CHARITY RATINGS & IMPACT
Why Direct Relief?
See how independent evaluators rate Direct Relief, how donations are used, and what they make possible.
What Direct Relief Does
Direct Relief gets medical aid to people facing crisis or hardship, across all 50 states and more than 90 countries, regardless of politics or ability to pay.
HOW DIRECT RELIEF COMPARES
Charity Ratings, Explained
A percentage. A ranking. A letter grade. An accreditation. Each charity assessment answers different questions. See what each one measures and compare Direct Relief’s performance.
BBB Wise Giving Alliance
The standards cover governance, effectiveness reporting, finances and fundraising practices.
Candid
Direct Relief holds Candid’s highest Seal of Transparency for sharing information about finances, programs and results.
“[Direct Relief is] the largest, most efficient, most effective, and most impactful global humanitarian group that you may never have heard of.”
Jeff Berman
Director, Direct Relief · Co-host, Masters of Scale
How Direct Relief Ranks by Size
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| Publication | Rank | What the list compares |
|---|---|---|
| Devex2026 | No. 1 | Total revenue among the 50 U.S. international NGOs in the analysis. |
| Forbes2025 | No. 5 | Private donations among the Top 100 U.S. charities. |
| The NonProfit Times2025 | No. 14 | 2024 total revenue within the NPT Top 100. |
The lists use different comparison groups, revenue definitions, and calculations.
IMPACT · AID DELIVERED
What Donations Make Possible
FY2025 · July 1, 2024–June 30, 2025
$2.0B
Total Aid Delivered
Medical material aid and financial assistance delivered.
$68.8M
Grants
Included in the $2.0B total aid delivered.
311.9M
Defined Daily Doses
What defined daily doses measure
A defined daily dose represents an assumed average daily maintenance dose for a medicine’s main use in adults. It standardizes medicine volume; it is not a count of patients treated.
29,657
Deliveries
Shipments to healthcare providers in 92 countries, all 50 U.S. states and five U.S. territories.
Source: FY2025 Annual Report, pp. 7–8
Medical Aid Value and Delivery Costs
FY2025
46x
$46 in medical aid value delivered per $1 in program delivery costs.
Both bars use the same scale.
≈ $2.15 in program delivery costs per $100 in medical aid delivered.
Medical aid includes donated medicines and supplies at fair value. Delivery costs exclude grants, administration and fundraising.
How this comparison is calculated
Medical aid value compared with delivery costs
FY2025 · July 1, 2024–June 30, 2025
Aid value per $1 of program delivery costs: $1,900 million ÷ $40.9 million ≈ $46.45, displayed as ≈46:1.
Program delivery costs per $100 of aid value: ($40.9 million ÷ $1,900 million) × $100 ≈ $2.15. This is the inverse of the same ratio. Both approximate ratios use the reported rounded figures of $1.9 billion in medical aid and $40.9 million in program delivery cost.
“Program delivery costs” refers to the Annual Report’s program implementation expense, which includes personnel, freight and transportation, contract services, packing materials, facilities and other program operating costs. It excludes cash grants and is broader than the cost of shipping alone.
Medical material aid is measured at reported accounting value, including donated medicines and supplies. Direct Relief records donated medicines at their estimated fair value. For FDA-approved medicines, the standard wholesale cost is used at the time of receipt. The ratio depends on this valuation basis.
FY2025 Annual Report: implementation expenses and medical aid, p. 45
MEDICINE THAT CHANGES LIVES
A Treatment. A Future She Can Imagine
For Yaroslava Koshel, cystic fibrosis made even a short walk difficult. After receiving Trikafta through a partnership involving Vertex, Direct Relief and Ukrainian hospitals, she reported breathing more easily, regaining weight and being able to walk farther.
The program connects donated specialized treatment with the local clinicians who provide her care.
“Trikafta has given me the possibility to live for many more years.”
Yaroslava Koshel
Ukraine Response
$2.5B+
in humanitarian support for Ukraine and people displaced by the war since February 2022.
