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← Knowledge For Change

2024-12-31-accounts

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Knowledge for Change Annual Report & Accounts 2024

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By the end of 2024, Knowledge for Change had directly benefitted

Over 1.2 million

health workers, hospital patients, local community members and school children in low-income countries by improving quality and access to health and education systems.

This has included:

Beyond the people who have benefitted directly, many more have benefitted indirectly from successful interventions being sustained and up-scaled; improved health and education outcomes for their family members and positive governmental policy changes influenced by our high quality and high impact research.

2024 highlights at a glance:

Front cover images (clockwise from top left)

1. K4C staff manufacturing honey gauze wound dressings in our laboratory in Fort Portal (Uganda)

2. Henry (Prosthetist) fitting new prosthetic arms for Ninsiima, a victim of domestic abuse, in Kampala (Uganda)

3. Timothy (Orthopaedic Technician) 3D scanning a patient’s foot for our NEEDS program (type-2 diabetes prevention and rehabilitation) ~ 2 ~

4. K4C staff, professional volunteers and students based at Fort Portal Regional Referral Hospital (Uganda).

5. Peter (Builder) constructing a ‘Lorena Stove’ which is healthier and more environmentally friendly than traditional cooking methods.

Contents

TRUSTEES ANNUAL REPORT
Foreword from our Chair 5
STRATEGIC REPORT
Who we are and what we do 7
An Overview of our Income and Expenditure 10
ACTIVITIES & IMPACTS IN 2024
Professional Volunteering Programme 13
Virtual Volunteering Programme 15
Ethical Student Placement Programme 17
Antimicrobial Stewardship, Wound Management & 20
Honey Gauze
Cervical Screening Programme 22
The Environment and Impacts of Climate Change on 24
Human Health
Commonwealth Professional Fellowships 25
Type-2 Diabetes Prevention & The NEEDS Programme 28
Infection Prevention & Control 30
Neonatal Sepsis Project 31
Rehabilitation & Supply Chains 34
Respectful Midwifery Care 37
Child Welfare, Education and Supporting Local 38
Community Based Organisations
University Education & Teaching 40
Publication and Dissemination of Global Health 41
Research
KEY STAKEHOLDER TESTIMONIALS 43
GOVERNANCE & ACCOUNTABILITY 44
RISK ASSESSMENT & MITIGATION 48
FINANCIAL REVIEW & STATEMENTS 49
INDEPENDENT EXAMINERS REPORT 56

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Francis Muhumuza (pictured) was working as a lorry driver for a cement company in Uganda when he was involved in a serious road traffic accident in early 2023, at the age of 25. Although he was lucky to survive, his injuries led to the amputation of his right leg. This meant he could no longer work as a lorry driver, and he struggled to find alternative employment to provide for his family.

Francis first heard about K4C’s rehabilitation programme later that year through a friend who we had previously fitted with a new prosthetic leg. He reached out to Timothy Isingoma (K4C Orthopaedic Technician) who eventually went on to fit him with a new prosthetic leg.

Francis has since secured a new job as a mechanical engineer, an opportunity he believes was only possible with his new leg. He and Timothy (pictured together below) remain in close contact!

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Foreword from our Chair

As chair of Knowledge for Change (K4C), I am pleased and excited to present our 10[th] annual report for the Charity, together with a summary of our activities and financial statements for the period 1st January to 31st December 2024. This year marks a decade since K4C officially began working in Uganda, taking over the activities of the LiverpoolMulago Partnership and embarking on a broader and more ambitious journey. Over the years, we’ve widened our charitable remit from initially focusing only on maternal and newborn health to include several other areas of health including both tropical and noncommunicable diseases, surgical care, rehabilitation services, antimicrobial resistance, domestic violence, inclusive education for disabled children and much more. We’ve also expanded our areas of work to additional health and education facilities across Uganda and into Tanzania, as well as other project work in India, Jordan and Mozambique.

The last 10 years has also seen our charity withstand the unforeseen impacts of Brexit, a global pandemic, several outbreaks of Ebola and Marburg Haemorrhagic Fever and more recently a fundamental shift in the UK and other governments’ commitment to international development and aid, essentially leading to its sharp de-prioritisation and an equivalent reduction in funding. Despite these immense challenges which have affected all organisations working in the sector, we have remained innovative and dynamic to diversify our income streams, sustain our project work and continue to have a strongly positive impact on our partner health and education systems, as well as our UK NHS, UK Universities and other stakeholders. Our staff bases in the UK, Uganda and Tanzania have all continued to develop, our student placement programme has expanded, and our annual income and expenditure have grown as we invest more and more into our programmes and activities.

Some of our main successes over the course of 2024 included the successful completion of our Burdett Trust funded ‘NEEDS Project’ which has greatly improved the identification and management of type-2 diabetes and reduced diabetic foot ulceration and resulting leg amputations. Our cervical screening project has continued at a pace with over 800 women being screened and/or treated for pre-cancerous lesions across 3 Community health facilities. We successfully co-hosted 8 Commonwealth Professional Fellowships in partnership with the University of Salford, focusing on diabetes care and supply chains for medical devices. Our rehabilitation teams directly supported over 800 patients to access essential prostheses and orthoses in Fort Portal and Zanzibar, 60 of which were funded by YouTube star ‘Mr Beast’ towards the end of the year. We also successfully launched our Global Health Partnerships funded Neonatal Sepsis Project which will run until June 2025 and aims to build capacity of health workers to reduce sepsis related morbidity and mortality across all our partner health facilities in Uganda and Tanzania.

Looking forwards to 2025, we are excited to be working in partnership with the University of Salford to undertake new project work supporting victims of domestic violence with psychosocial support and rehabilitation services. We’re planning to host 5 Commonwealth Professional Fellowships from February to May focusing on capacity building in neonatal sepsis and linking to our formal project work noted above. We’re also planning to actively expand our successful interventions from Uganda to Zanzibar, including our NEEDS programme and wider diabetes related work, our wound management and honey gauze projects and cervical screening programme.

I would like to thank all our trustees, staff, volunteers, students, patients, users and other stakeholders for their ongoing support throughout 2024, which has enabled us to continue to improve the health and wellbeing of some of the poorest and most vulnerable communities in the world. I look forward to continuing this exciting and highly beneficial work over the course of 2025.

Professor Louise Ackers Chairperson Knowledge for Change 31[st] December 2024

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Who we are and what we do

BACKGROUND

Knowledge for Change (K4C) was registered with the Charity Commission for England and Wales in January 2012 (no. 1146911) and has been hosted by the University of Salford in Manchester since July 2014. Its working names are ‘Knowledge for Change’, ‘Knowledge 4 Change’ and ‘K4C’. The official UK charity address is 11, Newmarket Street, Skipton, North Yorkshire, BD23 2HX.

K4C formally merged with its sister charity, the Liverpool-Mulago Partnership (no. 1136219), in 2015 and continues to manage the legacy of both organisations.

K4C is also registered as separate Non-Governmental Organisations (NGOs) in Uganda (no. 3592), Tanzania (00NGO/12/4270) and Zanzibar (0000210165). Each organisation has an independent board of directors, however relate and report closely to K4C UK, as outlined within existing Memorandums of Understanding (MOUs).

OUR OBJECTIVES

“To improve the standard of healthcare and education provision for the poorest and most vulnerable members of society in Low- and Middle-Income Countries”

For almost 20 years, we have been working across multiple hospitals and health centres in Sub-Saharan Africa to sustainably improve their health and education systems and achieve better standards of care for patients. The work we do includes the placement of professional (qualified) volunteer health workers, infrastructural developments, providing and repairing essential medical equipment, implementing staff training and capacity

building programmes, working with local educational institutions to develop new and improved undergraduate and postgraduate curricula, organising staff exchange programmes, running ethical international placements for undergraduate students and conducting high quality global health research.

Our charitable activities not only support people in Low- and Middle-Income Countries (LMICs) but also improve the quality of care provided by the UK NHS by upskilling both qualified and student doctors, nurses, midwives, allied health professionals, social workers and other staff.

CORE VALUES

Our core values centre on making ethical, sustainable and mutually beneficial improvements to health and education systems LMICs. We believe that the best way to do this is through the transfer of knowledge between professionals and students working in the health and education systems in order to improve their skills and experience. Sticking to these values ensures that we achieve the best longterm outcomes for all the High-, Middle- and LowIncome Countries that we work with.

