Registered number.. 07162518 Charity number= 1143018 LIFEBOX FOUNDATION (A company limited by guarantee) TRUSTEES, REPORT AND FINANCIAL STATEMENTS FOR THE YEAR ENDED 31 MARCH 2024 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l CONTENTS Page Rafgronc8 and administrative d8tails of thg Charity. its Trustees and advisors Tru5tses' report 2-15 Independent auditors. rnport on th• financial statemènts Statsment of financial activitios 16-19 20 Balan¢• sh¢¢t Stat8ment of cash flows 23 Notes to thè financlal Statsmènts 24-40 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l REFERENCE AND ADMINISTRATIVE DETAILS OF THE CHARITY. ITS TRUSTEES AND ADVISERS FOR THE YEAR ENDED 31 klARCH 2024 Tru$tg9$ Dr Millard Dert)ew Beyene Dr Robert John M¢Dougall Prof Alan Forbes Merry Pauline Mary Philip Dr Nobhojit Roy Dr Th¢ynas Geoghegan Weiser (app￿nted 1 April 20231 Company rggist8red number 07162518 Charity rogl¥tsred numb•r 1143018 Rggl$tsrgd offi¢e 21 Portland Place London W181PY Company Socretary Kristsna Torgeson Independent audltor¥ BKL ALKIit LLP Chartered Accountsnts 35 Ballards Lane London N3 1XW Bankfjrs HSBC Bank UK 90 Baker Street London W1U 6AX Sollcltors Kir*land and Ellis Inlemali¢)nal LLP 30 St Mary Axe London EC3A 8AF Page 1 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT FOR THE YEAR ENDED 31 klARCH 2024 The Trustees present their annual ￿port together the audited finan(ial stslements of the Charity for the year 1 April 2023 to 31 March 2024. The Annual report serves the purposes of both a Trustees, report and a directors, report under company law. The Trustees confirm that the Annual report and financial statements of the charitable company comply wth the current statutory requirements, the requirements of the charitable company's goveming document and the provisions of the Stslement of Recommended Practice ISORPI applicable lo charities preparing their accounts in accordance with the Finanual Reporting Standard applicable in the UK and Republic of Ireland IFRS1021 (effective l January 2019). Since the Charity qualifie5 as sm811 under section 382 of the Companies Act 2006. the Strategic report required of medium and large companies under the Companies Act 20r￿ Islralegic Report and Directors, Reporti Regulations 2013 has been omitted. oblec￿ve9 and actlvbtbes a. Poli¢598 and objg¢tivo$ As slated in the A￿CleS of Association. the objects of Lifebox are.. To preserve and protect the heallh of patsents worlthmde by providing and a$$isting in the provision of equipment and support services in low-resource, lower-middle income and upper.middle income countries, as assessed by the World Bank and Unrted Nations. al no or Tedueed coyt.. and To advance the education in healthcare of the general public and especially those in the medical or similar professions by the provision of education and training Wodd￿de. In setting obje¢tives and planning for activities. the Trustees have given due consideration to general guidance published by the Charity Commission relating to public benefit, induding the guidance 'Public benefit.. running a charity IPB21'. b. Strategios for achièving objo¢tiv•# As sel out in our charitable objeciives, Lifebox was established to improve the safety of healthcare around the world Ihrough the provision of essential equipment and training, and by implementing proven tools that foster a culture ol teamwork and safety in healthcare environmerts. While we have as our widest point a remrt to work wthin any a￿a of hearth¢8￿ to promote the health and gafely of patients. our focus continues lo be on improving the safety of surgery and anaesthesia. Our efforts lo date have been on three core areas, improving anaesthesia safety. strengthening surgical teamwork, and reducing surgical infection. Since its founding in 2011. Lrfebox has facilitsled the disth"bulion of over 35,000 pulse oximelers across 116 countries, and trained over 14.000 healthcare provideis. More than 252 million patsents have received safer surgery as a resuli of our work $0 far. Page 2 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 Oblo¢￿¥•$ and actlvltl•$ l¢ontlnu•d) c. Activities undertaken to achieve objectives