MP12 - Fundraising – Sustainability, Donor, Businesses, Subsidies

Co-ordinators Allen Dr Theresia Lightness Macha

Cost of Child Surgeries

It cost between $250 and $1500 per child for outreach, surgery and aftercare and it averages out at $800 per child. We feel its best to explain the nuances of costs via a short podcast below.

Donating in Africa - what we have found - more reading


We have found having clear goals and sticking to them the only way to avoid being overwhelmed when so many needy causes come across your desk.


Our goals are clear and ingrained in all we do and have evolved to


  • morechildsurgeries
  • targeted incentives for hospital medical workers
  • sustainable local hospitals


They are circular in that one goal feeds off the other. As you have morechildsurgeries you will have more income for staff and the hospital, which in turn allows morechildsurgeries


They are verifiable to all key players – sponsors in richer countries and partners, the medical workers in Africa. They are relatable because they are simple, measurable (and verifiable) and beneficial (pay and feelgood) to the sponsors, the medical workers and of course the focus, the children. They are common to all players – donors, doctors, cleaners, children, parents, community.


They are scalable as they are repeatable, relatable.


Finally the goals are non-political, non-religious, non …. – it’s hard to disagree with them and that in turn could foster major improvements in a community’s bedrock; its health and health systems, which in turn will improve its education and economy.


We have no mantra, no agenda and no motive other than morechildsurgeries of an improving quality that can change lives for the better (by any measurement).


Putting meaningless numbers up is just that, meaningless – that is why our focus is the name of a child, details of their surgery and the outcome of hopefully, one life change.


However, we do dream of those crazy numbers occasionally


999 surgeries then

999 surgeries per annum then

999 surgeries per annum at a 99.9 quality rate

999 surgeries per annum and 999 surgeries into another hospital then

999 surgeries per annum and 999 hospitals in Africa and then

999 surgeries per annum from 999 hospitals in Africa at a 99.9 quality rate

= 998,001 surgeries each year

998,001 surgeries each year at $200 per surgery and $100 per ancillary

= $200,400,300


Which should be enough to start asking - have we all done enough, is the job done?


We constantly look at the goal through the lens of


onemorechildsurgery and could it have been better.


We found we had preconceptions on colour and geography and poverty, based on what we learnt when we were young. This makes new steps hard. But if you take them, then new learnings open up your life and valuable new partnerships form.   


If you wanted to help an African child why would you not deal directly with an African doctor? Because……….. and your initial list of reasons why you cannot do that builds, ours did at first.


And from that, your first solution is help in your own country (noble enough). However if you still want to help the African child then you look for infrastructure that gives you comfort which is seldom African – maybe an African charity based in a  country you feel you know better and…….. within an instant, the cost of getting the help to Africa has lengthened in time dramatically and the value of your effort/donation diminished and finally the chance of helping has in all likelihood reduced.


There is enough wealth in the world to solve African medical poverty – but it’s not happening (yet). Why not? Communication?


Back to the child - more "noise" creeps into your mind and eventually your donation becomes too hard.


Yet a WhatsApp call, a photo and a direct bank transfer of $200 are all things you can do in 5 minutes, with basically no training.


You can talk direct to a community health worker or a doctor and save a life right now - if you really want to.




Communication - language and conversations. Google isn’t perfect and after the third sentence you have forgotten the content of the second and the flow or reason of your first because you are so focussed on understanding what each word means. Long agendas do not work.


It’s the same in reverse – keep it simple – keep repeating – google isn’t perfect and pictures and short written exchanges work better. Keep the meetings on zoom for relationship building.



it's a biggie - quality and safety

A big surprise it’s not a concept for all.


It’s not the most common outcome measure in many things.


Verification of money is popular; however verification of good child outcomes is not as popular.


In children’s surgery quality of outcome is hugely important.


We have largely set up our APP as a form a child safety.


Its not perfect but its a whole lot better than just winging it.


Here are additional rules and registrations we try to adhere to


  • Only the approved list of doctors will operate on the children we sponsor
  • Their qualifications medically - eg proof you receive when you engage them
  • Their specialities - what you as a hospital assess they can carry out competently



  • All operations are peer reviewed prior to starting surgery
  • All operations follow the WHO Surgical Checklist
  • All operations have an Aftercare Plan



  • That all operations have a before and after picture
  • That all children stay the time needed in hospital and are fed 2 meals a day
  • That any medications/prosthetics/plan for parents are given at time of leaving or in follow up - we will pay for all



  • All children are in fresh linen beds
  • All children we sponsor are in public wards (preferably for children)
  • All children we sponsor have a visit from doctor/nurse every day
  • All children are involved in painting/sport or music every day
  • All children are visited by Community Health Worker and a report sent



  • No child is photographed without clothes on
  • No child is photographed without parents permission
  • No child is identified with real name of village or name that goes public - change name and village
  • No culturally inappropriate pictures to be uploaded publicly

reinvent no thanks. CHWs are our glue

the smart and genuine money is finding what is working not reinventing it.

Community Health Workers  or Outreach workers work.

They are the glue that keeps the child's journey safe and progressing.

They are as important as the surgeon and the donor.

A really good video on the subject of CHW's or outreach workers is from Living Goods - we really admire their work:



If it’s not worth making a checklist, incentivising the checklist user, then it’s not that important. Without checklists that are easy to follow it's one step forward and two steps back.


Insisting on checklists makes the biggest difference to quality control.


A really good book to read or google Atul Gawande


A 5 minute video by him on reducing deaths in surgery


Perfection - we have found it important to strive for but not expect or require it.


We have found deal with what you have and keep trying to do it better.


We have found keeping a focus that 90% even 70% is ok, if the previous alternative were 0%.


Staying at grass roots – keeping it real, works for us. It may not work for you but staying connected gets a lot more out of with us and that is better for the childen.


Cost of money movement for poor people is horrendous. To send $50, a weekly wage - you lose almost all in fees our end, Africa end and currency exchange. Many do not have a bank account - can't afford it and how can they save?


Accountability we feel it’s a must if you really care about the children - we demand it. We have found it is a balance of respect - respect of the child and parents, respect of the surgeons and community health workers, respect of you and your contribution. Accountability eg reporting seems respectful it is done and then you pay for it.


Lack of identity – no medicare cards, passports or drivers license – how to identify


No phones – no email – no mail and a sick child. Churches work well for the jungle drums


Payments to workers – just because we don’t get paid or don’t want to be paid – doesn’t mean that a poorer person doesn’t want to be paid for their job. Well directed incentives really work if you want quality and consistency


Inertia and emotional connections - keep some distance if you want to keep to your goals - because things change and you may have to be strong and firm or change as well


Efficiencies of time – a foreign concept to many


Culture – wow, where do we start. All sides need to make allowances and respect the other position for it to work. And yes, we do too


Fun – its ok to be serious, but without fun and meaning its friggin boring


Mistakes – you maybe will never as many as we have made – get over them, keep going and don’t repeat them too often


Longshots – if it makes sense and the outlay is small – give it a go, do not fear failure if the potential upside is good. We back people just as we do in business.


Keep your cool - detective work – we have found treating problems as a game keeps you sane and not giving up when the going gets a little rough at times.