May 2025 signifies 10 years since the global surgery movement was enhanced by the passage of the WHA Resolution 68:15 ‘Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage’, the Lancet Commission on Global Surgery and the formation of The Global Alliance for Surgical, Obstetric, Trauma and Anaesthesia Care (G4 Alliance). Great excitement was generated about the potential to improve global surgical access and systems. This presentation explores these 10 years, where the global surgical community is now and what the future holds in the changed world environment. RACS led collection of regional data on Lancet Indicators designed to provide a framework for understanding Surgical Health System functioning, address disparities, and form a basis for development of National Surgical, Obstetric and Anaesthesia Plans. Globally, 32 countries developed such plans, but few were funded for implementation, limiting progress. Covid19 resulted in the WHO pivoting to alternate priorities emphasising pandemic preparedness and a continuum of Emergency, Critical and Operative Care (ECO) with new WHA resolutions and a plan to develop ‘a global strategy and action plan for integrated emergency, critical and operative care. Surgical care comprises 1 in 3 cases of primary health care; therefore, it is essential that the surgical community provides strong ongoing advocacy for the strengthening of surgical systems within this ECO framework. RACS membership of the G4 Alliance is critical, for such ongoing international advocacy to improve surgery in the region. Initiatives relating to this will be outlined in this presentation.