In 2000, the average cost of surgery for RHD in Africa was around US$5000;in low income countries of sub-Saharan Africa  with a GDP per capita of less than US$500, such as Ghana, the cost of surgery is therefore prohibitive and would also adversely affect any poverty reduction strategies.

Rheumatic and nonrheumatic valvular heart disease: epidemiology, management, and prevention in Africa.

Essop MR, Nkomo VT.

Circulation. 2005 Dec 6;112(23):3584-91. Review