Includes donated medical products valued at wholesale and more than $75 million in financial grants.
Ukraine response milestone · Cumulative total reported Sept. 22, 2026
CARE CLOSE TO HOME
An Inhaler Within Reach
At Wheeling Health Right in West Virginia, uninsured patients receive free inhalers donated by Teva through Direct Relief. A dependable supply lets the clinic dispense medicine during appointments and replace inhalers lost during floods.
U.S. Medical Aid
$3.1B
in donated medicines and supplies delivered to U.S. nonprofit health providers since 2008.
Cumulative wholesale value.
DISASTER RESPONSE
Before Disaster Strikes. Through Recovery
Direct Relief responds to requests from local health providers and coordinates with public health agencies and other responders to avoid duplicated efforts and keep unneeded supplies from delaying aid.
Prepare
Position medical supplies before emergencies and help health facilities keep operating when power and services fail.
Respond
Get requested medicines, supplies and emergency funding to local health providers responding to a disaster.
Recover
Help health providers maintain treatment as communities recover, including care for patients whose ongoing medical needs cannot wait.
Ukraine: Keeping Care Available During Conflict
Reliable power protects care during conflict. In Ukraine, Direct Relief-supplied batteries maintain lighting in eight operating rooms at the National Cancer Institute in Kyiv during grid disruptions.
Reliable power for Ukrainian hospitals · September 2026
Puerto Rico: When the Power Goes Out, Care Must Continue
At Profamilias in Puerto Rico, staff once took medicines home to keep them refrigerated during hurricanes. With Direct Relief-funded solar installations, the clinics can keep medicines safely stored and continue seeing patients during outages, according to services manager Michael Domínguez.
Financial transparency
Where Support Comes From—and How It’s Spent
Support Received
FY2025
$2.4B
Financial contributions and donated goods and services received. Excludes investment revenue.
$2.27B
≈ 95%
Donated medicines, supplies and other resources
$119.3M
≈ 5%
Financial contributions
Most reported support consists of donated medicines, supplies and other noncash resources. Financial contributions fund needs that product donations cannot meet, including purchases, delivery, grants and operations.
Source: FY2025 audited statements, p. 6
How donated medicines are valued
Donated products are recorded at estimated fair value under accounting standards. For FDA-approved medicines, Direct Relief uses product-specific Wholesale Acquisition Cost from RED BOOK at the time of receipt.
Expenses by Purpose
FY2025
99.31%
of the $2.3 billion in total reported expenses supported medical aid programs.
Cash-based expenses exclude donated goods and services, inventory adjustments and depreciation, which appear in the noncash column.
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| Category | Cash-based expenses | In-kind & other noncash | Total expenses |
|---|---|---|---|
| Program services | $121.6M | $2.17B | $2.29B99.31% of total |
| Administration | $12.4M | $150K | $12.5M0.54% of total |
| Fundraising | $3.3M | $148K | $3.5M0.15% of total |
| Total | $137.3M | $2.17B | $2.31B100% of total |
Why support, expenses and aid totals differ
These totals describe different activities and are not expected to match. Contributions can be recorded in one fiscal year and used in another.
Accounting basis: FY2025 audited statements, pp. 6–8 and 13–15
Support received · $2.391B. Financial contributions and donated goods and services received in FY2025. Audited statements
Total expenses · $2.309B. Aid distributed, program delivery costs, administration, fundraising and accounting adjustments such as expired inventory recorded in FY2025. Includes donated goods and services. Audited statements
Total aid delivered · $2.0B. Medical material aid and financial assistance delivered in FY2025. Annual Report, pp. 7–8
Medical material aid · $1.9B. The medicines, supplies and equipment component of aid delivered. Annual Report, p. 45
Exact expense figures and accounting notes
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| Category | Cash-based ($M) | In-kind & other noncash ($M) | Total ($M) |
|---|---|---|---|
| Program services | 121.624 | 2,171.658 | 2,293.282 |
| Administration | 12.369 | 0.150 | 12.519 |
| Fundraising | 3.322 | 0.148 | 3.470 |
| Total | 137.315 | 2,171.956 | 2,309.271 |
Cash-based expenses are calculated by subtracting donated medical products distributed, inventory adjustments, contributed freight and services, and depreciation and amortization from total expenses. Those excluded amounts make up the noncash column. This is an adjusted expense comparison, not a statement of cash flows.
