The Essential Role of Surgery in Achieving Universal Health Coverage

As featured in the THET February E-Bulletin

“Universal health coverage (UHC) is based upon the conviction that health is a human right, not a privilege. As Director General of the World Health Organization (WHO), I have made UHC my top priority, because I believe it is the best overall investment in health. WHO’s work is about serving people and serving humanity. As part of this mission, access to surgical services and anaesthesia is something to which I am deeply committed.”

So wrote Dr. Tedros, Director General of the WHO, in a message delivered at an official side event during the Universal Health Coverage Forum in Tokyo, Japan on December 12, 2017. This advocacy event, hosted by the WHO, and the governments of Zambia and Zimbabwe, in partnership with the G4 Alliance, the Program in Global Surgery and Social Change at Harvard Medical School, and Johnson & Johnson helped to draw recognition for the essential role of surgery and anaesthesia as part of UHC (Image 1).  World leaders, including Dr. Tedros Adhanom of the WHO, Dr. Jim Yong Kim, President of the World Bank, and Dr. Sania Nishtar, Co-Chair of the High-Level Commission on NCDs, shared strong support for the essential role of surgical and anaesthesia care (Image 2).

Around the world, 5 billion people lack access to safe, affordable surgical and anaesthesia care. This issue cuts across nearly all aspects of health including conditions such as obstructed labor, maternal hemorrhage, congenital birth defects such as clubfoot and cleft lip, traumatic injuries and accidents, soft tissue infections, as well as non-communicable conditions such as cancer and heart disease. Neglected surgical conditions, which comprise one-third of the global burden of disease, could be treated simply and cost-effectively through increased access to essential surgical and anaesthesia care. Access to essential surgical care could save the lives of nearly 17 million people each year, with millions more living free from disability and chronic disease.

The economic impact of surgical inequity also makes surgery essential in achieving UHC, which prioritizes affordability of health services for individuals and the role of health in the economic development of nations. Every year, 81 million people face catastrophic financial expenditure while seeking access to surgery. People are forced to choose between their health and their financial security, and many forgo treatment rather than face financial ruin. Nations that do not invest in surgical care, however, face a steep cost; low and lower-middle income countries stand to lose $12.3 trillion in potential GDP by the year 2030 if they do not make critical investments in surgical care. Achieving the financial imperative of UHC and working towards zero poverty as outlined by the Sustainable Development Goals will require strong health systems and the integration of surgical care as part of primary health coverage.

The barriers to care are numerous: workforce capacity, lack of infrastructure, lack of financing mechanisms, supply chain issues, and a long legacy of under-prioritization at every level of society. To holistically address each of these complex barriers, a coordinated global response was vital. In 2014, the G4 Alliance, a coalition of more than 85 of the world’s leading surgical, obstetric, trauma and anaesthesia care organizations, was formed to advocate for neglected surgical patients around the world. Through this coalition, we are working to develop a shared global advocacy and policy framework for surgical, obstetric, trauma, and anaesthesia care.

While the essential role of surgery as part of UHC has been recognized through political declarations and statements by high level officials, there is still much work to be done. The global surgical community must continue working with the WHO, Member States, and civil society to support integration of surgical care as part of national health plans, and to call for standardized monitoring and reporting of progress worldwide, as organizations like THET are already doing. You can help us take action to call upon world leaders to take the next step in prioritizing collection of surgical and anaesthesia indicators to help track national and global progress. Join us in this advocacy opportunity by February 4th, 2018, and join us throughout the year for additional opportunities to become an advocate for global surgery and health for all!

Surgery in the Spotlight at 72nd UNGA

September 12, 2017 marked the opening of the 72nd UN General Assembly (UNGA), the annual convening of world leaders that serves as the main policy-making and convening platform for the United Nations. The G4 Alliance coordinated a delegation of member advocates to attend the UNGA representing safe surgery, and promoting its essential role in achieving both the Sustainable Development Goals and universal health coverage. Thanks to the active engagement of our members and partners, there was no shortage of discussion and action around safe surgery at this year's UNGA! 

