**8. Sustainable cleft care facility**

International organizations have long provided cleft care through surgical missions to selected areas in LMIC with shortage of resources and experienced personnel. The drawback of this practice model is that these health missions often provide short-term relief, making treatment available to limited amount of people for a short time period [3]. The mission trips are dependent on proper funding, grants, and resources. This model of intervention is ideal for urgent humanitarian response to disasters or epidemics, where a substantial amount of resources can be mobilized quickly for disease-specific use in LMIC. However, it is less effective for sustaining long-term care to the indigenous population and for conducting educational/preventive endeavors. This type of practice has been criticized for operating outside of the existing health care systems and structures, doing little to strengthen the primary care systems in LMIC, and compromising countries' autonomy and participation in health care initiatives [6]. Finally, most of the mission trips are not designed to deal with the complex socioeconomic disease determinants many patients face, and lack the capacity to maintain prolonged post-operative follow-up and therapy.

It has become increasingly clear that one of the most important strategies that can help optimize and increase cleft care globally is to establish effectively run, high-volume, indigenous centers of excellence, capable of serving large and wide spread populations in the LMIC [6]. The ideal long-term goal for international groups should be to prepare local surgical teams to provide the same quality care for their population without outside medical assistance [8]. Once established and maintained, such local cleft care facilities not only provide services throughout the year to its region but can also contribute to the funding needs of much poorer sites in the future.

In order to offer effective surgical and orthodontic/orthopedic interventions, these facilities must develop and maintain an environment that meets world class minimums on proper workforce, access to supplies, instrumentation, infection control, and supporting infrastructure. See **Table 2** for a list of basic requirements.


Table 2. Basic requirements for a sustainable cleft care infrastructure/facility.