The Annual Report separately presents approximately $110.0 million for programs, $12.5 million for administration and $3.5 million for fundraising. That presentation includes some donated services and uses a different basis from the adjusted expense comparison above. Rounded amounts may not sum exactly.
Cash-Based Financial Efficiency
Three-year average · FY2023–FY2025
Fundraising Efficiency
$2.95
spent on fundraising per $100 in financial contributions.
Cash-Based Program Spending
≈90%
of operating expenses supported programs.
≈90% Programs
≈10% Administration & fundraising
How fundraising efficiency and program share are calculated
Both three-year averages are Direct Relief calculations using combined FY2023–FY2025 totals, excluding in-kind expenses and depreciation. What “adjusted” means: The exclusions cover donated medical products distributed, write-downs of expired donated inventory, contributed freight and services, and depreciation.
Fundraising expense relative to financial contributions
FY2023–FY2025
Between July 2022 and June 2025, Direct Relief recorded $311 million in financial contributions. During that same period, adjusted fundraising expenses totaled $9.18 million—meaning it cost $2.95 to raise every $100. The calculation combines three years of expenses and support rather than averaging annual percentages.
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| Fiscal year | Adjusted fundraising expense | Financial contributions | Expense per $100 |
|---|---|---|---|
| 2023 | $2.689M | $120.864M | $2.22 |
| 2024 | $3.171M | $70.895M | $4.47 |
| 2025 | $3.322M | $119.262M | $2.79 |
| Three years | $9.182M | $311.021M | $2.95 |
Financial contributions include donated securities and recorded pledges.
Program share of cash-based operating expenses
FY2023–FY2025
The calculation includes purchased medicines, paid shipping, disposal costs, grants, personnel and other program operating expenses. The shared exclusions above apply to the respective program, administration and fundraising categories.
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| Fiscal year | Adjusted program expenses | Adjusted total expenses | Program share |
|---|---|---|---|
| 2023 | $119.491M | $131.462M | 90.89% |
| 2024 | $106.475M | $118.514M | 89.84% |
| 2025 | $121.624M | $137.315M | 88.57% |
| Three years | $347.590M | $387.291M | 89.75% |
Three-year program share: $347.590 million ÷ $387.291 million = 89.749%, or ≈ 90%. This measures the allocation of adjusted expenses, not the percentage of contributions received that was spent on programs.
Direct Relief calculated these measures from Direct Relief and Affiliates’ consolidated audited statements and each year’s functional-expense detail. Source amounts are reported in thousands of dollars.
FY2023 audit, pp. 6–8 · FY2024 audit, pp. 6–8 · FY2025 audit, pp. 6–8
Compare program and fundraising measures
About 90% of cash-based operating expenses supported programs across FY2023–FY2025, excluding donated goods and services and depreciation—the accounting cost of assets wearing out over time.
Program expense shares
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| Measure | Result and period | Basis and source |
|---|---|---|
| Direct Relief · total expense share | 99.31%FY2025 | Program expenses ÷ total expenses, including donated goods and services. Audited statements |
| Direct Relief · cash-based operating share | 89.75% (≈90%)FY2023–FY2025 | Program expenses ÷ total expenses, excluding in-kind expenses and depreciation. Calculation above |
| CharityWatch · program percentage | 90%FY2024 | Program share under CharityWatch’s adjusted cash-based method. CharityWatch profile |
| Forbes · charitable commitment | 99%2025 list | Program expenses ÷ total expenses, including donated goods. 2025 results |
Fundraising measures
Cost per $100 raised measures fundraising efficiency. The percentage of total expenses shows how expenses are divided.