Improving AnaaSth￿Ia Satsty Activities mainly include distributson of devices (pulse oximeters, capnographs and headlights). This also includes training on the use of pulse oximeters arKI capnographs. Roduclng Surglcal Slt• Info¢tlon8 Adivities mainly include the implemenlalion of Ihe Lifel)ox Clean Cut programme. The programme is a series of workshops and trainings designed to reduce $urgical site infections. Promotlng Surglcal Teamwork Activities mainly include providing training to operating room stsff lo promote effective communicats'on in the operating room. d. Volunts•r8 The charity doe5 not use of volunteers as part of its charitable object. e. Maln a¢tlvltles undertaken to further the Ch•rlty'$ purposes lor the publlc b•n•flt One third of human disease requires surgery. Each year 313 million surgical procedures are perfomed worldwde. yel for billion$ of people in low and middle-income countries ILMICSI, these vital procedures are often unsafe. In LMICS. surgical patients are Iw'ce as likely lo suffer from an infection than patients undergoing surgery in the US. Postoperative infections result in a doubling or more of the co$t$ of surgical ¢are and in¢rea$e burdens on patients due to prolonged hosprtalizations and ongoing disabilities. A 2015 study in The Lancel eslimaled that more than 4.2 million deaths occur annually within 30 days of surgery, half of them in LMICS. Posl-surgical complications account for 7.7% of all deaths making them the third greatest contributor to deaths globally. after heart disease an(1 stroke. As a global nonprofit tackling the crisis of unsafe surgery, through tools, training, and partnerships, Lifebox makes surgery and anaesthesia safer worfdwde. Lifebox's activibes fijrther the public benefit in several ways including promoting health, Sawng lives and contributing lo relieving poverty. Page 3 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 A¢hlovem•nts and perfomianco a. Main achievements of the Charity Highlights of this yearfs strategic plan induded launching the new Smile Train-Lifebox Capnograph, delivering Clean Cut in Malaw wth a focus on Long Bone Fracture Trmth support from the Johnson & Johnson Foundation, and finalising our trial around safer caesarean sections. Year Four plans for the Smile Train-LifebDX Safe Surgery and Aneslhesia were suttessfully developed an¢J launched. Activities ¥Mlh Mercy Ships in Liberia wrapped up an impad evaluation. and plans were developed for new programs in Sierra Leone. We were also able to launch Clean Cul in Rwanda thanks to a new donor, the CRI Foundation. Improvlng Ana•stht8la Saf•ty This year, in partnership wth Smile Train, we launched the SMI￿ Train-Lifebox Capnograph to address a major gap in anaesthesia safety in Iowaresource settings. Despite being essential for the sale prowsion of surgery. capnography is virtually absent from Iow•resource setting operating rooms. The Smile Train-Lifebox Capnograph is an affordable. user-lnendly. high-quality device wth sturdy construction and long battery life. The device is dual parameter, providing pulse oximelry alongside ¢apnography. The device meets robust specifi¢ations for the monitoring ol both paedialric patsents and use in Iow-resource settings. and undeThvenl rigorous laboratory and field testing. In September, 97 anlesthesia providers path'cipated in the Smile Train-Lifebox Capnography Workshop in Uganda. held in partnership wlh the Assoualion of Aneslhesiologisls of Uganda IAAUI. 54 capnographs were dtsnaled to the AAU for distribution throughout the country This year 142 capnograph$ were di$tribLrted for safer anaeslhesia moniloring worfdwide and a capnography implementation study was launched in Ethiopia and Somaliland. This year marked the dislnbution of the 35.OOOth Lilebtix Pulse Oximeler wrth donations of devices including Bangladesh, Fiji, Malaw. and Nigeria. Slrgnglhgnlng Suryl¢al Tgamwork We launched the Lifebox Light.. A high44ualty, IowryCOSt surgical headlight for use in I0￿resOUrCe setting operating rooms. Developed in partnership with COAST, the Lifebox Light aims to improve the safety of Surgery where potsr operating rotsm Iighling puts patients