25-year review of REACH model for equitable craniomaxillofacial care in LMICs

INTRODUCTION: Access to safe, timely and affordable surgical care remains a major global health challenge, particularly in low- and middle-income countries. The Lancet Commission on Global Surgery highlighted the substantial burden of surgically treatable disease and called for scalable, sustainable health system solutions. This study evaluates the REACH (Rural Effective, Affordable, Comprehensive Healthcare) model, a long-standing healthcare delivery programme implemented in rural India, in relation to the Lancet Commission's core recommendations. METHODS: A retrospective programme analysis of the REACH model implemented through SHARE India and the GSR Institute between 2000 and 2025 was undertaken. Programme structure, workforce development, service delivery mechanisms, community engagement strategies, financing models and surgical care provision were reviewed. Alignment with key principles of equitable surgical access and health system strengthening was assessed. RESULTS: The REACH model expanded to cover approximately 25 districts and 1,010 villages, serving an estimated population of 3.9 million people. The programme trained 4,800 community health volunteers supported by 48 health supervisors and 12 local doctors. Approximately 34,000 surgical procedures were performed during the study period, predominantly for cleft and craniomaxillofacial conditions, with around 60% delivered free of charge. Decentralised referral pathways, community-based patient mobilisation and a hybrid financing model contributed to sustained service delivery and improved access to care. CONCLUSIONS: The REACH model demonstrates that long-term, community-integrated healthcare systems can provide equitable and sustainable surgical care in resource-constrained settings. The framework offers a potentially replicable model for strengthening surgical systems through local capacity building and sustainable financing.