Wading through my Google Reader feeds over the past few weeks, a couple of questions seem to be reappearing when it comes to the non-profit arena.

Firstly there have been various articles in ‘Third Sector’, the magazine for charity professionals about the rise in running costs, and one in particular that criticises increasing salaries in some areas of the sector.

The second, on the excellent US blog ‘Philanthropy’, asked whether non-profits were
too ‘nice’, avoiding the normal tests and rigour that a commercial environment would bring over effectiveness, value for money and impact. The premise described was that since people in non-profits are simply trying to help others, the close scrutiny of their approaches and evaluating their impact should not apply.

So, two questions seem to recur, and I come across them often as I travel in the UK and East Africa:

• Are you efficient? How much of my money goes on really helping people? This question usually centres around how much money is spent on what people call ‘admin’, but also whether funds are being used to run frivolous fundraising activities, often with a low return on investment.
• Are you effective? How good are you at solving real problems? Not just applying a quick fix, but consistently and methodically applying a well designed strategy that has a genuine impact on real people’s lives. Oh, and can you prove it?

These are fundamental, crucial questions that any charity should be able to answer.

Of course charities, by definition, don’t exist for the benefit of people that work for them, or anyone else, they exist for the benefit of people in need. If they don’t focus on this, then in my opinion, they aren’t charities. They may do something worthwhile, something of value, but they are a different kind of entity. When I am choosing who to support, if someone in genuine need isn’t benefiting from my donation, I won’t give.

And so, for the sake of clarity, here are the Bridge2Aid answers to these two key questions…

Because B2A grew from very small beginnings, we have always been aware of the importance of using money well. Like all growing enterprises, we faced periods where money was very tight indeed. Tight to the point of ‘we’re not getting paid!’. The people involved in B2A from the beginning have always had a great deal of ‘skin in the game’. We have always watched every penny. Our trustees are relentless in making sure we spend well (and don’t take anything in expenses themselves). This gives us all a very focussed perspective.

This approach has led, I am pleased to say, to a spend of around 85% on charitable activity. This is among the best you will find if you benchmark us against other organisations, whether dental or not.

To add to this, we also raise around 10% of our income through the profits of Hope Dental Centre, our own clinic in Mwanza. This sustainable source of funds means that that our administrative and fundraising costs are almost completely covered. In short, pretty much everything we receive, we spend on charitable activity.

When it comes to effectiveness and impact, clearly there is a huge need that we at B2A are trying to address – 60% annual pain prevalence from caries in East Africa, 75% of the world’s population with no access to a dentist. Result – a lot of people in pain, with no hope of help.

Faced with this, we’ve worked very hard to make sure our approach is appropriate and will have a lasting impact:

• No quick fixes that just look good
• Creating sustainable access to emergency dentistry through training
• Impact as many people as possible – focussing on the meeting the most basic needs, for the highest number of people
• Working ethically – in partnership with governments to increase capacity

To sharpen our approach, our DVP (Dental Volunteer Programme) model has been continually improved since we began work in 2004. In addition, we have a comprehensive monitoring and evaluation framework which assesses the effectiveness of our training and the impact on communities after training has finished. Our volunteer trainers provide feedback on the quality and impact of their experience. With trainee success scores of 92% and volunteer satisfaction at 95% reporting good, very good, or outstanding, we’re pleased with what we’ve achieved, but remain driven to improve even further.

The questions raised by the two articles that caught my eye go to the heart of why people do and don’t support charities. As a CEO, I am acutely aware that I am spending other people’s money, and take that responsibility seriously, to create maximum effect. As a donor myself, I know what I want to see from my donation – responsible spending and real impact for people in genuine need.

Charities need to be accountable and open about how much we spend on charitable activity. Just as important, we all need to be open to have our methodology and effectiveness questioned.

In reality there is a limited pot of funding (some estimates say 7 UK charities chasing every £1). There is limited time to address the issues that the oral health community can have an influence on. We owe it to the millions of people in genuine need from untreated dental disease to be focussed, efficient and effective. They cannot afford for us not to be.

Seems impossible? Unimaginable, but unfortunately all too common, as I found out recently.

A couple of weeks ago I was fortunate enough to be invited to a dinner hosted by one of our foundation donors visiting from the UK. Taking place on the shores of Lake Victoria in Tanzania, where we are based, I sat next to a US surgeon who was on a short-term visit with one of the foundations. As well as working within our local city of Mwanza she was carrying out surgery in one of the district hospitals where our emergency dental training teams have worked. As we chatted, the subject turned to this training, which we’ve been providing in the Lake Zone.

Although I knew that complications from untreated dental disease could cause real problems for people living in this part of the world, the comments that my dinner companion made about her patients shocked me. Many needed major surgery to remove diseased tissue caused by untreated dental infection. As she explained, when a dental infection fails to ‘drain’ properly, the infection can track into the neck and then spread into the chest. This leads to tissue necrosis (tissue death) and septicemia (severe infection in the blood), often fatal. Treatment is to cut away the necrotic tissue and give high doses of antibiotics.

Sadly, as she reflected, this very rarely works. Once a person has reached the stage where infection is tracking into their neck, the prognosis is not good. It was one of the enduring memories, and frustrations, from her visit. She summed it up with a comment at the end of dinner:

“If I had my way, I would  train an army of people to take teeth out safely. What people need in the villages here is someone who can simply remove a diseased tooth, and stop the infection spreading.”

It is 2013 and people are still dying from untreated dental decay.

