Access to surgical care is a massive global health challenge. In fact, five billion people around the world do not have access to safe, affordable surgical and anesthesia care when needed. Dr. Ruben Ayala, chief of policy and advocacy at Operation Smile, brought the issue into sharp focus during a session at Devex’s summit The future can’t wait: Shaping tomorrow, today on the sidelines of the 79th session of the United Nations General Assembly in New York.
Globally, over 313 million surgical procedures are performed every year to treat conditions such as congenital conditions, cancer, cardiovascular diseases, and injuries from accidents. However, only 6% of these surgeries take place in the world’s lowest-income countries. An estimated 143 million more surgeries are needed annually, requiring 2.2 million more surgeons, anesthetists, and obstetricians — setting the stage for an urgent call to action.
In a conversation with Devex Editorial Director Richard Jones, Dr. Ayala outlined the scale of the problem, the strategic approaches Operation Smile is using to tackle these barriers in the most underserved communities, and his views on how the global health community can support efforts.
Cultural, geographical, and structural barriers
Operation Smile has been providing life-changing surgery and comprehensive care for children with cleft lip and palate for over four decades. Yet, the challenge goes far beyond treating congenital conditions, Dr. Ayala explained. In many parts of the world, people with a wide range of surgical needs — whether related to burns, tumors, or trauma — are unable to access safe, affordable care.
“There are barriers that are cultural, financial, geographical, and structural,” Dr. Ayala explained. Cultural misconceptions can prevent families from seeking care in the first place. For example, some communities may view cleft conditions as a curse, causing parents to delay or avoid seeking medical intervention, Dr. Ayala said. For others, geographical distance or financial constraints make reaching surgical centers nearly impossible. And when families do reach a facility, they might find it lacking in trained medical staff or necessary equipment, compounding the difficulty, he explained.
Bringing care closer to patients
Operation Smile is working to address these barriers with an innovative strategy, aimed at building the capacity of local health systems so patients can receive care closer to home. Dr. Ayala explained that Operation Smile is investing in people through advanced training and professional development and equipping health care professionals with the resources they need to better serve patients.
“We continue to look at health as an expense, when in reality, it’s a way for us to really reap the benefits of a vision of a hopeful potential future, filled with dignity and opportunity.”
— Dr. Ruben Ayala, chief of policy and advocacy, Operation SmileWe’re leaning on hub hospitals that have excellence in training and care, and we're pushing that care closer to the communities, he said. This means that patients in remote areas can now receive vital care without having to travel long distances. At the same time, the hubs serve as centers of excellence for training health care workers, ensuring that the smaller, regional, and district hospitals are staffed by qualified professionals equipped to provide safe, high-quality care.
For example, in Guatemala, Operation Smile has established a central hub in the capital city while developing smaller clinics in remote areas to increase access to surgical care. Health workers in these regions receive education and training, enabling them to deliver care locally. “These local health workers are the real heroes,” Dr. Ayala said. “All they need is a little bit of support from us to be able to fulfill the promise that they've made to their own communities.”
A path forward
Looking ahead, Dr. Ayala stressed the need for sustainable solutions that can be scaled up to address global disparities in access to surgical care. This will require not only innovations and investments but also increased collaboration. "We have to stop thinking about the work that we do in health as specific single entities, and we have to start thinking about how together we figure out how to invest in health systems,” he said. “We continue to look at health as an expense, when in reality, it’s a way for us to really reap the benefits of a vision of a hopeful potential future, filled with dignity and opportunity.”
To achieve this vision, Dr. Ayala called for greater coordination among stakeholders. For policymakers, funders, and global health practitioners gathered at the summit, Dr. Ayala’s message was clear: The solutions are within reach, but it will take coordinated effort and visionary thinking to achieve the scale needed to truly close the surgical care gap. “Bring out the crazy ideas. We will figure out a way to make those big, hairy, audacious goals into an opportunity for people,” he said.
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