Recommendations for developing effective and safe paediatric and congenital heart disease services in low-income and middle-income countries: A public health framework

Babar S. Hasan, Areesh Bhatti, Shazia Mohsin, Paul Barach, Eltayeb Ahmed, Sulafa Ali, Muneer Amanullah, Annette Ansong, Tahmina Banu, Andrea Beaton, Ralph Morton Bolman, Bruna Cury Borim, John P. Breinholt, Edward Callus, Massimo Caputo, Marcelo Cardarelli, Tomas Chalela Hernandez, Ulisses Alexandre Croti, Yayehyirad M. Ejigu, Kathleen FentonAnu Gomanju, Ashraf S. Harahsheh, Peter Hesslein, Christopher Hugo-Hamman, Sohail Khan, Jacques Kpodonu, Raman Krishna Kumar, Kathy J. Jenkins, Kokila Lakhoo, Mahim Malik, Sanjiv Nichani, William M. Novick, David Overman, Alexis Palacios Macedo Quenot, Ceeya Patton Bolman, Dorothy Pearson, Vijayakumar Raju, Shelagh Ross, Nestor F. Sandoval, Gary Sholler, Rajesh Sharma, Fenny Shidhika, Sivakumar Sivalingam, Amy Verstappen, Dominique Vervoort, Liesl J. Zühlke, Bistra Zheleva

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)


The global burden of paediatric and congenital heart disease (PCHD) is substantial. We propose a novel public health framework with recommendations for developing effective and safe PCHD services in low-income and middle-income countries (LMICs). This framework was created by the Global Initiative for Children's Surgery Cardiac Surgery working group in collaboration with a group of international rexperts in providing paediatric and congenital cardiac care to patients with CHD and rheumatic heart disease (RHD) in LMICs. Effective and safe PCHD care is inaccessible to many, and there is no consensus on the best approaches to provide meaningful access in resource-limited settings, where it is often needed the most. Considering the high inequity in access to care for CHD and RHD, we aimed to create an actionable framework for health practitioners, policy makers and patients that supports treatment and prevention. It was formulated based on rigorous evaluation of available guidelines and standards of care and builds on a consensus process about the competencies needed at each step of the care continuum. We recommend a tier-based framework for PCHD care integrated within existing health systems. Each level of care is expected to meet minimum benchmarks and ensure high-quality and family centred care. We propose that cardiac surgery capabilities should only be developed at the more advanced levels on hospitals that have an established foundation of cardiology and cardiac surgery services, including screening, diagnostics, inpatient and outpatient care, postoperative care and cardiac catheterisation. This approach requires a quality control system and close collaboration between the different levels of care to facilitate the journey and care of every child with heart disease. This effort was designed to guide readers and leaders in taking action, strengthening capacity, evaluating impact, advancing policy and engaging in partnerships to guide facilities providing PCHD care in LMICs.

Original languageEnglish
Article numberbmjgh-2023-012049
JournalBMJ Global Health
Issue number5
Publication statusPublished - 4 May 2023
Externally publishedYes


  • cardiovascular disease
  • paediatrics
  • public health
  • review
  • thoracic surgery


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