global surgery – informing national strategies for scaling up surgery in sub-saharan africa

Surgery has the potential to address one of the largest, neglected burdens of disease in low- and middle-income countries (lmics), especially in sub-saharan africa (ssa). the lancet commission on global surgery (lcogs) has provided a blueprint for a systems approach to making safe emergency and elective surgery accessible and affordable and has started to enable african governments to develop national surgical plans. this editorial outlines an important gap, which is the need for surgical systems research, especially at district hospitals which are the first point of surgical care for rural communities, to inform the implementation of country plans. using the lancet commission as a starting point and illustrated by two european union (eu) funded research projects, we point to the need for implementation research to develop and evaluate contextualised strategies. as illustrated by the case study of zambia, coordination by global and external stakeholders can enable governments to lead national scale-up of essential surgery, supported by national partners including surgical specialist associations.