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MESSAGE FROM THE DIRECTOR ........................................................................... 3
2014 – 2015 KEY HIGHLIGHTS ................................................................................. 4
TRUSTEES’ ADMINISTRATIVE REPORT ................................................................ 5
INTRODUCTION TO HEALTH POVERTY ACTION............................................ 6
STRATEGIC REPORT ................................................................................................. 8
WHAT WE DO ..................................................................................................................................... 8
HOW WE DO IT ................................................................................................................................ 10
WHERE WE WORK ........................................................................................................................... 13
THE OUTCOME OF OUR WORK................................................................................................. 14
LOOKING AHEAD ............................................................................................................................ 27
FINANCIAL REVIEW ......................................................................................................................... 30
RISKS AND UNCERTAINTIES ........................................................................................................ 31
STRUCTURE GOVERNANCE AND MANAGEMENT .............................................................. 34
THANK YOU ....................................................................................................................................... 35
TRUSTEES’ RESPONSIBILITIES, AUDITOR’S REPORT AND FINANCIAL
STATEMENTS ............................................................................................................ 36
STATEMENT OF TRUSTEES’ REPONSIBILITIES ......................................................................... 36
AUDITORS REPORT ......................................................................................................................... 38
FINANCIAL STATEMENTS .............................................................................................................. 40
Front cover picture: A community in the border region of Myanmar proudly hold up to the
camera the first kids born through Health Poverty Action’s goat rearing initiative. Credit: Guowei
Nee/Health Poverty Action.
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MESSAGE FROM THE DIRECTOR
Over the last five years Health Poverty Action has
experienced significant growth.
We have expanded the reach and impact of our
development programmes overseas, strengthened our
policy and technical capacities, and built up an increasingly
significant body of activism and support here in the UK –
committed not just to the organisation Health Poverty
Action, but (more importantly) to the wider cause of
2014 was a particularly significant year for us as we commemorated our 30 th anniversary,
offering an opportunity to reflect on how far we have come together. It was clear that
throughout its evolution, the organisation has remained faithful to its founding philosophy –
based on the Alma-Ata Principles, and firmly rooted in the worldwide People’s Health
We have always been, and always will be, an organisation that sees health as not merely a
medical challenge, but a fundamental issue of justice and human rights. We still prioritise
populations missed out by others – as passionately committed as ever to the concept
of Health for All.
Prioritising the poorest and most marginalised means we have become particularly skilled at
working in hard to reach areas, and with marginalised populations such as indigenous people
and ethnic minorities. We attach great value to the precious relationships we have
developed with communities who have learnt through bitter experience to trust few others.
This year has not been without its challenges – and none greater than the outbreak of Ebola
that rocked the communities we work alongside in Sierra Leone. It devastated the already
weak health care infrastructure — through the tragic deaths of so many health workers, by
creating a fear of health facilities, and by diverting resources from other areas of public
health. The fact that this tragedy could and should have been prevented, for example
through a more just pharmaceutical Research and Development (R&D) system, is one of the
most heartbreaking scandals of our time.
There is much still to do. But our experiences over the last 30 years teach us to go
forward with hope – and with our passion and commitment as strong as ever. Thank you
for being part of the global movement for health justice and let us continue to build that
Martin Drewry - Director of Health Poverty Action
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2014 - 2015 KEY HIGHLIGHTS
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TRUSTEES’ ADMINISTRATIVE REPORT
The trustees of Health Poverty Action present their Annual Report for the year ended 31
March 2015 under the Charities Act 2011 and the Companies Act 2006, including the
Directors’ Report and the Strategic Report under the 2006 Act, together with the audited
financial statements for the year.
Health Limited t/a ‘Health Poverty Action’ (Limited by guarantee)
COMPANY NUMBER: No: 1837621
UK CHARITY REGISTRATION NUMBER: No: 290535
Jonathan Barton 2
Nouria Brikci 1
Professor Emma Crewe 1 (Chair) (from 08
Debra Davies 3 (Treasurer)
Dr. Isabelle De Zoysa 1
Dr. Rory Honney 1
Oliver Kemp 1
Donald Peck (Chair)(to 06 October 2015)
James Thornberry 1
Carolyn Ramage (Treasurer) (from 09
Appointed on the 10 December 2014
Resigned on the 06 October 2015
Resigned on the 31 October 2015
Health Poverty Action
London SW8 1SJ
Crowe Clark Whitehill LLP
Chartered Accountants and
St Brides House
10 Salisbury Square
London EC4Y 8EH
CAF Bank Limited
Kent ME19 4TA
8 Canada Square
London E14 5HQ
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INTRODUCING HEALTH POVERTY ACTION
Pictured: Traditional Birth Attendants at a training event organised by Health Poverty Action in Guatemala. Credit
Health Poverty Action
Health Poverty Action works to strengthen poor and marginalised people in their struggle
We have a distinct approach – which sees health not as primarily a medical
challenge, but as an issue of social justice. We recognise in particular the close
relationship between health and poverty, in all its manifestations.
Inspired by a vision of Health for All, we work with those whose health suffers as a result of
injustice, to strengthen their voice and increase their power over the determinants of their
health – so that they are able to access their rights.
Within this social justice orientated approach, three factors combine to give our work a
distinctiveness that experience has proven to be extremely effective.
1. We emphasise the need for justice rather than charity
We recognise that the greatest causes of poor health worldwide are political, social
and economic injustices. That is why we work to tackle the root causes of poor
health, not just the symptoms, and why our name is Health Poverty Action.
2. We prioritise those missed out by others
Development organisations tend to cluster together which leaves large populations
with almost no support at all. These people may be living in hard to reach areas, or
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are difficult to support for some other reason. We make these most neglected
populations our priority.
3. We specialise in providing an integrated approach
This is especially important for the poorest and most marginalised people who face
so many threats to their health with little support. Tackling one in isolation might
give the appearance of success while doing little more than changing the cause of
death. Tackling numerous factors together can bring lasting improvements – and also
give rise to new innovations through creative combined approaches.
Part of the People’s Health Movement
We draw strength from the knowledge we are not alone, but part of a global movement for
health justice – the People’s Health Movement (PHM).
The PHM is today’s embodiment of the primary health care movement that achieved
ground-breaking success at the UN Alma-Ata Conference in 1978 – giving birth to what
became known as the Alma-Ata Principles.
Primary health care is often (mistakenly) understood to mean the primary level of the health
service. This misunderstanding is a particular problem when applied to development, playing
to the prejudice that what is appropriate for poor people is just basic, low-tech health care.
In the context of the Alma-Ata Principles, Primary Health Care means something
different, and embraces all sectors, not just health. ‘Primary’ refers to two things:
1. Addressing the primary determinants of health – the root causes, including social,
economic, conflict and environmental.
2. Primary in terms of accountability – accountable and accessible to those affected.
Health Poverty Action’s founders believed that no one should be excluded from their right
to health. So they turned this hunger for justice into action. That same passion still drives
Health Poverty Action’s staff and volunteers today – working with communities in some of
the most challenging and neglected places on earth, and campaigning globally to transform
systems which deny proper health care to the most vulnerable citizens worldwide.
Today, Health Poverty Action works in 13 countries in Africa, Asia and Latin America. Over
400 staff are employed worldwide, mostly recruited from within the populations they serve,
with around 25 in our international headquarters based in London, UK. We continue to go
where other organisations can’t or won’t. We continue to emphasise the connection
between health and poverty. And we continue to tackle the two together, in integrated
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WHAT WE DO
Our work falls into to four broad categories:
1. In-country development programmes
We work in partnership with communities across Africa, Asia and Latin America,
helping them to tackle the primary factors denying their health rights. Our
approaches include (but are not limited to): health system strengthening, disease
control, health education, addressing harmful practices and gender issues, social
enterprises and income generation, food security and nutrition, and water and
2. Influencing policy and practice
We are driven by our conviction that the denial of health rights is not acceptable,
and we are committed to a vision of Health for All. We know that it is possible for
poverty to be eradicated and health to be improved, but that doing so requires
major changes in the world, including paradigm shifts in social, economic and
environmental policy. So we campaign for change too.
3. Responding to emergencies
Emergencies are not identified by what is given high profile in the global media, but
by the experience of the people affected. We recognise that for poor and
marginalised people, emergencies are not discrete events but one additional factor in
the ongoing struggle they face for health and well-being. Therefore, when
emergencies strike, we work with those affected to mobilise all possible resources
for an urgent response – and do so as an integrated contribution to their ongoing
struggle for health justice.
4. Providing consultancy and other contracted services
The expertise, resources and relationships of Health Poverty Action mean that we
are in a position to provide a wide variety of valuable services to others, which we
have been doing for the past five years. These services provide important benefits
for the poor, as well as generating income, and all profits are ploughed back into
developing our work.
Strengthening those whose rights we serve
Health Poverty Action does not replace state services. We know that charity provision is
not the answer. Instead we work with Ministries of Health, health workers, and
communities to make existing/state services more accessible, higher quality, better
resourced, and locally accountable. We do not set up parallel or duplicate systems, but build
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and strengthen local capacity – so that improvements are not only sustainable, but owned
and led by those whose rights they are intended to serve.