CURRENT AREAS OF FOCUS

We currently focus most of our activities in Uganda and Tanzania, however we also have past and ongoing linked projects and networks in Mozambique, India and Jordan. We initially focused primarily on maternal and newborn health, but have since expanded our remit to include other areas of health, rehabilitation, social care, children’s education, laboratory science, supply chain management, climate change and wildlife protection.

In line with our commitment to support populations of highest need, K4C works primarily in public (as opposed to private) health and education facilities, in recognition that these facilities cater for the poorest and more vulnerable members of society in LMICs. Our in-country partners range from large urban hospitals to small rural health centres, primary schools, Universities, community-based organisations, local councils and governmental bodies. We have several partnerships with various NHS trusts, Royal Colleges and funding bodies.

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AN OVERVIEW OF OUR ACTIVITIES

International Development Projects:

K4C has run numerous international development projects over the years including: promoting ethical and sustainable professional volunteering and student placements; improving biomedical engineering services for equipment procurement, maintenance and disposal; improving processes for infection prevention and control, antimicrobial stewardship and wound management; improving surgical safety; reducing sepsis related maternal and newborn mortality and morbidity rates; establishing effective cervical screening and treatment services; establishing high-quality rehabilitation services for upper- and lower-limb amputees; developing intensive/high dependency units; improving identification and management of type-2 diabetes and diabetic foot ulceration; promoting respectful maternity care; promoting including education for girls and children with physical and mental disabilities; and supporting the Uganda Blood Transfusion Service (amongst many other projects). Our main funders have included NHS England (formerly Health Education England), the UK Foreign Commonwealth & Development Office, Global Health Partnerships (formerly the Tropical Health Education Trust) and the Burdett Trust for Nursing. Many projects are run in partnership with the University of Salford, and all are designed and evaluated in line with our core values of sustainability, ethics and mutual benefit.

Clinical Staff:

Knowledge for Change directly employs several highly skilled health workers and project managers in Uganda and Tanzania to support local health and education services, ensure effective delivery of our global health and international development projects and provide high-quality care for patients. As of December 2024, we had 15 permanent fulltime staff based across Uganda and Tanzania including 4 midwives, 3 nurses, 1 doctor, 3 orthopaedic technicians, 2 project managers / administrators and 2 support staff. We also supported (via grant funding to the University of Salford) a project manager and a project officer to be based in the UK to manage our operations.

We were pleased to welcome a new nurse (Daisy Hasahya) to our team in September, and she’s already proven to be highly valuable colleague based at Kasangati Health Centre (Uganda):

“Working with K4C has been very rewarding so far. I’m grateful for the opportunity to combine clinical and research work, which has not only aligned with my career goals but also fuelled my growth and development” a

Professional Volunteering:

K4C’s primary activity has included the placement of over 750 professional (qualified) volunteers from High-Income Countries in Uganda and Tanzania over the last 15 years, initially supported by the UK Department for International Development through the Tropical Health Education Trust. These volunteers have included doctors, midwives, nurses, biomedical engineers, clinical scientists, microbiologists, allied health professionals, social workers and social scientists. Most volunteer placements are 6+ months in duration, however shorter placements are permitted when necessary. Our professional volunteers play important roles in our projects and work alongside local facility staff to exchange valuable knowledge, skills and experience.

More information about our Professional Volunteering Programme and its achievements can be found on page 13.

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International Training Fellowships:

We have supported over 140 Ugandan, Tanzanian and Mozambiquan health and social workers to travel to the UK to complete intensive training programmes to enhance their learning, primarily funded by the Commonwealth Professional Fellowship Scheme. More information on our CSC Fellowship Programme can be found on page 25.

Student Placements:

Since 2015, K4C has focused on improving the quality and ethics of international student placements in LMICs such as Uganda and Tanzania. Our student placement programme (initially funded by Health Education England) has now placed over 800 students in Uganda, Tanzania and India from courses including medicine, nursing, midwifery, the allied health professions, social work, prosthetics and orthotics, microbiology, biochemistry, psychology and business management. All student placements are linked to K4C’s ongoing development programmes and are supervised by our highly competent teams of local staff and professional volunteers. More information about our Student Placement Programme can be found on page 17.

Global Health Research:

K4C endeavours to remain at the forefront of Global Health Research and has been closely involved with several research projects and publications, many run in partnership with the University of Salford. All K4C projects are designed to be dynamic and are closely monitored and evaluated in order to maximise their impact and cost efficiency. Research findings have been shared through policy reports, books and journal articles as well as regular presentations at conferences, workshops and with UK and LMIC government officials. More information about our Global Health Research can be found on page 41.

OUR EFFECTIVENESS

Our expertise in research and project evaluation enables us to carefully review our activities and make positive changes on an ongoing basis to maximise their impacts and efficiency. Each of our individual projects is evaluated separately, however we also evaluate our overall impact across entire thematic areas.

Externally funded projects are also independently evaluated by their respective funding bodies. This was the case for our Burdett Trust for Nursing funded ‘NEEDS project’ which officially ended in December 2024 and focused on prevention and management of type-2 diabetes.

“It was great to read in the report all of the activities that were completed and congratulations to your team for bringing this fantastic work together”

Excerpt from the Burdett Trust for Nursing’s review of K4C’s End of Project Evaluation Report for the NEEDS Project

ACHIEVING OUR CHARITABLE OBJECTIVES IN 2024

Our work to strengthen health and education systems in Low- and Middle-Income Countries (LMICs) continued to grow and expand throughout 2024. In Uganda and Tanzania, where the majority of our project activities currently take place, we provided training and capacity building for over 350 medical, nursing, midwifery and rehabilitation staff in areas such as the identification and treatment of type-2 diabetes, cervical cancer screening and treatment, antimicrobial stewardship, wound management, neonatal sepsis, infection prevention and control, high-quality midwifery care and several aspects of rehabilitation.

Our activities directly benefitted over 50,000 local people who accessed new or improved healthcare services. For example, throughout 2024 our cervical screening programme was accessed by 586 women, 36 of whom were treated for pre-cancerous lesions and 18 referred for further assessment or a biopsy.

Over 75% of the total number of people reached by our activities were women or girls. This is highly significant as women make up the majority of disempowered and impoverished populations in LMICs. This success aligns with several of the UN Sustainable Development Goals: reducing poverty, improving healthcare and empowering women and girls.

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An Overview of our Income

Knowledge for Change’s total gross income in 2024 was £511,059. Two breakdowns of our income are provided below; the first in relation to sources of income and the second in relation to its intended purpose:

WHERE OUR INCOME CAME FROM IN 2024

Our total income for 2024 was £511,059, an increase of £77,234 (18%) on the previous year. This increase was primarily due to expansion of our student placement programme, growth of our partnership with Legs for Africa, grant income awarded by THET for our Neonatal Sepsis Project and income from consultancy work conducted by our trustees for the University of Greater Manchester. Overall, our project related income has continued to decline year on year, due to the ongoing significant cuts to the UK and other governmental International Aid budgets. We expect this challenge to continue or possibly worsen with the incoming administration in the US.

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An Overview of our Expenditure

Knowledge for Change’s total expenditure in 2024 was £501,823. A breakdown is provided below:

WHERE OUR EXPENDITURE WENT IN 2024

Our total expenditure for 2024 was £501,823, an increase of £91,891 on the previous year. This increase was largely due a 45% increase in grant funding for K4C Uganda (up to £116,539) and a 164% increase in grant funding for K4C Tanzania (up to £29,000). These increases were driven by our recruitment of additional clinical staff in each country to work across all our programmes. Our UK staff costs for research and project management also increased by 131% to £58,693 due to a reduction in the amount of co-funding provided by the University of Salford. We also saw significant increases in expenditure on our Neonatal Sepsis, Rehabilitation and Professional Volunteering Programmes.

Overall, for every £1 we spent during 2024, 86p was spent directly on our charitable activities. The remaining 14p was spent on our project management and administration costs in the UK, Uganda and Tanzania (totalling £71,893). A further breakdown of all income and expenditure can be found in our annual accounts (see pages 49-57).

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Professional Volunteering Programme

qualified volunteers from the UK NHS across Uganda and Tanzania on long-term (6+ month) placements. These included 3 midwives, 8 nurses and 2 doctors. 11 of these placements were fully-funded and the remaining 2 were part-funded to only include funding for their accommodation, airport transfers, insurance, clinical registration and work permit costs.

