Access to healthcare for children with CHDs in middle and low-income countries: a systematic literature review

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Abstract
CHD includes a wide range of cardiac disorders present at birth. If appropriate care is delivered in time, the prognosis is relatively good. However, in many parts of the world, access to healthcare continues to be a problem for these patients, particularly in low- and middle-income countries. The aim of this study was to synthesise and analyse the available evidence to provide a deeper understanding of this problem. The literature search identified 1578 articles, and the final selection included 57 articles. Using the patient-centred healthcare access framework for identifying facilitators and barriers, issues were found at all levels of the health provision pathway, of which diagnosis, referral systems, lack of qualified institutions/health professionals, financing, inappropriate health insurance, and quality of care stand out. More evidence is needed to analyse the effect of potential barriers linked to acceptability. Given the nature of the barriers that this population faces, solutions depend on the health system and the local context.

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