Jonathan Crown shows how small charities can thrive alongside the bigger beasts.

Ask some small charities for their views on the big charities surrounding them and you may get the impression of ‘killer sharks’ out there, constantly on the hunt for bigger shares of income, the oxygen of publicity and manpower.

Rather than be gobbled up, some small fish develop clever strategies to not just co-exist but actually thrive alongside the bigger beasts.

At Project Harar, a rural health service for people with facial disabilities that I founded ten years ago in Ethiopia, we think of ourselves as one such small ‘pilot fish’, proving exceptionally useful to the much larger Smile Train in a mutually beneficial relationship of resourcing, knowledge-sharing and quality control. With global headquarters in New York, working in 78 countries, and an annual income above $100m, Smile Train out-muscles Project Harar – a small charity with just three full-time field staff in Ethiopia and two coordinators in London.

Inspiration

I was inspired to found Project Harar in the eponymous ancient walled city in eastern Ethiopia, after an encounter with a street boy, Jemal, who survived noma, a devastating facial infection. After some investigation, I realised there were many thousands of children – particularly in rural communities – living with untreated facial disabilities which rob them of their place in society.

Africa can be proud of the improvements to its medical capacity over the past decade, but so much of it is concentrated in the major cities. Harar is famous for its exceptional coffee, but for a coffee farmer to take a child to hospital 500km away in Addis Ababa would cost more than his family’s entire annual income.

In response to this distressing need, we have developed a community-outreach and transport network. Our principal role is enabling the poorest, rural patients to access the best of the care available in their country.

Smile Train has been instrumental in building capacity in reconstructive plastic surgery, focusing on children with clefts – who comprise around 85 per cent of our patients. Their model – funding, training and equipping permanent local doctors – has enabled us to provide an all-year-round referral service to rural families, who benefit from safe, life-changing treatments.

We first engaged Smile Train in a concerted way when seeking to expand our own operations and respond to the recession, which we expected to hit individual and small trust income. To diversify income, we pursued the idea of cost-sharing.

Things developed tentatively in 2009, with Smile Train agreeing to make a per-patient contribution to our transport costs. We estimate this enabled us to care for 15 per cent more patients in 2010 and 2011.

With three years’ activity and a groundbreaking follow-up evaluation under our belt, we are now negotiating with Smile Train to find ways for them to make a bigger contribution towards transport and patient follow-up costs, cementing a winning formula.

Big impact

As much as we are a small partner within Smile Train’s global network, it is important that we remain true to our own ideals and confident in our own abilities. We are vigilant to threats to our core values; ensuring we maintain a strong division of labour between partners and a flexibility to cope with external changes.

In the last ten years we have reached 2,000 patients in one region of Ethiopia, meanwhile Smile Train has assisted 24,000 across the whole African continent. Our strength comes from a closeness to patients and our on-the-ground understanding of their needs and circumstances. Knowledge is power, after all.

Looking back on our developing relationship with Smile Train, the additional money it has brought has obviously helped greatly, but the most important aspect has been that they are listening to us and learning from our experience as a small charity trying to solve problems affecting rural Ethiopians.

Smile Train is recognising the same obstacles in other regions and asking for our ideas. This is one way our small charity may have a big impact as a ‘pilot fish’ in the coming years.

Jonathan Crown is a chartered accountant who founded, and now chairs, Project Harar Ethiopia