The Royal Australasian College of Surgeons (RACS) has developed strong partnerships for surgical care delivery and training with our Pacific and South East Asian neighbours. We write to you in view of your candidature for the position of WHO Director General, a leading position that holds great potential to improve universal health coverage, including access to safe, affordable surgery and anaesthesia care when needed.

In consensus with surgical colleges around the world, we believe that there is a pressing need to plan for, measure through meaningful metrics, and deliver safe and affordable emergency and essential surgical care to all communities. Surgical and anaesthesia care are needed to avoid premature death, correct deformity, and prevent or minimise disability. They can be delivered cost-effectively in Low and Middle-Income Countries.

If elected to the post of Director General, what actions will you take to support universal access to Emergency and Essential Surgical Care, and how are you going to include surgery and anaesthesia amongst the many health priorities that face our world?

As the Lancet Commission on Global Surgery highlights, two-thirds of the world's population still lack access to safe, timely, and affordable surgical care. More people die each year from lack of access to emergency and essential surgical care than do from HIV, TB, and malaria combined. It is estimated that by 2030, the lost financial output across the globe (total GDP loss) from death and disability due to poor access to safe and affordable surgery could total $12.3 trillion, reducing annual GDP growth in low and middle income countries by as much as 2%.

The passing of World Health Assembly resolution WHA68.15 was a significant step in recognising the need to address these issues. Indeed it has been one of the accomplishments of the WHO's Global Initiative for Emergency and Essential Surgical Care (GIEESC).

To build on such accomplishments, the Royal Australasian College of Surgeons requests the in-coming Director
General to develop a strategy to measure performance, scale up care delivery, and reduce avoidable mortality and
disability from lack of access to surgical and anaesthesia care, including the management of obstructed labour and

Yours sincerely,
Mr Philip Truskett AM
RACS President