Opinion: How trust-based philanthropy drives impact

In global health, funding is essential — but it’s only the starting point. Solving systemic challenges such as access to safe surgery requires more than money; it takes trust. Too often, NGO-corporate partnerships rely on checklists, short-term grants, and rigid budgets. Real impact — sustainable, scalable, lasting — depends on trust-based philanthropy that adapts and responds to realities on the ground.

Since 2019, Operation Smile and the Baxter Foundation have built a partnership rooted in trust — supporting not just surgeries, but local health systems, comprehensive cleft care, and stronger communities.

How it started

This partnership didn’t start with a prescriptive plan. It started with a shared vision, values, and mutual respect.

By 2018, the Baxter Foundation was undergoing a strategic shift from distributing small-scale grants mostly in the U.S. to making longer-term, globally focused investments designed to drive systemic change and build community resilience. We weren’t looking to fund isolated activities. We were looking to partner with organizations deeply rooted in their geographies and trusted by their communities.

At the same time, Operation Smile was seeking a partner that could fund a bold, long-term vision — not just performing cleft surgeries, but establishing a new comprehensive care hub in a rural area where access to surgery was virtually nonexistent. That vision required more than a one-year grant — it demanded multi-year investment, infrastructure development, and trust in local leadership.

India was a natural choice. Baxter has a long-standing presence there, and Operation Smile had already built strong partnerships with local health systems. When we aligned on the idea of launching a center in Durgapur, it became clear that we weren’t just aligned in mission, but in mindset.

How it’s going

What began as a cleft center in Durgapur has grown into a dynamic, evolving model of health system strengthening.

Initially, the plan was simple: set up one surgical center and perform cleft procedures. But five years in, the project looks nothing like the original blueprint, and that’s by design.

Our partnership’s flexibility and innovation allowed us to respond to real-world needs, adding nutrition programs to tackle malnutrition, speech therapy to restore communication, and dental and orthodontic care for long-term oral health. We’ve also trained local clinicians to lead, creating sustainable, locally driven solutions that strengthen health systems.

We also soon realized that many patients couldn’t travel long distances to Durgapur for follow-up care or to receive services such as speech therapy and orthodontic care. In response, we launched spoke centers in Siliguri and Hazaribagh, offering comprehensive care closer to home.

Through this hub-and-spoke approach, we have connected over 500,000 patients and their families to the services they need.

What we’ve learned

1. Trust is the foundation.
Our partnership works because we trust each other to lead, adapt, and innovate. Instead of strict reporting, we’ve had honest, two-way conversations. Rather than penalizing pivots, we’re encouraged to learn and evolve.

2. Flexibility enables innovation.
When COVID-19 hit, we adapted by extending timelines, reallocating funds for urgent needs, and launching programs such as nutrition support and distributing 100 oxygen concentrators during a critical shortage. This kind of agility isn’t possible in a rigid grant structure; the partnership feels like jazz: clear purpose paired with creative freedom.

3. Collaboration beats silos.
Partnerships are stronger when they include government systems, academic institutions, and local corporate social responsibility networks. This work extends beyond any one organization; it requires convergence.

4. Local leadership drives sustainability.
By investing in education and workforce development, we’re building local capacity that will outlast any single grant cycle and provide care that communities can trust.

5. Data matters, but context matters more.
We’ve worked together to develop strong measurement systems, but we’ve also allowed context to guide us. Sometimes, the most important indicator is what patients and providers are telling us in the field.

6. Trust-based models can scale when tailored thoughtfully.

Not every country or community is the same. Scale must be rooted in trust, local leadership, and cultural understanding. Listening and adapting care models to local needs is essential for lasting, system-level change.

What we’re building next and why it matters

The Durgapur hub is now an efficient model, and we’re scaling it.

Operation Smile is replicating the hub-and-spoke system in Karnataka. Each hub doesn’t just perform surgeries — it serves as a training ground for surgeons, nurses, and allied health professionals. In Bangalore, for example, we’re now hosting surgical fellows from India and abroad as part of a one-year comprehensive cleft training program.

This expansion reflects Operation Smile’s ongoing commitment to making a lasting impact by investing in local leadership, training, and partnerships — such as the multiyear collaboration with the Baxter Foundation. Rather than simply establishing treatment centers, we are focused on strengthening surgical ecosystems that bring care closer to home. Through this approach, we aim to enhance access to care and foster resilient, locally owned systems, ensuring sustainable impact long after the grant cycle ends.

The call to action: What we want others to take from this

• To funders: Don’t wait for a perfectly polished proposal. Invest in partners who are trusted by their communities and have the agility to lead. Be willing to go first and give partners the room to grow by establishing open lines of communication.

• To NGOs: Pitch what’s needed, not what is flashy. Find partners who value your insight and are ready to share both risk and responsibility. Build data systems that help you track and tell your story, but stay grounded in the day-to-day realities of your work.

• To all of us working in global health: Let’s not over-theorize partnerships and start practicing real collaboration. When trust is the starting point, everything else becomes possible.

The partnership between Operation Smile and the Baxter Foundation reminds us that in the face of overwhelming global need for resilient health systems and surgical access, the most powerful innovation is often the simplest: trusting one another to lead together.