges not only contribute to delay in evaluation, diagnosis, and treatment but also demotivate doctors in training from pursuing careers in pediatric neurology, thereby leading to disproportionately high morbidity and mortality among children with neurologic disorders and exacerbated shortage.⁵

Recognizing the need for coordinated global support, the Child Neurology Society International Affairs Committee (CNS-IAC) initiated a multiphase initiative in 2024 to identify educational needs and codevelop regionally contextualized goals and action plans. This approach aimed at aligning CNS educational goals with the realities of clinical practice in LMIC settings while promoting bidirectional knowledge exchange and regional ownership. The initiative was informed by global frameworks such as the International Child Neurology Association (ICNA) capacity reports and the World Health Organization Intersectoral Global Action Plan (WHO-IGAP) on epilepsy and neurologic conditions.^6,7 This manuscript summarizes the multicenter mixed methods process used to identify priorities and develop regional SMART action goals, with the objective of providing a replicable model for global child neurology capacity building. This reflects evolving engagement across the 2-year process, rather than static cohorts.

Methods

Study Design

The study design consisted of 2 phases and uses a descriptive mixed method design. The CNS-IAC coordinated both phases to ensure consistency, context relevance, and integration of findings into action planning.

Phase 1: 2024 Needs Assessment

Survey development

The online survey was developed de novo by CNS-IAC members based on prior global child neurology training frameworks, International Child Neurology Association (ICNA) reports, and WHO-IGAP domains. Twelve clinical subspecialty domains were included based on consensus expert opinions from CNS-IAC membership and prior to global training literature. The survey was reviewed by the CNS-IAC task force. The task force reviewed the survey for relevance and cultural applicability. Minor revisions were made based on task force feedback. The survey was administered in English, except in south America where both English and Spanish versions were used.

Pilot testing

The survey underwent informal pilot testing by 2 CNS-affiliated clinicians practicing in LMICs (S.Q., M.R.) to ensure clarity and feasibility. Feedback led to minor wording adjustments.

Inclusion criteria and distribution

Inclusion was limited to child neurologists and trainees practicing in LMICs according to World Bank classification.⁸ Clinicians from high-income countries who worked in close association in LMIC-based programs were also included, for example, through volunteer programs and local institutional support programs. The survey was disseminated through CNS-IAC networks, including CNS connect webpage, regional WhatsApp groups, SIG mailing lists, institutional partners, and regional child neurology professional associations. Participation was voluntary and anonymous.

Data collection and quantitative analysis

The survey was conducted through an online survey platform, Qualtrics. Descriptive statistics (frequency and percentages) were generated using Qualtrics, and further analysis and data consolidation were conducted in Microsoft Excel. Missing data were handled using pairwise omission, and denominators were specified for each item to address partial responses.

Qualitative analysis

Open-ended responses were analyzed using inductive thematic analysis. The independent reviewers’ coded responses developed a codebook iteratively and resolved discrepancies through consensus discussion. Themes were reviewed by a CNS-IAC chairperson to enhance analytic rigor.

In-person synthesis session (2024)

Nineteen participants contributed to discussions during the CNS-IAC SIG at the 2024 CNS Annual Meeting. Some participants had also completed the online survey. Discussions were summarized and integrated with survey findings.

Phase 2: 2025 SMART Action Planning

In 2025, a total of 39 clinicians participated in region-specific SMART planning sessions at the CNS Annual Meeting. The participants were self-selected into regional groups: Asia and Middle East, Africa and Caribbean, Latin, and South America. Each group was supported by CNS-IAC faculty moderators. Summaries of phase 1 findings were provided to the participants. Each group used structured worksheets to draft SMART goals and presented these to the entire group. Consensus was achieved through group discussion and iterative refinement. The follow-up virtual meetings ensured completion of timelines and measurable indicators.

Ethics

This initiative was categorized as educational program evaluation without human subjects research components and was therefore, based on consensus decision, IRB approval was not sought. All participation was voluntary and deidentified.

Results

Phase 1: Need Assessment

Forty-eight child neurologists from 18 LMICs participated in both online and in-person components (Table 1). There were 29 online participants and 19 in-person contributors with overlap of 2 participants, hence 46 unique contributors. Respondents represented diverse practice settings, predominantly tertiary care or teaching hospitals.

Table 1.

Phase 1 Data.

