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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


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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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

health justice.

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

movement together.

Martin Drewry - Director of Health Poverty Action

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2014 - 2015 KEY HIGHLIGHTS

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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)




Tom Baker

Jonathan Barton 2

Nouria Brikci 1

Professor Emma Crewe 1 (Chair) (from 08

October 2015)

Debra Davies 3 (Treasurer)

Dr. Isabelle De Zoysa 1

Dr. Rory Honney 1

Oliver Kemp 1

Donald Peck (Chair)(to 06 October 2015)

Ruth Stern

James Thornberry 1

Simon Wright

Carolyn Ramage (Treasurer) (from 09

December 2015)


Joanna Blackburn


Martin Drewry


Appointed on the 10 December 2014


Resigned on the 06 October 2015


Resigned on the 31 October 2015


Health Poverty Action

Ground Floor

31-33 Bondway

London SW8 1SJ

United Kingdom


Crowe Clark Whitehill LLP

Chartered Accountants and

Registered Auditors

St Brides House

10 Salisbury Square

London EC4Y 8EH

United Kingdom


CAF Bank Limited

Kings Hill

West Malling

Kent ME19 4TA

United Kingdom

HSBC plc

8 Canada Square

London E14 5HQ

United Kingdom

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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

for health.

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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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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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

more widely.

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

and credibility.

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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Last year we worked in 13 countries across Africa, Asia and Latin America


Latin America Africa Asia








Sierra Leone






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THE OUTCOME OF OUR WORK - Facts and Figures

We trained

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

Teachers 425

Peer Educators 476

Human Rights Defenders 80

Judges/Judicial Staff 49

Police 52

We gave

Condoms 133,970

Other contraceptives and family planning services 26,743

Mosquito nets/supplies for soaking nets 215,064

We immunised

Children against childhood diseases 102,542

Women 19,192

We facilitated

Women to access maternal health services 247,388

Children to access child health services 178,210

We provided

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

Ambulances 6

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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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

August 2014.

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.

Key Actions:

• 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

Savannakhet province.

Latin America

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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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.

London Marathon

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.

- 21 -

Ebola Crisis

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.


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

campaigns work.

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.

- 24 -

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.

Public events

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.

Social Media

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.

- 26 -


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.

- 27 -

Priorities for 2015-2016






Data Capture


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

qualitative data.

Continue to strengthen existing partnerships and forge new ones, testing

out tools and approaches, and sharing lessons learnt across countries.




Events and




Trusts and


Major Donors

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


Influence and


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.

- 28 -


Priority Areas



Priority Areas


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

Goals (SDGs).

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



Social Media



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

Cash Flow











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.

- 29 -



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.

Incoming Resources

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.

Charitable Activities

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 -


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

unstable environment

· 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

- 31 -

· Preparation of long-term global cashflow forecasts,

including the volume and timing of pre-financing


Non-compliance with donor

imposed restrictions resulting in

claw backs

· 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

in advance

· 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

- 32 -

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


- 33 -


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

and/or conflict”.

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.

- 34 -


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.

- 35 -

Trustees’ responsibilities, auditor’s report

and financial statements


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


Trustees’ responsibilities

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.

- 36 -

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

financial year.

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.

- 37 -



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

Accounting Practice).

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

for Auditors.

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

financial statements.

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

- 38 -

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

financial statements.

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

returns; or

- 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 -







Unrestricted Restricted Total Total

Funds Funds Funds Funds

2015 2015 2015 2014

£ £ £ £

Incoming resources

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

Charitable activities

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

(67,966) 67,966

- -

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.




AS AT 31 MARCH 2015

Registered Company Number 01837621

2015 2014

Notes £ £ £ £


Debtors & prepayments 10 1,521,880 1,482,933

Cash at bank and in hand 11 2,213,472 3,075,258

3,735,352 4,558,191


Creditors: amounts due within one year 12 (750,608) (590,740)

NET CURRENT ASSETS 2,984,744 3,967,451


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.





2015 2014

£ £ £ £

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

2,213,472 3,075,258

The notes on pages 43 to 51 form part of these financial statements.




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



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.


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

as income.

- 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



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.

- 43 -

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.


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.


UK assets costing more than £1,500 are capitalised. Brought forward cost at 01 April 2014 is £0. Net

Book value is £0.


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.


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


- 44 -


Liabilities are recognised when a charity has a legal or constructive obligation to a third party.


2015 2014


Restricted Income

Institutional 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 -

11,128,626 11,770,301

Other voluntary income

Trusts, foundations and individuals 223,621 279,669

Gift in Kind 1,403,042 1,704,383

1,626,663 1,984,052

Total Restricted Income 12,755,289 13,754,353

Unrestricted Income

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

- 45 -


2015 2014

£ £

Bank interest:

Restricted Funds 4,748 4,986

Unrestricted Funds 21 65

Total 4,769 5,051


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.


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.

- 46 -


Direct Support Total Total

Costs 2015 2014

£ £ £ £

Audits - 31,200 31,200 57,000

Staff preparation for &

In trustee meeting - 19,745

19,745 33,992

Trustee Meeting Costs - - - 30


50,945 50,945 91,022


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:


Cost of








Nature of cost £ £ £ £

Basis of


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

Office &

Administration 70,380 6,814 30,663 32,903 Number of employees

417,794 86,259 280,590 50,945


Is stated after charging

2015 2014

£ £

Annual Audit

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

- 47 -


2015 2014

£ £

UK Staff

Wages and salaries 771,097 655,907

Social Security Cost 84,034 71,623

Pension Costs 45,140 37,024

900,271 764,554


Wages and Salaries 2,472,009 1,927,359

Pension Cost 164,797 140,964

2,636,806 2,068,323

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:

2015 2014

Charitable activities – Health Projects 389 367

Costs of generating funds – private voluntary income 4 4

393 371


2015 2014

£ £

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

1,521,880 1,482,933


2015 2014

£ £

Cash held for projects overseas 1,855,351 2,237,134

Bank and Cash 358,121 838,124

2,213,472 3,075,258

- 48 -

12. CREDITORS: Amounts falling due within one year

2015 2014

£ £

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

750,608 590,740

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

2015 2014

£ £

Project Creditors 88,051 -


The company has no share capital as it is limited by guarantee, the liability of each member

being a maximum of £1.


Annual commitments under non-cancellable operating leases are as follows:

2015 2014

Expiry date £ £

Within one year

Plant and machinery 1,915 3,139

Between two and five years

Other – office 30,000 30,000

- 49 -








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


Funds at









Funds at



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.

- 50 -


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


There are no related party transactions to report.

- 51 -

- 52 -

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