BACKGROUND

Our Professional Volunteering Programme is our longest-standing, having been in place since the foundation of K4C and its predecessor charity, the Liverpool-Mulago Partnership. We have now placed over 750 professional volunteers across Uganda and Tanzania, primarily from health backgrounds such as medicine, nursing, midwifery and allied health professions, however also some social workers, biomedical engineers, microbiologists and social Scientists. Most of our professional volunteers complete long-term placements of 6+ months, however some have completed shorter-term (3+ month) placements. We provide financial support for the vast majority of our in-country volunteers, including the costs of their flights, accommodation, airport transfers, insurance, clinical registration, work permit and a living allowance of £300 per month to cover their subsistence. The role of K4C’s professional volunteers is to work alongside local staff on a co-present basis to share valuable knowledge, skills and experience.

The primary aim of the programme is to build the capacity of local staff and thereby strengthen local health systems and improve quality of care for patients. The placements are of mutual benefit as the volunteers also gain valuable knowledge, skills and experience to utilise in their practice when they return to the UK NHS. Professional volunteers also play an important role in designing and implementing our project work, as well as supporting students completing international placements with us, working our in-country teams to provide clinical supervision, pastoral support and guide their learning.

ACTIVITIES IN 2024

We continued our highly successful Professional Volunteering throughout 2024, placing a total of 13

Dr Augustine Ssemujju (Obstetrician) and Dr Thomas Liney (K4C Professional Volunteer) based at Fort Portal Regional Referral Hospital, Uganda

Our professional volunteers have played critical roles in implementing our Neonatal Sepsis and NEEDS (type-2 diabetes) Projects; establishing a maternity operating theatre at Kataraka Health Centre; supporting ongoing development of our cervical screening, wound management and diabetes programmes; providing ongoing training and mentoring for local health workers; providing highquality supervision for our students undertaking their international placements; and supporting candidates’ applications to the Commonwealth Scholarship Professional Fellowship Programme.

We have also continued to expand our professional volunteering programme in Zanzibar in 2024, hosting 4 nurses and 2 midwives across Mnazi Mmoja Referral Hospital, Kiddongo Chekundu Mental Health Hospital and Jitimai District Hospital. As our partnerships and relationships in Zanzibar are still relatively new, we have not yet begun formal implementation of any projects (aside from our student placement programme). However, our first

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volunteers have played a critically important role in building links, networks and relationships with local staff and stakeholders, guiding our understanding of the unfamiliar contexts and cultures and reviewing hospital data to identify trends and priority areas for K4C to focus on in future.

More information about our Professional Volunteering Programme can be found on our website:

www.knowledge4change.org/professionalvolunteer ing ~~—~~

PLANS FOR 2025

We’re planning to continue our Professional Volunteering Programme into 2025 and have already secured placements for 7 volunteers in the first half of the year including 3 nurses, 2 midwives and 2 doctors. Our recruitment has focused particularly on volunteers with Neonatal Sepsis related experience as we move into the training implementation phase of that project.

K4C staff and professional volunteers based at Fort Portal Regional Referral Hospital.

From left to right: Kayleigh (midwife, UK), Angela (midwife, Uganda), Sofie (nurse, UK) and Rachel (nurse, Uganda)

Professional Volunteer Midwife (Tiggy) and K4C Nurse (Rachel) cleaning, preparing and packing cervical screening instruments to go in the autoclave to be sterilised at Kagote Health Centre (Uganda).

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Virtual

Volunteering Programme

BACKGROUND

The idea of ‘virtual volunteering’ placements has evolved over time, driven by increased awareness of the harmful effects of international air travel on the climate; initiatives to widen participation for individuals who cannot travel internationally; and the covid-19 pandemic which dramatically inhibited international travel and led to rapid improvements globally in internet connectivity and related online software, including in the UK, Uganda and Tanzania.

We firmly believe in the value of our in-person volunteering and student placements, but also appreciate the need to carefully balance the positive impacts of our health partnership on the Ugandan/Tanzanian health systems and the NHS with our commitment to environmental sustainability.

In 2022/23, we received grant funding from the Tropical Health Education Trust (THET) and the University of Salford to establish a comprehensive Virtual Learning hub in Fort Portal (Uganda) to support our virtual wound management clinics and prosthetics workshops. This provided a physical space equipped with technology and reliable Wi-Fi, on site at the Regional Referral Hospital, to link specialists and students from the University of Salford with clinicians at Fort Portal Regional Referral Hospital and promote virtual knowledge exchange and strengthen relationships between the UK, Uganda and Tanzania.

ACTIVITIES IN 2024

Over the course of 2024, we have continued to integrate virtual working into the day-to-day running of all our programmes to enhance and enrich them while keeping our carbon footprint as low as possible. We received funding from THET via their Remote International Mentoring Partnership Scheme (RIMPS) programme to establish a new Virtual Learning Hub in Zanzibar to facilitate a diabetes focused mentoring scheme between several UK and Tanzanian specialists.

We harnessed the expertise of a team of 7 UK-based paediatricians and specialist neonatal nurses to virtually support the development of our Neonatal Sepsis Project across Uganda and Tanzania (see page XX). We also continued our virtual engagement between the University of Salford and Fort Portal Regional Referral Hospital (Uganda) to support our ongoing wound management, diabetes and rehabilitation programmes.

A Neonatal Sepsis Case Review Meeting taking place in K4C’s Virtual Learning Suite at Fort Portal Regional Referral Hospital, linking in specialists from the UK and Tanzania virtually

PLANS FOR 2025

K4C Trustee and Doctoral Researcher, Claire Horder, has been working to capture and evaluate the effectiveness of virtual working. An article was published in SCOPE magazine about this work: - https://www.ipem.ac.uk/media/413heltr/scope autumn-2023-full-lrc.pdf

Our Virtual Volunteering Programme will continue to be integrated into our Neonatal Sepsis Project and Wound Management and Rehabilitation programmes in 2025. We’re also planning to pilot a new and exciting virtual partnership between 2 secondary schools in Bury (UK) and Fort Portal (Uganda).

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CASE STUDY: LAURENCE KENNEY (VIRTUAL VOLUNTEER)

“I am a Professor of Rehabilitation Technologies at the University of Salford. My collaboration with the K4C team began in 2018 with the award of a £1.4 million EPSRC/GCRF-funded grant to develop fit-for-purpose upper limb prosthetics. The project involved six universities across three countries, including Uganda, and aimed to develop user-informed, and simple-tomaintain, purely mechanical prostheses.

The challenges of delivering the project in Uganda, particularly during Covid, were significant but working with the K4C team in Fort Portal enabled us to carry out a qualitative study to understand user needs, and to implement one of the first co-design workshops with users – there are surprisingly few such studies in any Sub-Saharan African country.

I’ve never travelled to Uganda, but working with the K4C team on this project gave me a much better understanding of the challenges inherent in translating good ideas for designs into practical devices which could have impact ‘on the ground’. Building on this insight, we were awarded an MRC-funded grant entitled “Promoting universal health coverage for amputees through social enterprise and engineering innovation” and as part of this carried out a clinical study of a ‘fit-for-purpose’ upper limb prosthesis. The results were positive and a manufacturer of the device is in discussions with K4C about distributing their product in Uganda. Watching the K4C centre in Fort Portal develop over the last few years and through their team being able to engage users and local clinicians in our work has been a real privilege and I look forward to whatever comes next!”

CASE STUDY: DAN PARKER (VIRTUAL VOLUNTEER)

“I’ve been supporting the setup and evaluation of the NEEDS programme as a virtual volunteer since 2023. My background in the use of technology for diabetic foot orthotic design and evaluation has allowed the team to put in place tools which provide the best value to the clinic.

The NEEDS programme and the work of the Fort Portal team have helped us to understand what diabetic people in Uganda want and need to better manage foot care and prevent ulcers.

The K4C team continues to explore ways to improve supply of materials and find solutions which meet this vital patient need. I hope that my experience in orthotic material evaluation will ensure that orthotics produced continue to be fit for purpose”.

