Cleft lip and/or palate (CLP) is the most common congenital anomaly of the craniofacial complex, with an estimated worldwide prevalence of 1/500-700 live births. [1] In South Africa (SA), CLP is among the 5 most common birth defects reported, [2] with an estimated prevalence of 0.1-0.4/1 000 live births. [2-4] Affected children present with a number of medical problems and potential complications that include feeding difficulties, hearing loss, speech problems, disfigured appearance and dental malformation. [5-8] Hence, individuals with CLP require coordinated and specialised treatment offered by a multidisciplinary team, [9-11] which includes geneticists, maxillofacial surgeons, otolaryngologists, orthodontists, paediatricians, plastic surgeons, paediatric dentists, psychologists, professional nurses, social workers and speech and language therapists. [12-14] These teams are available in high-income countries (HICs). Various clinical protocols have been proposed for the treatment of CLP. [15] Many HICs have adopted national protocols and guidelines and have centralised services and/or established centres for the management and follow-up of affected individuals. [16-19] The advantages of centralisation and/or concentration of specialised services include the following: coordination of treatment, standardised data collection, availability of a critical mass of experts, clinical audit and review to enhance quality of care, responsiveness to patient and family needs, and ongoing monitoring and evaluation. [12,20-26] Globally, it is estimated that only 20% of individuals with CLP have access to comprehensive treatment that involves a team coordinated approach. [27] The treatment and care gaps include: lack or shortages of healthcare professionals, lack of infrastructure and delays in surgical repair of the clefts. [27,28] These gaps are most pronounced in low-and middle-income countries (LMICs) in Africa, Asia and South America. [28,29] In many LMICs, outreach programmes by nongovernmental organisations (NGOs) have assisted in improving the services for individuals with CLP. [29-34] These NGOs, together with support groups that include parents of the affected children, have played an important role in the ongoing management of CLP patients. However, the majority of LMICs, including SA, lag behind in terms of national treatment protocols, standardised data collection, access to care by a multidisciplinary team, and evaluation of treatment outcomes. [12,18,35] Notwithstanding improvements in the treatment of CLP individuals in the preceding decades, [36-38] there is still no universal protocol for repair and ongoing clinical management. However, treatment modalities in the management of CLP are often based on chronological age and dentofacial development. [38] The common elements of clinical standards and sequence of treatment of CLP are shown in Table 1. [38] At birth, genetic counselling is given to parents, and feeding of the baby is evaluated. Depending on the size of the cleft, feeding plates are recommended withi...