Preventing lifelong impairment: Access to clubfoot treatment in low- and middle-income countries

Clinton Health Access Initiative

July 19, 2021

Global

Case Studies and Reports

PDF

Low treatment rates are driven by low awareness about clubfoot, a lack of ownership and prioritization by governments and global donors, and a lack of systemsneeded to deliver an effective treatment. Clubfoot programs in LMICs are often implemented with the support of non-governmental organizations (NGOs;) in contrast to high-income settings where treatment is embedded in the primary and tertiary health services. While governments contribute and partner on these programs, overall ownership is limited.

This is because clubfoot services require coordination and leadership between different departments within health ministries. Both are often missing. Global actors have also not yet prioritized congenital birth defects such as clubfoot under maternal, neonatal, and child health (MNCH). Now, there are no consensus or agreed treatment guidelines by the WHO that include the Ponseti method.

This contributes to a lack of integration of clubfoot services within government-led systems for neonatal and child health care. For children born with clubfoot who have access to treatment in LMICs, a successful outcome is not always guaranteed. Success primarily depends on availability of quality treatment and adherence to a long-term treatment process. When this is not the case, relapse after initial or incomplete rehabilitation may still occur.

phone showing a babies clubfoot, child above with straight feet after treatment

Credit: Miracle Feet

To increase access to clubfoot services in LMICs, further investment is needed to achieve the vision of a world where thousands of children each year can receive treatment for an impairment and therefore avoid a life-long impairment. The following actions are recommended:

Policy: Advocate to global and national actors - ministries of health and donors - for the integration and mainstreaming of clubfoot treatment as an essential neonatal and child health service.
Provision: Develop global guidance and standards on the delivery of clubfoot services and products.
Personnel: Integrate clubfoot treatment into government-led MNCH policies, plans and training curricula for health workers at the country level.
Products: Ensure an adequate supply of all treatment materials – plaster, padding and tenotomy supplies and affordable, quality Foot Abduction Braces in LMICs.
People: Test, validate, adopt, and scale new solutions and technologies that promote patient-centred care to improve adherence in low resources settings.

Current and new stakeholders, such as implementing partners, suppliers, donors, country governments and end-user advocacy groups, should collaborate on strategies to achieve these objectives. Based on the learnings from initial actions, plans can be refined to inform a sector-wide strategy.

mother holding a child with the corrective assistive technology on her feet

Credit: Miracle Feet