al risk. 255 headlights were disth"buled to surgical providers this year. The Lrfebox Light was featured in The Guardian. The Lifebox Nursing Leadership for Surgical Excellence {NLSEI program was finalised for piloting With seven mentors and 12 perioperative nurse Fellows recrurted. The Fellows are leading quality improvement initiatives al three hosprtals in Ethiopia and ￿ in Malawi. The pilot aim5 10 improve perioperative nursing care proces5e5 and practices, and patient outcomes. The global roll out of Team Cleft - the new mulbdisaplinary *Y)rkshop developed wth Smile Train to improve teamwork and communicab'on for safer cleft care - began workshops delivered in Madagascar, Nigeria, Tanzania and India, wth 114 cleft team members trained. Teamwork workshops Continued to be delivere<1 including Safe OR in Honduras, Burundi, and India. More than 1,400 learning opportunities were provided this year for perioper3b.ve providers. Page 4 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 A¢hlovem•nts and perfomianc• 1contlnu￿1 Reducing Suryical Infection The Lifebox Surgical Infection reduction program- Clean Cut- W85 implemented in 27 siles in nine countries with results from several key programs finalised this year. As part of the Smile Train-Lifebox Inrtiative, the Clean Cut for Cleft research pilot completed in Ethiopia and Cote d'lvoire at three Smile Train partner hospitals. The pilot aimed to reduce surgical infection as well as tackle the main complications faced by cleft patient5 such as delayed bleeding and airway compromise. Initial results show Signrficanl reductions in complications for patients. Clean Cul for Cleft was scaled to G.S. Memorial Plastic Surgery Hospital And Trauma Center in India this year. The results for LifeboK's Stepped wedge, duster randomi$ed control trial CLEAN£S - were written up for publication. Results show a significant decrease in the composite outcome of surgical infection and maternal or perinatal mortality. Thi5 work is part of a Bill & Melinda Gales Foundation Grand Challenges Inilialive, funded by UBS Optimus Foundation. The piloting of Clean Cul for Long Bone Fra¢tufe wlh Ihe Johnson & Johnson Global Surgery Initiative in Malaw demonstrated a signffjicanl retjuth'on in surgical site infedion wlh improved use of the WHO Surgical Safely Checklist and instrument slerilisation processes. Lrfebox aims to roll out Clean Cut for Long Bone Fracture to other srteg in Malawi in the coming fiscal year. In Liberia, Clean Cul has been implemented al five srtes since 2021 has demonstrated a risk ￿dUction in inpalienl SSI of nearly half and a risk reduction in inpalienl mortality of nearfy a third. Results are awaiting publication. Clean Cul launched al our first sile in Central America at the natsonal hosprtal of Honduras.. Hospital Mario Calarino Rivas in San Pedro Sula. This work 1$ supported by the IZUMI Foundation. Clean Cul implemenlaty'on began al hospitals in Rwanda. in parthership vAlh the University of Global Health Equity, funded by the CRI Foundation. Implementatson began at the University Teaching Hosprtal of Butare and Kabgayi Level 11 Teaching Hospital. addibonal hospitals - Kirehe and KibDgora to join next fiscal year. Work in Rwanda include5 pilotsng an antibiotlc Stewardship program to tackle antibiob'c over-prescribing in surgery. A study by Lifebo¥ on the wdespread adoption of postoperalwe anlibiolic prophylaxis in low- and middle-lncome countries ILMICS) was published by the British Joumal of Surgery IBJSI tilled 'An observational cohort study on the effects of exiended postoperative anlibiolic Proph￿8x1$ on surgical-sile infections in low- and middle-income countries, ￿lch examined data from over 8,000 patients. A new Clean Cut publication was published in JAMA Surgery %thich demonstrated a 34% relative risk reduction of Surgical sile infection ISSII after implementslion of the Lifebox Clean Cul program. The study 'Scalabilily and Sustainability of a Surgical Infe¢lion Prevention Program in Low-lncome Environments, was based on data from 3.364 surgical patients across seven Ethiopian hospitals. Page 5 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 