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Africa is witnessing a rapid epidemiological transition with the emergence of non-communicable diseases (NCDs). Indeed, Mensah and colleagues have shown that in sub-Saharan Africa (SSA), there has been a rise in cardiovascular disease (CVD) mortality since 1990, mainly due to population growth and an increase in the proportion of people older than 65 years.1 Despite the increasing prevalence of CVD in developing countries including SSA, many patients in these countries do not have access to treatment modalities like pacemakers and implantable cardioverter defibrillators (ICDs) that are associated with substantial reduction in morbidity and mortality due to CVD in industrialised nations. For example, in a 2009 global review of pacemaker implantation in 61 countries, there was a large gap between the developed and developing nations in the number of implants; for example, there were 782 implants per million people in France compared with four implants per million in Pakistan.2 Although the statistics on pacemaker implantation rates are not readily available in most SSA countries, cardiac pacemaker use remains dismally low at <10 implants per million population (with the exception of South Africa with 39 per million population, most for those with private health insurance).3 This disparity is believed to be due to the high cost of new cardiac devices. The price of the pacemaker generator without accessories is between US$2500 and US$3000, while that of the leads is US$800–1000. An ICD generator price is between US$20 000 and US$40 000 and leads cost over US$10 000. These costs exceed the yearly earnings of the average citizen in most lower-income and middle-income countries (LMICs).4
Every year, one million people die due to lack of access to pacemaker treatment.5 Apart from premature deaths, the non-availability of pacemaker treatment also adversely affects the individual’s quality of life due to poor physical performance, persistent tiredness and …