An estimated 5 billion people cannot get safe, affordable surgical and anaesthesia care when they need it, at least 160 million needed operations go undone each year, and tens of millions of people face financial catastrophe because of what surgery costs them.
Written from the sources listed below, not independently peer-reviewed.
In low-income and lower-middle-income countries, how many people out of every 100 cannot access basic surgical care, according to the Lancet Commission on Global Surgery?
5 billion
People without safe, affordable surgery
Modelled estimate of people who cannot get safe, affordable surgical and anaesthesia care when needed. It has not been updated since 2015, and a 2025 review found it unlikely to have improved.
Data year 2015. Source: Meara J.G. et al., The Lancet Commission on Global Surgery, The Lancet, 2015
160 million+
Operations needed but not done each year
Unmet need estimated in 2025 against the benchmark of 5,000 operations per 100,000 people a year, up from 143 million in the 2015 estimate.
Data year 2025. Source: Nepogodiev D. et al., The Lancet 406(10505):860–880, 23 August 2025, 2025
81.3 million
People facing catastrophic costs for surgery each year
Modelled estimate: 32.8 million from the costs of surgery itself and 48.5 million from non-medical costs of getting care. 3.7 billion people are at risk if they need an operation.
Data year 2015. Source: Shrime M.G. et al., The Lancet Global Health 3, 2015
Unit: million operations
Years are when the estimates were made: the Lancet Commission's 2015 estimate (based on 2012 surgical volumes) and the 2025 review, which gives at least 160 million. Both are modelled gaps against a benchmark of 5,000 operations per 100,000 people, not counts of patients, so the change is approximate.
Safe surgery is part of SDG target 3.8 on universal health coverage. In 2015 the World Health Assembly adopted resolution WHA68.15 on emergency and essential surgical care and anaesthesia, and the Lancet Commission set six targets for 2030. A 2025 review found that only 26% of low- and middle-income countries are on track for the access target, that no low-income or lower-middle-income country has reached the volume benchmark, and that no country with data has met the targets for protection from catastrophic or impoverishing costs. In May 2026 the World Health Assembly approved a Global Strategy for Integrated Emergency, Critical and Operative Care 2026–2035, with an action plan and targets due by the end of 2026.
75% of low-income countries and 61% of lower-middle-income countries have fewer than 20 surgeons, anaesthetists and obstetricians per 100,000 people, while 93% of high-income countries meet that target.
Source: Nepogodiev D. et al., The Lancet 406(10505):860–880, 23 August 2025, 2025No low-income or lower-middle-income country performs the benchmark of 5,000 operations per 100,000 people a year, compared with 79% of high-income countries.
Source: Nepogodiev D. et al., The Lancet 406(10505):860–880, 23 August 2025, 2025A 2021–2023 survey covering 172 countries found 76 countries with fewer than 5 physician anaesthesia providers per 100,000 people, and density did not rise in low-income countries or in WHO's African region.
Source: Law T.J. et al., Anesthesia & Analgesia, 2024, 2024Even if surgical services keep growing, an estimated 38 million additional caesarean sections will still be needed by 2030, with the largest gap in sub-Saharan Africa.
Source: Nepogodiev D. et al., The Lancet 406(10505):860–880, 23 August 2025, 2025Each country is shaded by its latest available value, so you can see where the gap is widest. Hover or tap a country, search for one, or open the full table.
Loading country values…
Values in per 100,000 people.
Specialist surgeons, anaesthetists and obstetricians per 100,000 people, so darker shades mean fewer specialists; the Lancet Commission's target is at least 20. Values are the latest year available per country and are old, mostly 2013–2018 (one as early as 2008); they leave out non-physician providers such as nurse anaesthetists and clinical officers, and very small territories can show extreme values.
Source: Lancet Commission on Global Surgery and WHO Collaborating Centre for Surgery and Public Health (Lund University), via World Bank Open Data. Latest year available per country; years differ.
Values load from World Bank Open Data. Simplified Natural Earth borders; they imply no position on disputed territories.
