Brave Hearts Children's Initiative: A Motivational Strategy to Scale Up Pediatric Cardiac Surgery in Uganda

Abstract

Congenital heart disease (CHD) is the leading cause of pediatric heart disease in Africa. In Uganda, approximately 16,000 infants are born annually with CHD, yet only a small proportion access timely surgery due to financial constraints and a shortage of pediatric cardiology and surgical expertise. Amid prolonged surgical waiting lists and ongoing efforts to expand local capacity, we introduced a morale-strengthening strategy focused on celebrating incremental surgical milestones to enhance motivation, ownership, and continuous quality improvement.The Brave Hearts Children's Initiative was launched on December 7, 2023, at the Uganda Heart Institute under the theme "Little Hearts, Big Courage." Initially conceived as a children's Christmas event, it evolved into a structured platform for advocacy, family support, and fundraising. The initiative highlights annual achievements in pediatric cardiac surgery and brings together families, clinicians, and key stakeholders, including government, academic institutions, and international partners.A key system change involved shifting surgical listing and patient selection from the surgical team to the cardiology team, improving coordination and reducing delays. This restructuring, alongside increased government and partner support, was associated with improved surgical output.Following the second Brave Hearts Children's event, surgical volume rose to 8 to 12 open-heart and approximately 8 closed-heart procedures per month. The waiting list is now systematically managed, team engagement has improved, and families report better psychosocial support.Celebrating milestones beyond statistics can strengthen team cohesion, build stakeholder trust, and support sustainable growth of pediatric cardiac services in resource-limited settings.