INTRODUCTION: Since 2007, observations reveal that low- and middle-income countries (LICs and LMICs) experience similar surgical access and safety issues, though the etiology of these challenges varies by country. The collective voice of surveys completed to date has pushed the agenda for the inclusion of safe surgery and anesthesia within global health discussions. Comparison of four countries across the world shows similar basic progress as well as ongoing surgical and anesthesia needs in resource-challenged countries. By studying these common needs, a comprehensive plan to provide infrastructure and personnel support can work in multiple austere settings. METHODS: A standardized survey tool published, designed, and developed initially by the Harvard Humanitarian Initiative and modified at Vanderbilt University was completed in Guatemala, Guyana, Laos, and Mozambique. The survey assessed eight key areas of essential surgical care: access to and availability of surgical services, access to human resources, essential infrastructure (including access to water, electricity, sanitation, blood products, and essential medicines including supplemental oxygen), surgical outcomes, operating room information and procedures, equipment, International Organization, and Non-Government Organization provision of surgical care. These results were compared and contrasted to evaluate resource challenges and assets in each country. RESULTS: A total of 49 hospitals were surveyed in this comparison cohort. The results reveal common needs for emergency and essential surgery in each country, but some differences in human and capital resources exist. While minimal resources exist, all surgical sites provided running water, electricity, and oxygen-assets not seen in previous surveys as recent as 2011. CONCLUSION: The most basic needs to provide essential surgery are now present in LICs and LMICs. Many more resources are needed to ensure access to safe surgery and anesthesia. The next steps to provide essential surgery must include common solutions for access to surgery and anesthesia, and an evaluation of patient safety in these endeavors through the perioperative mortality rate.