Each year approximately 17 million people die as a result of surgically treatable conditions (surgical conditions) and millions more suffer from surgically preventable disabilities.[1] Currently only 6% of all surgical procedures benefit the poorest third of the world’s population.[1] Lack of access to surgical and anesthesia care perpetuates poverty, inequality, and economic instability.

Surgical conditions represent nearly one-third of the global burden of disease and are a leading cause of death and disability worldwide.[2] They include maternal health and obstetric conditions; cancer and other noncommunicable diseases (NCDs); injuries; infectious diseases such as HIV/AIDS; and congenital issues, including cleft lip and clubfoot.

Approximately 5 billion people around the world lack access to safe, timely, and affordable surgical care. Surgical conditions that go untreated can have devastating economic impacts on communities and countries. Without investment in surgical conditions, estimates show that low- and middle-income countries (LMICs) will experience $12.3 trillion in lost GDP by 2030.[1]

Improving access to safe surgical care is a cost-effective investment that advances the U.S. government’s global health objectives and assists priority countries in achieving self-reliant, sustainable health systems and workforces. In fact, the World Bank has identified surgical care as one of the most cost-effective health interventions available.[3] For every $1 invested in building surgical capacity, an estimated $10 is generated by improved health and productivity.[4]

At least 1 million additional specialists are needed to meet current demand for surgical, anesthesia, and obstetrical treatments in LMICs. Without concerted action to strengthen these health workforces, this shortfall is expected to more than double by 2030. Additional investment in frontline health workers is also needed to safely deliver this surgical care.[1]


Incorporate report language into the State, Foreign Operations, and Related Programs appropriations bills for the U.S. Agency for International Development (USAID) to assess the need and cost effectiveness of programs that strengthen surgical care systems and address surgical conditions such as hydrocephalus, burns, injuries, NCDs, fistulas, and obstructed labor.

Hold U.S. government agencies accountable for surgical systems strengthening, so that foreign assistance and global health investments integrate surgical care as an essential strategy for progress on targeted diseases and issues, including preventable child and maternal deaths, HIV/AIDS, and the development of global health capacity.

Support the U.S. government commitment to strengthening essential surgical, emergency, and anesthesia care, as agreed to in World Health Assembly Resolution 68.15 in 2015. Additionally, support robust reporting mechanisms, including the World Health Organization commitment to biannual reporting on surgical care progress and the coordinated collection and aggregation of national surgical care data to track regional and global progress over time.[5]

Call for the development of a special advisory committee, bringing together experts from the private and public sectors to guide integrated prioritization of surgical care. As part of existing programs at the Department of State, USAID, Centers for Disease Control and Prevention (CDC), and the National Institutes of Health (NIH), this prioritization will help countries address service-delivery gaps and strengthen health systems.

Affirm the high priority of policies that strengthen health workforces to achieve core global health goals as outlined in the Frontline Health Workers brief in the Global Health Briefing Book.

Credit: ReSurge/Jeffrey Davis
Jonas post-surgery with dad. Credit: ReSurge/Jeffrey Davis


Surgical care is a cost-effective, cross-cutting public health service that is critical for strengthening health systems, health workforces, and health security; for advancing maternal and child health; and for treating NCDs, trauma, infectious diseases, and congenital issues.

The World Bank has identified essential surgical care as one of the most cost-effective health interventions available and a health priority that is within reach for countries around the world. Building surgical capacity benefits an entire health system, empowering the health workforce, stimulating the economy, and contributing to healthier, more productive populations.

Moreover, the cost of inaction is too great. Without investment in strengthening surgical systems, LMICs face a projected loss in GDP of $12.3 trillion by 2030.[1] Without safe, timely, and well-integrated surgical services at the community level, the economic burden of accessing essential surgical care can be devastating. As many as 81 million people become impoverished by seeking lifesaving surgery each year,[3] burdened by disproportionate out-of-pocket costs and the additional expense of traveling long distances or taking time away from work.

Surgical care is an essential component of resilient health systems and primary health coverage. Health targets for maternal and child health, health workforces, NCDs, and health systems strengthening cannot be achieved without access to safe, timely, and affordable surgical care. Essential surgical care is an important preventive, diagnostic, and curative strategy for a cross-section of disease conditions and illnesses. Furthermore, increasing access to safe surgical care further contributes to global health security by stimulating economic growth and national stability, encouraging foreign investment, and fostering regional stability.

Surgical interventions have a transformative impact on the lives of millions of patients and their families each year. With surgical care, a traffic-accident victim can return to work and feed his family; a child with a repaired cleft can go to school and lead a normal life; and a woman with a repaired fistula can return home to her village. Integrating surgical care into existing health systems is a proven, cost-effective strategy that can save millions of lives each year, greatly contributing to economic productivity, gender equality, and poverty alleviation.


  1. The Lancet Commission on Global Surgery
  2. Disease Control Priorities Third Edition: Essential Surgery
  3. Resources for National Surgical Systems Strengthening, The G4 Alliance


Sara Anderson, ReSurge International,
Sarah Hamilton, The G4 Alliance,
Mira Meheš, The G4 Alliance,

The G4 Alliance ( is a network of more than 85 member organizations, working in more than 160 countries, dedicated to supporting increased access to safe, timely, and affordable surgical, obstetric, trauma, and anesthesia care through service delivery, on-the-ground training, capacity building, and thought leadership. We are dedicated to advocating for neglected surgical patients, and we support the integration of essential surgical care as part of health systems strengthening.


[1] Meara, John and Andrew Leather, et al. “Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development,” The Lancet. August 2015; 386(9993):569-624.

[2] Shrime, Mark and Stephen Bickler, et al. “Global burden of surgical disease: an estimation from the provider perspective,” The Lancet Global Health, April 2015; 3(2):S8-S9.

[3] Mock, Charles and Peter Donkor, et al. “Essential surgery: key messages from Disease Control Priorities, 3rd edition,” The Lancet, February 2015; 385(9983):2209-2219.

[4] “A New Global Partnership: Eradicate Poverty and Transform Economies through Sustainable Development,” United Nations, 2013.

[5] Haider, Adil and John Scott, et al. “Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance),” World Journal of Surgery, October 2017; 41(10):2426-2434.

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