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| Measure | Result and period | Basis and source |
|---|---|---|
| Direct Relief · fundraising cost | $2.95 per $100FY2023–FY2025 | Adjusted fundraising expenses ÷ financial contributions. Calculation above |
| CharityWatch · cost to raise $100 | $5 per $100FY2024 | Fundraising cost under CharityWatch’s adjusted cash-based method. CharityWatch profile |
| Forbes · fundraising efficiency | 100% (rounded)2025 list | Private donations remaining after fundraising costs, including donated goods. Forbes methodology |
| Direct Relief · fundraising expense share | 0.15%FY2025 | Fundraising expenses ÷ total expenses. Audited statements |
Reports & Policies
The documents donors need to evaluate how the organization operates and uses its resources.
How Medicines Reach Patients
Local health professionals know their patients and identify what is needed. Direct Relief connects those requests with medical resources, distribution expertise and funding, so providers can focus on care.
-
01
Start with Local Knowledge
The people providing care know what their communities need. Direct Relief works with local clinics and hospitals to identify gaps in care and the medicines and supplies that can help.
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02
Turn Support into Medical Aid
Qualified healthcare organizations receive donated medical products at no charge. Direct Relief matches donated medicines and supplies with local requests. Financial contributions help fill gaps through purchases and grants.
-
03
Get Medicines There Safely
Medicine needs careful handling at every stage. With support from transportation and technology partners, Direct Relief manages storage, quality checks and specialized shipping to protect supplies and meet regulatory standards.
-
04
Help a Patient Get Treatment
The delivery becomes care in the hands of a local health professional—helping a child access insulin, a patient manage asthma or a community continue treatment after a disaster.
Treatment That Continues, Month After Month
Each year, Direct Relief helps thousands of children with Type 1 diabetes access insulin and supplies through local health providers. Since 2011, it has supported Life for a Child, a program that helps children and young people access diabetes care.
In Tanzania, that support also includes refrigeration: Direct Relief funded and sourced pharmaceutical refrigerators for 78 public clinics in late 2025, providing space to safely store insulin for more than 6,200 children and young people.
Professional Standards for Pharmaceutical Distribution
Direct Relief holds NABP® Drug Distributor Accreditation for wholesale drug distribution and NABP® OTC Medical Device Distributor Accreditation.
Awards & Recognition
Seoul Peace Prize
“Direct Relief has exemplified true humanitarianism by providing medicines and medical supplies around the world—not through temporary aid, but sustained, patient-focused support uniquely tailored to each region.”
Jaeho Yeom
Chairman, Seoul Peace Prize Cultural Foundation · April 2025
TIME Dreamer of the Year
Recognition presented by TIME in collaboration with American Family Insurance.
Past ratings and recognition
Rating history: In November 2025, Direct Relief received its 15th consecutive four-star rating from Charity Navigator.
Read the November 2025 rating announcement
Awards and editorial recognition are distinct from independent charity evaluation. Current evaluator profiles appear in the ratings section above.
