Voices beyond the Operating Room: centring global surgery advocacy at the grassroots

While some progress has been made towards equity in global surgery over the past decade, especially by advocacy at the international level, global surgery advocates have not yet achieved the goal of the movement—to ensure access to quality life-saving surgical and anaesthesia care for under-resourced communities. Global surgery as access to equitable surgical and anaesthesia care was defined by the landmark publications of the Lancet Commission on Global surgery, and the Diseases Control Priorities 3 in 2015.4 5 Furthermore, in 2015, the World Health Assembly (WHA) passed Resolution 68.15, and WHA decision 70(22) in 2017, recognising surgical and anaesthesia care as essential for universal health coverage and requiring the director-general to report on the progress of its implementation, respectively.6 7 The efforts of various coalitions have led to the recent inclusion of global surgery in the US 2020 Appropriations bills directing the United States Agency for International Development (USAID) to support global surgery financially.8 9 In addition, several countries have developed National Surgical, Obstetric, Anaesthesia Plans (NSOAPs), as comprehensive policy commitments to strengthen surgical systems at the domestic level.10–13 Given this progress, it is possible to conclude that surgery has moved beyond the operating room and is no longer a neglected stepchild of global health. Coalitions of patients and advocacy groups, such as AIDS Coalition to Unleash Power (ACT UP) in the USA and Treatment Action Campaign (TAC) in South Africa, among others, led grassroots level campaigns for the reduction of the cost of the antiretroviral drug azidothymidine and advocated for the prioritisation of treatment for HIV patients.20 These grassroots advocacy groups engaged in civil disobedience, peaceful street demonstrations, and distributed data-driven pamphlets. Drawing on lessons from the HIV/AIDS movement, Basilico et al, suggest some strategies that could be used to advocate for surgical care at the grassroots (table 1).20Table 1 Advocacy strategies for centring global surgery advocacy at the grassroots20 Advocacy strategy Description Engage in critical self-reflection Begin with individual introspection to consider own position, sources of inspiration, and potential role in movement.