UNAUDITED ANNUAL REPORT & ACCOUNTS 2021-22
UK REGISTERED CHARITY 1120236
COMPANY REGISTRATION NUMBER: 05815194 (ENGLAND AND WALES)
CONTENTS PAGE Legal and administrative information 2 Chairman’s Statement 3 Trustees’ Report 4 to 11 Independent examiners report 15 Statement of financial activities 16 Balance sheet 17 Notes to the financial statements 18 to 25
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ATIVE INFORMATION
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TRUSTEES
Mr Imran Pasha (Chair) Prof Harold Gee Dr Saliya Chipwete Mrs Maria Gee Mr Kiong Chan Dr Peter Rookes Mr Mukhtar Karim Dr Chipiliro Florence Kalebe-Nyamongo Mr Andrew Jones Prof David Davies
REGISTERED OFFICE
4th Floor Institute of Transitional Medicine Heritage Building Mindelson Way Birmingham B15 2TH
None of the directors has any beneficial interest in the company. All of the trustees are members of the company and guarantee to contribute £1 in the event of winding up
Charity number: 1120236
Company number: 05815194 (registered in England and Wales)
INDEPENDENT EXAMINER: PAUL BOWATER ACA
ACCOUNTANTS BVSC FIRST FLOOR LIVERY PLACE 35 LIVERY STREET BIRMINGHAM B3 2PB
BANK THE CO-OPERATIVE BANK PLC PO BOX 250 SKELMERSDALE WN8 6WT
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MESSAGE FROM THE CHAIR:
Covid-19 and its disruption to healthcare systems around the world unfortunately, but not unexpectedly, has had a negative impact on global maternal mortality rates.
In 2019 maternal mortality ratio was 151 deaths per 100,000 live births. The latest data for 2020 which covers the first full year of Covid has seen this increase to 152 per 100,000.
The current trajectory projects 133 deaths per 100,000 live births in 2030, nearly double the SDG target. This is why the work of Ammalife is more crucial now than ever.
Imran Pasha Chair of Trustees
Our work is primarily focused on sub Saharan Africa as that is where the challenge is more acute - with 302 deaths per 100,000 live births - with the overwhelming majority of these deaths are avoidable with the right intervention.
Our work has 4 strands – research, change makers, projects and collaboration. Work continued in all these areas during 2021.
Our research work has continued to focus on the two main causes of maternal mortality: post partum haemorrhage and sepsis.
Through the Gates Foundation funded E-MOTIVE programme, Ammalife has secured funding to share evidence of what works. In addition Ammalife has funded life saving medicines for the E-MOTIVE trial in Nigeria.
With regards to sepsis Ammalife has supported the FAST-M research, co-funded the development of the Sepsis bundle and is looking to support a further Change Maker in this area.
With the efforts of everyone involved - including donors, volunteers, partners and change makers - work has continued to save lives through the dissemination of research, sharing and implementing best clinical practice, providing life saving medicines and hygiene products.
Ammalife aims to build its capacity by investing in appropriate resources. With the updated business plan, post pandemic environment and a renewed focus the aim is to ensure Ammalife is fit for purpose to address the challenges in maternal health.
With your ongoing support and encouragement we will continue striving to save mothers lives.
Thank you to all.
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ABOUT US
Founded by doctors and midwives, Ammalife is a specialist, research-driven organisation committed to tackling obstacles to good maternal health in some of the poorest parts of the world.
Everything we do is designed to build on the strengths and capacities of local people to enable them to find economic, culturally appropriate, and sustainable solutions to their problems.
Our Partnerships support appropriate and effective solutions to the problem of maternal death, our Change Makers work on the ground to provide compassionate care and share knowledge and good practice throughout their careers and our practical research is contributing to important discoveries which are profoundly changing practice and improving outcomes for mothers whose health rights are denied.
AMMALIFE: SAVING MOTHERS AROUND THE WORLD
Vision
A safe and healthy pregnancy and childbirth for all mothers, regardless of where they live, now and for future generations.
Mission
We carry out research to make pregnancy and childbirth safer. We support communities and healthcare providers to take evidence-based action that saves the lives of mothers and babies in some of the poorest parts of the world.
