Barriers to implementing cardio-obstetrics programs in sub-saharan Africa

Background

Globally, maternal mortality remains disproportionately high in Sub-Saharan Africa (SSA). While obstetric hemorrhage, hypertensive disorders of pregnancy, peripartum cardiomyopathy and infections are the leading causes of maternal mortality, undiagnosed or untreated rheumatic and congenital heart diseases pose a significant risk of maternal mortality and morbidity in young pregnant women in SSA. In addition, there are limited structured programs to provide care to women with cardiovascular diseases in pregnancy.

Purpose

Assess feasibility of implementing Cardio-Obstetric programs in SSA.

Methods

Between 2024 -2025 two teaching institutions, one in Ethiopia and one in Tanzania were selected. To ensure sustainability, a three-phase approach was undertaken.

Phase 1: Initial discussions with institutional leadership and department heads (Obstetrics, Cardiology, Anesthesiology, Pediatric Cardiology, and Nursing) secured program support, with unanimous agreement on its clinical and strategic importance.

Phase 2: A small equipment grant enabled launch of a dedicated weekly multidisciplinary clinic, supported by referral outreach within the institution and surrounding community.

Phase 3: With a functioning clinic, regular case discussions were held to formulate a patient treatment plan. Computer based patient registries and data collection were started.

Results

Several key barriers were identified during implementation of the program

1.Limited availability of Maternal–Fetal Medicine (MFM) specialists: Tanzania faces a shortage of MFM specialists; one obstetrician was sponsored for a two-year MFM fellowship to build local expertise.

2.Restricted use of epidural anesthesia for high-risk deliveries: Limited catheter supply and inadequate training constrained epidural use; targeted training and equipment procurement later strengthened anesthesia capacity and improved care quality.

3.Inconsistent International Normalized Ratio monitoring: Inconsistently available in the clinic, but this gap was later resolved, improving anticoagulation management.

4.Limited access to advanced diagnostic equipment: Dedicated echocardiography services were initially unavailable; acquiring an echocardiography unit later improved onsite diagnostic capacity.

5.Restricted access to advanced cardiac interventions: Patients needing specialized care were referred to higher-level centers, often requiring travel to distant facilities.

6.Lack of maternal cardiovascular disease registries: Local data collection to influence national maternal health policy was encouraged.

Conclusion

Both programs remain operational with steady gains in service delivery, capacity building, and patient outcomes. Although resource limitations in SSA constrain Cardio-Obstetric program growth, coordinated strategies, mentorship, and targeted support can overcome many barriers while generated data can guide health-system planning.