…As Thousands of Nigerian Children Remain Underserved

…Nigerian cleft experts seek dental clinics in 774 LGAs, NHIA coverage for oral diseases

The Federal Government has pledged to integrate cleft care into Nigeria’s mainstream health system, warning that thousands of children born with cleft conditions every year still face barriers to surgery, speech therapy, orthodontic care, nutrition support and psychosocial assistance.

Meanwhile, the Nigerian Association for Cleft Lip and Palate (NACLP) has urged the Federal Government to establish at least one community dental clinic in each of the country’s 774 local government areas as part of efforts to expand access to oral healthcare.

Minister of State for Health, Dr. Adekunle Salako who made the commitment while speaking at a Speaking at the opening of the 6th Biennial Congress of the Pan-African Association for Cleft Lip and Palate (PAACLIP) in Abuja, called for a shift from treating cleft surgery as an act of charity to making comprehensive care a routine component of the national health system.

Salako said the scale of the challenge should be measured not only by the number of surgeries performed, but by the children and families whose lives are affected when treatment is delayed or unavailable.

“Behind every number is a child,” the minister said, stressing the need to ensure that children affected by cleft conditions can eat, speak, attend school and live with dignity and confidence.

Cleft lip and palate are among the most common congenital conditions requiring specialised surgical and multidisciplinary care. Experts estimate that thousands of Nigerian children are born with cleft conditions annually, although the true figure may be higher because many cases are never recorded and some affected children do not gain access to appropriate medical care.

He noted that programmes supported by SMILE Train in Nigeria have contributed to 45,786 cleft surgeries, alongside 1,853 speech therapy interventions, 2,433 orthodontic treatments and 2,033 nutrition interventions.

According to him, the intervention dates back to 2002, when the first free cleft surgery under the programme was performed at Ahmadu Bello University Teaching Hospital, Zaria.

“What began as an intervention at a single hospital has since developed into a network involving Nigerian medical professionals and treatment centres across the country”.

Salako acknowledged the contribution of medical professionals and partners to the expansion of cleft services, describing their work as an example of medical expertise combined with compassion.

He, however, insisted that the next phase must involve integrating cleft services into existing government health structures rather than creating parallel systems.

According to him, the Federal Ministry of Health is prepared to work with professional associations, health insurance institutions and development partners to establish a defined package of comprehensive cleft care for vulnerable children, particularly those under five years.

He said such a package should cover surgery and the wider continuum of care, including speech therapy, orthodontics, nutrition and follow-up services.

The minister also disclosed plans to strengthen cleft care at the primary healthcare level through improved referral systems and team-based training for healthcare workers.

Another major proposal is the integration of a national cleft registry into Nigeria’s health information system.

Salako observed that the registry would enable government to routinely track cleft cases across health facilities and use reliable data to guide annual planning, budgeting and resource allocation.

The minister further called for stronger coordination among development partners, professional bodies and the private sector, arguing that cleft programmes should operate within a common national work plan.

He linked the initiative to broader Federal Government reforms in surgical and health financing, including the National Surgical, Obstetric, Anaesthesia and Nursing Plan and the country’s expanding health insurance coverage.

Salako said the government’s broader objective was to ensure that vulnerable Nigerians are not excluded from essential healthcare because of their inability to pay.

He also pointed to the Vulnerable Group Fund established under Nigeria’s health insurance framework as a potential mechanism for extending financial protection to children with cleft conditions and other vulnerable groups.

“With the right systems in place, cleft care should become a routine part of healthcare, not an act of charity,” Salako said in his address.

For families living with cleft conditions, the significance of such a shift extends far beyond surgery.

Successful treatment can affect a child’s ability to eat, speak and communicate, as well as their confidence, education and social development. Comprehensive care may require several interventions over a period of years, making continuity of care as important as the initial operation.

Also speaking, President of PAACLIP, Professor Adeola Olusanya, said the ultimate objective of expanding access to cleft surgery must be the creation of health systems that can survive existing infrastructure, workforce and geographical challenges and continue delivering quality care for future generations.

According to Olusanya, the continent must establish healthcare frameworks that “can withstand systemic challenges, empower local multidisciplinary teams” and ensure that high-quality, holistic cleft care remains accessible to every African child.

She said the challenges confronting cleft care in Africa required more than surgical expertise, stressing that multidisciplinary and interdisciplinary approaches were essential to achieving lasting outcomes.

“While we strive towards expanding access to surgical and comprehensive cleft care, our ultimate goal must be longevity,” Olusanya said.

Olusanya added that the Abuja congress was particularly significant because it marked the beginning of a new tradition in which African national cleft associations would host PAACLIP conferences, describing the development as an important step towards creating a stronger African voice in global cleft-care advocacy.

The PAACLIP president said the initiative would also strengthen locally led and sustainable solutions tailored to the realities of African health systems.

Surgery alone is not enough

President and Chief Executive Officer of Smile Train, Susannah Schaefer, reinforced the call, arguing that sustainable cleft care must extend beyond surgery.

She said Smile Train’s experience over the past 27 years had demonstrated the value of investing in local medical professionals rather than relying on visiting teams.

“When our founder, Charles B. Wang, started Smile Train, the idea was straightforward: invest in the doctors and teams already on the ground — people who know their communities, languages, cultures and health systems — rather than flying doctors in and out,” Schaefer said.

