## **NETWORK FOR AFRICA** ## **TRUSTEES’ REPORT (INCLUDING DIRECTORS’ REPORT)** ## **FOR THE YEAR ENDED 31 DECEMBER 2021** The trustees present their report and financial statements for the year ended 31 December 2021. The financial statements have been prepared in accordance with the accounting policies set out in note 1 to the financial statements and comply with the charitable company’s government document, the companies Act 2006 and “Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective January 2019)”. ## **Objectives and activities** Network for Africa (N4A) works with communities in the aftermath of conflict and genocide. We help the survivors of African conflicts who have been left behind after the fighting stops and the humanitarian aid moves on. We provide training for these survivors in specialised trauma counselling so they can tackle the long-term psychological consequences that often block their communities’ recovery. We equip community leaders with the skills to identify those in need and challenge the stigma attached to trauma, depression and mental illness. We listen to what these communities tell us they need, so we can offer appropriate and sustainable support. We currently have projects in Rwanda, Sierra Leone and northern Uganda. The trustees of the charity have given due regard and adhere to the Charity Commission’s guidance in public benefit. ## **SUMMARY AND REVIEW OF 2021** People living in sub-Saharan Africa have been disproportionately affected by conflict in recent decades, with a damaging legacy on their mental health and wellbeing (BMJ Global Health 2021) – such as the genocide against the Tutsi in Rwanda, an 11-year civil war in Sierra Leone (closely followed by an Ebola epidemic) and a brutal 21-year civil war in northern Uganda. The legacy of conflict and genocide, coupled with extreme poverty, has had a profound impact on people’s mental health, leaving millions living with conditions such as depression, anxiety or post-traumatic stress disorder (PTSD). The UN states that 1 in 5 people in conflictaffected areas have a mental health disorder (UN 2019), compared to 1 in 8 globally, while mental health care provision in post-conflict areas of sub-Saharan Africa remains limited. Meanwhile, there are estimates of the burden of mental disorders across sub-Saharan Africa doubling in the next four decades (Global Mental Health Journal 2021). In all three countries, the Covid-19 pandemic continues to exacerbate people’s mental health due to the social and economic shocks it has triggered, while climate change and Russia’s war in Ukraine are each already impacting some of the world’s poorest and most vulnerable people in Rwanda, Sierra Leone and Uganda. Each of these are driving up food insecurity and poverty – which N4A knows from experience exist in a vicious cycle with mental ill health. **Network for Africa (N4A)** works with local organisations in Rwanda, Sierra Leone and Uganda to address the psychological, social and health problems created by conflict that prevent community members from rebuilding their lives. We work with our implementing partners, sharing capacity to deliver and manage these programmes. Once participants are sufficiently recovered, we provide livelihood support to lift them out of poverty and break the cycle of mental illness and poverty – with livelihoods programmes in all three countries currently. **In Rwanda** we worked with Survivors Fund (SURF) in 2021, running a community-based peer counselling model, supporting young survivors of the genocide – helping them talk about their trauma and address their post-traumatic stress disorder – and will be introducing livelihoods support in 2022. **In Sierra Leone** , we work with Conforti Community Aid Children Organisation’s Port Loko branch (Conforti PL) and Health Poverty Action (HPA) supporting people with mental illness and their caregivers to conduct livelihood 1 activities and save money in their self-help groups, while continuing to support community mental health activities – counselling, community outreach and education, mental health clinics and provision of epilepsy medication. **In Uganda** , with our partner BNUU, we continued to support people with livelihoods in 2021 alongside community mental health work, and have recently been awarded a new grant to expand BNUU’s mental health work in more areas of northern Uganda. **Covid-19** continues to affect people’s lives and mental health worldwide, not least among sub-Saharan Africa’s poorest and most marginalised communities. The prevalence of mental health issues across Africa has risen during the pandemic, which has compounded existing inequalities and deepened pre-existing social and economic challenges – exacerbating the mental health of those already struggling, while driving new cases of mental illness (Africa Academy of Sciences, 2021). For example, the economic and social hardship driven by the pandemic in Sierra Leone has increased prevalence of drug abuse (BBC, 2021). The pandemic caused ongoing disruption to each of N4A’s mental health programmes during 2021 – for example, restrictions on movement and gatherings in Rwanda meant SURF had to provide counselling by telephone through part of the year, while lockdowns in Uganda meant livelihood input distribution was delayed by three months until March and clients’ ability to restock and access markets were at times impacted. Vaccination rates in sub-Saharan Africa remain lower than the global average, with lack of supply being a bigger driver than mistrust of the vaccine, though supplies began to be boosted during the last quarter of 2021 (Our World in Data, 2022). **Climate change** is already causing issues for our clients in Rwanda, Sierra Leone and Uganda, predominantly through disruptions to the timing and intensity of rainy seasons. Many of our clients depend on subsistence farming for their livelihood and food supply, and are therefore some of the most vulnerable people to climate change in their respective countries. This increases stress levels, which in turn increases the risk of people with mental illnesses relapsing, drives up rates of intimate partner violence/sex and gender-based violence, and also causes major issues for those on mental health or epilepsy medication – most of whom need to take their medication with food, and some of whom may find their appetites increased as a side effect of their medication. Our partners in Sierra Leone and Uganda, Conforti PL and BNUU, both power their offices with solar panels, which limits our own project-related emissions (as well as local noise and air pollution) by removing the need to use petrol-fuelled generators. **War in Ukraine –** at the time of writing in 2022, Russia’s war in Ukraine is causing huge disruptions to global fuel and food supplies which are further compounding people’s access to and ability to afford food in subSaharan African countries such as Rwanda, Sierra Leone and Uganda. Before the war, half of Africa’s wheat came from Ukraine or Russia, and the World Food Programme’s single biggest supplier of food was Ukraine. The price of some basic foodstuffs has doubled in Sierra Leone since February, while all our programmes are affected by fuel price increases and shortages. By installing solar panels on Conforti PL’s office during 2021, which used to run on a petrol generator for over half the year, we have reduced our demand for fuel in Sierra Leone which has mitigated against some of the burden of price rises. **Plans for the future -** N4A continues to develop ideas for potential mental health projects for Cameroonian and South Sudanese refugees in camps in Nigeria and northern Uganda respectively, as well as monitoring funding opportunities for our proposed community mental health project in Plateau State, Nigeria. ## **Achievements and performance** ## **RWANDA** ## **2021 highlights included:** - **268** new clients were enrolled in peer support groups where they received group counselling. The total number of young genocide survivors helped in this way since the project started is more than **1,500.** - **24** new Peer Support Counsellors were recruited and trained to run the peer counselling groups. They get to know the group members well and look out for anyone who needs extra support, and refer them to the project’s counsellors. - **22** health workers were trained in mental health case management. - **181** group counselling sessions were held and **118** clients had individual counselling. - **1,703** telephone counselling sessions took place during lockdowns. 2 - **198** vulnerable clients who needed extra support were visited at home. - **35** clients started their own small businesses and **12** clients found employment. - **50** of the clients were selected at the start of 2021 to take part in a baseline survey, and the same cohort took part in the survey at the end of the year. The improvements included: - The number of clients who felt their thoughts were preventing them from doing something others do reduced from 92% to 12% over the year. - At the start of the year 64% had thought about taking their own lives in the previous week – this figure had reduced to 6% at the end of the year. Whilst we would obviously prefer there to have been no suicide ideation, the counsellors know who these clients are and are providing them with extra and continuing support. - Even though some clients are still facing issues of trauma and its symptoms, at least 94% of them agree that they know how to deal with their trauma symptoms. **Our project partner in Rwanda in 2021 was Survivors Fund (SURF).** Founded in 1997 by Mary Kayitesi Blewett OBE, SURF supports survivors of the 1994 genocide against the Tutsi in Rwanda through working with survivorled organisations including AVEGA (Association of Widows of the Genocide) and AERG (National Students’ Association of Genocide Survivors). SURF delivers technical support including capacity building and monitoring and evaluation to their partner organisations, delivering projects ranging from healthcare to housebuilding, education to entrepreneurship. SURF is a UK registered charity, managed and run from its head office in Kigali, Rwanda. Our project in Rwanda is a community-based peer counselling model, supporting young survivors of the genocide through group counselling - helping them talk about their trauma and address their post-traumatic stress disorder. Approximately 250 clients from local communities are enrolled on the programme each year. They are divided into 12 groups and elect 2 peer support counsellors (PSCs) from each group to moderate and lead the group counselling sessions. The PSCs are trained to carry out this role, and are supported by the project’s counsellors, in addition to receiving quarterly supervision, so that they can refer clients for individual counselling and also receive support for more challenging cases. Training and up-skilling of clients to undertake key roles is a central component of this project, ensuring that skills and professional development remain in the local community, in order to promote sustainability. Thus the 12 PSCs all receive training and supervision, as do the 4 project counsellors, in addition to health workers from health centres in the participating project areas. In 2021 the project got off to a slightly late start owing to Covid-19 and restrictions on movement. However, 268 clients were recruited and started their group counselling sessions in March. The group members selected 12 Peer Support Counsellors (2 from each group) who received training from the project’s counsellors in trauma and group counselling skills. They were supervised by SURF’s counsellors and received their own supervision sessions quarterly. There they were able to strengthen their counselling skills and discuss difficult cases in a supportive environment. Covid-19 caused some disruption during the year, making it impossible for the groups to meet at times. However, SURF compensated by making sure that telephone counselling was available, providing 1,703 telephone counselling sessions. In total over the course of 2021, 181 group counselling sessions were held. This was lower than the target figure but not a surprise given the restrictions on movement imposed by Covid19. Home visits were an integral and important part of the programme, and 198 vulnerable clients were visited at home during the year. The annual commemoration of the genocide in April was particularly difficult in 2021 because it coincided with a period of lockdown. However, the clients managed well, all things considered, and they reported that they had been helped with the coping mechanisms they had been taught. The excavation and reburial of genocide victims from a mass grave in Kiziguro, Gatsibo district, was very traumatic for those affected, clients, peer support counsellors and project counsellors alike. We provided extra support and supervision to help them through that very difficult period. Twenty-two health workers from health centres in the participating areas took part in a three-day training course on the essentials of mental health case management. There were 12 clinical psychologists and 10 general nurses working in mental health services. The training covered topics such as communication, active listening, post-traumatic stress disorder, resilience theory, depression, suicide and substance abuse (drugs and 3 alcohol). The training included a questions-and-answers session, group discussions and case study discussions. The pre and post assessments of the health workers’ current knowledge and understanding showed a marked improvement at the end of the course. The project’s counsellors worked with the District Administrators to carry out awareness-raising in the community on mental illness and how to manage depression. They also delivered a programme of psychoeducation for the clients, where they discussed topics such as the benefits of Covid-19 vaccinations, drug and alcohol abuse, the prevention of unwanted pregnancy and family planning, and taught relaxation exercises to help combat loneliness and isolation exacerbated by Covid-19 lockdowns. Some of the clients started savings and were able to loan money to other group members, earning them some interest. Others are planning to group together to buy livestock and are saving towards that goal. The counsellors were successful in obtaining grants from the government for 23 clients (13 women and 10 men) to start small income generating projects. Five of the clients resumed their studies at university, and 25 carried out charity work in their communities. The benefits of the project have not gone unnoticed by local government leaders and community members who are appreciative of the positive changes they can see in the clients and wider community. We are very pleased that together with SURF we have secured the funds to provide entrepreneurship training and start-up costs for livelihoods for the new 2022 cohort. We have received feedback from the clients since the project started that livelihoods would exponentially improve their life outcomes. This is backed up by our own learning that poverty reduction improves mental health outcomes. Next on our list is to raise funds to provide free on-site childcare for the counselling groups, as so many of the clients are single mothers who don’t have the means to access baby-sitting, and find that having their babies and toddlers at the group counselling sessions, detracts from their ability to fully engage. ## **Covid-19** Rwanda put in place a national nighttime curfew from February to March 2021, as well as strict limits on numbers in indoor public spaces, and restricting travel between Kigali and the rest of the country. SURF reintroduced telephone counselling during this period, as it had done in 2020, though this was also limited by the number of clients without access to phones. 