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VALUES:
AMMALIFE OPERATES WITH FIVE KEY PRINCIPLES AT OUR CORE.
WE STRIVE TO ENSURE THAT EVERYTHING WE DO IS:
Proactive and agile Collaborative Sustainable Empowering Transparent
OUR ACHIEVEMENTS:
Our main focus over the last year continued to be the reduction of sepsis, miscarriage and postpartum hemorrhage, three big contributors to maternal mortality rates globally.
We scaled back COVID response as partner health facilities move towards care of providing pregnant mothers in their “new normal” way.
Sepsis Prevention
Healthcare acquired infection can pose a risk of Sepsis to pregnant and birthing mothers which is why we have invested in research and intervention around handwashing. However, this year one of our partner organisations in Malawi submitted a request for support to re-cover 200 mattresses in their maternity unit, to enable them to be effectively washed and cleaned between patients for infection control purposes. We recognised that sometimes it’s the small practical steps which can make a big difference, and we were pleased to provide a small grant to help make this happen.
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POSTPARTUM HEMORRHAGE (PPH)
The E-MOTIVE trial is the Early detection of Postpartum Haemorrhage and treatment using the WHO MOTIVE 'first response' bundle: a cluster randomised trial with health economic analysis and mixed methods evaluation
Postpartum haemorrhage (PPH), defined as a blood loss of more than 500 ml, is the leading cause of maternal death worldwide and a major concern in low-resource countries.
Ammalife are a key partner with the E-MOTIVE trial, and our work to support the initiative has continued this year. We have continued to raise funds to purchase tranexamic acid in Nigeria and Tanzania, which has ensured that high quality medication has been available for the trial, but more importantly has saved the lives of countless mothers.
NAOCO CONFERENCE 2022
We were delighted to support the 2022 Annual Scientific conference National Association Of Clinical Officers in Malawi this year, following a year’s hiatus due to COVID and the challenges in bringing large numbers of people together safely.
Around 50 obstetric Clinical Officers from across the country and all health districts attended.
The E-MOTIVE More than Blood documentary was aired - ensuring that cutting edge research on treating PPH is reaching those at front line. We were also able to distribute Misoprostol, an important drug for treating PPH, at the conference - for transport back to rural clinics, which would usually be challenging due to unreliable courier services.
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MISCARRIAGE
Losing a baby during pregnancy is still a taboo subject worldwide. In some countries where abortion is illegal, mothers often fear seeking medical help when they experience symptoms of miscarriage, for fear that they may be accused of terminating their pregnancy. This leaves them at risk of illness and infection.
We are working with communities to tackle these taboos, so that mothers receive appropriate and respectful care.
This year we have produced 2 animations which aim to start sensitive conversations around baby loss, and encourage families to seek help and support. The first, an English language version, was launched during Babyloss Awareness Week, and the second - a Chichewa version was launched during the annual NAOCO conference alongside a related education session.
MISSION MOROGORO
A full time midwife to serve the community and local women's groups is being employed at Tunguli Health Centre, Tanzania. Ammalife were able to provide funding for a year’s salary, which was matched by another charity to fund an additional 12 months.
The midwife will work both clinically and carry out health promotion and public health messaging on maternal and child health issues, with the aim of training community champions to further the health promotion within their communities on a voluntary basis.
In the community they will support our work on PPH by distributing the life saving drug, TXA, and specialist equipment to local health facilities. The midwife will also provide education on signs of sepsis and offer miscarriage support.
They will also be starting dialogues on major health challenges such as anaemia -prevention and treatment including adherence to haematinics, preterm labour and creating birth plans for women with previous Cesarean Sections
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CHANGE MAKERS
"WITH HARD WORK AND COMMITMENT TOWARDS MATERNAL HEALTH, I AM AN AMMALIFE CHANGEMAKER, BEING SUPPORTED FOR A MASTER OF SCIENCE IN GLOBAL HEALTH AT LIVERPOOL SCHOOL OF TROPICAL MEDICINE.”