Instead of one “percent solved” score, DO GOOD rates three separate dimensions. A problem can have mature solutions that still reach too few people. These ratings are an editorial reading of the sources on this page, not a measured index.
Has the situation improved in the real world?
LowThe estimated number of operations needed but not done rose from 143 million in 2015 to at least 160 million a year, and the 2015 estimate of people without access is thought not to have improved.
How mature and validated are the available solutions?
HighThe procedures that matter most, such as caesarean delivery, laparotomy and fracture care, are long established and the Commission described surgery as highly cost-effective. Evidence on how to deliver them safely in low-resource hospitals is thinner: of nine randomised trials of safety measures in low- and middle-income countries, none has shown a significant reduction in deaths.
How widely are effective solutions actually used?
LowThree in four low-income countries are below the workforce target, none meets the volume benchmark, and in first-referral hospitals, where most people first seek surgery, the median number of surgeons is one.
Access and financial risk figures are models from around 2015 that have not been updated, very few countries have reported workforce data since 2019, and many health systems cannot routinely record deaths after surgery.
Global surgical volume grew only modestly, from 234 million operations in 2008 to 266 million in 2019, not keeping pace with need, and most national surgical plans remain unfunded. The 2026 WHO strategy creates a new framework, but its targets are not yet set.
Surgery is not only for rare or complex illness. Caesarean delivery, emergency abdominal operations, the treatment of open fractures and injuries, and cancer operations are part of everyday health care, and each needs a trained team, anaesthesia, a working operating theatre and safe follow-up. The Lancet Commission on Global Surgery estimated in 2015 that 5 billion people do not have access to safe, affordable surgical and anaesthesia care when they need it, and that conditions needing surgical care caused about 16.9 million deaths in 2010, a third of all deaths worldwide. WHO now estimates that conditions which timely emergency, critical and operative care could address cause 38 million deaths a year. A 2025 review found no sign that the access estimate has improved, put the unmet need at no fewer than 160 million operations a year, and estimated that 3.5 million adults die within 30 days of surgery each year, which shows that safety after an operation matters as much as access to one.
The gap follows income. Of roughly 313 million operations performed worldwide in 2012, only 6.3% took place in the countries home to the poorest 37.3% of the world's population, and the unmet need is largest in sub-Saharan Africa, followed by South and Southeast Asia. Where human development is lowest, surgery is dominated by childbirth: obstetric procedures make up 35% of operations in those countries, against 7% in the countries with the highest human development. Paying for care is a second barrier. An estimated 81.3 million people a year face catastrophic spending to get surgery, 48.5 million of them because of the non-medical costs of reaching and staying at a hospital, and within every country the burden falls on the poor. Untreated surgical conditions also cost economies dearly: the Commission projected US$12.3 trillion in lost output for low- and middle-income countries between 2015 and 2030.
The Lancet Commission on Global Surgery defined surgical care broadly, to include operations, anaesthesia, obstetric care and the management of surgical conditions without operating. Access means that care exists, can be reached in time, is safe and is affordable. In 2015 the Commission proposed six indicators with targets for 2030, grouped here into four:
Timely access to essential surgery
The share of the population that can reach, within two hours, a facility able to perform three 'bellwether' procedures: caesarean delivery, laparotomy (opening the abdomen) and treatment of an open fracture. The target is at least 80% coverage in every country by 2030.
Specialist surgical workforce
The number of specialist surgeons, anaesthetists and obstetricians per 100,000 people, with a target of at least 20 in every country by 2030. It leaves out non-physician providers such as nurse anaesthetists, who account for 2.3 of the 8.8 anaesthesia providers per 100,000 people worldwide.
Surgical volume and perioperative mortality
The number of operations per 100,000 people, with a benchmark of at least 5,000 a year, and the perioperative mortality rate, the share of patients who die after surgery. Unmet need is estimated as the gap between a country's volume and the benchmark, so it measures capacity, not every individual's need.
