Digital health systems to improve perioperative patient outcomes - Phase 1

Phase 1

Research Questions

Is it feasible to develop surgical registries in three African countries to allow linkage and shared data analysis? What are the stakeholder views and perceptions on the use of digital health resources to improve quality of perioperative care?

We will expand existing surgical registries across three countries, in accordance with criteria for inter-operability (coding and standards), accessibility (data governance and data security) and use (stakeholder ownership, research ethics). We will do this by sharing technical expertise to strengthen individual country level cloud-based data registries that adhere to national information governance requirements (e.g. Data Protection and Privacy Act 2019 [Uganda]) and comply with international information security standards (e.g. ISO27001). We will enhance existing registry datasets by incorporating variables from the APORG minimum dataset encouraging ‘lean’ data collection methods.

Can national datasets from registries in three African countries be linked to produce an international epidemiological study with risk-adjusted comparisons of activity and outcomes?


Technical, governance and feasibility issues will be overcome collaboratively through regular working group meetings and shared learning, built on previous experience.


To enable linkage in Phase 3, we will ensure coding and case definitions are compliant with data specification standards of the Fast Healthcare Interoperability Resources (FHIR). Automated analysis and data access at a facility level will ensure local medical and administrative leadership.

Individual countries will develop their registries during Phase 1.


  • South Africa: we have received ethics approval for the WFSA-Utstein funded project to establish the DHIS2 based registry
    • This now allows us to obtain regulatory approval from South Africa provinces, which is crucial for government involvement
    • In South Africa an opportunity to engage with the National Department of Health presented an advocacy moment which has resulted in plans to engage more and discuss national surgical metrics and indicators.
  • Ethiopia: routine data collection and entry is ongoing
  • Uganda: The Data Reflection Tool from the 5Rs to Rescue project has been created in our registry and is being piloted
    • Data entry and validation is still ongoing
    • In Uganda a small separate internal university grant has been won by the team to integrate the current maternity register into the surgical registry. This will strengthen the system making it more scalable and allow linking of obstetric outcomes to caesarean sections.
To learn more about Phase 2