NIHR Global Health Research Group on Perioperative and Critical Care Background: More than 600,000 patients die after surgery in Africa each year, a death rate which is twice the global average. Those patients who develop complications after surgery but survive, have a reduced overall life expectancy, reduced quality of life and significant financial hardship. Poor patient outcomes primarily result from failings in perioperative care and critical care (before, during and after surgery) rather than surgery itself. Meanwhile, a three-fold increase in procedures is required to meet the needs of 1.2 billion people across Africa who cannot access safe affordable surgical treatment. As health systems work to increase the number of surgical procedures, we anticipate a further increase in complications and deaths after surgery. Without effective perioperative care, the positive impact of increasing provision of surgery will be limited, as will any net improvements in health for individuals and societies. We will establish sustainable research infrastructure in Africa and build on our world-leading applied research in a range of health-system contexts to develop effective solutions to this problem.

Aim: To develop centres of research excellence in four African nations within the African Perioperative Research Group (APORG) of 705 hospitals in 42 countries, creating equitable partnerships to deliver an international research programme and improve the safety and quality of perioperative and critical care across Africa.

Impact: Our research findings will inform changes in healthcare which could reduce deaths after surgery to the global average across Africa, saving 300,000 lives each year, improving long-term health and reducing financial hardship. 1. Develop research leadership and capacity in four African nations Establish research hubs in four African universities with managerial, financial and governance infrastructure to become centres of research excellence, with a pan-African research design centre to lead international clinical trials. We will develop current and future research leaders and research professionals through training programmes, mentoring and PhD fellowships. Ultimately these hubs will become training centres for future African research professionals in our field.

2. Delivering research to improve outcomes after surgery across Africa Building on our successful international global health research, we will deliver a programme of observational studies of patient care, interviews with patients, staff and other stakeholders, large dataset research and large clinical trials across four key themes:
1) Developing realistic and sustainable models of Essential Critical Care
2) Improving identification of patients with life-threatening complications after surgery
3) Preventing and treating life-threatening bleeding after childbirth
4) Building linked national health data platforms (health registries) to assess the impact of Projects 1 to 3 and improve patient outcomes after surgery through international clinical audit and research

3. Engage patients, communities and policy-makers Led by teams in Africa, we will establish meaningful community engagement at local, national and pan-African levels allowing us to work together to produce the research which is most relevant to patients. We will develop links with civil society, policy-makers and health professionals across partner nations and to ensure our research impacts patient care.