Ethical Student Placement

Programme

BACKGROUND

Health students have been travelling from the UK (and other high-income countries) to low-income countries such as Uganda and Tanzania for decades to undertake elective placements. However, the sector is poorly regulated with many private companies offering opportunities which are prohibitively expensive (excluding disadvantaged students from poorer socioeconomic backgrounds), high-risk for students, and perhaps most worrying are damaging to hosting health systems and patient care. Students often lack proper support and supervision which inhibits their learning and puts them and the patients in vulnerable situations, working outside of their competency to provide care. Also, students often lack professionalism whilst on placement, jumping between clinical areas without permission, taking inappropriate photos of vulnerable people, arriving late/leaving placement early and being rude to local staff. All of this fuels resentment and damaging perceptions of ‘voluntourism’.

K4C’s student placement programme has gone from strength to strength since it was first established in 2015. It was initially funded by Health Education England (now NHS England), with the aim of developing, piloting and evaluating an ethical, cost effective, sustainable and low-risk placement program which yielded highly impactful learning outcomes for students and mutual return benefits for the UK NHS. We have now hosted over 800 students through this programme from various study backgrounds including medicine, nursing, midwifery, Allied Health, social work and education (amongst others).

In 2023, we became a formally approved and registered placement provider for NHS England,

largely in recognition of our ethical focus and the high-quality supervision provide for students through our multinational, fully trained and registered teams comprising both local and UK staff and professional volunteers. This also enables us to meet the supervision requirements of professional councils, for example the UK Nursing and Midwifery Council (NMC) which enables students to complete our placements as a formal part of their academic programme (including placement hours and sometimes competencies/proficiencies).

Our students follow a carefully structured placement programme which is negotiated to meet the requirements of their respective University and professional body, as well as our in-country partners’ needs. They work with our staff and professional volunteers to support implementation of our projects, as well as gaining beneficial skills and experience whilst on clinical placement.

We currently place students across 2 locations in Uganda (Fort Portal and Kampala) and 2 locations in Tanzania (Moshi and Zanzibar), where they complete placements within our partner hospitals, health centres and community-based organisations. We have agreements in place with all partners which include provision for a financial investment into their facility for each student they host. This ensures that our partners and local communities also benefit in an ethical and sustainable way. To date, our student placement programme has generated over £360,000 of direct investment into our partner organisations.

Local staff, K4C midwife (Tiggy) and students on placement at Kasangati Health Centre (Uganda)

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ACTIVITIES IN 2024

Our student placement programme has continued to grow throughout 2024, with our newer partner sites in Tanzania generating particularly high levels of interest. Over the course of 2024, we hosted 164 students, an increase of 10% compared to the previous year. The majority of students were from nursing and midwifery backgrounds, however there was also strong representation from social work, psychology, medicine, physiotherapy, paramedic science, biomedical science and prosthetics and orthotics. Our main University partners were Kingston University, Liverpool John Moore’s University, University of Salford, Hertfordshire University and the Universities of Agder and OsloMet in Norway. New positive relationships have also been established with Leicester University, Birmingham City University and the University of Bern (Switzerland).

The programme continues to demonstrate very positive learning outcomes for students and positive feedback from partner health facilities. 100% of the students surveyed felt the experience and learning achieved during their placement was relevant for their academic programme, and 88% felt their placement would have a ‘very positive impact’ on their future career. 69% of students rated their overall placement experience as ‘excellent’ and another 27% as ‘very good’.

The financial return for K4C and our partners has also been positive; over £115,000 was generated for use towards our charitable activities in Uganda and Tanzania, with over £25,000 being directly invested into our partner health facilities and over £90,000 being invested in our Professional Volunteering Programme and clinical staff salaries, both of which are highly beneficial for our partners. Additional revenue raised by the programme covered direct costs incurred in arranging students’ travel and accommodation, as well as our other general administrative costs.

“It was an amazing experience and something I’d recommend to anyone!” P&O student, Salford University, Zanzibar placement .

“It exceeded all expectations of what I imagined an elective would entail, and I am already excited at the idea of being a long-term volunteer with K4C after my foundation training as a doctor.” Medical student, UCL, Fort Portal placement .

PLANS FOR 2025

Moving into 2025, we are excited to be exploring further expansion of our existing student placement programme in Uganda and Tanzania, as well as to potential new destinations in Cambodia, in partnership with several like-minded charities and NGOs. We

This graph summarises post-placement feedback received from students in 2024 about the impact they felt their placements had on their learning

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Testimonials from our University Partners

“The partnership between LJMU and Knowledge for Change offers student paramedics a unique opportunity to engage in global health practice. Through shared learning and cultural exchange, students broaden their clinical thinking and develop a deeper awareness of how healthcare knowledge and resources are distributed around the world. The placement encourages reflection, adaptability, and connection, with learning flowing in both directions. Our students return to the programme and profession in the UK with renewed purpose and a richer understanding of their role within a global health community. It’s an experience that stays with them long after they return home, with many describing it as life changing and we are forever grateful for this opportunity”.

Jen Vasey, Lecturer in Paramedic Science, Liverpool John Moore’s University

“We’d like to share our appreciation for the fantastic collaboration we’ve had with the Knowledge for Change team during the nursing exchange to Zanzibar. We have worked with James and his team for 3 years and from the very beginning, communication was clear, consistent, and supportive, which made planning and delivery smooth and stress-free.

The team has been great to work with—open to ideas, responsive to feedback, and always willing to help. Their support didn’t stop at the planning stage; they were there for us as co-ordinators and the nursing students throughout the trip and continued to offer guidance and debrief afterwards.

It’s been a genuinely positive experience working together, and we’re really looking forward to building on this partnership in future exchanges”.

Nic Hubbard (Lecturer in Paediatric Nursing) and Sarah Lowiss (Lecturer in Adult Nursing), School of Health and Society, University of Salford

OsloMet has for several years collaborated with Knowledge for Change in the practicum placement of our bachelor's social work students. K4C has proven to be a flexible partner and has accommodated changing circumstances, providing new placements according to our evolving needs. We are very grateful for the opportunity to have our students learn social work skills in Tanzania, and we appreciate that this provides circumstances that are very different from the local Norwegian context. We believe this placement gives them valuable tools and a professional head start.

Kjetil Wathne, Associate Professor and International Academic Coordinator, Institute of Social Work, Oslo Metropolitan University

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Antimicrobial Stewardship, Wound

Management & Honey Gauze

SUMMARY

Antimicrobial Resistance is one of the biggest threats to global health, food security and development in the world today and has the potential to reverse decades of medical progress. Multi-drug-resistant bacteria don’t respect national borders; what happens in one country affects us all. LMICs such as Uganda and Tanzania are particularly hard hit. Infectious diseases still cause a high proportion of deaths and, as many of the most commonly used antibiotics fail to work, resource-poor settings struggle to cover the costs of newer and more expensive antibiotics. Sepsis is a major cause of maternal mortality in Uganda and Tanzania and is often a result of poor Infection Prevention and Control (IPC) during surgery, leading to surgical site infections.

Our initial Antimicrobial Stewardship (AMS) project began in November 2018, funded by the Commonwealth Pharmacy Association and the Tropical Heath Education Trust (£60,000 in partnership with the University of Salford and Tameside and Glossop NHS Trust). Since then, K4C’s clinical staff and professional volunteers have provided ongoing comprehensive training and mentoring for over 150 pharmacy and nursing staff at Fort Portal Regional Referral Hospital in areas including prescribing practices, the management of sepsis and IPC measures.

One core element of the AMS project was a Maternal Sepsis Intervention which focused on two key contributors to AMS; reducing the incidence of infections (especially those acquired from hospitals)

and improving the use of antibiotics to fight the infections that do occur.

The Maternal Sepsis Intervention fostered multidisciplinary teamworking to improve Infection Prevention and Control, wound swabbing and management and the laboratory analysis of swab results to identify the bacteria responsible and target the most effective antibiotic. Over the course of the funded project, the percentage of suspected sepsis cases being tested for culture and sensitivity has risen from 0% to 95%. Furthermore, the hospital’s score on the WHO’s IPC Infrastructure Audit Tool has risen from 58.7% to 96.8%.

The Maternal Sepsis Intervention led to transformational change on the wards. Major improvements in infrastructure and the quality of care resulted in improved patient outcomes, reduced maternal mortality (to almost zero!), reduced length of stay on the wards and substantial financial savings for the hospital. Appropriate new and existing tools and protocols were developed within the hospital; the Medicine Therapeutic Committee was restarted and the ‘Rx system’ remains fully functional which will have a positive impact on Antimicrobial Stewardship and the procurement of appropriate antibiotics.

