• V Santhirapala, C J Peden, J G Meara, B M Biccard, A W Gelb, W D Johnson, M S Lipnick, E M Makasa, J Martin, S Maswime, J Mellin-Olsen, and C D McClain.
• Harvard Medical School, Boston, MA, USA.
• Anaesthesia. 2020 Jan 1; 75 Suppl 1: e18-e27.

AbstractArticle 25 of the United Nations' Universal Declaration of Human Rights enshrines the right to health and well-being for every individual. However, universal access to high-quality healthcare remains the purview of a handful of wealthy nations. This is no more apparent than in peri-operative care, where an estimated five billion individuals lack access to safe, affordable and timely surgical care. Delivery of surgery and anaesthesia in low-resource environments presents unique challenges that, when unaddressed, result in limited access to low-quality care. Current peri-operative research and clinical guidance often fail to acknowledge these system-level deficits and therefore have limited applicability in low-resource settings. In this manuscript, the authors priority-set the need for equitable access to high-quality peri-operative care and analyse the system-level contributors to excess peri-operative mortality rates, a key marker of quality of care. To provide examples of how research and investment may close the equity gap, a modified Delphi method was adopted to curate and appraise interventions which may, with subsequent research and evaluation, begin to address the barriers to high-quality peri-operative care in low- and middle-income countries.© 2020 Association of Anaesthetists.

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