Barriers to comprehensive cleft care as perceived by healthcare professionals in Sub-Saharan Africa

Abstract

BACKGROUND : Cleft lip and palate (CLP) is a common congenital malformation. It results in substantial healthcare utilization and financial burden on families and healthcare services. Research shows that comprehensive cleft care (CCC) leads to better outcomes. To date, little is known about the barriers to CCC in sub-Saharan Africa. Understanding these and their possible solutions is paramount when engaging national policymakers on achieving equity in healthcare. Therefore, the aim of this study was to identify the barriers sub-Saharan African healthcare professionals face in implementing CCC and their potential solutions. METHODS : A questionnaire was sent to healthcare professionals representing the Pan African Congress for CLP, Operation Smile, and Smile Train foundations regarding the most important barriers and potential solutions to CCC. RESULTS : A total of 119 professionals participated; 76.5% were men, and 56.3% were surgeons. Most respondents worked in Nigeria or Ethiopia. The most commonly reported barriers were long travel distances and financial constraints, followed by limited public awareness. The most critical improvement identified was financial support for establishing multidisciplinary teams (MDTs). The absence or inadequate function of MDTs was largely attributed to a shortage of trained professionals. CONCLUSIONS : Patients’ inability to reach hospitals due to travel distance, especially for follow-ups, was the most important barrier. Action to increase geographic accessibility of hospitals is needed. Healthcare professionals overwhelmingly supported establishing MDTs and providing financial aid to patients as the most effective solutions for CCC. To enable MDTs to reach their full potential, a budget for employing and educating healthcare professionals to increase trained staff is needed.