1.     The size of the problem

2.     Different developing countries might have different problems, needs, and resources, that should be addressed individually

3.     There are potential differences in etiology of PH between developing and developed countries that should always be addressed epidemiologically.  Also, clinical trials done to test new drugs may exclude the typical PH patients of the developing countries. By extrapolation, PAH-specific drugs are used in these conditions, though their efficacy cannot be certain.

4.     Poor awareness about the disease and its burdens between patients, health care providers, and the authorities

5.     The weak economic power, which is present in most developing countries, is one of the main challenges in the field. In addition, the absence of the basic infrastructure and medical resources required to diagnose and treat PH patients are also issues that should be addressed.

The controversy about the ownership of PH project is another issue that may halt the whole project. In many developing countries, certain parties try to own such projects to gain power, including political, financial or medical.