We take respect for local knowledge and culture extremely seriously – and the vast
majority of our staff come from the local populations they are working for and with. As
insiders, they know that lasting transformation comes when people experience their own
power to bring change – to develop their own solutions and succeed in getting these
implemented. Similarly, as insiders they are able to work for change in ways that no one else
could when local practices need challenging – such as working to end female genital
mutilation (FGM) and other gender based injustices impacting on health.
We attach great value to the relationships of trust we have developed with so many poor
and marginalised communities. Their marginalisation may be a consequence of factors such
as ethnicity, culture, gender, geography, politics, economics – or all of these. This trust is
especially valued and respected because many of these communities have learnt through
bitter experience to trust few outsiders – marginalisation and persecution so often go
Because we prioritise the most poor and the most marginalised, we have become
particularly skilled at working in hard to reach areas, with populations such as indigenous
people, ethnic minorities and mobile pastoralists. This means we often work in very remote,
rural communities. However, we do also work in large cities and urban areas – there are
marginalised people there too.
Picture: A group of young girls in Ethiopia put on a community theatre show to help promote and share key health
messages. Credit: Health Poverty Action
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HOW WE DO IT
Pictured: Health workers in Kenya take part in Integrated Management of Childhood Illnesses (IMCI) training. Credit:
Health Poverty Action
Our Vision: A world in which the poorest and most marginalised enjoy their rights to health
Our Mission: We work to strengthen poor and marginalised people in their struggle for health
Our mission statement reminds us of some of the fundamentally important principles
relating to the ways we work with poor and marginalised people, including:
- They do it. We do not do it for them.
- We respect the power and potential of poor and marginalised people to bring
change. We neither perceive nor portray them as helpless victims.
- Whilst we do support accessible and quality service health provision, our work is
not about providing the needy with services – it’s about strengthening people in their
struggle for justice.
Today, built up over three decades, we have ongoing programmes in Africa, Asia and Latin
America that benefit hundreds of thousands of people each year.
Our overall priority for 2014-15 was to continue to grow these in both size and
effectiveness, building on our established strengths, and aiming to benefit more people in
even better ways.
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We aimed do this while remaining faithful to our organisational values, inspired by the
principles of the 1978 groundbreaking UN Conference on Primary Health Care at Alma-Ata,
and always seeking to place power and leadership where it should be – in the hands of those
whose health rights have been denied them.
We followed five strategic priorities indentified as enabling us to build the capacity of Health
Poverty Action, so that we can do more to strengthen the poorest and most marginalised in
their struggle for health. These were to:
1. Increase the impact of our development programmes
Constantly monitor and improve the quality of our programmes, and apply learning
from all available sources worldwide – our own experience and also that of others.
Pay particular attention to feedback from local partners and the communities we
work to strengthen.
Attach great importance to creativity and innovation:
- Pioneering new approaches that can be replicated or developed further
elsewhere, potentially multiplying their benefits many times over.
- Adapting tried and tested approaches to be relevant and effective in new
contexts, cultures and settings.
Design programmes not just with a view to direct impact but also with attention to
how they will influence others and contribute to improving development practice
2. Strengthen our policy and technical capacity
In order for our programmes to be of the highest possible standards, it is essential
that they are able to draw upon the strongest possible technical resources. Similarly,
in order for Health Poverty Action to influence the policy and practice of others, we
need internal policy and technical capacity that enables us to speak with authority
3. Increased unrestricted income
In recent years, Health Poverty Action has been very successful in winning large
amounts of restricted project funding. We celebrate this and aim to increase it
further. However, many important costs cannot be funded out of our project
budgets. If we are to be as valuable to poor and marginalised people as they require
us to be, it is essential that we are able to supplement this project-funding with
unrestricted income. Increasing our unrestricted income presents a uniquely viable
opportunity to profoundly increase our overall organisational impact, influence and
capacity for growth.
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Consultancy and other services
Providing these to others represents an opportunity for substantial income
generation. Also, the services we provide can be valuable pieces of development
work in their own right – and can introduce us to new partners and donors, and
new technical and geographical areas.
4. Build strong supporter base
Volunteers are the life blood of the voluntary sector. Voluntary contributions, be
they time or resources, are what gives the voluntary sector its name – and Health
Poverty Action is proud to be a part of it. We are committed to its ideals, and
uphold the spirit of voluntarism. We believe that all people can make a difference,
and we want to give them opportunities to do so – not as supporters of us as an
organisation, but as passionate supporters of the cause we exist to serve. The
millions of poor and marginalised people currently denied their health rights deserve
the strongest possible supporter base among the general public. Individuals can make
a powerful difference – campaigning, fundraising, giving, and generally contributing in
whatever ways they can.
5. Increase media profile of work and messages
If we ever doubt the importance of a strong voice, we need only look at the poorest
and most marginalised people we work with. They have a voice – and they
undeniably have important things to say – but too few people hear it. If their
messages were heard loudly enough, much more would have to be done in
recognition of their rights. A high and well managed media profile for Health Poverty
Action and its work can both influence an ability to attract funds. It can also attract
and retain a high calibre of staff, and recruit and mobilise a powerful supporter base.
A cross-cutting theme: networking and partnerships
Strong networking, especially at country level, is key to our success. This needs to be with
all sectors – public, private and voluntary – learning from (and influencing) others. And it is
through partnerships that new opportunities are to be found – diversifying income and
generating more resources, reaching new communities, and developing new technical
capacity and enhancing innovation.
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WHERE WE WORK
Last year we worked in 13 countries across Africa, Asia and Latin America
Latin America Africa Asia
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THE OUTCOME OF OUR WORK - Facts and Figures
Health workers including nurses, midwives and doctors 1,866
Traditional Birth Attendants 846
Community Health Volunteers/Workers 3,733
Community Leaders and Representatives 1,090
Community Committee Members 2,765
Radio Workers/Audience Group Members 157
Peer Educators 476
Human Rights Defenders 80
Judges/Judicial Staff 49
Other contraceptives and family planning services 26,743
Mosquito nets/supplies for soaking nets 215,064
Children against childhood diseases 102,542
Women to access maternal health services 247,388
Children to access child health services 178,210
People with general health services 340,588
People with malaria testing and/or treatment 279,453
HIV testing & counselling, treatment & care 4,493
Children and adults with nutrition support or supplements 127,706
Improved or newly built water sources 274
Improved or newly built latrines 1,676
Top-up funding for doctors and nurses 205
Drug users with clean needles, health care and support 1,549
GBV (Gender based violence) survivors with health care, emotional and legal support 3,430
Clinics/health centres/safe homes and/or birthing homes with supplies 280
Families with livestock such as chickens, fish and pigs 1,360
Families with tools and resources to grow nutritional food 580
Villages with livestock/resources to grow nutritional food 40
People with agricultural training 1,832
We reached (estimate)
People with health messages relating to disease prevention 332,290
We produced and broadcast radio programmes 432
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THE OUTCOME OF OUR WORK - On the Ground
This year we continued to increase the impact of our development programmes across
Africa, Asia and Latin America.
In Somaliland we continued our work in Hargeisa implementing maternal, neonatal and
child health programmes in 11 health centres and Haregisa Group Hospital. This year we
constructed a neonatal unit, and continued to provide essential medicines and equipment.
Also in Hargeisa, we continued to pilot our Beneficiary Feedback Mechanism project, which
uses a mix of modern technology (free hotline SMS/calls) and traditional methods
(community meetings, suggestion box etc.) to gather feedback from those accessing services
supported by Health Poverty Action. 976 community members supplied feedback which has
now been used to improve the quality of services.
In the region of Sahil, we continued to lead on improving access to health care for some of
the most remote communities in the region. Our integrated outreach programme
supported local health workers to reach communities with immunisation services, antenatal
and postnatal care, health education, family planning and nutrition screening.
This year we also started supporting health centres in the Burao district, where we have
facilitated a mobile outreach programme which provides health services, including
immunisations and treatment of severe acute malnutrition, to 66 villages that do not have
access to a health centre.
Across all our projects in Somaliland, we continued to provide support and training to
community health committees and traditional birth attendants (TBAs), who play a vital role
in connecting communities with health services. In Hargeisa 165 TBAs helped to ensure 85%
of deliveries took place within the presence of a skilled attendant, up from 78% last year. In
Sahil 53% of women gave birth in the presence of a skilled attendant, up from 34%.
In Ethiopia, we continued to work in the SNNP and Somali regional states to increase the
access and utilisation of improved and integrated health services for pastoralist communities.
As a result of Health Poverty Action’s coordinated approach, working together with
community health workers to map and track pregnant mothers, 90% of pregnant women in
the Hammer and Dassanech communities of South Omo attended at least one antenatal
care visit. The number of women of reproductive age using modern contraceptives has risen
from 20% to 35% in the last 3 years.