19 clients tested positive for Covid-19 during 2021, which has affected them both mentally and physically. Rwanda requires that people test before attending public gatherings, which continues to limit some clients’ attendance at group counselling sessions. Covid-19 restrictions also limited the ability of many to attend the reburial of their family members who were victims of genocide discovered in a mass grave in Kiziguro. At the time of writing, 8.15m Rwandans (61% of the total population) are fully vaccinated, the highest of the three countries in which N4A works. ## **Climate change** The rural areas where SURF runs its peer support counselling programmes are already witnessing heavier than usual rains during the farming season, which destroy people’s crops. 70% of Rwandans’ livelihoods depend on the agriculture sector, and they are especially vulnerable to climate change. _I love my family. Now I would ask for individual counselling rather than isolating. I hope the good things I was able to get through these counselling services could be offered to many young survivors who are suffering like I did for many years._ (Project client) **Thanks –** We would like to thank the Bryan Guinness Trust, the Eleanor Rathbone Charitable Trust, the Blackfriars Overseas Aid Trust and the James Tudor Foundation. We would also like to thank all those who donated to our Big Give Appeal: the Reed Foundation, Mr. & Mrs. D Bliss, Carol Bryson, Philippa Clegg, Frida Critien, Mike Diggins, Pam East, Mr. & Mrs. K. Feber, Ashley Fleischer, Max Gibbs, David Gye, Melanie Harris, Mark Harris, Annabel Harris, Louis Harris-White, Martin Haworth, Lara Haworth, Serena Heller, Micheál Jacob, Oliver Lubbock, Arun Malhotra, Gerard Markes, Sophie McCann, Ross McClean, James Middleton, Annie Nicholson, Ciaran Nilan, Peter O’Sullivan, Tristan Parsons, Mr. & Mrs. A. Patullo, Lesley Pavincich, Jack Pilkington, David Russell, Joanne Ryan, Paula Smyth, John Spayne, Francine Stock, Mr. & Mrs. H. Tinsley, Olivia Warham, Howard White, Julia Wisdom and Robert Woodfield. 4 ## **SIERRA LEONE 2021 highlights included:** - **New grant –** We secured a new 3-year grant from the Addax and Oryx Foundation for this project. We also secured funding from the Allan and Nesta Ferguson Trust for year 1. - **180** self-help group members participated in a baseline survey to assess their mental health, and are receiving ongoing training and support to do group savings and plan for their livelihoods through their 9 SHGs. - **45** self-help group members attended a 5-day training workshop covering skills and knowledge for successful livelihoods and village savings and loans, which they are cascading to their remaining 135 fellow group members. - **256** clients with mental disorders/epilepsy received individual counselling. - **783** clients participated in group counselling. - **362** clients attended our monthly mental health clinics. - **56** clients with epilepsy received epilepsy medication which previously they had not had access to. - **695** pregnant women and breastfeeding mothers attended mental health information sessions, including on post-natal depression, of whom **24** subsequently came forward for counselling. - **669** primary and secondary school students and teachers attended a mental health presentation, covering issues such as corporal punishment, mental health and stigma. - **417** community members, including community leaders and other duty bearers, were engaged in mental health education and stigma reduction sessions in their communities. - **12** team members and district mental health staff participated in supervision, training and continuing professional development. ## **Our project partners in Sierra Leone in 2021 were:** - **Conforti Community Aid Children Organisation** is a Sierra Leonean NGO based in Freetown and Port Loko. It addresses the educational and welfare needs of young people including their mental health. - **Health Poverty Action (HPA)** is an international NGO that has a direct presence in 13 countries, including Sierra Leone, where it has been implementing programmes since 2005. Founded in 1984, it was set up to meet gaps in the provision of medical aid to people affected by prolonged and complex conflicts. Its vision is a world in which the poorest and most marginalised enjoy their right to health. We were delighted with our successful application to the Addax and Oryx Foundation for funding towards a 3- year livelihoods and mental health programme in Port Loko with Conforti’s Port Loko office (Conforti PL). This programme started in July 2021 and began with the baseline survey that involved reassessing all 180 self-help group (SHG) members’ mental health (formed into 9 SHGs), with depression and stress being the most prevalent conditions, affecting 29% and 27% of members respectively. 37% of members are caregivers of a person with mental disorders/epilepsy (PMDEs), and 79% of these caregivers also have a mental illness of their own. 13% of SHG members have epilepsy. Besides mental health conditions, 13% of SHG members are war survivor amputees (2 of the 9 SHGs are based in Port Loko’s post-war ‘amputee camps’ for survivors and their families), and 16% are survivors of Ebola. In November, a five-day training workshop took place, covering the fundamental skills and knowledge needed by SHG members to start and make a success of their livelihoods and village savings and loans activities (VSLAs). The training was delivered to five members per SHG (45 in total), who with the support of Conforti PL’s livelihoods team are sharing the training with other SHG members. The SHGs have got off to a really positive start with their VSLAs. They have established their rules and processes, agreed by all group members with members paying in what they can weekly or monthly (which could be as low as SLL 5,000 - approximately £0.40). The savings are kept in a collective pot but with each owning the amount they contribute; they can borrow for income generating purposes, which they pay back with interest; the interest is owned by all group members according to the same % as their individual contributions. Some SHGs have chosen to allocate some of their savings to a collective fund, which is used to fund group costs, such as refreshments for meetings, and some have already begun to develop their own livelihoods practices using loans. 5 Alongside the livelihoods programme, we have continued to support Conforti PL with their community mental health activities. The counsellors provided individual counselling to 256 clients (133 female, 123 male) and group counselling to 783 clients (480 female, 303 male) across the whole of 2021, while also supporting the mental health nurse to provide monthly mental health clinics at the 5 health centres in our operational area to 362 clients. Our provision of epilepsy medication to 56 clients, who would otherwise be unable to afford or access it, has meant that they have been able to reintegrate into their communities, and take up work and schooling again. All 17 children receiving treatment are now in school and doing well. Thanks to our work, the Port Loko district office of the Ministry of Basic and Senior Secondary Education has picked up on this, and started to conduct a district-wide study on the number of school age children with epilepsy who are at risk of dropping out of school (or have already done so) due to their condition. So far, they have established that 35 further children in Conforti PL’s existing operational areas have untreated epilepsy, 14 of whom have dropped out of school, with a further 48 in the adjacent chiefdom. We are looking to provide epilepsy medication to these children through further grants, as we now have an established system in place for providing this service, with oversight and supervision from a specialist epilepsy nurse from another district. Our in-country mental health consultant has supported the team with ongoing training and supervision. Our social workers and counsellors attend weekly maternity clinics to deliver information on maternal and child mental health to pre and post-natal women. The team talks about postnatal depression, and child and family mental health including parenting methods. Across the whole of 2021, we reached 695 such clients, of whom 24 subsequently came forward for counselling in the second half of the year. Due to the high demand from schools as they reopened following pandemic closures, and following consultation with 65 students and 35 teachers, the team has developed a short mental health awareness presentation for teachers and students, covering issues such as corporal punishment, youth mental health and stigma reduction, with the aim of improving child wellbeing, and reducing the level of dropouts. A nationwide study recently estimated 89% of Sierra Leonean students are subjected to regular corporal punishment at school. Daily floggings occur more often with people with disabilities than others. Our youth consultation showed the excuses for such punishment are mostly due to circumstances beyond students’ control, such as extreme poverty, or for no reason at all, and that it has a detrimental impact on students’ wellbeing. We reached 358 primary school students and teachers, and 311 secondary school students and teachers between July and December 2021. This built on feedback we received from Grand Challenges Canada to our 2020 application, suggesting the team needed to have already piloted a project in schools. We were therefore able to add this experience into the 2021 application to Grand Challenges. Though this application was unsuccessful, we now have a youth mental health programme for schools ready to go subject to future funding opportunities. ## **Covid-19** Sierra Leone reintroduced a night-time national curfew in January 2021. Travel between Freetown and the rest of the country was also restricted at the start of the year. Such measures have been lifted and reintroduced at points over the year. Conforti PL were involved in education and combatting misinformation on the vaccine, which they incorporated into some of their outreach talks. As a result, a majority of the clients in the amputee camps have been vaccinated. The pandemic has caused continued economic and social hardship in Sierra Leone, especially among the poorest, which throughout the pandemic has been a greater source of stress and anxiety than fear of the virus itself. It has led to a rapid rise in the use of a drug named ‘kush’ (a strong synthetic marijuana), which now accounts for the majority of male admissions to the country’s one psychiatric hospital, and has now reached Port Loko. Conforti PL is engaging with the district mental health nurse and district health officer on this problem. Many of the amputees travel to Freetown in the week to beg, and they were hit hard by restrictions on travel to and from Freetown. At the time of writing, 1.1m Sierra Leoneans (14% of the total population) are fully vaccinated (below the Africa-wide average of 16%). ## **Climate change** In 2021, the annual rainy season in Port Loko arrived the latest it ever has, and is becoming shorter and more intense by year. This is severely affecting local farming, with subsistence farming the most common existing 6 livelihood activity of Conforti PL’s clients. This is an extreme source of anxiety for clients. According to the latest census data (Stats SL 2016), in Port Loko district as a whole, 81% of the population depend on agriculture as their main source of income, and 92% of residents in the district face some form of food insecurity. However, there are no government food aid programmes. Additionally, Port Loko town and its surroundings rely on a small, local hydroelectric power plant for electricity, which is sporadic and unreliable during the dry season. Climate disruption is meaning people face unreliable electricity supply for more of the year, as the dry season expands in length of time year on year. In order to mitigate against this, to reduce our own project-related emissions, and to reduce local noise and air pollution, during 2021 we invested in solar panels for the Port Loko office. These now provide 100% of the office’s power needs, whereas it was previously forced to run on a petrol generator during the dry season. This has also meant we have reduced our demand for fuel, which has mitigated against some of the burden of current fuel price rises. **Looking ahead:** Our key immediate priority is to fill the funding shortfall for Conforti PL’s livelihoods project and wider mental health programme, which is currently being met with N4A’s unrestricted reserves. We will also support Conforti PL to develop their own strategic plan, incorporating the various strands of mental health work they are engaged in, in order to help plan and apply for funding to expand work in future. Finally, we will support Conforti PL to further develop its relationship with government bodies, such as the district education office, in order to further mental health support in the district. _I had been living with epilepsy for almost 20 years, without any medication. My condition was so miserable that I could not do any work. My life became useless._ _One day, I found the counsellors coming to my aid and they started talking to me about my problem. They started having regular visits with me to talk about the impact this condition has had on my life, and eventually were able to provide me with regular epilepsy medication through the clinics. I have had three months without any seizures and now feel able to do some small farming. Now I get income from the farm, and also contribute to my family from the farm._ (Project client) **Thanks –** We would like to thank the Addax and Oryx Foundation and the Allan and Nesta Ferguson Trust for their support. ## **UGANDA** ## **2021 highlights included:** - **548** clients attended BNUU’s monthly mental health clinics, of whom **413** reported improvement in their condition. - **339** clients received individual counselling. - **625** PMDEs and caregivers from **35** self-help groups received start-up items to begin their income generating activities. - **UGX 10,345 (£2.35)** were the average savings by PMDEs over the course of the year – an increase of **84.7%** since the start of 2021. - **UGX 10,119 (£2.30)** were the average savings by caregivers over the course of the year – an increase of **84.1%** since the start of 2021. - **93%** of PMDEs and caregivers are able to afford to eat two meals a day, where previously many could only afford one. - **218** PMDEs and caregivers took part in an analysis of their livelihoods to establish which livelihoods are doing well and why. **Our project partner in Uganda in 2021 was BNUU,** a Ugandan NGO that supports access to mental health services through training, research, advocacy and awareness raising, targeting clients with mental disorders. It addresses stigma, discriminatory policy, access to quality mental health care and poverty affecting clients with mental illness. The mental health clinics, counselling services and home visits continued throughout 2021. 