Smile Train

My wife and I spent a night last week learning about Smile Train, a non-profit that provides free cleft surgery to poor children throughout the world. We’ve made donations to them in the past (including this one), but we never really knew much about them. All we knew was that a $250 donation could pay for an operation that would transform a child from this:
Shiva, before surgery

to this:

Shiva, after surgery

and that seemed like an awfully good way to spend $250. (You can read about this little girl Shiva’s story here.) I had never thought at all about how Smile Train managed to make this happen.

A night with Smile Train convinced me that this is one of the most amazing organizations around.

Consider these two facts:

1) They have a total of 24 employees worldwide.
2) They are responsible for over 190,000 cleft repair surgeries since the year 2000.

How in the world can so few people accomplish so much good? By approaching their problem in a way that is very different than others have thought about it before.

The typical model for cleft repair in developing countries has been to convince U.S. doctors and nurses to volunteer a week’s time, fly to a country, and do 80 surgeries. This turns out to be an expensive way to get the job done, and it also isn’t easy to find doctors to volunteer. Smile Train instead partners with and trains local doctors to do the surgeries, which turns out to be far more efficient.

Smile Train isn’t just smart about how it delivers the surgeries, it is smart about how it attracts donors. It covers all of its non-surgery costs through contributions of its board members. So every dollar that a donor provides goes directly to surgeries. As a donor, this feels really good. I like to think about my money going for surgeries, not office parties. Being able to link a $1,000 donation to four lives changed is a powerful motivator. (One thing they don’t do, but maybe they should do, is literally link each $250 donation to a particular child and send before and after pictures.)

They also have created amazing software to teach doctors how to do the surgeries, you’ve got to take a look at it to believe it.

There was one thing that impressed me more than anything about Smile Train. I sat at a table with one of the people from Smile Train, DeLois Greenwood. A nurse by training, she has been involved with cleft surgeries for 25 years. One could easily imagine that, by now, she would have become jaded or hardened. But when they showed a video about the life’s work of one of their partners, Dr. Hirij Andewalla, tears were streaming down her face. That more than anything convinced me that was a charity worth supporting.

Juliana, beforeJuliana, after
(Read about Juliana.)

(Read about Kabir.)

Peter D

Curious.. What did the eBay auction close at? it's more than gone now..

Great charity.. Anyone considering donating should check their company's benefits to see if they'll match. Mine does up to 2500 a year..



I am underemployed at the time, but couldn't resist the urge to help. My contribution is on it's way.

To think that for the price of a night out on the town I can make such a dramatic difference in a child's life - it's rather amazing.

Thanks for sharing,


Fred Flintstone


You have mentioned before that no one recognizes you in public. I also attended the Smile Train dinner and didn't recognize you. You probably should have stood out because the average age of the attendees was probably close to 60.

I also thought their presentation was very effective.


I've seen the 100% of donor dollars going to care with other organizations. Even if the organization is good, the gimick annoys me. They are still collecting the same amount of money, buy playing with words. What I'm suspicious of is that % of donated money that reaches a cause is a major ranking factor for charities. If this gimick spreads will groups start using it to say that board donations aren't really donations so that they can fake that number.

I do think Simile Train is a great organization, but I do hope they stop the spread of this silly advertising gimick.


BSCI, if it wasn't for silly advertising gimmicks, marketing as we know it would disappear.

We can't have THAT, can we?

Seriously, it's a gimmick but it does show that they are paying serious attention to efficiency.


It doesn't show anything about efficiency. Their overhead to be 2% or 20% of their total budget as long as their board members can cover the whole thing. If anything it make you need to dig an another layer down before being able to figure out the true efficiency.

Advertising gimmicks are fine, but for Levitt to say that it feels better to have every dollor go to a surgery shows that he fell for the gimmick.


I'm not sure it's a gimmick. The average contribution might not be more efficient, but the marginal contribution is. The obvious flaw in my reasoning is if overhead is always paid first anyway, in which case just about every charity spends 100% of the marginal contribution on surgeries or whatever it does.


bsci still has a point. The problem is that they are comparing themselves against other organizations who use different accounting standards. Many different systems would be fine if everybody used the same standard. Cash is fungible: obviously, most donors could care less if the donations from "board members" or the guy down the street are being used for overhead costs.
The problem is that (now) they don't. They are simply "marketing" by making it appear that something substantial is going on.
Personally, I would like more organizations to market themselves off of meaningful indicators. E.g. what is the end (net) benefit of the marginal donation dollar to each organization. Isn't that what we, as donors, want to base our decisions off of? If you ask me too many are relying on marketing gimmicks and misleading numbers.
Does anyone know of a reliable source of information that can be used to compare different nonprofits -- not for budget allocations -- for actual effectiveness?



