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World J Pediatr Congenit Heart Surg. 2019 May;10(3):321-327. doi: 10.1177/2150135119837201.

Workforce Cost Model for Expanding Congenital and Rheumatic Heart Disease Services in Kenya.

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1 Harvard Medical School, Boston, MA, USA.
2 Division of Pediatric Cardiology, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
3 Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.



Cardiovascular disease is the number one global killer, with over three quarters of these deaths arising from the populations of low- and middle-income countries (LMICs). Addressing the burden of cardiovascular disease in LMICs must include medical and surgical services for these patients. In this article, we model the needs and costs to scale up the cardiac provider workforce in Kenya, which can be adapted to other LMICs based on country-specific workforce hours and workforce salaries.


Using published epidemiological reports from sub-Saharan Africa, we structured the model based on the expected disease burden of congenital and rheumatic disease in a simulated 1,000-person population. Services modeled include clinic visits, echocardiograms, diagnostic cardiac catheterizations, interventional catheterizations, and heart surgery. Costs were modeled based on Kenyan public sector salaries. After scaling the model, we created a sensitivity analysis of change in service duration and salaries.


Based on a 1,000-person Kenyan population, we estimate that 2.5 heart surgeries will be needed every year, with a corresponding annual workforce cost of US$526. Including accompanying services of clinic visits, echocardiograms, and both diagnostic and interventional cardiac catheterizations, the total annual workforce cost is US$899. Based on estimated productive hours for public sector workforce, 196 full-time equivalent cardiac surgeons will be needed for the entire population of Kenya (2017 figure).


We present a model for appropriate cardiovascular service staffing based on disease burden and workforce costs. This model can be scaled up as needed to plan for local capacity building.


congenital heart disease; international; modeling; nursing; rheumatic heart disease; surgery


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