339 PMDEs and caregivers received counselling; 548 PMDEs attended the monthly mental health clinics; and of home visits, 92% of PMDEs were adhering to their medication, largely attributable to supportive families, the drug bank 7 initiative and increased household income because of the livelihoods. There was some fall in adherence to medication from men, due to excessive alcohol consumption, but this was met with extra counselling. The distribution of livelihood inputs provided by The National Lottery Community Fund took place in March - delayed from 2020 due to Covid-19. This distribution took place over 8 days – 2 days in each participating area, requiring careful planning because of Covid-19 safety measures. The distribution was well attended by local government officials, many of whom by their own admission, had never previously engaged with PMDEs. They pledged future support for PMDEs and their caregivers, and the distribution process was hugely motivating for all involved. In total, 625 self-help group members from 35 of the total 61 self-help groups supported by BNUU received livelihood inputs. This saw an almost immediate increase in household income compared to the previous quarter. However, there was a marked differential between the income of PMDEs and that of caregivers, so much so that BNUU stepped up its support for PMDEs in order to increase their income. The rates of income fluctuated for the remainder of the year, owing to price increases during lockdown that had an impact on expenditure on restocking their livelihood inputs, thus reducing their profit margins. Other factors included unpredictable weather patterns that negatively impacted farming and reduced availability of food, and resulted in some PMDEs spending more of their savings on buying food for personal consumption. However, overall, the level of savings increased, which was further boosted by BNUU offering cash prizes to the SHGs that had saved the most money. The average savings amongst PMDEs and caregivers increased by some 80%. This increase in savings had a positive impact on the setting up of the drug banks – a key component of the programme that protects PMDEs from medication shortages and resulting relapse. The SHG members had training in setting up drug banks; what the purpose of them is; what factors make them successful and effective; and what challenges they can expect. They elected chairpersons, secretaries and treasurers, and 60 representatives from the SHGs formed management committees. All the SHGs are encouraged to contribute a proportion of their savings to the drug banks and found the training very motivating. Towards the end of 2021, 218 PMDEs and caregivers took part in an analysis of their chosen livelihoods, to find out which businesses were working well, with stock and cash in hand, and those that are not working so well and also to understand the impact of Covid-19 on their business outcomes. In summary, 96% of those who participated in this exercise have businesses that are doing well, with 4% saying that their businesses are not doing well. Of those doing well, PMDEs had an average working capital (value of stock plus cash in hand) worth UGX 177,715 (£40) as opposed to the initial investment of UGX 100,000 (£22). Caregivers had done slightly better with an average working capital of UGX 193,972 (£43) compared to the initial investment of UGX 100,000 (£22). The analysis showed that the majority of BNUU’s clients with sustainable livelihoods were selling dried fish, cooking oil, soap and green vegetables, and that they had diversified/were selling more than one item. It also showed that 88 of the clients had invested some of their profit into long-term businesses e.g. farming, buying livestock etc., and had little working capital for running their livelihood. However, when probed a bit further they said that they would use their profit from selling their harvests to reactivate their livelihoods. There is a long tradition of agriculture in this area, so it is understandable that clients are drawn to farming to supplement their income, and their actions show initiative. The SHG members demonstrated that they now understand their rights through their advocacy actions, and were proactive in presenting issues at stakeholders’ meetings that were attended by local government representatives as well as sub-county chiefs. These issues included a lack of involvement of PMDEs in government programming; long distances to reach mental health clinics; inadequate supply of medication; stigma; bad roads preventing access to mental health clinics; rude and unwelcoming behaviour from health workers etc. These interventions produced results e.g. unannounced visits by officials at health centres to monitor health workers’ absences, rudeness and negligent practice; the repair of inaccessible roads. In July 2021 we received a grant from the Charles Hayward Foundation to provide training and livelihood startup items for 10 more SHGs benefitting 178 PMDEs and caregivers. The training programme for this cohort has begun - they have all participated in: - Training in enterprise selection, which helps clients understand what to consider when choosing their livelihoods e.g. their health, local market demand, what products will generate an early profit; - Financial literacy to equip PMDEs and caregivers with basic business and financial management skills, including record keeping, budgeting, savings and loans; 8 - Village savings and loans (VSLAs) including the importance of saving as a group rather than individually, how to be an effective member of a VSLA, leadership, internal rules and regulations, introduction to written records; - Drug bank training to explain the concept of a drug bank and why it is important to have one, how to set one up, how to form a drug bank committee and increasing understanding of factors leading to success and possible challenges. One of the difficulties that came up during 2021 as a direct result of Covid-19, was a lull in PMDEs and caregivers’ ability to restock livelihood items owing to restrictions on movement which also caused price increases and a temporary loss in income. This resulted in food shortages, or lack of sufficient income to buy food, which is bad enough under normal circumstances, but if you are taking strong anti-psychotic medication, makes the medication difficult to tolerate. We were therefore very grateful to the Kenneth Miller Trust for providing a grant for seeds and training for SHG members to grow vegetable gardens in their compounds to stave off food shortages, ensure a steady supply of staples and enable them to earn a small income from selling any surplus. BNUU enlisted the support of an agricultural extension worker from the local government who has offered training to the clients and will support them through the first season of growing through to harvest, to make sure that the necessary skills are embedded. The response from local government to BNUU’s community mental health interventions has been consistently good and appreciative. BNUU is assiduous in maintaining regular communication with key stakeholders in local government and in encouraging the SHG members to develop advocacy actions and take them to the relevant duty bearers. This gives them the profile and self-esteem that they so badly need and proves to them that their human rights do count and that the authorities should be held accountable if their rights are eroded. It has been so rewarding to see the positive impact that a longer funding investment can have, starting with the Comic Relief grant in December 2017 that laid the foundations for the community mental health programme, followed by The National Lottery Community Fund and Charles Hayward Foundation grants that have built on those foundations by giving PMDEs and caregivers a further step up in their recovery journey through livelihoods. ## **Covid-19** Uganda experienced a big surge in Covid-19 cases with the arrival of the Delta variant in May 2021, leading to the introduction of a new national lockdown from early June until August, including a ban on travel between districts. This has led to ongoing hardship in Agago district, and led to some SHG members avoiding group meetings out of fear - they instead met their SHG chairperson and treasurer individually to conduct their savings. Uganda’s schools remained closed due to the pandemic for the whole of 2021, not reopening until January 2022 after 21 months of closure – one of the longest Covid-19 related schools closures of any country in the world. Some children have found it really hard to be back at school, and many had taken up work in their family businesses while off school. Some girls have not returned to school due to having been forced into early marriage and/or falling pregnant while schools were shut. There were reports of a couple of children taking their own lives around the time schools reopened. There is also a shortage of school places, as some teachers (especially from private schools which form a large part of Uganda’s school provision) moved into other work for survival during the long school closures. At the time of writing, 10.13m Ugandans (21% of the total population) are fully vaccinated. ## **Climate change** BNUU reports that cases of intimate partner sexual and gender-based violence (SGBV) tend to be highest around harvest time, and especially when there are low yields which puts enormous stress on families. The Uganda Bureau of Statistics (2016) estimates that rain-fed subsistence agriculture is the main livelihood source for 60% of households in northern Uganda. Climate change is already disrupting weather patterns in Agago district, making crop failure more likely. N4A fundraised during 2021 for seeds and support for clients to start small kitchen gardens close to their homes, in order to mitigate against food shortages and diversify their food supply. The BNUU office is powered by solar panels, which help to limit our project-related emissions and local pollution in Uganda. 9 **Looking ahead:** In January 2022 we heard that we were successful in being awarded a 3-year grant from Fondation d’Harcourt to replicate, expand and strengthen BNUU’s mental health work in northern Uganda. We hope that this will confirm BNUU as a key provider of community mental health services in northern Uganda. _I received dried fish from BNUU in March 2021. I sold them and got UGX 75,000. But due to the difficulty in restocking at that time, I decided to use that money to pay for a training course in tailoring from a senior tailor in the trading centre. I used part of my savings to acquire a sewing machine and I now buy materials and make 2-3 clothes in a day. My weekly savings have doubled and I am able to save more in my group savings and loans scheme._ (Project client) **Thanks –** We would like to thank The National Lottery Community Fund, Comic Relief, the Kenneth Miller Trust, the Charles Hayward Foundation, Bob Buhr, Michael Davis, Thomas Doughty, Annabel Harris, Juney, Pier Productions and an anonymous donor. **Safeguarding -** N4A believes that everyone we come into contact with, regardless of age, gender, identity, disability, sexual orientation or ethnic origin has the right to be protected from all forms of harm, abuse, neglect and exploitation. N4A will not tolerate abuse and exploitation by staff or associated personnel. We expect all staff contracted by N4A to abide by our safeguarding and associated policies. This includes staff working for our implementing partner organisations who are actively involved in the delivery of programmes and projects designed and funded by N4A. This also applies to associated personnel whilst engaged with work or visits related to N4A, including but not limited to the following: consultants; volunteers; contractors; programme visitors including journalists, celebrities and politicians. We will continue to actively engage with safeguarding developments and make sure that our policies are kept up to date. The following policies are available on our website www.network4africa.org: - Code of Conduct - Safeguarding Policy - Dealing with Safeguarding Reports - Safeguarding Complaints Policy - Malpractice Policy ## **Fundraising** N4A focuses its fundraising on trusts and foundations and high value fundraising. This was decided jointly by the trustees and staff as offering the best return on investment, given N4A’s limited in-house capacity for fundraising, and its small supporter database. Its founder, Rebecca Tinsley is hugely supportive with her relationship fundraising both in the UK and the USA. N4A actively engages in fundraising via the annual Big Give Appeal and bi-annually with the London Marathon as well as other appeals through its social media and newsletters. We are aware that the London Marathon is currently reviewing its Bonded places, so we may lose this place or have to reapply for it. We are aware of the growing movement for large funders to fund incountry (e.g. Comic Relief) – there is currently a great deal of discussion around this. We are adapting our fundraising and supporting our project partners to meet this development, as well as having an active voice in its roll-out, such as through our membership of the Bond mental health steering group (bond.org.uk), and using our position to platform our partners’ voices on this topic (a blog by the programme manager of our Ugandan partner, BNUU, exploring how their partnership with N4A can be a precedent for decolonisation, has been picked up by the UN). N4A is addressing this challenge in practical ways, and our actions have been acknowledged in an academic study which praises us as one of the few NGOs enabling our local partners to play a central role in planning and execution of projects. Where possible, we try to ensure that donations are unrestricted, in order to support our running costs and to allow some flexibility in project priorities. We try, wherever possible, to submit full-cost recovery budgets to trusts and foundations to reflect the true cost of our programmes and to recover some of our overheads. ## **Strategic Plan** Network for Africa has a three-year strategic plan covering the period 1 January 2021 – 31 December 2023, against which we base our plans and progress. 10 ## **Online presence** We use our website (network4africa.org), Facebook, Twitter and email newsletters to communicate with current supporters, demonstrating the need for the work and its impact. We also use LinkedIn and Instagram to promote our projects and attract new supporters. We regularly publish blog posts about our work on our website and Facebook, as well as using Twitter to raise awareness of developments in global mental health and other relevant issues, and to engage with others who are posting about mental health and development. ## **Financial review** The merger of the UK Government’s Department for International Development (DFID) with the Foreign and Commonwealth Office (FCO) into the Foreign, Commonwealth and Development Office (FCDO) in September 2020, the impact of the Covid-19 pandemic on funds available for international development, and the UK government’s reduction of Overseas Development Assistance (ODA) from 0.7% to 0.5% of gross national income, have all contributed to a reduction in expenditure on international development in the UK. Whilst we don’t currently have any government grants, the opportunity to apply for them has been drastically reduced. There is a trend from statutory funders to fund organisations in-country directly, rather than through UK NGOs. This will have an impact on our income and will also prevent many small civil society organisations from benefiting from funding. Meanwhile, our fundraising strategy continues to be to raise funds from individuals and trusts and foundations. Our total income in 2021 was £335k – a decrease of £29k on last year. Despite this drop in grant income we continued to support all of our existing projects utilising unrestricted reserves to support our Port Loko partner in particular. At the end of 2021 our combined reserves were £94k (2020 £107k), of which £40k is restricted to our ongoing projects for future disbursement and £54k is unrestricted (2020 £80k). ## **Risk** We have examined the major risks to which Network for Africa is exposed and we review them at each Board meeting. The CEO and the Chair, under the supervision of the Board, maintain the Risk Register. Below is an overview of the major financial and operational risks we were facing at the time of writing this report (April 2022). |**Risk**|**Explanation**|**Impact**|**Probability**|**Management**| |---|---|---|---|---| |Large funders
change strategy
to fund directly
in-country|The growing movement
towards ‘shifting the power’
removes funding opportunities
both for N4A and for its project
partners who likely won’t have
a sufficient minimum income
level to be eligible to apply for
funding.|High|High|Follow developments
closely. Research how other
small organisations are
managing this change.
