A Decade Of Progress In Global Surgery: Expectations And Commitments For Latin America

A Decade of Progress in Global Surgery: Expectations and Commitments for Latin America

The year 2025 marks a decade since the adoption of the historic World Health Assembly (WHA) Resolution 68.15 [1], a milestone that positioned surgical care as essential components of Universal Health Coverage (UHC). This achievement catalyzed a global movement that has transformed the perception of surgical healthcare systems as indispensable pillars for achieving health equity.

Over the ten years since the adoption of this resolution, global and regional advancements have significantly changed the landscape of surgical systems strengthening. Notably, there have been two other major regional policy movements in surgical healthcare in recent years—one in the Asia-Pacific region and another in Africa—demonstrating a growing global commitment to addressing surgical inequities. These initiatives reflect a broader recognition of surgery as a critical component of health systems, laying the groundwork for collaborative, region-specific strategies. In this context, Latin America has made significant strides, further propelled by the recent approval of Resolution CD61.R9, “Strategy for the Integration of Emergency, Critical, and Operative (ECO) Care 2025–2030,” issued by the Directing Council of the Pan American Health Organization (PAHO) on October 3, 2024 [2]. This landmark resolution provides a strengthened framework for regional collaboration, aligning efforts to address critical gaps in surgical, emergency, and critical care. Moreover, it has generated substantial momentum and raised significant expectations for the coming years, welcoming pathways toward more cohesive and effective healthcare systems across the region.

Latin America, is a region historically marked by health inequities and now has the opportunity to take a leadership role in addressing what is often described as the “most serious manifestation of social inequity in healthcare: access to surgical care” [3].  Alarmingly, 365 million Latin Americans lack access to timely, safe, and affordable surgical care [4], a reality that disproportionately affects the most vulnerable populations, particularly those in marginalized or hard-to-reach areas. For instance, in the remote Amazonian regions, individuals requiring surgical interventions often face extraordinary logistical and financial barriers. Some must walk or navigate rivers in small boats for days to reach the nearest surgical facility, while others rely on costly and precarious flights in single-engine planes, an option often beyond the financial reach of their communities [4]. Among rural and Indigenous populations, the likelihood of accessing surgical services is up to 70% lower compared to their urban counterparts, perpetuating cycles of poverty and unnecessary suffering [4]. These inequities, rooted in structural, geographical, social, and economic disparities, have left millions without essential services. These challenges highlight the stark disparities in access and underscore why Latin America’s progress is critical to global health equity.

Hence, the PAHO CD61.R9 resolution aims to integrate surgical systems as an essential component of public health aims to redefine health equity and position surgical care as a crucial tool to address the structural inequalities. It builds upon foundational efforts like WHA Resolution 68.15 and aims to create cohesive, integrated systems of care that bridge the gap between emergency, critical, and operative services. Its primary objectives include improving accessibility, efficiency, and quality in surgical and emergency systems, particularly for underserved populations [2].

A defining feature of the ECO strategy is its emphasis on integrating services across all levels of care, from community-based interventions to tertiary hospital systems. The approach recognizes the interdependence of healthcare components, ensuring that failures in one area—such as emergency response or critical care—do not cascade into broader systemic weaknesses [2]. By embedding these services into Universal Health Coverage (UHC) frameworks and linking them to primary healthcare through robust communication, transportation, and referral mechanisms, the strategy addresses historical inefficiencies while building resilience against health emergencies and disasters.

Implementation of surgical policies like this, designed to meet the needs of vulnerable populations, particularly in rural and Indigenous areas, holds the promise of transforming lives, reducing the impact of treatable conditions that continue to cause unnecessary suffering.

In this context, Ecuador has emerged as an inspiring example, becoming the first Latin American country to develop a National Surgical, Obstetric, and Anesthesia Plan (NSOAP) [5]. This achievement reflects both the technical capacity and the political commitment of the country to address gaps in access to surgical care.

Ecuador’s NSOAP, launched on November 13, 2023, stands out for the efforts made to integrate diverse stakeholders, including public and private sectors, academia, international organizations, civil society, and—critically—end users, in its design and implementation. This participatory approach ensured that the policy was not only comprehensive but also deeply rooted in the realities of its population [5].

After the initial results from the situational assessment and gap identification process were obtained in early 2023, the Ministry of Health (MOH) began making reinforced investments in the surgical health sector to support the drafting and enactment of the surgical, obstetric and anesthesia (SOA) public policy, demonstrating a strong commitment to investment and action. As part of this effort, the MOH allocated $26.7 million for infrastructure, $98.8 million for surgical tools, and $79.5 million for workforce expansion. In terms of workforce, this investment translated into the addition of 6,785 healthcare professionals, of whom 4,281 were dedicated to surgical care [6].

This combined total investment of $205 million represents approximately 2.79% of the country’s total health expenditure and 0.19% of its Gross Domestic Product (GDP). (based on the most recent data available from the Ecuadorian National Institute of Statistics and Census INEC Health Satellite Accounts released in 2021) [7].

