Orofacial clefts remain among the most common congenital anomalies worldwide, with an estimated incidence of 1.1 in 1000 live births.1 In Nigeria, Africa’s most populous nation, the absolute burden of cleft lip and palate is substantial, yet comprehensive cleft care (CCC) remains unevenly accessible.2 While notable progress has been made through surgical outreach programs and public–private partnerships, the Nigerian experience underscores a critical global lesson: cleft care cannot be reduced to surgery alone. It must be embedded within a coordinated, interdisciplinary, and sustainable health system. CCC advocates interdisciplinary rather than multidisciplinary management of people with clefts. Over the past two decades, Nigeria has witnessed a significant expansion in cleft lip and palate surgery, largely driven by collaborations between local hospitals and international nongovernmental organizations. These efforts have transformed thousands of lives, reduced stigma, and demonstrated that high-quality cleft surgery is feasible in low- and middle-income settings.3 However, the dominant outreach-based model, though impactful, has limitations. It often prioritizes surgical volume over continuity of care and does not consistently address the long-term functional, psychosocial, and developmental needs of affected individuals. Complex cases are also less likely to be managed in outreach settings due to the difficulty of assembling full cleft teams and safety infrastructure.4 CCC encompasses far more than the initial surgical repair. Optimal outcomes require coordinated input from surgeons, psychologists, nurses, pediatricians, orthodontists, speech and language therapists, audiologists, dentists, anesthetists, and social workers. In high-income settings, such care is delivered through well-established cleft teams following standardized protocols from infancy through adolescence.3 In Nigeria, by contrast, interdisciplinary structures are scarce, fragmented, or concentrated in a few urban tertiary centers, leaving vast rural populations underserved.5 One successful model for CCC in Nigeria is the network of Smile Train-supported cleft centers, which demonstrate the effectiveness of multidisciplinary approaches in improving outcomes and expanding access to surgery and follow-up services.6 Local professional bodies – including the Nigerian Association of Plastic, Reconstructive and Aesthetic Surgeons, Nigerian Association for Cleft Lip and Palate, and other professional bodies – have also contributed to advocacy, training, and service development. One of the most pressing gaps in Nigeria’s cleft care landscape is access to speech and language therapy. Cleft palate-related speech disorders are common even after successful surgical repair, yet the country faces a severe shortage of trained speech therapists. Many patients, particularly those from low-income families, complete surgery without postoperative speech intervention, limiting functional outcomes and social integration. Similar shortages affect orthodontic care, audiology services, and long-term dental follow-up, all essential components of CCC.7 Late presentation further complicates care delivery. Many Nigerian children with cleft conditions present months or years after birth due to poverty, limited health literacy, cultural beliefs, and fear of stigma. Adults with unrepaired clefts are still encountered, reflecting systemic barriers and deep-rooted social marginalization.8 Addressing late presentation requires community engagement, integration of cleft awareness into maternal and child health services, and stronger referral pathways from primary care to specialized centers. Financial barriers remain central. Although many surgical repairs are offered free through donor-funded programs, indirect costs – transportation, accommodation, loss of income, and follow-up visits – often fall on families, and nonsurgical services such as speech therapy and orthodontics are rarely subsidized.9 Without deliberate policy action and effective insurance inclusion, CCC will remain inaccessible to vulnerable populations. Workforce development is another critical pillar. Nigeria has skilled cleft surgeons and anesthetists, but the pipeline for allied health professionals essential to cleft teams remains weak. Investment in local training, regional centers of excellence, and context-appropriate task-sharing is urgently needed. International partnerships should increasingly prioritize capacity building and systems’ strengthening rather than short-term service delivery alone. Data systems and research capacity also warrant attention. Nigeria lacks a visible national cleft registry, making it difficult to quantify incidence, track outcomes, or plan services. Strengthening data collection and supporting locally generated research are essential for context-appropriate standards of care and improved accountability. Despite these challenges, there are reasons for cautious optimism. Growing awareness, increasing numbers of locally trained specialists, and gradual institutionalization of cleft services in some teaching hospitals suggest a shifting paradigm. The opportunity now exists to transition from episodic surgical missions to integrated, patient-centered care embedded within Nigeria’s health system. Government leadership is essential, as long-term dependence on nongovernmental organizations is not sustainable. Achieving CCC in Nigeria will require coordinated action from multiple stakeholders. Government must integrate cleft services into national maternal and child health strategies, expand insurance coverage, and support workforce training. Professional associations must champion interdisciplinary collaboration and standardized protocols. Nongovernmental organizations and international partners should align with national priorities and invest in sustainable capacity. Patient advocacy groups and community leaders also play a crucial role in stigma reduction and social inclusion. The Nigerian context reflects broader realities across many low- and middle-income countries, where the success of surgical scale-up now demands an equally ambitious commitment to comprehensive care. Cleft lip and palate are lifelong conditions with medical, social, and economic dimensions. Ensuring that every child born with a cleft in Nigeria can survive, speak, hear, smile, and thrive is both an ethical imperative and a marker of health system maturity. By moving from access to surgery toward access to comprehensive care, Nigeria has the potential to provide a powerful global model for equitable and sustainable cleft care in resource-constrained settings.
Nnadozie et al. (Tue,) studied this question.