Maintain a presence on this
issue on the Bond Mental
Health Steering Group.| |Statutory
funders shift
international
funding to the
UK e.g. National
Lottery
Community
Fund|The strategy changes and so
projects that stood a reasonable
chance of securing long-term
funding have that option
withdrawn.|High|High|Maintain the relationship
with previous grant
managers as their strategy
may change again in the
future.| |Climate change
affects food
production and
causes food|Increasingly unpredictable
weather patterns make it
harder to guarantee decent
harvests thatprovide much|High|High|Provide inputs for kitchen
gardens to mitigate against
food shortages. Encourage
clients to diversifytheir| 11 |**Risk**|**Explanation**|**Impact**|**Probability**|**Management**| |---|---|---|---|---| |insecurity and
inflation|needed income and a source of
food for clients. Food shortages
impact on the mental health of
clients, especially those on
medication, and poverty creates
stress and anxiety that can
cause mental illness relapses.
Additionally, those with existing
mental health conditions may
be less resilient in the face of
climate-related disasters and
stressors.|||livelihoods and reduce their
reliance on agriculture.
Engage with others in the
mental health and
environmental sectors to
keep on top of the latest
developments, and also of
opportunities to obtain
funding related to climate
change and mental health.| |Merging of DFID
with FCO
reduces funding
opportunities|The government has now
created the FCDO and reduced
its ODA funding target, which
has limited funding
opportunities not only because
of reducing its contribution to
international development, but
because of increasing the
number of organisations that
will be applying to other
funders to compensate from
the loss of DFID funding.|High|High|Follow developments and
trends closely to see if the
situation changes.| |Dependency on
income sources|Loss of income and ability to
support area/areas of work.
Lack of success with securing
available funding from funders
we apply to.|High|High|Identify major sensitivities;
consider diversification
plans. Review programmes
to ensure they’re relevant
to current donor focus;
keep abreast of donor and
development trends.| |Competition for
funds from
similar
organisations|Reduced fundraising potential;
reduced public profile.|High|High|Agree fundraising strategy;
ensure regular contact with
funders; monitor public
awareness and profile of
charity.| |Lack of funding
opportunities in
light of
recession
brought about
by Covid-19|Loss of income and potential to
support area/areas of work.|High|High|There will undoubtedly be
an ongoing impact on
funding as a result of Covid-
19. Some funders have
paused their grant making
pending a clearer picture
regarding Covid. It is hard
to predict how bad it will
be, but we will continue to
monitor it.| |War in Ukraine
disrupts global
fuel and food
supplies|At the time of writing in 2022,
Russia’s war in Ukraine has
started to cause major spikes in
global fuel and food prices,
which have driven up fuel costs
in countries like Sierra Leone by
as much as 50%(with knock on|High|High|Monitor the situation in
Rwanda, Sierra Leone and
northern Uganda, and keep
abreast of any
humanitarian food
programmes to ensure
people with mental| 12 |**Risk**|**Explanation**|**Impact**|**Probability**|**Management**| |---|---|---|---|---| ||effects on all food supplies, and
an associated rise in civil
unrest). Additionally, half of
Africa’s wheat comes from
Ukraine and Russia, and in 2021
Ukraine was the largest source
of food to the World Food
Programme. Thus, some of the
poorest people in sub-Saharan
Africa are already having to cut
their food intake, and there is
risk of food insecurity and
shortages getting worse,
compounded by climate
change. This puts greater
stresses on those with mental
illnesses, increases risk of
relapse, and also creates a
major issue for those who need
to take their mental health
medication with food.|||disorders/epilepsy can
access these. Invest further
in kitchen gardens, as has
been started by BNUU in
northern Uganda. Fundraise
for food aid for our clients
where necessary –
especially those on
medication.| |Covid-19|Impact on delivering project
targets because some activities
cannot be implemented owing
to in-country constraints
brought about byCovid-19.|High|Medium|We will monitor
developments and the
impact of new variants and
restrictions on face-to-face
counselling,travel etc.| |Loss of key staff|N4A has a very small staff team.
If key staff leave it could
undermine its work and
overload the staff that are left
in post.|High|Medium|Ensure organisational and
operational knowledge is
shared and does not lie
with one staff member
only. Monitor workload
and staff welfare at
quarterly Trustees’
meetings. Provide support
as necessary.| |Project partners
are dependent
on N4A as their
sole funder|Project partners do not have
any other funders and so if
N4A’s funding ceases, they will
be unable to operate.|High|Medium|Help them with capacity
sharing to fundraise in-
country. Try to find
partners with other funding
sources.| |Project partners
in low income
countries lack
the necessary
skills to manage
grants
effectively|The skill sets of our project
partners vary across the
different countries we work in.
We need to be aware of the
differing needs.|High|Medium|Provide training and
capacity sharing where
possible and/or partner
with bigger organisations
with better infrastructure| |Reputational
risk|In-country partners are not able
to meet reporting requirements
of funders.|High|Medium|Carry out thorough due
diligence prior to any
partnership agreement. Be
aware of in-country| 13 |**Risk**|**Explanation**|**Impact**|**Probability**|**Management**| |---|---|---|---|---| |||||capacity to deliver the
work.| |Safeguarding
risk|Issues with partner
organisations and misconduct
towards clients.|High|Medium|Integrate safeguarding and
whistleblowing into training
and reporting.| ## **Reserves policy** The trustees have established a policy whereby the intention is that unrestricted funds should be maintained at a level equivalent to a minimum of three months’ core operating costs. This is currently on track. ## **Plans for the future** Plans for 2022 include: ## **Programmes:** - **Rwanda -** Continue to support the SURF project in Rwanda to provide group counselling services to 250+ young genocide survivors using our peer counselling model; raise the necessary funds to provide much needed on-site childcare; and roll out entrepreneurship training, including livelihood start-up inputs, measuring the impact on the clients. - **Uganda -** Complete the final year of The National Lottery Community Fund grant for livelihoods for our mental health clients in northern Uganda whilst trying to secure funding to support more self-help groups in Uganda with livelihoods; complete and share the Learning Study to demonstrate the positive impact of poverty reduction on mental health outcomes; replicate our mental health work in northern Uganda in one or two new sub-counties, funded by a recent grant from Fondation d’Harcourt; employ a psychiatric nurse to work with the team in northern Uganda; develop a programme for mental health in schools. - **Sierra Leone –** Continue our mental health and livelihoods programmes in Port Loko District; increase the number of self-help groups; continue to develop a programme for maternal mental health; continue to develop and fundraise for a programme for mental health in schools; continue and expand provision of support for people with epilepsy in the district. - **Cameroon –** Explore the feasibility of starting a peer counselling project for Anglophone community members from Cameroon who are currently in refugee camps in Nigeria and develop a project proposal. - **Nigeria –** Continue to monitor funding opportunities to implement our project proposal for providing community mental health provision in Plateau State. - **South Sudan –** Continue to develop a project proposal to support South Sudanese refugees currently in settlement camps in northern Uganda. **General –** Explore other options for providing start-up capital for self-help groups e.g. universal basic income; complete the mental health network and mapping of mental health provision in Rwanda, Sierra Leone and Uganda; support our project partners with training in fundraising and grant writing; work with our project partners to develop their online presence, where necessary; refine Network for Africa’s mental health model for each operational area; continue to develop strategic partnerships with other NGOs e.g. Health Poverty Action, to enable consortium funding bids, shared learning and increased support in-country; keep safeguarding policies up to date and maintain regular dialogue with project partners and share training materials with them; continue to develop Network for Africa’s profile and voice in the mental health NGO community; continue to refine our mental health training model that can be shared with other organisations; continue to monitor developments in the Covid-19 pandemic. ## **Structure, governance and management** Network for Africa is registered as a company limited by guarantee (without share capital) no. 06317689 and a registered charity no. 1120932. Its governing instrument is its memorandum and articles of association. The directors are the members of the company and each member, during his or her membership or within one year afterwards, undertakes to contribute a sum not exceeding £1 to the assets of the company in the event of it being wound up. 14 The trustees, who are also the directors for the purpose of company law, and who served during 2021 were: F Critien D Gye (Hon Treasurer) D Russell (Chair) R C Tinsley J Hogwood H Walters (appointed on 17 March 2021) New trustees are appointed as required and receive comprehensive induction on the activities of the charity. The trustees have assessed the major risks to which the charity is exposed, and are satisfied that systems are in place to mitigate exposure to the major risks. ## **How Network for Africa is run** Network for Africa is a charitable company, registered in England and Wales with both the Charity Commission and Companies House. This structure, which is used by many charities, allows us to have all the advantages of charitable status, and simultaneously to limit the trustees’ liability through the company’s ‘limited’ status. As a charity and a company limited by guarantee, Network for Africa has no share capital and therefore cannot be owned by anyone. The charity is governed by its Memorandum and Articles of Association, dated 19 July 2007. A Board of Trustees heads Network for Africa. For company-law purposes, the trustees are also the directors of Network for Africa Ltd. The Chief Executive Officer undertakes day-to-day management of the organisation. The Board of Trustees has authority over and responsibility for the organisation and acts as its legal guarantors. The effective involvement of the Board of Trustees is considered crucial to the success of Network for Africa and is dependent on shared goals, the development of sound and creative working practices and significant time commitments. The Board meets four times a year, to assess the charity’s progress since the previous meeting, and to set milestones to be achieved by the next meeting. The CEO attends each Board meeting and provides an update to the Trustees on the charity’s progress, and assists in the setting of goals. Trustees also provide valuable assistance to the CEO and other members of staff when necessary. Current trustees are: - David Russell (Chair): David is Founder and Director of The Social Enterprise, which advises an array of charities and social businesses. From 2009 to 2013, David served as Director of Survivors Fund (SURF), which represents and supports survivors of the genocide against the Tutsi in Rwanda. - Frida Critien: Frida is a strategic communications professional, with experience of managing a wide range of campaigns. Currently a Global Corporate Communications Director at Unilever, she is responsible for managing relations with international media and driving the company's purpose-led, future-fit agenda. - Rebecca Tinsley: Becky founded Network for Africa. She is a freelance journalist and a novelist and a former BBC politics reporter. Together with her husband Henry, she was asked by President and Mrs Carter to start the Carter Centre UK. - David Gye: David has recently retired as an adviser on financial aspects of the energy and infrastructure sectors, working with government and private sector worldwide. He became independent in 2009 after a 25-year career with Morgan Stanley and other investment banks. - Jemma Hogwood: Jemma has a Doctorate in Clinical Psychology from University College London in the UK and is registered to practice as a Clinical Psychologist with the Health and Care Professions Council in the UK. She has been living and working in Rwanda for the past 8 years, mostly working for the Survivors Fund (SURF), supporting survivors of the genocide against the Tutsi in Rwanda. She is currently working for Solid Minds, offering individual, couple and family therapy. 