Abstract
Pediatric congenital and acquired heart diseases contribute substantially to morbidity and mortality in low- and middle-income countries (LMICs), including Ethiopia, where access to pediatric cardiac services remains limited. Constrained infrastructure and financing, workforce shortages, fragmented referral systems, and limited longitudinal follow-up delay diagnosis and treatment and worsen inequities. Comorbid infection and malnutrition further complicate care delivery and outcomes.
We propose a tiered framework for integrating pediatric cardiac services into Ethiopia’s primary healthcare system. The model prioritizes early recognition, decentralized diagnostic capacity, structured referral pathways, telemedicine-supported specialist consultation, and continuity of long-term follow-up. Integration across primary, secondary, and tertiary levels can strengthen workforce capacity, enable task sharing, support quality improvement, and improve equitable access to care.
We also describe Ethiopia’s Pediatric Heart Initiative, a locally led implementation model that trains general pediatricians in basic echocardiography and provides ongoing virtual mentorship to expand regional pediatric cardiac capacity. This framework may offer a scalable approach for improving pediatric cardiovascular care in Ethiopia and other LMICs with similar health system constraints.
Keywords
Pediatric cardiac disease, Congenital heart disease, Health equity, Health system integration, Low- and middle-Income Countries (LMICs)