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Background: Congenital heart anomalies are the most common major birth defect in the world, affecting one in every 120 children, 90% of whom live where medical care is inadequate or unavailable. Increased access to paediatric cardiac care is a priority for most low-income and middle-income countries today. Children's HeartLink is dedicated to increasing access and improving quality at paediatric cardiac centres by use of a collaborative model that fosters sustainable clinical, organisational, and community capacity. Methods: Children's HeartLink works in India, China, Brazil, Malaysia, Ukraine, and Vietnam. The programme delivery model supports development of self-sustaining paediatric cardiac centres of excellence by using a three-phase approach of training and mentoring partnerships between developed and developing world programmes. Metrics in areas of clinical skills improvement, multidisciplinary teamwork, and administrative systems demonstrate progress towards becoming a sustainable regional centre of excellence, culminating in designation as a Children's HeartLink Global Partner in Pediatric Cardiac Care. Partner hospitals report clinical outcomes to Children's HeartLink; clinical and organisational competency is tracked through medical volunteer feedback. Findings: Markers of improved partner site outcomes include reduced mortality and morbidity, increased patient volume, and improved interdisciplinary communication, resulting in superior clinical judgment and decision making. This capacity-building model has resulted in one partner becoming a Global Partner in Pediatric Cardiac Care and Training and two becoming Global Partners in Pediatric Cardiac Care. Interpretation: Quantitative and qualitative analysis has shown that this capacity-building model leads to sustainable, accessible, and improved quality paediatric cardiac care in low-income and middle-income countries, and can be replicated in other health-care areas. Funding: None.