This year we also started two new projects, the first in Dollo Ado where we have been
focusing on strengthening the capacity of local facilities to improve referrals between health
posts, health centres and hospitals. 170 people were transferred by the ambulance we
provided to referral health facilities. The second project is based in South Omo, where we
have been concentrating on improving maternal and child health through strengthening the
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facilities of local health centres. This year we provided five health centres with health
management information systems, carried out maintenance on two health centre
ambulances, purchased almost £3,000 worth of medical supplies and supplied 450 baby kits.
In Kenya we continued our work in the Mandera region, supporting our local partners to
help improve maternal and child health for pastoralist communities. This included building
the capacity of health workers to provide quality maternal and child health services,
the provision of essential maternal and obstetric care medical equipment, refurbishment and
extension of peripheral health facility buildings, and strengthening the referral system.
A key part of these activities also focused on raising awareness of healthy practices among
the community. We facilitated a series of community conversations to explore a range of
topics on harmful practices such as female genital mutilation (FGM), as well as theatre shows
to increase education around maternal, neonatal and child health services. 60 community
based reproductive agents were also trained to help connect communities to health facilities
and improve the uptake of maternal, neonatal and child health services.
Through our mobile health insurance scheme, we were able to introduce five donkey cartambulances
to refer women in labour from their villages to the nearest health facility. So far
these have referred 879 women.
In Rwanda we continued to address the barriers to girls’ education in the district of
Nyaryguru by helping to establish 75 mother daughter clubs, building 14 girls’ changing
rooms with reusable sanitary pads and water facilities to prevent girls from missing school
during menstruation, and broadcasting radio soap operas with key messages almost 100
times. We also supported our partner Teach a Man to Fish to launch school businesses
whose profit will be reinvested to support marginalised girls’ education in 24 schools.
Also in Nyaryguru, we continued our work improving water, sanitation and hygiene in the
area. This year we specifically focused on constructing and repairing water and sanitation
infrastructure by establishing 60 water user committees who were trained in the operations
and maintenance of 61 target springs. By the end of the year, 57 of these springs had been
rehabilitated. Across 14 schools, 81 eco-friendly toilets have also been built which sanitise
human waste to produce manure for school gardens.
Elsewhere in Rwanda, we continued to address gender based violence, rehabilitating two
safe homes and representing almost 400 victims of gender based violence (GBV) in court.
We also started a new project reaching 33 schools to promote youth employment oriented
In Namibia we continued our work strengthening local communities to treat and prevent
tuberculosis (TB). Using methods learned and demonstrated by Health Poverty Action, 48
suspected cases of TB were referred to health facilities, of which 36 were confirmed.
This year we were also awarded funding to begin a new project supporting pregnant
women, new mothers, and infants from the indigenous San population.
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Ebola epidemic in Sierra Leone
In Sierra Leone, Health Poverty Action witnessed the devastation brought about by the
Ebola epidemic. The first confirmed case in the country was recorded on 24 May 2014,
with the World Health Organisation declaring the outbreak a public health emergency on 8
Prior to the outbreak, Sierra Leone already had a fragile health system and was ill-prepared
for an outbreak of a highly contagious hemorrhagic fever such as Ebola. When the epidemic
began, health workers were ill-equipped to correctly diagnose and prevent the
transmission of Ebola and were one of the groups hardest hit by the disease. As a result,
local hospitals and health centres suffered even further from a lack of trained health care
In response to this emergency, Health Poverty Action launched a successful campaign to
raise funds specifically aimed at providing support to the health system, and to prevent
further transmission of Ebola within communities in Bombali district, our main project area.
• Provided 28 peripheral health units serving over 130,000 people with basic Ebola
infection control kits.
• Provided support including beds, drugs, food and logistics to the Ebola isolation unit
at Kamakwie Wesleyan Hospital – the only referral hospital in northern Bombali.
• Broadcast daily radio jingles in the main 4 local languages on Ebola prevention
measures (only 43% of adult Sierra Leoneans are literate).
• Set up 53 hand-washing stations in public areas, used on average by 30,000 people
per month since September 2014.
• Trained 208 traditional healers and 450 local leaders on essential Ebola knowledge to
help influence positive behaviour change in their communities.
• Provided122 mountain geared motorcycles to contact tracers, who helped to
identify individuals who may have contracted Ebola.
At the height of the epidemic there were 570 confirmed new cases in one week. Measures
such as those taken by Health Poverty Action helped to bring this down to just 1
confirmed new case a week by the end of March 2015. We will continue to be vigilant in
our fight against Ebola until Sierra Leone is declared Ebola free.
Unfortunately, the Ebola epidemic did impact on the strides Health Poverty Action had
achieved in recent years, particularly around maternal health. Due to the high risk of
transmission, many of our activities had to be scaled down temporarily. However, we were
still able to record some significant successes. Maternal and newborn health promoters
were able to refer 33,573 women in Bombali and 23,024 women in Bo to health centres
after receiving refresher training incorporating Ebola prevention techniques and basic Ebola
prevention kits. The 28 birth waiting homes we support hosted 972 women in their local
communities after we delivered similar refresher trainings. We also continued our work
providing medical, legal and financial support to 58 survivors of gender based violence and
43 used our safe homes.
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Pictured: A group of mothers take part in an education session organised by Health Poverty Action in Cambodia. Credit:
Daniel Dimick/Health Poverty Action
In Myanmar and China, we continued to work with communities in hard-to-reach areas,
mainly concentrated in the remote and mountainous border region between the two
countries. Together with local actors, we worked to strengthen primary health care
services including support for improving maternal, infant and child health, providing
immunisations to 13,000 children, promoting health and hygiene, improving access to water
and sanitation, tackling malaria, and strengthening the capacity and skills of health
departments and staff. More than 11,000 mothers received pre and postnatal care and
120,000 mosquito nets were provided to families.
We also continued our work with marginalised groups such as drug users and sex workers,
carrying out harm reduction activities with 951 people to reduce risks of HIV and improve
their access to health.
Humanitarian support was also given to those displaced through insecurity and conflict in
recent years, providing 1,400 children with nutritional supplements, 15,000 people with food
and 580 kits containing items such as soap, toothbrushes and blankets.
In Cambodia, we continued to work with communities in the remote Preah Vihear
province, focusing on maternal health, sexual reproductive health, and feeding and nutrition
through activities which promote behaviour change. Results show 78% of children under five
received de-worming treatment this year following educational sessions, up from 37%. 60%
of women of child bearing age indicated that they now used a modern method of
contraception, with condom distribution up 82% from the previous year.
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Towards the end of this year, we also set up a Village Emergency Referral System (VERS)
within 16 pilot villages to train and equip local community members to make initial
assessments and arrange transportation for those who require emergency health services.
13 patients have been referred through this system so far.
We also continued working with remote communities to provide treatment and prevention
interventions for infectious diseases such as TB and malaria. Our TB programme has
expanded to 4 additional provinces, covering 1/3 of the country geographically and 85% of
Cambodia’s indigenous populations. The programme referred over 1,300 suspected TB
cases for testing this year and is reaching almost 937,000 villagers with community and
health centre TB support services.
In Laos, we continued to work through a bottom-up approach, training, supervising and
strengthening local health workers across a continuum of care, to create a sustained
community health delivery model. In particular, we focused on promoting maternal,
newborn and child health and the prevention, control and elimination of malaria.
The combined efforts of those involved have resulted in positive changes in knowledge and
practices. 84% of mothers in 36 villages where Health Poverty Action works now practice
exclusive breastfeeding. Of the 1,078 children identified as malnourished by staff earlier on
in the year, 64% have now made a full recovery. 72% of households now have access to a
new or improved water source, up from 61% in the previous year.
We also continued our work supporting community members, village malaria volunteers,
and local government departments to improve their ability to identify, diagnose and treat
those most at risk to the emergence or spread of artemisinin-resistant malaria. By training
community health workers and working in tandem with the National Malaria Control
Program, we have successfully tested 22,700 people from high risk endemic areas in the
south and identified and provided treatment for 7,274 positive cases of malaria. In addition,
we have used these same village malaria volunteers to pioneer the first ever Directly
Observable Therapy (DOT) approach to malaria in Laos and successfully completed DOT
treatment for 2,709 positive cases.
This year we also started preliminary work on a new innovative project designed to address
health promotion and livelihood initiatives for 400 poor and vulnerable households in
In Nicaragua, we continued to work in the North Caribbean Coast Autonomous Region
(formerly known as the North Atlantic Autonomous Region) alongside the indigenous
Miskitu communities. In particular, we focused on tackling violence against women, working
together with local traditional leaders, law enforcement, health departments and civil society
to create a clearer route for women between the different services, so that their care can
be coordinated and their case resolved with the perpetrator brought to justice.
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Simultaneously, we also raised awareness of new laws in Nicaragua which are designed to
help tackle violence against women.
Pictured: A Guatemalan mother rests with her newborn baby in a health facility supported by Health Poverty Action.
Credit: Mauricio Vazquez/Health Poverty Action.
During the year, Health Poverty Action was granted new funding for projects which will
significantly improve the health of the indigenous Miskitu women and newborns over the
coming years. These will build upon the successes of the intercultural safe motherhood
model which we pioneered, and include new aspects, such as the joint training of formalmedically
trained doctors and nurses with traditional birth attendants.
