To the Editor:

Since 2015, there has been a notable increase in global efforts by various stakeholders to promote and advance surgical care policies, as proposed by the Lancet Commission on Global Surgery (LCoGS) namely, the development of the National Surgical Obstetric Anesthesia Planning (NSOAP), a country-driven framework that offers a comprehensive approach to health ministries to enhance their surgical systems.¹1. Albutt K, Citron I, Johnson W, et al. National surgical, obstetric and anaesthesia planning Manual (2020 edition). Zenodo; 2020. DOI:10.5281/ZENODO.3982869.
https://doi.org/10.5281/ZENODO.3982869... These plans are strategically designed for integration into national health policies, ensuring the development, implementation, and monitoring of surgical capacity.²2. The Program in Global Surgery and Social Change. National surgical, obstetric and anesthesia planning. Available from: https://www.pgssc.org/copy-of-national-surgical-planning-re. Accessed Nov 11, 2023.
https://www.pgssc.org/copy-of-national-s... The NSOAP addresses six key health system components: infrastructure, service delivery, information management, workforce, financing, and governance. This momentum has led to the promotion of NSOAPs in over 40 countries, with 11 having fully completed their plans. A significant advancement was the publication of the NSOAP Manual in 2022, followed by a Spanish translation, amidst Ecuador’s version of an NSOAP, the National Surgery Strengthening Plan (NSSP; Plan de Fortalecimiento Quirúrgico Nacional).¹1. Albutt K, Citron I, Johnson W, et al. National surgical, obstetric and anaesthesia planning Manual (2020 edition). Zenodo; 2020. DOI:10.5281/ZENODO.3982869.
https://doi.org/10.5281/ZENODO.3982869... Ecuador´s NSSP exemplifies the framework's strategic and scalable integration into national policies.

Ecuador has affirmed its position as a leading advocate for surgical care in Latin America. Following a two-year process, Ecuador is the first country in the Region of the Americas to launch an NSSP as a key component of a robust health system, including improving emergency responsiveness and preparedness.⁴4. Torres Perez-Iglesias C, Hill SK, Jhunjhunwala R, et al. Strengthening surgical, obstetric, and anesthesia care in the Americas: a call to action. Lancet Reg Health Am. 2023;22:100499. With 365 million Latin Americans lacking access to essential surgical care, an urgent regional response is needed.³3. Alkire BC, Raykar NP, Shrime MG, et al. Global access to surgical care: a modelling study. Lancet Glob Health. 2015; 3:e316–23. Ecuador has called upon the Pan American Health Organization (PAHO) and its member states to recognize the need to fortify surgical health systems in the region.⁴4. Torres Perez-Iglesias C, Hill SK, Jhunjhunwala R, et al. Strengthening surgical, obstetric, and anesthesia care in the Americas: a call to action. Lancet Reg Health Am. 2023;22:100499. Failure to do so poses a significant threat to the population's overall health and economic productivity. These efforts gained widespread recognition for embedding surgical infrastructure development within multilateral health organizations' core public health priorities, most notably PAHO, and reaffirming the country’s steadfast commitment to achieving the targets outlined in the Sustainable Development Goals (SDGs).⁵5. Pan American Health Organization. PAHO Director calls for urgent actions to reduce health inequities in the Americas. Available from: http://www.paho.org/en/news/28-9-2023-paho-director-calls-urgent-actions-reduce-health-inequities-americas. Accessed Nov 11, 2023.
http://www.paho.org/en/news/28-9-2023-pa...

Ecuador’s dedication to strengthening surgical care systems extends to the international stage. During the 75^th Session of the Regional Committee of the World Health Organization (WHO) for the Americas, held in Washington D.C., United States of America, from September 25^th to 29^th, 2023, the government of Ecuador advocated for the inclusion of surgical system strengthening in the agenda for 2024 and led a side event convening international experts to better understand the political and financial challenges and how to overcome them in the Region.⁵5. Pan American Health Organization. PAHO Director calls for urgent actions to reduce health inequities in the Americas. Available from: http://www.paho.org/en/news/28-9-2023-paho-director-calls-urgent-actions-reduce-health-inequities-americas. Accessed Nov 11, 2023.
http://www.paho.org/en/news/28-9-2023-pa... This initiative reinforces Ecuador’s commitment to advancing surgical care within its borders and across the Americas. Ecuador’s national surgical plan is a testament to the power of collaboration and political advocacy in action to shape the future of health systems, within its borders and across the region.

On November 13^th, 2023, Ecuador formally launched the national plan to strengthen surgical care delivery. The plan integrates surgical system strengthening into its health, climate, and emergency preparedness agenda. Moreover, in Ecuador, the plan aligns with the three strategic objectives proposed in the Ten-year Health Plan 2022-2031 (“Plan Decenal de Salud de Ecuador”): 1) Equity in health; 2) Timely and quality care; and 3) Integrated and efficient health system, in addition to four key population health priorities: 1) maternal and child health, 2) non-communicable diseases, 3) trauma and injury, and 4) climate change. This policy comes at a critical time–as the region prepares for the El Niño Phenomenon–with a focus on health systems strategic planning to address broader national priorities. Surgical system strengthening is an indivisible component of national security and emergency preparedness. Ecuador’s groundbreaking initiative encourages regional governments to adopt a similar integrated approach towards health system strengthening, achieving the SDGs, and universal health coverage.

Disclaimer.

The authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the RPSP/PAJPH and/or PAHO.

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