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Advocating for Safety in Global Surgery: An Introduction

November 19, 2014

Surgery has long been recognized as an essential element of a comprehensive health system, yet its introduction into the global health dialogue has only been relatively recent. While the Director General of the World Health Organization (WHO), Dr. Mahler, stated over 30 years ago that “people in need must have access to skilled surgical care at the first-line referral hospitals,” the role of surgery in universal health care was not widely recognized until decades later. In 2005, the WHO established the Global Initiative for Emergency and Essential Surgical Care (GIEESC) to help support the promotion of surgical capacity development. Since this time the science, programming, and research supporting global surgery development have rapidly progressed. 

To date, we know that two billion people around the world lack access to basic surgical services. Studies conducted in low- and middle-income countries in Asia, Africa, and Latin America have shown a severe dearth of material and human resources for surgical care, particularly in rural areas. Although there are large barriers to overcome, several groups have demonstrated marked success in increasing access to surgical care using a range of delivery models, such as training programs, hospital infrastructure support, and surgical missions. Each model offers its own unique and complementary benefits. While much work remains to be done in regards to increasing access to surgical care, one of the foremost considerations in this work must be safety. 

It is estimated that over 234 million operations are performed worldwide each year. Complications may occur in up to 25% of these and operative mortality rates are known to range from 0.5 – 5% depending on the setting and circumstances. While surgery is intended to save lives and avert disability, unsafe surgery has the capacity to cause substantial harm. The concept of “safe surgery” is not a new one and is in fact assumed in most high-income settings. It follows from the physician credo of, “First, do no harm.” Safety in surgical care is a multi-faceted concept including aspects of infection prevention, patient monitoring, and clinical effectiveness. In 2009, the WHO issued a report titled “Safe Surgery Saves Lives.” In these guidelines, the authors begin to delineate properties of safe surgery and make recommendations. A key component of these guidelines is the Safe Surgery Checklist. The use of this checklist in various settings has been shown to reduce complication rates by more than half.

As the role of surgery in universal health care continues to expand in the global dialogue, safe service delivery will need to be continued to be emphasized. The groundwork for this has been laid by global actors like the WHO and active non-governmental organizations (NGOs), but greater, sustained efforts are necessary to increase access to not only surgery, but surgery that is safe and effective.



  • The Second Global Patient Safety Challenge: Safe Surgery Saves Lives. World Health Organization; 2009. Available from:  Accessed: November 16, 2014.
  • Emergency and Essential Surgical Care. World Health Organization.  Available from: Accessed: November 16, 2014.
  • Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009 Jan 29;360(5):491-9.
  • Jha AK, Prasopa-Plaizier N, Larizgoitia I, Bates DW; Research Priority Setting Working Group of the WHO World Alliance for Patient Safety. Patient safety research: an overview of the global evidence. Qual Saf Health Care. 2010 Feb;19(1):42-7.
  • McQueen KA, Malviya S, Gathuya ZN, Tyler DC. International advocacy for education and safety. Paediatr Anaesth. 2012 Oct;22(10):962-8.

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