WFSA

  1. Home
  2. Resources
  3. Surgery Metrics
  4. Pilots

Pilots

To test the validity of the metrics and systems needed to collect the data points, the programme funded two pilot programmes in South Africa and Ghana.

The Ghana Surgical Metrics Pilot

The Ghana Pilot Project was conducted between mid-2023 and early 2024 to test the feasibility of collecting key surgical indicators at the national level. Led by Dr Adam Gyedu and a Ghanaian research team from Kwame Nkrumah University of Science and Technology (KNUST) and Dr Jade Nunez from the University of Virginia, the project was coordinated with Ghana’s Ministry of Health.

The pilot was implemented across 16 regional hospitals and two tertiary hospitals to gather data on the five Utstein indicators.

Data was collected through a combination of existing hospital records, interviews with facility leads, and surveys with patients, using standardised tools adapted for the Ghanaian context.

Key Achievements:

  • Feasibility demonstrated: All five indicators were captured to some extent, with strong success in measuring POMR and surgical volume.
  • Broad stakeholder engagement: High response rates from participating hospitals and strong collaboration with facility administrators.
  • Identified challenges such as fragmented data systems and limited digitalisation, but also clear opportunities for integrating indicators into national health data systems like DHIMS2.
  • Policy relevance: The findings will directly inform Ghana’s evolving National Surgical, Obstetric, and Anaesthesia Plan (NSOAP) and broader health sector monitoring.

This pilot confirms that collecting surgical systems data in low-resource settings is both practical and impactful, providing a replicable model for other countries aiming to improve surgical care through evidence-based planning.

The South Africa Surgical Metrics Pilot

The South Africa Surgery Metrics Pilot was a proof-of-concept study conducted between March 2023 and April 2024 to evaluate the feasibility and utility of routinely collecting surgical indicators for inclusion in the country’s National Indicator Data Set (NIDS).

Led by Prof. Hyla Kluyts (Sefako Makgatho Health Sciences University) and Prof. Bruce Biccard (University of Cape Town), the project was implemented at hospitals across six provinces, including key sites such as Groote Schuur Hospital (Western Cape), Dr George Mukhari Academic Hospital (Gauteng), and Nelson Mandela Academic Hospital (Eastern Cape).

The pilot aimed to test the collection of two indicators: Perioperative Mortality Rate (POMR) and Surgical Volume, using a combination of hospital records, structured interviews, and the DHIS2 tracker application. The project involved collaboration with national and provincial health departments, Safe Surgery SA, and private sector data platforms such as CareConnect Health Information Exchange.

Key Achievements:

  • Demonstrated feasibility of collecting surgical indicators at selected sites, particularly in the Western Cape where health data systems are more advanced.
  • Piloted a DHIS2-based surgical tracker, with positive results at some sites despite limitations in resources and internet connectivity.
  • Expanded stakeholder engagement, including presentations at the National Health Coordinating Committee and ongoing collaboration with the National Health Insurance (NHI) team.
  • Generated interest in using private sector datasets (via CareConnect) to enable national-level reporting on surgical indicators.
  • Identified key enablers and barriers, including strong hospital-level support but limited national policy focus on surgical care.

Surgical/operative care is not a priority for health policy makers in South Africa (SA), despite the country being a signatory to the WHA resolution 68.15 on strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage. To include surgical indicators in the NIDS, health programme managers need to accept, adopt and use indicators in a defined health programme, at national and provincial level. The lack of a surgical health programme in SA is a significant barrier to data availability.

Nevertheless, this pilot lays important groundwork for integrating surgical metrics into routine national health monitoring, contributing to South Africa’s progress toward universal health coverage. The project also supports advocacy for the establishment of a formalised National Surgical, Obstetric, and Anaesthesia Plan (NSOAP) framework.

Top