Health System Factors Influencing Availability and Access to Comprehensive Care for Cleft Lip, Palate, and Craniofacial Anomalies in Dar es Salaam, Tanzania

Abstract

Background: Cleft lip and palate are common craniofacial anomalies. In low- and middle-income countries, patients with these conditions face barriers to comprehensive care. In Tanzania, despite some hospitals performing surgical procedures, the health system factors affecting access to full cleft care remain unclear. This study aimed to assess the health system factors influencing the availability and access to comprehensive care for cleft lip, palate, and associated craniofacial anomalies in Tanzania. Methods: A multicenter cross-sectional study was conducted across 37 health facilities selected based on their capacity to provide cleft care services. Facility readiness, availability of specialized personnel, infrastructure, and financing were assessed through structured questionnaires administered to health facility managers. Data were analyzed descriptively, and cross-tabulations were performed to determine predictors of cleft care availability and accessibility. Results: Among the 37 facilities surveyed, 89.7% (33 of 37) could diagnose cleft lip and palate; however, only 24% (9 of 37) provided comprehensive management. There was a severe shortage of specialized personnel required for comprehensive cleft care. Plastic surgeons were available in only 3 out of 37 (8.1%) hospitals surveyed. Speech therapists were available in only 2 facilities (5.4%), and only 1 public hospital offered speech therapy services. Limited financial resources and inadequate equipment were major barriers to providing comprehensive care. Conclusions: Although many Tanzanian health facilities can diagnose cleft lip and palate, few provide comprehensive care. Addressing these gaps requires targeted government funding, expanded local surgeon training programs, improved retention strategies, structured referral pathways, and investment in a multidisciplinary approach for cleft care services.