2025 marks ten years since the 68th World Health Assembly, where Resolution WHA 68.15 was unanimously adopted. This was a landmark moment for the global surgery community.  It acknowledged that no health system is complete without Universal Health Coverage,  including access to safe, timely and affordable surgical and anesthesia care.

Ten years on, what have we achieved?

We have a lot to acknowledge and celebrate:

• The 2015 Lancet Commission on Global Surgery 2030 defined scalable solutions for providing high-quality surgical and anaesthesia care for all;

• That same year, the World Health Assembly adopted Resolution 68.15;

• The World Bank’s Disease Control Priorities: Essential Surgery strengthened the economic case;

• The publication of Optimal Resources for Children’s Surgical Care in 2015 established the first comprehensive global framework for delivering safe, high-quality surgical care to children;

• Several countries have now developed and implemented National Surgical, Obstetric and Anaesthesia Plans: Ethiopia (2016), Zambia (2017), Tanzania and Rwanda (2018), Madagascar (2019), Nigeria (2019), Pakistan (2020), Fiji (2021), Palau (2021), Vanuatu (2021), Zimbabwe (2022), Republic of Namibia (2023), Ecuador (2023) and most recently, Ghana (2024);

• In 2020, member states in the WHO Western Pacific Region approved the Action Framework for Safe and Affordable Surgery. Work commenced in five countries - Mongolia, Cambodia, Fiji, Vanuatu and the Solomon Islands – focusing on surgical system planning;

• In 2023, member states adopted WHA Resolution 76.2, building on the foundations of earlier efforts, including surgical systems strengthening. This resolution reflects a broader, integrated agenda focused on cross-cutting system readiness and survival focused care at all levels, notably for public health emergencies, disasters and climate-related crises.

This is real progress, and we applaud countries that have led the way, especially in the  Southern African Development region.

We recognise the vital role of regional health and economic bodies and networks in  accelerating progress at the national level and embedding surgical care within the broader

health system strengthening agenda. These efforts have been transformational in advancing  access to safe, timely and affordable care across diverse settings.

Ten years on, what must we do differently, for the next five years?

Despite this progress, we must also face a sobering truth: there is more work to do. In many  places, access to surgical care has stagnated or deteriorated.

Too many people still lack access to even the most basic surgical and anaesthesia services.  Too many countries have national plans, but no implementation. The global burden of  surgical disease remains unacceptably high.

The cost of inaction is staggering – an estimated 1.3% of GDP is lost each year due to a lack  of access to safe and timely surgical care. This amounts to a projected loss of 21 trillion  dollars in global GDP between 2015 and 2030.

COVID-19 impact

The COVID-19 pandemic was a significant contributor to the current state of our health  systems. It exposed and widened systemic inequities, strained supply chains and diverted  essential resources. Surgical backlogs are immense. Recovery has been uneven. Fragile  systems have become even more vulnerable.

Despite these challenges, our community has achieved more than expected. The pandemic  accelerated access to oxygen and helped catalyse reforms in critical care infrastructure. It  also highlighted the interdependence of disciplines – from surgery and anaesthesia to  emergency medicine, intensive care, rehabilitation and palliative care.

We now find ourselves in a very different global health landscape

Global health financing is evolving. There is a shift away from traditional donor-driven models toward domestic investment and regionally led, locally informed partnerships that  reflect national priorities and contexts.

Political instability, climate-related disasters and conflict are placing an increasing burden on  surgical and trauma systems, amplifying the need for emergency, critical and operative care  to treat injuries, preserve life, and support health system resilience when it is needed most.

In this context, now more than ever, we need sustained investment in surgical systems as a  core component of preparedness and response.

Children are uniquely vulnerable in crisis settings and must have due priority. Trauma  remains the leading cause of death among children in low and middle-income countries.  Without access to surgical care, our children are not safe.

Our recommendations

1. To World Health Organization Member States:

Investment in systems:

Renew your commitment to resilient health systems. Invest in surgical, anaesthesia, and  secondary care infrastructure as a core part of universal health coverage.

