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To achieve our vision of providing Universal access to safe, affordable surgical and anesthesia care when needed, the PGSSC is working with several Ministries of Health to develop National Surgical, Obstetric and Anesthesia Plans (NSOAP). This is a national health plan specifically focused on surgical capacity and access in a country - something which has been traditionally not present in most national health plans. 


Ethiopia's national flagship initiative-Saving Lives through Safe Surgery (SaLTS) was launched in 2016 in order to streamline all efforts towards defining a package of essential and emergency surgical care 


Zambia's National Surgical, Obstetric and Anaesthesia Plan was signed in May 2017, making Zambia a leader in creating and implementing a major policy document focused on global surgical systems


Tanzania's National Surgical, Obstetric and Anaesthesia Plan was signed in March 2018.


Rwanda's National Surgical, Obstetric and Anaesthesia Plan


If you are interested in learning more about your country's surgical system and implementing an NSOAP the following resources have been developed to facilitate this process. 

WFSA Anaesthesia Facility Assessment Tool
Plan National Chirurgical Obstétrique et d'Anesthésie (PNCOA) - Centre for Global Surgery McGill University Health Centre

Further information and documents for the development of a national surgical, obstetric, and anesthesia plan, translated in French, from the Centre for Global Surgery at McGill University Health Centre

Optimal Resources for Children's Surgery  (OReCS) -  Global Initiative for Children's Surgery

Further information and tools for the development and planning processes related to children’s surgery

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Letter Template to Request Technical & Financial Support

A template letter to send to WHO country office to request technical and financial support for creating a national strategic plan for surgical care. Versions also available in French and Spanish.

Technical Guide to NSOAP Planning
Coming Soon
NSOAP Template

The National Surgical, Obstetric and Anaesthesia Planning Template contains the most critical components of a resilient surgical system

Surgical Indicators

Six essential indicators of surgical system strength covering preparedness, delivery, and finance. For Spanish copies, please click here

Surgical Assessment Tool (SAT)

The SAT is used to evaluate the strength of a surgical system within 5 domains: infrastructure, service delivery, workforce, information management, and financing

Qualitative Interview Tool

The semi-structured interview is a qualitative tool designed to understand the key factors affecting the provision of safe, affordable and timely surgical care 

Discussion Framework

Discussion frameworks are available in each domain to facilitate productive discussions amongst stakeholders that ultimately provide the foundation for a NSOAP

Cardiac Surgery Needs Assessment 

A semi-structured interview guide, facility questionnaire, and needs assessment tool to evaluate the availability and possibility of cardiac surgical services in tertiary hospitals globally. 

Implementation Strategies

Specific guidelines, recommendations, and prior implementation strategies on some of the more common identified gaps in surgical, obstetric, and anesthesia care. These documents contain only a sample from the literature and are not in anyway all inclusive or supported by the PGSSC.

Strategizing National Health in the 21st century: a handbook

A WHO handbook and resource for national health planning based on the experiences of the WHO in planning and strategizing health systems globally.

Surgical Care Systems Strengthening

A monograph from the WHO and the Program in Global Surgery and Social Change on developing national surgical, obstetric and anesthesia plans.

NSOAP Costing Template

Costing template for national surgical, obstetric, and anesthesia planning.

Safe Surgery Organizational Readiness Tool (SSORT)

The purpose of the Safe Surgery Organizational Readiness Tool (SSORT) is to evaluate surgical facility members’ baseline beliefs and attitudes toward such interventions and their implementation.


Recent efforts have drawn attention to the urgent need to address the lack of access to safe and high-quality surgical care in low- and middle-income countries (LMIC); however, not all interventions intended to improve quality and safety in LMICs achieve successful outcomes. More strikingly, multiple facilities implementing the same intervention may not all achieve success. This heterogeneity could be explained, in part, by pre-intervention organizational characteristics and lack of readiness of surgical facilities to implement safety and quality improvement interventions.


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