Save a Child’s Heart has saved the lives of many children by bringing them to Israel for surgery. Imagine how many more lives could be saved if the required medical staff and facilities were available in the countries where the children live? It is this vision that drives the SACH Outreach Program.

It is the intention of Save a Child’s Heart to develop "Centers of Competence" in all 17 partner countries, in which SACH personnel are trained to provide a higher level of care in their countries. To do so, SACH volunteers train doctors and nurses in pediatric cardiac surgery at the SACH medical Center in Israel so that they can operate in their own hospitals and in their own countries. If there were "Centers of Competence" in all the countries in which SACH currently operates, it would mean that there would be 17 centers treating children with heart disease. Instead of saving a maximum of 250 children at Wolfson Medical Center the program could perform needed surgeries on thousands of children each year instead of hundreds.

Today there are three "Centers of Competence" in which children are having their sick hearts repaired in their own countries; Ethiopia, Nigeria, and China. SACH has "working partners" in other countries who, although not able to perform the surgeries, can conduct the initial screening of potential patients and in some cases treat less severe cases of heart disease.

Here is how children in partner countries are screened for treatment:

• Children whose parents think that they have heart defects come to the local cardiologist for examination.
• After the local cardiologist has gathered a quantity of candidates that he believes have heart defects and require surgery the SACH doctors from Wolfson Medical center are notified and they arrange to visit the local hospital where the candidates are gathered.
• The children are then examined by the SACH doctors and those who cannot be helped by the surgery, or those that can be helped by medication alone are excused. The remainder of the children are arranged in order of the seriousness of their condition and those for whom there is money are scheduled for surgery.

As the program grows, the program faces a big dilemma: due to lack of sufficient funds, the SACH doctors must decide who will receive surgery and who will have to wait. Dr. Cohen was quoted as saying "Once I see the children, I am going to operate to save them. I cannot look the kids in the eye and I cannot say to the parents, 'We do not have enough money to save your child'." Most of the children are in desperate need of cardiac surgery for their survival, and not knowing whether they will still be alive at the next visit or when funds are available is a moral dilemma that the program faces very often.