**Abstract**

In this article, we will discuss the management of congenital heart disease in low-income and low-middle income countries. First, we will review the epidemiology of congenital heart disease in the low-income and low-middle income countries and compare it to that in the high-income countries; cardiac disease is the commonest cause of death globally. The challenges that are facing the delivery of pediatric cardiac services will be discussed and some solutions will be suggested to improve these services. Pediatric cardiac services face huge economic, financial, social, and health care system delivery challenges. Collaboration between countries and non-governmental and philanthropy organizations is strongly needed to improve delivery of pediatric cardiac services in low-income and low-middle income countries. Planning of pediatric cardiac services in these countries should consider the context of each country or region; some countries managed to transform their pediatric cardiac services to be better.

**Keywords:** congenital heart disease, pediatric, low-income countries, low-middle income countries, management, children
