ECG not available in other countries!

there are many people who bought apple watch in third world countries only to find out that the the ECG feature is not available, i mean it could have saved lives if people were warned about irregular heart rates outside the America? what's making it so long to enable such feature? i already have 3 relatives who does from heart related problems and they own an apple watch, i guess their lives cound have changed if the feature were just available in poor countries.