5 Highlights from 72nd UNGA

1. #SurgeryUHC Thunderclap

                 There is no #UHC without #SurgeryUHC!

                 There is no #UHC without #SurgeryUHC!

G4 members and partners came together to generate a resounding Twitter Thunderclap on Monday September 18th. Using the hashtags #SurgeryUHC and #SafeSurgery, participants called upon world leaders to recognize the essential role of surgical care as part of universal health coverage (UHC).  This campaign was timed in advance of a high-profile UNGA event entitled "World Leaders for Universal Health Coverage: A High-Level Discussion at the United Nations on Achieving the SDGs Through Health for All."  Online advocacy reached 59,724 people directly over social media, raising the profile of global surgery and world leaders.  Thanks to all who joined us!


2. Dr. Tedros Meets with G4 Members

 The G4 Alliance coordinated a delegation of members to participate at this year's UNGA .  Over 20 delegates attended a high-level event at the UN bringing together world leaders to discuss progress towards achieving universal health coverage (UHC). In addition to promoting our #SurgeryUHC campaign, our delegation had the opportunity to engage directly with a number of key leaders including Dr. Tedros Adhanom (Director General of the World Health Organization) and representatives from the World Bank, Rockefeller Foundation, UHC 2030, UHC Coalition and various UN Agencies .  A special thanks to all members who participated at UNGA, especially the team from the Harvard Program in Global Surgery and Social Change for contributing much time and energy to our campaign.  We will continue to build on these advocacy efforts to ensure leaders such as Dr. Tedros continue to advocate for the essential role of surgery to achieve UHC and health for all! 

3. Spotlight on Safe Surgery Maternal + Newborn Health

Each year, more than 300,000 women die from preventable surgical conditions during pregnancy or labor. The same conditions that kill mothers often result in the death of their newborns. These tragedies are by no means inevitable — safe surgery can prevent the maternal and newborn deaths that devastate so many families around the world.

To shed light upon this global injustice, the G4 Alliance, in partnership with Jhpiego, GE Foundation and Safe Surgery 2020, co-hosted an advocacy side event entitled, "Accelerating Progress in Maternal + Newborn Health: The Role of Surgical Innovations to Catalyze Change".  Speakers and panelists highlighted the critical role of surgery in averting preventable maternal and newborn deaths and focused upon the strategies and tools that are making an impact. Special remarks were shared by Mr. John Rice, Vice-Chairman of GE and President & CEO of GE Global Growth and Operations,  Dr. Tim Evans, Senior Director of Health, Nutrition & Population,  World Bank and Dr. Leslie Mancuso, President and CEO, Jhpiego.  The event was moderated by Ambassador Dr. Neil Parsan, G4 Alliance Board Chair & Special Advisor to the World Bank.

The panel was moderated by Wendy Taylor, Former Director, USAID Center for Accelerating Innovation. Expert panelists brought diverse perspectives to the discussion and included the following partners: 

  • Dr. Miliard Derbew, President, College of Surgeons of East, Central, and Southern Africa (COSECSA) - G4 Member
  • Dr. John G. Meara, Kletjan Professor of Global Surgery and Director of the Program in Global Surgery and Social Change, Harvard Medical School - G4 Member
  • Kris Torgeson, MSC, MPhil, Global CEO, Lifebox Foundation
  • Dr. Pierre Theodore, Vice President, Medical Devices, Johnson & Johnson
For an in-depth look at the discussion and outcomes of the event, please read these fantastic pieces from our friends at Global Health NOW and GE Reports.
"The scope of the problem is clear: More than 300,000 women will die from preventable conditions during pregnancy, such as a ruptured uterus or obstructed labor." Dayna Kerecman Myers, Writer/Editor for Global Health NOW.

"The scope of the problem is clear: More than 300,000 women will die from preventable conditions during pregnancy, such as a ruptured uterus or obstructed labor." Dayna Kerecman Myers, Writer/Editor for Global Health NOW.

“This is not sending someone to Mars,” said John Rice, GE vice chairman and president and CEO of the company’s Global Growth Organizations. “We need basic protocols, technology and training.”

