The future of global surgery demands epistemic accountability.

Abstract

To examine whether the current methodological foundations of global surgery remain adequate for the field's transition from advocacy to a mature discipline focused on health-system transformation. This Insights into Global Surgery article presents a critical perspective on the evolution of evidence generation in global surgery. While early global surgery research successfully established surgery as a global health priority, traditional methods alone are insufficient to address contemporary challenges of sustainability, implementation, governance, and equity. The field increasingly requires context-sensitive and systems-oriented approaches that better reflect real-world surgical care delivery. Global surgery has entered a phase in which its future credibility depends not only on expanding access but on strengthening the epistemic foundations that guide policy and practice. Methodological recalibration toward context-sensitive, equitable, and systems-oriented evidence is essential for the field's continued maturation.