Identifying knowledge needed to improve surgical care in Southern-Africa using a theory of change approach

Lucia D'Ambruoso, Maria Lisa Odland* (Corresponding Author), Danyca Shadé Breedt, Balisi Bakanisi, Edward Clune, Moneimang Makgasa, John Tarpley, Margaret Tarpley, Akutu Munyika, Jacob Sheehama, Theresia Shivera, Bruce M Biccard, Regan Boden, Sean Chetty, Liesel de Waard, Rowan Duys, Kristin Groeneveld, Susan Levine, Tamlyn Mac Quene, Salome MaswimeMegan Naidoo, Priyanka Naidoo, Shrikant Peters, Ché L Reddy, Savannah Verhage, Godfrey Muguti, Shingai Nyaguse, Kathryn Chu, Justine Davies

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
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Surgical healthcare has been prioritised in the Southern African Development Community (SADC), a regional intergovernmental entity promoting equitable and sustainable economic growth and socioeconomic development. However, challenges remain in translating political prioritisation into effective and equitable surgical healthcare. The AfroSurg Collaborative (AfroSurg) includes clinicians, public health professionals and social scientists from six SADC countries; it was created to identify context-specific, critical areas where research is needed to inform evidence-grounded policy and implementation. In January 2020, 38 AfroSurg members participated in a theory of change (ToC) workshop to agree on a vision: ‘An African-led, regional network to enable evidence-based, context-specific, safe surgical care, which is accessible, timely, and affordable for all, capturing the spirit of Ubuntu[1]’ and to identify necessary policy and service-delivery knowledge needs to achieve this vision. A unified ToC map was created, and a Delphi survey was conducted to rank the top five priority knowledge needs. In total, 45 knowledge needs were identified; the top five priority areas included (1) mapping of available surgical services, resources and providers; (2) quantifying the burden of surgical disease; (3) identifying the appropriate number of trainees; (4) identifying the type of information that should be collected to inform service planning; and (5) identifying effective strategies that encourage geographical retention of practitioners. Of the top five knowledge needs, four were policy-related, suggesting a dearth of much-needed information to develop regional, evidenced-based surgical policies. The findings from this workshop provide a roadmap to drive locally led research and create a collaborative network for implementing research and interventions. This process could inform discussions in other low-resource settings and enable more evidenced-based surgical policy and service delivery across the SADC countries and beyond.
Original languageEnglish
Article numbere005629
Number of pages9
JournalBMJ Global Health
Issue number6
Early online date15 Jun 2021
Publication statusPublished - 15 Jun 2021

Bibliographical note

We would like to acknowledge all the individuals who participated in the theory of change workshop.

Funding for the workshop was provided by the UK Academy of Medical
Sciences, Global Challenges Research Fund Networking Grant. The funding did not
include any studies or papers that were based on the workshop findings.

Data Availability Statement

All data relevant to the study are included in the article or uploaded as supplementary information. Additional supplemental material is published online only. To view, please visit the journal online (


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