Category	Finding	Key data of survey
Participants	Total respondents	48 total participants across 18 LMIC countries (29 online survey; 19 in person, 2 overlap)
Practice Setting	Predominant institutional environment	Majority from tertiary care centers and teaching hospitals
Clinical Interests: Top Five	Most frequently selected domains with overlap	Epilepsy (76%) Neurodevelopmental and behavioral neurology (62%) Headache medicine (55%) Neurocritical care (14%) Neuromuscular disorders (34%) Others: cerebral palsy, neurometabolic, stroke etc (<10%)
Learning Resources Used	Overlapping resources used for clinical skill development	Online resources and journals (>80%) Conferences (65%) Bedside teaching and group discussions (60%) Formal didactics (45%) Problem based learning (35%)
Mentorship & Training Structure	Availability of structured mentorship	Limited access to structured mentorship and training, including internal exposure through exchange programs or visiting academic exposures Standardized training programs within institutions
Themes From Open-Ended Responses	Four major qualitative themes	Need for standardized CNS-led educational initiatives. Interest in faculty and trainee exchange programs. Need for hybrid, low-bandwidth–compatible learning models. Desire for shared educational materials (modules, lectures, case libraries).
Overall Sentiment	Preferred CNS role	CNS is viewed as a collaborative partner supporting equity and regional ownership

Abbreviations: CNS, Child Neurology Society; LMIC, low-and middle-income country.

Clinical interests

Epilepsy (76%) was the most selected subspecialty interests, followed by neurodevelopmental and behavioral neurology (62%), headache medicine (55%), neuromuscular disorders (34%), and neurocritical care (14%). There was an overlap in subspeciality interests.

Learning resources

Various responses overlapped. More than 80% relied on online resources and journals for clinical learning. Conference participation (65%), bedside teaching and group discussions (60%), formal didactics (45%), and problem-based learning (35%) were also used.

Qualitative themes

There were 4 most common themes.

Need for standardized CNS led educational initiatives

Desire for structured mentorship and faculty trainee exchanges

Value of hybrid learning accessible in low-bandwidth settings

Need for shared educational resources such as case libraries and lecture modules

Participants emphasized CNS's role as a collaborative partner rather than a traditional top-down educator.

Phase 2: SMART Action Planning

During phase 2, a total of 39 participants representing 3 geographic regions engaged in structured SMART action planning sessions at the 2025 CNS Annual Meeting (Table 2). These facilitated discussions built on findings from the 2024 needs assessment and enabled each group to translate regional challenges into measurable goals. The planning process revealed both cross regional priorities shared by all groups and distinct goals tailored to each region's specific context.

Table 2.

SMART Framework.

Region	Specific	Measurable	Achievable	Relevant	Time-bound
Asia / Middle East	Develop a regional network for community-based education through digital connectivity	Identify local leaders; deliver recurring online sessions and webinars	Use low-cost digital tools and local champions for sustainability	Strengthen local leadership, and regional collaboration	Implementation and leader identification completed by end 2025
Latin America / South America (Costa Rica)	Launch a pilot educational curriculum using Costa Rica as a regional model	Curriculum module drafted and reviewed; participant feedback collected	Leverage existing collaborations with CNS-IAC, regional professional associations, and volunteer educators	Address gaps in standardized child neurology training and supports regional harmonization	Working group formed by Q2 2025; draft curriculum within 12 mo
Africa / Caribbean	Establish education and advocacy programs integrated into existing training	Pre-post knowledge gains; one abstract or publication by 2026	Partner with local educators and embed training in national curricula	Address critical workforce shortages and high disease burden, especially for epilepsy and headache	Lecture series focusing on headache and epilepsy launched and integrated into curricula by 2026.

Abbreviation: CNS-IAC, Child Neurology Society International Affairs Committee.

Across all regions, participants emphasized 3 unifying priorities. First, there was consistent interest in developing standardized yet adaptable educational curricula that could be implemented across diverse training environments. Participants highlighted the importance of harmonizing core child neurology content while allowing flexibility to align with local clinical realities, resource levels, and training structures. Second, the need for strengthened leadership development and mentorship infrastructure emerged as a priority across settings. Clinicians identified a desire for sustainable models of mentorship, opportunities for leadership growth, and systems that support trainee development, especially in areas with limited subspecialty expertise. Third, all groups underscored the value of community engagement and sustainable educational implementation, emphasizing programs that build long-term capacity rather than short-term external support.

In addition to these shared themes, each region identified specific priorities shaped by its geopolitical, educational, and workforce landscape. The Latin and South America group selected Costa Rica as a pilot site for developing a regional curriculum model, recognizing its potential to serve as a scalable template for neighboring countries. Participants from the Asia and Middle East region prioritized the creation of digital learning networks, particularly low-bandwidth platforms for case-based discussions and ongoing professional exchange opportunities across geographically dispersed clinicians. The Africa and Caribbean group focused on advocacy and training programs, particularly for front-line general physicians, nurses, and allied health professions, targeting high-burden conditions such as epilepsy, cerebral palsy, neuromuscular disorders, and headache, integrating these efforts into existing local and national training frameworks.

Together, these region-specific goals reflect the diversity of needs across LMIC settings while maintaining alignment with a shared global vision for strengthening child neurology education.

