Operation Smile has been working in Malawi since 2012, providing care for children born with cleft conditions. Since then, we have delivered life-changing surgeries to over 3,230 patients.
This work has been possible with the support of approximately 330 dedicated Malawian medical volunteers who offer their time and talent to improve the health and well-being of children born with cleft conditions. Through our network of robust partnerships with local hospitals, we provide cleft care and burn care.
But there is more to do.
During Fiscal Year July 2025-June 2026, Operation Smile will invest $1.2 million to deliver life-changing surgical care for 520 patients and provide training for over 390 health workers.
Over the course of the following five years, Operation Smile will provide more than 2,700 patients with surgery and over 4,000 patients with comprehensive care services.
Cleft Care Programs
Over the course of the year, Operation Smile will deliver surgery to 520 patients, which will include 320 patients living with cleft conditions. We will expand comprehensive cleft care in Malawi by providing oral health care for 180 patients, nutrition care for 350 patients, psychosocial care for 300 patients and speech therapy for 120 patients. Approximately 120 patient advocates will support Operation Smile’s patient recruitment campaigns.
Education Programs
Partnering with Malawian medical leaders and enabling access to education opportunities will allow local health systems to provide care to a greater number of patients in need of cleft care. Operation Smile will provide training opportunities to over 390 providers working in the fields of surgery, nursing, biomedical engineering, burn treatment, pain management, nutrition, oral health, pediatrics, speech therapy, anesthesia and patient advocacy. We will continue to build expertise in high-quality cleft care through our competency-based pathways. This fiscal year, one surgeon will graduate from our Cleft Surgery Training Program (CSTP). Additionally, we will have three additional trainees progressing along Operation Smile’s surgical education pathway this year.
We will sponsor new fellows through the College of Surgeons of East, Central, and Southern Africa (COSECSA) and deliver Basic Life Support training in collaboration with the American Heart Association. Operation Smile will train nurses specializing in anesthesia and burn care, as well as those working in the operating room and post-anesthesia care unit. Operation Smile will also equip 100 caregivers in Malawi with the knowledge and skills needed to support their children throughout the cleft care journey.
THE NEED
0.7 per 1,000 births. In Malawi, the cleft prevalence rate is 0.7 per 1,000 births.
Out-of-pocket expenses. 22% of the population in Malawi is at risk of catastrophic expenditure for surgery, while 67% faces impoverishing expenditure for surgical care. With 70% of the nearly 20 million population falling below the poverty line, many patients with cleft conditions face financial barriers to receiving the care they need. 5.4 million Malawians face chronic food insecurity.
Limited access to surgery. Malawi performs just 372 surgical procedures per 100,000 population. This falls short of the target set by the Lancet Commission on Global Surgery of 5,000 procedures per 1,000 people. Malawians are often unable to reach surgical care due to a lack of medical facilities, inadequate basic amenities and insufficient diagnostic equipment.
Shortage of providers. The health workforce shortage contributes to the lack of access to care. Compared to high-income countries, which have an average of 11.4 nurses and midwives per 1,000 people, Malawi faces a shortage, with just 0.4 nurses and midwives per 1,000 individuals. Malawi has 0.4 specialized surgical workers per 100,000 population, which is much lower than the Lancet Commission’s target of 20 providers per 100,000 people.
BRINGING CARE CLOSER TO HOME
To ensure that every child has access to care close to home, we equip the providers within our patients’ communities with skills and resources to deliver high-quality care. We strengthen health system capacity by harnessing the talent and resources concentrated in larger cities, the hubs, to train providers in under-resourced areas, the spokes, where access to care is most limited.
In Malawi, Operation Smile has hubs at the Kamuzu Central Hospital in Lilongwe and the Mercy James Center at Queen Elizabeth Central Hospital in Blantyre.
We have spokes at Mzuzu Central Hospital in Mzuzu and at Zomba Central Hospital in Zomba.
We also work with nine district hospital partners.
FIVE-YEAR VISION
Operation Smile Malawi aims to provide more than 2,700 patients with surgery and over 4,000 patients with comprehensive care over the next five years. Utilizing our successful hub and spoke model allows us to reach communities across the country and will be the key to achieving this target.
Operation Smile will enhance cleft competency training pathways through strategic educator exchanges to enable ongoing hands-on training. Operation Smile will also provide residencies through the College of Surgeons of East, Central and Southern Africa (COSECSA), training at short-term surgical programs and cleft surgery externships. Over the next five years, we will provide 960 training opportunities to health workers across Malawi.
Operation 100, our bold strategy to bring essential surgical care closer to patients’ homes, will impact Malawi as we equip cleft operative teams at Mzuzu Central Hospital in Mzuzu and Zomba Central Hospital in Zomba with advanced skills, essential equipment and enhanced health care infrastructure over the next five years.
Over the next five years, Operation Smile Malawi will recruit new patients, supported by our pool of community health volunteers and the utilization of their Buffalo Bikes. Buffalo Bikes allow volunteers to travel to the most remote areas within their communities to reach potential patients and visit health facilities. Additionally, we will focus on targeted recruitment at birth and maternity facilities to identify and assist newborns and their families as early as possible.