A¢hlovem•nts and perfomianc• 1contlnu￿1 b. Key perfomiance indicators The key objectives for the period which are used to assess perfom)ance are the following.. Objective 1.. Compliance wth surgical infeckn'on prevention and safety pro¢e$ses is improved in partner faalilies. including cleftlpaediatric and maternity facilibes, resulting in a 30% reducts'on in surgical site infection Objective 2.. Patient monitoring practices are improved in operab.ng rooms and recovery are85 in p8rtner facilitie5 th 10,000 professionals providing safer palient monitoring pulse oximetry andlor capnography Obje¢live 3.. Perioperative teamwork is improved among $urgeon$, anae$thesia providers, nurses and obstetricians and gynaecologists wth eviden￿ of improved teamwork at partner facilities Objective 4.. Evidence of the need for, and impact of, Interventions related lo safer anaeslhesia and surgery is generated, disseminated, and used lo Infomi action. The key deliverable for this objecb.ve Is. len peer-reviewed publications and len abstract presentslions, at least 75 percent of ¥thich have first andlor senior authors from LMICS. ¢. R•vl•w ol actlvltl•s Objective 1.. complian￿ wlh surgical infects'on prevention and safety processes is improved in partner facilities. including deftlpaedialric and matemity fa¢ilth'es, resultin9 in 8 30% reduth'on in surgical srte infection. Lifebox further expanded our surgical site infeclion reduction program, Clean Cul. lo 10 additional hospitsls in 8 countries. Some highlights in¢lude". Clean Cut for Long Bon8 Fracture ICCIL8FI- Malawl.. Successfully s￿led CCfLBF to 2 fa¢ility'e$ in Mala full implementation * Queen Elizabeth Central Hospital IQECHI and trainin9 of trainers at Lilongwe Inststution of Orthopedic5 and Neurology ILIONI hospitsl. Enrolled 257 orthopaedic patienls at QECH, reducing inpatient surgical sile infeth'on rate from 9.57% 10 1.34% anLI overall posl-op infection rates from 24.3% 10 11%. Achieved significant improvements in compliance ￿th all 6 infeth'on prevenlion measures, from 45.3% to 93.8%. Trained 50+ Operab'ng Room staff ￿To$S disciplines ¢)n WHO Surgical Safety Checklist, Infedion Prevention Control, Safe Instruments, and Safe Operating Room. Clean Cut for C-section - Ethiopia: Completed a ￿SIte clinical tn'al evaluth'ng the impact of Clean Cut on C-section outcomes across Ethiopia, showng a 7.7°h change in reducb.on in posl-opeTats"ve infeth.ons (comparing baseline and Intervention). Enrolled 10,666 Obstetrics and Gynaecological patients across 9 hospitals. Change in reduced postoperative infections in C-section5 by 7.7%, obstetn.cal and gynaecological operations by 6.7%, need for ￿OperatIOn by 74.5%. and mortality rates by 62.3%. Trained 222 healthcare professionals across disciplines on WHO Surgical Safety Checklist, Infection Prevention Control, Safe Instruments, and Safe Operating Room. Page 6 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 A¢hlovem•nts and perfomianc• 1contlnu￿1 Clean Cut for Cleft- Ethiopia.. Complemented implementation of the Clean Cut for Cleft pilot in partnership wth Smile Train across 2 facilities, providing care to over 195 deft patsents. Clean Cut- Rwanda.. Delivered antibiotics re51Stance workshops at CHUB ar￿ Kabgayi L2TH, attended by 16 participants. Lifebox hosted a Clean Cut side event, 'Driwng surgical Safety forward". Highlight5 from the Lifebox Clean Cul Inilialive. al the College of Surgeons of East, Central. and Soulhem Africa ICOSECSAI 23rd Annual Scientific Conference in December 2023. The aim of the event was lo share 7-years of program outcomes and challenges, gather inp(rt on enhancing implementstion across clini¢al areas, engage high-level stskeholders lo support Scal￿￿p and sustainability in the region, $trengihen ¢ollaboration$ amongst surgical $o¢ielies and partners, and advocate for hei9hlened investments into safe surgery globally with the ernpha5is on Clean Cul. Objective 2.. Patient monitoring practices are improved in operab.ng rooms and recovery areas in partner facilities ￿￿h al least 10,000 Pfofessionals providing safer patient monilonng pulse oximetry andlor capnography Lifebox made leaps in the