15 - Hannah Walters: Hannah currently works for Comic Relief as a Portfolio Manager for Levelling the Field (a co-funded initiative with the Scottish Government focusing on women and girl’s empowerment in Malawi, Rwanda & Zambia), alongside a number of mental health investments. She previously worked at Feed the Minds from 2016-2019, firstly as a Programme Officer before taking on the role of a Senior Programme Officer later in 2016. In 2017 Hannah took on the role of Programme Manager, having strategic oversight for FTM’s programme’s portfolio and directly managing a £1.5m portfolio of grants including DFID, Comic Relief and Big Lottery. ## **Staff team** Network for Africa has three permanent staff members: - Annabel Harris (CEO) is responsible for the overall management of Network for Africa, including international projects, fundraising, budgets, strategy and governance. She is responsible for reporting to statutory donors and is a steering group member of Bond’s Mental Health and Psychosocial Disability group. - Lesley Eaton (Office Manager) works part-time is responsible for office management, donor management, online fundraising, policies including safeguarding, bookkeeping, Network for Africa’s website and social media communications. - Thomas Doughty (International Programmes and Research Manager) is responsible for the management and development of our international projects and works closely with our international partners, supporting them with their work and capacity sharing. He manages the monitoring and evaluation of our projects, and carries out research for project development and proposal writing. He is also a steering group member of Bond’s Mental Health and Psychosocial Disability group. - In addition, we are supported by: - Michael Davis (freelance) who manages our finances. In addition to managing Network for Africa’s annual budget, Michael also manages our international programme budgets, and prepares all our financial reports for our funders and our board. - Christa Bennett (Director of Network for Africa USA) who manages all aspects of our branch in the USA. Christa helped start Network for Africa in 2006 and oversaw the successful application for non-profit status for Network for Africa USA. - Robert Woodfield, our Management Accountant who has supported N4A since it was started. We use consultants to help with grant writing and reporting. ## **Volunteers** N4A’s success, work and growth would not be possible without the loyal support of our volunteers. We are so grateful to Rebecca Tinsley for her incredible fundraising and formidable writing skills; our Chair David Russell for his advice, support and encouragement of the staff; Dr. Barbara Bauer and Dr. Shelly Evans for their professional oversight of our mental health programming; Carrie Braes for her design skills; David Ferguson for his IT Support; Liam Dempsey for his website development; Robert Woodfield for his financial overview of our operations; and Lily Nicholson for supporting our forthcoming schools programme in Uganda. ## **Thanks** In addition to the donors recognised above, we would like also to thank our supporters in the UK: Tim Allen, Steve Atack, Philippa Ball, the Bliss Family Trust, Brendan Carroll, David Chapman, L.S. Collins, Alexander Critien, Dean Davies, Lesley Eaton, Ashley Fleischer, C.P. Gale, Max Gibbs, Alexander Gibson, Annabel Harris, Louis Harris-White, Rachel & Julian Hubbard, Micheál Jacob, Sandra Jones, Oliver Lubbock, Lindsay Madden-Nadeau, Simon McGrath, Hans Olsen, Robert & Joy Pickard, John Pindar, Philip Rudge, David Russell, Gus Shaw-Stuart, Mike Shipley, George Tench, Christine Thomas, the Tinsley Charitable Trust, Mark Tinsley, the van Mesdag Fund, Margaretha Visser, Howard White, Julia Wisdom and an anonymous donor, We would also like to thank our supporters in the USA: Michael Abate, Sara Aldape, All Saints-by-the-Sea Episcopal Church, American Online Giving Foundation, Tracy Bollag, Ken Collamore, Annabel Davis-Goff, Denine Diaz, Martha Elliott, Susan Gibson, Diane Giles, Mary 16 Harvey, Jody & Mel Heyman, Jewish Communal Fund, Sally Kauser, Carol Kline, Richard Lamb, the Laurie Campbell Foundation, Stephen and Carol Lombardi, Karen Pick, Julie Schneringer, the Schwab Charitable Foundation, Brian Silverman, Sasha Spielvogel, Ann Symington, Pell Tanner, Sydney Walker, Elisabeth Weber, the Writer Family Foundation and Pamela Zurer. ## **Disclosure of information to independent examiners** Each of the directors has confirmed that there is no information of which they are aware which is relevant to the independent examination of the accounts, but of which the independent examiner is unaware. They have further confirmed that they have taken appropriate steps to identify such relevant information and to establish that the independent examiners are aware of such information. 17 Charlty RegIstra￿On No. 1120932 Company Registrdtlon No. 06317689 {England and Wales) NETWORK FOR AFRICA ANNUAL REPORT AND FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 DECEMBER 2021 NEIWORK FOR AFRICA LEGALAND ADMINISTRATIVE INFORMATION Trustees D Russell F Crrtien R Tinsley DGye J HoW￿d H Warters (AppO￿ted 17 March 20211 Charity number 1120932 Company Trurnber 06317689 Prlncipal address 14 Sl Mary's Street Stamford Lincolnshire PE9 2DF Registsred offlGe 14 Sl Mary's Street Stamford Lincolnshlre PE9 2DF Audltor Stephenson Smart & Co 36 Tyn(1811 Court Comm8rce Road Lynch Kbod Peterb￿oUgh PE2 6LR Bankers HSBC Barjk ple 25 Notting Hill Gate Lon(k)n W113JJ Sollcltors Bates. Wells and Brathwarte 10 Queen Street Pla London EC4R 1BE NETWORK FORAFRICA CONTENTS Page Trustees, report statement of trustees, responsibilities 19 IndepeThJenl wjditor's report 20-22 statement of finanual adÉwties 23 Balance sheet 24 Notes to the fin￿Cial statement5 25-33 NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) FOR THE YEAR EAIDED 31 DECEMBER 2021 The trustees presènt Ihelr repcrt and financial ststements fLY the year ended 31 December 2021. The financial statements have been prepared in accordance wth the 8ccounliThJ poliues sat out in not8 1 to the rinancial statements and comply with th& charitable companys goveming document, Companies Act 2006 and "Accounting anLI Reporting by Charrties.. Statement of Recommended Pra￿1￿ applicable to charibes preparing their accounts in accordan￿ the Financi￿ Reporting Standard applicable in Ihe UK and Republic of Ireland (FRS 102} (effective 1 January 20191" Obje¢tNes and activitiès Ne￿rk forAfrica (N4AI works with communitie5 in the aftemialh of conliet and genocide. We help the survivors of African corfflicts who have been left behind after the fighting stops and the hUmanrtarI￿ aid moves on. We provide training for these survivors in spe(aalised trauma counselling so they can tackle the long-lerm psychological consequ8nces that often block their communities, reeovery. We equip community leaders wth the skills to identh.fy those in need and thallenge the sligma attached to trauma, depression and mental illness. We listen to what these communits.es tell us they need, so we can (rffer appropriale and sustainable SUPPC•rt We urrently have projects in Rwanda, Sierra Leone and northem Uganda. The trustees of the charity have gNen due regard and adhere to the Charity Cc*nmlssion's guidan￿ on publi beneffit. SUMMARY AND REVIEW OF 2021 People living in sutrtrsaharan Africa have been disproportionately affecled by confiict in recent decades, with a damaging legacy on Ihew mental health and wellbeing IBMJ Global Heamh 20211- such as the genocide ogair)sl th6 Tutsi in Rwanda, an 11-year ovil war in Sierra Leon& Idosely followed by an EtrKJla epidemic} and a brutal 21- year avil waf in northem Ug8nda. The legacy of conflict and gen￿lde, coupled with extreme poverty. has had a profoutKI impact on people's mentsl heamh. leaving millions Ilving with conditions SLKh as depression. anxiety or post-traumalic stress disorder (PTSDI. The UN states that 1 in 5 peop18 in confiict-affecled areas have a mental health disorder {UN 20191. wnpared to 1 in 8 globally, while mental health care prowsion in post-confflict areas of su￿aharan Afn"ca remains limited. Meathile, there are estimal8s of the kyjrden of mental disorders across sub-saharan Africa doubling in th8 n8xt four decades (Global Mental He￿th Journal 2021). In all three countnes, the Covid-19 pandemic eonltnues to exacerbate people's mental health due to the social and econom￿ shocks it has triggered, while dimate change and Russia's war in Ukraine a￿ e8th already impacting somè of the worfd's poorest and most vulnerable people In Rwanda. Sierra Leone and Uganda. Eath of these ale driving up lood insecurity and povety - which N4A knows from experien￿ exist in a vicious cycle wth mental ill health. Network for Africa {N4AI workg w￿th local organisations in Rwanda. &"erra Leone and Uganda to 8ddr8SS th8 psychological, scKial and health problems created by confiict that prevent community members from rebuilding their lives. We work wrth our implementing partners. shaTing eapacty lo deliver and manage these programmes. Oll￿ pat*cipants are sufficiently rec£Jvered, we provide livelihoc*J support to lift them out of poverty and break the ￿le of mental illness and poverty - with livelihoods programmes in all three countries currently. In Rwanda we worked with Survivors Fund (SURF} in 2021, running a community-based peer counselling modd, supporting young survivors of the g8nocxle - helping them talk about their trauma and address Ihelr p)st-traumatic stress disorder and will be introducing livelih¢))ds support in 2022. In Slem Leone, we worked with Conforti Comrnunity Aid Children Orgonisalion's Port Loko branch (Conforti PLI and Health Poverty Ath"on IHPAI supporting people with mental illne55 and their caregivers to conduct livelihood activities and sav& money in their self-help groups, while continuing to supwrt community mental health actwilies counselling, wmmunity outreach and education, mental health dinics and provision of epilepsy m9j1￿lI0Tr. In Uganda, wth our partner BNUU. we Contir￿ed to suppcsrt people with livelihoods in 2021 alongsd8 communrty mental health work, ar¥J have I￿ntlY been awardecl a new grant to expan¢J BNUU'8 mental health *tJrk in more areas of northern Uganda. NETWORK FORAFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2021 Covkl-19 continues to affect people's Iwes and mentsl health worldwde, not least among sub-saharan Afrira's poorest most marginalised communities. The prevalen￿ of mental health issues across Africa has risen during the pandemic, wknich has cOmpDUnd￿ existing inequalities and deepened p￿Xist1ng social and economic eh8llenges - eXa￿rbatlng the ment81 health of those already struggling. while (Jriving new cases of mentsl illness (Africa Academy of Sciences, 2021). For example, the economic and social hardship driven by the pandemic in Sierra Leone has increase(I prevalence of drug abuse (BBC, 20211. The pandemic caused ongoing disruption to each of N4A's mental heath progrommes during 2021- for example, restrictions on movement and gatherings in Rwanda meant SURF had to provtde counselling by td@phone through part of the year. while lockdowns in Uganda meant livelihood input distribution was delayed by three months until March and dients, ability to restock and aC￿SS maTkets were at limes impacled. VaccinatÈon rates in sU￿Saharan Africa remain lower than thè global average, with lack of supply being a bigger driver than mistrust of the v?