Protection from catastrophic and impoverishing costs
The share of people who would face catastrophic spending (out-of-pocket costs above a set share of income) or be pushed into poverty if they needed surgery. These are modelled estimates, not survey counts, and they depend strongly on how catastrophic spending is defined.
What works
A national plan sets out how a country will build its surgical workforce, hospitals, supplies, financing and data, and links surgery to the rest of the health system. As of July 2024, 23 countries had an active plan and 40 had surgical provisions within broader national health plans.
Limits
26 countries had plans that had expired, and most plans remain unfunded. Nigeria's plan was costed at US$16.8 billion over five years, far beyond what many health budgets can absorb without outside support.
What works
District or first-referral hospitals that can reliably perform the bellwether procedures (caesarean delivery, laparotomy and treatment of open fractures) within two hours' reach of most people cover most emergency surgical needs and support obstetric care.
Limits
These hospitals have a median of one surgeon, compared with 20 in tertiary hospitals, and electricity outages affect 40% of hospitals overall and 90% in low-income countries. Buildings without staff, power, oxygen and supplies do not provide surgery.
What works
Countries are expanding training for surgeons, anaesthetists and obstetricians and also rely on non-physician providers, such as nurse anaesthetists and clinical officers. The global anaesthesia workforce has grown, and task shifting appears safe for selected patients undergoing caesarean section.
Limits
The world is short of more than 1 million surgeons and anaesthetists, and more evidence is needed on which tasks can safely be shared and how providers should be supervised.
What works
Building a safety culture, for example through the WHO Surgical Safety Checklist, reduces deaths after surgery. The checklist is a short set of checks that the operating team completes together at set points before, during and after an operation.
Limits
A checklist only helps where it is actually used. A trial of a modified checklist in maternity theatres found no overall fall in deaths, although hospitals that implemented it well saw larger reductions in maternal deaths.
What works
Including surgery and anaesthesia in publicly financed benefit packages or national health insurance, as in Ghana, or community-based health insurance, as in Rwanda, reduces what patients pay at the point of care.
Limits
More than half of the estimated 81.3 million catastrophic cases a year are caused by non-medical costs of getting care, which insurance for hospital fees does not cover.
Promising, but not proven at scale. The stage shows how far each approach has come; it is not a recommendation.
Because routine recording of deaths after surgery is not feasible in many health systems, researchers propose short international studies that follow every operation in participating hospitals for a set period. Whether they can become a standing monitoring system with national targets is still open.
The 2025 review proposes that countries measure the readiness of their hospitals with a Surgical Preparedness Index, as one of 13 benchmarks for 2025–35. Its usefulness depends on countries adopting it and acting on the results.
With electricity outages affecting 90% of hospitals in low-income countries, the review proposes onsite clean energy plans for 1,000 hospitals in low- and middle-income countries. Financing and maintaining such systems at scale is not yet worked out.
Telemedicine can bring specialist advice to distant hospitals, reduce costs for patients and hospitals and cut emissions, and several low-cost, open-access electronic health records have been developed. Evidence that they improve surgical outcomes in low-income settings is still limited.
Implementation gap
There is a global shortage of more than 1 million surgeons and anaesthetists, and three in four low-income countries are below the target of 20 specialists per 100,000 people. Those who exist are concentrated in tertiary hospitals: first-referral hospitals have a median of one surgeon, against 20 in tertiary hospitals.
Coordination gap
Most national surgical plans are unfunded, and 26 countries had plans that had expired by July 2024 against 23 with an active plan, so commitments on paper often do not turn into services.
Implementation gap
An estimated 3.7 billion people would face catastrophic spending if they needed surgery. Both hospital charges and the non-medical costs of getting care can deter people from seeking it or leave them with spending they cannot afford.
Technology gap
Electricity outages affect 40% of hospitals overall and 90% in low-income countries. The 2025 review also calls for every hospital doing emergency laparotomies to have access to CT imaging, and proposes that countries track it.
Knowledge gap
Very few countries have reported workforce data since 2019, the estimate of people without access has not been updated since 2015, and deaths after surgery are not routinely recorded in many health systems, so progress is hard to track.
