**Abstract**

Children born with cleft lip and palate in low- and middle-income countries (LMICs) have limited access to surgical care and suffer substantial morbidity as a result of delayed treatment. Charitable organizations have sought to tackle this problem through high-volume surgical missions, but these efforts have been fraught with high rates of complications and variable esthetic results. Over the past decade, Operation Smile (OS) has placed considerable emphasis on improving the quality of care delivered to patients in LMICs. By establishing an outcome evaluation program among other interventions, OS has achieved measurable improvements in complication rates and post-operative follow-up. The founding of the Guwahati Comprehensive Cleft Care Center in India has been pivotal to the success of OS's work in this field and is the evidence of the impact that an optimized model of care delivery can make. Here we describe OS's efforts to improve the quality of care delivered to patients in LMICs with a focus on the organization's work in India.

**Keywords:** cleft lip and palate, low and middle-income countries, global surgery, models of health care delivery, quality improvement
