Implementation strategy for data-driven surgical systems: a South African perspective

Surgical care is essential to achieving universal health coverage, yet many African low-income, lower-middle-income countries (LMICs) and upper-middle-income countries - including South Africa—struggle to harness healthcare data for surgical system strengthening. Despite global advocacy efforts and the adoption of surgical indicators such as perioperative mortality rate and surgical volume, fragmented routine health information systems, limited human resource capacity and siloed data architecture hinder effective, data-informed planning and policy. Drawing on a South African case study, this high-level perspective highlights institutional momentum for integrating routine perioperative data into strategic health planning, while also identifying key technical and operational challenges. The study demonstrated the inability of clinician-led initiatives to generate routine perioperative health information to guide practice at an institutional level. To close the implementation gap, a context-adapted approach, that includes participatory network weaving, stakeholder-driven data use cases and collaborative planning for interoperable data systems, is proposed. These elements are positioned within an implementation framework designed to support policy development, guide clinical practice and improve access to safe, high-quality surgical care across African countries. We propose taking advantage of opportunities for concurrent implementation assessment and adaptation of a clinical health information system module for South African surgical patients.