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

Area of Science:

• Global Health
• Congenital Anomalies
• Surgical Care Delivery

Background:

• Cleft lip and palate (CLP) is a common congenital anomaly, disproportionately affecting LMICs.
• Existing cleft care models often rely on unsustainable international missions.
• There is a need for locally driven, comprehensive cleft care solutions in resource-constrained environments.

Purpose of the Study:

• To describe the operational structure, clinical protocols, and outcomes of the CLAPP humanitarian program.
• To provide a replicable framework for comprehensive cleft care in LMICs.
• To evaluate the sustainability and cost-effectiveness of a locally managed cleft care model.

Main Methods:

• Utilized a mobile surgical infrastructure and a hub-and-spoke strategy for patient outreach.
• Implemented standardized clinical workflows including preoperative screening and structured follow-up.
• Focused on local training and workforce integration, avoiding reliance on international teams and local hospitals.

Main Results:

• Conducted 205 surgical programs, treating 25,028 patients across Pakistan and Afghanistan since 2004.
• Achieved high procedural volume (avg. 121 surgeries/program) with low complication rates.
• Demonstrated comprehensive coverage of primary and secondary cleft deformities at an average cost of USD 400 per patient.

Conclusions:

• The CLAPP model offers a sustainable, cost-efficient, and clinically effective approach to cleft care in LMICs.
• Local ownership, training, and mobile infrastructure are key to overcoming limitations of traditional cleft programs.
• This programmatic model is viable for scale-up in other regions facing similar challenges.