**9. Patient follow-up**

Whether it is a cleft mission or a permanent cleft care facility, arrangements for adequate follow-up are important to maximize treatment effectiveness, access the available options for future treatment, and monitor outcomes. As shown in **Figure 3**, a basic post-operative follow-up has two intervals.

However, such a simplified follow-up regimen is rarely adequate for most cleft patients. From birth throughout childhood and adolescence, a cleft patient requires coordinated care among surgeons, orthodontists, and other health care providers. Even after surgery, most cleft patients require regular ear examinations during infancy. Approximately 75% of cleft patients require two to three additional orthodontic/dentofacial orthopedic interventions and continued speech therapy throughout childhood and adolescence to achieve satisfactory growth, speech, and language competence. Coordination of various dental procedures is crucial from the period of mixed dentition through adolescence. Furthermore, overall health and the psychosocial impact of having a cleft also need to be monitored routinely [1, 12, 21].

To achieve such a prolonged follow-up plan, it is the responsibility of the cleft team to maintain communication with the patients and families, extensively educate them on the importance of follow-up and maintain appropriate documentation and record keeping.

**Figure 3.** Patient follow-up stages.

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

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

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 infrastruc-

assessment, operating rooms, preoperative, and post-operative

examination, anesthesia, surgery, orthodontics, nasoalveolar

the cleft center as well as support patients that cannot afford the

to international standards, assures patient/family satisfaction, conducts staff performance reports, and develop guidelines to

**Physical space** An adequate space should be present for patient screening,

**Laboratory** A basic clinical laboratory to perform regular blood and electrolyte

molding, and ward care **Staff** Administrative, management, nursing, and permanent or visiting

**Donors** Various funding agencies and/or private donors to run and maintain

treatment otherwise **Quality control** A system that ensures that quality of cleft care provided is according

expert surgery staff to run the facility

address the problems faced in the facility

wards

tests **Equipment** The minimum number of instruments required for patient

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

Whether it is a cleft mission or a permanent cleft care facility, arrangements for adequate follow-up are important to maximize treatment effectiveness, access the available options for future treatment, and monitor outcomes. As shown in **Figure 3**, a basic post-operative

follow-up and therapy.

52 Designing Strategies for Cleft Lip and Palate Care

sites in the future.

**9. Patient follow-up**

follow-up has two intervals.

ture. See **Table 2** for a list of basic requirements.
