Abstract
In many low-income and middle-income countries, access to specialised surgical care is limited by infrastructure gaps, workforce shortages and weak financing, leading to unmet needs and cross-border inequities. The African Network of Medical Excellence (ANME) was created as a public–non-government organisation partnership to strengthen national health systems through specialised centres of excellence providing free, high-quality care. This paper outlines the design, implementation and outcomes of the ANME Regional Programme (RP), a coordinated cross-border referral system.
The RP operates through formal agreements with Ministries of Health, structured referral pathways, specialist outreach missions, and full coverage of patient travel, accommodation, surgery, follow-up and essential medicines. Two ANME hospitals—the Salam Centre for Cardiac Surgery in Sudan and the Children’s Surgical Hospital in Uganda—serve as regional hubs. By December 2024, 190 screening and follow-up missions had reached over 16 000 patients across 28 countries, with 2024 receiving specialised surgical care.
Outcomes confirm the feasibility and safety of this model. At the Salam Centre, early postoperative mortality among RP-referred patients was lower than that of host-country patients (1.8% vs 2.9%), reflecting effective case selection and continuity of care. At the Children’s Surgical Hospital in Uganda, early implementation of the paediatric RP addressed major unmet needs for complex congenital conditions, with no postoperative deaths reported.
The ANME regional programme demonstrates how a not-for-profit, government-supported referral system can expand equitable access to specialised care, strengthen local capacity and support sustainable, rights-based health system development. Its approach offers transferable lessons for regional collaboration in other resource-limited settings.
Keywords: Africa South of the Sahara, Child health, Surgery, Cardiovascular disease, Health policy
WHAT IS ALREADY KNOWN ON THIS TOPIC
Access to specialised surgical care in sub-Saharan Africa is severely limited due to fragile health systems, inadequate infrastructure and workforce capacity, weak referral networks and limited funding, often resulting in financially catastrophic out-of-pocket payments for patients and their families. Existing international or non-government organisation (NGO)-led interventions have frequently relied on short-term missions or parallel service delivery models, which have struggled to generate sustainable, system-wide improvements.
WHAT THIS STUDY ADDS
This study describes the design and implementation of the African Network of Medical Excellence Regional Programme, a government-endorsed regional referral system operating through two NGO-led specialised surgical centres—the Salam Centre for Cardiac Surgery in Khartoum, Sudan and the Children’s Surgical Hospital in Entebbe, Uganda. It shows that high-quality specialised surgery can be delivered safely, equitably and free of charge across borders in sub-Saharan Africa through long-term NGO–government partnerships.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
These findings suggest that regional collaboration and public–NGO partnerships can serve as effective strategies for expanding equitable access to specialised surgical care while strengthening workforce capacity and regional health systems.
Introduction
Surgical and anaesthesia care are essential components of comprehensive and equitable health systems. However, in many low-income and middle-income countries (LMICs), access to safe, timely and affordable surgery remains severely limited,1 particularly for highly specialised and technologically demanding procedures. In sub-Saharan Africa (SSA), universal health coverage remains a distant goal: most people lack access to specialised care owing to limited health infrastructure, workforce shortages, long travel distances and catastrophic out-of-pocket expenditures.2,10
Public surgical hospitals, with few notable exceptions,11 are scarce and frequently constrained by organisational inefficiencies and unpredictable financing. These limitations translate into low case volumes, high operating costs and reduced training capacity.12 Inadequate risk-pooling mechanisms further contribute to delayed treatment, impoverishment and avoidable disability from otherwise treatable conditions.13 As a result, a vicious cycle persists, whereby major surgical diseases—including cancers, congenital anomalies and cardiac conditions—remain untreated, contributing substantially to morbidity, mortality and economic loss.14 15
International aid and non-governmental organisations (NGOs) have long sought to address these gaps. However, short-term interventions or parallel service delivery models often fail to generate durable, system-wide improvements. Sustainable interventions—including those led by NGOs—must be embedded within public health systems, strengthen local capacity and expand access to high-quality surgical care provided free of charge as a cornerstone of health equity.16 Ultimately, full ownership of such initiatives should be transferred to national authorities.