The financial investment in infrastructure development addressed systemic gaps, including the opening of 42 new operating rooms and the strengthening of diagnostic services with 220 laboratories and other complex equipment. In addition, efforts were directed toward improving emergency response capabilities, enabling the repair and upgrade of ambulance fleet and the acquisition of 186 new ambulances, with an additional 123 planned. Therefore, this policy demonstrates the tangible impact of coordinated efforts on expanding access to surgical care.

Furthermore, Ecuador’s impact extends beyond its national borders. In September 2023, the country took a leadership role by spearheading the motion at the 173rd PAHO Executive Committee, which ultimately led to the issuance of the CD61.R9 resolution.

The results of Ecuador’s initiatives underscore the critical role of public policy in transforming healthcare systems. The inclusion of diverse voices and a focus on sustainability highlight the replicable nature of its model. The country’s experience serves as a powerful testament to what is achievable through strategic policymaking and collaborative action.

As other countries in the region, such as Paraguay, Brazil, and Colombia [8,9,10,11], work toward strengthening their surgical systems, their progress highlights both the opportunities and challenges of advancing surgical equity in Latin America. Each nation brings unique approaches, reflecting its context and resources, yet all face common barriers such as limited infrastructure, workforce shortages, and geographical disparities in access [12].

Paraguay, for instance, has focused on reducing surgical disparities in underserved areas by expanding rural health infrastructure and integrating surgical services into existing regional hospitals [8]. While progress is evident in the development of referral systems and surgical centers, challenges remain in recruiting and retaining skilled professionals to operate in remote regions. Brazil, with its robust healthcare system, has implemented programs such as the “Safe Surgery Saves Lives” initiative and its National Transplant System, which demonstrate the potential for scaling surgical care [9,10]. However, the country continues to face issues of inequitable distribution of resources, particularly in the northern Amazonian states where logistical barriers hinder timely access to surgical interventions. Similarly, Colombia has prioritized addressing geographical challenges through mobile surgical units and telemedicine initiatives [11], though financial constraints and political instability often impede sustained progress.

Regional collaboration and knowledge sharing are essential to overcoming these barriers and accelerating progress. The PAHO ECO resolution provides a framework for collective action, encouraging countries to learn from each other’s successes and challenges [12].

As Latin America progresses toward achieving the objectives outlined in resolution CD61.R9, expectations go beyond meeting technical standards to transforming the region’s health systems into engines of equity. International expectations for Latin American leadership are high: the world looks on with hope as these countries not only meet global commitments but exceed them, innovating and demonstrating that social justice and equity are achievable. This level of regional leadership is not merely aspirational but a critical necessity to address current challenges and build resilient and sustainable health systems.

However, meeting these expectations requires greater political and financial investment. Decision-makers in the region must prioritize surgical strengthening in their national and regional agendas, allocating the necessary resources to develop robust public policies, improve infrastructure, train specialized human resources, and ensure the sustainability of surgical systems. Effective progress depends on the development of strong national public policies that transform international commitments into concrete actions, supported by regulatory frameworks that overcome historical barriers to accessing essential surgical services [13,14]. These policies must prioritize the design and implementation of national plans tailored to the specific needs of each population, integrating surgery into all levels of the health system. This ensures it is not treated as an isolated service but as an integral part of primary, secondary, and tertiary care.

It is time to redirect global attention to Latin America, recognizing its fundamental role in advancing Universal Health Coverage (UHC) and building a future where health, as a human right, becomes a central pillar of development and justice for all nations. Without firm political and financial commitments, even the most visionary strategies risk remaining unfulfilled aspirations, unable to overcome the inherent challenges of high-inequality contexts. Latin America must seize this unique opportunity to lead with determination and show the world that it is possible to build equitable, accessible, and sustainable surgical systems that pave the way for truly universal health.

Conclusion

Surgical strengthening in Latin America is more than a technical milestone; it reflects a deep commitment to social justice and equity. Grounded in WHA and PAHO resolutions, national public policies have the power to translate political commitments into tangible improvements. These policies must address urgent healthcare needs while laying a sustainable foundation to ensure access to essential surgical services for the most vulnerable populations across the region.

As the 10th anniversary of WHA Resolution 68.15 approaches, Latin America stands at a pivotal moment. Bold and inclusive policies, coupled with strategic investments, have the potential to transform healthcare systems into engines of equity. Ecuador’s success through its NSOAP offers a powerful model, while progress in countries like Paraguay, Brazil, and Colombia highlights the opportunities and challenges of scaling surgical care. By fostering regional collaboration and knowledge sharing, these nations can collectively overcome barriers and accelerate equitable healthcare outcomes.

This moment calls for sustained political and financial investment, robust infrastructure, and global recognition of Latin America’s leadership. The region has the potential to redefine global surgery, proving that equitable, accessible, and sustainable systems are achievable. Policymakers, stakeholders, and the international community must support this journey, building a future where safe, timely, and affordable surgery is a universal right, setting a global standard for health equity.