Prioritising Cleft Care as a Public Health Issue

Context:
India continues to face a significant public health challenge in addressing cleft lip and cleft palate deformities, with an annual backlog of around 7,000 surgeries, despite sustained efforts by non-governmental organisations (NGOs). An editorial highlights the need to mainstream cleft care within public health systems, rather than treating it as a charitable concern.

Key Highlights:

Scale of the Problem

• Around 1 in 700 children in India is born annually with cleft lip and/or palate.

• Independent estimates suggest nearly 36,000 babies are born with cleft abnormalities each year.

• Despite NGOs performing nearly 30,000 surgeries annually, a surgical backlog persists.

Role of NGOs & Existing Efforts

• Smile Train has facilitated over 750,000 cleft surgeries in India over 25 years.

• NGOs often collaborate with private urban hospitals due to limited specialised facilities in government hospitals.

• Emphasis on training local doctors and covering surgical costs to ensure sustainability.

Health & Nutrition Concerns

• A 2022 report found children with Orofacial Clefts (OFCs) are 1.5 times more vulnerable to severe malnutrition.

• Feeding difficulties, social stigma, and delayed treatment worsen outcomes.

Policy & Awareness Gaps

• India lacks systematic documentation of birth anomalies.

• Craniofacial anomalies are yet to be recognised as a notifiable disease, despite WHO inclusion in the Global Burden of Disease initiative.

• National Birth Defect Awareness Month (August 2024) with the theme “Breaking Barriers” aimed to improve dialogue on congenital malformations.

Relevant Prelims Points:

• Issue: Persistent backlog and inadequate public health prioritisation of cleft care.

• Causes:

  • Limited government infrastructure

  • High surgical costs

  • Low awareness and poor parental counselling

• Government Initiatives:

  • Rashtriya Bal Swasthya Karyakram (RBSK) for early detection of birth defects

  • ASHA-based community outreach

• Benefits of Early Intervention:

  • Improved nutrition and speech development

  • Reduced social stigma and disability burden

• Challenges:

  • Uneven access between urban and rural areas

  • Dependence on NGO-driven service delivery

• Impact:

  • Untreated cleft deformities contribute to malnutrition, disability, and exclusion

Relevant Mains Points:

• Key Definitions:

  • Cleft Lip/Palate: Congenital defect due to incomplete fusion of facial tissues during pregnancy.

  • Orofacial Clefts (OFCs): Group of congenital facial and oral anomalies.

• Governance & Social Justice Dimensions:

  • Health equity and access for vulnerable children

  • Need to integrate cleft care into public healthcare delivery

• Institutional Role:

  • NGOs as gap-fillers, not substitutes for the state

• Way Forward:

  • Recognise cleft deformity as a public health issue and notifiable condition

  • Strengthen government hospital infrastructure for cleft care

  • Integrate early screening through RBSK and ASHAs

  • Improve data collection, counselling, and follow-up care at grassroots level

UPSC Relevance (GS-wise):

• GS 2: Social Justice, Health Governance

• Prelims: Congenital disorders, RBSK, NGO role in health