Currently a large proportion of those suffering rheumatic heart disease are not diagnosed, or are diagnosed at a late stage when damage to the heart is very severe. Rheumatic heart disease remains the leading cause of maternal cardiac complications in pregnancy. In many rheumatic heart disease-endemic countries there is little or no access to life-saving heart valve surgery. Measures to halt the progression to severe rheumatic heart disease require long-term treatments and a well-functioning health system to deliver this service.