Five million people are thought to be living with untreated cleft conditions worldwide. Many of them are outside the reach of existing health services. Over the next decade, Operation Smile has made the ambitious commitment to reach and care for 1 million patients. And, through our ‘hub and spoke’ model of care we will equip and empower health facilities in the countries where we work, to benefit local communities.

The hub and spoke model focuses staff, training and resources at central ‘hub’ hospitals, and expands the reach of care into more remote areas via partnerships and investment in smaller ‘spoke’ hospitals. This model of care is already proving successful in countries like India and Guatemala. Here, Operation Smile Care Centres act as ‘centres of excellence’ providing training and additional resources for the spoke hospitals when needed.

Ghana’s hub and spoke model in action

With a population of 32million, Ghana has an ever-increasing need for trained surgeons and specialists. Although short-term surgical programmes provide life-changing care for many patients, training local teams and investing in local resources is the key to long-term success. In Ghana, the hub and spoke model is already helping to tackle the shortage of trained surgeons and specialists in the country.

Hub hospitals are usually located in areas where there’s a concentration of medical expertise and resources. They serve as the primary site for surgery, diagnostics and post-operative care. Ghana’s Korle Bu Teaching hospital in the capital Accra, is the hub, actively training surgeons and specialists including anaesthetists, nurses and speech therapists.

Little Farida receiving care at Korel Bu Teaching Hospital.
Photo – Lorenzo Monacelli

Ghana’s spoke hospitals are sited in the regions that surround the country’s capital (Cape Coast, Koforidua and Ho) where there is the greatest need. And, in Tamale in the far north of the country. The spokes call on the hub hospital for additional resources, training and expertise when needed. Strengthening resources in the spoke hospitals means more patients can access specialised care closer to home.

Dr Opoku Ampomah is Operation Smile Ghana’s Medical Director and cleft surgeon. He recalls how things were in 2011 when Operation Smile first started working in the country. Only a couple of hospitals were able to provide reconstructive surgery, and resources were stretched to breaking point: 

When I came on board, we tried to build local capacity in terms of cleft care. Initially, I was the main surgeon for Ghana. Now, we have about five or six surgeons who have been trained through the Operation Smile system,” he says, “We’ve also been able to build a local team involving nurses and all the other workers, including child life specialists and other disciplines. We’ve transitioned from just about 10% of the volunteers were Ghanaians to a situation where over 70% of the volunteers are local people. That’s how much capacity we’ve built. The Ghanaian volunteers are now a resource Operation Smile can count on.

Dr Opokuh Ampomah, Plastic surgeon and Medical Director Operation Smile Ghana
Patient Coordinator, Clement Ofosuhemeng, interacting with patients at Korle Bu Teaching Hospital
Patient Coordinator, Clement Ofosuhemeng, interacting with patients at Korle Bu Teaching Hospital. Photo – Lorenzo Monacelli

Operation Smile Ghana’s Patient Coordinator, Clement Ofosuhemeng has seen firsthand the impact of this more sustainable approach to healthcare. He describes the increased reach of the spokes in Ghana as ‘tentacles’ and is proud of the positive benefits it brings for patients who would previously have had to travel long distances for care. He explains:

The biggest achievement is sustainability, and then training more people. If you come in fly in, fly out, it’s good, but it’ll be better if you train the local team to be able to carry on what you are teaching them. If you look at Operation Smile Ghana now, I think we’ve chalked a lot of success. When I joined it wasn’t like that, but now you see that we have a lot of stakeholders coming on board. 

We believe in this hub and spoke model. It means that in all these places now we are running nutrition clinics and speech clinics as well. It is limiting the distance that the patient will travel. Now they’re having the service closer to them. It means that we are growing. Now we have a lot of volunteers who are credentialed. When we go on surgical programmes outside of Ghana they call on some of our volunteers now.

I think that is one of the biggest achievements for Operation Smile.

Clement Ofosuhemeng, Patient Coordinator, Operation Smile Ghana

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