WOUND MANAGEMENT & HONEY GAUZE

K4C’s wound management and honey gauze programme built on our successful Maternal Sepsis Intervention, which demonstrated that implementation of improved wound care practices could reduce instances of maternal sepsis, and also reduce hospital costs, resources, staff time and instances of other hospital acquired infections by improving recovery times and greatly reducing women’s length of stay in the hospital.

In 2021, three Ugandan midwives were awarded Commonwealth Professional Fellowships to study at the University of Salford, focusing primarily on the Tissue Viability program run by Dr Melanie Stephens. During their fellowship, they learnt about the benefits that honey infused gauze can have for wound care. On their return to Uganda, the team led by K4C midwife Rachel Namiiro used this experience to establish a small base for manufacturing honey

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gauze within K4C’s laboratory premises in Fort Portal. The honey gauze is made in a sterile environment by combining 2 properties (20% Vaseline and 80% locally made pure honey (which is registered with the Uganda National Bureau of Standards (UNBS)). After mixing them, the paste is smeared onto sterile gauze and vacuum packed. A dry piece of sealed honey gauze can last up to 5 months.

Several of our publications relating to these projects are listed on page 41. The success of these projects has also been recognised through receipt of 2 awards:

reducing both the length of patient stays and the direct cost of their extended treatment plans. K4C is currently negotiating a social enterprise agreement with Fort Portal Regional Referral Hospital to enable us to provide the honey dressings sustainably into the future; we hope to have this finalised in early 2025.

2024 also saw the introduction of Honey Gauze to K4C’s new partnership sites in Zanzibar. Two members of K4C Zanzibar staff (Rebecca Kobelo and Hasan Mhunzi) travelled to Uganda to join our Diabetes Self-Management workshop and during their visit also received a demonstration in the manufacture and use of honey gauze. They established the honey gauze programme at Jitimai District Hospital upon their return to Zanzibar and have since manufactured and distributed 50 packs to the hospital as part of an initial pilot project.

ACTIVITIES IN 2024

The team first utilised the honey gauze for dressing the wounds of maternity and gynaecology patients at Fort Portal Regional Referral Hospital (FPRRH). Due to the success of the project and the positive outcomes observed for patients, the project was upscaled between 2022 and 2023 to also treat wounds (including burns) in the Surgical, Paediatric and Nutrition wards. Between February 2022 and December 2024, K4C supplied over 7000 sealed packs of Honey Gauze to Fort Portal Regional Referral Hospital (2800+ pieces to Surgical Ward; 2300+ pieces to gynaecology; 1500+ to paediatrics and 400+ to nutrition).

Over the course of 2024, we have seen a doubling of requests from Fort Portal Regional Referral Hospital for Honey Gauze. In total, we provided 1722 items: 321 to paediatric ward; 621 to gynaecology ward and 780 to surgical ward.

The gauze continues to be manufactured in the K4C premises as part of the training we provide for students on placement with us on infection prevention control and wound care. Each pack of gauze costs just 1000 Ugandan Shillings or 600 Tanzanian Shillings (roughly £0.20) to produce, making it a relatively cheap and possibly even cost saving for the hospital given the savings achieved by

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K4C Nurse
(Hasan) applying
honey gauze to
a patient’s
wound at Jitimai
District Hospital
(Zanzibar)
----- End of picture text -----

Feedback from patients and staff remains highly positive, with staff reporting significant improvements in wound healing and reduced costs to the hospital.

We’ve also begun expanding some of our wider AMR work from Uganda to Zanzibar, beginning with a research study (conducted by one of our Masters students, Eline Tuset) into the perceptions and attitudes of health workers and community members on antibiotics and antibiotic resistance in Zanzibar. Her report improved our understanding of the Zanzibari context and will be used as an evidence base to inform our future interventions.

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Cervical

Screening Programme

screening specialist doctors and Liger ‘coldcoagulation’ devices are used for the treatment of any pre-cancerous lesions identified. Both devices are rechargeable and do not require consumables which improves their sustainability. Any women identified with cancerous lesions are referred to a Regional Referral Hospital for a biopsy and further diagnosis, treatment and management.

BACKGROUND

Cervical Cancer is one of the most pressing women’s health issues globally, despite being largely preventable through HPV vaccination, regular screening and the treatment of precancerous lesions. In Uganda and Tanzania, cervical cancer contributes to over 80% of all female malignancies and is the leading cause of cancer-related deaths, mainly because of late presentation and delays in receiving appropriate treatment. Both counties have implemented a national roll out of HPV vaccinations for several years, however there is typically low uptake and coverage. Other problems affecting cervical screening programmes are a lack of trained staff, sociocultural factors (including a lack of public awareness), and lack of quality-assured screening programmes. Most existing screening programmes lack functional referral systems and do not reach target populations.

Knowledge for Change developed its first Centre of Excellence for cervical screening and treatment at Kagote Health Centre III in Fort Portal (Uganda) in 2017 and went on to expand this to 4 other health facilities in Fort Portal (Bukuuku, Kataraka and Kasusu Health Centres and Fort Portal Regional Referral Hospital) with funding support from UKAid, and also to Kasangati Health Centre in Kampala (Uganda).

ACTIVITIES IN 2024

K4C’s service model takes a holistic approach to maximise sustainability and efficiency. All women between the ages of 25-60 can access our free of charge screening and treatment services.

K4C utilises innovative technology to deliver cervical screening and treatment services. MobileODT ‘Enhanced Visual Assessment (EVA)’ devices are used to ensure high quality screening and access to telemedicine support from UK based cervical

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Angela (K4C Midwife) explaining the Enhanced
Visual Assessment (EVA) cervical screening device
to Parliamentary Minsters and local leaders.
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Our ‘one stop’ Point of Care screen and treat services are fully integrated into government health centres, enabling women to access the services free of charge and at local health centres that they know and trust. This has hugely expanded uptake and access for cervical screening across the areas that we work. An extensive awareness raising campaign in the community was enabled by GIS mapping, developed by K4C’s longstanding project manager Allan Ndawula as his Master’s degree research project. Combined with regular local radio broadcasts and ongoing targeted engagement with local HIV clinics and maternity departments, this has dramatically increased uptake of the service.

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ACHIEVEMENTS TO DATE

K4C’s staff and professional volunteers have been actively involved in direct delivery of the services and have also played important roles in providing comprehensive training to relevant local staff. Since establishing our initial screening and treatment services in 2017, K4C has trained over 100 doctors, nurses and midwives in Uganda in cervical screening and treatment. Our teams have directly screened over 4000 women and treated over 250 women for pre-cancerous lesions from across Kabarole and Wakiso Districts. Over the last 12 months, we have screened 586 women and treated 36 women for precancerous lesions. An additional 18 women were referred for a biopsy and/or further treatment. Approximately 83% of the women screened have been HIV+. We have specifically targeted HIV+ women as they are at higher risk of developing cervical cancer.

The vast majority of women that accessed our screening and treatment services would not have otherwise had access to such services, and as a result may have gone on to develop cervical cancer.

PLANS FOR 2025

The success of our service model has led us to apply for further funding to upscale it to additional health facilities, including our newer partner sites in Tanzania and Zanzibar, in 2025.

Current service provision in Zanzibar is extremely limited, with the 1 existing publicly available screening service due to close in 2025 to allow for the health facility to be renovated. We are planning to implement an extensive awareness raising campaign across both countries to improve uptake of preventative screening services, particularly amongst HIV negative women, as many women currently only access services if they notice symptoms, by which time it can often be too late.

We are also planning to pilot a new model of screening device which is AI enabled to better support clinical decision making. The new models are currently completing the final stages of clinical trials, so we expect them to become available towards the end of 2025.

Separately, we are planning to apply for external grant funding to improve the efficacy of the national Human Papillomavirus (HPV) vaccination programs in Uganda and Tanzania. HPV vaccination is a highly effective method of preventing cervical cancer (as well as some other types of cancers), however uptake rates remain low for many reasons. These include lacking parental education, various misconceptions and vaccine hesitancy, cultural beliefs and the fact that existing vaccination programs run through schools, however many children (and particularly girls) are not enrolled in school in Uganda and Tanzania and so are not captured.