LAURA MUNTHALI
AMMALIFE CHANGE MAKER, SENIOR RESEARCH NURSE (MLW), GLOBAL HEALTH STUDENT (LSTM)
As the tenure of some of our existing Change Makers drew to a close this year, we were excited to welcome Laura Munthali to our Change Maker programme.
Laura is a graduate with a BSc in Nursing and Midwifery from Kamuzu College of Nursing. She is currently working with the Maternal Health Group, at the Malawi-Liverpool Wellcome Institute on the MAT-SURV project and FAST-M+ study in Blantyre, Malawi while also studying for her Masters degree by distance learning.
She has many years’ experience in maternity care, as a team leader on Labour Ward and as a maternity unit Matron. She has also gained experience experience working with research teams, co- ordinating and conducting research work.
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WHO IS AMMALIFE?
MEET THE TEAM!
RAJ KAUR Volunteer Exec Member
LOUISE JACKSONOUR TRUSTEES AND SANDERS FOUNDER Operations Manager
We are keen to ensure that as much of our income goes to finding solutions to improving maternal health outcomes, and as such Ammalife currently has just one part time member of staff. Louise is supported by a dedicated team of volunteers, who give up their time freely because they refuse to sit on the sidelines whilst hundreds of thousands of mothers die in pregnancy and childbirth each year.
These volunteers make up our board of trustees, our voluntary executive team, and support our operations by creating content for our website or social media, summarising the latest research articles, helping us sort and pack donations for shipments and so much more!
RAJ KAUR
THANKYOU TO EVERYONE WHO DONATES THEIR TIME We couldn't do it without you!
Volunteer Exec Member
We welcomed Raj to our Executive Team this year; here's why she was keen to support Ammalife:
"I have been a project manager in academic research for the last ten years and became Centre Manager at Tommy’s National Centre for Miscarriage Research in 2020. Through this I became aware of barriers that hugely impact being able to access good maternal healthcare birth in the UK and overseas. When I learnt about Ammalife I felt compelled to to give my time and operational knowledge as volunteer for the exec team to contribute to improving maternal outcomes for families."
TRUSTEES & ACCOUNT PORT
TRUSTEES REPORT (INCLUDING DIRECTORS REPORT)
YEAR ENDED 31 MAY 2022
THE TRUSTEES, WHO ARE ALSO DIRECTORS OF THE CHARITY FOR THE PURPOSES OF THE COMPANIES ACT 2006, PRESENT THEIR REPORT AND UNAUDITED FINANCIAL STATEMENTS OF THE CHARITY FOR THE YEAR ENDING 31 MAY 2022.
STRUCTURE, GOVERNANCE AND MANAGEMENT
Constitution
The charity is registered as a charitable company limited by guarantee and was set up by a Memorandum of Association on 12 May 2006.
The principal object of the charity is to promote the physical and mental health of women.
Methods of appointment or election of Trustees
Trustees can be appointed by the Board of Trustees, subject to confirmation at the next Annual General Meeting or nominated and elected at an Annual General Meeting.
Organisational structure and decision-making policies:
The Board of Trustees meets a number of times throughout the year to oversee the charity’s strategy, finance and legal obligations.
The Executive Board meets more frequently and is responsible for the day-to-day running of the Charity including idea acquisition, projects, fundraising, website and social media, and networking and collaboration. The Executive Board reports to the Board of Trustees.
Risk management
A risk register has been established with regular reporting by the Executive Board to the Board of Trustees.
Capacity
Capacity continues to be a challenge for the organisation, although there have been improvements this year with the addition of new executive members. We have continued to meet jointly with Executive and Trustee boards to help to ensure greater alignment and focus for the Charity.
Fundraising
Due to capacity with our only member of staff on maternity leave for a portion of the year, we did not partake in this year's Big Give initiative which generates a large proportion of our usual income. Community fundraising initiatives were also limited due to ongoing COVID limitations. We anticipate both initiatives will be reinstated for the coming financial year. Regular donations have remained stable, and we hope to grow both these, and our trust income , in the coming year with the support of additional fundraising expertise.
Website
This is the main channel for all stakeholders of Ammalife to learn about the organisation and keep up to date with the latest developments.
No major changes were made. A nominal fee was paid for website maintenance and administration so we were able to update items. This is an area which needs to be constantly reviewed and updated to ensure it is relevant and engaging.
