May 22, 2025
Children’s HeartLink is proud to share a new paper authored by Bistra Zheleva, vice president of global strategy and advocacy at Children’s HeartLink. Her article, published in the Indian Journal of Thoracic and Cardiovascular Surgery, addresses one of the most urgent issues in global health today: the inequities in access to care for children with congenital and pediatric heart disease.
In many parts of the world, children born with heart defects face tremendous barriers to diagnosis, treatment and long-term care. These challenges are not caused by a single factor but rather by a complex combination of systemic issues. As Bistra writes, “Financial constraints and inertia in the health system often feed into each other, creating a vicious cycle.”
Bistra’s paper takes a comprehensive look at the root causes of these disparities, including underinvestment in health systems, a shortage of trained specialists, lack of public awareness and inadequate policies that fail to prioritize pediatric cardiac care.
Despite these challenges, addressing inequities in pediatric and congenital heart care starts with closing the financing gap and requires national strategies that combine domestic investment, international partnerships, workforce development and political advocacy.
Additionally, sustainable progress depends on building local expertise and infrastructure while tackling both financial and systemic barriers to care.
The article highlights examples of success — many rooted in the ongoing work of Children’s HeartLink — proof that change is possible with the right approach:
- In Vietnam, long-term partnerships and investment in workforce development helped Nhi Dong 1 Hospital become a Children’s HeartLink Center of Excellence, reducing wait times for heart surgeries and expanding access to care for children across the country.
- Framing congenital heart disease as a public health priority is essential to achieving global health goals like reducing childhood mortality and expanding universal health coverage. Examples such as Argentina’s Programa Sumar and India’s Hridyam project show how national planning, early screening and organized referral systems can significantly improve outcomes for children with heart disease.
- Through global advocacy, including efforts at the World Congress of Pediatric Cardiology and Cardiac Surgery, and the formation of the Global Coalition for Pediatric and Congenital Hearts, Children’s HeartLink has helped put congenital heart disease on the map for policymakers and donors alike.
The paper calls for national and subnational planning based on population health needs, rather than donor-driven or hospital-based efforts alone. It makes the case that equitable access can only be achieved when governments, health systems and civil societies work together to prioritize and fund care for children with heart disease.
This work underscores the critical role Children’s HeartLink plays — not only in strengthening care delivery through partnerships and training — but also in driving advocacy that moves systems toward equity.
“The most important step in addressing inequities in pediatric and congenital heart care,” Bistra concludes, “is the one that will be taken today.”
We’re honored to have Bistra’s voice shaping the conversation — and we invite you to join us in this movement for change.
Reach out: Email Bistra
Read the paper: https://link.springer.com/article/10.1007/s12055-025-01916-9