di$tributson of t¢)ol$ e$sentsal for patient safety. Since the launch of the Smile Train- Lifebox Capnograph last year, in partnership wth Smile Train, we have equipped 313 operating rooms with capnographs across 17 countries. We have supplied 802 Lifebox Lights acr055 28 countries since ils launch last year. This year we dislnbuted our 36,OOOth pulse oximeler, 744 Lifebox Pulse Oximelers gupplied in 2024 alone. Objective 3.. Perioperative teamwork is improved among surgeons, anaesthesia providers, nurses and obstetricians and gynaecologists wth evidence of improved teamwork at partner facilities The key highlight of work under this objective was the launching of the Nursing Leadership for Surgical Excellence INLSEI project In Ethiopia and Malay￿. The NLSE project engaged 9 nurse fellews. 5 mentors. 209 nurses and 257 parti¢ipanl$. By identi￿.n9 gaps in the surgical nursing care process and key training needs, the project demonstrated improvements in perioperats've care quality, surgical safety, nurse skills, and satisfaction among both patients and nurses. Objective 4." Evidence of the need for. and impact of. interventions ￿lated to safer anaeslhesia and surgery is generated, disseminated. and used lo infom action. The key deliverable for this objective 19". len peer-reviewed publi¢ations and len abstract presentations. at least 75 pe￿ent of %thi¢h have first andlor senior authors from LMICS. Over the period, Lrfebox conducted several studies to delemiine the effectiveness of inlervenlions and published 8 peer reviewed articles on a range of topics from results of an observational cohort study on the effects of extended postoperative antibiotic prophylaxis on surgicaksile infe¢tions in low- and middle-in¢ome countries lo results of a Mixed Methods Study." Exploring the Use of a Fit-for-Purpose Surgical Headlight in Sub-saharan Africa. Articles were published in the 8ntish Joumal of Surgery, JAMA Surgery, the West Afn'can Journal of Medicine and the Worfd Joumal of Surgery. Two publications are pending.. results of the Stepped-wedge Cluster Randomised Clinical Trial evaluating Clean Cut for Caesarean Section as well as the results of Clean Cut for Cleft lo complete the 10. Over 16 abstracts ￿re submitted and 12 p￿sen18b"0nS We￿ delivereil al global Conferences. Page 7 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 A¢hlovem•nts and perfomian¢• 1contlnu￿1 d. Factors relevant to achieve objectives The COVID-19 pandemi¢ and staffing issues during the period impacted our ability to maintain and build individual small. mid. and large donor ￿labonshIps. Donors a stated interest in global surgery have decreased over the past years in favour of making investments in addressing climate change, antimicrobial resislance, and primary health care. Unrestricted fvnding required to cover administrative costs and strategic inve51menl in new programs is espe￿allY hard lo raise. g. Fundraising activities and incom8 gengrntion Lifebox has a significant track record of raising private lunds- notsbly from individuals and family foundations lo support its work. New partnerships wth other NGOS has al$0 been ¢riti¢al lo raising Lifebox's revenue and a Significant increase in Trusts and Foundations revenue supported the doubling of revenue. During the 2023-2024 period Lifebox continued to inuease ts outreath to Trusts arKI Foundatsons and began exploring in5tilutional donors. Flnan¢lal revlew a. Golng concorn After making appropriate enquiries. the Trustees have a reasonable expectation that the Charity has adequate resources lo continue in operational existence for the foreseeable future. For this reason. they continue lo adopt the going eoncern basis in preparing the financial ststemenls. Further details regarding the adoption of the going concern basis can be found in the accounting policies. b. Ro$•rve# policy At the close of the period under review we retsined unrestricled general funds of £483,818. The trustees consider this to be a prudent reserve at this stage of the charity's development, having regard to our current plan5 Staffing and other commrtmenls for 2024125. In 2014115 the Trustees approved a policy lo maintsin