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STRUCTURE, GOVERNANCE AND MANAGEMENT
Final review and reflection
Operational resilience continues to be an ongoing challenge for the charity. As part of our new strategy the trustee's have committed to building our capacity by means of additional paid staff, and new skilled volunteers.
Despite these operational challenges this year we have developed our partnerships, saved mothers lives by providing life saving drugs, provided education opportunities to clinical officers, and instated a new change maker.
Financial Review and statement: Performance during the year
During the year the charity has sustained its income with donations from two chief sources. The regular givers have contributed £15,460 and E-MOTIVE £14,328, giving the charity an income of £29,788.
Expenditure has been spread over the charity’s direct spending on projects; providing medicines and equipment for the E-MOTIVE PPH programme, providing supplies to support the sepsis work, the COVID emergency appeal supplies for Malawi and supporting NAOCO’s service improvement and professional development work among Clinical Officers; and the regular operational expenses of running the organisation. All these activities were accommodated within an expenditure of £34,207.
Reserves policy
The reserves policy of the charity is based on an understanding of income streams (including the risk profiles of these); projected activities and contractual commitments to expenditure; and the overall risk environment in which the charity operates. Any designations and/or re-designations of the charity’s reserves will be agreed by discussion and recorded in the minutes of meetings of the trustees and Annual General Meeting of the charity.
Currently the policy is to hold an amount equivalent to approximately six months expenditure (approximately £15,000 - £20,000). The free reserves at the year end were £13,305 (2021: £24,630). The trustees will be reviewing the policy in the context of future plans to consider if this remains an appropriate policy.
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Statement of Trustees responsibilities
The trustees (who are also the directors for the purposes of company law) are responsible for preparing the Report of the Trustees and the financial statements in accordance with applicable law and United Kingdom Generally Accepted Accounting Practice.
Company law requires the trustees to prepare financial statements for each financial year which give a true and fair view of the situation of the charitable company and of the incoming resources and application of resources, including the income and expenditure, of the charitable company for that period. In preparing those financial statements, the trustees are required to select suitable accounting policies and then apply them consistently; observe the methods and principles in the Charity SORP;
make judgements and estimates that are reasonable and prudent;
state whether applicable UK Accounting Standards have been followed, subject to any material departures disclosed and explained in the financial statements; prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charitable company will continue in business.
The trustees are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the charitable company and to enable them to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.
Approval
The Trustees Report was approved by the Board of Trustees and signed on its behalf by:
Imran Pasha
Chair of the Trustees 16th September 2022
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INDEPENDENT EXAMINERS REPORT TO THE TRUSTEES OF AMMALIFE LIMITED
I report to the trustees on my examination of the financial statements of Ammalife Limited for the year ending 31 May 2022.
Responsibilities and basis of report
As the trustees of the charity (and also its directors for the purposes of company law) you are responsible for the preparation of the financial statements in accordance with the requirements of the Companies Act 2006 (the 2006 Act).
Having satisfied myself that the financial statements of the charity are not required to be audited under Part 16 of the 2006 Act and are eligible for an independent examination. I report in respect of the examination of the charity’s financial statements carried out under section 144 of the Charities Act 2011 (the 2011 Act). In carrying out my examination I have followed all the applicable Directions given by the Charity Commission under section 145(5)(b) of the 2011 Act.
Independent Examiner’s Statement
I have completed mu examination. I confirm that no matters have come to my attention in connection with the examination giving me cause to believe that in any material respect:
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accounting records were not kept in respect of the charity as required by section 386 of the 2006 Act; or
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the financial statements do not accord with those records; or
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the financial statements do not comply with the accounting requirements of section 396 of the 2006 Act other than any requirement that the accounts give a true and fair view which is not a matter considered as part of an independent examination; or
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the financial statements have not been prepared in accordance with the methods and principles of the Statement of Recommended Practice for accounting and reporting by charities applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102).;
I have no concerns and have come across no other matters in connection with the examination to which attention should be drawn in this report in order to enable a proper understanding of the financial statements to be reached.
