BACKGROUND
In 2018, 40 years after the Declaration of Alma-Ata, the global community renewed its commitment to universal health coverage (UHC) and reemphasized the importance of primary health care in health systems strengthening (HSS) in the Declaration of Astana.1,2 If we are to achieve UHC, several important synergistic health services must be considered beyond only primary health care. In particular, access to surgical, anesthesia, and obstetric services is essential to enhancing physical, mental, and social well-being.
Despite calls for surgery and health for all from World Health Organization (WHO) leaders as far back as 1980,3 surgical, obstetric, and anesthesia (SOA) care has often been deemed too expensive and complex to deliver at scale4 and has, until recently, remained largely neglected in global surgery policy.5 To address this gap, a surge of research, advocacy, policy, and implementation efforts to expand access to these services have been taking root in several low- and middle-income countries.
In 2015, the Lancet Commission on Global Surgery published a report that approximately 70% of the world still lacked access to safe, affordable emergency and essential SOA care when needed—a shortfall disproportionately affecting those living in low- and middle-income countries. The Commission proposed 6 indicators to measure surgical systems (Table 1).4,6–8
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In the same year, the World Health Assembly passed a resolution (WHA 68.15) that declared emergency and …