Editor’s note: This executive summary of The Lancet Commission on Global Surgery was published online on April 27,
2015, by The Lancet.* It has been edited here to conform
with Bulletin style and is reprinted with permission from
Elsevier. The full report can be accessed at TheLancet.com/
Remarkable gains have been made in global health in the last 25 years, but progress has not been uniform. Mortality and morbidity from
common conditions needing surgery have grown
in the world’s poorest regions, both in real terms
and relative to other health gains. At the same time,
development of safe, essential, lifesaving surgical and
anesthesia care in low- and middle-income countries
(LMICs)† has stagnated or regressed. In the absence of
surgical care, case-fatality rates are high for common,
easily treated conditions, including appendicitis, hernia, fractures, obstructed labor, congenital anomalies, and breast and cervical cancer.
Global health burdens
In 2015, many LMICs are facing a multifaceted burden
of infectious disease, maternal disease, neonatal disease,
non-communicable diseases, and injuries. Surgical and
anesthesia care are essential for the treatment of many
of these conditions and represent an integral component
of a functional, responsive, and resilient health system.
In view of the large projected increase in the incidence
of cancer, road traffic injuries, and cardiovascular and
metabolic diseases in LMICs, the need for surgical ser-
vices in these regions will continue to rise substantially
from now until 2030. Reduction of death and disability
hinges on access to surgical and anesthesia care, which
should be available, affordable, timely, and safe to ensure
good coverage, uptake, and outcomes.
Despite growing need, the development and delivery of surgical and anesthesia care in LMICs has been
nearly absent from the global health discourse. Little
has been written about the human and economic effect
of surgical conditions, the state of surgical care, or the
potential strategies for scale-up of surgical services in
LMICs. To begin to address these crucial gaps in knowledge, policy, and action, The Lancet Commission on
Global Surgery (LCoGS) was launched in January 2014.
The commission brought together an international,
multidisciplinary team of 25 commissioners, supported
by advisors and collaborators in more than 110 countries and six continents.
Five key messages
The LCoGS formed four working groups that focused
on the domains of health care delivery and management; workforce, training, and education; economics and finance; and information management. The
commission has five key messages—a set of indicators and recommendations to improve access to safe,
affordable surgical and anesthesia care in LMICs, and
a template for a national surgical plan. Our five key
messages are as follows:
• Approximately 5 billion people do not have access to safe,
affordable surgical and anesthesia care when needed.
Access is worst in LMICs, where nine of 10 people cannot access basic surgical care.
• An additional 143 million surgical procedures are needed
in LMICs each year to save lives and prevent disability.
Of the 313 million procedures undertaken worldwide
each year, only 6 percent occur in the poorest countries,
*Meara JG, Leather AJM, Hagander L, et al. Global surgery 2030:
Evidence and solutions for achieving health, welfare, and economic de-
velopment. Lancet. 2015; published online April 27. Available at: http://
dx.doi.org/10.1016/S0140-6736( 15)60160-X. Accessed March 31, 2015.
†LMICs: Although this term has been used throughout the report for
brevity, the commission acknowledges that tremendous income diversity exists between and within this group of countries.
Little has been written about the human and economic effect
of surgical conditions, the state of surgical care, or the potential
strategies for scale-up of surgical services in LMICs. To begin to
address these crucial gaps in knowledge, policy, and action, the
LCoGS was launched in January 2014.