Before I give a dime I do some research at The following information also can be obtained from the IRS for $1.

Uses of Funds as a % of Total Expenses

Use your mouse to place the cursor over the the Pie Chart to see each value
Programs: 76% Fund Raising: 23% Administrative: 1%

Total income $24,195,634
Program expenses $23,188,460
Fund raising expenses 7,135,933
Administrative expenses 266,444


Total expenses $30,590,837


Expenses in Excess of Income (6,395,203)
Beginning net assets 46,219,637


Ending net assets 39,824,434
Total liabilities 8,793,363


Total assets $48,617,797


Note 1: According to the organization's 2004 audited financial statements, ST claims that 100% of all contributions received from individuals who are not members of the Board of Directors or are otherwise affiliated with the organization are used by ST for program expenses. The stated reason for this claim is that members of ST's Board and others affiliated with the organization have in the past donated funds specifically designated to cover administrative and fund raising costs.

Note 2: According to ST's 2004 audited financial statements, the organization received $5,203,939 in donated services. Of this total, $3,816,079 was in treatment contracts, and $1,387,860 was in medical advisory fees.


Michelle Cruz

Gimmick or not, I like that I can make a donation and know where all my money is going. Let the board worry about efficiency.

Rose Pimentel

It is so heartwarming to see the people here who are dedicated to doing something good, but even more heartwarming to see the sophisticated thinking being utilised.

I've worked for charities for years and I have always felt that the '0%' claim is damaging and misleading. Smile Train and others who claim this are manipulating the facts to dupe their audience. I refer you to this article -

By no means do I want to discourage you from donating; far from it. I just want those who give to make informed decisions, as knowledge is the route to effective giving.

It is hard to overstate the difference this surgery will have on a child's life, but when I investigated this charity I found myself questioning their tactics, so instead I donate to Operation Smile, who have a excellently documented track record of performing this over 25 years.

Craig Laub

With Smile Train's "0% overhead & fundraising" claim in mind, I thought I'd investigate the "$250 per operation" claim.

In the fiscal year ending 6/2006, they took in $43,917,066 in "direct public support" (IRS Form 990, Part I, line 1a). They did about 41,667 surgeries (my reading of their chart at That's $1,054 of contributions per surgery. Form 990 Part III shows a "Total of Program Service Expenses" of $29,580,700, or 67.4% of contributions (so much for the "...every dollar of your tax-deductable donation goes DIRECTLY AND IMMEDIATELY towards helping children" claim in the solicitation on my desk). Of the $29,580,700, 72.7% goes to "Treatment", 2.1% to "[Doctor] training" and 25.1% to "Public education". So for a $1,054 contribution, they perform one surgery ($798 for treatment + training) and do $265 of "Public education". I find it interesting that "Public education" went from $715,869 in FYE 6/04 when they were a private foundation (see Form 990-PF Part IX-A) to $6,381,427 in the next year, their first as a public charity, and has gone up for FYE 6/06, whereas "Treatment" went DOWN from $20,971,913 in FY04 to $10,243,961 in FY05. Education or fundraising?

Applying the same sort of analysis to Operation Smile: For the FYE 6/06, they did 9,334 operations (from their annual report). They received $18,047,884 in private, corporate, foundation, and government donations, not counting donated services and supplies or "other revenue". That's $1,934 per operation ($1,500 for treatment + $201 for Doctor training = $1,701 and $232 for development of local, eventually self-sustaining, offices). They claim $240 per operation.

So it looks like both organizations stretch the figures considerably, but Smile Train does do more surgeries per donor dollar, so I guess I'll give to them.


Monica Bohlman

Very interesting. The ad campaign for these charities is everywhere I look. In magazines, in my local paper, etc., and they are not small ads. They immediately touch one's heart. I also have been doing numbers in my head and they haven't been adding up either. I tried to research how much this advertising actually costs but really couldn't get a handle on it. I am thinking they must be spending about as much in advertising and fundraising as they take in, yet they pride themselves that someone other than donors are paying for it. I think this is very duplicitous. I believe they probably spend more money than other charities on these activities and what difference does it make whther board members or donors are paying for it. The bulk of the money spent on fundraising and advertising would be better spent on fixing cleft lips and palates. Because of this I simply can not support these organizations no matter how good the work is they do. They are playing games and there are too many good charities that play it straight and actually keep there costs down.


