title: A Health Systems Perspective on the Mission Model for Cleft Lip and Palate Surgery: A Matter of Sustainability or Responsibility?
abstract: One in 700 children around the world are born with cleft lip and/or palate (CL/P). Although reconstructive surgery is widely available in high-income settings, over 2 billion people in low- and middle-income countries lack access to essential surgical care. The mission model has been demonstrated to be highly effective in responding to the global surgical workforce crisis, but has been questioned in regard to its sustainability, value, and overall impact. Through effective health systems integration, the mission model presents abundant opportunities for streamlined delivery and horizontal impact. Still, the primary goal of the mission model is direct care delivery; and although the value of sustainability is indisputably vital, we contend that the mission model, when executed responsibly, creates high-value, sustained impact on the individual lives of those presently in need. We furthermore advocate for the sustained commitment of implementing organizations, patient safety, local integration, and a new focus on patient centeredness as key elements of the responsible mission model.
authors.affiliation: *Johns Hopkins Bloomberg School of Public Health, Baltimore, MD †Operation Smile, Inc., Virginia Beach, VA.
authors.forename: Lucas Cummings
authors.initials: LC
authors.lastname: Carlson
authors.forename: Kristin Ward
authors.initials: KW
authors.lastname: Hatcher
authors.forename: Richard
authors.initials: R
authors.lastname: Vanderburg
authors.forename: Ruben Eduardo
authors.initials: RE
authors.lastname: Ayala
authors.forename: Charles Edward
authors.initials: CE
authors.lastname: Mbugua Kabetu
authors.forename: William P
authors.initials: WP
authors.lastname: Magee
authors.forename: William P
authors.initials: WP
authors.lastname: Magee
mesh_terms: D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D008493:Medical Missions / Q000458:organization & administration*; D061214:Patient Safety; D019651:Plastic Surgery Procedures / Q000379:methods*