Surgical diseases constitute a significant portion of the global disease burden, yet they have historically been underrepresented in global health agendas. Since 2015, global initiatives by the World Health Organization (WHO), United Nations, Disease Control Priorities group, and Lancet Commission on Global Surgery have underscored the critical need for surgical system strengthening, particularly in low- and middle-income countries. A key strategy recommended by these groups is the development of national surgical plans (NSPs) to ensure universal access to surgical, obstetric, and anesthesia care. This study provides a comprehensive assessment of NSP development across 194 countries, classifying them into five categories: current NSP, no NSP but current national health plan (NHP)&nbsp;with provisions for surgery,&nbsp;no NSP but current NHP without provisions for surgery, expired NSP/NHP, and no NSP/NHP. Our analysis revealed that only 12% of countries have a current NSP, with significant disparities in NSP development based on income level and WHO region. Low-income countries are particularly underrepresented, with 50% having no health plan at all. These findings highlight the urgent need for targeted financial interventions and international collaboration to bridge the gaps in surgical care as a key component of meeting the targets of Sustainable Development Goals by 2030.<br><br>Funding: Alan Zambeli-Ljepović is a National Clinician Scholar at University of California, San Francisco, United States, funded by NIH T32 grant in implementation science (5R25HL126146-09)<br><br>Declaration of Interest: We declare no competing interests<br><br>Ethical Approval: This study was approved by the University of Global Health Equity Institutional Review Board (UGHE-IRB/2024/305 dated 6th May 2024). Methods were re