Concepts for Regional Referral Cardiac Centers in Sub-Saharan Africa

 

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Objectives: The concept of visiting heart teams (VHTs) to develop a cardiac program with local resources over the past 50 years has saved many lives but has not contributed to a sustainable infrastructure development. Some regions currently have no substitute for VHTs. Easily treatable congenital (CHD) and rheumatic heart diseases (RHD) become chronic conditions in adulthood and, together with coronary artery disease, lead to disability. Reliable data for effective concepts to develop sustainable programs are lacking.

Methods: The challenges facing cardiac surgery (CS) in sub-Saharan Africa (SSA) were defined: prevalence of congenital heart disease (CHD), surgical load for CHD, RHD and coronary artery disease (CAD), mitral valve repair (MVR), density of pediatric cardiologists and cardiothoracic surgeons (CTSs), performance of local and visiting teams, costs of CS related to the gross domestic product (GDP) and health expenditure per capita, over $1bn billion capital flight in medical tourism, projections of open heart surgery (OHS) based on 400 OHSs per 10 million people in West Africa (WHO recommendation: 400 OHS/1 million people). The GDP and health expenditure per capita of the countries were retrieved from the World Bank report and used to calculate the financial strength of the five sub-regions of SSA.

Results: Over three million children in SSA have CHD needing an operation. Although in comparison to the late 70s the volume of CHD operations has increased from 30% to 64%, only 2% of the pediatric patients have access to treatment. Rheumatic valve surgery has decreased from 50% to 24% and coronary artery bypass surgery is on the rise with 5%. MVR constitutes 10% of the mitral valve procedures. 32 indigenous CTSs perform 46% of the operations. In some regions the visiting teams account for 70–100%. The costs of OHSs range between $7,500 and $11,200. The costs are very high in relation to the GDP (1,631 - 4,309 $) and health expenditure per capita (49 - 236 $) of the communities.

Conclusion: Under strong leadership, the concept of a high standard regional heart centers married with international institutional cooperation, social health insurance systems and political collaboration might help to ensure more patients' access to affordable and efficient cardiovascular healthcare in SSA. The strategy would build trust among the local community and discourage medical tourism and reduce the ensuing capital flight; reduce morbidity, disability and mortality.