This report examines one such sustainable approach: the African Network of Medical Excellence (ANME). Initiated by EMERGENCY, an Italy-based international NGO, ANME was established in collaboration with the governments of selected African countries. Drawing on the experience of two ANME hospitals in Sudan and Uganda, we illustrate how an ad hoc ANME Regional Programme (RP) can leverage cross-border collaboration to foster sustained improvements in specialised surgical care. We describe how the RP operates within the ANME framework and provide a comparative evaluation of the clinical characteristics and outcomes of RP-referred patients vs those treated in the host countries.
African Network of Medical Excellence
EMERGENCY operates several healthcare programmes in selected African countries and other LMICs, with a primary focus on surgical care. This analysis focuses on two specialised hospitals established and run in partnership with national governments: the Salam Centre for Cardiac Surgery (Salam Centre) in Khartoum, Sudan, and the Children’s Surgical Hospital (CSH) in Entebbe, Uganda. Opened in 2007 and 2021, respectively, both facilities provide comprehensive care, free of charge, including preoperative assessment, surgery, postoperative management and long-term follow-up.
The Salam Centre initially treated ischaemic, rheumatic and congenital heart diseases and now focuses primarily on rheumatic and congenital heart disease, which remain highly prevalent in the region. As of December 2024, a total of 10 769 open-heart procedures had been performed on 10 149 patients.
The CSH specialises in the surgical care of children with congenital anomalies and sequelae of acute conditions, particularly post-burn contractures. Minor procedures are also performed and, where appropriate, contribute to surgical training under supervision. Between April 2021 and December 2024, 5059 operations were performed on 3866 paediatric patients.
These two hospitals represent the first centres established within the ANME network, which was founded in 2008 in Venice (Italy) in collaboration with the health authorities of selected African countries. The initiative aims to develop specialised centres of excellence that guarantee the right to free, high-quality healthcare. Its conceptual foundation is the Manifesto for Human Rights-Based Medicine,17 which rests on three core principles: equality (equal access to care), quality (clinical excellence) and social responsibility (health as a public priority).
In February 2023, the sixth ANME meeting was held in Khartoum,17 bringing together representatives from the health authorities of 15 African countries (Burundi, Central African Republic, Chad, Democratic Republic of Congo, Djibouti, Egypt, Eritrea, Ethiopia, Niger, Nigeria, Somalia, South Sudan, Sudan, Uganda and Zimbabwe). The meeting culminated in the Khartoum Declaration 2023, unanimously endorsed by all participating delegations. While EMERGENCY retains operational responsibility, host governments contribute to financing and governance. Prior to the 2023 conflict, Sudan covered a substantial proportion of the Salam Centre’s running costs (51% in 2022); Uganda currently covers approximately 57% of the operating costs of the CSH.
ANME hospitals also function as hubs for training and knowledge transfer, enabling African clinicians and healthcare professionals to gain experience in managing region-specific disease burdens within a resource-appropriate environment. Training partnerships include Sudanese Medical Specialisation Board, the College of Surgeons of East, Central and Southern Africa and several Italian universities and local hospitals.
The African Network of Medical Excellence Regional Programme
The ANME RP operates under the Memoranda of Understanding with the Ministries of Health of participating countries. EMERGENCY works in close coordination with designated focal points at referring hospitals. The RP facilitates cross-border access to specialised surgical care. Approximately 20% of hospital admissions are reserved for foreign patients, who receive the same comprehensive services as host-country nationals, free of charge, from diagnostic evaluation to postoperative follow-up and medication provision. Patients are referred either through organised outreach missions or, less frequently, through self-presentation from neighbouring countries. The RP conducts at least one specialist mission per participating country each year to identify new surgical candidates and to follow-up on previously treated patients.