Discussion

This 2-year initiative demonstrates a collaborative and transferable model for global child neurology capacity building within a professional society framework. By integrating data-driven needs assessment with regionally led action planning, the CNS-IAC translated broad educational challenges into concrete, contextually grounded strategies. This approach directly aligns with the priorities outlined in the World Health Organization's Intersectoral Global Action Plan (IGAP), which emphasizes workforce development, improved access to education, strengthened training pathways, and the creation of sustainable international networks. The initiative not only addresses these IGAP pillars but also models how a professional society can serve as a catalytic convener rather than an external direct force.^9,10

Our findings also align with and complement existing global child neurology efforts, including the ICNA training surveys and reports.¹ Although ICNA reports have documented gaps in training, infrastructure, and mentorship across LMICs, the current CNS-IAC initiative has further advanced this work, particularly with respect to providing actionable region-specific solutions. The structured SMART framework offered a mechanism to translate needs into measurable goals, allowing each region to tailor its priorities while maintaining alignment with global capacity-building standards. Based on phase 1 work, CNS-IAC has successfully implemented an International Academic Visiting Professor Program at the University of Manitoba, Canada. This program is designed to offer hands-on education and training exposure in neurology (both general and subspeciality exposure) to 1 academic child neurologist from an LMIC per year. By the end of 2025, this new program is expected to host 1 academic child neurologist from Pakistan.

The SMART planning process also mirrors established global health approaches, such as cascade training, mentorship pyramids, and twinning models.⁹ Cascade training employs a stepwise dissemination strategy in which content is transferred from experts to regional leaders and subsequently to frontline providers, allowing efficient scale-up while preserving curricular fidelity. The mentorship pyramid model uses a tiered structure in which senior clinicians mentor midlevel providers, who in turn support junior trainees, thereby fostering distributed leadership and sustainable mentorship capacity. Twinning models establish long-term, bidirectional partnerships between institutions in high- and low-resource settings, promoting shared curriculum development, faculty exchange, and durable systems strengthening through equity-based collaboration. These models succeed when they emphasize local ownership, shared decision making, and long-term sustainability, all of which were foundational principles in this project.⁹ By centering regional voices and fostering collaborative problem solving, the initiative enabled the development of goals that were realistic, context appropriate, and grounded in the lived realities of clinicians across LMIC settings.

Regional outcomes achieved by this project illustrate how the CNS-IAC model can adapt to diverse needs and infrastructures. In Latin America and South America, the Costa Rica pilot demonstrated the feasibility of standardized curriculum development that can serve as a template for broader regional harmonization. In the Asia and Middle East region, digital learning networks emerged as a scalable solution for connecting geographically dispersed clinicians, leveraging low-bandwidth technology to facilitate case discussions, mentorship, and shared learning.⁸ In the Africa and Caribbean region, participants highlighted systemic challenges including workforce shortages and limited training integration. Their resulting strategies focused on embedding neurologic content within existing pediatric and general medical training pathways, demonstrating a context informed approach. This strategy demonstrates contextual ingenuity, transforming barriers into opportunities for sustainable curriculum reform.^11,12 However, the outcome data from the SMART goals developed in 2025, including curriculum implementation, number of training sessions, and measurable knowledge gains, are not yet available. Early outcomes are anticipated by late 2026.

Collectively, these regional insights illustrate the strength of a coordinated yet locally empowered model. The CNS-IAC initiative shifts global child neurology collaboration from isolated educational activities toward a more cohesive, multiregional strategy grounded in shared priorities, measurable outcomes, and sustained partnerships. As these SMART goals progress toward implementation, the initiative has the potential to serve as a replicable framework for other professional societies seeking to address global inequities in subspecialty training and clinical capacity. Importantly, clinicians actively practicing in LMIC settings contributed to both phases of the initiative and participated in regional working groups, ensuring that the resulting priorities and SMART goals reflected locally informed perspectives and clinical realities.

Limitations

This project has few limitations. We did not systematically collect detailed demographic information for in-person participants (eg, trainee vs attending status or country-level representation). Future iterations of this initiative will incorporate structured demographic tracking to improve transparency and representation assessment. The survey and meetings were conducted in English, which may have excluded some clinicians and introduced language bias. Participation relied on digital access, potentially underrepresenting clinicians in areas with limited connectivity. The denominator of invited clinicians is unknown, which limits calculation of response rates and introduces nonresponse bias. Participants may not represent the full spectrum of child neurologists within each region. Outcome data from the SMART goals, including curriculum implementation, number of training sessions, and measurable knowledge gains, are planned but not yet available. Early outcomes are anticipated in late 2026. Additionally, reliance on World Bank income classifications may oversimplify the realities of health-related inequities. Countries designated as high income by narrow gross national income thresholds (eg, US$14 000 annually) are categorized alongside nations with significantly higher income levels such as the United Kingdom and the United States. This classification does not account for unique economic pressures, interest rates, or resource constraints faced by Small Island States in the Caribbean and South Pacific. As a result, several health-reserved populations in these regions may be overlooked despite having needs like LMIC settings.¹³

Future Directions

Moving forward, several strategic initiatives will be essential to sustaining and expanding the impact of this work across LMIC regions:

Ongoing Participation and Collaboration: Continued active participation of CNS members and collaboration with local partners in child neurology is imperative for the progression and sustainability of this longitudinal child neurology education initiative.