Explore historical ratings and recognition
Independent ratings and accreditation
- 100% Impact Rating (2026), Charity Navigator (Sept. 13, 2026)
- Perfect 100 Score, Charity Navigator (Sept. 13, 2026)
- Four-star charity, Charity Navigator (Sept. 13, 2026)
- National Charity Seal, Better Business Bureau Wise Giving Alliance (August 2025)
- Top-Rated Charity: International Relief and Development, American Institute of Philanthropy (July 3, 2011)
Editorial recognition and charity lists
- Best Charities with Lowest Overhead Costs, Nonprofit Point (June 5, 2026)
- 2026 List of Household Name Charities, Charity Navigator (May 2026)
- Best Charities 2026 – Humanitarian Relief Charities, Charity Navigator (May 2026)
- List of Well-Known Charities 2026, Charity Navigator (May 2026)
- Best Humanitarian Relief Charities, Charity Navigator (May 2026)
- 9 Charities with Highest Percentage to Cause, Nonprofit Point (April 30, 2026)
- 25 Best Nonprofits to Donate to, Money Minder (April 13, 2026)
- 5th Largest Charity in the U.S., Forbes (Dec. 12, 2025)
- America’s Top Charities, Forbes (Dec. 12, 2025)
- Best Humanitarian Charities to Donate to on GoFundMe, GoFundMe (Nov. 19, 2025)
- Best Emergency Relief Charity to Donate to, GoFundMe (Nov. 6, 2025)
- When Disaster Strikes, These Top Charities Actually Deliver, Forbes (Dec. 10, 2024)
- 9 Best Charities for International Aid, Impactful Ninja (Oct. 9, 2024)
- Top global causes you should support in 2024, Global Impact (Oct. 6, 2024)
- Donate to a Top-Rated Charity – Hurricane Helene, CharityWatch (Sept. 27, 2024)
- The Top Charities to Give to Before the End of the Year, Global Impact (Dec. 20, 2022)
- Best Charities for 2023, WalletHub (Nov. 8, 2022)
- 10 Best Charities, Charity Navigator (June 2022)
- High Impact Giving Guide, Center for High Impact Philanthropy, University of Pennsylvania (December 2018)
- 10 Best Humanitarian Relief Organizations, Charity Navigator (July 24, 2018)
- 10 Highly Rated Charities Relying on Private Contributions, Charity Navigator (2018)
- Best Charities for Holiday Giving, WalletHub (2018)
- 5 Non-profits that Do the Most with Your Money, Las Vegas Review-Journal (Dec. 22, 2015)
- Best Charity, Independent Charities of America’s “Best in America” list (2013)
- How to Help: Hurricane Helene, Fidelity (Oct. 1, 2024)
- Top-Rated Charities to Help the Ukraine Relief Effort, CNBC (March 9, 2022)
- The 50 Best Charities to Donate To, Let’s Roam (Oct. 7, 2021)
- The 50 Best Charities to Give to Right Now, Good Housekeeping (Nov. 9, 2020)
- Top 100 Nonprofits on the Web, Top Nonprofits
Innovation, supply chain and other awards
- Finalist, Best Storytelling, Shorty Awards (Oct. 14, 2020)
- Winner, Qlik Global Transformation Award 2023 (April 19, 2023)
- Winner, Global Health Supply Chain Summit Prize (November 2020)
- Oktane Award Finalist, Okta for Good (May 2018)
- Award for Social Entrepreneurship, Ernst & Young (June 15, 2017)
Community health partnerships
- Board Chair’s Award, Texas Association of Community Health Centers (2020)
- Community Partner Award, California Association of Free and Charitable Clinics (2020)
- Healthy10 Award, BD Helping Build Healthy Communities, U.S. Chamber Foundation (Feb. 16, 2017)
- Power through Partnership Award, National Association of Community Health Centers (August 2014)
- Global Health Partnership Award, BD (2013)
Reporting and Giving Guides
Emergency response coverage
The New York Times
Featured Direct Relief in its earthquake giving guide.
Regional recovery coverage
Associated Press
Highlighted ways to support earthquake recovery in Venezuela and Colombia.
Venezuela earthquake guidance · Colombia earthquake guidance
Verified relief funds
CNN Impact Your World
Included Direct Relief in its emergency relief fund.
Help Deliver Medicine Where It Can Do the Most Good
Your support helps equip health professionals caring for people across the United States and around the world—every day, during emergencies and through recovery.
Other Ways to Give
IRA Charitable Gifts
Explore whether a qualified charitable distribution fits your plans.
Stock and Other Gifts
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Private funding and donor instructions
Direct Relief does not accept government funding. Gifts designated for a specific emergency or program are used only for that purpose, including directly related administrative costs. Unrestricted support allows Direct Relief to respond to needs across its work.