In sub-Saharan Africa, 93% of the population does not have access to basic surgical services.[1] Mortality after surgery in Africa is twice the global average.[1][4][5][7] Low- and middle-income countries in sub-Saharan Africa have only 0.1 to 1.4 anesthesia workers per 100,000 population, significantly less than the Lancet Commission's recommended 20.[2] Randomized controlled trials (RCTs) in perioperative care in sub-Saharan Africa show an exponential increase between 2000 and 2022, identifying 169 studies involving 45,376 patients.[1] The majority of RCTs are from Nigeria (37.3%) and South Africa (24.3%), are single-center, and focus on intraoperative interventions, mainly pharmacotherapy (37.9%) and analgesia (24.9%).[1] The most frequently investigated surgical field is obstetrics (30.2%).[1] Clinical trial capacity is limited to a few countries and institutions with low methodological quality, creating an opportunity for improvement through collaboration.[1]