“This is not sending someone to Mars,” said John Rice, GE vice chairman and president and CEO of the company’s Global Growth Organizations. “We need basic protocols, technology and training.”

4. Big, Bold Ideas: Essential Surgery & SDGs

 Essential surgery and the great work of G4 members were in the spotlight at Johnson & Johnson's UNGA event.  On September 20th, J&J hosted "Big, Bold Ideas to Achieve the SDGs: The Johnson & Johnson Commitment to Improve Health for Humanity". The event featured a Changemaker's Expo to highlight the work of J&J partners, including G4 Members Operation Smile, CCBRT/Kupona Foundation & Smile Train.   The event also featured a panel discussion showcasing the company's commitment to the Global Goals, including a commitment to bring safe, essential, and timely surgical care to 50 million people over the next 5 years. Dr. Rusty (Ross) Segan, CMO, Medical Devices and Global Medical Affairs served as the voice for surgery on the panel. Our thanks to Dr. Segan for highlighting the essential role of surgery as a cross-cutting strategy for achieving the SDGs and for noting the importance of civil society networks such as the G4 Alliance for helping to fulfill these goals. Dr. Segan spoke to the economic potential of essential surgery, emphasizing that LMIC economies stand to lose 12.3 trillion dollars without the swift integration of safe surgical and anaesthesia care. We commend Johnson & Johnson on their commitment to global surgery!

5. Surgery at Global First Ladies Alliance & Facebook Live Event

The Global First Ladies Alliance  (GFLA) is a non-profit organization that supports First Ladies in their efforts to advance positive change in their communities and around the world. On Thursday September 21st,  we were invited to participate in  The Future of Women, a day-long summit hosted in parallel with the UNGA, and co-hosted by the GFLA, Facebook, MAC AIDS Fund and OkayAfrica. The objectives of this interactive event were to "feature tangible solutions for creating more equitable societies, host working sessions on women’s empowerment, and explore the role of technology and social media in amplifying voices and impacting positive change." Founding G4 Alliance Executive Director Dr. Jaymie Henry was invited to discuss the importance of essential surgery during an intimate round table discussion with First Ladies and their cabinets.  Dr. Henry and G4 Director of Operations Ms. Mira Mehes also participated in a workshop with leadership from the GFLA and First Ladies' Chiefs of Staff to discuss how surgery can be integrated as part of national advocacy, SDG campaigns and health portfolios. Read more about the event here

Safe Surgery in the News

Too many women face death while giving birth. Here’s how we can improve their chances. By Monica Kerrigan (Jhpiego) in The Lily, Sept, 2017.

Saving Mothers: ‘No Woman Should Die Giving Life,’ Safe Surgery Partners Stress By Tomas Kellner (GE) in GE Reports, Sept, 2017.

In countries with a shortage of surgeons, other health care workers can fill in the gaps  By Dr. Tigistu Adamu Ashengo (Jhpiego) in STAT, Aug, 2017.

Childbirth Is Awe-Inspiring. Making It Safe Shouldn’t Be. By Adam Lewis (Gradian) in Huffpost, Aug, 2017.

Surgery must be a core part of health care – even in the poorest countries. By David Barash (GE Foundation) in The Guardian, Aug, 2017.

ImPACT Africa Pioneers Essential Data Collection Method

Perioperative mortality rate (POMR), or post-operation mortality, is a key global surgery indicator endorsed by the WHO, the Lancet, and the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care. It is considered to be a reliable indicator of the quality and safety of surgical and anaesthesia care, and it is essential to know this data to improve care within health systems. Data regarding this metric, however, is rarely collected in low- and middle- income (LMIC) countries, which are in urgent need of healthcare systems strengthening.

In East Africa, researchers and partners have come together to form the Perioperative Mortality Rate data collection project to fill this information gap and build a model of data collection that can be easily replicated throughout other regions. 

