Two thirds of the world’s population have no access to safe and affordable surgery.

A major new Commission on Global Surgery, published today in The Lancet. and launched at a day-long symposium at the Royal Society of Medicine in London, suggests that the number of people worldwide who are unable to access basic surgery and anaesthesia is more than twice as high as previously thought.

The Commission was written by a group of 25 leading experts from across the fields of surgery and anaesthesia, with contributions from more than 110 countries. The report examines the case for surgery and anaesthesia care as an integral component of health care, focusing on low- and middle-income countries (LMICs), where need is greatest. 

“In the absence of surgical care, common, easily treatable illnesses become fatal. The global community cannot continue to ignore this problem – millions of people are already dying unnecessarily, and the need for equitable and affordable access to surgical services is projected to increase in the coming decades, as many of the worst affected countries face rising rates of cancer, cardiovascular disease, and road accidents.” Andy Leather, one of the Commission’s lead authors, from King’s College London.

Despite the gross disparities in access to safe surgical care worldwide and resulting deaths, surgery has remained a peripheral concern in global health discourse, often considered too complex and too expensive to address. Its central role is now gaining recognition, underscored by research which suggests that as much as 11–30% of the global burden of disease requires surgical care or anaesthesia management, or both.

The Commission’s five key messages are presented as follows:

  • 5 billion people do not have access to safe, affordable surgical and anaesthesia care when needed. Access is worst in LMICs, where nine of ten people cannot access basic surgical care.
  • 143 million additional surgical procedures are needed in LMICs each year to save lives and prevent disability. 
  • 33 million individuals face catastrophic health expenditure due to payment for surgery and anaesthesia care each year.
  • Investing in surgical services in LMICs is affordable, saves lives, and promotes economic growth. To meet present and projected population demands, urgent investment in human and physical resources for surgical and anaesthesia care is needed. 
  • Surgery is an “indivisible, indispensable part of health care.” Surgical and anaesthesia care should be an integral component of a national health system in countries at all levels of development. Surgical services are a prerequisite for the full attainment of local and global health goals in areas as diverse as cancer, injury, cardiovascular disease, infection, and reproductive, maternal, neonatal, and child health. Universal health coverage and the health aspirations set out in the post-2015 Sustainable Development Goals will be impossible to achieve without ensuring that surgical and anaesthesia care is available, accessible, safe, timely, and affordable.

In addition, the Commission also provides a set of indicators and recommendations to improve access to safe and affordable surgery and anaesthesia, and a policy template for national surgical plans. It is accompanied by a substantial body of original research which was used to inform the Commission’s findings, and is published in the journals Surgery and The Lancet Global Health.

Find out more about THET's work to strengthen emergency and essential surgical care and anaesthesia through health partnerships here