Research shows that working equids in low and middle-income countries play an essential role in supporting the livelihoods of their owners. The objective of the study was to provide the first description of the welfare status of working horses in Fiji by analysing animal-based parameters alongside owner knowledge and perceptions of horse management. Trained assessors used a structured interview to question 279 horse owners on their knowledge and management practices, while their horses (n = 672) were assessed on health and welfare parameters. Horse owners supporting five or more dependent family members had horses with an increased prevalence of wounds than those with less dependents. The presence of wounds was associated with draught work and “carrying people or goods on back” while hoof neglect was associated with draught and breeding/other work. A lower body condition score was found in horses with neglected hooves and the presence of hoof neglect and wounds was associated with a negative general attitude in these horses. However, this study also found indicators of good welfare in these horses. These findings suggest that intervention, in the form of targeted veterinary services alongside training programs for owners, is required in order to improve the welfare of working horses in Fiji.