Alarmingly, say experts, the world is still a long way from meeting targets for safe and affordable surgical care for all, according to their recently published study in The Lancet, with contributions from the University of Cape Town’s (UCT) Professor Bruce Biccard in the Department of Anaesthesia and Perioperative Medicine.
UCT is at the forefront of a major international drive to tackle the global surgical care crisis that is leaving more than 160m people without access to life-saving procedures each year, and Biccard is one of 60 health experts across 20 countries behind the study titled Surgical Health Policy 2025–2035: Strengthening Essential Services for Tomorrow’s Needs.
The research, led by the University of Birmingham’s NIHR Global Health Research Unit on Global Surgery, reveals that low- and middle-income countries (LMICs) carry the heaviest burden to provide safe and affordable surgical care for all.
“As an example, sub-Saharan Africa has the largest gap between demand and capacity to provide Caesarean sections, despite this being the most common operation in Africa. Surgery is a key contributor to antimicrobial resistance (AMR), with up to 96% of infected wounds in LMICs being linked to AMR,” said Biccard.
The study found that only 26% of LMICs are on track to meet the global target for patients to access essential surgery within two hours. No country in this group is achieving the recommended surgical volume of 5 000 procedures per 100 000 people per year.
Innovative funding models
Other areas of concern include the fact that 3.5m adults die within 30 days of surgery every year, more than HIV/Aids, TB and malaria combined. Furthermore, 50m patients worldwide experience postoperative complications annually: surgical site infections are the most common issue, and AMR is a rising threat.
Authors also advanced critical government and health system interventions, which include developing innovative funding models for surgery; currently, half of the patients undergoing cancer surgery in LMICs make out-of-pocket payments, which can result in catastrophic expenditure and poverty, as well as focusing efforts on making surgical services more resilient to future emergencies, including pandemics, climate change, natural disasters and armed conflict.
The report links surgical access directly to progress on several Sustainable Development Goals (SDGs), including improved health, stronger economies and national stability.
“We must continue to secure funding to expand access to surgery while maintaining quality. At the same time, we must prepare surgical systems for an increasingly unpredictable world,” said co-lead author Dr Dmitri Nepogodiev, from the University of Birmingham.
“Pandemics, climate change, and armed conflict all threaten to disrupt care in the future, but most countries have made little progress in their preparedness since the Covid-19 pandemic.”
Study details
Surgical health policy 2025–35: strengthening essential services for tomorrow’s needs
Dmitri Nepogodiev, Maria Picciochi, Adesoji Ademuyiwa et al.
Published in The Lancet on 14 July 2025
Summary
Progress towards The Lancet Commission on Global Surgery's 2030 targets has been too slow and too patchy, particularly in low-income and middle-income countries. The unmet need for surgery has continued to grow, reaching at least 160 million operations per year. Ensuring high-quality surgical care remains a crucial global challenge, with 3·5 million adults dying after surgery each year. The COVID-19 pandemic exposed the fragility of surgical services long undermined by chronic underfunding, workforce shortages, and under-resourced infrastructure. However, The Lancet Commission on Global Surgery inspired a new generation of surgeons to engage with policy, and several countries have developed national surgical plans, although most remain unfunded. Advancements in surgical data science have allowed health systems to identify priorities for improvement. Preserving this infrastructure is important, especially during periods of uncertain global health funding. The next decade requires urgent change to prevent economic instability and armed conflict from forcing surgery down the global health agenda. Reframing surgery as an essential service that saves lives, strengthens health systems, and fosters economic productivity could unlock much needed investment. Sustained progress requires integration of funding both within hospital infrastructure and across care pathways. Such holistic approaches would reinforce entire hospital systems, which are essential to national security and well-being.
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