During screening visits, patients are placed on a priority-based waiting list and receive preoperative counselling covering the surgical procedure, postoperative care, lifestyle modifications and anticipated improvements in quality of life. In many African settings, adult patients make healthcare decisions collectively with their families, often requiring multiple counselling sessions. Consultations are always conducted in the patient’s preferred language, with support from local healthcare personnel as needed.
Once patients are placed on the active surgical list, the local focal point initiates the process of securing travel documentation. In rural areas, the absence of formal identification frequently causes delays or prevents travel altogether and remains a major barrier to care. When documents are ready, the RP handles flight bookings and visa applications, with the support of partner governments that facilitate visa issuance for patients and accompanying guardians as part of the collaboration framework. All travel and hospital care costs are fully covered by EMERGENCY.
Upon arrival at the ANME facility, patients and accompanying caregivers are accommodated free of charge in the 40-bed guest house. Additional counselling is provided prior to discharge, and patients receive sufficient medication to cover the period until their next scheduled follow-up or delivery.
Screening, follow-up and prescription data are entered into the hospital’s electronic medical record system in real time, ensuring continuity of care. These data allow the RP to coordinate long-term medication provision, including anticoagulants. For patients treated at the CSH, medication supply is organised through a dedicated pharmacy hub based at the CSH, with export procedures facilitated by the Ugandan National Drug Authority. Individualised 8-month medication packages are dispatched two times per year to buffer against customs delays or temporary disruptions in access. All medications are provided free of charge and, under Memorandum of Understanding agreements, are exempt from import taxes.
Clinical outcomes
This observational data review was approved by the Independent Review Board of Emergency ONG (n.5/2025, April 2025). Clinical data were extracted from electronic medical records, pseudonymised and analysed using standard statistical methods.
Categorical variables are reported as frequency and proportion, and continuous variables as median with first and third quartiles (Q1 and Q3) and mean with SD. Group comparisons were performed using χ² tests with Yates correction and the Mann–Whitney U test with Holm adjustment for multiple comparisons. Early mortality was defined as in-hospital death or death within 30 days of surgery. All consecutive RP-referred patients who underwent surgery at either hospital were included and compared with host-country patients treated during the same period.
From programme inception to December 2024, the RP conducted 190 missions, performed 15 983 cardiological screenings and 496 paediatric evaluations and referred 2024 patients from 28 countries for surgery: 1867 at the Salam Centre (92.2%) and 157 at the CSH (7.8%) (figure 1).
Figure 1. Left panel: the regional programme of the Salam Centre for Cardiac Surgery in Khartoum (2007-2022). The red dots indicate the number of patients from countries different from Sudan who underwent open heart surgery. Right panel: the regional programme of the Children’s Surgical Hospital in Entebbe (2023–2024). The blue dots indicate the number of patients from countries different from Uganda who underwent paediatric surgery.
Salam Centre for Cardiac Surgery
At the Salam Centre, the analysis includes patients undergoing surgery for valvular or congenital heart disease between 2007 and 2022, when conflict in Sudan interrupted regional referrals and reduced surgical activity. Since then, the RP has prioritised follow-up care for previously treated patients. Among the 9393 patients who underwent open-heart surgery during this period,18,20 1867 (19.9%) were referred by the RP. Rheumatic valve disease was the predominant diagnosis (85.1%). Compared with Sudanese patients, the RP cohort showed a higher proportion of congenital heart disease cases (22.7% vs 13.0%; p<0.001), were younger (median, 18 (IQR 11–29) vs 22 (IQR 14–34) years; p<0.001), a result driven not only by the higher number of children (37.1% vs 26.6%; p<0.001) but also by the low median age of adults (median, 26 (IQR 19–36) vs 28 (IQR 20–38); p<0.001). RP patients also underwent fewer urgent procedures (5.4% vs 8.2%; p<0.001) and fewer reoperations (3.5% vs 5.6%; p<0.001) (table 1).
