Changing Faces, Changing Futures: The CLAPP Humanitarian Cleft Program Model for Cleft Care in Low-Resource Settings

Cleft lip and palate (CLP) represents the most common congenital anomaly worldwide, with the majority of untreated cases concentrated in low and middle-income countries (LMICs). The Cleft Lip and Palate Association of Pakistan (CLAPP) has developed a locally driven, programmatic model to deliver comprehensive cleft care in resource-constrained settings. This study describes the operational structure, clinical protocols, and outcomes of the CLAPP humanitarian program, providing a replicable framework for similar health care systems. Since 2004, CLAPP has conducted 205 surgical programs across Pakistan and Afghanistan, delivering cleft care to 25,028 patients. The model utilizes a mobile surgical infrastructure, a consistent multidisciplinary team, and a standardized clinical workflow that includes preoperative screening, intraoperative efficiency measures (eg, extubation in recovery), and a structured follow-up protocol. Programs are executed using a hub-and-spoke strategy to optimize patient recruitment and outreach. Data from 2 decades of programmatic activity demonstrate high procedural volume (average 121 surgeries per program), low complication rates, and comprehensive coverage of both primary and secondary cleft deformities. The average cost per patient, including surgery, postoperative care, and follow-up, was approximately USD 400. By avoiding reliance on international teams and local hospital infrastructure, and emphasizing local training and workforce integration, the CLAPP model addresses critical limitations of short-term mission-based cleft programs. Its operational sustainability, cost-efficiency, and clinical outcomes position it as a viable model for scale-up in other LMICs with similar disease burden and infrastructure.