The SHARMA-30 framework: a proposed global taxonomy and classification system for frugal surgical innovations

Frugal surgical innovations (FSIs) are increasingly recognized as practical solutions for improving access to safe, affordable surgical care, particularly in resource-constrained settings. However, the absence of a standardized taxonomy limits their description, comparison and evaluation. We developed the SHARMA-30 Framework to provide a common language for characterizing FSIs. Based on published examples and the authors' experience in resource-constrained surgical settings, the framework comprises six domains - Scale of innovation, Health-system integration, Affordability gain, Regulatory readiness, Maturity of evidence and Adaptability - each scored from 0 to 5, yielding a cumulative score (0-30) and a standardized profile. The framework enables consistent classification across surgical specialties, settings and innovation types, facilitating communication, comparison, prioritization and identification of strengths and evidence gaps. Although prospective validation and international consensus are required, SHARMA-30 Framework offers a practical foundation for standardizing the evaluation and reporting of frugal surgical innovations.