About this page
GiveWell aims to find the best giving opportunities we can and recommend them to donors. We tend to put a lot of investigation into the organizations we find most promising, and de-prioritize others based on limited information. When we decide not to prioritize an organization, we try to create a brief writeup of our thoughts on that charity because we want to be as transparent as possible about our reasoning.
The following write-up should be viewed in this context: it explains why we determined that we wouldn't be prioritizing the organization in question as a potential top charity. This write-up should not be taken as a "negative rating" of the charity. Rather, it is our attempt to be as clear as possible about the process by which we came to our top recommendations.
A note on this page's publication date
The last time we examined Smile Train was in 2009. In our latest open-ended review of charities, we determined that it was unlikely to meet our criteria based on our past examination of it, so we did not revisit it.
We invite all charities that feel they meet our criteria to apply for consideration.
The content we created in 2009 appears below. This content is likely to be no longer fully accurate, both with respect to what it says about Smile Train and with respect to what it implies about our own views and positions. With that said, we do feel that the takeaways from this examination are sufficient not to prioritize re-opening our investigation of this organization at this time.
Table of Contents
We investigated Smile Train because they appear to focus entirely on supporting corrective surgeries to repair cleft lips and palates for children in the developing world. For more on this cause, see our report on the cause of developing-world surgery.
However, based on materials we found on Smile Train's and in its IRS Form 990 for 2008,1 we do not have a clear picture of the impact of Smile Train's activities.
The following chart shows our interpretation of Smile Train's program expenses by area.2
We explain what we know about each program below.
Activity 1: treatment partnerships
It appears that Smile Train funds developing-world doctors to perform surgeries, while requiring them to adhere to its Safety and Quality Improvement Protocol and to participate in Smile Train Express, an online patient record-keeping database.3
The Smile Train Express database is not accessible to the public, so it is unclear exactly what participation consists of. It is also unclear to us how Smile Train audits and enforces adherence to its Safety and Quality Improvement Protocol.
The final report from grantees4 includes questions about financials and activities carried out, as well as open-ended questions, but it is not clear to us how (or whether) Smile Train (a) ensures that its grantees are carrying out the activities they say they are and (b) checks on the quality of these activities.
Activity 2: treatment grants
Treatment grants are "one-time grants for medical professionals, hospitals, and organizations that provide treatment for poor children with clefts in developing countries, but who may not meet the requirements to become a treatment partner."5 They do not appear to include the same requirements as treatment partnerships, but both final reports from grantees appear identical in form.6
For this program, similar to treatment partnerships, we wonder how (and whether) Smile Train (a) ensures that its grantees are carrying out the activities they say they are and; (b) checks on the quality of these activities.
Activity 3: education grants
Smile Train funds "doctors, hospitals and medical schools to develop and deliver advanced in-country cleft lip and palate teaching and education programs."7 It is not clear to us how (or whether) Smile Train monitors the quality of this training or its ultimate impact on surgeons' skills.8
Which activities are focused on?
Smile Train does not specify on its website how much of its funds go to each of the activities above. Page 3 of its IRS Form 990 for 2008 clarifies the picture partly but not fully, listing:
- $40.5 million on "providing free reconstructive facial surgery for indigent children with cleft defects worldwide," of which $12.6 million is grants to other organizations. We would guess that the $12.6 million corresponds to Activity 2 above, while the remainder corresponds to Activity 1.
- $3.9 million on "free cleft-related training and education for doctors and medical professionals." We would guess that this corresponds to Activity 3.
- $23.6 million "provides educational materials on cleft lip and palate for free to anyone interested in this birth defect." It is unclear from Smile Train's website what exactly this involves, though this may correspond to "Public Awareness Campaigns," which include information for American families with children with clefts, mass media campaigns, and production of film documentaries.9 This activity accounts for over 30% of total program expenses.
We also cannot identify items on the tax filing corresponding to the research grants10 or treatment and education grants11 programs, and would therefore guess that these two programs receive only small amounts of funding (as they are not included in the top 3 activities on the tax return).
We do not have the information we would need to be confident in the effectiveness of Smile Train's programs, particularly regarding quality control of surgeries and education in the developing world. We also do not have a clear breakdown of how funding is spent by program (as over 30% of program expenses are spent on a program that we can't identify a description for). We have contacted Smile Train for clarification, but have not spoken with them as of yet.
More on this general category of charity at our report on developing-world corrective surgery charities.
