The Alliance for Surgery and Anesthesia Presence envisions a world where those seeking care for surgical conditions in low and middle income countries have similar access to appropriate, reliable, safe, cost-effective anesthesia and surgical care as those in developed countries. This includes timely diagnosis of surgical conditions, sufficient numbers of adequately trained and supported personnel, safe delivery of anesthesia and surgical care, sustainably funded and resourced infrastructure, and priorization of surgical care within national health plans. When emergency and essential surgical and anesthesia care are considered critical and necessary components of global public health, sharp reductions in premature death and disability due to surgically treatable conditions will be achievable.