A new challenge has emerged for 5 billion people in low- and middle-income countries (LMICs) without access to safe and timely surgical and anesthesia care: the chasm of quality of care (Lancet 2015;386:569-624). Perioperative mortality in high-income countries has remained low (1.1%-1.3%) despite an increase in the complexity of patients; in contrast, perioperative mortality in LMICs remains high even after simple surgeries like hernia repair. Poor-quality health care is the third-leading cause of global death (Anaesthesia 2020;75 Suppl 1:e18-27; Lancet 2019;393:401). In 2016, 5 million deaths in LMICs resulted from poor health care, compared to 3.6 million due to lack of services, and three times higher than all global deaths from diabetes (Lancet 2018;392:2203-12).

The World Health Organization launched the “Safe Surgery Saves Lives” and “Surgical Safety Checklist” in 2008 (N Engl J Med 2009;360:491-9). The Lancet Commission on Global Surgery...

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