Knowledge gap
Of nine randomised trials of measures to make surgery safer in low- and middle-income countries, none showed a significant reduction in deaths, and large pragmatic trials are needed to show what works.
Unresolved questions, not vetted breakthroughs. Answering any of them would change what is possible.
How can access to timely, safe and affordable surgery be measured directly and repeatedly, for example from travel times to equipped hospitals, rather than relying on models from a decade ago?
Which affordable changes in practice, such as checklists, infection control or monitoring after surgery, actually reduce deaths and complications in hospitals with few staff and limited equipment?
Which operations and anaesthesia tasks can non-physician providers perform safely, with what training and supervision, and how does this affect outcomes beyond caesarean section?
How can health systems reduce travel, food and lost-income costs that cause most catastrophic spending on surgery, and which financing models do this at national scale?
Donate to or volunteer with established organisations that train surgeons, anaesthetists, obstetric teams and nurses in low- and middle-income countries, and look for programmes that build lasting local capacity.
When health coverage and budgets are discussed in your country, ask whether surgery, anaesthesia and emergency obstetric care are included in what is covered and whether patients are protected from high costs.
If you work in surgery, anaesthesia, obstetrics or biomedical engineering, consider long-term teaching partnerships with hospitals in low-resource settings, led by the needs of local teams.
Many people assume surgery is a luxury in poorer countries. Sharing reliable information, such as the work of the Lancet Commission on Global Surgery, helps make the case that safe surgery is basic health care.
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Nepogodiev D. et al., The Lancet 406(10505):860–880, 23 August 2025 (repository copy, University of the Witwatersrand), published 2025
Peer-reviewed review of progress against the Lancet Commission's 2030 indicators ten years on (DOI 10.1016/S0140-6736(25)00985-7). Source of the unmet need of at least 160 million operations (and the earlier 143 million), 3.5 million postoperative deaths, workforce and volume target attainment by income group, national plan counts, power outages, caesarean gap, trial evidence and the 2025–35 benchmarks.
Meara J.G. et al., The Lancet Commission on Global Surgery, The Lancet (published online 27 April 2015; copy hosted by UCSF), published 2015
The Commission's report (DOI 10.1016/S0140-6736(15)60160-X). Source of the 5 billion people without access, nine in ten without access in low- and lower-middle-income countries, 16.9 million deaths in 2010, the distribution of 313 million operations, US$12.3 trillion in projected losses, and the six indicators, bellwether procedures and 2030 targets.
Shrime M.G. et al., The Lancet Global Health 3 (Suppl 2), April 2015 (DOAJ record), published 2015
Peer-reviewed modelling study prepared for the Lancet Commission. Source of the 3.7 billion people at risk of catastrophic spending if they need surgery and the 81.3 million annual cases (32.8 million from surgical costs, 48.5 million from non-medical costs), concentrated among the poor.
Law T.J. et al., Anesthesia & Analgesia, 2024 (abstract record, Aga Khan University eCommons), published 2024
World Federation of Societies of Anaesthesiologists survey of national societies, 2021–2023, with responses for 172 of 193 UN member states. Source of the global density of 8.8 anaesthesia providers per 100,000, the 76 countries with fewer than 5 physician providers per 100,000, and trends by income group and region.
World Health Organization, Executive Board document, 3 December 2025, published 2025
WHO's draft strategy recommended to the Seventy-ninth World Health Assembly. Source of the estimate that conditions addressable by emergency, critical and operative care cause 38 million deaths and 1.3 billion disability-adjusted life years a year, of the catastrophic spending linked to out-of-pocket and non-medical costs, and the plan for targets by 2035.
World Health Organization (news release, 22 May 2026), published 2026
Confirms that the World Health Assembly approved the Global Strategy for Integrated Emergency, Critical and Operative Care 2026–2035 and that WHO will draft an action plan with targets by the end of 2026.
DO GOOD International (2026). Safe Surgery for Everyone. Global Challenges. Updated October 15, 2026. https://www.dogood.world/challenges/surgical-care
For figures, please cite the original sources listed above.