In Guatemala, we continued to work towards improving the health of indigenous Maya
women and children. In particular, we have focused on supporting culturally appropriate
services for indigenous communities by providing equipment and training on protocols for
vertical birth in health facilities. We also introduced new culturally appropriate practices
such as traditional birth attendant (TBA) accompaniment in delivery rooms, and redesigned
patient gowns and bed linen.
Innovative technology allowed us to produce a translation device this year which allows non
indigenous health staff to communicate better with indigenous mothers during consultations.
Our work with Women's Groups and Health Commissions has improved local community
ownership of their health service.
This year we concluded our project work with communities in Peru, but began preliminary
work on an exciting new regional project spanning Nicaragua, Guatemala, Honduras
and El Salvador, which focuses on sexual and reproductive health rights for indigenous and
marginalised women across Central America. We are working with Christian Aid in
Honduras and El Salvador to help deliver this project through local partners.
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THE OUTCOME OF OUR WORK - Raising Funds
Pictured: Two volunteers brave the wet and cold weather to help collect donations for Health Poverty Action during our
March for Mothers event in Greenwich Park. Credit: Health Poverty Action
This year we continued our efforts to increase our unrestricted income to supplement our
restricted project funding.
30 th Anniversary
As 2014 marked Health Poverty Action’s 30 th anniversary, we harnessed this milestone’s
fundraising potential. We organised an event in central London to bring together past and
present staff, trustees and friends of the organisation. It was a night enjoyed by all and
resulted in over £3,000 in donations, and introduced some new potential donors/key
contacts for the organisation in the future.
This year we had 38 runners in the London Marathon and raised £57,000. The reception
afterwards was a great success and a good opportunity for us to meet the runners, take
photos and thank them in person. This along with close management of all the runners and
arranging meet ups resulted in many pledges of continued support including running for us
again in future.
Live Below the Line
52 participants took on the Live Below the Line challenge on behalf of Health Poverty Action
this year, raising over £6,000 in total. These figures are very similar to the previous year.
Thanks to all those who took part, including staff and board members.
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It was a particularly difficult year for our colleagues in Sierra Leone with the Ebola crisis and
across all private fundraising streams we tried our hardest to raise funds to support the
work in Sierra Leone as they fought to prevent the spread of the disease. We launched an
emergency appeal which was positively received, and secured additional funds through trust
and foundation grants. We are also grateful to our supporters who organised fundraising
events to support the fight against Ebola.
Trusts and Foundations
Trusts and Foundations remain a crucial source of income. We were pleased to continue
relationships with a number of important ongoing supporters – including Emerging Markets
Benefit Ltd, whose fundraising ball was once again a highlight of the year. We were also
pleased to gain the support of several new donors, as well as receiving renewed support
from a few who have supported us in the past.
During the year, we raised £244,000 from trusts and foundations as well as undertaking
discussions with several larger trusts which we hope will lead to funding in the near future.
The sector remains very competitive, with many worthy causes contending for limited funds
making fundraising challenging. We are therefore extremely grateful to those trusts who
enable us to reach those we do.
THE OUTCOME OF OUR WORK - Speaking Out
This year we continued to build upon our ability to speak out about the structural (political,
economic and social) causes of poverty and poor health worldwide through our policy and
Africa’s Billion Dollar Losses
We brought together a loose network of organisations to commission research and
produce a report on the resource flows to and from Africa. The final report, Honest
Accounts? The true story of Africa’s billion dollar losses, attracted over 30 pieces of media
coverage and our corresponding animation on YouTube had over 14,500 views by the end
of the year. The news article relating to its launch on our website was our most popular
news post ever. Campaign actions included meetings and sending letters to MPs relating to
the report’s messages. Overall, the report had a significant impact on our profile and
positioning and saw a surge of engagement through our digital communications channels
from existing and new supporters.
Drug Policy Reform
We launched the Development Sector Drug Policy Forum where we aim to mobilise and
coordinate engagement by development sector players in the debate on the impact of the
War on Drugs on poverty and inequality. As part of this work we successfully launched our
report, Casualties of War: How the War on Drugs is harming the world’s poorest, on the
- 22 -
importance of drug policy reform to development at a meeting jointly held with the British
Group of the International Parliamentary Union, in the House of Commons. The audience
of around 45 included parliamentarians, members of parliamentary staff, and NGO
representatives. Media coverage included pieces in the Guardian, the Morning Star, and a
LBC radio interview, as well as mentions in the Washington Post and Al Jazeera. We
subsequently held a side event at the annual session of the UN Commission on Narcotic
Drugs in Vienna in March, which was attended by 10 government and NGO representatives.
Tax and health
We joined the Tax Dodging Bill Campaign: a coalition calling for a commitment by all
political parties to introduce a Tax Dodging Bill in the run up to the May 2015 UK General
Election. Smaller parties such as the Green Party, Plaid Cymru and the SNP backed the Bill
in full while other parties made some commitments towards tackling tax dodging. While the
Bill was not introduced by the Conservative Government, the campaign helped to keep the
tax issue on the agenda and we continue to monitor developments.
Pictured: A Crystal Maze inspired stunt put on by the Tax Dodging Bill Campaign coalition outside the Houses of
Parliament. Credit: Oxfam
Health workers and strong health systems
Our work on health workers, calling for compensation to be paid by countries like the UK
where they hire health workers trained in developing countries, has been particularly
successful. This included a submission to the International Development Committee (IDC)
of the UK Parliament and a public campaign action calling for the UK act to tackle the
urgent global health worker crisis. The UK Department for International Development
(DFID) has now agreed to produce a strategy to map out all its work with regards to health
- 23 -
workers, to see where the gaps are and what action is needed. In its review of DFID, the
International Development Committee has backed our call for countries to receive
compensation for their trained health workers that are recruited to work in the UK.
We continue to Chair the Action for Global Heath Human Resources Group, meeting with
DFID officials and coordinating advocacy. With this group we also called for DFID to give
more priority to health systems strengthening and in particular to do more to tackle those
cultural barriers that prevent many ethnic and disadvantaged groups accessing health care.
This demand has also been reiterated by the IDC in their parliamentary inquiry. In their
response to the IDC, DFID agreed to develop a framework on Health Systems
Strengthening and have agreed to consult with us on the draft.
International development beyond 2015
We have continued to advocate, through briefings, face-to-face meetings and coalition work
with the Beyond 2015 network, for equity to be at the heart of the new global framework
which will replace the Millennium Development Goals in 2015. In particular we have called
for the indicators measuring progress against the goals to break down data by ethnicity so
that the health issues that affect minority groups can no longer be ignored. This has made it
into the open working group outcome document – the draft of the new framework.
We have also continued to demand a goal in the new framework on health and well-being
including the need for health care for all, as well as promoting a goal to ‘reduce inequality
within and among countries’. Both of these have made it into the draft framework too.
THE OUTCOME OF OUR WORK - Building a strong supporter
This year we continued to focus on growing our supporter base, not just as supporters of
us as an organisation, but as passionate supporters of the cause we exist to serve.
The millions of poor and marginalised people currently denied their health rights deserve
the strongest possible supporter base among the general public. Individuals can make a
powerful difference – campaigning, fundraising, volunteering and generally contributing in
whatever ways they can.
New donor recruitment approach
We trialled a significantly new donor recruitment approach this year through an online
petition. 5,000 people who signed our online petition on maternal mortality were added to
our mailing list. They were later called to convert to regular giving, resulting in over 200
new regular givers.
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Pictured: Both current and former staff, supporters and friends of Health Poverty Action gathered in London in
September 2014 to celebrate our 30 th anniversary event. Credit: Health Poverty Action
Public campaigning activity
Public campaigning activity has continued to contribute to building a strong supporter base
for the organisation through engaging new and existing supporters in campaign actions,
usually email or web based. The Tax Dodging Bill Campaign proved particularly popular. 547
of our supporters signed our petition online, and 324 later took the second campaign action
to write to David Cameron. A postcard action also received over 100 respondents.
This year we organised a photography exhibition open to the public, focusing on our work
in the border region of Myanmar. Funded by the EU, the exhibition was held for one week
in London’s Brick Lane Gallery before travelling on to a building near the Espace Léopold in
Brussels where it was on display for a full month. It is estimated that the exhibition was seen
by approximately 500 people.
All our social media channels grew this year, reaching just under 4,000 followers on Twitter
(an increase of 36%) and over 2,600 page likes on Facebook (an increase of 40%). We also
set up Vine and Instagram accounts to help reach new audiences. With improved capacity to
produce photographic and video material, we managed to create and share more visually
stimulating content which has contributed to increased user engagement. We also carried
out a number of live tweeting sessions at events which helped to reach audiences of
interest, such as those at our Health in Action conference with Medact in November, and at
the launch of our report on drug policy reform in the Houses of Parliament in February.
- 25 -
This year we secured just under 100 pieces of media coverage spanning print, broadcast and
radio, helping us to reach new audiences and encourage new supporters. Much of this
coverage stemmed from the launch of our policy reports on Africa’s billion dollar losses and
reforming global drugs policy. However, we also managed to secure coverage around our
health worker advocacy, particularly with regards to the global health worker ‘brain drain’
phenomenon. This became a particular topic of interest during the Ebola epidemic, which
led to us securing coverage in the Times, on BBC World News and Voice of America. We
also focused more on securing regional press around fundraising events, successfully pitching
stories to both print and radio.