The project, funded by GE Foundation, is lead by researchers at Kijabe Hospital-Department of Anesthesiology and Vanderbilt University Medical Center-Department of Anesthesiology under the umbrella project "ImPACT Africa".  A team of anaesthesiologists at Kijabe Hospital designed and implemented an electronic data collection tool to track postoperative mortality within their hospital. Anaesthesia providers were able to use this device to collect valuable perioperative data in almost real time and analyze information on the outcomes of various surgical procedures. 

These G4 member organizations are working together to improve safe surgery and anaesthesia in Africa. Currently, ImPACT Africa is involved in building a sustainable model for anaesthesia capacity-building (including strengthening clinical work, education, data collection) in East Africa, with plans to extend their model beyond the region. 

Read more about their work, the results of their data collection, and commentary on the significance of this achievement below!

The Full Study

Commentary by Isabeau A. Walker, B.Sc., M.B., B. Chir., F.R.C.A., Iain H. Wilson, M.B., Ch.B., F.R.C.A. 


Safe Roads, Safe Surgery: Achieving SDG 3

Traumatic injuries from road traffic incidents (RTIs) are among the top causes of death and disability worldwide.  Approximately 1.25 million die each year and an additional 20-50 million suffer non-fatal injuries as a result of road traffic accidents. Due to increased urbanization and industrialization, low and middle-income (LMIC) countries bear a disproportionate number of injury-related deaths and will continue to bear this burden until governments invest in the expansion of infrastructure and the development of roads. Improving the survival of trauma patients hinges upon timely and effective pre-hospital and hospital-based interventions, including access to safe and affordable surgical care. 

The Sustainable Development Goals (SDGs), introduced in 2015, set 17 goals and 169 targets for the eradication of poverty, improving health, promoting education, and overall progress of humanity. SDG 3 aims to ensure healthy lives and promote well-being for all at all ages. To achieve this ambitious goal, 13 specific targets were set, including the global reduction of morbidity and mortality from RTIs by 50% by the year 2020. Development of organized and integrated pre-hospital and emergency care systems decrease morbidity and mortality from RTIs, and surgical care is an integral part of that framework. Surgical interventions, particularly in an emergency setting, are cost-effective and pivotal in preventing long-term disability.

Without investment in the surgical systems, losses in economic productivity in LMICs will total 12.3 trillion USD by 2030.

Lack of effective political advocacy and insufficient resources continue to be major barriers to providing emergency surgical care in LMICs. Without investment in the surgical systems, losses in economic productivity in LMICs will total 12.3 trillion USD by 2030. Improvements in trauma care can save up to 2 million lives annually in these countries, but only with the effective integration of surgical care. Improving health to ensure well-being is a complex matter that necessitates societal, governmental, and economic involvement. It is a public health priority to invest in safe surgical and anesthesia care to develop a sustainable health system.

Call to Action
Over 90% of RTIs occur in LMICs, causing considerable economic losses not just to the victims and their families, but also to nations as a whole. The targets set forth in SDG 3 will not be possible without the prioritization of surgical care as an essential strategy for reducing morbidity, mortality, and disability caused by these traffic injuries.

  1. Sign on to the speed vaccine campaign to reduce traffic speeds to a level safe for children. The campaign is endorsed by leading public health figures including Michael Bloomberg, Jimmy Carter, and Margaret Chan and builds on SDG 3.6 and the Habitat III New Urban Agenda call for ‘a safe and healthy journey to school for every child as a priority.’
  2. Engage in cross-sector collaboration and report back on commitments and progress to support the SDG 3 on health and wellbeing and work towards halving road deaths by 2020;
  3. Prioritize robust investments to strengthen national health systems, ensuring that universal health coverage includes essential surgical and trauma care to save lives and prevent disability resulting from road-traffic related accidents and injuries.  

Read more about the 2017 UN HLPF Advocacy Side Event we hosted with FiA Foundation and the Global Initiative for Child Health and Mobility Here


-Dr. Maryam Saeed is a global surgery research fellow working with the G4 Alliance. 

Partnerships for Progress

This post is a contribution of G4 member Diamedica UK Ltd

In the early dawn, after the call for prayer that rang out over Hargeisa had fallen silent, a group of very special individuals gathered together at the Edna Adan Teaching Hospital. It was the start of the first ever Safe Anaesthesia for Somaliland Conference, or SANSOM project, where 30 newly trained nurse anaesthetists met together for three days of refresher training and to share the challenges of their recent professional experiences.