Table 1. Baseline demographics, surgical characteristics and postoperative outcomes in 9393 patients operated at the Salam Centre (2007–2022).
| Total | Sudan | Regional programme | |||||||
|---|---|---|---|---|---|---|---|---|---|
| VHD | CHD | Total | VHD | CHD | Total | ||||
| Total | n (row %) | 9393 (100.0) | 6549 (87.0)* | 977 (13.0)* | 7526 (80.1) | 1443 (77.3)* | 424 (22.7)* | 1867 (19.9) | |
| Sex | Female | n (column %) | 5070 (54.0) | 3561 (54.4)† | 457 (46.8) | 4018 (53.4)† | 829 (57.4)† | 223 (52.6) | 1052 (56.3)† |
| Male | n (column %) | 4323 (46.0) | 2988 (45.6)† | 520 (53.2) | 3508 (46.6)† | 614 (42.6)† | 201 (47.4) | 815 (43.7)† | |
| Age, years | Total | mean (SD) | 23.7 (13.2) | 26.4 (12.6) | 11.4 (9.4) | 24.4 (13.2) | 24.0 (11.6) | 10.6 (9.6) | 20.9 (12.5) |
| median (Q1, Q3) | 21 (14, 33) | 25 (16, 35)* | 9 (5, 15) | 22 (14, 34)* | 21 (14, 33)* | 7 (4, 14) | 18 (11, 29)* | ||
| ≤14 | n (column %) | 2691 (28.6) | 1287 (19.7)* | 712 (72.9) | 1999 (26.6)* | 370 (25.6)* | 322 (75.9) | 692 (37.1)* | |
| mean (SD) | 9.4 (3.7) | 11.2 (2.4) | 6.8 (3.8) | 9.6 (3.6) | 11.2 (2.4) | 6.1 (3.6) | 8.8 (3.9) | ||
| median (Q1, Q3) | 10 (7, 13) | 12 (10, 13) | 7 (4, 10) | 10 (7, 13)* | 12 (10, 13) | 6 (3, 9) | 10 (6, 12)* | ||
| >14 | n (column %) | 6702 (71.4) | 5262 (80.3)* | 265 (27.1) | 5527 (73.4)* | 1073 (74.4)* | 102 (24.1) | 1175 (62.9)* | |
| mean (SD) | 29.5 (11.0) | 30.1 (11.2) | 23.8 (8.6) | 29.8 (11.2) | 28.4 (10.2) | 24.7 (9.0) | 28.1 (10.2) | ||
| median (Q1, Q3) | 28 (20, 37) | 28 (20, 38)* | 21 (17, 27) | 28 (20, 38)* | 27 (20, 36)* | 21 (18, 28) | 26 (19, 36)* | ||
| BMI | ≤14 | mean (SD) | 13.6 (2.1) | 13.3 (2.1) | 13.6 (2.2) | 13.4 (2.1) | 14.0 (2.3) | 14.1 (2.0) | 14.1 (2.1) |
| median (Q1, Q3) | 13 (12, 15) | 13 (12, 14)* | 13 (12, 15)* | 13 (12, 14)* | 14 (13, 15)* | 14 (13, 15)* | 14 (13, 15)* | ||
| >14 | mean (SD) | 18.9 (22.9) | 19.0 (25.8) | 17.6 (4.4) | 19.0 (25.2) | 18.7 (3.8) | 18.8 (3.3) | 18.7 (3.7) | |
| median (Q1, Q3) | 18.0 (16, 21) | 18 (16, 21) | 17 (15, 19)‡ | 18 (16, 21) | 18 (16, 21) | 18 (16, 21)‡ | 18 (16, 21) | ||
| Acuity§ | Elective | n (column %) | 8640 (92.4) | 5948 (91.0)‡ | 937 (97.2) | 6.885 (91.8)* | 1344 (93.4)‡ | 411 (98.8) | 1755 (94.6)* |
| Urgent | n (column %) | 713 (7.6) | 586 (9.0)‡ | 27 (2.8) | 613 (8.2)* | 95 (6.6)‡ | 5 (1.2) | 100 (5.4)* | |
| Redo | Number | n (column %) | 485 (5.2) | 388 (5.9)* | 32 (3.3) | 420 (5.6)* | 45 (3.1)* | 20 (4.7) | 65 (3.5)* |
| Timing (months)¶ | mean (SD) | 29.3 (36.6) | 29.8 (35.5) | 17.2 (34.1) | 28.8 (35.5) | 42.7 (45.8) | 10.7 (24.4) | 32.8 (42.9) | |
| median (Q1, Q3) | 14 (2, 43) | 16 (3, 44) | 2 (0, 17) | 14 (2, 42) | 21 (2, 80) | 0 (0, 9) | 12 (1, 56) | ||
| Early mortality** | Deaths | n (column %) | 250 (2.7) | 187 (2.9)‡ | 30 (3.1) | 217 (2.9)‡ | 20 (1.4)‡ | 13 (3.1) | 33 (1.8)‡ |
p-adjusted < 0.001
p-adjusted < 0.05
p-adjusted < 0.01
40 patients are missing body mass index values