Our website continues to perform better each year and the number of visits suggests our
profile is growing. We saw a 63% increase in the number of visits to our website compared
to the year before.
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This coming year, 2015-16 will be the first year of Health Poverty Action’s new
strategic framework (which covers 2015-2020).
Our new strategic framework is a living document, subject to ongoing ‘informed reflection’
which may result in revisions in light of experience or new developments.
It has been designed to recognise the complexity of health and development, and resist the
temptation to reduce this to a small set of key indicators. It is deliberately not a traditional
strategic plan. Rather than attempt to determine in advance what will be achieved by when
in an unknown future, it affirms that good strategy continually evolves, and emerges as much
as it is pre-planned. The framework is a tool to enable an ongoing process of ‘strategising’.
Our strategic framework will be accompanied by yearly work plans, relating to specific
departments and their key activities for the year ahead. Whilst our activities and objectives
will be subject to informed reflection, our strategic framework does outline our core
commitments and focus for the next five years.
These are based on 4 key pillars of the embedded Alma-Ata Principles:
A justice-oriented approach
To ensure a justice-oriented approach, we will continue to prioritise those populations
missed by others; offer a progressive voice and positioning within the development sector;
seek to transform the factors that contribute unjust power relations; and ensure our
communications remain consistent with our values.
Strong community roots
To ensure strong community roots we will continue to build long term trust and
commitment among the people we work alongside; seek to make health services culturally
appropriate; support community education and empowerment; and uphold accountability.
Comprehensive health systems
To ensure comprehensive health systems we will take a comprehensive and integrated
approach to what we do; focus on delivering a continuum of care; work to strengthen both
supply and demand; ensure health care services have the resources they need; and refrain
from building parallel systems, building on the local systems already available instead.
Social determinants of health
To tackle the social determinants of health we will work to ensure communities have access
to essential services and resources; strengthen our emergencies and disaster preparedness;
take measures to address gender justice, ethnicity, and forms of discrimination; and commit
to poverty eradication and equity.
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Priorities for 2015-2016
Continue to build on efforts to improve programme quality and address
issues of accountability.
Build our technical capacity by seeking expertise from medical professionals
as well as other experts in important areas such as cash transfers, resilient
livelihoods and climate change.
Continue to build upon our new M&E system piloted last year to collect
quantitative information and seek to improve our ability to capture
Continue to strengthen existing partnerships and forge new ones, testing
out tools and approaches, and sharing lessons learnt across countries.
Continue to carry out fundraising activities which work well and are
scheduled for the coming year, whilst exploring new options such as
developing a school fundraising pack or building relationships with local
Focus on existing donor stewardship, in particular proactively promoting
legacy fundraising in a targeted way.
Follow on from positive developments in 2014 and plan ahead for projects
coming to an end in Africa (which is one of the most attractive regions for
trusts and foundations).
Seek to improve our ability to attract Major Donors using resources
available to us such as our new trustees and database.
Policy & Campaigns
Continue to build our own voice, running regular campaign actions, and
providing people with materials that engage them in a deeper and more
political understanding of health justice.
Continue to work with others to raise a progressive voice, exerting influence
in and through networks such as the People’s Health Movement, the
Progressive Development Forum and others.
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Continue our policy and advocacy activities focusing on drugs and
development; health workers; reforming the medical research and
development regime; tax and health justice and the Sustainable Development
Continue to call for culturally appropriate health services, supporting
advocacy at country and regional level, such as to partners and staff in
Ethiopia/Kenya, and in the new Latin America programme.
Support efforts to build accountability and participatory methods of
influencing policy and practice, in the Commonwealth Foundation crosscountry
learning project in Kenya, Rwanda and Namibia
Review usability of website and ensure it is mobile optimised, search engine
optimised and that content is up to date.
Produce a new social media strategy in light of changing demographics of
followers and roll this out across all channels.
Improve ability to gain press coverage by mapping out our expertise and
focusing on developing relationships with journalists.
Ensure branding and key messages are firmly integrated across the
organisation and that resources and assets are easily available to staff.
Finance and Administration
Co-ordinate closely with programmes to allocate cash in the most
strategically effective way.
Mitigate match funding risk, ensuring shared understanding between
departments and setting up plans to address them.
Work closely with programmes staff to improve internal controls and
ensure donor compliance, and safeguard financial resources across the
whole of Health Poverty Action.
Work closely with Programmes to minimise impact of currency fluctuations
as efficiently as possible.
Oversee a rolling plan of internal audits of country offices, working with
programmes staff to ensure issues arising are addressed.
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During 2014-15 we maintained our financial strategy of investing in our programmatic work
(up £1.3m or 10% on last year). The net deficit of just over £1.0m was in line with our
budget for the year. This deficit was met from our restricted funds and was a result of
timing of in country programmatic activities.
Total income in 2014-15 was £13.2m, compared to £14.4m in 2013-14, which represents a
decrease of £1.2m. This was strongly influenced by the income we received in 2013-14
earmarked for projects planned for 2014-15 and was in line with our budgets and detailed
plans for the year.
Other voluntary income decreased £0.2m and this was due to an exceptional legacy income
received in 2013-14 of £0.15m which was not repeated in 2014-15.
Our increased commitment and investment into developing our programme work saw the
charitable expenditure increase to £13.9m (up £1.3m or 10% on last year). We have
continued to steadily increase our programme work, which has grown from £7m in 2010-11
to almost doubling in size during 2014-15. This remarkable achievement has been
accomplished without a corresponding increase to our support activities which is detailed in
Note 7 in our accounts. The support costs represent 3% of total resources expended which
compares favourably in the sector. From a geographical perspective, the main area of
increase was our activities in Myanmar, China and Rwanda, where we continued our work
in hard to reach and conflict areas.
The chart below provides an analysis of total resources expended over the last five years.
- 30 -
PRINCIPAL RISKS AND UNCERTAINTIES
Health Poverty Action works to strengthen poor and marginalised people in their struggle
for health. The risks we face are mostly inherent to the environments we work in and the
way that international development is funded.
In common with many charities, the current difficult fundraising environment creates
uncertainty about meeting both unrestricted and restricted income targets. The nature and
location of Health Poverty Action’s work, combined with its funding model (based largely on
restricted project grants), means that at any point in time the scale and allocation of future
funding is hard to project with certainty.
The Board has adopted a formal Risk Policy, and the Trustees and management have
identified risks and ranked these by likelihood and impact. Key risks are regularly reviewed
and monitored by senior managers as part of ongoing risk management throughout the year,
while the trustees review the major risks that face the organisation on at least a quarterly
basis and more often if needed. The Board has established systems and clear reporting
mechanisms to monitor, manage and mitigate the exposure to risk.
The principal risks and uncertainties are:
Risks related to operating in an
· Specialist local staff in the countries we operate in,
with strong local knowledge, have systems in place to
manage the risks associated with that specific
· Proactive monitoring, reporting and investigation of
incidents that might have a negative impact
· Regular visits and continual supervision by senior
managers to assess and mitigate risks of fraud,
malpractice, and harm
· Consolidation of strong relationships with donors,
UN agencies, governments and civil society to ensure
HPA programmes are supported and meet their goals
Keeping cash flow positive in
spite of the constraints imposed
by funding programmes
· Prioritizing and monitoring by senior managers and
Trustees of timely and accurate reporting to donors
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· Preparation of long-term global cashflow forecasts,
including the volume and timing of pre-financing
Non-compliance with donor
imposed restrictions resulting in
· Prioritizing staff allocation to ensuring and
monitoring donor compliance, including a senior donor
compliance manager with overall oversight, and a team of
specialist Programme Finance Officers ensuring donor
compliance in each country
· Consolidation of strong and close relationships with
institutional donors to ensure HPA is fully informed
about compliance requirements, and donors understand
our implementation in detail
Meeting matched funding
requirements on projects
· Continuing global assessment of match requirements
during each proposal application to avoid incurring
matched funding beyond our capacity
· Monitoring of long-term global forecasts to
anticipate and prepare for matched funding demands far
· Increase income from high net worth individuals,
trusts and corporates
Senior staff based in London visit all field offices at regular intervals and most projects at
least once a year. Trustees are also encouraged to visit programmes when appropriate and
practicable. Finances are monitored by the management regularly using a system of monthly
checks and reviews. Board meetings are held quarterly and reports on progress in
programmes and finances are presented in formats approved by the Board.
To increase its own capacity the Board has established a new Finance and Audit Committee
to monitor risks (as above) as well as uncertainties. This will enable Trustees to review the
organisation’s financial progress and security more intensively on at least a quarterly basis.