￿ine, though SUP￿leS began to be t￿osted during the last quarter of 2021 (Our ￿)r1d in Dats. 20221. Cllmate change is already causing issues for our clients in Rwanda. Slerra Leone and Ugarmla, predominantly through disruptions to the liming and intensity of rainy seasons. Many of our clients depend on subsistence farming for their livelihoLyJ arKI focd supply, and are therefore some of the most vulnerable people lo d￿nat8 hange in their resp8Ctive CDuntries. This increases stress levels, whith in turn increases the rssk of people with mental illnesses relap5iNJ. drives up rates of intimate partner violencelsex and gender-based violence, and also causes major issues for those on mental heatth or epilepsy Tnedicatic most of need to take their medication wth food. and some of whom may find their app8btes increased as a &de effect of their medication. Our partners in Sierra L8one and Uganda, Conforti PL and BNUU, both power thair offices Mlh solar panels. which limits our own project-related emiswons (as ￿11 as local noise and air polluts'onl by removing the need lo Use Ixtrol-fuelled generators. War in Ukraine- at Ihe time of wnting in 2022, Russia's Wdr in Ukraine is causing huge disruptions to global fuel and food supplias which are further compounding people's access to and ability to afford f(M)d in sub-saharan Afn"can countn.es such as Rwanda, Sierra Le¢Jne and Uganda. Before the war, half of Africa's wheat came from Ukraino or Russia, and the World Food Progrdmme's single biggest supplier of food was Ukraine. The price of some basic food5tuNs has doubled in Sierra Leone since February, while all our programmes are affected by fuel pri￿ increases and shortages. By installing solar panels on Confoth PL'S uffice during 2021, which used to run on a petrol generator for over half the yeai, we have reduced our demand for fuel in Sierra Leone Ythich has rnitigated against some of the burden of price ris8S. Plan5 for tho future - N4A continues to develop ideas for r￿ntIal mental health projects for Camero)nian and South Sudanese refugees in camps in Nigeria arHJ northern Uganda respècb"vely, as well as m￿ltOring funding opportunities for our pyoposed community mental health project in Plateau Slate, Nigeria. NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS, REPORT) (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2021 Achiev8ments and parforniance RWANDA 2021 hlghllghts Included.. 268 new clients were enrolled in peer support gr¢YJPS where they received group counselling. The total number of yOLTrng ￿er￿￿Ide survivors helped in this way since the proiecl started is more than 1.600. 24 new Peer Support Counsellors wère recruited and trained to run the peer counsellirKJ groups. Th&y gel to know the group members well and look out f¢x anyone %￿0 needs extra support, and refer them to the project's counsellors. 22 health workers were trained in mentsl health cas6 management. 181 group ￿UnSelling sessions were held and 118 dienls had individual counselling. 1,703 teleph￿e cwnselling sessions took place during lod(downs. 198 vulnerable clients who neèded extra supwrt were visited at home. 35 ck'ents started their own small businesses and 12 dienls fourKI employment. 50 of the dients were sdected at the start of 2021 to take part in a baseline survey, and the same cohort took part in Ihe survey at the end of th8 year. The improvements included.. Th8 nunber of dients who felt Iheir th￿ghts were Fwenting them from doing Something others do reduced from 92% to 12% over the year. At the start of the year 64% had thought about takn.ng their own lives in the pr8vious week - this figure had reduced to 6% al the end of the year. ￿lIst we would obviously prefer there to hav8 been no suicide ideation. the counsellors know who these Glients are and are providing them Trmth extra and continuing support. Even though some dients are still facing issues of trauma and rts symptoms, at least 94% of thém agree that they know how to deal with their trauma sy￿p10￿$. Our project partnor In Rwanda In 2021 was Sup4[vo￿ Fund {SURF}. Founded in 1997 by Mary K8yltesl Blewett OBE, SURF supports suNvors of the 1994 genocide against the Tu*1 in Rwanda through working with SUTvivor-led organisalions including AVEGA {A$S￿latiOn of IAfidows d the Genocide) and AERG (National Students, Asswation of Ger#xide Survivors). SURF dolivers technical support including cApacty building and monitoring and evaluats.on to their pather organisations, delivering projects ranging from healthcare lo housebuilding, education lo entrepreneurship. SURF is a UK register8d charity. managed and run from its head office in Kigali, Rwanda. Our prqect in Rwanda is a communty-based peer tounsellSng M￿le1, supporting young SLThvor8 of the genocade through group counselling - helping them talk about their trauma and address their posl-lraumalic stress disorder. Approximatety 250 clients from local coTrmunrties are enrolled on the programme each year. They are divided into 12 groups and elect 2 peer st￿pOrt counsellors IPSCS) from each group to moderate and lead the group counselling sessions. The PSCS are trained trj carry out this role, and are suppc41ed by the project's counsellors, in addition to receiving quarterfy supervision, so that they can réfer dients for individual counselling and also re￿1ve support for morè Challenging ￿se5. Training and upskilling of clients lo urvjertake key roles is a ￿ntral eomponenl of this project, ensuring that skills and profe55iond development rèmain in the Itxal communty, in order to promote sustainability. Thus the 24 PSCS all receive trairking and supervision. as do the 4 project counsellors, in addition lo heaf(h workefs from health centres in tho partKipating prcyect areas. In 2021 the project gol off lo a s11￿￿Y late start owng to Covid-19 and restrictions on rnvement. kh%vever. 268 clients were recxuited and started their group counselling sessions in March. The group members selected 24 Peer Support Counsellors (2 from each group) who received training from the project's counsellors in trauma and group coun5elling skills. They were supervised by SURF'S counsellows and received their own supervision sessions quarterfy. There they were atle to strengthen their coun5elling skn'lls and diwJss difficum ￿Se$ in a $upportiV6 enwronm8nt. NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORTI (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2021 Covid-19 caused some disruption during the year. makn.ng it impos>ble for the groups to meet at times. However, SURF compensated by making swe that telephone counselling was available, providing 1,703 telephone counselling sessions. In totsl oveT course of 2021, 181 group counselling sessions were held. This was lower than th8 target figure but not a surprise given the restrictions on movem8nl imposed by Covid-19. Home visits were an integral and important part of the Pfugramme, and 198 vulnerable clients were visited at home duri￿g the year. The annual commemoration of the genucide in April was particularly diffieutt in 2021 because it coinad8d wilh a period of lockdown. H¢)wever. the dients managed wdl, all things considered. and they reported that they had been helped with the coping methanisms they had been taught. The excavation and reburial of genocide victims from a mass gravè in KrLiguro. Gatsibo district. was very traumatic for those affected, dients, pe8r support counsellors and project counsellors 81ike. W8 provided extra support and supervisÉon to help them through that very difficult peril￿. Twenty-ts¥o health workers from health centres in the participating areas took part in a Ihree-day training course on the essentials of mental health case management. There were 12 clinical psychologists and 10 general nurses working in mental health services. The training covered topics suth as communieation, aclrve listening, posl-traumalic stress (Isorder, resilience theDry. depression, suicide and SLthtance abuse IdTugs and alcohol}. The Iroining incbuded a questsons-and-anwers session. group discussions and case sludy discussions. The pre and post assessments of th8 health workers, current kno￿edge and understsnding showed a marked improvement at the end of the course. The project's counsellors worked with Ihe District Administrators lo cary out awaTen8SS-raising in the community on mental illness and how lo manage depression. They also deliVe￿d a programme of psych￿dUCatIon for the clients, where they discussed topics such as the benefits of Covid-19 vacunalions, drug and alwhol ?buse, the prevention of urhwanled pregnancy and family planning. and taught relaxatson exercise5 to help combat loneliness and isolation exacert)ated by Covid-19 I￿kdOWn8. Some of the dients stsrted savings and weie able lo loan money to other group metnbers, earning them some Interest. Others are planning to group together to ￿lY livestock and are saving towards th8t goal. Th8 counsellors were successful in obtsining grants from the govefnmenl for 23 dients 113 women and 10 men) lo start small income gener8ting rxojects. FNe of the dients resumed their skndies al university, and 25 carried out tharty work in t￿r communities. The b8rKrfIts of the project have not gone unnob.ced by local goverrffnenl 18ad8rs community members who are apprery8tive of the positive thanges they can see in the diènts and wider community. We are very pleased that together with SURF we have secured the funds to provide entrepreneurship training and start-up costs for livelihoc￿5 for the new 21)22 cohort. ￿ have received feedback from the clients Sin￿ the project stsrted that livelihoods would exponenb.ally improve their lrfe outcomes. This 15 bad(ed up by our own laamiThJ that povety reduction improve5 mental health outcomes. Next on our list is to raise funds to provide free on-sit8 childcare for the counselling groups, as so many of the clients are single Mott￿r$ who dont have the means to access baty-sitting, and find that hawng I￿1r babi6s and toddlers at the group C￿nS￿lIng sessions, detracts frum their ability lo fijlly engage. Covld-19 Rwanda pul in place a natitThl nighttime ¢Lrfew frcKn February to March 2021, as well as strict limits on numbers in indoor public spaces, and restricting travel between Kigali and the rest of the country. SURF reinlroduc8d telephon8 counselling during this pencd, as it h8d done in 2020, though this wa8 also limited by the number of clients without ac￿SS to phones. 19 Clients tested positive for Covid-19 during 2021, bvhich has affected them both mentally and phy￿CallY. Rwanda requires that people lest before attending public gatherings, whith continue5 to limrt some dients, attendaw at group counselling se55ions. Covid-19 restrctions also limited the ability of many to attend the reburial crf their family members were vicbm$ of genocide dI￿o¥ered in a mass grave in lfjaguro. At the time of writing. 8.15m Rwandans161% of the total population) we fvlly vaccinated. the highest of the three countries in which N4A Y￿rkS. NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2021 Climate change The rural areas where SURF runs its peer supw)rt ￿u[￿lI1nY prLyammes are already witne￿ng heavier than USU81 rains during the farming season. which destroy people's crops. 70 % of RwaThJans' livelihwds depend on the agricultur8 sectOT. and they are especialty vulnèrable to climate change. I love my family. Now I would ask for individual c(wnselling ffither than isolaling. I hope fhe good things I was able to get thffjugh th8s8 counselling sèThices could be offgr8d to many young suThivots WIKJ are suffering like I did for many yea￿. IProj8Ct client} Thanks - We would like to thank the Bry8n Guinness Trust, the Eleanor Rathbone Charitsble Trust, the BlaCkfrIa￿ O¥ers8as Aid Trust and the James Tudor Foundation. We Would also like to thank all those who donated to our Big Givè Appe81'. the Reed Foundation. ￿. & Mrs. D Bliss, Carol Bryson, Philippa Clegg, Frida Critien, Mike Diggins. Pam East. Mr. & Mrs. K. Feber. Ashley Fleischer, Max Gibbs, David Gye, Melanie Harris, Mark Harris, Annabel Harfls, Louis Harris-white, Martin Haworth, Lara Haworth, Serena Heller. Micheai Jacob, Oliver Lubbock. Arun Malhotra, G8rard Markes, Sophie McC￿n, Ross Meclean. James Iliddlelon, Annie Nicholson, Ciaran Nilan, Peter O'sullivan, Tristsn Parsons, Mr. & Mrs. A. Patullo. Lesley Pavincich, Jack Pilkington, David Russell, Jo￿ne Ryan, Paula Smyih, John Spayne, Fr￿Cine Stock, Mr. & Mrs. H. fIn￿eY, Olivia Warhgm. Howard White. Julia WsdDm and Robert Woodfidd. SIERRA LEONE 2021 hiyhllghts included-. New grant- We sècured a new &year ￿t from the Addax and Oryx Foundation for this project. We also secured fun(ling from the Allan arKI Nests Ferguson Trust for year 1. 180 sdf-help groLV members participated in a baseline Su￿eY to assess their mental heallh, and are receiving ongoing training and suppcxt to do gruup savings and plan for their Ilvelihwds through their 9 SHGS. 46 seff-hèlp group members attended a 5-day tr•ning workshop coverirvJ skills and knowledge for successful livelihoods 8nd village savings and loans, which they are eascatling to their remaining 135 fellow group members. 256 clients wlh mental disorderslepilepsy received intlividual counselling. 783 clients participated in group counselling. 362 Elienls attended our monthly mental heatth dinic8. $6 Clients with epilepsy re￿iVed epilepsy medication whlch previously they had not had acce88 to. 695 pregnant women and breastfeeding mothers attended mental health info￿latIon sessions, indudng on post-natal depresston, of whom 24 subsequentty came forward for eounselling. 669 primary and secondary school students and teachers attended a mental heaKh presentation, covering issues such as corporal punishment. mental health and stigma. 417 Comm￿)rtY members, including community leaders and other duty be8rers, w8re engaged in mental health education and stigma reduction sessions in their communities. 12 team members and di8tn.ct mental health staff p8rtSclpated in supervision, training and cL￿tinuIng professional development. Our project Partne￿ in Sierra Leone In 2021 were: Confortl C(fftmunlty Ald Chlldrgn Organlsation is a Sierra Leor*an NGO based in Freetoym and Port L(*0. It addresses the educational and we￿are needs of young peoF4e induding their mental health. Health Poverty Action IHPA) is an intemalional NGO that has a direct presence in 13 countries, including Sierra Leone, wh&re il has been implementing programmes 51fj￿ 2005. Founded in 1984, it was set up lo meet gaps in the provision of medical aid to people affected by prolonged and wnp18x conflicts. Its vision is a wodd in which the poorest and most marginalised enjoy their nghl to heahh. NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS, REPORT) (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2021 We were delighted our successful application to the Addax and Oryx Foundth"on for funding towards a year livelihoods and mental health programme in Port Loko with Conforti's Port Loko Offi￿ (Conforti PL}. This programme started in Jvly 2021 and began with the baseline SUTvey that involved reassessing all 180 self-halp group ISHGI members, mental hea￿h (formed into 9 SHGSI. with depression and stress being the most prevalent conditions, affecting 2W/o and 27% of members respectively. 37% of members are caregivers of a person wth mental disorderslepilepsy IPMDES), and 79% of these caregivers also have a mentsl illrws of their own. 13% of SHG meM￿lS have epilepsy. Besides mental health ￿ndElionS, 13% of SHG member5 are war survivor amputees12 of the 9 SHGS are based in Port Loko's p05t-war 'amputee Carr￿5, for survivors and their familias), and 16% are suNivors of Etyjla. In November. a fve-day training workshop took pla￿, eoveriThJ the ft￿daMenIal skills and knowledge needed by SHG members lo start and make a success of their livelihoods and village savings and loans a¢tivib"es (VSLASI. The training wa5 delivered to fwe members per SHG145 in totall, vtho with thè support of Conforti PL'S livelihwds team are sharing the training with other SHG members. The SHGS have gol off lo a really p0s￿Ve start with the￿ VSLAS. They have estsbli5hed their rules and processes, agreed by all group members wrth members paying in ￿at they Can weekly or monthly Iwhich eould be as low as SLL 5.000 - approximately £0.40). The sawngs are kept in a collectsve pot bul with each owning the amount they contribute,. they can borrow for irKome generating purposes, which they pay back with interest", the interest is owned by all group meml)ers s￿r(lIng to the same % as their iTrJividual contributions. Some SHGS have thosen to allocate some of their savings lo 8 collective fund, which is used to fvnd groLV costs, such as réfreshments for meetings. and some have already begun to develop th&ir own livelihoods practices using loans. Alongsidè the Iiv81ihoods programme, we have continued to support Conforkn" PL 7Mth their community mentsl heahh ath"vitses. The eounsellors provided indNidual counselling lo 256 dients1133 female, 123 male) and group eounselling to 783 clients {480 female. 303 malel across the ￿Ole of 2021, wh￿e also supporting the mental health nurse to provide monthly mental heath clinics at the 5 heatth ￿ntre$ in our operational arèa to 362 clients. Our provision of epilepsy Medicatic￿ to 56 dients, who would otherwise be unable to afford or access it, has meant that they have t)een able to reintegrate into their communities, and take up work and schooling again. All 17 thildren receiving treatment are now in sthool and doing well. Thanks lo our work, the Port Lc*o distrid office of thè Ministry of Basic and Senior Secondary Education has picked up on this, aThY started to co￿Uct a distriGt- wde study on the number of school age children wi(h epilepsy who are at risk of dropping out of school lor have already done so} due lo tr¢eir condib'on. So frdT. they have established that 35 further children in Conforti PL'S existing operational areas have untreated epilepsy, 14 of whom have dropped OLrt of school, with a fjJrther 48 in the adjacent chiefdotn. We ¥e1goking to provide epilepsy medicaion tu these children through further grants, as we nrjw have an estsblished system in p18ce for providiThJ ￿"$ service, with oversight and supervision from a SP8cialist epilepsy nurse from another districL Our in-counlry m8nlal health Gonsuhanl has SUPE￿rted the te8m with ongoing tsaining and supervision. Our social workers arKI counsellors attend weekly maternty diThc8 to deliver information on matemal and child mental heatth to pre and post-natal women. The team talks about postnatal depression. and child and family mental health including parenting methods. Across the whole of 2021, we reached 69S such dients. of lthom 24 sub5equenOy came fO￿ard for counselling in the 8econd half of the yèar. NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORD (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2021 Due to the high demand from sd)ods as they reopened follown9 pandemic doSU￿, and following ConsU￿ation Ih 65 students and 35 teathers, the t8am has developed a shcwt mental health awareness presentation for teachers and stL¥Jents, covering issues such as corporal punishment. youth mental health and stigma reduction. with the aim of improving child wellbeing, and Teducing the lev81 of dropouts. A nationwide study re￿ntlY estimated 89% of Sierra Leonean studen15 are subjected to regular corporal punishment at school. Daily floggings LKcur mcwe often wrth people with disabilities th￿ others. Our youth consultation sh¢)wed the excuses for such punishment ¥e m05Uy due to arcumstances beyond students, control, 5uth as extreme poverty, or for no reason at 811, and that il ha5 a detrim8ntal impact ¢￿ students, wellbeing. We reathed 358 primary school students aTh3 teachers. and 311 secDnd8ry sdirx)I students and teachers betr￿en July and De￿mber 2021. This buirt on fe8dback we received from Grand Challenges Canada to our 2020 application, suggesting the team needed to have already piloted a project in schools. We were therefore able lo add this èxperience into the 2021 application lo Grand Challenges. Though this application was unsuccessful, we now have a yCAJth mental health programme for schools ready to go subjèct to ffiJture funding opportunities. Covid-19 Sierra Leone reintroduced a nigm-hme nats.onal curfew in January 2021. Travel betwe￿ Freetown and the rest of the county was 8180 restricted al the start of the year. Such measures have been lifted and reintroducoJ at points over the year. Conforti PL were Involve(l in education ond combatbng misinformation on the vacune, which they incorporated into some of their outrèach talks. As a resutt, a majority of the clients in thè amputee amps have been vaccinated. The pandemic has caused Continu￿ economic and social hardship in Sierra Leone. esp￿lalIY among the pcK)rest, which throughout the pandemic has been a greater source of stress and anxiety Ihan fear of the VINS itsew. It has led to a rapid rise in the use of a drug named 'kush' {a strong synthetic marijuana), which now accounts for the majority of male admissions to thè county's one psychiatric hO$￿"tal. and has now reached Port Loko. Corrforti PL is enyaging with the district mental health nurse and district heatth officer on this problem. Many of the ampuiees travel to Freetown in the week to Lw, and they were hil hard by restridlons on travd to and from Freetown. Al the time of wriling. 1.1m Sierra Leoneans {140A of the total population) are Ajlly vaccinated (bélow the Afrka- avewe of 16%). Cllmate change In 2021, the annual rainy season in Port Loko arrived the lalest it ever has. arml is becoming shorter and more intense by year. Thls is sèverely affecting local famiing, with subsistence famiing the most common exisbng I￿velIhOod activty of Conforti PL'S clients. This is an extreme source of anxiety for dients. According to the latest census data Istats SL 20161, in Port Loko (listrict as a whole. 81% of the ￿pUlatIOn depend on agr￿lI￿re as their main source of income. and 920A of residents in the district face some fomi of fo￿1 insecurty. However, there are no government food aid programmes. Additionally, Port Loko town and fts surroundings rely on a small, local hydroelectric power plant for electriuty, which is sporadic and unreliable (￿rIng the dry season. Climate disruption is meaning people face unreliable electricity supply for more of the yeai, as the dry season expands in length of time year on year. In order to mitigate against this, to reduce our project-relaled emissi￿5, and to reduce local noise and air pollution, during 2021 we invested in solar p￿e1$ for the Port Loko office. These now provide 100°A of the office's power needs, where8S it was previously forced to run on a petrol generator during Ihe dry season. This has also meant we have ieduced our demand for fuel. whlth has mitigated agwnst some of the burden of current fuel price rises. Looking ahead: Our key immediate priority is to fill thè funding shC￿f81l kn Conforti PL'S livelihoo¢Js project and wider mental health programme, which is currently beiThJ met wlh N4A's unrestricted resetves. We will also support Conforti PL to develop the￿ own strategic Fdan, inCOTporaling the various strands of mental health work th&y are engaged in, in ord8r to help plan and apply for funding to expand work in future. Finally, we SUF)POrt Conforti PL to further d8v8lcp ils rdalv)nship wrth govemmenl bcxlies, suth as the distrfct education office, in order to further rnentsl health support in the district. I had been living with eprfepsy for almosl 20 Yea￿ wrfhout any me¢*cation. My condition was so miserable thal I could not do any work. Aly life became useless. One day. I found tho counsellors coming to my aid and they started talking to me about my problem. They started having wular wsils with me ¢0 talk about t1￿ impact this condilDn has had on my lrfe, and evèntU811y We￿ able to pmvmle m8 with regular epilepsy Med￿at￿rt thmugh the clinics. I have h8d thre8 n70nths without s&izurns and now feel able to do ￿me sm811 f8milng Now I get income fffjm the fami, arKI also contnbute to my family I￿)M the famp. (Proioct clAent) NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) (CONnNUED) FOR THE YEAR ENDED 31 DECEMBER 2021 Thanks- We wcmjld Ilke to thank the Adtjax and Oryx Foundation and the Allan and Nesta Ferguson Trust for their support. UGANDA 2021 hlghllghts Included: 548 clients attended BNUU'5 monthly mental health Clinics. of whom 413 reported improvement in their condition. 