Timing is considered the time elapsed from first operation to re-operation.
Early mortality defined as in-hospital or within 30 days after surgery.
The overall early mortality rate was 2.7% (95% CI 2.36 to 3.01); it was higher among Sudanese patients (2.9%, 95% CI 2.53 to 3.29) than among RP patients (1.8%; 95% CI 1.26 to 2.47; p=0.009). This difference was significant only in the subgroup of patients with valvular heart disease (2.9 vs 1.4%, p=0.002).
Children’s Surgical Hospital
At the CSH, a descriptive analysis was conducted for RP patients treated between January 2023 and December 2024, corresponding to the initial phase of the paediatric RP. During this period, 157 RP patients underwent surgery, accounting for 7.7% of the total CSH caseload. Major procedures were more frequent among RP patients (84.1% vs 52.6%), with urogenital anomalies representing the most common diagnosis (56.7%), followed by gastrointestinal malformations (21.0%). No postoperative deaths occurred in the RP cohort (table 2).
Table 2. Baseline demographics and surgical characteristics in 2040 patients operated at Children’s Surgical Hospital (2023–2024).
| Total | Uganda | Regional programme | ||||
|---|---|---|---|---|---|---|
| Total operated patients | n (row %) | 2040 (100.0) | 1883 (92.3) | 157 (7.7) | ||
| Sex | Female | n (column %) | 531 (26.0) | 487 (25.9) | 44 (28.0) | |
| Male | n (column %) | 1504 (74.0) | 1391 (73.9) | 113 (72.0) | ||
| Age | mean (SD) | 5.6 (5.0) | 5.6 (5.0) | 5.5 (4.6) | ||
| median (Q1, Q3) | 4.0 (1.0, 9.0) | 4.0 (1.0, 9.0) | 4.0 (2.0, 8.0) | |||
| BMI | mean (SD) | 16.1 (3.1) | 16.2 (3.1) | 15.4 (2.8) | ||
| median (Q1, Q3) | 15.5 (14.4, 17.2) | 15.6 (14.4, 17.3) | 15.0 (13.9, 16.7) | |||
| Treated conditions | Head and neck | n (column %) | 91 (4.5) | 75 (4.0) | 16 (10.2) | |
| Cleft lip and/or palate | n | 26 | 10 | 16 | ||
| Others | n | 65 | 65 | 0 | ||
| Gastrointestinal | n (column %) | 267 (13.1) | 234 (12.4) | 33 (21.0) | ||
| Anorectal malformations | n | 147 | 128 | 19 | ||
| Hirschsprung disease | n | 66 | 54 | 12 | ||
| Others | n | 54 | 52 | 2 | ||
| Hepatobiliary system, pancreas, spleen | n (column %) | 9 (0.4) | 8 (0.4) | 1 (0.6) | ||
| Kidney and urinary tract | n (column %) | 314 (15.4) | 239 (12.7) | 75 (47.8) | ||
| Hypospadias | n | 180 | 118 | 62 | ||
| Posterior urethral valves | n | 45 | 43 | 2 | ||
| Others | n | 89 | 78 | 11 | ||
| Genitals | n (column %) | 588 (28.8) | 574 (30.5) | 14 (8.9) | ||
| Undescended testis | n | 247 | 239 | 8 | ||
| Others | n | 341 | 335 | 6 | ||
| Hernia | n (column %) | 599 (29.4) | 595 (31.6) | 4 (2.5) | ||
| Post-burn contractures | n (column %) | 73 (3.6) | 56 (3.0) | 17 (10.8) | ||
| Other | n (column %) | 482 (23.6) | 456 (24.2) | 26 (16.6) | ||
| Lymphatic system | n | 34 | 34 | 0 | ||
| Cyst, sinuses and fistulas | n | 63 | 63 | 0 | ||
| Others | n | 385 | 359 | 26 | ||
| Patients with multiple conditions treated | n (column %) | 323 (15.8) | 312 (16.6) | 11 (7.0) | ||