Investment in people:

Remember that the surgical, anaesthesia and nursing workforce are at the centre of all this.

Commit to training, equipping and supporting professionals, without which no system can  deliver safe care.

Invest in graduate and postgraduate training:

Ensure effective supply chains, data systems and equipment maintenance. These are not  technical luxuries—they are the foundation of functioning hospitals and are essential to  delivering safe, reliable care, particularly for children whose surgical needs require  specialised skills, planning and equipment.

Investment in research:

Prioritise fit-for-purpose data collection and internet connectivity. Data is still missing, and  reporting is inconsistent. Routine surgical data collection should become standard practice.

2. To Civil Society and Academic Institutions:

Commit to high standards in research and clinical practice, foster shared learning and  promote equitable partnerships across global surgery and related areas, including  noncommunicable diseases, primary and secondary care, respiratory health, paediatric  surgery and beyond.

3. To Pan American Health Organizations and Global Partners:

Make surgical care a visible, measurable and financed priority within health, humanitarian  and climate resilience agendas.

Collaborate with governments and multilateral financing institutions to implement concrete,  localised mechanisms for delivering safe, timely and appropriate care.

Conclusion

Ten years on, we stand not just in reflection but in renewed determination.

This is not the time for complacency. It is the time for recalibration and renewed  commitment, as countries strive to meet their Sustainable Development Goals and help  shape the post-Universal Health Care global health agenda beyond 2030.

Progress is possible – but only with political will, sustained financing and a shared  recognition that surgical care is not an isolated intervention but a vital part of integrated,  resilient health systems – essential to saving lives, protecting dignity and building stronger,  more equitable societies.

On behalf of the following stakeholders:

African Partnership for Perioperative and Critical Care Research (APPRISE)  African Perioperative Research Group (APORG)

Association for Socially Applicable Research (ASAR)

Association of Academic Global Surgery (AAGS)

Association of Anaesthetists

Association for Perioperative Practice

Barrow Global

CapaCare

Center for Surgical Healthcare Research (CSHR)

College of Surgeons of East Central and Southern Africa (COSESCA)  EECC Global

Friendship

G4 Alliance

Global Initiative for Children’s Surgery (GICS)

Global Neuroscience Nurses

Global Surgery Policy Unit (GPSU)

Global Surgery Umbrella

Harvard Medical School - Program in Global Surgery and Social Change (PGSSC)  InciSioN

Innovations in Global Surgery

Intuitive Foundation

International Association of Student Surgical Societies (IASSS)  International Collaboration of PeriAnaesthesia Nurses

International Federation of Medical Students’ Association

Kids Operating Room (KidsOR)

Latin America Corporation for Health

Lifebox

Lunds University

National Institute for Health and Care Research Global Health Research Group on  Global Injury

Neurosurgery Outreach Foundation (NOF)

Ohana One

Operation Smile

Operating Theatre Practitioners Association of Kenya

Oxford University Global Surgery Group

Pacific Islands Surgeons Association (PISA)

People’s Health Movement

Public Health Concern Trust – Nepal

Reach Another Foundation

Resurge International

Royal College of Obstetricians & Gynaecologists Sadanah Foundation Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) Simurgh  Global Surgery Collaborative

Smile Train

Solidarity Bridge

Stop Aids

Surgery Obstetrics Trauma Anaesthesia Convoys (SOTAC)

Surgical Society of Kenya

The International Federation of Surgical Colleges and Societies (IFSCS Ltd)

University of California San Francisco - Center for Health Equity in Surgery and  Anaesthesia (UCSF CHESA)

University of Cambridge - Public Health & Primary Care Unit University of Ghana  Medical Centre

University of Global Health Equity University of Utah Center for Global Surgery

University of Witwatersrand-SADC (Southern African Development Community)  Regional Collaboration Centre for Surgical Healthcare (WitSSurg)

World Federation for Societies of Anaesthesiologists (WFSA) World Federation of  Neurosurgical Societies

World Orthopaedic Concern

Download the Civil Society Consensus Statement here.