This review explores how to build critical care capacity in low-income countries (LICs) using a health systems framework based on six World Health Organization (WHO) “building blocks”: service delivery, workforce, information systems, medicines and equipment, financing, and governance. LICs bear a disproportionately high burden of critical illness but have limited access to emergency and critical care due to systemic challenges such as workforce shortages, limited infrastructure, and inadequate funding.

The paper highlights the need for context-sensitive approaches, noting that simply importing high-income country models may not be sustainable or effective. Recommendations include prioritising essential services before expanding to advanced care, integrating critical care training into national programs, leveraging partnerships for workforce development, and customising health information systems to support quality improvement.

Access to medicines and equipment is often constrained by unreliable supply chains and high costs, while health financing in LICs is inadequate, leading to high out-of-pocket costs and limited insurance coverage. Strong leadership and governance are essential to developing sustainable policies and protocols. The review concludes that a coordinated, systems-based approach—tailored to local contexts—is critical to expanding and improving critical care delivery in LICs, with further research needed to inform implementation strategies and economic evaluations.