| Surgery type | Minor surgery | n (column %) | 917 (45.0) | 892 (47.4) | 25 (15.9) | |
| Major surgery | n (column %) | 1123 (55.0) | 991 (52.6) | 132 (84.1) | ||
| Number of operations | 1 surgery | n (column %) | 1686 (82.6) | 1601 (85.0) | 85 (54.1) | |
| ≥2 surgeries | n (column %) | 354 (17.4) | 282 (15.0) | 72 (45.9) | ||
Comments and considerations
Although limited in scale, the long-standing experience of the Salam Centre’s RP and the early results from the CSH-RP confirm the positive outcomes associated with the ANME RP. The data indicate that RP patients—despite the inherent challenges associated with travelling abroad for care—are appropriately selected: they require surgical intervention but are generally not in an immediately critical condition. Using early mortality as a key indicator of case selection and surgical quality,21 outcomes were comparable for patients with congenital heart disease and significantly better for the rheumatic valvular heart disease cohort among RP patients compared with host-country patients. The slightly better short-term outcomes observed in the RP group appear to be related to the lower proportion of urgent procedures (p<0.001), previously identified as a major risk factor for mortality.20
Early mortality, defined as any death occurring after surgery, either in hospital or within 30 days postoperatively,21 remains the most widely reported quality indicator for rheumatic heart disease-related valvular surgery in African case series, enabling meaningful comparisons across studies. In the RP cohort, early mortality following single or multiple valve operations was 1.4% (95%CI 0.90 to 2.13), compared with 2.9% (95%CI 2.48 to 3.26) in the Sudanese cohort. These outcomes compare favourably with two recent systematic reviews and meta-analyses reporting median early postoperative mortality rates across Africa of 4.6% (95% CI 3.48 to 6.03)22 and 6.35% (IQR 4.9%–13.3).23 24 Several factors likely contribute to this difference, including a stable hospital environment, an efficient intensive care unit and the high surgical volumes achieved at the Salam Centre for Cardiac Surgery.
The experience of the CSH in Uganda, although still at an early stage, further supports the feasibility and relevance of the ANME model. The case mix—dominated by congenital malformations of the urogenital and gastrointestinal tracts—reflects the substantial burden of treatable paediatric surgical conditions across the continent. Strengthening referral pathways from paediatricians and general surgeons remains essential, particularly in settings where the specialised expertise required to manage congenital malformations is limited or unaffordable. Early outcomes suggest that complex surgical procedures, together with effective postoperative care, can be successfully delivered within a not-for-profit, regional health system, provided that robust clinical governance, specialised training, and sustained institutional support are in place.