Regarding unrestricted income, the likely introduction of new fundraising restrictions on UK
charities is likely to adversely affect the many organisations. We have reviewed Health
Poverty Action’s exposure to these restrictions, and concluded that any impact on our
streams and costs is likely to be low. Nevertheless, because private fundraising currently
represents a small proportion of our income, we will be making it a priority to investigate
ways of increasing this to bolster the level of our resources that are unrestricted. As
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mentioned, we currently depend mostly on restricted grants, often with pre-financing
and/or match funding requirements, so increasing unrestricted income from high net worth
individuals, trusts, corporates and other sources – especially those with a connection with
health – over the next three years will enable greater financial security and operational
Our planning process and financial projections have taken into consideration the issues
mentioned above, as well as the current economic climate and its potential impact on the
various sources of income and planned expenditure. In the unlikely event that we were
unable to reach our income targets, the organisation’s decentralised management structures
are designed in such a way that they can be scaled up or down as required, and resources
are in place to cover the costs of this if and as needed. Trustees are confident the
organisation has adequate resources to operate successfully for the foreseeable future, and
we believe that there are no material uncertainties that call into doubt the organisation’s
ability to continue as a going concern.
In recent years the Health Poverty Action has seen significant growth, and trustees are
optimistic about the prospects for further organisational development and strengthening.
The board has determined that Health Poverty Action will maintain unrestricted reserves in
order to meet the following purposes:
- To provide working capital for the effective implementation of programmatic
activities and the effective running of the organisation,
- To protect the organisation against unforeseen organisational obligations due to the
inherent risks of operating in uncertain environment,
- To protect the organisation against unforeseen currency fluctuations,
- To manage the timing of income within the organisation and protect against
unrestricted income fluctuation.
At the end of the year we had unrestricted reserves equal to 5% of overall expenditure
(2014: 6%) The level of reserves is reviewed at least annually, and the need to increase the
levels is weighed against programme implementation and development requirements, and
the need to invest in fundraising to secure greater stability in the medium to long term. The
trustees aim to maintain reserves of at least 5% of annual expenditure (excluding gifts in
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STRUCTURE, GOVERNANCE AND MANAGEMENT
Health Poverty Action is a registered charity and a company limited by guarantee, set up in
1984 to “preserve and protect the health, through the provision of primary health care, of
communities who receive little or no external assistance because of political instability
In accordance with the Memorandum and Articles of Association, the trustees comprise the
membership of the organisation and are responsible for electing new trustees. All trustees
resign each year and either stand down or stand for re-election. In 2004 the trustees agreed
that no trustee should serve for more than eight years. The minimum number of trustees is
five and the maximum is twelve. There were 12 trustees at 31 March 2015.
New trustees are recruited through advertisement in the public media and a range of
networks. Newly appointed trustees receive a full induction introducing them to Health
Poverty Action and its work and covering the essentials of what being a trustee involves.
Trustees are encouraged to visit projects and some have participated in the evaluation of
projects and organisational development in the regions.
The trustees meet at least four times a year. One meeting is for a full day which is devoted
to the discussion of key issues facing the organisation and its responses to emerging trends.
Where necessary the Board establishes working groups to deal with particular issues and
report back to the full meeting. In 2014-15 the trustees met four times during the year.
Day-to-day management of the organisation is delegated to the Director and staff. In
keeping with the principle of devolved management, the number of staff in London has been
kept small. We also have part time volunteers working from time to time.
In 1999 we took the decision to decentralise direct management of our programmes to four
regional offices supporting locally recruited project managers. Over the past few years we
have continued to develop different approaches in response to circumstances in different
regions. In areas where we have had long term programmes we have gradually devolved
responsibility to country managers and offices.
Public Benefit Statement
The trustees confirm that they have complied with the duty in section 4 of the Charities Act
2006 to have due regard to the Charity Commission’s general guidance on public benefit,
‘Charities and Public Benefit’. Health Poverty Action’s charitable purpose is enshrined in its
objects ‘to preserve and protect the health, through the provision of primary health care, of
communities who receive little or no external assistance because of political instability and/or
conflict’. The trustees ensure that this purpose is carried out for the public benefit in
accordance with our mission statement thereby promoting a world in which all enjoy their
right to health.
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Health Poverty Action is privileged to work in partnership with very large numbers of poor
and marginalised people every day. They are the leaders of the changes they are bringing –
and the progress they have made is their own.
With that, Health Poverty Action is both humbled and thrilled to have been able to support
them. It is clear that this support has been of immense value to their health and well-being.
That support has been made possible thanks to those who have given so
generously to support our work, and to those who work with us (paid and
We are immensely grateful and hope that in the time ahead we will be able to grow to do
even more together.
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Trustees’ responsibilities, auditor’s report
and financial statements
STATEMENT OF TRUSTEES’ RESPONSIBILITIES
We have set out in the trustees’ report a review of financial performance and the charity’s
reserves position. We have adequate financial resources and are well placed to manage the
business risks. Our planning process, including financial projections, has taken into
consideration the current economic climate and its potential impact on the various sources
of income and planned expenditure. We have a reasonable expectation that we have
adequate resources to continue in operational existence for the foreseeable future. We
believe that there are no material uncertainties that call into doubt the Charity’s ability to
continue. The financial statements have therefore been prepared on the basis that the
Charity is a going concern.
The trustees who are directors of the company and who served during all or part of the
year from 1 April 2014 up to the date of signing these accounts, are stated on page 5 of this
The trustees as Directors are responsible for preparing the Annual Report and the financial
statements in accordance with applicable law and regulations.
United Kingdom company law requires the trustees to prepare financial statements for each
financial year under the law the trustees have elected to prepare financial statements in
accordance with United Kingdom Generally Accepted Accounting Practice (United Kingdom
Account Standards and applicable law). The financial statements are required by law to give
a true and fair view of the state of affairs of the company and the profit or loss of the
company for that period. In preparing these financial statements the trustees are required
- Select suitable accounting policies and then apply them consistently;
- Make judgements and estimates that are reasonable and prudent;
- State whether applicable UK Accounting Standards have been followed;
- Prepare the financial statements on the going concern basis unless it is inappropriate
to presume that the company will continue in business;
- Observe the methods and principles in the Charities SORP.
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The trustees are responsible for keeping proper accounting records that disclose with
reasonable accuracy at any time the financial position of the company and enable them to
ensure that the financial statements comply with the Companies Act in 2006. They are also
responsible for safeguarding the assets of the company and hence for taking reasonable
steps for the prevention and detection of fraud and other irregularities. The trustees are
responsible for the maintenance and integrity of the corporate and financial information
included on the company’s website Legislation in the United Kingdom governing the
preparation and dissemination of financial statements may differ from legislation in other
Provision of information to auditors
Each of the persons who is a trustee at the date of approval of this report confirms that: so
far as the trustee is aware, there is no relevant audit information of which the company’s
auditors are unaware; and the trustee has taken all the steps that she/he ought to have
taken as a trustee in order to make herself/himself aware of any relevant audit information
and to establish that the company’s auditors are aware of that information. This
confirmation is given and should be interpreted in accordance with the provision of section
418 of the Companies Act 2006.
Crowe Clark Whitehill LLP has expressed its willingness to continue as auditor for the next
The Annual Report and Accounts including the Strategic Report is approved by the Board of
Trustees and signed on its behalf by Emma Crewe, the Chair of the Board.
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INDEPENDENT AUDTOR’S REPORT TO THE MEMBERS OF
HEALTH POVERTY ACTION
We have audited the financial statements of Health Poverty Action for the year ended 31
March 2015 which comprise the Statement of Financial Activities, the Balance Sheet, the
Cash Flow Statement and the related notes numbered 1 to 19.
The financial reporting framework that has been applied in their preparation is applicable
law and United Kingdom Accounting Standards (United Kingdom Generally Accepted
This report is made solely to the charitable company’s members, as a body, in accordance
with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken
so that we might state to the charitable company’s members those matters we are required
to state to them in an auditor’s report and for no other purpose. To the fullest extent
permitted by law, we do not accept or assume responsibility to anyone other than the
charitable company and the company’s members as a body, for our audit work, for this
report, or for the opinions we have formed.
Respective responsibilities of trustees and auditor
As explained more fully in the Statement of Trustees' Responsibilities, the trustees (who are
also the directors of the charitable company for the purpose of company law) are
responsible for the preparation of the financial statements and for being satisfied that they
give a true and fair view.
Our responsibility is to audit and express an opinion on the financial statements in
accordance with applicable law and International Standards on Auditing (UK and Ireland).
Those standards require us to comply with the Auditing Practices Board's Ethical Standards
Scope of the audit of the financial statements
An audit involves obtaining evidence about the amounts and disclosures in the financial
statements sufficient to give reasonable assurance that the financial statements are free from
material misstatement, whether caused by fraud or error. This includes an assessment of:
whether the accounting policies are appropriate to the charitable company's circumstances
and have been consistently applied and adequately disclosed; the reasonableness of
significant accounting estimates made by the trustees; and the overall presentation of the
In addition, we read all the financial and non-financial information in the Strategic report
and the Trustees’ Annual Report to identify material inconsistencies with the audited
financial statements and to identify any information that is apparently materially incorrect
based on, or materially inconsistent with, the knowledge acquired by us in the course of
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performing the audit. If we become aware of any apparent material misstatements or
inconsistencies we consider the implications for our report.