Number & VIA Status of Attendees at Kataraka Health Centre

Number & VIA Status of Attendees at Kagote Health Centre

The graphs above show the numbers of women screened and their VIA status at 2 of the health facilities where our cervical screening and treatment services operate (Kagote and Kataraka). We also screened 112 women at Kasangati Health Centre in Kampala (Uganda), of whom 31% were HIV positive and 7.2% were found to be VIA positive.

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The Environment and Impacts of Climate Change on Human Health

bacteria, for example from their faeces, which can cause both minor and severe illnesses.

In 2022, we hosted 9 Fellows via the CSC’s theme of “Clean Energy, Clean Oceans and Clean Air”. Each undertook bespoke training programs looking at promoting solar power, healthy and environmentally friendly cooking methods and effective governmental environmental policies.

ACTIVITIES IN 2024

BACKGROUND

Knowledge for Change recognises the direct and growing impact that climate change and the environment that people live in can have on their health and wellbeing. For example, there is strong evidence that climate change is leading to an increasing risk of tick-borne diseases in Uganda, which formed the basis of one of our recent projects.

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K4C Builder (Peter) constructing a new Lorena Stove for a as | y/ ae
family in Fort Portal (Uganda)
----- End of picture text -----

We continued our project on tick borne disease throughout 2024 in partnership with the University of Salford. We also piloted the construction of 6 Lorena stoves in households around Fort Portal (Uganda) to evaluate users’ experiences, calculate cost savings from reduced wood usage, and use this to assess local demand for self-funding the stoves in their households based on the potential for longterm cost savings and improved health outcomes.

Local vets and K4C funded researchers collecting ticks from cattle to analyse their pathogens

Environmental factors can also have a strong impact on human health; one recent area identified by K4C is the impact that cooking on open charcoal fires can have on respiratory health, particularly of women who do the vast majority of cooking in the Ugandan and Tanzania contexts and also their children who will often be present in the kitchen area. Another area we identified is the risk of having livestock colocated with human accommodation and shelter; many people in Uganda rear chickens which often wander into living areas and spread harmful

PLANS FOR 2025

We will continue our project work on tick borne disease and the impacts of climate change on human health. We are also developing new and exciting research (in collaboration with the University of Salford) into the impact that international travel undertaken by academics, project managers and volunteers has on the climate, particularly in relation to carbon footprints. The research plans to evaluate the different types and purposes of travel being undertaken by different organisations and individuals, and measuring their resulting net carbon dioxide emissions. The aim is to guide future policy for funding bodies, Universities and Charities.

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Commonwealth

Professional Fellowships

BACKGROUND

The Professional Fellowship scheme (facilitated by the Commonwealth Scholarship Commission) funds mid-career professionals from LMICs to come to the UK to develop their skills and knowledge in a topic relevant to their professional field. Selected Fellows participate in a 3-month intensive training programme and upon their return home use their newly acquired knowledge to effect positive change in their areas of interest. K4C and its partners have hosted over 120 Fellows since 2011 from a variety of professions including nurses, doctors, midwives, allied health professionals, social workers, engineers, policymakers, hospital administrators and climate change activists.

coordinates the structure of each Fellowship programme to meet a specific need that has been identified in advance, and many of these link to K4C’s on-going programmes of work.

Each Fellow receives financial support from the Commonwealth Professional Fellowship Scheme which funds all their travel, visa, accommodation, subsistence and course costs.

OUR ACTIVITIES IN 2024

Knowledge for Change hosted 8 colleagues from Uganda, Tanzania and Mozambique for 3 months between February and May 2024 through the 2 separate themes described below:

Theme 1: The role of diabetes self-management in Amputation-Reduction Strategies in Low- and Middle-Income Countries.

This theme focused on training a multi-disciplinary team to develop a preventive and contextually relevant version of Manchester’s “Amputation Reduction Strategy”. Diabetes is fast emerging as the primary cause of lower-limb amputation in LMICs. Diabetic Foot Ulceration (DFU) and resulting limb loss represents a major fiscal threat to public health systems and has catastrophic consequences for livelihoods.

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Dr James Ackers-Johnson (K4C Programme
Coordinator) hosting the CSC’s Annual
Professional Fellowship Conference
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The fellows have travelled from our partner organisations in Uganda/Tanzania to the UK for between 1 and 6 months to complete educational courses (such as diploma, undergraduate and Masters level modules), to enhance their knowledge, experience and skills through practical sessions and to build professional networks through attending workshops and conferences. K4C designs and

The Fellowships built upon and integrated programs of work arising from two highly successful previous Fellowship Programs (on wound care and prosthetic limb manufacture). Fellows joined nursing modules on Tissue Viability, Leg Ulcer Management and Diabetes Complications in the Management of Marginalised Groups. The team combined this learning with on-going workshops to co-design a new approach to Community-Based Diabetes Clinics. This work began to develop once Fellows returned home with plans for new clinics to be established in both Uganda and Zanzibar.

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Theme 2 (in partnership with the University of Salford): Building Supply Chains in LMICs as the basis for sustainable health systems strengthening and local manufacture.

This theme built on Professor Ackers’ (K4C Chairperson & Research Lead) work on supply chains in the manufacture of prosthetic and orthotic devices in Uganda. Supply chains are overlooked in global health as the focus is on medical ‘treatment’. COVID-19 drew public attention to the role of supply chains in health systems. Professor Ackers’ work on laboratory strengthening during COVID-19 focused attention on the stark impacts on LMICs. Overseas Development Assistance has had the unintended consequence of undermining supply chain development (through reliance on donations). This, in turn, undermines the potential to build manufacturing capacity and local supply chains in essential drugs, devices and consumables.

The multi-disciplinary, cross-national team of Fellows worked together to identify ‘low-hangingfruits’ in supply chain development supporting a model for scale-out to other contexts/products. Building on K4C’s ongoing complex intervention work in Uganda and Zanzibar, we focused supply chain development on a specified range of commodities (orthotics; IPC consumables, wound dressings and antibiotics).

Fellows visited a wide range of UK companies and organisations supplying materials for Prosthetic and orthotic manufacture, joined prosthetic clinics and visited STAND, one of K4C’s lead partners supplying second hand prosthetic componentry to LMICs.

“The CSC Fellowship at Knowledge for Change exceeded my professional expectations. From the moment I arrived, their kindness and support were evident, guiding me throughout the entire fellowship journey. The program exposed me to cutting-edge technologies in prosthetics and orthotics, providing real-time insight into advanced practices in the UK. The flexible structure of the program helped me to develop both technical and soft skills. Their partnership with the University of Salford gave me unlimited access to peer-reviewed journals and research resources, which greatly supported my academic growth. Attending conferences and networking with experts broadened my perspective and inspired my work back home. Since completing the fellowship, I have remained in contact with the team and continue to explore further collaboration opportunities.”

Stanslaus Francis (Lecturer in Prosthetics & Orthotics, Muhimbili University of Health and Allied Sciences)

All Fellows from both themes actively participated in the National Diabetes UK Conference and the African Health Summit, as well as joining relevant teaching sessions at the University of Salford and the University of Greater Manchester’s MBA in Global Healthcare Management Program. Both of the Fellowship programme themes were extremely successful and yielded positive learning outcomes for all of the fellows. K4C maintains a close relationship and provides on-going support for Fellows when they return to their home country, and many continue to support our projects longer-term.

CSC Fellows (Stella and Richard) and K4C builder (Peter) visiting the Yorkshire Dales

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K4C and University of Salford Fellows, along with Professor Louise Ackers (K4C chairperson) and 2 students from the University of Greater Manchester’s MBA in Global Healthcare Management Program

“I would like to express my sincere gratitude for the professional scholarship I \N received from the Commonwealth. I am very grateful!

The central theme of the course was to strengthen the capacity to manage the supply chain linked to health services in developing countries, and I learned a lot. The course was important because it aimed to enable countries with limited resources, such as Mozambique, to drive frugal innovations and design practical, inexpensive and sustainable products, methods and services for the African context.

During the training, the course mentors from Knowledge for Change and the University of Salford demonstrated that Africa can innovate with practical solutions, such as health technologies, that can minimise the impact of physical disabilities through orthopaedic solutions for people with amputated limbs, for example. This is an example of the logic and problem-solving capacity of frugal innovation.