SANSOM is a project initiated by Diamedica UK Ltd, a member of the G4 Alliance that specialises in making medical equipment for challenging environments. Its aim was to equip newly qualified anaesthesia providers with kits of appropriate equipment. The project marks the start of a new and vital healthcare framework designed to support nurse anaesthetists and is unique because, in addition to ongoing training and support, the collection of anaesthesia data is central to it – and this is a first for Somaliland.

From now on anaesthetists will record patient details before, during and after their operations – from their vital signs of life statistics (body temperature, blood pressure, heart rate, and respiratory rate) through to recovery time or, if appropriate, time and cause of death following a procedure. This will serve as an important aid for reviewing, modifying and ultimately improving anaesthetists’ performance.

Training director Dr. Mark Newton and his team from Kijabe Hospital in Kenya had trained the nurse anaesthetists who attended over a two year period and aimed to assess, update and build on students’ progress.

Students and trainers assemble outside the Edna Adan Training Hospital following the first SANSOM conference. Photo: ©Tim Bekir, 2017

Students and trainers assemble outside the Edna Adan Training Hospital following the first SANSOM conference.

Photo: ©Tim Bekir, 2017

One workshop run by Dr. Newton involved a simulation exercise with a Laerdal manikin, whose vital signs he controlled from a laptop, unseen behind a dark screen.

While initially the surprised students who entered the room one at a time were dubious about the plastic 'baby' on the operating table, it didn’t take long before the wailing patient monitor prompted the first student to call for the help of a colleague, who was then briefed on the patient’s condition.

With Dr. Newton in charge of the ‘baby’s’ rapid deterioration, the atmosphere in the room grew tense, with one student administering an adrenaline injection, another beginning CPR. Ultimately the tiny patient ‘died’ on the theatre table, giving rise to a post-op review between Dr. Newton and the students concerned. One team of anaesthetists had to be repeatedly asked to stop giving CPR – the simulation was over, yet it seemed so real to them. Students were plainly engaged and inspired, and the feedback given about this session was excellent.

Other workshops were run by training leaders Hosea Cheruiyot and Mary Mungai, Gatwiri Murithi and Joash Kiptanui – all from Kijabe Hospital. Content was hard-hitting and topical, with lectures covering management of a range of obstetric complications and neonatal emergencies.

Those involved in the delivery and installation of the equipment were met with a growing sense of optimism that a corner in Somaliland’s healthcare provision was being turned.

Students were also given workshops in the use of the electronic tablets they’d been given for data collection. Interestingly, these tablets were also programmed to serve as anaesthesia libraries and were enthusiastically received by students as a fantastic resource.

In addition to the contributions from the Kenya team, Diamedica’s director Robert Neighbour talked students through the care and maintenance of equipment donated by numerous charities including Safe Anaesthesia Worldwide and the DAK Foundation. His expertise in the donated DPA02 portable anaesthesia machines was important to ensure students were confident in their use and upkeep. Robert also delivered a short course in the use of Lifebox’s pulse oximeters.

The conclusion of the three-day conference saw the start of hundreds of miles of road trips across Somaliland to deliver anaesthesia and other related medical equipment to eight different government hospitals.

Dr. Edna Adan herself led a convoy of four trucks to Hargeisa Group Hospital, Berbera Regional Hospital, Borama Regional Hospital, Burao General Hospital, Gabiley General Hospital and Sheikh District Hospital, and also hospitals in both Lasanod, Erigavo, and Gargaar Hospital. Those involved in the delivery and installation of the equipment were met with a growing sense of optimism that a corner in Somaliland’s healthcare provision was being turned.

With one of the highest rates of maternal and child mortality in the world, and with the majority of the population living in isolated, rural areas of the country, the SANSOM project addressed these issues head-on.

It’s important to note that the portable nature of the DPA02 anaesthesia machines means that while they are a vital hospital resource, they can easily be transported for outreach work. Essentially, the SANSOM project will help to increase Somaliland’s surgical life saving capacity.