Centralized CNS-IAC Educational Repository: A dedicated, open-access repository will allow clinicians and trainees to access standardized curricula, lecture modules, case libraries, and adaptable teaching tools. This centralized platform will ensure that high-quality educational resources remain continuously available and updated to reflect evolving clinical needs.

Virtual Mentorship and Case Consultation Platforms: Establishing structured virtual mentorship programs and real-time case discussion channels will help address the widespread shortage of subspecialty mentorship in LMICs. These platforms can support clinical decision making, provide longitudinal career guidance, and promote bidirectional learning between LMIC and high-income country partners.

Ongoing In-person Training and Educational Opportunities: This will be available through the current newly developed International Academic Visiting Professor program at the University of Manitoba, Canada, as well as development of similar opportunities through other North American Academic institutions.

Evaluation Dashboards for SMART Goal Tracking: Creating visual dashboards to monitor progress on regional SMART goals will support accountability and ongoing quality improvement. Metrics may include curriculum uptake, number of sessions delivered, participant engagement, mentorship activity, and early indicators of educational or clinical impact.

Expansion to Multicountry Regional Collaborations (2026-2027): Scaling successful pilot models, such as the Costa Rica curriculum project, into multicountry initiatives will strengthen regional networks and harmonize training standards. Broader collaboration will improve to promote shared problem solving and enhance sustainability across diverse LMIC contexts.

Together, these next steps will position the CNS-IAC as a sustained partner in global child neurology education and support long-term capacity building across regions.

Conclusion

This CNS-IAC initiative shows that global child neurology collaboration can be strengthened through intentional and structured engagement. Transitioning from a broad needs assessment to regionally owned SMART action goals created a scalable and replicable model that aligns with international frameworks. Empowering regional leaders fostered ownership, sustainability, and cross-regional learning, positioning the Child Neurology Society as a convener and catalyst for global child neurology capacity building.

Supplemental Material

sj-docx-1-jcn-10.1177_08830738261453469 - Supplemental material for Global Child Neurology Capacity Building Through the Child Neurology Society International Affairs Committee: From Needs Assessment to SMART Action Goals

Supplemental material, sj-docx-1-jcn-10.1177_08830738261453469 for Global Child Neurology Capacity Building Through the Child Neurology Society International Affairs Committee: From Needs Assessment to SMART Action Goals by Sharoon Qaiser, Alcy Torres, Jorge Vidaurre, Maria T. Acosta, Thembi Katangwe-Chirwa, Dave Clark, Soe Mar, Carlos Palomino, Tarif Bakdash and Mubeen F. Rafay in Journal of Child Neurology

Supplemental Material

sj-pdf-2-jcn-10.1177_08830738261453469 - Supplemental material for Global Child Neurology Capacity Building Through the Child Neurology Society International Affairs Committee: From Needs Assessment to SMART Action Goals

Supplemental material, sj-pdf-2-jcn-10.1177_08830738261453469 for Global Child Neurology Capacity Building Through the Child Neurology Society International Affairs Committee: From Needs Assessment to SMART Action Goals by Sharoon Qaiser, Alcy Torres, Jorge Vidaurre, Maria T. Acosta, Thembi Katangwe-Chirwa, Dave Clark, Soe Mar, Carlos Palomino, Tarif Bakdash and Mubeen F. Rafay in Journal of Child Neurology

Footnotes

Acknowledgements

The authors thank the Child Neurology Society and its Child Neurology Society International Affairs Committee for supporting this initiative. We are grateful to the regional working groups for their leadership and to the clinicians whose insights and participation helped shape this project. We also acknowledge the valuable contributions of Andrea Espinoza Herrera, Federico Baltar Yanez, Noor Sabah, and Tipu Sultan to this work. The authors thank Aryeh Qaiser for volunteer assistance with session logistics.

ORCID iDs

Sharoon Qaiser

Mubeen F. Rafay

Author Contributions

Maria T Acosta

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Current work for Maria T. Acosta is supported by the intramural NHGRI of the National Institute of Health (NIH). The contribution of the NIH author is considered work of the United States Government. The findings and conclusions presented in this paper are those of the authors and do not necessarily reflect the views of the NIH or the US Department of Health and Human Services.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental Material

Supplemental material for this article is available online.

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