The programme was facilitated by Knowledge for Change and included three months of practical exercises and seminars at various levels at the University of Salford's School of Health and Society in Manchester. We had regular classes where we learnt about experiences and went on field trips in the UK. Based on knowledge mobility, we learnt that Africa has something to share with the UK — something that was previously unthinkable. We also had regular lessons on specific diseases, such as diabetes, and the need to strengthen prosthetics and orthopaedics”.

Aladino Manhiça, Health Policy Specialist & Partnerships Manager, National Medicines Regulatory Authority, Mozambique

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Type-2 Diabetes Prevention & The NEEDS Programme

BACKGROUND

Around 436 million adults across the world live with diabetes and prevalence continues to rise, especially in Low- and Middle-Income Countries (LMICs) where approximately 80% of adults with diabetes are located. In many LMICs, including those in Sub-Saharan Africa, diabetes is often poorly managed. For example, as many as 89% of diabetes patients in Uganda are undiagnosed or are not on medication for diabetes management. Many patients go on to develop complications such as diabetic foot ulcers, leading to higher rates of lower limb amputations, and increased mortality. However, with proper care and management, type2 diabetes can be managed and deterioration of the condition, including the development of diabetic ulcers, can be prevented.

The team followed a task-shifting approach to create a model for nurse leadership in the multi-disciplinary management of diabetic foot complications. Ethical approval was sought from the University of Salford and Mbarara University of Science and Technology.

ACTIVITIES IN 2024

We followed a multi-method approach to coproduce a nurse led, culturally congruent, frugal, and sustainable education intervention and diabetic foot screening service. This involved the combined analysis of:

K4C’s Type-2 diabetes prevention programme began in Fort Portal (Uganda) in March 2023 with the following 2 key objectives:

Our goal was to improve the availability and quality of services for patients to prevent deterioration of their condition, reduce the development of diabetic foot complications (such as diabetic foot ulcers) and resulting amputations. As with many K4C interventions, our diabetes self-management programme was primarily designed as a preventative intervention, and therefore focused on patients who were not yet insulin dependent and had not yet developed advanced foot ulcers.

We called our new DSME programme ‘NEEDS’ ( N utrition, E ducation, E xercise, D rugs and S elfmanagement). Two of our K4C nurses were based at the weekly diabetic outpatient clinic to support knowledge transfer between staff, improve record keeping and provide direct services to patients. We procured essential equipment such as Dopplers and

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monofilaments to test patients for peripheral neuropathy.

In terms of training, the team focused on coproducing high quality, contextually relevant materials that were immediately relatable by users in Uganda with low levels of formal education, complex health beliefs and poor health literacy. Culture proved a strong driver of beliefs and behaviours both around nutrition, exercise, fasting but also witchcraft (Ackers et al., 2025).

The success of the programme has been highlighted by Bolton NHS Foundation Trust, who have expressed interest in partnering with K4C and the University of Salford to pilot a UK version of the NEEDS programme in the UK. This would mark an interesting opportunity for ‘frugal innovation’ for the benefit of the UK NHS.

We began a series of pilot delivery cycles. After each cycle of delivery, a period of reflexivity was built into the process to enable continuous improvement. Changes were made to deliver the programme in the local language (Rutooro, rather than English) and sessions became more interactive including the use of a Fitness Instructor and Nutritionist. Posters and leaflets were created to meet the health literacy needs of the participants.

A total of 34 adults completed our pilot NEEDS Programme and attended the DFU prevention clinic. We ran a mixed method evaluation of the programme, with findings suggesting statistically and clinically significant improvements in HbA1c with a reduction for 72% of participants (Mean - 1.04±2.05, t (32)=2.901, p=0.003). For 48% of participants HbA1c was reduced to below 7% representing change equivalent to efficacy seen in drug trials. Participants also showed an increase in self-management activities, and reported how they had become advocates and champions of a healthy lifestyle to family, friends and work colleagues. Many reported that the previously held view of diabetes being a ‘death sentence’ had been lifted.

Colleagues from K4C (UK, Uganda and Tanzania), the University of Salford and Mnazi Mmoja Hospital (Zanzibar) attending a stakeholder engagement workshop in Fort Portal (Uganda) for the NEEDS Programme

PROJECT FUNDED BY:

PLANS FOR 2025

The impact of this programme so far has been very positive, so we plan to upscale it to our other partner health facilities in both Uganda and Tanzania during 2025. We are also planning to pilot a communitybased version of the programme to assess its viability at health centre (as opposed to hospital) level in Uganda, in line with the Uganda Ministry of Health’s recently updated strategic plan which aims to promote more community-based services.

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Infection

Prevention & Control (IPC)

SUMMARY

Sepsis is one of the most common causes of death of patients in Uganda. Many infections that lead to sepsis are contracted within health facilities and can be avoided by implementing Infection Prevention and Control (IPC) measures and making relatively small investments in hospital equipment and infrastructure, such as sinks and washing facilities.

Over the last 5 years, K4C has run several capacity building and infrastructural development projects across multiple health facilities in Uganda and Tanzania, covering various aspects of IPC including hand hygiene, antimicrobial stewardship and surgical safety. For example, we have provided running water to more than 40 hospital wards by fitting new (or fixing existing) sinks and plumbing systems. This work was of even higher priority during the Covid-19 pandemic and more recently during outbreaks of Ebola and Marburg Haemorrhagic Fever.

again highlighted as a key cause of neonatal sepsis during the scoping phase of our Neonatal Sepsis Project and went on to form a core component of our training packages that are currently under development. More information about this project can be found on page 31.

Other IPC related activities undertaken during 2024 include ongoing training and mentoring provided by our professional volunteers across all of our partner health facilities. Their training covered a wide range of areas including surgical safety (for example implementing the WHO safe surgery checklist), hand hygiene, appropriate cleaning and decontamination of medical equipment, antibiotic prescribing practices, improved operative techniques (for example transverse c-section) amongst others. Our volunteers also implemented new and existing policies, protocols and guidelines to further support staff clinical practice.

ACTIVITIES

Throughout 2024, our hand gel project provided free supplies of locally manufactured alcohol hand sanitiser to 3 public health facilities and 1 primary school in Fort Portal (Uganda). We have also sold it at cost price (not for profit) to other charities and not-for-profit health facilities in the area.

We have also purchased various equipment such as autoclaves (for sterilising medical equipment), rubber mattress covers, delivery beds and drugs trolleys and have invested over £4,000 in renovating hospital and health facilities to reduce infection risks via our Neonatal Sepsis Project.

We had previously identified inadequate IPC measures as a key contributing factor to antimicrobial resistance in Uganda during our Antimicrobial Stewardship Project. This year it was

Local staff at Kasangati Health Centre (Uganda) learning how to manufacture Jik (a hand sanitiser and bleach used in health facilities)

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Neonatal Sepsis Project

BACKGROUND

Sepsis is one of the key causes of neonatal morbidity and mortality in Uganda and Tanzania, accounting for between 9% and 15% of all neonatal deaths. Building on the success of our Maternal Sepsis Intervention, we successfully applied to Global Health Partnerships (GHP, formerly THET, funded by NHS England) for £50,000 to begin a new project focusing on reducing neonatal sepsis rates in our partner health facilities in Kasangati and Fort Portal (Uganda). Our ‘Neonatal Sepsis Project’ officially started in January 2024 and will run until June 2025. Although the remit of the official project funding only covered work in Uganda, we used other internal funding to extend the project to our partner facilities in Zanzibar too.

The primary aim of the project is to create an ‘orientation training package’ for all existing and new staff at the hospitals and health centres, especially intern doctors, nurses and midwives. Some aspects of the training package could eventually be rolled out to other hospital staff including pharmacists and allied health professionals, as well as later being incorporated into the teaching at our partner nursing and medical schools. The orientation package will focus on 6 key areas:

  1. Infection prevention and control

and implement its activities and objectives. Key activities and achievements for far include:

The secondary aim of the project was to leverage and evaluate the reciprocal benefits to the NHS from engaging UK health workers in international development interventions, through their learning and personal and professional development.

ACTIVITIES IN 2024

The funding for this project was received in March 2024, and we began working immediately to design

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The women interviewed by our staff and volunteers were generally very positive about the care they had received following the ongoing training and mentoring provided by our K4C staff and professional volunteers.

Feedback from the formal training sessions conducted in blood culture and sensitivity testing and infection prevention control was very positive and demonstrated strongly positive learning outcomes.