J. Kline

Thanks all for doing the research and posting the results. Because of your time on the web, and for the cause, I just covered the cost of one surgery. My wife said to give someone a smile for Christmas so we did : )



Speaking of the ellusive "100%" charity (where one's entire donation is spent on the charity's area of charitable focus)...

I grew up Mormon, and my wife is still what we call "active" and relatively orthodox. Mormons tithe 10% of their "increase" to the church. On the donation slips the church provides, there is a section that allows you to allocate funds. Choices include: Tithing (a general church fund used to build stuff, run schools,pay staff [but not clergy] etc.); Fast Offering (used to purchase food and other necesities for any needy person who applies to a Mormon bishop for help); Perpetual Education Fund (basically a microloan program for college and professional training in developing countries); and a few others. One category in particular, the Humanitarian Fund, has always interested me. The church apparently uses this exclusively for disaster relief and other large-scale aide projects all over the globe.

Now, here's where it gets interesting: I am not a believing Mormon, but I still think it's good to tithe. So does my wife. On her donation slip, like all "orthodox" Mormons, she pays her tithing into the general Tithing fund of the church, which funds all of the church's day-to-day operations, including the staff that runs Bishop's storehouses (funded through Fast Offerings) and the humanitarian aide programs. It is well-understood among church members that a "real" tithe should be allocated directly to the Tithing fund on the donation slip. But I think that gives us non-believers a nice way to get a dollar's worth of charitable work for each dollar of our donation. I still tithe, but I allocate my whole 10% into the church's Humanitarian fund, which is essentially, for us non-believers, a 0% overhead charity.

Yeah, yeah. I know all the true-believers general tithes are funding the non-believers' 100%-charitable warm fuzzies. But I still think it's an interesting "loophole" to the whole "100% of dollars going to charity" thing.


Keating Willcox

I really like this efficient charity. And I really like Sam's note, explaining exactly what stuff costs and how much goes to medicine. Believe me, there are tons of charities that really keep most of their monies for fund-raising.

When asked about giving to the United Way, I mentioned that the heads of the United Way and Red Cross each had a salary north of $600,000. The Salvation Army, $35,000. I give to the Salvation Army.


As someone who was born with a cleft and has also had a child with a cleft, I say THANK YOU! to organizations like Smile Train and Operation Smile. A first impression is so important and therefore, such an immediately obvious defect as a cleft is a severe handicap. In the US, we have marvelous Craniofacial Teams, that guide families through the myriad of problems which clefts can cause; but these children in underprivileged countries have no such care available to them. They are hidden away, rejected, ridiculed or WORSE~and there is nothing they can do to change that! But, these dedicated professionals can.

Please give to any/all of these reputable charities. For the good that is done, the cost is so minimal! I estimate that the cost for my child's care (surgeries, speech therapy, orthodontia, etc.) over the years was probably about $50,000. Granted, these children will not receive the kind of comprehensive care that we have here, but they will receive care that will allow them to function more normally in society. Trust me, YOU WILL CHANGE A LIFE!


J Rosenberg

Please send me your EIN# so that I may forward a donation.

Why do your websites make it so difficult to contact you?

mikey v

yes, admittedly, i've become more and more jaded about donating to charities over the years. when you hear about the CEO's of so called non profits making in the millions as compensation, it makes you sick. i've also donated to st. judes in the past and needless to say, i will never be donating to st. judes again. whatever i donated, it feels like they've used that money to send me emails, letters, phone calls over and over again. instead of using the money to heal a child, they've decided to use the money to solicit more money. they're almost as bad as telemarketers in my book. likewise with the leukemia foundation. i donated since a couple friends were running in their TEAM IN TRAINING program. now, im much more of a believer in PAYING IT FORWARD. i think using the money to help a family in need and asking for them to help someone else in return is a great way to spread good will. i must admit, this smile train org. intriques me a bit. i may just end up donating although im much more cynical about charitable organizations than i was before.



Thanks for introducing us to this wonderful organization.
My biggest hindrance in giving charity is that I want to know how exactly my charity money is being spent. In Smile train I understand this. My donation for one operation is on its way. Thankfully my employer matches this donation too.