World Journal of Surgery

, Volume 34, Issue 3, pp 386-390

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Improving Surgical Care in Low- and Middle-Income Countries: A Pivotal Role for the World Health Organization

  • Stephen W. BicklerAffiliated withDivision of Pediatric Surgery, Department of Surgery, University of California at San Diego Email author 
  • , David SpiegelAffiliated withChildren’s Hospital of Philadelphia, Division of Orthopedic SurgeryThe University of Pennsylvania School of Medicine


In response to increasing evidence that surgical conditions are an important global public health problem, and data suggesting that essential surgical services can be delivered in a cost-effective manner in low- and middle-income countries, the World Health Organization (WHO) has expanded its interest in surgical care. In 2004, WHO established a Clinical Procedures Unit within the Department of Essential Health Technologies. This unit has developed the Emergency and Essential Surgical Project (EESC), which includes a basic surgical training program based on the “Integrated Management of Emergency and Essential Surgical Care” Toolkit and the textbook “Surgery at the District Hospital.” To promote the importance of emergency and essential surgical care, a Global Initiative for Emergency and Essential Care was launched in 2005. In what maybe the most important development, surgical care is included in WHO’s new comprehensive primary health care plan. Given these rapid developments, surgical care at WHO may be approaching a critical “tipping point.” Lobbying for a World Health Assembly resolution on emergency and essential surgical care, and developing “structured collaborations” between WHO and various stakeholders are potential ways to ensure that the global surgery agenda continues to move forward.