Background Even though injury surveillance systems is considered a prerequisite to the effective development of injury prevention strategies and public health policies, its development over the past 40 years has been slow or uneven. Low- and middle-income countries (LMIC), where the highest concentration of injuries occur, civil and vital registration systems (CVRSs) are reportedly not functioning well enough to produce consistent monitoring data. A South African-based Injury Mortality Surveillance System (IMSS), a rich epidemiological injury mortality database, was implemented in the Province of Mpumalanga’s Forensic Pathology Service (FPS) facilities to promote the quality and timeliness of surveillance data.

Objective This study aimed to determine the intersecting systemic and FPS operational and staffing barriers experienced following implementation of the IMSS.

Methods Forty-seven IMSS trained FPS staff (24 data capturers, 20 facility managers and 3 district co-ordinators) in the Mpumalanga province participated in the formative evaluation study from November 2019 to November 2022. Thematic analysis was conducted on 12 focus group discussions. Key themes offer a description of how organisational systems intersect with the FPS staff member’s individual performance.

Results At the individual level, the barriers focused on the nature of FPS staff work and skill requirements (implying on-the-job and surveillance system operating requirements); along with the working conditions. The systems-level barriers were associated with unbalanced access and distribution to resources. The two sets of barriers were often interrelated and FPS staff often struggled to identify the various types of support required to improve their working conditions and subsequently, support their facility-level IMSS data management practices. Accurate documentation of a surveillance system requires active participation of the concerned agencies, who are also the intended users of the data, so to ensure that the methodological realities and conceptual accepts have been addressed accordingly.

Conclusions Whilst the IMSS will aid the development of injury mortality profiles and preventative responses, lack of structured and formal education among FPS leads to poor service delivery, and subsequently influences the adequate documentation case files, and the quality of datasets. Quality assurance measures and best data management practices needs to be built in all steps of the FPS system to promote quality data.