The unfinished journey: A narrative review of inequities in secondary cleft lip and palate care in low- and middle-income countries

Abstract

Cleft lip and/or palate (CLP) is among the most common congenital anomalies worldwide. While primary surgical repair is essential, comprehensive CLP care also depends on equally important secondary services such as speech therapy, audiologic support, orthodontic care, and revision surgeries. In many low- and middle-income countries (LMICs), these services remain limited or inaccessible, resulting in suboptimal long-term functional, aesthetic, and psychosocial outcomes. Our narrative review searched across PubMed and Embase databases to identify the availability, delivery models, and outcomes of secondary CLP services in LMICs. We found 17 relevant studies and mapped existing evidence, identified key gaps, and explored barriers related to workforce shortages, training, infrastructure, and financial constraints. Our findings highlight the urgent need to strengthen multidisciplinary CLP care pathways beyond primary surgery. Investments in sustainable local capacity, tele-health enabled service models, task-sharing, and community-based interventions are crucial to achieving equitable, high-quality CLP outcomes in resource-limited settings.