A humanitarian collaboration between the Paediatric Cardiac and Cardiac Surgical Units of our University and the Paediatric Cardiac Unit of the Orota Hospital in Asmara has been established since 2004. In the last 3 years, an electronic data-base of the evaluated patients has been created. This paper aims at describing the typology of patient referring to the cardiac outpatients’ clinic in Asmara and outlining guidelines for the optimization of the economical resources. A total of 561 children were screened, in 3 weeks, one per year. Simple cardiac lesions (ASD, VSD, PDA, PS, AoS, simple ToF) were present in 199 of them (35,2%), chronic rheumatic disease (CRD) in 97 (17,2%), complex CHD (single ventricle, asplenia syndrome, common arterial trunk) in 45 (8%), other medical lesions (cardiomyopathies, MV prolapse, arrhythmia) in 37 (6,6%). One hundred forty-nine cases (24,7%) had a normal heart, 44 (7,8%) were followed postoperatively. Among the 199 simple lesions, 81 (PDA, AoS or PS)(41%)could be treated also by interventional cardiology, at an estimated lower cost than surgery. Moreover, in most of the 29 ASD patients a percutaneous closure was feasible, at a cost comparable to surgery. In conclusion, in a very low income country such Eritrea, patients with complex CHD are a minority of those referring to the tertiary hospital, surviving the first months of life. Among simple lesions, completely curable, at least 40% can be treated in the catheterization laboratory. Rheumatic disease is a sanitary emergency in Eritrea and its prophylaxis deserves resources allocation.