Approximately 5 billion out of 7 billion people in the world have no access to basic surgical care. Lack of access to safe and timely surgical care results in more deaths and disability than HIV/AIDS, tuberculosis and malaria combined. Although international priorities are starting to reflect the importance of non-communicable diseases, provision for essential services lags behind.
This is an exciting time for Global Surgery! With the launch of the Disease Control Priorities 3 (DCP3) at the ASC 2015 in Las Vegas, Nevada to the launch of the Lancet Commission in London, all building to the excitement leading to the unanimous passing of the World Health Assembly resolution, Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage.
As the Global Affairs Committee reported in the March 2015 blog post, the AAS joined the Global Alliance for Surgical, Obstetric, Trauma and Anaesethesia Care ?(The G4 Alliance) as a founding member. The G4 Alliance is an advocacy-based organization dedicated to building political priority for surgical care as part of the global development agenda that was formed in response to a mounting call for greater unity in the global surgical community. The goal of the G4 Alliance is to advocate for surgery as a global health priority and to promote improved access to quality surgical, obstetric, trauma and anaesthesia worldwide. The Alliance fulfills the need for an advocacy-based organization promoting universal access to quality health care. The Alliance advances this cause on behalf of its constituent organizations to guide global health policy, and to raise awareness and funding towards strengthening global surgical, obstetric, trauma, and anaesthesia care delivery.
In December 2014, The AAS was represented at the inaugural board meeting of the 21 founding organizations to lay the groundwork of the governance of the alliance in London, United Kingdom. Committees were formed, and the AAS representative was nominated and voted to be the chair of the G4 Alliance Membership Committee. 
Six months later, the Alliance has grown to 46 organizations, representing 15 countries. The second board meeting was held May 17 and 18, 2015 in Geneva, Switzerland, just before the World Health Assembly. The discussion centered on deliverables, setting the framework and timeline of the Alliance, and diversification of the member organizations.
Framework:
- Key Messages
- Target/Metrics
- International Standards
- Database Creation for Operative logs
- Database of country/region specific efforts
The launch of the G4 Alliance then followed and was live streamed on May 19, 2015. Speakers at the event included Honorable Dr. Joseph Kasonde, Minister of Health of the Republic of Zambia, Dr. Karen DeSalvo, U.S. Acting Assistant Secretary for Health, Department of Health and Human Service of the US government, as well as Dr. Luong Ngoc Khuê, Director of Medical Service Administration with the Ministry of Health of Vietnam.
Ambassadors and representatives from the Republic of Trinidad and Tobago, Uganda, Timor Leste, Vietnam and Moldova attended. Additional special guest speakers included Sir George Alleyne, Director Emeritus, Pan-American Health Organization. Dr. Patrick Hérard, Consultant Surgeon with MSF and Dr. Harald Veen, Chief Surgeon, International Committee of the Red Cross also spoke. Dr. Teri Reynolds with the WHO’s Emergency, Trauma and Acute Care Division of the Department for Management of Non-communicable Diseases, Disability, Violence and Injury Prevention commented on looking forward to working with the G4 Alliance to collaborate. Thus invoking a diverse groups common focus: the neglected surgical patient.
With the unanimous passing of the resolution at the World Health Assembly of the resolution on Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage, on May 22, 2015, the work of all surgical organizations and surgeons begins. The outcomes researchers, the educators, the clinicians, and the basic scientist. We all have a role to play.
How has the AAS been involved with the G4 Alliance?
- Lancet letter written to global health leaders and signed by 120 supporting organizations outlining the importance of including surgical indicators as part of the World Health Organization (WHO), USAID and World Bank endorsed global reference list of health indicators
- Signing of the Amsterdam Declaration
- Founding member of the alliance with participation in the inaugural board meeting to help shape the governance and organization of the alliance
- AAS representative selected as G4 Alliance Membership Committee Chair
- Member of the Ad Hoc Executive Director Search Board Committee
- Participation in working groups focusing on targets and metrics and international standards
- Participation in the Global Launch of the G4 Alliance in Geneva on May 19, 2015
What is next?
The G4 Alliance has advocated for the inclusion of a surgery-related target or indicator as part of the post-2015 sustainable development goals (SDGs), making public statements during the United Nations Open Working Group consultation process and participating in the United Nation’s Non Governmental Organizations Major group as an advocate for greater prioritization of surgical care as part of the SDGs.
In light of these efforts, some progress has been made. The Sustainable Development Solutions Network (SDSN), a branch of the United Nations directly involved in the post-2015 sustainable development process, has endorsed an indicator for the availability of surgical care as part of Goal 3: Attain healthy life for all at all ages. The Government of Tanzania has proposed increasing access to essential surgery as a sustainable development goal in the post-2015 agenda.
For the AAS and academic surgery, the passing of the resolution should lead to an increase in focus and funding from the government as well foundations for surgical work and research. As the surgical workforce is strengthened, opportunities to participate in surgical education and programmatic development will ensue. The focus on outcomes will lead to opportunities to affect quality improvement globally and locally. Surgical innovation research to improve efficiency and effectiveness will be endorsed. The need for mentorship, already great, will continue to increase.
As a part of the G4 Alliance, the AAS will continue to access and influence the global surgical space. The AAS is present and visible at the events of the alliance to enhance our presence in the global surgery arena. A timeline of upcoming events can be found HERE.
Please watch the following videos for more information about the G4 and the structure of the alliance.