IFGH 2012: The Burden of Facial Clefting and How its Global Impact can be Addressed by NGO-Led Global Partnerships

January 27, 2012

Authors: Earley MJ.

Author Affiliations:Children’s University Hospital, Dublin

Option 2– Lessons from the field; project and programme evaluations; and syntheses or analyses

Presented as – Oral Presentation


Clefts of the lip and palate occur in 1 in 800 live births, resulting in 250,000 babies annually worldwide at high risk – if they survive infancy – of being outcast, unschooled and unemployed. Lack of surgery for clefts in poor countries is due to public sector shortages, families’ inability to pay for surgery, inaccessible services, and inadequately trained surgeons.


Several developed country NGOs provide cleft surgery in resource-poor countries. The author presents eight years’ experience with Operation Smile missions in Belarus, Morocco, China, Cambodia, Vietnam, Paraguay and Ethiopia demonstrating the importance of an organisational structure that enables local communities to achieve a sustainable programme of high standards. Initially, in-country representatives assess local burden-of-disease; facilities and supplies; and presence of qualified personnel. Missions include screening, and 4-5 days surgery with with postoperative care.

Achievements and Lessons learned:

In 30 years Operation Smile has performed 200,000 surgical procedures in 40 countries worldwide. Best practice ‘Global Standards’ have been introduced – in surgery, anaesthesia, nursing, electronic patient records photographic imaging and outcome measurements (primarily of appearance and speech). These have reduced mortality and enabled routine programmatic evaluations. A sustainable model has been developed as shown in 2009 when 60% of surgeries were performed by in-country foundations. Cleft centres have been established in Colombia, Morocco, Vietnam, China, India (Guwahati) etc. In Africa alone we collaberate with UNICEF, the Peace Corps, Action Aid, MSF, and many others.l

Next steps:

Operation Smile has evolved into a self-reflective organisation using capacity-building partnerships both with other NGO’s and with collaborations between countries, both North to South and East to East, increasing attention on teaching and training local communities. Provision of care in remote, impoverished areas and the retention of trained local staff in centres of excellence in the face of competing health needs, are major challenges.



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