INTRODUCTION:
Sustainable and resilient health systems depend on leadership that is capable of translating data into timely, equitable and evidence-informed decisions. While data-driven decision-making (DDDM) has been widely institutionalised in high-income health systems, its integration into clinical leadership in low- and middle-income countries remains uneven, particularly in rural and resource-constrained contexts. This gap undermines system responsiveness, accountability and long-term sustainability. This study seeks to evaluate and strengthen the implementation of DDDM within clinical leadership structures in two predominantly rural South African provinces, the Eastern Cape and Limpopo, positioning DDDM as a strategic lever for health system resilience and policy-aligned governance.

METHODS:
A convergent parallel mixed-methods design will be employed. Quantitative data will be collected from clinical leaders across district, regional, and tertiary public hospitals using a structured questionnaire that assesses data access, analytical capacity and utilisation in decision-making. Qualitative data will be generated through in-depth focus group discussions exploring leadership practices, institutional culture and systemic enablers and constraints. Integrated analysis will inform the adaptation of a contextually relevant, data-driven leadership framework aligned with results-based management and learning health system principles. Expected results The study anticipates identifying critical structural, organisational, and human-capacity barriers to effective data use, alongside emergent practices that enhance adaptability and service continuity in constrained settings. Findings are expected to demonstrate how strengthened data literacy, governance, and leadership accountability can improve strategic planning, resource optimisation and policy implementation at sub-national levels.

CONCLUSIONS:
By situating data-driven clinical leadership at the nexus of sustainability, resilience, and health system governance, this study contributes actionable evidence for policymakers and health leaders in low-resource settings. The proposed framework offers a scalable pathway to institutionalising evidence-informed leadership, advancing equitable, resilient, and sustainable health systems in alignment with global public health priorities.