### A Call for Transformation: Addressing Congenital Heart Diseases in Low and Middle-Income Nations

The arrival of a child is universally acknowledged as a celebration of life, possibility, and fresh starts. Nevertheless, for numerous families within low and middle-income countries (LMICs), the sounds of a newborn can swiftly shift to pleas for assistance when confronted with congenital heart diseases (CHDs). Affecting 1 in 100 live births worldwide, CHDs are structural heart abnormalities present from birth. Despite notable progress in global healthcare, these conditions continue to impose a considerable burden, especially in LMICs such as Ghana, Namibia, and Pakistan, where families grapple with systemic deficiencies in diagnosis, treatment, and financial accessibility.

#### The Global and Local Impact of Congenital Heart Diseases

Globally, CHDs contribute to a significant number of years lost due to disability and illness among children. Although the occurrence of CHDs is stable at around 1% of births, the overall disease burden is disproportionately felt in LMICs. This gap is driven by various interconnected factors: inadequate healthcare access, limited expertise, poorly equipped facilities, and financial limitations.

In nations like Ghana, these obstacles are further complicated by other public health emergencies. For example, water contamination in certain areas impacts fetal health, leading to a rise in birth defects, including CHDs. Unfortunately, the healthcare infrastructure in the country is insufficient to thoroughly tackle this increase. Even the optimal plan of setting up a center of excellence for CHD care comes with a decade-long investment timeframe, leaving countless children and families without immediate support.

#### The Issue of Delayed Diagnoses and Transportation Challenges

In LMICs, the lack of extensive screening and early interventions means that many CHD cases are identified only when the child experiences severe complications or unexpectedly dies. This situation is worsened by the concentration of specialized medical training and resources in urban areas, often far from the rural populations that make up the majority.

Take the case of Martha Naambo from Namibia. Her mother had to undertake an arduous month-long journey with her to reach an urban hospital for surgery. This separation from the rest of the family highlights not only the logistical and emotional burdens of seeking essential care but also the uneven distribution of healthcare services within these nations.

#### Financial Challenges of CHD Care

For families able to secure treatment, the financial burden can be overwhelming. In many LMICs, public health insurance is either nonexistent or covers only a small portion of the costs for specialized surgeries and extended hospital stays. To cope with this crisis, families frequently rely on community fundraising, take out loans, or exhaust their savings.

In Ghana and Namibia, this situation is further complicated by the scarcity of local expertise and facilities equipped to perform complex CHD surgeries. Consequently, many patients must travel abroad for treatment, incurring enormous expenses. The story of Ruth Ngwaro, whose family fell into long-term debt following her surgery, serves as a stark example of how the financial challenges of CHD care can burden families for an extended period.

In Pakistan, as Mr. Farhan Ahmed painfully described, even families with financial resources are not shielded from the difficulties posed by an overtaxed and underdeveloped healthcare system. His daughter’s struggle with tricuspid and pulmonary atresia illustrates the additional anguish resulting from delays in intervention, inadequate facilities, and follow-up complications like pneumonia.

#### Systemic Concerns and Workforce Issues

One of the most urgent issues facing LMICs is the “brain drain” of healthcare professionals. Many congenital heart surgeons and specialists relocate to high-income nations or better-equipped urban hospitals in search of greater salaries and improved working conditions. This trend not only deepens existing inequalities but also leads to service delivery bottlenecks, with rural areas lacking essential expertise.

#### The Significance of Technology and Data in Crafting Solutions

Despite advancements in medical technology, LMICs are lagging in utilizing innovations such as artificial intelligence (AI) and machine learning to bridge healthcare gaps. AI has the potential to transform pediatric cardiology by facilitating early CHD detection through predictive modeling and enhancing diagnostic precision. Yet, the absence of comprehensive data collection and research in LMICs keeps these tools out of reach for many communities that desperately need them.

Moreover, while high-income countries are investigating revolutionary technologies like robotic heart surgery, LMICs experience a stark contrast. The limited use of even basic imaging and diagnostic instruments in these areas underscores the widening chasm in global healthcare equity.

#### Towards a Decentralized and Fair Healthcare System

Addressing CHDs in LMICs demands both prompt action and creative strategies. Here are several actionable initiatives that could lead to substantial improvements:

1. **Decentralized Healthcare Framework**:
Enhancing the availability of primary and secondary healthcare facilities in rural locations is vital. By decentralizing care, patients in underserved communities can gain timely diagnostic and treatment services without the need for long-distance travel or additional financial burdens.