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World Health Assembly resolutions have recently placed emphasis on emergency, critical and operative care to achieve universal health coverage. This will require a move away from vertical health programmes and a stronger emphasis on health systems strengthening, including data systems. There has also been an increased recognition of the need for data to advance the global surgery agenda. We share our efforts in the Democratic Republic of Congo (DRC) to strengthen surgical data collection, analysis, interpretation and dissemination sustainably. Working with individuals, institutions and systems, we outline interventions used to strengthen the health system and lessons learnt. Our work has highlighted the negative consequences of vertical programmes with demanding data management processes and the importance of taking a systems-level approach to improving surgical data and ultimately surgical outcomes.