BACKGROUND: Recommendations by the Lancet Commission on Global Surgery regarding surgical care in low- and middle-income countries (LMICs) require development to address the needs of children. The Global Initiative for Children's Surgery (GICS) was founded in 2016 to identify solutions to problems in children's surgery by utilizing the expertise of practitioners from around the world. This report details this unique process and underlying principles. METHODS: Three global meetings convened providers of surgical services for children. Through working group meetings, participants reviewed the status of global children's surgery to develop priorities and identify necessary resources for implementation. Working groups were formed under LMIC leadership to address specific priorities. By creating networking opportunities, GICS has promoted the development of LMIC-LMIC and HIC-LMIC partnerships. RESULTS: GICS members identified priorities for children's surgical care within four pillars: infrastructure, service delivery, training and research. Guidelines for provision of care at every healthcare level based on these pillars were created. Seventeen subspecialty, LMIC chaired working groups developed the Optimal Resources for Children's Surgery (OReCS) document. The guidelines are stratified by subspecialty and level of health care: primary health center, first-, second- and third-level hospitals, and the national children's hospital. The OReCS document delineates the personnel, equipment, facilities, procedures, training, research and quality improvement components at all levels of care. CONCLUSION: Worldwide collaboration with leadership by providers from LMICs holds the promise of improving children's surgical care. GICS will continue to evolve in order to achieve the vision of safe, affordable, timely surgical care for all children.