Paul Bowater ACA Birmingham Voluntary Service Council 138 Digbeth Birmingham B5 6DR
16th September 2022
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The statement of financial activities also complies with the requirements for an income and expenditure account under the Companies Act 2006.
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For the year ending 31 May 2022 the company was entitled to exemption from audit under section 477 of the Companies Act 2006 relating to small companies. No members have required the company to obtain an audit of the financial statements for the year ending 31 May 2022 in accordance with section 476 of the Companies Act 2006.
The trustees acknowledge their responsibilities for complying of the Act with respect to accounting records and the preparation of financial statements.
These financial statements have been prepared in accordance with the provisions applicable to companies subject to the small companies regime.
The financial statements were approved by the Board of Trustees on 16th September 2022, and signed on behalf of the board by:
Imran Pasha Chair of the Trustees
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NOTES TO THE FINANCIAL STATEMENTS YEAR ENDED 31 MAY 2022
1.ACCOUNTING POLICIES
Accounting convention
The accounts have been prepared in accordance with the Companies Act 2006 and “Accounting and Reporting by Charities: Statement of Recommended Practice (SORP) applicable in the UK and Republic of Ireland (FRS 102)” (as amended for accounting periods commencing from 1 January 2016). The charity is a “Public Benefit Entity as defined by FRS 102.
The charity has taken advantage of the provisions in the SORP for charities applying FRS 102 Update Bulletin 1 not to prepare a Statement of Cash Flows.
The financial statements are prepared in sterling, which is the functional currency of the charity.
The financial statements have been prepared under the historical cost convention. The principal accounting policies adopted are set out below.
Going concern
At the time of approving the financial statements, the trustees have a reasonable expectation that the charity has adequate resources to continue in operational existence for the foreseeable future. Thus the trustees continue to adopt the going concern basis if accounting in preparing the financial statements.
Charitable funds
Unrestricted funds are available for use at the discretion of the trustees in furtherance of their charitable objectives unless the funds have been designated for other purposes.
Restricted funds are subject to specific conditions by donors as to how they may be used. The purposes and uses of the restricted funds are set out in the notes to the financial statements.
Incoming resources
These are included in the Statement of Financial Activities (SOFA) when:
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The charity becomes legally entitled to the resources after any performance conditions have been met;
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The trustees are virtually certain that they will receive the resources; and The monetary value can be measured with sufficient reliability.
Cash donations are recognised on receipt. Other donations are recognised once the charity has been notified of the donation, unless performance conditions require deferral of the amount.
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Accounting Policies (continued)
Resources expended
Charitable activities includes all costs relating to general administration, which support the charitable purpose.
Grants offered subject to conditions, which have not been met at the year-end date are noted as a commitment, but not accrued as expenditure.
Expenditure is accounted for on an accruals basis and has been classified under headings that aggregate all costs related to the category. Where costs cannot be directly attributed to particular headings that have been allocated to activities on a basis consistent with the use of the resources.
Incoming resources with related expenditure
When incoming resources have related expenditure (as with fundraising or contract income) both are reported gross in the SOFA.
Cash and cash equivalents
Cash and cash equivalents include cash in hand, deposits held at call with bankers, other short term liquid investments with original maturities of three months or less, and bank overdrafts. Bank overdrafts are shown within borrowings in current liabilities.
Financial instruments
The charity has elected to apply the provisions of Section 11 “Basic Financial Instruments” and Section 12 “Other Financial Issues” of FRS 102 to all of its financial instruments.
Financial instruments are recognised in the charity’s balance sheet when the charity becomes party to the contractual provisions of the instrument.
Financial assets and liabilities are offset, with the net amounts presented in the financial statements, when there is a legally enforceable right to set off the recognised amounts and there is an intention to settle on a net basis or to realise the assets and settle the liability simultaneously.
Basic financial assets
Basic financial assets, which include debtors and cash and bank balances, are initially measured at transaction price, including transaction costs and are subsequently carries at amortised cost using the effective interest method unless the arrangement constitutes a financing transaction, where the transaction is measured at the present value of the future receipts discounted at a market value of interest. Financial assets classified as receivable within one year are not amortised.
