A Path Forward: Integration and Advocacy at MiracleFeet 

MiracleFeet’s mission to increase access to clubfoot treatment in low- and middle-income countries (LMICs) is guided by the principles of universal health coverage, equal right to healthcare, and sustainability. We believe that by integrating clubfoot in national public health systems, we can make clubfoot treatment accessible for all children born with this condition. Investing in clubfoot treatment aligns with four of the United Nation’s sustainability pillars: well-being of people; prosperity for all; and peace through partnerships across nations, sectors, and communities.

The challenge: Congenital anomalies are a global problem, but the toll is particularly high in LMICs where more than 94% of the births with serious congenital anomalies occur. Access to prevention and treatment is limited in these countries, due to lack of prioritization by the global health community, donors, and governments. 

Universal health coverage for clubfoot care 

At MiracleFeet, we believe that everyone should have access to health services they need, when and where they are needed, and without financial hardship. By leveraging existent national public health systems, we can ensure lasting and sustainable change.  

To ensure universal access to clubfoot treatment, MiracleFeet and our local partners work to integrate clubfoot screening and treatment into the already established and staffed primary health clinics. We advocate with Ministries of Health to include care for clubfoot and other congenital anomalies in their country’s maternal, newborn, and child health (MNCH) programs and services. In partnership with governments, civil society organizations, policy makers and health professionals, we raise awareness of clubfoot and work to increase the capacity of health systems and clinicians through training, technical support, and provision of treatment supplies. 

Equal access to clubfoot treatment 

MiracleFeet believes that healthcare is a human right. More than 85% of babies born with clubfoot in LMICs do not receive treatment due to lack of access. By integrating clubfoot care into the national health systems in the countries where we work, and by advocating for inclusion of congenital anomalies in the global health policy agenda for newborn and children’s health, we are promoting equitable distribution of healthcare resources and services. 

We believe in lasting change 

Our programs are intentionally designed to sustain access to clubfoot treatment long into the future and, eventually without MiracleFeet’s support. Because clubfoot treatment is relatively inexpensive, is delivered through existing healthcare infrastructure, and can be provided in out-patient settings, long-term sustainability can be achieved through partnership agreements with governments.   

Whenever possible, our local partners open and operate clubfoot clinics within public hospitals or other government-run facilities to reduce the cost of clubfoot treatment, so that it can be easily available in the communities. In addition to clinic space, in most countries Ministries of Health also cover provider salaries, and, in some cases, casting supplies and braces. Furthermore, we work closely with our in-county partners to advocate for initial and continuing education of midwives and community health workers to identify clubfoot early (ideally at birth) and refer families to a treatment center. At the same time, we collaborate with orthopedic associations and professional societies to conduct Basic, Advanced, and Train the Trainer workshops in the Ponseti method to ensure clinical excellence and expand the clubfoot healthcare workforce sustainably and over time.  

Full government adoption is elusive for many health interventions, but because clubfoot treatment is inexpensive, easy to teach, and requires simple supplies, it is well-suited for integration into the health systems by gaining political suppot and building local capacity. By weaving the provision of clubfoot care into the fabric of national health systems, MiracleFeet strives to achieve universal access to clubfoot treatment in as many countries as possible. Although we will never abandon a country program where support is needed, reducing external support is key for sustainability and a core part of MiracleFeet’s long-term vision for a world free of clubfoot disability. 

What does integration look like?

To advance government responsibility for clubfoot treatment at national levels and to build experience and examples of successful integration, MiracleFeet works with our in-country partners and stakeholders to develop strategic roadmaps with measurable objectives, defined roles, and workplans. Examples of our integration efforts include:

In addition to the above focused efforts, MiracleFeet is creating a “readiness for integration” assessment to determine which and when partners are ready to take the next steps in their integration journey. Advocacy efforts will evolve differently in each country, but may include:

Global Advocacy

While MiracleFeet’s national advocacy focuses on integration of clubfoot in government systems, our global advocacy focuses on raising awareness about clubfoot and other congenital anomalies to influence global health policy and support.  We engage with policy makers, donors, and influential civil society organizations dedicated to improving health outcomes of newborns and children, worldwide. 

Successful integration of clubfoot treatment at country level requires collectively elevating clubfoot as a critical global health issue. By raising the profile of clubfoot and other congenital anomalies through social media campaigns, global webinars, in-person convenings, research and journal articles, and presentations at scientific conferences, MiracleFeet is raising the visibility of clubfoot by highlighting gaps in health policy and systems for treatment of children born with congenital anomalies. 

 Recent successes of our global advocacy are: