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2022-12-31-accounts

Doctors for Nepal (“DFN”)

Trustees’ Annual Report and Unaudited Financial Statements Year ended: 31 December 2022

Charity No: 1133441

1

Reference and Administrative Information

Date registered as a UK charity

4 January 2010

Registered charity number in the UK

1133441

Governing document

Trust deed dated 16 October 2009

Trustees

Dr Kate Yarrow (chair) Anne Yarrow (secretary) Nigel Lewers (treasurer) Chris Yarrow Dr Natalie Thurtle Dr. Richard Howell (together the “ Trustees ”)

Operational address

Dr Kate Yarrow Highwell, Hamsey, Nr.Lewes, Sussex BN8 5TD

Other contact information

info@doctorsfornepal.org www.doctorsfornepal.org www.justgiving.com/doctorsfornepal Twitter: @DoctorsForNepal

2

Bank account details

Lloyds Bank 171/173 North Street Brighton BN1 1GL

Sort Code: 30-91-25 Account Number: 00284204

SWIFTBIC: LOYDGB21002 IBAN NO: GB67 LOYD 3091 2500 2842 04

1 Structure, Governance and Management

Governing document

Doctors for Nepal (“DFN”) is a registered charity, number 1133441, and is constituted under a trust deed dated 16 October 2009. New Trustees are appointed by the existing Trustees in accordance with the provisions set out in the trust deed. The trust deed provides for a minimum of 3 trustees.

Trustees

There were no changes to the Board of Trustees during the year.

All Trustees give their time voluntarily and receive no financial benefit from the charity. The Trustees bring wide and relevant experience to the charity. Three Trustees are medical doctors, 2 Trustees are working or have worked for Médecins Sans Frontières, 1 Trustee is a lawyer and former trustee of a school,1 Trustee has long experience as a school governor, and 3 Trustees have experience working abroad.

The Trustees are also committed to personally raise funds for the charity.

During the year our UK Operations Manager, Cesca Eaton, reluctantly gave up her position due to the pressure of other work commitments. She has contributed a great deal to the charity, particularly in fund-raising and in supporting the Nepal team. She is succeeded by our new UK Operations Manager, Caz Winter, who is already making her mark on the successful running of the charity.

Risk Management

The Trustees have a duty to identify and review the risks to which the charity is exposed and to ensure appropriate controls are in place to provide reasonable assurance against fraud and error.

The main risk to which the charity is subject is that of a student not completing the agreed time period of service as a doctor or nurse in rural Nepal. DFN has, in co-operation with Patan Academy of Health Sciences (PAHS) and Karnali Academy of Health Sciences (KAHS) put in place measures to minimise this risk. In particular, the Academies both have a policy which provides that no medical, nursing or midwifery student on a DFN scholarship may receive his or her final degree certificate until having served for an agreed number of years as a doctor/midwife/nurse in a rural area of Nepal (2-4 years, depending on scholarship received).

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There is a risk of a student not completing their course for academic, social or personal reasons.

DFN is exposed to fluctuations in foreign currency as tuition and other fees for the students are paid in Nepalese rupees.

The charity is committed to holding a reserve fund to guard against financial risk, and ensure it can continue to fund its scholars through their studies.

2 Charitable objectives and aims

The trust deed provides that DFN’s objectives are:

  1. To advance the education of medical students in Nepal by providing financial assistance to enable them to pursue their studies; and

  2. To relieve sickness and to preserve the health of people living in Nepal by assisting in the provision of healthcare.

Doctors for Nepal’s aim is to improve healthcare in rural Nepal. DFN does this by sponsoring selected students from very poor backgrounds in Nepal to attend medical, nursing or midwifery courses in Nepal. In return, the students pledge to work for an agreed period post-qualification as doctors, midwives or nurses in rural areas of Nepal. (2-4 years, depending on scholarship received). Apart from providing scholarships, DFN may also implement health care projects and provide continuing education for health care staff such as midwives and nurses, and support postgraduate medical education.

To ensure that DFN’s work delivers its aims and meets the objectives as set out in the trust deed, the trustees review its projects and fundraising activities on a regular basis throughout the year. On the basis of this review, the trustees are able to plan DFN’s future projects and fundraising activities.

3 Main activities: How our activities deliver public benefit

In deciding what activities Doctors for Nepal should undertake, the Trustees have complied with their duty to have regard to the public benefit guidance as set out in section 4 of the Charities Act 2006. Our activities deliver a tangible public benefit by helping improve health care standards in rural Nepal.

In 2022 the work of the charity resumed a more normal course after the two years of Covid 19 upheavals. Our students could return to their colleges after the disruption of on-line learning during Covid lockdowns, and there was no longer the need to fund PPE and other equipment specific to the pandemic.

DFN continues to fund and support medical, nursing and midwifery training at Patan Academy of Health Sciences (PAHS) in Kathmandu and Karnali Academy of Health Sciences (KAHS) in Jumla (in the far west of the country). Both colleges are dedicated to improving Nepal’s rural health by training health workers in rural community medicine. They aim to produce graduates that will not only provide sorely needed medical care in rural Nepal, but will also eventually become leaders in health care policy, dedicated to improving the health of the remote and impoverished communities

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in Nepal. The charity continues to extend its collaboration with the relatively new college of KAHS, which has the great advantage of being nearer the home districts of most of our students, although its remote location presents challenges for trustee visits.

As more of our medical students graduate, we are extending our educational support to their postgraduate medical training, which is essential if our doctors are to be effective practitioners. With regards to our growing band of nurses, an issue that arose during the year was the lack of government-funded posts in remote areas, meaning that several of our graduate nurses were having difficulty in finding posts for their post-qualification years of bonding. After a great deal of discussion and negotiation, we have agreed to create DFN- funded posts for them in the Far West of Nepal with two partner organisations: PHASE Nepal (with whom we have collaborated for a number of years), and the Oda Foundation, a charity co-founded by a native of Kalikot, which builds local leadership, and supports health and education for those who need it most.

By the end of 2022 DFN had supported 27 scholars:

Our impact in the community

Our model means that when our scholars qualify, they serve the remote regions that are lacking in medical staff and resources, and thereby healthcare in Nepal is improved in a sustainable and measurable way. Our qualified doctors and nurses are currently working in the following districts: Kalikot, Mugu, Jumla, Humla, Doti, Surkhet, Gorkha and Kathmandu

In 2005, when the idea of DFN began, there were 0 doctors in the Karnali zone from that area. Today, DFN has produced 8 doctors from this region .

The impact of DFN doctors in just one month (July 2022)

1032 outpatients seen by 1 DFN doctor at Karnali Hospital, Jumla

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0 cases of maternal mortality in Mugu District Hospital, where one of our doctors works in obstetrics.

12 ultrasound scans conducted in 1 day by 1 doctor.

Medical equipment and resources

Trustees had agreed in principle to fund clinical resources at the expanding district hospitals in the Far West where our qualified doctors and nurses are working, so that they can practice more effectively. We consulted them on what equipment they would ideally need and would have the largest impact on patient care, and early in 2022 launched the “Equipment Appeal”. This raised about £9,000, thanks to the generosity of DFN supporters, and in particular a £6,000 corporate donation. Equipment has been supplied to Kalikot, Jumla and Mugu Hospitals in the Far West where our qualified doctors and nurses are working, and PAHS Hospital in Kathmandu, where DFN students train. The items include two portable CTG (cardiotocography) machines (to record fetal heartbeats and uterine contractions during pregnancy), three Caesarean section operating kits, and three portable ECG (electrocardiogram) machines.

Additionally, £2,500 was given to PHASE Nepal for ultrasound equipment.

In practice, the procurement and delivery process proved difficult and time-consuming, so it has been decided that in future we shall make use of our partner NGO’s such as PHASE and Oda, which have experienced staff on the ground in Nepal. The equipment is now in place, and Dr. Lalit (our first DFN doctor) recently travelled to the hospitals to give training so that the equipment is used effectively.

Dr Meena receiving the DFN-donated equipment at Mugu Hospital (right)

DFN nurse Parbati using a CTG probe (left)

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Our students

During the year Jeevan passed his finals, to become DFN'S eighth doctor. He is currently undertaking his internship at Patan Hospital in Kathmandu. Our team of three medical students was joined by Man Darji, who is in his fourth year at PAHS. He was struggling financially because of new family health problems.

Our doctors and nurses

Drs. Apsara and Kamal have obtained placements in their remote western home districts. They are both in their second year of DFN bonding. Apsara is working at Manma Hospital in Kalikot, and Kamal at Jumla Hospital.

Dr. Meena and Dr Nahakul have completed their four-year DFN bonds. Meena continues work in Mugu district, where she lives with her young family. Nahakul has returned to Kathmandu to study for postgraduate entrance exams. Dr Prakash is in the last year of his DFN bond, and works in Doti. All intend to apply for postgraduate training.

Our first DFN doctor, Dr. Lalit, has been working as a specialist in Obstetrics and Gynaecology in Surkhet Hospital, Western Nepal, since November 2021. He is the first-ever specialist O&G from his district. He has also set up a foundation to improve women’s health, and is providing free care to impoverished women in a remote area by means of outreach services in Health Camps (more on Health Camps below). This is gaining national media interest. In exchange for his Government and DFN postgraduate scholarships, he is bonded to work for at least four years in a remote rural area of Nepal.

Binita Rai and Apsara Jirel, our first graduate nurses, have completed their bonded periods and continue to work with PHASE Nepal in the remote western region of Humla. Three other nurses, Prabha, Satya and Samina, are working their bonded periods with PHASE in Bajura and Gorkha districts.

During the year an issue arose with the employment of nurses in remote areas for their bonded periods (and beyond). KAHS and PAHS were unable to find government-funded posts for three of our graduate nurses; after a great deal of negotiation, they have taken up DFN-funded posts in the Far West with PHASE Nepal and the Oda Foundation.

Trustee visits to Nepal are absolutely vital to the effective work of the charity, to keep in touch with and build relationships with our students and graduates, and our partner training institutions and NGOs. In December this year our Chair, Dr. Kate Yarrow, Treasurer Nigel Lewers and new UK Operations Manager Caz Winter visited Kathmandu for the usual action-packed trip. They were able to meet with all the students, doctors and nurses based in or around the Kathmandu valley, and with PAHS and the Oda Foundation, but there was no time to travel to the Far West to visit KAHS and those working in remote areas.

Film-maker Gareth Taylor overlapped with the trustee visit for two days as he was filming another project in Nepal. He was able to film a number of interviews with DFN students, which will be used for a new promotional film about the charity. Film footage is a vital way to share our work, and has proved to be essential for effective fundraising.

The visit revealed some unexpected challenges with the employment of nurses in remote areas, and a satisfactory resolution would not have been possible without face-to face-meetings. .

7

Trustee and student teambuilding day

Electives

An elective is a period spent away from UK medical school, giving the opportunity to experience healthcare outside the NHS. In 2022 DFN facilitated, through PAHS, the electives of three students from Bristol university. They spent time in Kathmandu and Gorka, and DFN organized their safe travel by jeep. In the months leading up to the trip, DFN helped them with communications with the medical school and advice about preparation. DFN also organized a group of our scholars to meet them at PAHS in order to welcome and support them. The group’s elective fees were waived by PAHS and donated to DFN.

Looking ahead

Under the new government procedures for the selection and funding of undergraduate and postgraduate medical students, the Government pledges to provide full or partial scholarships for the tuition fees of 75% of places, at both undergraduate and postgraduate level. The entrance exams are now nationalised; although there is no longer a system that positively discriminates towards students from marginalised backgrounds, a certain number of places at each medical school are allocated to students from disadvantaged backgrounds, such as remote areas. The allocation of students to a particular institution is decided nationally rather than by the individual medical schools. The courses continue to have a strong focus on community/remote medical care. There is still a need for DFN tuition fee scholarships to assist students from needy rural backgrounds if they are offered one of the 25% partial-funded, or 25% unfunded, places. There is no Government financial support for living and studying costs, so DFN has a vital role in providing subsistence scholarships that cover these additional costs, to enable applicants from poor rural backgrounds to take up their places.

DFN continues to offer help to existing students from remote areas who would have to drop out of their courses without additional financial support, because of changes in their family circumstances.

DFN is committed to supporting its doctors through postgraduate training, so that they can become effective practitioners, and leaders in medical care, and has assured Drs.Nahakul, Meena, Prakash and Apsara that DFN can potentially offer full scholarships, with a subsequent bonded period, if they are not offered government-funded places, and have to apply for training places at non-government (private) hospitals. There is currently a severe bottleneck with regards to the

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small number of funded postgraduate places available, and therefore it is likely that DFN will be called on to fund postgraduate training of its doctors at private institutions. A generous UK doctordonor has pledged to support Meena through her post-graduate training.

The issues this year with finding appropriate employment for nurses, and with purchasing and transporting equipment, have highlighted how vital it is to work in co-operation with other charities and NGOs in Nepal. We look forward to working with the Oda Foundation in providing nursing and midwifery scholarships for appropriate members of their staff, many of whom are dalits from very remote areas; Oda will then provide bonded employment, in posts financed by DFN. A generous DFN supporter has already agreed to finance one such scholarship.

One of the highlights of the trustee visit was a team-building exercise based around designing the content and delivery of a "Health Camp". These can be a very effective way of bringing healthcare to remote and under-served areas, and it is anticipated that we shall be initiating and supporting such initiatives by the DFN team in the future.

4 Fund-raising and donations

As always, a huge thank-you to all those who have given of their money, time and skills to support DFN during the year. The charity would not exist without you.

The charity is particularly grateful to have received an anonymous legacy of £20,000. Another generous individual donated £10,000 towards a nursing/midwifery scholarship and the costs of the trustee visit to Nepal.

Two generous donations boosted the Equipment Appeal - a donation of £6,000 from FEST Medical Services, and a £1,000 individual donation.

Our annual story-telling evening by a professional storyteller moved into the atmospheric setting of Hamsey Church, near Lewes, introducing a new audience to the charity.

5 Statement of financial activities for the year ending 31 December 2022

A summary of income and expenditure is given on page 11 below.

Income

Over the year income from all sources totalled £68,229, a net decrease of nearly £10,000 from the previous year (which had included the very successful on-line appeal for covid equipment). At £15,061, standing orders again remained almost exactly the same as the previous year. .

Donors are encouraged to confirm that they are eligible for Gift Aid, which substantially increases their donation.

Expenditure

At £56,644, expenditure for the financial year was slightly down on 2021. Support for students amounted to about £15,000 (the same as the previous year). £10,664 was spent on medical equipment. Expenditure on student support was again relatively low, as we awaited clarification on future Nepali government support for medical and nursing training.

9

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Doctors for Nepal Doctors for Nepal Doctors for Nepal No (ifany) CC16a
Receipts andpayments accounts
For the period
from
Period start date
To Period end date
01/01/2021 31/12/2021
Section A Receipts and payments
Unrestricted
funds
Restricted
funds
Endowment
funds
Total funds Last year
to the nearest
£
to the nearest £ to the nearest £ to the nearest £ to the nearest £
A1 Receipts
Standingorders 15,716 - - 15,716 15,710
CAF donations 445 - - 445 360
Easyfundrasing 184 - - 184 238
Justgiving 30,799 - - 30,799 7,428
Global Giving - - - - 203
Virgin Money 475 - - 475 351
Fundraisingevents 3,947 - - 3,947 5,236
Other donations 23,055 23,055 26,169
Giftaid - - 8,965
Nepal visit expenses 1,693 1,693 -
Miscellaneous 1,536 - - 1,536 2,199
Sub total(Gross income for
AR)
77,850 - - 77,850 66,859
A2 Asset and investment
sales, (see table).
- - - -
- - - - -
Sub total - - - - -
Total receipts 77,850 - - 77,850 66,859
A3 Payments
PHASE scholarships 3,333 - - 3,333 3,333
PAHS scholarships 7,708 - - 7,708 15,707
KAHS scholarships 3,013 - - 3,013 10,209
Graduate support 967 - - 967 5,378
Covid relief 15,000 15,000 -
PHASE Covid treatment 2,185 - - 2,185 2,000
Administration 9,203 - - 9,203 10,904
Administration Nepal 631 - - 631 400
PHASE administration 1,614 - - 1,614 3,190
Trustee visit to Nepal 6,207 6,207 2,298
Filmingcosts 2,684 2,684 -
Justgiving 331 331 215
Printing 135 135 240
Event costs 608 608 49
Venue hire - - 1,000
Bank charges 424 424 616
Administration expenses 372 372 260
Website 284 284 1,701
Merchandise 891 891 348
Other fundrasingcosts 1,788 - - 1,788 391
**Sub total ** 57,378 - - 57,378 58,239
A4 Asset and investment
purchases, (see table)
- - - -
- - - -
**Sub total ** - - - - -
Total payments 57,378 - - 57,378 58,239
Net of receipts/(payments) 20,472 -
-
20,472 8,620
A5 Transfers between funds - - - - -
A6 Cash funds lastyear end 86,243 - - 86,243 77,623
Cash funds thisyear end 106,715 -
-
106,715 86,243

Section B Statement of assets and liabilities at the end of the period

Categories Details Unrestricted
funds
Restricted
funds
Endowment
funds
to nearest £ to nearest £ to nearest £
B1 Cash funds Working cash 106,715 - -
Reserve 25,023 - -
Cash 572 - -
Total cash funds 132,310 - -
(agree balances w ith receipts and payments
account(s))
Agreement Error OK
Unrestricted
funds
Restricted
funds
Endowment
funds
Details to nearest £ to nearest £ to nearest £
B2 Other monetary assets - - -
- - -
- - -
- - -
- - -
- - -
Details Fund to which
asset belongs
Cost (optional) Current value
(optional)
~~11~~
B3 Investment assets
- -
- -
- -
- -
- -
~~Fund to which~~ ~~Current value~~
Details
asset belongs
Cost (optional)
(optional)
- -
- -

Doctors for Nepal

No (if any)

Receipts and payments accounts

Period start date Period end date To 1/1/2022 12/31/2022

For the period from

Section A Receipts and payments

Unrestricted funds

Restricted Endowment funds funds

Total funds

----- Start of picture text -----
to the nearest
to the nearest £ to the nearest £ to the nearest £
£
A1 Receipts
Standing orders 15,061 - - 15,061
CAF donations 455 - - 455
Easyfundraising 292 - - 292
Justgiving 7,346 - - 7,346
Virgin Money - - - -
Fundraising events 4,316 - - 4,316
Donation for equipment 7,000 7,000
Donation to support trustee visit 5,000 5,000
Donation for scholarship 5,000 5,000
Other donations 22,911 - - 22,911
Electives 781 781
Nepal visit expenses -
Interest on reserve 13 13
Miscellaneous 67 - - 67
51,242 17,000 - 68,242
Sub total (Gross income for AR)
A2 Asset and investment sales,
(see table).
- - - -
- - - -
Sub total - - - -
Total receipts 51,242 17,000 - 68,242
A3 Payments
PHASE internships 3,181 - - 3,181
PAHS scholarships 11,358 - - 11,358
KAHS scholarhips 407 - - 407
Graduate support - - - -
Covid relief - - - -
PHASE Covid treatment - - - -
Medical equipment 1,164 7,000 - 8,164
PHASE medical equipment 2,500 - - 2,500
Administration 13,282 13,282
Administration Nepal 75 75
PHASE administration 1,546 1,546
Visit by trustees and operations manager
to Nepal 6,988 5,000 11,988
Filming costs 1,350 1,350
Justgiving 446 446
Printing 149 149
Event costs 156 156
Venue hire 160 160
Bank charges 285 285
Administration expenses 66 66
Website 363 363
Merchandise 293 293
Other fundraising costs 875 - - 875
Sub total [ 44,644 ] 12,000 - 56,644
A4 Asset and investment
purchases, (see table)
- - - -
- - - -
Sub total [ - ] - - -
----- End of picture text -----

----- Start of picture text -----
|||||| |---|---|---|---|---| |Total payments|44,644|12,000|-|56,644| |Net of receipts/(payments)|6,598|5,000|-|11,598| |A5 Transfers between funds|-|-|-|-| |A6 Cash funds last year end|106,715|-|-|106,715| |Cash funds this year end|113,313|5,000|-|118,313|

----- End of picture text -----

Section B Statement of assets and liabilities at the end of the period at the end of the period at the end of the period
Unrestricted Restricted
Categories Details funds funds
B1 Cash funds Working cash
Reserve
Cash
Total cash funds
to nearest £
88,277
25,036
113,313



to nearest £
5,000
-
-
5,000
(agree balances with receipts and payments
account(s))
OK
OK
Unrestricted Restricted
funds funds
B2 Other monetary assets Details
Balance of unspent Nepal expenses
to nearest £
595
-
-
-
-
-





to nearest £
-
-
-
-
-
-
B3 Investment assets Details Fund to which
asset belongs
Cost (optional)
-
-
-
-
-
B4 Assets retained for the Details Fund to which
asset belongs
Cost (optional)
-
charity’s own use






-
-
-
-
-
-
-
-
Fund to which Amount due
B5 Liabilities Details liability relates



-
-
-
-
-
(optional)
Signed by one or two trustees on
behalf of all the trustees
Signature Print Name

Signed by one or two trustees on behalf of all the trustees

----- Start of picture text -----
CC16a
----- End of picture text -----

Last year

to the nearest £

15,716 445 184 30,799 475 3,947 23,055 - 1,693 1,536 77,850

77,850

3,333 7,708 3,013 967 15,000 2,185 - - 9,203 631 1,614 6,207 2,684 331 135 608 - 424 372 284 891 1,788 57,378

-

57,378 20,472 - 86,243 106,715

Endowment funds to nearest £ - - - -

----- Start of picture text -----
OK
----- End of picture text -----

Endowment funds to nearest £ - - - - - -

Current value (optional)

-

Current value (optional)

When due (optional)

Date of approval

CHARITY COMMISSION FOR ENGLAND ANO WALES Independent examiner's report on the accounts Section A Independent Examiner's Report Report to the trustees On accounts for the year onded Charity no (If any) 113344 Set out on pages J I jremernber to indwjelhe page nurn￿r5 01 aooillonal slie&s'i I report to the trustees on my examination of the accounts of the above charty (Ihe Trusn for the year erKI As the charitys trustees, you are iesponsible for the pieparation of the accounts in accordance wilh the requirements of the Charities Act 2011 (Ihe Acn RèsponsibilFties and basis of report I report in respe¢t of my examination of the Trusys accounts carried out under section 145 of the 2011 Act and in carying out my examination, I have followed all the applicable Directions given by the Charity Commission under section 145(5)(b) of the Act. Independent examinorfs statoment Pph$￿ De￿te I l rfnot appltsblo. I have completed my examination. I confinn that no material matters have come to my attent.on in ￿nnectIOn wrth the examination tothepth d8e$88￿ which gives me cause to believe that in, any material respect: the ac£ountiThJ records I￿re not kept in accordan￿ with sedion 130 of the ChaTibes A(X" or the accounts did not accord wrth the accounting records" or the accounts did not comply ￿ryth the 8pplicable requirements con￿mIng the fomi and content of accounts set out in the Charities (Accounts and Reports) Regulations 2008 other than any requirement that the accounts give a ttrue and fairf view which is not a matter considered as part of an independent examination. I have no concerns and have come 2cross no other matters in connection vKth the examination to which attention shoukl be drawn in this report in order to enable a proper understanding of the accounts to be reached. . Pleas delete the wonts in the bTrckets rfthey do not apply. Date: Signod: Name: Relevant professlonal qualiflcation(sl or body Ach IER Oct 2018

(If anyl: Address: Section B Disclogure Only complete rf the examiner needs lo h&hlighl material matters of Con￿ (see CC32. Independent examination of charfy accounts.. directions and guidance for examiners). Give here brlef delalls of any Items that Iho examlner wlshes to dlsclose. IER Oct 2018