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Accounting Policies (continued)
Basic financial liabilities
Basic financial liabilities, including creditors and bank loans are initially recognised at transaction price unless the arrangement constitutes a financing transaction, where the debt instrument is measured at the present value of the future payments discounted at a market rate of interest. Financial liabilities classified as payable within one year are not amortised.
De-recognition of financial liabilities
Financial liabilities are derecognised when the charity’s contractual obligations expire or are discharged or cancelled.
Pensions
The company operates a defined contribution pension scheme and the pension charge represents the amounts payable by the company to the fund for the year.
2. CRITICAL ACCOUNTING ESTIMATES AND JUDGEMENTS
In the application of the charity’s accounting policies, the trustees are required to make judgements, estimates and assumptions about the carrying amount of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from these estimates.
The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised where the revision affects only that period, or in the period of the revision and future periods where the revision affects both current and future periods.
3. DONATIONS, GRANTS AND LEGACIES
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4. EXPENDITURE ON CHARITABLE ACTIVITIES
5. TRUSTEES
None of the trustees (or any persons connected with them) received any remuneration or benefits from the charity during the year (2021 - £nil).
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6.STAFF COSTS
The average number of administration employees during the year was 1 (2021 – 1), who did not earn more than £60,000 in either year.
Pension commitments
The charitable company operates a defined contribution scheme. The assets of the scheme are held separately from those of the charitable company and are independently administered. The pension cost charge above represents contributions payable by the charitable company to the fund. Contributions totalling £46 (2021 – £nil) were payable to the fund at the balance sheet date are included in creditors.
7.FINANCIAL INSTRUMENTS
8. DEBTORS
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9.CREDITORS: AMOUNTS FALLING DUE WITHIN ONE YEAR
10. RESTRICTED FUNDS
The income funds of the charity include restricted funds comprising the following unexpended balances of donations and grants held on trust for specific purposes:
Current year
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Restricted funds (continued)
Prior year
EMBRACE
This is restricted funding to be donated onto a similar project to Ammalife working in Tanzania.
On a roll
These funds have been donated to provide toilet paper and carbolic soap for 11,000 new mothers in the Maternity Unit at Queen Elizabeth Central Hospital, Malawi. This is the first defence in infection control and offers dignity to new mothers as well as securing the good working order of the new toilets and washing facilities, which Ammalife has co-funded.
Funding FAST-M
Ammalife has helped seed fund a collaboration between health workers in Malawi and Birmingham to design FAST-M, a “toolkit” to tackle maternal sepsis in low resource settings: Fluids, Antibiotics, Source identification, Transport to better care and Monitoring of the mother and new born. Right now, we’re supporting staff training and providing essential medical supplies to the fifteen centres involved in the pilot study year. We’re planning to continue our support to these centres after the pilot study so that the lifesaving work can continue.
PRISM
This represents a grant that has been awarded for dissemination.
Big Give
This appeal took place in December 2020 as part of the nationwide Big Give Christmas Challenge, run by the Big Give via their online donations platform. The money we raised was for a hand hygiene project to help prevent maternal sepsis in Malawi . This included training for health care workers on hand hygiene, giving access to soap and water through handwashing stations and purchased alcohol gel for hospital maternity units. Additionally, we aimed to improve sustainable access to alcohol gel through investigating the local production of alcohol hand gel.
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Restricted funds (continued)
COVID 19 Emergency Fund
This appeal was raising money for equipment to protect mothers, babies and healthcare workers in Malawi maternity units from COVID-19. It included the purchase of handwashing stations, soap, paper towels, hand sanitiser and protective equipment for healthcare workers, including gowns and face masks. These supplies have been distributed at Queen Elizabeth Central Hospital, Blantyre and six further sites around the country; Dowa, Kabudula, Chitipa, Ndirande, Thyolo and Zomba.
E-MOTIVE
Is a restricted reserve relating to the translation of the University of Birmingham’s research project.
11. Analysis of net assets between funds
Fund balances at 31 May 2022 and 31 May 2021 are represented by current assets/(liabilities.
12. Related party transaction
Donations without restriction from the Trustees during the year amounted to £1,380 (2021 - £1,412) from 3 (2021 – 3) Trustees.
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