From package to practice: standardizing surgical equipment to increase efficiency and access

Surgical conditions account for approximately one third of the global burden of disease. In 2025 at least 160 million additional operations per year were needed to meet this need, which is greatest in low- and middle-income countries (LMICs). Standardizing surgical packages is a key step toward improving operating room (OR) efficiency and expanding surgical care delivery across high-, middle-, and low-resource settings. Yet in low-resource settings, surgical equipment procurement often remains fragmented, non-standardized, and driven by facility-level ad-hoc processes rather than procedure-based planning. A universal standard could support high-quality surgical care that is both nationally scalable and internationally consistent. The World Health Organization's (WHO) service package delivery and implementation (SPDI) tool is a viable candidate for such standardization of surgical instrument sets as it already covers nearly all essential surgeries identified by existing normative frameworks, making it a strong foundation for universal surgical package standardization. National implementation of reduced, standardized surgical sets could extend demonstrated single-center efficiency gains by improving OR efficiency and increasing case volume, supporting case reproducibility and more consistent care, and making supply chains more reliable, cost-effective, and environmentally sustainable. Pre-defined packages lend themselves to rapid, cost-effective scale-up of supply chains, while minimized sets can also lower the carbon emissions associated with surgical care. Ministries of health, hospital networks, and practitioners at the facility level may consider the WHO's UHC Compendium as a foundation for expanding access to safe, high-quality surgical care.