Built on the President's Emergency Plan for AIDS Relief (PEPFAR), the President's Global Health Initiative was President Obama's promise to fundamentally 鈥渞estructure US global health enterprise.鈥� In 2009, the Global Health Initiative pledged to invest $63 billion over 6 years (fiscal years 2009-2014): $51 billion for PEPFAR (HIV/AIDS, tuberculosis, and malaria) and $12 billion for broader global health issues (eg, maternal and child health, nutrition, and neglected tropical diseases).¹

Unfortunately, surgery was not explicitly part of the Global Health Initiative. We echo Paul Farmer's call that surgery should no longer be the 鈥渘eglected stepchild of global public health.鈥�² The increasing awareness of the unmet needs of surgical care worldwide³ must be reciprocated with sustainable steps to meet these needs. Why should a woman in obstructed labor not have access to a cesarean delivery, which would not only save the life of her unborn child but also prevent the lifelong disability and stigma of a vesicovaginal fistula? Why should a young boy die from perforated appendicitis or a young man from an incarcerated hernia because no supplies for an operation were available? Why not prevent the disability or even death of the middle-aged farmer with bilateral femur fractures after a fall from a tree with stabilization and traction? These are but simple and common examples of how people living in low- and middle-income countries (LMICs) suffer owing to a lack of access to basic emergency and essential surgical services.