5 billion people lack access to surgery. Here’s what needs to change

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Around 5 billion people — about two-thirds of the world’s population – globally lack access to safe, affordable surgical care. To meet the 143 million surgeries needed in low- and middle-income countries annually, the world requires 2.2 million more surgeons.

Unlike other public health interventions, expanding access to surgery isn’t just about building infrastructure or supplying equipment — it requires investing in people. Training and retaining a skilled surgical workforce is a long-term, resource-intensive effort that many countries have struggled to prioritize. “Just imagine how hard it is to create the surgical side of the health care ecosystem,” said Dr. Billy Magee, chief medical officer at Operation Smile. “You need facilities. You need equipment. And then, even more importantly, you need people that are really well trained to deliver that care.”

Nowhere is the surgery access gap more acute than in Africa, where a shortage of surgical professionals threatens health systems, economic development, and the realization of universal health coverage.

Despite carrying 25% of the global surgical disease burden, Africa is served by just 2% of the world’s surgical workforce. The reasons for this disparity are complex — from underresourced medical education systems to the migration of trained professionals seeking better pay and working conditions abroad. Addressing the gap isn’t just about numbers, but about providing access to high-quality training, said professor Faustin Ntirenganya, professor of plastic surgery at the University of Rwanda. “We also have to produce the quality of the surgeons that we need, and that needs investment,” he said.

That vision is at the heart of Operation Smile’s Operation 100 — a blueprint to transform the future of access to surgical care globally, bringing care closer to patients’ homes by investing in frontline health workers and strengthening district hospitals. This strategy marks an important step in the organization’s four-decade-long commitment to advancing health equity to ensure no one is left behind.

Operation Smile’s long-standing work in Rwanda, one of 37 countries where the organization operates, offers an example of how investing in local partnerships and using education to train surgical professionals can transform health systems. When the organization began working in Rwanda, there were only two plastic surgeons serving a population of 13 million. Today, thanks to expanded training programs and mentorship, there are nearly two dozen specialized surgeons.

In this podcast episode, Magee and Ntirenganya join Devex’s Kate Warren to discuss some of the strategies that have emerged as the most promising for enhancing surgical care access, and learnings from Operation Smile in Rwanda. They also discuss progress made at the inaugural Pan-African Surgical Conference, which took place in late February in Kigali, and was organized by Operation Smile in partnership with the Rwanda Ministry of Health, Rwanda Surgical Society, and the University of Rwanda. This conference gathered 550 academics, policymakers, and frontline health care experts from 36 countries — 23 of which are in Africa — to drive locally led, scalable solutions that will expand surgical access across the continent.

The two ended the podcast by sharing what gives them hope, referencing collaboration from volunteers, communities, partners, investors, and organizations globally to make the world a better place.

“We’re seeing a lot of momentum,” said Magee. “It is a very exciting time to be a part of global and essential surgery. I think we’ll see a lot of progress in the next five years.”