Now all we need to ensure is that this provision continues to grow.

Diamedica UK is a member of the G4 Alliance, a advocacy coalition of more than 80 of the world’s leading surgery, obstetric, trauma, and anaesthestia organizations. G4 Alliance members, including Diamedica, have recently co-authored a manuscript published in the World Journal of Surgery. The manuscript announces a global unifying target of access to safe surgical and anaesthesia care  for 80% of the world by 2030. To measure progress towards this goal, the G4 Alliance has developed 15 target consensus indicators that will act as a global dashboard of health systems strengthening.

Recap: Global Surgery at the 70th World Health Assembly

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The 70th World Health Assembly - the WHO's health-policy decision making body - took place from May 22-31, 2017.  Each year, the WHO's 194 member states convene in Geneva to discuss major global health issues and to agree upon the WHO's program of work. This year's WHA also featured the appointment of the next Director General.

The G4 Alliance and global surgery stakeholders were pleased to see momentum building around the issue of surgical and anaesthesia care for the billions of neglected surgical patients!


Global Surgery Highlights at the 70th WHA:


20-21 May

The G4 Alliance hosted our Member Permanent Council (PC) Meeting in parallel with the WHA on May 20-21, 2017.  The PC represents the heart of the G4 Alliance and provides the knowledge, diversity and expertise that make our network unique. Our Permanent Council represents the only collective body in the world that is passionately advocating for all neglected surgical patients.

G4 Permanent Council Meeting Photos Here 


22 May


The G4 Alliance and our 80+ members, in partnership with GE Foundation and SS2020 hosted a Global Surgery Advocacy Side Event in parallel with the 70th World Health Assembly.

Entitled "From Commitment to Action: Partnerships to Strengthen Surgical and Anaesthesia Care for All", this event convened members of civil society and country representatives to highlight partnerships between NGOs, private sector and government that are supporting progress towards WHA resolution 68.15 on emergency and essential surgical and anaesthesia care.

Secretary Tom Price - G4 Alliance Global Surgery Event - 70th World Health Assembly.jpg

Special guest speakers included Hon. Prof. Yifru Berhan Mitke, Minister of Health of Ethiopia, Secretary Thomas Price of the United States Health and Human Services, Dr. Mpoki Ulisubisya, Permanent Secretary of Ministry of Health of Tanzania, and Dr. Nthuli Mzaza, Director of Clinical Care and Diagnostic Services with the Ministry of Health of Zambia.

Over 150 people joined and 25+ country representatives were in attendance.

Read more here

23 May


Dr. Tedros Adhanom Ghebreyesus of Ethiopia was elected to the position of Director General of the World Health Organization. Dr. Tedros has expressed his support for surgical and anaesthesia care. We look forward to working with the new Director General to prioritize surgical, obstetric, trauma, and anaesthesia care and to ensure that WHA resolution 68.15 is implemented.

24 May

Lifebox and the World Federation of Societies of Anaesthesiologists (WFSA) hosted a side event featuring the G4 Alliance, InciSioNOperation Smile and the Zambian Ministry of Health. This event brought together members of civil society to ask the question: What's next for surgery and anaesthesia? This event also provided a preview of the WFSA's World Anaesthesiology Workforce Map and for #GlobalSurgeryDay (May 25), which is led by the International Federation of Medical Student's Associations (IFMSA)'s Global Surgery Working Group (InciSioN).


25 May

The WHO Emergency and Essential Surgical Care (EESC) programme hosted a Global Public Health Surgery - Technical & Programmatic Working Meeting assembling country representatives and civil society to share updates and discuss strategies for scaling up universal surgical and anaesthesia care coverage. At this meeting, Zambia announced the launch of its National Surgical, Obstetric & Anaesthesia Strategic plan, developed in partnership with Harvard Program in Global Surgery and Social Change (PGSSC). Thursday also marked #GlobalSurgeryDay!