Despite these achievements, progress to date remains modest relative to the magnitude of healthcare needs across Africa. Nevertheless, we propose ANME as a distinctive and innovative model for supporting the development of sustainable health systems in LMICs. A well-managed, not-for-profit hospital, supported by government engagement and strengthened through collaboration between international and local professionals, including physicians, nurses, pharmacists, technicians, biomedical engineers, administrators and logisticians, and operating under the leadership of a dedicated management team aligned with the NGO’s central coordination may serve as a powerful catalyst for systemic change.
Conclusion
ANME centres are expected to serve purposes beyond providing medical care—they are designed to foster connections between African nations by encouraging knowledge sharing, healthcare worker mobility and potentially supporting broader development in health, pharmaceuticals and related fields. By facilitating contacts between governments and communities, they play an important part in advancing ‘health diplomacy’.
The recognition as centres of excellence addresses three main dimensions: delivering excellent clinical care, building the skills of healthcare professionals and making scientific contributions to medicine.
A steadfast dedication to quality patient care is the cornerstone of any ANME hospital; without this, the goals of professional capacity-building and scientific advancement cannot be achieved. Looking ahead, the project’s success depends on how appealing it is to African doctors and healthcare workers, as well as its ability to provide tailored, practical postgraduate education that meets the population’s evolving needs. The third dimension—research—drives progress by testing, understanding and improving practices over time. Being effective clinicians and educators relies on a commitment to ongoing research.
Effective management serves as a mandatory condition for ANME hospitals, ensuring continuous, accessible and affordable care and extending the scope of action beyond national borders.
These combined activities should reinforce the role of these centres as regional leaders, with also other countries looking to them as training grounds for their healthcare workforce.
Despite its ambitious, arguably utopian, vision, the experience in Sudan and Uganda demonstrates that high-quality specialised care, delivered free of charge and inclusive of foreign patients, can be sustainably achieved when supported by long-term governmental commitment. Through the RP, access to care is determined by clinical need rather than nationality or income.
Publicly accessible referral hospitals that provide free care and are open to patients from neighbouring countries embody the core values of ANME: equality, quality and social responsibility. The Salam Centre for Cardiac Surgery and the CSH represent the first concrete realisations of this model.
Acknowledgements
The authors acknowledge all African and international collaborators and donors who provided essential financial support to the regional programme. The authors wish to thank Dr John Omagino, Chief Executive Officer of the Uganda Heart Institute; Mr Ato Hiuy Ali, Chief Executive Officer of the Children’s Heart Fund of Ethiopia Cardiac Center; Dr Tewelde Yohannes, Director of Orotta Referral National Hospital, Eritrea; and Dr Thuou Loi from the Ministry of Health of South Sudan for their institutional support and collaboration within the ANME Regional Programme. The authors are also grateful to Dr Lubega Sulaiman, paediatric cardiologist at the Uganda Heart Institute, and Ms Kitooleko Samalie, Senior Nursing Officer at the Uganda Heart Institute, for their essential role as national focal points, their continuous coordination, and their commitment to patient referral and follow-up activities. They also acknowledge the graphical contributions of Marta Mascolo and thank Cristiana Ravizza for secretarial support.
Footnotes
Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Handling editor: Walter D Johnson
Patient consent for publication: Not applicable.
Ethics approval: This study involves human participants and was approved by the Independent Review Board of Emergency ONG (n.5/2025, April 2025). Retrospective observational outcome study with waived consent form from IRB.
Provenance and peer review: Not commissioned; externally peer reviewed.
Map disclaimer: The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.
Author note: This report is dedicated to Gino Strada,25 surgeon and founder of the NGO EMERGENCY, who was a strong advocate for the establishment of these hospitals in Sudan and Uganda within the framework of the AMNE project. He often stated, “Utopia is just a place we haven’t been yet”.
Data availability statement
Data are available upon reasonable request to the corresponding author.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data are available upon reasonable request to the corresponding author.