Opinion on financial statements
In our opinion the financial statements:
- give a true and fair view of the state of the charitable company’s affairs as at 31
March 2015 and of its incoming resources and application of resources, including its
income and expenditure, for the year then ended;
- have been properly prepared in accordance with United Kingdom Generally
Accepted Accounting Practice; and
- have been prepared in accordance with the requirements of the Companies Act
Opinion on other matter prescribed by the Companies Act 2006
In our opinion the information given in the Strategic report and the Trustees Annual Report
for the financial year for which the financial statements are prepared is consistent with the
Matters on which we are required to report by exception
We have nothing to report in respect of the following matters where the Companies Act
2006 requires us to report to you if, in our opinion:
- adequate accounting records have not been kept; or
- the financial statements are not in agreement with the accounting records and
- certain disclosures of trustees' remuneration specified by law are not made; or
- we have not received all the information and explanations we require for our audit
- 39 -
HEALTH LIMITED T/A HEALTH POVERTY ACTION
STATEMENT OF FINANCIAL ACTIVITIES
FOR THE YEAR Y
ENDED 31 MARCH 2015
Unrestricted Restricted Total Total
Funds Funds Funds Funds
2015 2015 2015 2014
£ £ £ £
Incoming resources from generated
Voluntary income – Institutional 2 - 11,128,626 11,128,626 11,770,301
Other voluntary income 2 444,382 223,621 668,003 894,504
Gift in kind income 1,403,042 1,403,042 1,704,383
Investment income 3 21 4,748 4,769 5,051
Total incoming resources 444,403 12,760,037 13,204,440 14,374,239
Costs of generating funds
Costs of generating voluntary income 4 357,562 - 357,562 326,994
Costs of Health Projects 5 12,874 13,853,817 13,866,691 12,580,060
Governance Costs 6 50,945 - 50,945 91,022
Total Resources Expended 421,381 13,853,817 14,275,198 12,998,076
Net Income/(Expenditure) for the year 23,022 (1,093,780) (1,070,758) 1,376,163
Transfer between funds 17
Net movement in Funds for the year (44,944) (1,025,814) (1,070,758) 1,376,163
Total funds brought forward 1 April 2014 758,186 3,209,265 3,967,451 2,591,288
Total funds carried forward 31 March
713,242 2,183,451 2,896,693 3,967,451
The statement of financial activities includes all gains and losses recognised in the year. All incoming
resources and resources expended derive from continuing activities. The loss for Companies Act
2006 purposes is £1,070,758
The notes on pages 43 to 51 form part of these financial statements.
HEALTH LIMITED T/A HEALTH POVERTY ACTION
AS AT 31 MARCH 2015
Registered Company Number 01837621
Notes £ £ £ £
Debtors & prepayments 10 1,521,880 1,482,933
Cash at bank and in hand 11 2,213,472 3,075,258
Creditors: amounts due within one year 12 (750,608) (590,740)
NET CURRENT ASSETS 2,984,744 3,967,451
LONG TERM LIABILITIES
Creditors: Amount falling due after one year 13 (88,051) -
NET ASSETS 16 2,896,693 3,967,451
Unrestricted funds 17 713,242 758,186
Restricted funds 17 2,183,451 3,209,265
TOTAL FUNDS 2,896,693 3,967,451
Approved by the Trustees and signed on its behalf by:
The notes on pages 43 to 51 form part of these financial statements.
HEALTH LIMITED T/A HEALTH POVERTY ACTION
CASH FLOW STATEMENT
FOR THE YEAR ENDED 31 MARCH 2015
£ £ £ £
Net Cash (outflow)/inflow from Operating Activities (866,555) 902,199
Returns on investments and servicing of finance
Bank Interest received 4,769 5,051
Net (Decrease)/Increase in cash in the year (861,786)
Reconciliation of excess of Expenditure over income
net cash inflow from operating activities
Net (outgoing)/incoming resources (1,070,758) 1,376,163
(Decrease) in debtors (38,947) (416,090)
Increase in creditors 247,919 52,823
Interest Received (4,769) (5,051)
Net Cash (outflow)/inflow from Operating activities (866,555) 902,199
Analysis of Net Cash Resources
Cash 3,075,258 (861,786) 2,213,472
Location of Cash Resources 2015 2014
HQ Bank Accounts 358,121 838,124
In-Country bank accounts 1,855,351 2,237,134
The notes on pages 43 to 51 form part of these financial statements.
1. PRINCIPAL ACCOUNTING POLICIES
A. ACCOUNTING CONVENTION
The financial statements are prepared on the historical cost basis. These accounts have been
prepared in accordance with applicable United Kingdom accounting standards, the Companies Act
2006 and the Statement of Recommended Practice - Accounting and Reporting by Charities (SORP
2005). In the trustees report there is a review of financial performance and of the charity’s reserves
B. GOING CONCERN STATEMENT
Health Poverty Action, like many charities, is facing uncertainties arising from the current difficult
fundraising environment. The nature and location of Health Poverty Action’s work, combined with its
funding model (based largely on restricted project grants), means that at any point in time the scale
and allocation of future funding is hard to project with certainty.
HPA’s planning process and financial projections have taken into consideration the issues mentioned
above, as well as the current economic climate and its potential impact on the various sources of
income and planned expenditure. In the unlikely event that we were unable to reach our income
targets, the organisation’s decentralised management structures are designed in such a way that they
can be scaled up or down as required, and resources are in place to cover the costs of this if and as
needed. Trustees are confident the organisation has adequate resources to operate successfully for
the foreseeable future, and can manage the uncertain funding environment such that there are no
material uncertainties that call into doubt the organisation’s ability to continue as a going concern.
C. INCOMING RESOURCES
All incoming resources are included in the SOFA when the charity is legally entitled to the income and
the amount can be quantified with reasonable accuracy. The following specific policies apply to
categories of income:
-Gifts in kind are included at the value to the charity where this can be quantified. No amounts are
included in the financial statements for services donated by volunteers.
- Gifts in kind are recognised as both income and expenditure. The value of gifts in kind from donors
is pre-determined by the donor according to grant agreements, typically based on market prices for
relevant goods. An amount equivalent to the beneficiaries is included as in-kind expenditure in the
statement of financial activities. Only the amount of gifts in kind distributed in the year is recognised
- Legacies are included as income when evidence of entitlement exists and executors have
established that there are sufficient assets in the estate to pay the legacy. If a legacy payment is
received after the reporting period but it is clear that the payment was agreed by the executors prior to
the end of the reporting period, it is accrued as income. If there is uncertainty as to the amount of the
payment, for example if residual, and it cannot be measured reliably we will not make an income
D. RESOURCES EXPENDED
All expenditure is accounted for on an accruals basis and has been classified under headings that
aggregate all costs related to that category. Where costs cannot be directly attributed to particular
headings they have been allocated to activities on a basis consistent with use of resources. Staff
costs are allocated on an estimate of time usage and other overheads have been allocated on the
basis of the head count.
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Costs of generating funds are those incurred in seeking voluntary contributions and do not include the
costs of disseminating information in support of the charitable activities.
Governance costs are the costs associated with the governance arrangements of the charity which
relate to the general running of the charity as opposed to those costs associated with fundraising or
charitable activity. Included within this category are costs associated with the strategic as opposed to
day to day management of the charity’s activities.
Support costs, which include the central office functions such as general management, payroll
administration, budgeting and accounting, information technology, human resources, and finance, are
allocated across the categories of charitable expenditure, governance costs and the costs of
generating funds. The basis of the cost allocation has been explained in the notes to the accounts.
E. FUND ACCOUNTING
Unrestricted funds are available for use at the discretion of the directors in furtherance of the general
objectives of Health Poverty Action. Restricted funds are subject to restrictions imposed by donors or
the purpose of the appeal.
All income and expenditure is shown on the statement of financial activities.
F. FIXED ASSETS
UK assets costing more than £1,500 are capitalised. Brought forward cost at 01 April 2014 is £0. Net
Book value is £0.
G. FOREIGN CURREINCIES
Transactions in foreign currencies are translated into sterling at the weighted average rate of
exchange during the period and are disclosed in the Statement of Financial Activities. Current assets
and liabilities held on the balance sheet are retranslated at the year-end exchange rate.
The charity contributes to personal pension plans in respect of certain employees. The expenditure
charged in the financial statements represents contributions payable in respect of these schemes
during the year.
I. OPERATING LEASES
Rentals under operating leases are charged to the income and expenditure account as payments are
Health Poverty Action is a registered charity and as such is potentially exempt from taxation of its
income and gains to the extent that they fall within the charity exemptions in the Corporation Taxes
Act 2010 or Section 256 Taxation of Chargeable Gains Act 1992. No tax charge has arisen in the
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Liabilities are recognised when a charity has a legal or constructive obligation to a third party.
