InterSurgeon at G4 Alliance Permanent council meeting, 17-18th May 2025 and their decennial report.
InterSurgeon attended G4 Alliance Permanent Council meeting and their decennial report in Geneva last week. We are so pleased to support our partners at such a wonderful event and delighted to share with all our members a summary.
G4 alliance Permanent Council meeting
WHO resolution discusions:
Saturday 17th May marked the one day event of G4 alliance permanent council (PC). Significantly shorter than previous meetings, this year the PC focussed on advocacy and finance of global surgery. The meeting was sponsored, for the first time, by private partners; Proxime, Rods&Cones and Ohana one.
InterSurgeon was present to hear all about the impact on Surgical, Obstetrics, Trauma and Anaesthesia (SOTA) care on the 10th Anniversary of the passing of resolution 68.15. “Strengthening emergency and essential surgical care and anaesthesia as a component of universal coverage”
On Saturday we were very fortunate to hear speaking Professor Emmanual Makasa, from the Republic of Zambia, speaking about the inception and passing of Resolution 68.15. This resolution was co-sponsored by Zambia, USA and World Council of Churches amongst other NGOs after Professor Makasa was trying to meet maternal health goals set out by a previous WHO resolution and found that Zambia was falling short of these goals and they wanted to improve surgical care.
Ambassador Jimmy Kolker explained how difficult it is to pass a resolution and it is a minimum of a 2 year process which requires 194 political representatives to meet a consensus. It requires working groups, large sponsors (both non-state and state actors) and very specific language.
In the case of resolution 68.15, after it was sent back to the drafting room, it was finally approved 26th May 2015. Dr Walt Johnson, WHO, was then employed to support the resolution and meet it’s sustainable development goals (SDGs) however the estimated cost of implementation of resolution 68.15 was not met. They set about creating a road map in 2015/16 to help drive implementation. He also set up WHO Global Initiative for Emergency and Essential Surgical Care (GIESC). His group identified that one of most effective methods of meeting Resolution 68.15 was to enable nations to create their own national surgical plans. Dr Johnson outlined that what was vital was developing partnerships to reach these goals.
Following these wonderful presentations, Professor Kemel Ghotme gave information about his project GASBiF (Global Alliance for the Prevention of Spinal Bifida). Having successfully written and established a WHO resolution for spinal bifida, he was able to start working with the government in Ethiopia. In Ethiopia, they have 10,000 cases of neural tube defects annually. With impact analysis, they were able to predict a reduction in cases by 8,000 using wheat fortified with folic acid. The remaining cases could then be treated. This reduced mortality and surgical care costs enormously by reducing the number of surgical cases and having relatively low operating costs. They retain some funding for a surveillance program to measure outcomes and checking product labelling. Professor Ghotme says; “The cost of wheat fortification is $6 per metric tonne.” For helping to reduce spinal bifidia in other areas of the world, they can also use lessons learnt in Ethiopia and focus on fortification of other foods including rice and cornflour.
Afternoon session: Financing global surgery and emerging leaders
The afternoon was predominantly talking about mobilising financing for global surgery and different financing strategies from Dr Kee Park and his fellows from Blavatnik Institute of Global Health & Social Medicine at Harvard Medical School. Dr Park and his group have been conducting essential research to help guide the next strategies for national funding of surgery and global surgery to aid with the creation of national surgical plans. This work is due to be published soon. Finally, we enjoyed an open discussion with the group of emerging leaders as part of one of the new G4 alliance pledges made in January. The discussions centred predominantly around the role of surgery and peri-operative care in remote communities. The results of the discussions are due to be published by the G4 fellows.
Dr Michael Mwachiro left a very resonant message at G4 Alliance; “Where you live determines if you live”. InterSurgeon commits to supporting the global surgery community to make partnerships and disseminate information to each other to move towards universal health coverage.
Decennial Report
After 10 years of G4 Alliance, they held a wonderful event to launch their 10 year impact report. As long-time partners of InterSurgeon, we were delighted to support G4 alliance and celebrate with them.
President of G4 Alliance, Dr Neil Wetzig, opened the event with some salient remarks which reminded the audience that “5 billion people still do not have access to safe timely surgical care… [G4 alliance is there to] change the lives of the poor and marginalised.”
The three wonderful guest speakers all brought different perspectives to the event. The first speak Professor Meena Cherian spoke about bringing the operating room to the public arena using the WHO. She was heavily involved in getting surgery on the WHO agenda including the first resolution mentioning surgery which was passed in 2013. She was present during the build up to the passing of resolution 68.15 including many years of side events to consult other global surgery stakeholders and hear their voices and opinions.
Next to speak was Professor Emmanuel Makasa discussing a member state journey to pass a resolution. After passing the resolution in 2015, they had specified a follow up in 2017 – which has now been extended to 2030. Professor Makasa has been instrumental in helping African nations to plan their own national surgical plans. He started with the South Africa Development Community (SADC) – an economic block which includes his home country of Zambia. He moved through various economic hubs to build up the number of countries sharing knowledge and skills. Deployment of the national surgical plans remains a problem with funding being an important factor.
To follow Dr Mehreen Zaigham gave a review of the global status of global surgery indicators for the last 10 years. She outlined that since 2017 recording of global surgery indicators has declined massively with no data being added to the World Information Bank by 2020. In addition, after the WHO resolution 68.15 in 2015, only 43 countries have developed a national surgical plan with only 19 of those that are currently in action. This leaves 6 billion people living in areas without an active national surgical plan.
Finally, we heard from the first female president of the ICS, Dr Aij-Lie Kwan, who has spent her career running missions in her native Indonesia starting with no budget in 2012. She has also travelled the world sharing knowledge and expertise specifically in the pacific region.
Dr Gail Rousseau presented the impact report very swiftly and highlighted the continuing importance of G4 alliance community which has grown in the last 10 years into a family. Their mandate of research, policy and tools for advocacy remains central to what they continue to do today by having many working groups to support members and developing the Operative Encounter Registry (OER) which will be invaluable for advocacy and quality improvements at local levels.
The final section of the meeting was a panel discussion with the Drs Thav Thambi, Jaymie Henry, Kee Park, Lee Wallis (WHO emergency lead), Geoff Ibbotson, Professor Ric Henker and Dr. Alfredo Borrero Vega. A lively discussion followed discussing the breakdown of silos across the global health community, national surgical plan funding strategies (to be discussed more at the GSF side event) and climate change considerations in global surgery.