free reserves lo cover th￿e monlhg essential operations. c. Principal risks and uncertainties See table on next page. Page 8 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l InVestM￿t In dèvelopment. ct(rinunicatsDns. and marketin9 Staff In r• Plan 202>30 gw staff. K*ogrnm¥ and 0r*r8bfy￿. rxWbn9 ty19r¥rts fr*ful ryoJ8cicosbw 8nO potsn Devdop andd&¥eron fundwrva $trategy lo suprth strateg plan 202￿0 m0nrtordosqtrfuThYs￿d cashlo* Di¥wyFKatnn of tuTh*n9 SOUTQ Ertgage￿Thi ty GGC M fund¢8i*no ethnmthents DIBruplion ol opera￿On5 and wcgrams due toda 18¥¢h. bss oi regu18tw e<*nrlK*n¢e8s • lesl￿ ol Oevdop and iwnenl strKtintemaldata and Intom￿tKJn sy51èm Kaep al IT¢quipmenl aTrJ up to dat•- updat¢•rKJntsln rrt4188oJnty fixuio keep the 08vto wo*•d Oala protec￿n n￿hanISm$ soci311poiiti￿l unresi In Counines LrfebDx opera*s advvrWy IrnPaCtsW toddwcrf4wr pmgramwlic g081s. Oeyelop 8nd Imp*n*nl irnpro¥ed nsk rn8nagemenl polioes ano re5 kn Lrfetox Fyograms and 5taTtitav Se¢untyiHR mtyw emwgin9 Issu￿. dwiin9 on he8th & Mech•AgnB w)rau¢•J• rfwonl Informakn quickty mathx In plthx toinlorm knfebox respon￿10 emer9kn9 disease authreaknabJra14isaster bankty systsms thai enauo wnning of Jihj *imin me pL9n¥ ao•pt•iilty 8no fioxiiilty that can Glob81 Pvf Ip¥ndem¢. war downtum et¢) 8¢vet¥ety Imp¥cts re50uri* tnoiM115a andior ddivery On gtant4urthd wtyJtaN ¢llunding souwwth an empha$i$ on seeking g-lenn [nU￿ yeargrants ano ￿M￿￿￿t￿lStrQtn donors and Ensuriw sjund fina￿￿ pokn5 that rna￿tain a gOalof￿X ￿￿1hS Page 9 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 d. Financial risk managem8nt objectives and policies The Trustees are committed to a policy of Identi￿'ng. monitoring and managing the risks that might adversely affect the activities of Lifebox. In this context. risk is deffined as the potential lo fail lo achieve the charity's objectives and lor loss, financial andlor reputational. An ongoing process is in place for identifying, evaluating and managing any significant risks faced by Lifebox and identified by the Trustees or senior management. Appropriate ath'ons have been put in pLice to M￿'gate the exposure to and possible consequence5 of these risks. •. Principal funding Lifebox UK is primarily funded through private individual and foundation gifts, the majority of which are managed through our sister charity, Lifebox US. Lrfebox US reimburses Lifebox UK lor activities ¢arried out in delivery of programs as per a collaborative agreement and grant temis. Major grants include from ELMA Philanthropy, CRI Foundation, Johnson & Johnson Charitable Foundation. etc. f. Review of thg Y•ar The lolal donations we received during the period amounted to £517,657, of ￿1¢h £289,250 was unreslricled and £228.407 restricted. Our lolal expenditure wa$ £785.592 comprising £430 on fvndraising and £785,162 on ¢harrtable aclivilies. Our deficit of income over expenditure during the period was thus 1£267,9351 and after other gains left us with reserves of £513,254. Our principal asset at the end ol the period was a bank balance of £406,384 and Stock worth £66,123 held wlh Acare Technology Co.. Ltd in Taiwan. We did not own any Investments. StructUrn* governanc• and management a. Constltutlon Lifebox is a charitable company limrted by guarantee and govemed by ils Memorandum and Articles of Association, as amended by special resolutions dated 15 July 2011, 15 May 2012 and 21 Ntsvember 2015. The Memorandum and Arhcles restrict the liats'lty of members on wnding up to £5. In the case of wnding up none of the accumulated funds are distribLrtable to the members, but will be applied for charitable causes as decided by a majority of the Trustees. b. Mothods of appolnlment or •lKtlon of Tru$tse$ Lifebox Trustees.. Directors are appointed by re501ub.on of the members for a three-year tem. Directots are eligible for ￿appOintment al the first Board meeting of the year in vknich their lemi expl￿$. None of the Trustees has any beneficial interest in the charity. The Trustees, who are also the directors for the purpose of company law, and vtho served during the year were.. Pauline Philip, DBE- CHAIR Professor Alan Merry Mb. ChB- TREASURER Professor Millard Derbew Beyene. MD Rob McDougall, MB8S Professor Nobhojit Roy, MD, MPH Thomas Weiser, MD, MPH Page 10 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 Structur•. gov•rnance and manag•m•nt l¢ontInu￿) c. Oryanisational structure and decision4naking policies The 8oard of Trustees is the body responsible for the management of Lifebr)x. The Board meets throLJgh formal video Conferences at regular intervals throughout the year. Katie Femandez, Chief Programme Officer, is the UK charity's most senior staff member. She reports to Global CEO and UK Company Secretary Kris Torgeson. There is close collaboration betsveen the charity and our sister organisation in the USA, also called Lifebox Foundation, particularly in developing strategies and deliveiing projects aimed at achieving the common mission. The CEO of Lifebox USA. Kris Torgeson works closely together wth all stsff members of Lifebox UK and the UK Board. All major decisions regarding Lifebox Foun¢Jats'on are approved by the Board of Twslees. d. Pollclos adoptod for the Inductlon and tralnlng of Trustees New Tru$tee$ undergo an orientstion to brief them on their legal obligations under charity and Company law, the content of the Memorandum and Articles of Association, the decision-making process within Lifebox, risk register, annual largels and finoncial performance. Trustees are also Introduced lo the charity's staff and briefed on their areas of work. Trustees are encouraged lo attend appropriate extem81 training events where these will facilitate the undertaking of their role. •. Pay pollcy for kèy mana9em•nt Pornonn Lifebox 1$ committed to providing staff with fair compensation for their work, en￿uragIng strong workplace performance, and ensuring siaff maintain a qualty standard of living. Our pay scales presently are informed by Birches, with annual cost of living adjustments applied to all staff salaries lo account for inflation and other increases in cost of living. Staff also qualify IOT an Increase rf their level or scope of responsibility significantly increases. A revised job description is developed and an adjuslmenl lo remuneration andlor tslle wll be recommended by their line manager in consultation ￿th HR and approved by the CEO. Salaries lor new position$ are infomied by the budget. looking at comparable positions wthin the organisation as we aim for pay equity, and scanning the market for extemal parity. Part of being a responsible employer also means remuneration derAsions are ahvay5 made ￿ afftjrdability for sustainability and Statutory obligation5 in mind. Page 11 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 Structur•. gov•rnance and manag•m•nt lcontlnu￿￿ f. Related party relationships There is close collaboration behveen the charity and our sister organisation in the USA, also called Lifebox Foundation, particularly in developing strategies and delivering projects aimed at achieving the common mi$sion. The CEO of Lifebox USA, Kristina Torgeson works closely together with all staff members of Lifebox UK and the UK Board. Lifebox works closely wth several other nowovemmental organisalions including". Mgrcy Shl Mercy Ships and Lifebox have established a collaborab'on for Education. Trainin9 and Advocacy programs and project5 to make surgical and anaesthesia care safer In the counlnes that Mercy Ship5 partners through reducing surgical site infections. improving anaesthesia safety, and promob.ng teamwork. Projects include implementslion of the Clean C￿￿ Program. donation of life-saving equipment, and other trainings such as SAFE Operating Room and Nursing Leadership lor Suigical Excellence. SmlloTraln Lifebox and SmileTrain have developed the Smile Tiain-Lifebox Safe Surgery and Aneslhegia Initiative lo develop and deliver high-impacl tools and program$ lo improve surgical and anaeslhesia safely and care for cleft patients in Smile Train's 1100+ partner facilities., distinguish Smile Train as the leader in safe cleft care and raise the standard of surgical and anaesthesia safety in lO￿Tes0urce settings wortdwide,. and strengthen Lifebox's capacity to provide expertise on surgical and anaesthesia safety in LMIC5 for the