2. INCOMING RESOURCES FROM GENERATED FUNDS
VOLUNTARY INCOME £ £
Department for International Development (including PSI) 5,283,579 5,042,083
European Commission 1,445,701 2,877,338
Global Fund 1,597,033 1,660,314
Big Lottery Fund 519,161 414,398
ECHO - 456,601
Liverpool School of Tropical Medicine 301,208 303,043
World Food Programme 276,105 316,983
UN bodies 614,868 157,661
Irish Aid 156,024 152,376
Other 56,018 136,199
Concern Worldwide 86,279 118,591
Christian Aid 40,000 70,000
Cordaid 289,346 64,714
Department of Foreign Affairs and Trade (Govt of
Australia) 160,075 -
Comic Relief 145,448 -
DEERF (GOAL) 157,781 -
Other voluntary income
Trusts, foundations and individuals 223,621 279,669
Gift in Kind 1,403,042 1,704,383
Total Restricted Income 12,755,289 13,754,353
Other voluntary income
Donations 288,740 361,749
Legacies 29,454 148,102
Consultancy 16,134 2,148
UK and European trusts / foundations 110,054 102,836
Total Unrestricted Income 444,382 614,835
Total incoming resources from voluntary
income 13,199,671 14,369,188
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3. INVESTMENT INCOME
Restricted Funds 4,748 4,986
Unrestricted Funds 21 65
Total 4,769 5,051
4. COST OF GENERATING FUNDS
Direct Support Total Total
Costs 2015 2014
£ £ £ £
Costs of generating voluntary 271,303 86,259 357,562 326,994
271,303 86,259 357,562 326,994
Cost of generating funds comprises all costs identified as wholly or mainly attributable to the
generation of incoming resources other than from charitable activities and includes an
appointment of overheads.
5. CHARITABLE ACTIVITIES
Direct Support Total Total
Costs 2015 2014
£ £ £ £
Costs of health projects 13,586,101 280,590 13,866,691 12,580,060
13,586,101 280,590 13,866,691 12,580,060
Costs of charitable activities comprises all costs identified as wholly or mainly attributable to
charitable objects of the charity. These costs include staff costs, wholly or mainly
attributable support costs and an apportionment of overheads.
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6. GOVERNANCE COSTS
Direct Support Total Total
Costs 2015 2014
£ £ £ £
Audits - 31,200 31,200 57,000
Staff preparation for &
In trustee meeting - 19,745
Trustee Meeting Costs - - - 30
50,945 50,945 91,022
7. SUPPORT COSTS
Cost allocation includes an element of judgement and the charity has had to consider the
cost benefit of detailed calculations and record keeping. To ensure full cost recovery on
projects the charity adopts a policy of allocating costs to the respective cost headings. This
allocation includes support costs where they are directly attributable. Therefore the support
costs shown are a best estimate of the costs that have been so allocated.
Support costs and basis of apportionment:
Nature of cost £ £ £ £
Human resources 302,975 71,716 215,149 16,110 Allocation of staff time
Establishment costs 44,439 7,729 34,778 1,932 Number of employees
Administration 70,380 6,814 30,663 32,903 Number of employees
417,794 86,259 280,590 50,945
8. NET INCOME FOR THE YEAR BEFORE TRANSFERS
Is stated after charging
Statutory Audit 31,200 21,600
Additional fee for overruns incurred - 17,400
Rentals in respect of operating leases:
Plant and machinery 1,915 1,866
Other – Office 30,000 30,000
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9. STAFF COSTS AND TRUSTEES’ REMUNERATION
Wages and salaries 771,097 655,907
Social Security Cost 84,034 71,623
Pension Costs 45,140 37,024
Wages and Salaries 2,472,009 1,927,359
Pension Cost 164,797 140,964
TOTAL STAFF COSTS 3,537,077 2,832,878
One employee received remuneration of between £70,000-£80,000 in 2014-15 (2014: one).
Employer’s pension costs relating to that individual was £3,607 (2014: £3,555)
The Trustees neither received nor waived any emoluments during the year (2014: £nil)
No Trustees received expense reimbursements during the year (2014: £nil)
The Average number of employees, analysed by function was:
Charitable activities – Health Projects 389 367
Costs of generating funds – private voluntary income 4 4
Other Debtors in UK - 4,132
Cash advances to overseas partners - 12,597
Staff advances - 4,240
Other overseas/project debtors 208,049 220,795
Prepayments 2,603 24,846
Accrued income –Gift Aid & Other 17,264 3,548
Accrued income – Grants 1,293,964 1,212,775
11. CASH AT BANK AND IN HAND
Cash held for projects overseas 1,855,351 2,237,134
Bank and Cash 358,121 838,124
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12. CREDITORS: Amounts falling due within one year
Project Creditors 318,897 203,950
Other Creditors 99,841 64,022
Deferred income - 14,236
Other taxes and social security 22,013 25,010
Field Severance pay liability 274,478 201,348
UK Accruals 35,379 82,174
Deferred income: movement in
Balance brought forward 14,236 -
Released to income (14,236) -
Received in year - 14,236
Balance carried forward - 14,236
Deferred income represents grants received from donors in advance of the programme start.
13. CREDITORS: Amounts falling due after one year
Project Creditors 88,051 -
14. SHARE CAPITAL
The company has no share capital as it is limited by guarantee, the liability of each member
being a maximum of £1.
15. LEASEHOLD COMMITMENTS
Annual commitments under non-cancellable operating leases are as follows:
Expiry date £ £
Within one year
Plant and machinery 1,915 3,139
Between two and five years
Other – office 30,000 30,000
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16. ANALYSIS OF NET ASSETS BETWEEN FUNDS
Fund balances at 31March 2015 £ £ £
Current assets 866,296 2,869,056 3,735,352
Current Liabilities (153,054) (597,554) (750,608)
Long Term Liabilities )- (88,051) (88,051)
Total Net Assets 713,242 2,183,451 2,896,693
17. STATEMENT OF FUNDS
Cambodia 102,928 501,541 (392,095) 28,280 240,654
China & Myanmar 1,406,748 4,261,738 (5,189,130) (27,678) 451,678
Ethiopia 171 325,579 (176,798) - 148,952
Global 58,683 30,000 (62,152) (6,422)-
Guatemala 13,400 670,615 (378,140) 13,140 319,015
Kenya (1,036) 669,928 (538,438) 27,135 157,589
Laos 189,249 550,160 (695,952) (13,317) 30,140
Namibia 33,929 92,748 (106,002) 47 20,722
Nicaragua 85,911 167,325 (149,823) 14,352 117,765
Peru 3,487 56,821 (57,220) - 3,089
Rwanda 381,858 698,931 (928,108) 30,369 - 183,050
Sierra Leone 276,331 873,623 (876,064) 1,982 275,872
Somaliland 657,606 3,861,028 (4,303,895) 78 214,817
Total restricted funds 3,209,265 12,760,037 (13,853,817) 67,966 2,183,451
Unrestricted funds 758,186 444,403 (421,381) (67,966) 713,242
Total funds 3,967,451 13,204,440 (14,275,198) - 2,896,693
The transfer of £67,966 from restricted funds to unrestricted funds reflects the write off of old
project balances relating to concluded projects which were in deficit at the end of the year.
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18. STATEMENT OF FUNDS
Big Lottery Fund Receipts Expenditure
ICB/2/010415059 85,705 142,870 Ethiopia (main grant)
ICB/2/010445412 160,981 167,104 Cambodia (main grant)
ICB/2/010462606 85,101 92,881 Guatemala (main grant)
ICB/2/010462606 - 5,000 Guatemala (development grant)
URN: 0010065516 150,325 109,834 Sierra Leone (main grant)
URN: 0010065516 5,000 4,750 Sierra Leone (development grant)
URN: 0010237333 5,000 5,000 Nicaragua (development grant)
URN: 20243776 5,000 4,000 Namibia (development grant)
URN: 0010231645 23,976 302 Namibia (main grant)
Oxfam Novib Receipts Expenditure
A-320-02B05632 (22,866) - Myanmar
Irish Aid Receipts Expenditure
CSF019-1201 156,024 127,045 Rwanda and Nicaragua
DFID funding Receipts Expenditure
GPAF - IMP - 045 373,529 375,712 Somaliland
GPAF - IMP - 081 188,951 193,712 Kenya
GPAF - IMP - 069 159,014 159,141 Laos
AGA 203400 - 107 1,235,277 1,291,209 Myanmar
AGA 203138 -102 607,935 848,174 Myanmar (Phase 4)
AGA 203138 -102 732,151 786,110 Myanmar (Phase 5)
CSCF 522 (10,540) - Namibia
CSCF 545 56,821 58,603 Peru
Girls Education Challenge -
GEC Receipts Expenditure
6317 278,740 321,419 Rwanda
6317 mobilisation payment 88,051 - Rwanda
DFID Emergency Ebola Relief
Fund - DEERF Receipts Expenditure
DFID-DEERF-017 88,125 61,793 Sierra Leone
DFID-DEERF-037 - 7,753 Sierra Leone
Cordaid Receipts Expenditure
110811 60,182 45,633 Sierra Leone
111634 154,845 123,146 Sierra Leone
111077 74,319 41,247 Ethiopia
Medici con l’Africa CUAMM Receipts Expenditure
CFMCH-109957 20,108 16,993 Ethiopia
19. RELATED PARTY TRANSACTIONS
There are no related party transactions to report.
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