26 May

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The official WHO side event entitled "Global Public Health Surgery: WHA High Level Health Policy Surgical Side Event" addressed progress towards WHA Resolution 68.15. This meeting was well-attended by Member States, civil society and WHO representatives, with several G4 Alliance members represented and delivering statements. Following discussions at this meeting, Member States requested the G4 Alliance's  assistance to seek country support for the development of a Global Action Plan for surgical and anaesthesia care.

27 May

An amendment calling for the Director General to report back every 3-years until 2030 on progress towards Resolution 68.15 has been approved. We thank Zambia, Morocco, and Thailand for their leadership.  Kenya also delivered a statement on behalf of the African region, supported by Zambia and Namibia, calling for a Global Action Plan to support implementation of Resolution 68.15 to strengthen surgical and anaesthesia care. While time restrictions meant that a second amendment was not introduced, this statement represents an important step towards introducing a new WHA Agenda Item specifically addressing the need for a Global Action Plan at the next assembly.  We will keep our G4 network updated with more details. 

30 May

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On the final day of the WHA, Member States, WHO representatives and members of civil society assembled for the report back on WHA Resolution 68.15. Thanks to all countries and NGO representatives who delivered a statement. Read the full report here and the appendix with additional details here.

Thank you to all members and organizations that attended events, advocated, and joined us on social media using #ICommit2Surgery, #SafeSurgery, #WHA70 and #GlobalSurgeryDay. This was an unprecedented year for surgical, obstetric, trauma, and anaesthesia care at the World Health Assembly and we look forward to moving the needle forward in years to come. 

Angel's Story: Smile Train Working to Reach 80 by 2030

Globally, 1 in every 700 children are born with a cleft lip and/or palate, making clefts the leading birth defect in many developing countries. Angieleca (Angel) Hayahay was one of these children. Although she dreamed of becoming a nurse from a young age, she quickly faced discrimination which threatened to destroy her dream, all because of her cleft lip. While applying for a job at a call center to help pay for her education, she was told that there was a strict policy against hiring anyone with a cleft.

Many cultures view a cleft as a curse or a lifelong disability, with some even believing that a physical deformity is a sign of a mental disability as well.

Thanks to the help of Smile Train, who provided free surgery to Angel to repair her cleft, she was able to persevere and meet her dream of becoming a nurse in 2009. She now works at the same hospital where she received her surgery, Philippine Band of Mercy, which is a partner hospital of Smile Train.

Angel achieved her dream of being a nurse following free surgery by Smile Train

Angel achieved her dream of being a nurse following free surgery by Smile Train

Angel's story comes at a critical moment for global surgical, obstetric, trauma and anaesthesia care. A manuscript developed by the 80+ members of the G4 Alliance, including Smile Train,  was recently published in the May issue of the World Journal of Surgery. The paper announces the G4 Alliance’s unifying target of access to safe surgical and anaesthesia care for 80% of the world by the year 2030, and proposes 15 key consensus indicators that will track global progress towards this goal. Angel is a great example of how Smile Train is helping to achieve this goal, because as a child she was able to receive safe surgical care with Smile Train. Now, Angel is able to provide safe surgical care to other children in need.

Angel, left, working as a nurse in the Philippine Band of Mercy hospital. Image: Smile Train

Angel, left, working as a nurse in the
Philippine Band of Mercy hospital.
Image: Smile Train

"Angel is now seen as a role model to those with clefts, proving how they too can achieve dreams which once appeared unattainable"

Angel is now seen as a role model to those with clefts, proving how they too can achieve dreams which once appeared unattainable. Working as part of the Smile Train outreach program, Angel locates patients who, due to their remote location, cannot access or are not aware of the proper care which is available to them.

She says, “I feel…very thankful that there are people and organizations, like Smile Train, who are willing to help children with clefts for free….Being a nurse and serving children with a cleft is very rewarding….During our medical outreach programs in the provinces, parents look at me and make me a model for their children who are afraid to undergo surgery. I am proud because I can now be an instrument to inspire others.”

Smile Train is an international children’s charity working to ensure that children in developing countries who suffer from untreated clefts have the opportunity to receive a 100% free cleft repair surgery in their own communities.