She disclosed that a child currently receives a safe, high-quality surgery from a Smile Train partner approximately every five minutes globally, but cautioned that surgery represents only one component of the cleft-care journey.
In 2025 alone, she said, Smile Train partners worldwide delivered more than 131,000 non-surgical interventions, including speech therapy, orthodontic and nutrition services.

Schaefer identified the cost and difficulty of travel, geographical and socioeconomic barriers, fragmented health systems and shortages of trained professionals as major obstacles preventing many families from accessing continuous care.

She called for specialist centres to serve as hubs for leadership, training and complex care while appropriate services are brought closer to communities.

She also advocated greater use of digital technology and telehealth to connect specialists and extend expertise to underserved areas.

“Comprehensive cleft care should be the standard everywhere, not the exception,” she said, adding that African leadership in clinical care and advocacy deserved greater recognition and investment internationally.

Africa faces massive health workforce shortage

Smile Train Vice President and Regional Director for Africa, Nkeiruka Obi warned that the continent’s shortage of healthcare professionals could undermine efforts to establish resilient cleft-care systems.

Obi, who welcomed delegates to the congress, cited the World Health Organisation’s State of the Health Workforce in Africa 2026 report, which projects a shortage of approximately 5.85 million health workers by 2030, potentially rising to 6.28 million by 2035 if current trends are not reversed.

She said the figures demonstrated that resilience could not be achieved through training alone.
“Africa must also create environments where health professionals can build careers, lead institutions, conduct research and serve their communities for the long term,” she said.

Obi disclosed that Smile Train’s work in Africa had contributed to comprehensive cleft care for more than 200,000 people, while its programmes globally had reached about two million people.

She said behind every statistic was a child and family whose lives had been affected by cleft conditions, including children subjected to bullying and social exclusion and parents who had struggled to care for them in communities where awareness and services remained limited.

Obi said partnerships with institutions including the West African College of Surgeons and the College of Surgeons of East, Central and Southern Africa were helping to strengthen the pool of African professionals who would lead the next generation of cleft care.

She urged young professionals to document their experiences, publish research and share innovations, saying Africa should not merely participate in global health conversations but help shape them.

On his part, the Chairman of the Local Organising Committee, Professor Nnadozie Ugochukwu, urged African governments to treat cleft care as a matter of equity, dignity and human rights rather than charity.

He said the conference represented a significant milestone in the history of PAACLIP as the first time an African national cleft association had hosted the continental congress.

Ugochukwu said the Nigerian Association for Cleft Lip and Palate (NACLP), with the support of its partners, had used the conference to demonstrate what could be achieved when professional bodies, government and development partners worked together.

He disclosed that about 112 abstracts had been submitted for the conference, describing the volume as an indication of the growing interest in cleft-care research and innovation across Africa and beyond.

He also highlighted the breadth of support provided to patients, including professional training, patient mobilisation, transportation to treatment centres, hospital equipment, treatment funding, nutritional support, feeding during admission and assistance with reintegration into society.

According to him, the approach represents the concept of complete cleft care that should be replicated and ultimately integrated into national health systems.

“We must ensure that every African child born with a cleft has access to safe, dignified, affordable and sustainable care,” he said.

“Cleft care should not be viewed merely as charity; it is a matter of equity, dignity and basic human rights.”

Also speaking, President of the Nigerian Association for Cleft Lip and Palate (NACLP) Dr Seidu Bello urged the Federal Government to establish at least one community dental clinic in each of the country’s 774 local government areas as part of efforts to expand access to oral healthcare.

Bello called for cleft lip and palate and other major oral diseases to be covered under the National Health Insurance Authority (NHIA) framework, saying financial barriers continue to prevent many indigent Nigerians from accessing essential oral healthcare.

He stated that oral health remained an integral component of general health and urged the Federal Government to move beyond years of discussions on integrating oral healthcare into primary healthcare delivery.

According to him, equipping one primary healthcare centre in each of the 774 local government areas with a community dental clinic would bring basic oral healthcare closer to ordinary Nigerians.

He said the proposed clinics could be staffed by dental auxiliaries, including dental surgery assistants and dental therapists, as well as other trained oral-health personnel already available within the health system.

He explained that the clinics would provide oral-health education, dental counselling, preventive services, scaling and polishing, early detection of oral diseases and appropriate referral of cases requiring dentists and specialists.

“This would be a practical way of bringing oral health to the doorsteps of ordinary Nigerians,” Bello said.

The NACLP president also appealed to the government to ensure that the management of cleft lip and palate and other major oral diseases was appropriately covered by the NHIA.

He said such a policy would enable more disadvantaged Nigerians to access essential services without the financial burden that currently discourages many from seeking care.

Bello further called for a review of the structure of oral healthcare within the Federal Ministry of Health.

He advocated strengthening and, where administratively feasible, renaming or restructuring the Dentistry Division as an Oral Health Division to create a broader platform for coordinating the management of cleft conditions, dental diseases, noma and other oral-health challenges.

“Clefts, dental diseases, noma and many other conditions all constitute important components of oral health,” he said.

Bello described cleft lip and palate as a congenital condition that affects populations across the world, stressing the importance of ensuring that Nigerians born with the condition receive appropriate care irrespective of their location or socioeconomic status.

He also acknowledged the role of international partners in expanding cleft care in Nigeria, particularly Smile Train, which he credited with contributing significantly to the development of local capacity.

He described Smile Train as a “giant force” in making cleft care feasible and sustainable in Nigeria and expressed the association’s gratitude to the organisation and other partners working to improve cleft care across Nigeria and Africa.