Bang for the Buck: What Are Donor Dollars Achieving Through This NGO?

Smile Train is one of those rare NGOs working in poor countries that's managed to break through with the American public and raise some serious money. Last year, we talked to Susannah Schaefer, Smile Train’s executive vice chair and CEO, who offered us an inside look at the group's powerful fundraising machine. Since 2012, Smile Train—which provides free corrective surgeries for cleft lips—has averaged around $98 million in annual charitable contributions and $170 million in overall revenues.

But while Smile Train has inspired legions of donors and hundreds of surgeons who've volunteered their time to the organization, and while it's now provided 1 million surgeries for children around the world, it remains an enigma to some charity evaluators. Charity Navigator doesn't provide a rating of the group, explaining that it's hard to evaluate Smile Train since it relies so much on donated services. Meanwhile, GiveWell, which last looked at Smile Train in 2009, also declined to issue a definitive judgment of the group, saying "we do not have a clear picture of the impact of Smile Train's activities."

As a reminder, orofacial clefts are among the most common types of birth defects in the world. In wealthy countries like the United States, they are routinely prevented or corrected. That's not the case in poor countries, where children born with orofacial clefts are often left to suffer the physical, emotional, and mental consequences of the birth defect.

It seems like common sense that corrective surgery could yield a lifetime of dividends for children born with cleft lips, delivering a lot of bang for the buck to donors. But common sense is not a metric, and anyway, some of the questions around Smile Train have revolved around its heavy investment in advertising and promotional materials.

This background helps explain why Smile Train is keen to draw attention to a new independent study on the impact of fixing cleft lips. For the study, "Economic Valuation of the Global Burden of Cleft Disease Averted by Large Cleft Charity," researchers examined around 550,000 "primary cleft procedures" performed in 83 countries around the world over the course of 10 years. Fifty-eight percent of the surgeries investigated were for cleft lip and 42 percent for cleft palate. The findings are pretty remarkable, and include the following:

The number of disability-adjusted life years (DALYs) averted due to cleft surgery ranged between 1.46 and 4.95 million. The World Health Organization describes DALYs like this: "One DALY can be thought of as one lost year of healthy life."
A $250 commitment to the average surgical costs can result in up to $50,000 put back into local economies.
The return on investment of cleft surgeries (at a $250 cost) comes in at around 175 to 200 percent.
The total global economic impact from Smile Train's cleft repair surgeries over a 10-year period is estimated to be as much as $20 billion.

Let's just repeat that last number: The impact of the hundreds of millions of dollars donors have given to Smile Train may run as high as $20 billion.

That's a lot of bang for the buck, although it doesn't answer the question of whether this nonprofit could have delivered even higher returns on the money it's raised. Of course, this kind of question can rarely be answered definitively for any organization—and especially one that works worldwide with a range of partners.

What we do know is that the many donors who've been drawn to Smile Train, often in an emotional way, have understood intuitively what has now been shown empirically: Inexpensive surgeries to free children of cleft lip is money well spent. Could Smile Train be deploying donor dollars more efficiently? Maybe or maybe not. But there should now be no question about the overall impact this organization is making.

One final point, here: Cleft lip surgeries aren't the only procedures that can deliver tremendous bang for the buck. Research has shown that greater access to surgery could dramatically reduce an economic burden that's estimated to run into the trillions of dollars between now and 2030. This sounds like a promising area for new philanthropy in coming years.