A global policy content analysis of congenital heart disease in national health priorities.

Abstract

Survival from congenital heart disease (CHD) strongly depends on local health system capacity and lesion complexity, yet the extent to which CHD is recognised within national health policy frameworks remains poorly understood. We aimed to assess the presence, framing, and level of policy commitment to CHD within national health priority documents across countries of different income levels. We conducted a cross-sectional policy content analysis using publicly available national health strategies, child health plans, non-communicable disease strategies, and universal health coverage roadmaps. Documents were sourced from government websites and international repositories. References to CHD were classified as explicit, implicit, or absent, and policy commitment was categorised as none or actionable. Analysis was stratified by the country's World Bank income group. Among 193 UN countries and two observer states, CHD was absent from national policy documents in 109 countries, implicitly mentioned in 48 countries, and explicitly referenced in 38 countries. Overall, 44% of countries mentioned CHD in any form within their national health policies. Actionable commitments were identified in 19% of countries; of those that referenced CHD, 42% progressed to actionable measures. Countries that have explicit reference to CHD more often had actionable commitment (79%), compared with countries with implicit framing (13%). Recognition increased with income, from 19% in low-income countries to 59% in high-income countries, yet actionable commitment did not follow a clear income gradient. CHD is inconsistently represented within national health priority frameworks despite its substantial global burden. Where explicitly recognised, CHD is more likely to be accompanied by structured commitments than when implictly referenced. Strengthening policy positioning of CHD within national strategies represents a crucial step towards coordinated congenital cardiac care systems.