339 clients received Indi￿dual cours811ing. 625 PMDES and caregivers from 35 sdf-help groups received startaup item8 to begin their income generating activf(ies. UGX 10.345 1£2.351 were the average savlngs by PMDES over the course of the y8ar ~ an increase of 84.7% since the start of 2021. UGX 10.119 1£2.301 were the average savings by caregivers over the coups8 of the year- ￿ increase of 84.1% since the start of 2021. 93% of PMDES and caregivers are able to afford to 8at tsvo mea15 8 day, vthere previously many could only afford one. 218 PMDES and caregivers tC*)k part in an anatysis of their liveAihoc*ls to estatrAish which livellhoods are dling well and wty. Our prolgct partner In Uganda in 2021 Tbvas 8NUU. a Ugandan NGO that supports a￿sS to mental health services through training, research. advocaty and awareness raising. targeting clients with mental disorders. 11 adclresses sts"gma. dlscriminalory policy. acce88 to qualty mèntal health care and povety aff￿ting clients mental illness. The mental heatth dinics, counselliThJ Services and home vislts conlnu8d throughout 2021. 339 PMDES and caregivers re￿Ived counselling.. 548 PMDES attended the monthly mental heaf(h clinics.. and of home visits, 92% of PMDES were adhering to tt)eir medication, largely attributable to supportThfe families, the drug bank initi*ive and increas8d household income because of the liveSrfioods. Thera was some fall in adhere￿e to medicab'r from men, due to excessive alcohol consumption. bul this was md with èxtra eounselllng. The thslribution of livelihood inputs r*ovided by The National Lottery Community Fund took place in Mareh dolayed from 2020 due to CDvid-19. Tr￿$ distn"bution took place over 8 days- 2 days in each participating area, requiring carelul planning because of Covid-19 safety measures. The distribution was well attended by loEal government officaals. many of whom by their own a¢*nisson, ha never previously errfJaged PMDES. They pledged fijture support for PMDEs and their caregivets. and the distribution process was hugely motsvaling for all involved. In tolal, 625 sell-help group members from 35 of the total 61 self-help groups supported by BNUU re¢eNed livelihood inputs. This saw an almost immethate increase in household income compared to th8 previous quarter. However, there was a maTked drfferenlial be￿en the income of PMDES and that of caregivers, so much so that BNUU slepped up its support for PMDES in order to increase their income. The rates of income fluctuated for the remainder of the year, tiwng to pric& increases during I￿kdOWn that had an impact on expenditure on restocking their livelihood inputs, thus reducing their profit margins. Other factors indudèd unpredictable weather pattems that negatively impacteil famiing and reduced availability of food, and resulted in some PMDES spending more of their savings on buying food for personal consumpt"on. However, overall. the level of Savings increased, whith was further boosted by BNUU Dffering cash prizes to the SHGS that had saved the most money. The average savings amongst PMDES and caregivers increased by some 80%. This increase in savings had a pxiti.ve impact on th8 setting up of the drug banks - a key componènt of the programme that prOt￿S PMDES from medication shortages and resulting relapse. The SHG members had training in setbng up drug banks: what tho purpose of them is". %that f8ctrws make them successful ar¥J effective., and what challenges they can expect. They elected chairpersons. secretaries and treasurers. and 60 representatives frorn the SHGS fomed management committees. All the SHGS are enoy)waged to ccffltribute a prOpo￿On of their savings lo the drug banks and found the training very motivating. NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) (CONTINUED FOR THE YEAR ENDED 31 DECEMBER 2021 Towards the end of 2021. 218 PMDES and caregivw5 look part in an analysis of their thosen livdihoods, to find out which bU￿￿eSseS were viorting well. wrth stock cash in hand, and those that are not working so well and also lo understand th& impact of Covid-19 on their business Outcomes. In summary, 96% of those who participated in this exerase have businesses that are doing well, Kmth 4% saying that their businesses are not doing wdl. Of those d￿ng well, PMDES had an average worknng caprtal (value of stock plus cash in handl worth UGX 177,715 (£40) as opp(Ised to the inits'al investment of UGX 100,000 (£221. Caregivers had done sligmly better wth an averoge working capitsl of UGX 193,972 (£431 compared to the initial investment of UGX 100,000 (£221. The analysis ShO￿d that the majority of BNUU'5 dients with sustsinable h"velihoods were selling fish, cooking oil, soap and green vegetables, and that they had div8rsifiedlwere selling more than one item. 11 also showed that 88 of the clients had invested some of their profft into long-temi businesses e.g. farming, buying livestock elc.. and had little working capital for wming their livelihood. However, wthen probed a bil further they saKI that they would use their profit from selling their harv&sts to reactivate their Iiv81ihoods. There is a long tradition of agricultrjre in this area, so it is understsndable that clients are drawn to farming to supplement their incorne, and their actions show inrtiative. The SHG memtws demonstrated that they now undeTsland their rights through their advocacy actions, and were proactive in presenting issues at stakeholders, m8@tings that were attended by local government representatives as ￿*11 as s￿￿OUnty chiets. These issues included a lack of involvement of PMDES in government programming., long di5tanees lo reach mentsl health dini(£" inadequate suppty of medication., stigma," bad roads preventing to mentsl health clinic5', rude and unwelcoming behaviour from health workers 8tc. These interventions PToduc£d results e.g. unannounced visAts by officials al health centres to monitor health workers, absences, rudeness and negligent practice". the repar of In￿essible road5. In July 2021 we re￿ve￿ a grant from the Charfes Hayward Foundation to provide training and livelihood start-up items for 10 more SHGS benefitting 178 PMDES and caregivers. The training programme for this CAJhort has begun - they have all parts"cipated in.. Training in enterprise selection, which helps dierts understsnd what to consider when thoosing their livelihmys e.g. their health, local market demand, what products will generate ￿ early profft", Finanual lrteraey to equip PMDES and caregivers wth basic business and financial management skills. •idtJding record keeping, budgeting. 5aMngs and loans; Village savings and loans (VSLAS) including the imwrtance of saving as a groLW rather than individually. how to be an effefAive member of a VSLA. leadership. intemal rules and regulations, introduction to written record5.' Drug bank training to explain the concept of a dnjg bank and why il is important to have onè, how to set one up, h(w to fomi a drug bank o)mmittee and increasing understsndrLg of factor5 leading to suc￿￿8 and Possible challenges. One of the difficulles that came up during 2021 as a direct result of Covid-19. was a lull in PMDES and caregivers, ability to restock livelih(Jod tiems owing to restn"ctions on movement which also caused price increases arKt a temporary loss in income. This ￿s￿lted in food shortage5, or lack of sufficient irwme to buy food. which is bad enough under normal urcumStan￿. tr￿t if you are taking strong anti-psychotic m¢di¢ation, makes the medication difficult to tolerate. were therefore very grateful to the Kenneth Miller Trust for providing a grant for seeds and training for SHG members to vegetable gardens in their eompounds to stave off food shortages, ensure a steady supply of staples and enable them lo earn a small income from selling any surplus. BNUU enlisted the support of an agricultural extension worker from the local govemment who has offered Irairing 19 the dients and will support them through the first season of grOv￿n9 through to harvest, to make sure that the necessary skills are embedded. The response from local government to BNUU'S communty mental health interventions has b88n consiSten￿Y good and ai)preciative. BNUU is assiduous in maintaining regular communication wth key stakèholders in local govemmenl and in encouraging the SHG members to develop advocAcy actions and lake them to the relevant duty bearers. This gives them the profile aTvJ self*steem that they so bady need and proves to Ihern that their human nghts do count and that the authorities shoukl be held accountsble if their rights are eroded. It has been so rewarding to see the wsitNe impact that a I0￿er ￿ndIng Investment can hwe, starting with the COMK Relief grant in December 2017 that laid Ihe fOL￿dationS for the communty mental health programme. followed by The National Lottery Community F￿d and Charfes Hayward Foundation granls Ihat have buim on those foundations by giwn9 PMDES and ￿re9ver5 a further step up in their recoveryjourney through Iwelihoods. NETWORK FOR AFRICA TRUSTEES. REPORT (INCLUDING DIRECTORS. REPORT) (CONTINUED) FOR THE YEAR ENDED 31 DECEMBER 2021 Co¥ld-19 Uganda experienced a blg surge in Covid-19 cases with the arrival of the Ddts variant in May 2021, leading lo thè introduction of a new national locJ(dovffl from early June unbl August, Induding a ban on travel be￿een districts. This has IBd to ongoing hardship in Agago distrKt, and led to some SHG members avoiding group meetings out of fear- they instead met their SHG chairperson aThY treasurer indivithally lo conduct Ihelr savings. Uganda's sch1￿1$ remained closed duè to tf* pandemic for the vthole of 2021. not r￿penIng until January 2022 after 21 months of dosure - one of the longest Covid-19 related sthools dosures of any county in the world. Some children have found il really h8rd to be back at school. and many h&J taken up work in their family businesses while off ￿h0O1. Some girls have not TettAmed to schoL4 due to having been forced into earfy marriage andlor falling wegnant while sch¢xJls were shut. There were reports of a couple of children taking their Dwn lives around the time schools reopened. There is also a shortage of school places, as some teachers lespeaalty from w.vate Se￿OIS which fomi a large part of Uganda'$ sch)ol provision) moved into other work for survival during the long school closures. At the lime of wrrting. 10.13m Ugandans121% ofthe total PCf*ulationl are fvlly vaconated. Cllmate Change BNUU reports that ￿SeS of intimate partner sexual and gender-based violence (SGBV) t&nd to be highest around harv8St lime. and especially when there are low which puls enOm￿￿$ strèss on families. The Uganda Bureau of Statistic512016) estimates that rain-fed subsistence agricutture is the main livelihood source for 600k of households in northern Uganda. Climate change is already disrupting weather pattems Sn Agago district, making crop failure more likely. N4A fundraised during 2021 for seeds and support for clients lo start $m811 kitchen gardens close to their homes, in order to mitigate against focd short4es and diversify their food supply. The BNUU office is power8d by solar panels, which ￿1p to limit our proj-èct-related emissions and local pollution in Uganda. Looklng ah￿d. In January 2022 we heard that we were suc￿$$fUl in being aw8rded a 3-year grant from Fondation d'Harcourt to rèplieate, expand and strengthen BNUU'S mentsl heatth work in northem uga￿a. We hope Ih8t this wll confirrn BNUU as a k&y provider of eommunity mental health services in northem Ug8nd8. I received t*ied fish from BNUU in March 2021. 1 sold them and got UGX T5,000. But Iyue to the difficulty In stocking at that time. I daC￿d lo use that money to P8y for a training couw in tailonng fmm a seniortsilor Ihe tr8ding cen￿. l us8dpart ofmy savings to 8CqUIfft 8 S8wino machine and I now buy materials and make 24 clothes in a day. My weety savings h8ve JWtXMJ'. Jemma has a Doctorate in Clinical Psychology from University College London in th& UK and is registered tr) PTacbee as a Clinical Psychologist with the Health and Care Professions Council in th8 UK. She has been living and working in Rwanda for the past 8 years, mosuy wo￿n9 for the Survivors Fund ISURFI, supporting survivors of the genocide against the Tutsi in Rwarkla. Sh8 is currentty working for Solid Minds. offering individu81. couple and famity therapy. Hannah V*dller8.' Hannah currently works for Comic Rel￿ as a Portfolio ManwJer for Levelling the Field la c