The IQIC for Congenital Heart Surgery in Developing World Countries was launched in 2008 by Boston Children's Hospital representatives, Children's HeartLink, and other NGOs, including Humanitarian Association Coeurs pour Tous, the KM Cherian Foundation, and the Novick Cardiac Alliance.75 This collective endeavor specifically seeks to address significant gaps that exist with care of children with CHD in LMICs when compared with advanced economies The IQIC seeks to provide benchmarking data for health care professionals and guides QI efforts at more than 50 sites in 22 LMICs The impressive decrease in morbidity and mortality rates at participating sites has been steady and significant.53 Continuing Medical Education and Training Initiatives In many LMIC settings, pediatric cardiac professionals come from varied training backgrounds and often perform in roles that they have not been specifically trained in Vital support staff that include perfusion, respiratory therapy, and intensive care nurses are especially in need of constant training Limited opportunities exist for access to continuing medical education programs and training workshops among nursing and resident doctor staff Funds for travel to conferences and workshops are in short supply The Internet has helped to overcome many of these limitations, and robust elearning platforms have been established for all pediatric cardiac professionals The IQIC conducts regular webinars for nurses on key drivers of QI, and its website serves as an excellent resource (https://iqic.chboston.org/) A structured e-learning initiative has been established to facilitate teaching of pediatric cardiology fellows through e-classes conducted twice every week This is integrated into the course curriculum of fellows in training.76 The CHIP Network, the Congenital Heart Professionals Network (http://www.chipnetwork.org/), is designed to provide a single global list of all CHD-interested professionals.77 This initiative seeks to connect pediatric and adult CHDinterested professionals to events, conferences, and increase education and provider awareness of new developments in the field An important mission that pediatric cardiac professionals have to undertake in LMIC environments is in educating primary caregivers (mostly general pediatricians).21 Critical areas that pediatricians need to be educated include identification of heart disease in infants and newborns, stabilization of a sick child with critical heart disease prior to referral, the need for postsurgical holistic care, and the improved outlook for children with heart disease in current times It is vital to liaise with professional bodies for general pediatricians and neonatologists to enable continued interaction and constant feedback Conclusions The demographic shift of pediatric diseases brought about by improving human development has unmasked a massive burden of CHD in LMICs RHD remains unconquered, and the absolute burden of other acquired heart diseases is high simply because of the large number of affected children As a result, the magnitude of pediatric heart disease is immense Although several new pediatric cardiac programs are being established in many emerging economies in Asia and South America, the vast majority of the world's children still do not have any access to comprehensive pediatric cardiac care and much needs to be done to address this fundamental challenge From a global perspective, we can claim to have progressed only when every child born in the world with heart disease has access to comprehensive pediatric cardiac care For those children who reach pediatric cardiac programs in LMICs, important challenges are posed by late presentation, comorbidities such as undernutrition, infections, and limitations in human and material resources The challenges necessitate important adaptations and innovations in clinical practice It is also necessary for pediatric cardiac professionals in LMICs to find answers to the unique clinical problems that they face through systematic research and collective efforts such as multicenter studies and registries Summary Much of this chapter speaks to the need for advocacy and activism for and on behalf of the neglected 90% of children with heart disease Parents and patientbased support groups have a crucial role to play in putting heart disease in children firmly on the global health agenda However, physicians and surgeons have a heavy burden of responsibility and therefore need to show leadership in these campaigns Partnership is important, and the most important global institutions need to be used to good advantage The Sustainable Development Goals (SDGs) are a collection of 17 global goals set by the United Nations General Assembly in 2015 The SDGs are part of Resolution 70/1 of the United Nations General Assembly: “Transforming our World: the 2030 Agenda for Sustainable Development.”80 In the SGGs The United Nations set global targets for “good health and well-being.” Included here under SDG 3 is the target to “reduce by one-third the mortality from noncommunicable diseases by 2030 through prevention and treatment” and by 2030, “to end preventable deaths of newborns and children under 5 years of age with all countries aiming to decrease neonatal mortality to at least as low as 12 per 1000 live births and under-5 mortality to at least as low as 25 per 1000 per 1000 live births.” We have shown in this chapter that these goals will never be reached without sustained global action with investment to increase access to affordable and effective surgery and treatment for children with heart disease Furthermore, the call in the SDG's “to achieve universal health coverage and access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines for all” is consistent with what is required to provide primary prevention for children at risk of rheumatic fever, secondary prevention for children with RHD and treatment for all forms of children's heart disease For the first time the global pediatric cardiac care coalition and the public health constituency, moved, motivated and driven by the United Nations and the World Health Organization, share a set of objectives which are necessary to reach the SDG's and get cardiac care to the neglected 90% ... is vital to liaise with professional bodies for general pediatricians and neonatologists to enable continued interaction and constant feedback Conclusions The demographic shift of pediatric diseases brought about by improving human... simply because of the large number of affected children As a result, the magnitude of pediatric heart disease is immense Although several new pediatric cardiac programs are being established in many emerging economies in Asia and... have progressed only when every child born in the world with heart disease has access to comprehensive pediatric cardiac care For those children who reach pediatric cardiac programs in LMICs, important challenges are posed by late presentation, comorbidities such as undernutrition,