Untreated clefts mean that children have difficulty eating, breathing and speaking.

Smile Train empowers doctors in more than 85 countries to provide these surgeries, training local doctors who can then go on to teach others, creating a sustainable and long term system. So far, the lives of more than 1 million children have been transformed.

The G4 Alliance represents a network of over 80 member organizations working in more than 160 countries that are dedicated to increasing access to safe, timely and affordable surgical and anaesthesia care for the estimated 5 billion neglected surgical patients. We believe surgical care is essential to robust health systems and represents an important strategy for supporting peace, prosperity and sustainable development around the world. 

G4 Members Speak Out! Health and Human Services Listening Session

On May 5th, 2017, G4 Alliance members convened in DC for the annual Health and Human Services Listening Session. The U.S. Department of Health and Human Services (HHS), the department charged with leading the United States delegation to the 70th World Health Assembly (WHA), holds these informal sessions to facilitate a dialogue with all stakeholders in the global health community in order to collect input on what items will be on the agenda at the World Health Assembly. These sessions are a valuable opportunity to influence the global health development agenda for the upcoming year.

Dr. Edward L. Trimble (Director, Center for Global Health National Cancer Institute, NIH, DHHS); Capt. Mitchell I. Wolfe (Acting Assistant Secretary for Global Affairs, HHS, OGA) and additional US Gov. representatives respond to comments.

Dr. Edward L. Trimble (Director, Center for Global Health National Cancer Institute, NIH, DHHS); Capt. Mitchell I. Wolfe (Acting Assistant Secretary for Global Affairs, HHS, OGA) and additional US Gov. representatives respond to comments.

Our member network was well-represented this year, with our delegates delivering nine separate statements throughout the session focusing on various WHA agenda topics that relate to surgical and anaesthesia care.


A copy of the 70th WHA agenda can be found here.





G4 members presented several key facts to United States officials:

Dr. Gezzer Ortega represents G4 Alliance at the 2017 HHS / OGA Listening Session

Dr. Gezzer Ortega represents G4 Alliance at the 2017 HHS / OGA Listening Session

  • 5 billion people lack access to safe affordable surgical and anaesthesia care around the world.

  • Surgical care is a cost-effective and cross-cutting health service that treats a broad range of conditions and diseases.

  • Without investment in surgical care, millions will suffer needless deaths, disabilities, and related financial catastrophe each year.

Based upon these facts, G4 members urged the United States Delegation to the WHA to:

  • Support a decision point presented by the Permanent Mission of the Republic of Zambia, asking the Director General to review and report every third year after 2017 to the WHA on global progress of implementation of Resolution WHA 68.15 until 2030.
  • Prioritize safe surgical care and anaesthesia in discussions with fellow country delegations.

  • Express the United State’s support of surgical and anaesthesia care to all Director General candidates and encourage them to commit to supporting a robust and adequately-funded WHO Emergency and Essential Surgical Care Program.

Read our full statement from the HHS Listening Session here.


In two weeks, the G4 Alliance will take this message to global health leaders in Geneva, Switzerland as we host our 1st Member Permanent Council Meeting and send a delegation of representatives to attend the 70th World Health Assembly.

On May 22nd, in partnership with GE Foundation and Safe Surgery 2020, we will be hosting an advocacy side event entitled: “From Commitment to Action: Partnerships to Strengthen Surgical and Anaesthesia Care For All.”  Two years after WHA Resolution 68.15 was passed, prioritizing the role of surgical and anaesthesia care as part of universal health coverage, we are convening a group of global leaders to discuss progress towards fulfilling this resolution, challenges faced by the global health community and the importance of partnership and collaboration. This side event will feature special remarks from ministers of health taking action to implement national surgical and anaesthesia care plans, as well as the civil society partners who are helping to strengthen surgical and anaesthesia care.

RSVP here

Whether it’s on the national or international level, advocacy is the heart of the mission of the G4 Alliance. Thank you to our members who were ready to stand up and speak for surgery, obstetric, trauma and anaesthesia care to United States policy makers, and thank you to our members who stand and speak for these causes each and every day!