Five billion people worldwide do not have access to safe, affordable surgical, obstetric, trauma and anesthesia care (Meara, JG et al. 2015). Of the 313 million surgical procedures that are done each year, only 6% are done in the poorest countries (37.3% of the world’s population). A quarter of people who have a surgical procedure will incur financial catastrophe and most of those are in low and middle-income countries. The goal of this presentation will be to provide an understanding of the current policy and workforce issues related to access to anesthesia care in low and middle-income countries. The G4 Alliance in conjunction with other organizations has set a goal; safe surgical and anesthesia care for 80% of the world by 2030. Strategies to attain this goal will be reviewed and include advocacy, development of national surgical plans, coordination of projects and expanding workforce.