- GiveWell. Program report: Developing-world corrective surgery
- Smile Train. Final grant report for education and training grant recipients (PDF).
- Smile Train. Final grant report for treatment partners and treatment grant recipients (PDF).
- Smile Train. IRS Form 990 (2008) (PDF).
- Smile Train. Website:
- Cleft research offers hope for a long term solution. http://medpro.smiletrain.org/medpro/programs/research_grants.htm (accessed April 20, 2010). Archived by WebCite® at http://www.webcitation.org/5p8etx8DU.
- Education and training grants. http://medpro.smiletrain.org/medpro/programs/education_grants.htm (accessed April 20, 2010. Archived by WebCite® at http://www.webcitation.org/5p9eRZJMw.
- Financial information. http://www.smiletrain.org/site/PageServer?pagename=financials (accessed June 9, 2010). Archived by WebCite® at http://www.webcitation.org/5qMgEkOzt.
- Safety and quality improvement protocol. http://medpro.smiletrain.org/medpro/safety/safetyprotocol.htm (accessed April 20, 2010). Archived by WebCite® at http://www.webcitation.org/5p8cUHtBg.
- Smile Train Express database. https://smiletrainexpress.org/index.html (accessed April 20, 2010). Archived by WebCite® at http://www.webcitation.org/5p8cevFDv.
- Treatment and education grants. http://medpro.smiletrain.org/medpro/programs/treatment_education_grants… (accessed April 20, 2010). Archived by WebCite® at http://www.webcitation.org/5p8etxsEA.
- Treatment grants. http://medpro.smiletrain.org/medpro/programs/treatment_grants.htm (accessed April 20, 2010). Archived by WebCite® at http://www.webcitation.org/5p8dQPnSe.
- Treatment partnerships. http://medpro.smiletrain.org/medpro/programs/treatment_partnerships.htm (accessed April 20,2010). Archived by WebCite® at http://www.webcitation.org/5p8cNXuLI.
Smile Train, IRS Form 990 (2008).
Data from SmileTrain, IRS Form 990 (2008), Pg 3, Part III. Smile Train lists 3 program areas: Treatment, Training, and Public Education. The document specifies that Treatment includes $12,592,190 for "grants and allocations," which we have allocated to the category, "Treatment grants."
- Smile Train's description of the program: "The Smile Train has supported free cleft surgery and related treatment for children around the world. All of these surgeries are performed by local doctors that The Smile Train has empowered through various partnerships and grants. As our treatment programs grow rapidly around the world, we never forget that safety and quality of care is always our #1 priority. Our Medical Advisory Board has developed a strict protocol that all of our treatment partners follow. And, we constantly monitor the quality of care we provide. Treatment Partnerships involve an on-going relationship with The Smile Train and require a long-term commitment providing free surgical treatment for children with cleft who would not otherwise be helped. Treatment Partnerships significantly increase the number of cleft surgeries performed at a qualified hospital/center." Smile Train, "Treatment Partnerships."
- Safety and Quality Improvement Protocol: "All of The Smile Train's treatment partnerships are required to follow The Smile Train's Quality Improvement Protocol, which lays out the basic elements needed to insure safe surgeries and to provide for the ongoing review and improvement of the quality of care." Smile Train, "Safety and Quality Improvement Protocol."
- Smile Train Express database: "Treatment Partners are reimbursed based on the number of patients treated. All Treatment Partners are required to participate in Smile Train Express, an online patient record-keeping database." Smile Train, "Smile Train Express Database."
Smile Train, "Final Grant Report for Treatment Partners and Treatment Grant Recipients."
Smile Train, "Treatment Grants."
Smile Train, "Final Grant Report for Treatment Partners and Treatment Grant Recipients."
Smile Train, "Education and Training Grants."
The grant reporting template is Smile Train, "Final Grant Report for Education and Training Grant Recipients."
"Thousands of Americans come to The Smile Train for information on how to find a good cleft team and how to take care of their newborn baby with a cleft. Through websites, newspapers, radio, TV, public service announcements, documentaries, public relations, etc., we do more to raise public awareness about clefts both in developing countries and in the United States than any other organization in the world. More than 2 million Americans watched our Oscar®-winning documentary, Smile Pinki, on HBO and it was broadcast to 900 million people in India. Over the past 10 years, our public awareness efforts reached more than one billion people." Smile Train, "Financial Information."
Smile Train, "Cleft Research Offers Hope for a Long Term Solution."
Smile Train, "Treatment and Education Grants."