Academic Journal
The Mission-to-System Continuum: international partnerships for sustainable paediatric cardiac programme development in low- and middle-income countries.
| Τίτλος: | The Mission-to-System Continuum: international partnerships for sustainable paediatric cardiac programme development in low- and middle-income countries. |
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| Συγγραφείς: | McMahon CJ; Department of Pediatric Cardiology, Children's Health Ireland, Crumlin, Dublin 12, Ireland. cmcmahon992004@yahoo.com.; School of Medicine, University College Dublin, Belfield, Dublin, Ireland. cmcmahon992004@yahoo.com., Oketcho M; Uganda Heart Institute, Kampala, Uganda., Zheleva B; Global Strategy and Advocacy, Children's HeartLink, Minneapolis, USA., Magee A; Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Upper Maudlin St., Bristol, BS2 8BJ, UK., Shaughnessy L; Department of Paediatric Cardiology & Lifelong Congenital Heart Disease Operational Delivery Network, Guys and St. Thomas' NHS Foundation Trust, London, UK., Yao NA; The National Cardiothoracic Centre, Korle-Bu Teaching Hospital, Accra, Ghana., Little S; Department Pediatric Cardiothoracic Surgery, Bustamente Hospital, Kingston, Jamaica., Hjortal V; Department of Cardiothoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Jacobs JP; Congenital Heart Center, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, FL, USA. |
| Πηγή: | European journal of pediatrics [Eur J Pediatr] 2026 Aug 19; Vol. 185 (9). Date of Electronic Publication: 2026 Aug 19. |
| Τύπος έκδοσης: | Journal Article; Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Springer Verlag Country of Publication: Germany NLM ID: 7603873 Publication Model: Electronic Cited Medium: Internet ISSN: 1432-1076 (Electronic) Linking ISSN: 03406199 NLM ISO Abbreviation: Eur J Pediatr Subsets: MEDLINE |
| Imprint Name(s): | Publication: Berlin : Springer Verlag Original Publication: Berlin, New York, Springer-Verlag. |
| Ιατρικοί όροι (MeSH): | Heart Defects, Congenital*/surgery , Developing Countries* , International Cooperation* , Program Development*, Delivery of Health Care/organization & administration ; Humans ; Resource-Limited Settings ; Capacity Building ; Child |
| Περίληψη: | Congenital heart disease (CHD) remains a major contributor to childhood morbidity and mortality worldwide, with the greatest burden borne by low- and middle-income countries (LMICs), where access to specialised cardiac care remains severely limited. International assistance partnerships, including paediatric cardiac surgical volunteer programmes, have historically sought to address this disparity through short-term externally supported interventions. Over time, many of these partnerships have evolved beyond episodic service delivery toward models emphasising capacity building, workforce development, and health system strengthening. This narrative review examines the evolution of paediatric cardiac surgery assistance partnerships in LMICs and proposes a conceptual framework-the Mission-to-System Continuum-to characterise the evolution of partnership models from episodic external intervention toward sustainable, locally led systems of care. Contemporary partnership models are described across a spectrum ranging from short-term service delivery initiatives to training-focused collaborations, hybrid adaptive models, and partnership models supporting increasing local autonomy. Persistent barriers to sustainable programme development include workforce shortages, infrastructure limitations, funding constraints, inequitable access, delayed diagnosis, and restricted availability of specialised consumables and perioperative resources. Emerging strategies increasingly emphasise longitudinal partnerships, distributed training pathways, South-South collaboration, and hybrid engagement models aimed at strengthening multidisciplinary cardiac teams and supporting long-term programme sustainability. Conclusion: The review argues that traditional measures of success based primarily on procedural volume are insufficient to evaluate sustainable impact. Future progress will require greater emphasis on workforce development, local surgical independence, longitudinal outcomes, and integration of congenital cardiac services within national health systems. Although many paediatric cardiac programmes in LMICs have developed through alternative pathways independent of external partnerships, the Mission-to-System Continuum provides a conceptual framework for understanding the evolution of international partnership models and identifying strategic priorities for sustainable congenital cardiac care. What Is Known: • Paediatric cardiac programmes in LMICs have historically relied on short-term international surgical partnerships, although contemporary initiatives increasingly emphasise workforce development, multidisciplinary training, and health system strengthening. • Despite this shift toward capacity building and more sustainable models of care, major inequities in access to congenital cardiac care persist worldwide. What Is New: • This review introduces the Mission-to-System Continuum, a conceptual framework that integrates existing partnership models and describes how international partnerships may evolve from episodic surgical missions toward sustainable, locally led paediatric cardiac programmes with increasing local ownership, institutional capacity, and health system integration. • The framework highlights that sustainable programme development requires long-term partnerships extending beyond surgical service delivery to encompass leadership development, governance, quality improvement, research, and regional collaboration. (© 2026. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.) |
| Competing Interests: | Declarations. Competing interests: The authors declare no competing interests. |
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| Contributed Indexing: | Keywords: Capacity building; Congenital heart disease; Global surgery; Health systems strengthening; International partnerships; Low- and middle-income countries; Paediatric cardiac surgery; Workforce development |
| Entry Date(s): | Date Created: 20260819 Date Completed: 20260819 Latest Revision: 20260912 |
| Update Code: | 20260912 |
| DOI: | 10.1007/s00431-026-07347-x |
| PMID: | 42613381 |
| Βάση Δεδομένων: | MEDLINE |
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