Today two of our teams will return from the regions of Musoma and Bukoba, where for the last 10 days they have been training local health workers (clinical officers) in emergency dentistry.  Next week there will be 12 medically-qualified people who are now able to treat their communities day in, day out, helping to prevent development of the hideous conditions that my dinner companion was seeing all too often.

The shocking reality is that three-quarters of the world’s population have no access to even the most basic dental services. Dental Caries – or tooth decay – is the world’s most common disease. It causes debilitating pain and drastically affects a person’s ability to function. Most developing countries don’t have enough dentists: for example, here in Tanzania there is one dentist for approximately every 100,000 people (in the UK  the ratio is 1:2,500). To make matters worse, these dentists live in cities and large towns, where only a quarter  of the population lives. This lack of access to pain relief for the majority leads to enduring suffering, loss of the ability to work and support the family, withdrawal of children from school to help support subsistence farming, and as outlined above, complications that can and do lead to death.

The idea of ‘access to a dentist in every village’ is Utopia. What we believe is necessary, and where our partnership with the Tanzanian government is leading the way, is to train medical personnel already deployed to these rural areas to provide a basic, pain relieving service, combined with oral health education. We’re extending that partnership elsewhere in Africa now, backed by the support of many western dental professionals. Obviously oral health education is important to prevent future problems. We could also raise the number of dentists available to treat people in towns and cities. But above all we must focus on relieving dental pain, through training, so that local medics can carry out safe tooth extractions. Otherwise, literally, a toothache can kill.

To continue this work, we need you! Our plans to expand this year will only be made possible if we can find the volunteer and financial support to make it happen.

If you are dentally qualified, you can volunteer for one or our training teams. You could help us by raising funds to make the training possible for more people, or you can make a difference through a regular financial donation. Whatever your contribution, I hope you’ll join with us and play your part in making death from untreated dental infections a thing of the past.

I don’t know about you, but I often find that it’s the small things that are so revealing about an organisation’s culture.

Last week I travelled to Dar es Salaam for a couple of meetings, as well as attending the farewell garden party for the outgoing British High Commissioner. During the day I took advantage of the quiet time and spent lunch time working in my hotel room.

Having eaten lunch, I set out to deposit the room service tray outside my hotel room door. As I opened the door with my tray, a maintenance man was making his way down the corridor. I nodded to acknowledge him, but instead of nodding and walking past he made a beeline for me and quickly collected my tray.

Very courteous I thought.  But he wasn’t done.  Rather than placing the tray on the floor next to my door for someone to pick up later, he turned and headed off in the opposite direction, towards the service elevator where he placed my tray.

I have stayed in this hotel a lot over the past 5 years and what I have noticed continually is the complete commitment at every level to customer service.  This isn’t limited to a smile or hand shake at the door – it penetrates every level of the organisation.

The maintenance man is a guy whose principal responsibility is to fix things.  He was no doubt off to fix a squeaky door, blown light bulb or leaking air conditioning system.  But rather than walk past me, he understood that every member of the organisation has the responsibility to look after the guest.  He took responsibility for this and went beyond my expectation in doing something very simple, and yet very powerful, to make sure that the values of the organisation that he had been taught were lived out and demonstrated at every opportunity.

This is an aspect of the Bridge2Aid culture that I am very proud of.  This week we have welcomed another volunteer training team into Tanzania.  Over the year we have hosted so many of these and one of the common themes in the feedback, which makes me very happy, is the positive impression the Bridge2Aid team create for our volunteers.  It is something that everybody has responsibility for at all levels of the organisation.

It is the simple things that will make or break your business (or organisation).  Last week was a great reminder for me that those simple things are the responsibility of anyone and everyone working within the team.

The last three weeks has been somewhat of a blur!

I began 2013 with a 10 day trip to the UK, meeting with the UK based team, trustees and advisors – kicking off the year with a lot of discussion of our 3 year plan.

After getting home, we then welcomed Shaenna our Head of UK and Alan our Chairman to Tanzania, where we spent 3 days away with the Tanzanian Management and wider team, including leadership and management training, a trip to the Serengeti, and the discussion of that all important plan.

I can’t tell you how powerful it has been to document the details of what we intend to achieve, state some of the ways we will do this, as well as the challenges we’ll face, and then see the team go to work on the plan.

I am very excited about what we’ll achieve together over the coming months, and also about communicating the aims to others in the coming month.

The key element for me as we’ve begun communicating the plan is the ALIGNMENT it has created.

If you’ve ever seen a really good tug of war team in action (forgive me non-British readers), you’ll know what I mean. I chatted to Alan about this during our time away together, and he recounted the story of a Tug of War (ToW) team that had turned up at a big rugby festival where there was a Tug of War competition. Sizing up the ToW team, the rugby players, who were much larger and stronger than their competitors, were very confident of a win. The resulting contest however, ended quickly with a resounding victory for the ToW team, and the big boys on their backsides.

They didn’t win because they were bigger, they won because they were aligned.

Having held the initial pull from the rugby players, the ToW team then began their well rehearsed and very well co-ordinated effort. Pulling together, as a team, pull by pull, their focussed, aligned and unified effort was more than a match for the greater weight, size and strength of the other team.

Some lessons from this for me have been:

• Know the goal – effort that isn’t focussed in the same direction dissipates quickly. Knowing the eventual goal gives the team the opportunity to use their creativity to achieve more and spot problems.
• Know the role – with a clear, written role for each person, and an understanding of what is expected of them, people are released to play their part.
• Keep in time, listen, work together – the heart of alignment, this comes with time, trust, mutual appreciation and a willingness to work together. Relationships are crucial.

Bigger doesn’t necessarily mean better – what counts is alignment.

After 3… PULL!