Cleft lip and palate are birth defects that occur when a fetus is developing. During the second and third months of pregnancy, the bones and tissues of a fetus’ upper jaw, nose, and mouth normally fuse to form the roof of the mouth and the upper lip. If this doesn't happen, a baby is born with a cleft lip, palate, or both. The condition can cause eating, dental, speech and hearing problems due to the lack of proper separation between the chambers of the head.
The condition occurs in about one in 700 births. It’s thought to be produced by genetic propensity triggered by environmental factors, but because it’s such a disfiguring condition, its cause has been the subject of much speculation. “It’s amazing in my travels around the world to hear some of the superstitions as to why people had a child with a cleft: They looked at knives. They laughed at handicapped people or they looked at the eclipse of the moon,” said Susannah Schaefer, Smile Train’s executive vice chair and CEO in an interview with Inside Philanthropy. Every baby born in Uganda with a cleft is called “Ajok,” which means “cursed by God.” Schaefer has heard of parents considering extreme measures with their babies: “It’s so sad to think that death is really an option.”
In the developed world, the condition is readily repaired, usually leaving no more than a scar on the upper lip. Smile Train places the average cost of surgery at $250, a modest figure, but still beyond the resources of the more than 1 billion poor people in developing countries who live on $1.25 a day or less, according to the World Bank’s most recent figures.
Since 1999, Smile Train has stepped in to help, partnering with hospitals around the world to provide free surgery to children with cleft. Schaefer said: “We started in China because there were plastic surgeons there, so why couldn’t we use them to train plastic surgeons in more hospitals than in just the big cities? So we applied the ‘teach a man to fish’ principle to cleft. It went from China to India. Now we’re in 87 countries [also the Navajo nation in the U.S.]. We’ve trained 2,200 partner surgeons and have treated over a million children in 15 short years.”
Smile Train reported $94 million in fundraising contributions for the fiscal year that ended in June 2014, while pulling in another $57 million in in-kind contributions. It also reported assets of $253 million.
These are startling numbers for an NGO that's focused on a very specific global health niche. For example, Smile Train raised seven times more money in FY 2014 than the Against Malaria Foundation did last year, even though nearly half a million people will die from malaria every year.
We'll leave it to others to argue about whether cleft is the best focus for global health dollars or how effective Smile Train is in its work. (There's been debate on both points.) Here, we ponder a different question: Why is Smile Train so good at raising lots of money?
Part of the answer to that question is obvious, lying in those heartbreaking photos of children with cleft. It's hard to not want to write a check to lift children from such disfigurement. Said Schaefer: “When I think about what we do and how we do it, that we’re transforming a life, giving a child a smile, it’s very compelling and very tangible so it’s easy for donors to connect with us."
It isn't surprising to learn from Schaefer that Smile Train raises its money not from places like the Gates and Hewlett foundations, but from smaller donors. “Our biggest supporters are mostly private family foundations. The primary funding is from individual donors who contribute,” Schaefer said. "Our supporters are long-standing, and tend to give nice annual gifts to Smile Train."
The charity oversees a large, multi-pronged fundraising effort. “We have a tremendous group of grassroots community supporters. We have events all over the U.S. that take place every week. We have athletes all over running for smiles, biking for smiles,” Schaefer said. “We have events through our Young Leadership Circle, a younger demographic of supporters who are challenged to find innovative ways to raise money for Smile Train to create more smiles."
Smile Train has a remarkable level of brand recognition for an NGO working in poor countries, and that's not accidental. Its fundraising ads are ubiquitous and very powerful. In 2008, a heart-wrenching film about a five-year-old Indian girl whose life was changed by Smile Train won an Oscar for best documentary short.
"We’re constantly finding ways to build awareness and find innovative ways to raise money,” Schaefer said. “One of them which we just we just celebrated was World Smile Day, which is the first Friday of October. It celebrates the smiley face that the graphic artist Harvey Ball created, so we had a large-scale event in Madison Square Park, New York right outside our headquarters’ front door to raise awareness of cleft. We had a great interactive installation there, where people could come by and donate a smile or donate what they could,” Schaefer said.
Lately, Smile Train has been gearing up for Giving Tuesday, which falls the week after Thanksgiving Day. "On Giving Tuesday, we are actually lighting the Empire State Building in Smile Train colors red and blue, so it’s very exciting for us," Schaefer said. "Our longtime supporter Christie Brinkley is flicking the switch.”
Recruiting celebrities is yet another area where Smile Train has excelled, and Brinkley is only one of a number of entertainment industry figures who publicly support the organization. (You can see the full list here.)
Meanwhile, Smile Train is hard at work pulling all the usual fundraising levers. Schaefer said, “We are continuing to look for new ways beyond traditional methods such as direct mail, advertising and grants. We’re very much focused on the digital space and social media. We have a nice, robust email program. As our donor base becomes younger, it’s much easier to communicate with them electronically rather than through direct mail, which is so much more costly."
“We have the smartest marketing team, I think, of any nonprofit,” Schaefer said. She credits it with using the web for fundraising in creative ways. For example, donors can create pages on the Smile Train site for fundraising. “So for instance, if it’s your birthday, you can create a page and email a link to your friends and family so they can donate to Smile Train in your honor for your birthday. We have people who do that as a memorial gift for someone who passed away, and so they create a special memorial page. It could be for someone who’s running in a race or doing a lemonade stand or doing a recycling campaign. We have a lot of community-based activities at schools, churches and synagogues."
Naturally, too, Smile Train hits up corporations for help, and with considerable success. It's skilled at building corporate partnerships and affinity programs, and at pulling in employee matching gifts.
Bequests also figure into the mix. Said Schaefer: “Smile Train did very heavy direct mail for many years, and as that donor base has aged with us, recently we’ve had many more bequests come our way, and it’s been a nice source of income for us.”
What about large events, like galas? Interestingly, this has not been a major fundraising tool of Smile Train. While the organization did have a gala in 2014, when it celebrated its 1 millionth surgery, that was a one-off. Schaefer doesn't see galas as yielding the most bang for the buck in terms of creating an efficient, sustainable fundraising model. "We have a small, lean team... Undertaking a gala takes tremendous resources."
One last secret to Smile Train's fundraising success—one that's true for many health nonprofits—is that a great many of its donors have been "touched by cleft in their lives," said Schaefer. Maybe it was sibling or a childhood friend.
"Later in life, they come into wealth, and they have this desire to give back in memory of the child a playground that they remember who had a scar up on their lip."