Beyond Access: The New Priorities for Global Surgery

The best global surgery initiatives are based on enduring partnerships, mutual trust, and locally driven leadership

More than five billion people worldwide still lack access to safe, affordable surgical and anaesthesia care when they need it. Behind that figure are women unable to access emergency obstetric care, children waiting for life-changing surgical treatment, trauma patients facing long journeys to reach care, and patients living with conditions that would be routinely treated elsewhere.

For many years, the global surgery movement focused on a critical challenge: The shortage of trained surgeons, anaesthesiologists, and other specialist healthcare professionals, particularly across low- and middle-income countries. Expanding the surgical workforce remains essential, but today it is clear that workforce shortages are only one part of a much bigger picture.

The future of global surgery will be determined not simply by how many surgeons we train, but by whether we can build health systems capable of delivering safe, timely, and affordable care for everyone who needs it.

This shift from workforce building to systems building is emerging as one of the defining priorities in global surgery.

COSECSA

The progress achieved through the College of Surgeons of East, Central and Southern Africa (COSECSA) demonstrates both the value of long-term investment and the scale of the challenge that remains. Through a partnership that the RCSI has supported for more than two decades, more than 1,100 specialist surgeons have now graduated, and surgical training has expanded across a network of accredited institutions throughout the region.

These achievements reflect the importance of investing in local training, enabling countries to develop and retain their own specialist workforce. However, as programmes mature, the focus increasingly turns towards quality assurance, accreditation, standards, and patient outcomes. Training more clinicians is important. Ensuring those clinicians can work within strong, well-functioning systems is equally important.

SURGhub

The same principle applies to surgical education. Historically, access to specialist training has often depended on geography and resources. Today, digital education is helping to change that reality. Through SURGhub, the United Nations Global Surgery Learning Hub, supported by the RCSI and international partners, tens of thousands of healthcare professionals from almost every country in the world, including many in conflict zones, now have access to educational resources that were once beyond reach.

Digital learning is not a replacement for clinical training, but it is an increasingly powerful tool for expanding access to knowledge, reducing professional isolation, and supporting healthcare workers in resource-constrained settings. The addition of multilingual content and the use of technology to broaden access have further demonstrated how innovation can help address inequities in education.

Yet one of the most important lessons from global surgery is that surgery itself cannot be separated from the broader systems that support it.

A surgeon cannot operate safely without water. Sterilisation depends on reliable infrastructure. Cancer care depends on diagnostics, referral pathways, and trained multidisciplinary teams. Maternal health depends on functioning operating theatres, anaesthesia services, and emergency transport systems.

Increasingly, global surgery is grappling with these realities, and some of the most exciting work taking place today sits at the intersection of surgery, public health, implementation science, and health systems strengthening.

In Malawi, researchers from the RCSI Institute of Global Surgery and their partners are investigating how water insecurity affects maternal and newborn care while testing practical solutions that combine infrastructure improvements with sustainable technologies. Similar work is now being expanded into Guatemala, where climate change, water security, and maternal health are increasingly interconnected challenges.

At first glance, water security may not appear to be a surgical issue. In reality, it is fundamental to safe surgery. Without clean water, infection prevention becomes more difficult, hospitals become less resilient, and patient outcomes suffer.

Resilience

This points to another growing priority for the sector: Climate resilience. Climate change is beginning to reshape the environments in which healthcare systems operate. Extreme weather events, resource pressures, and infrastructure disruption are creating new challenges for healthcare providers worldwide. Surgical systems are particularly vulnerable because they depend on reliable water supplies, electricity, transport networks, and functioning facilities.

As a result, the future of global surgery must include a stronger focus on resilience. Health facilities need to be able to continue providing care during periods of environmental stress, resource scarcity, and disruption. Building that resilience requires collaboration across disciplines far beyond surgery alone.

Conflict presents similar challenges. Recent global events have highlighted the devastating consequences of damaged infrastructure on healthcare delivery. Research underway at the RCSI examining the impact of water shortages on surgical services in Gaza reflects a wider priority for the international community. Understanding how surgical systems function, and fail, in fragile and conflict-affected settings is essential if we are to protect access to care during crises.

Research

Research itself is also evolving. It is increasingly focused on implementation rather than observation alone. Whether supporting national breast cancer guidelines in Malawi, improving access to paediatric surgical care in rural districts, strengthening diagnostic capacity through ultrasound training, or informing health workforce policy in Sierra Leone, the goal is the same: Generating evidence that leads to practical improvements in care.

This emphasis on implementation reflects a broader maturity within the field. Success should not be measured by publications alone, but by whether research can help decision-makers improve services, strengthen systems, and deliver better outcomes for patients.

Partnership

The most impactful global surgery initiatives are founded on enduring partnerships, mutual trust, and locally driven leadership. Across Africa, Latin America, Europe, and Asia, innovative models of collaboration are fostering joint research, education, capacity building, and technological innovation. These partnerships are grounded in the recognition that expertise is universally distributed and that meaningful, sustainable progress is achieved through reciprocity, shared learning, and the co-creation of solutions that address local priorities while advancing global health.

There are reasons for optimism. Over the past decade, global surgery has moved from the margins of global health discussions to become an increasingly recognised component of universal health coverage. The conversation has expanded beyond workforce shortages to include quality, resilience, education, climate adaptation, digital innovation, and health systems strengthening.

That evolution is both necessary and welcome, but the challenge remains immense. Billions of people still lack access to safe surgical care. However, we now have a better understanding about what it will take to close that gap.

The future of global surgery will depend on building systems that are resilient, equitable, and locally led. It will depend on partnerships that strengthen capacity rather than create dependency. And it will depend on our willingness to acknowledge that safe surgery is not simply a clinical service, but a cornerstone of strong and effective health systems.

Only by embracing that broader vision will we succeed in making safe surgical care accessible to all.

Research underway at the RCSI examining the impact of water shortages on surgical services in Gaza reflects a wider priority for the international community