long-temi. g. Flnanclal rl$k managgm•nt The Trustees are committed to a policy of Identl￿"nY. monilonng and managing the nsks that might adversely affect the activities of Lifebox. In tt)is context. fisk is defined as the potential lo fail lo achieve the charity'g objectives and lor loss. financial andlor reputational. An ongoing pr¢)cess 1$ in place lor identifying. evaluating and managing any significant risks faced by Lifebox and identified by the Trustees or senior management. Appropriate acb'ons have been put in place to mrtlgate the exposure to and possible consequences of these risks. Page 12 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 Plans for futur• perlods Our focus for the next year (April 2024-March 20251 is to develop a new five-year Strategic Plan12025-20301 focused on surgical systems strengthening. Our approach will evolve lo focus on supporting partner hospitals lo identify, define, and reach their own goal$ for surgical safety- Our aim is to adopt an integrated approach lo programming. focused on working wrth Ministries of Health and partner hospitals to assess and map gaps and challenges in perioperalive processes. We will provide a range of flexible solutions including quality improvement. training. and key safety equipment, with the dual goals of improving patsent outcomes and strengthening systems. This 'LEED approach, wll span four key spheres of work.. LEARNING: Creating a community of leaming by identifying and supporting the leaming goals of professionals in low. resource settings on perioperative safety. EVIDENCE.. Improving adherence to evidence-based best practices and generab.ng evidence of what works lo increase compliance proven surgical patsent safety guidelines and protocols EQUIPMENT.. Developing and increasing a￿$$ to key. environment-appropriate $afety equipment and supplies DATA,. Increasin9 the capacity for sur9ical teams and systems lo make dat&driven decisions to improve surgical safely The 2025-2030 Strategic Plan wll address key issues to the safety of Surgi￿1 patients in Iow-resource $etting$.' Infectlon prfrvontlon: continue lo Idapt the surgical infection reduction program Clean Cut to incorporate new evidence and infection prevention standards wth an emphasis on flexibility for partner hospitals. Matèmal and neonatsl out¢om•$- continue the adaptation of the Lifebox Clean Cul program to addre88 other key risks associated with caesarean seclion. including postpartum haemorrhage. Pa8dlatrlc 8uryory.' invests'gate use of the Clean Cut methodology to reduce key risks of infection and mortality for paediatric surgery and develop and roll out additional quality improvement components at hospitals that provide paediatric surgery. Nursing leadership.. implement the Lrfebox Nursing Leadership for Surgical Excellence program al partner hospitals lo build the leadership skills in perioperatsve nurses for safer patient care. Saf•r monitorlng: continue lo address the lack of access lo Capnography in Iow-resource setting operating rooms wth core partner Smile Train to improve anaesthesia safety. Antimicrobial resistance: pilot and scale up an antibiots"c stewardship program to address the overuse of postoperative antibiotics with the aim of it being incorporated into the Clean Cut program. Environmental impact- pilot worfK lo minimise environmentsl impact of surgery by adapting a Green Theatre Che¢klisl lo reduce the environmental impact of surgery. Biomedical ¢ngineering.' develop and pilot a biomedical equipment management program lo address gaps in equipment management and maintenance. In 2024-2025, alongside developing a new strategic plan, V•* aim to work with 18 hospitals in nin8 countries to improve the safety of surgery and anesthesia for 263.000 patients. Page 13 UFEBOX FOUNDATION {A ¢¢mpany limited by guarante•l TRUSTEES. REPORT ICONTINUEDI FOR THE YEAR ENDED 31 klARCH 2024 Statsm•nt of Tw$tges' rnspon$lbllltl•$ The Trustees (who are also the directors of the Charity for the purposes of company lawl are responsible for preparing the Trustees, report and the financial ststemenls in a¢cordan¢e wlh appli¢able law and United Kingdom Accounty'ng Standards IUnrte