Next week, healthcare leaders from across Africa will gather in Accra to shape the future of how countries plan, staff and pay for surgical, obstetric, and anaesthesia care. At the G4 Alliance Meeting, I will be in the room as someone who has lived on the other side of those plans. I was born with a cleft lip and palate, and have spent my life learning that cleft is a bellwether for the strength of health systems, and surgery should be where cleft care begins, not where it ends.

I was told my father didn't want a child born with a cleft, so he left. As an adult, I asked him whether that was true. He told me it was. When I was three months old, my grandmother took me in and raised me until she died when I was ten. Then I returned to my mother in Kumasi, Ghana. While she became the pillar of my life, my family never explained my cleft to me.

In school, teachers told children not to laugh at me, but I didn't understand why. I simply loved learning. The truth arrived at Kwame Nkrumah University of Science and Technology when I answered a question into a microphone in a packed lecture hall. Students laughed at the way I spoke. The lecturer joined in and asked whether someone like me could even finish school. Classmates imitated my speech and refused to sit near me. Some believed my condition might somehow pass to them or their future children.

A classmate dared me to record my voice. Playing it back, I heard for the first time what everyone else heard. I cried for more than a week. My family said they kept quiet so that fear would not drive me out of school. I understand that now. But no family should have to hide or deny a child's condition to protect her from her own community.

I came close to giving up on school and, at my lowest, on life itself. A head of department sat me down and told me not to let other people's behaviour decide my future. "Not everyone is mature," he said. I stayed in school and studied psychology, thinking about young people like me who had no one to sit them down.

With the help of surgeons and supporters including Smile Train and the Ghana Cleft Foundation, I have now had seven or eight operations, the most recent this year at the National Cleft Care Centre in Kumasi. Each one made a difference, but none made the stares go away. I still walk into new rooms unsure how people will react when I speak, and I have been diminished even in places meant to care for me.

Today I work with children born with clefts and their mothers. What I see most often isn't fear of the operating theatre. I see a mother hiding her child because of stigma. I see treatment stalled because families cannot afford transportation to medical appointments. At one community outreach event, someone asked whether a child with a cleft could become a professional. A colleague pointed at me as an example. People were surprised. I want a Ghana where no one is surprised that a child with cleft can reach their full potential.

That is why I am asking the delegates in Accra - government officials, surgeons, anaesthesia providers, nurses, funders and advocates - and the consensus statement they expect to adopt on 10 November, to commit to five things.

First, name cleft care in national surgical plans. Cleft is one of the most common conditions children are born with, and treating it well tests whether a health system can deliver quality surgery close to home. Ghana already has a National Surgical, Obstetric and Anaesthesia Plan for 2025 to 2029. It names structural birth differences among neglected conditions we must reach, and highlights that we perform only about 30% of the surgery Ghanaians need. Its steering committee should set cleft care targets covering how many children are treated and how early, and report on progress every year.

Second, close the insurance gaps. Cleft surgery and follow-up care should be covered under the National Health Insurance Scheme, so no child goes untreated because their parents cannot pay. Today they are not covered. Yet, the scheme already pays for child hernia repair. Cleft repair deserves the same. Without it, families far from Kumasi must travel for donor-funded surgery or go without, impacting child wellbeing.

Third, fund the journey, not just the operation. Transport support, follow-up visits and speech therapy should be budgeted and measured as part of the plan, not left to charity and chance. Complete cleft care can take 18 years, from infant feeding support to nutrition, dental, speech and psychological care into early adulthood. Before the National Cleft Care Centre opened, Komfo Anokye, Ghana's second largest hospital, could offer speech therapy to only about 25 patients a year. The centre is built to give comprehensive care to hundreds more, but only if families can reach it. That's why I write proposals to cover transport, so no appointment is missed for want of a fare.

Fourth, treat dignity as part of quality. Psychosocial support belongs in every cleft programme; everyone should learn what a cleft is and is not. Awareness is relatively cheap. Stigma is far more expensive. Some parents still hide their babies from neighbours or look for spiritual explanations before medical ones. Cleft awareness should be part of how we train nurses, teachers and community health workers. Outreach teams like the one I work with should be funded, not run on goodwill.

Fifth, keep patients at the table. Health plans should be shaped by people with lived experience. The steering committee overseeing Ghana's surgical plan brings together experts, policymakers, health workers and partners. It should also include patients and families, and their experience should be one of the measures of whether the plan is working. President Mahama has said that health sovereignty must come with accountability at home. That accountability begins with the people who live with the plans.

I was lucky. My grandmother took me in, my mother kept encouraging me, a teacher refused to let me quit and surgeons kept operating. But children born with clefts in Ghana today should not need luck. They need a plan that sees all of them. In Accra this month, our leaders have the chance to write it.

Ernestina Obour-Tabi is a counsellor in Ghana who supports children born with clefts and their families. She will speak at the G4 Alliance's 20th Permanent Council Meeting, supported by Smile Train, in Accra on 9 November.