We have already seen an increase in staff taking vital signs when there is a concern for a baby across all our partner health facilities, due to improved availability of the essential medical equipment we’ve provided and improved awareness and skills of staff following training.

RESULTS SO FAR

The case review meetings run at each partner facility have been instrumental in highlighting the current gaps in care and areas of need. These include (amongst other things):

Nurses and Midwives from Fort Portal Hospital (Uganda) attending training sessions run by K4C medical volunteer (Charlie, centre) on the blood culture procedure, identifying sepsis early, and obtaining prior verbal consent from a baby’s parent or caregiver to ensure ethical caregiving.

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PLANS FOR 2025

We plan to continue running the case review meetings throughout 2025 as a form of ongoing professional development for the staff attending. We will also begin formulation, piloting and implementation of the orientation training package across each of our partner health facilities.

Further details about our Neonatal Sepsis Project can be found in a more comprehensive report here:

We have 5 Fellows travelling from Uganda to the UK for 3 months between February and May 2025 (supported by the Commonwealth Scholarship Commission) to undertake extensive training in neonatal sepsis. The Fellows include a doctor, a nurse, 2 midwives and a nursing lecturer from Mountains of the Moon University in Fort Portal. These Fellows will work with our partners at the University of Salford nursing school and our virtual professional volunteers to lead the development of the training package. We plan to pilot the package from April 2025 onwards, initially at FPRRH then rolling it out to Kasangati Health Centre and Mnazi Mmoja Hospital in Zanzibar.

Staff and volunteers in Uganda and Tanzania will continue with data collection where appropriate, help to facilitate the presentation of the pilot orientation package, and continue to model and encourage best practice in this area.

We are partnering with the head of laboratory at FPRRH, Moses Mulimira, who has a fellowship with the Flemming Fund. He will be relating his work to the neonatal sepsis project, and we are hoping our work can contribute to the formulation of an antibiogram for the neonatal unit.

Theatre staff using hand sanitiser dispensers (newly installed by K4C) at Fort Portal Regional Referral Hospital (Uganda)

PROJECT FUNDED BY:

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Rehabilitation & Supply Chains

BACKGROUND

Limb amputations are far more common in LMICs such as Uganda and Tanzania. The most common cause is trauma as a result of road traffic accidents or conflict. Other common causes include congenital defects, infections, tumours and (increasingly) diabetes. Losing a limb can have severe repercussions on people’s livelihoods as more people are reliant on physical activity to earn a living, for example through manual labour, farming and transportation. People’s access to prosthetic or orthotic devices is extremely limited due to them being relatively expensive to design, manufacture and maintain. Additionally, there is no social security system to provide support for people living with disabilities.

K4C’s focus on prosthetics and orthotics began in 2017, stimulated by a woman named Ninsiima who was a victim of domestic violence whilst being 8 months pregnant. As a result of the attack, Ninsiima lost both of her arms from the elbow down, however thankfully her baby was delivered successfully with the support of K4C’s midwifery staff and volunteers. At this point, K4C embarked on a project (in partnership with the prosthetics department at the University of Salford) to provide Ninsiima with prosthetic arms to enable her to care of her 5 children and continue to earn a living through chicken farming. A fundraising campaign was setup and the project subsequently featured on BBC World News.

Ninsiima’s story highlighted the challenges faced by amputees in countries like Uganda. This led a team of researchers at the University of Salford to design a project aimed at developing fit-for-purpose, affordable and locally manufactured upper-limb prosthetic devices in Uganda (in partnership with K4C) and Jordan. The ‘Fit-For-Purpose Prosthetics Project’ received £1.4M of EPSRC funding and ran from February 2018 through to January 2022.

REHABILTATION RELATED ACTIVITIES IN 2024

Since 2021, K4C has been working on an MRC funded project titled “Promoting Universal Health Coverage for Amputees through Social Enterprise and Engineering Innovation”, in partnership with Makerere, Salford, Manchester and Aga Khan Universities. This exciting project was led by one of our K4C trustees (Dr Robert Ssekitoleko) and officially came to an end this year, culminating in the publication of a range of papers and a monograph. The key findings formed the basis of a Policy Report presented to the Ugandan Ministry of Health in a dedicated workshop event in November 2024 and several meetings of the group responsible for the development of the National Rehabilitation and Assistive Technology Strategic Plan.

We’ve also continued to grow our broader rehabilitation related programmes in both Fort Portal Regional Referral Hospital (Uganda) and Mnazi Mmoja Hospital (Zanzibar, Tanzania) through the employment of 3 orthopaedic technicians. Our staff in Fort Portal provide ongoing support for the ‘Ninsiima Centre for the Rehabilitation of People with Disabilities’ and the linked Paediatric Rehabilitation Department which K4C established in 2022 and 2023 respectively. 311 patients have accessed these services within the last 12 months, of whom 44% were under the age of 15 and 46% were female. 60 of these patients had their prosthetic devices funded in partnership with philanthropic YouTube star ‘ Mr Beast ’.

In Zanzibar, our orthopaedic technician (Maryam) supported over 300 clients that attended the Prosthetics & Orthotics Department, as well as 93 babies attending the club foot clinic, at Mnazi Mmoja Hospital over the course of 2024.

The map below illustrates the increase in distances that patients have travelled to attend our rehabilitation workshop in Fort Portal (Uganda) between 2021 and 2024, due to its positive reputation:

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SUPPLY-CHAIN RELATED ACTIVITIES IN 2024

In 2019, the World Health Organisation launched its ‘Rehabilitation 2030 Call for Action’. This stimulated the Ugandan Ministry of Health to commence an ambitious planning process to develop and implement the first Ugandan National Rehabilitation and Assistive Technology Strategic Plan. The Strategic Plan identified 3 ‘Key Actions’:

  1. Collecting information to enhance health information systems

  2. Building research capacity and expanding the availability of robust evidence for rehabilitation.

  3. Establishing and strengthening networks and partnerships in rehabilitation, particularly between LMICs.

In direct response to these ‘Key Actions’, K4C has worked with research teams in Uganda and the UK to generate an evidence-based intervention model at Fort Portal Regional Referral Hospital (Uganda), leveraging funding from various sources including:

  1. The UK’s Engineering and Physical Sciences Research Council (EPSRC) and National Institute for Health Research (NIHR) which provided funding through the UK Global Challenges

K4C worked intensively in 2024 to support the development of the Ninsiima Rehabilitation Centre. This included extensive work on supply chains. An over-reliance on donations has stifled supply chains in Uganda and, in turn. Its capacity to manufacture prosthetic and orthotic devices. To the extent that limited supplies were available they were very limited in scope and expensive.

At the present time K4C is working closely with our partnership with STAND who continue to provide high-quality second-hand componentry for the manufacture of prosthetic legs (mainly feet, knee joints and pylons).

Supply chains are seen as central to any ‘marketshaping’ activities and the future for economic growth in LMICS. With this in mind K4C established a Social Enterprise approach to supply chain development in January 2024. In the first instance this has focused on researching supply opportunities, negotiating prices and transport arrangements to increase exposure to a wider range of technologies and materials whilst also pushing down the unit costs of P&O devices.

The Social Enterprise work is now established and beginning to deliver the planned-for economies of scale and price reductions:

The table below gives some examples of the progressive reductions in costs we’ve achieved over the course of the intervention (2021-2024) for manufacturing a prosthetic socket. The column headed “2024 SE (£)” is the further reduced cost at which we sell each item to facilities via our Social Enterprise:

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Capturing evidence of device use through activity monitoring helps to build advocacy in support of increasing government funding for rehabilitation services.

We’re continuing to establish K4C as a key provider of materials for Uganda’s P&O sector, and received a boost in October receiving $30,000 of funding from philanthropic YouTube star ‘Mr Beast’ (through our Partnership with STAND) to underwrite the costs of providing 60 amputees with lower limb prosthetics.

We have also worked hard to put Upper Limb amputations on the Universal Health Coverage agenda, as these cases are often forgotten and service provision is sporadic and unreliable. Working in partnership with specialist teams from Salford University, our Medical Research Council funded project has tried and tested the use of a novel approach to upper limb prosthetics through the ‘ Koaala ’ upper limb, which is designed by a UK startup. Our teams have piloted the use of ‘Activity Monitoring’ to assess the extent to which users actually wear their Koaala devices, for example how often and where they typically wear them.

K4C has complemented this with interviews with patients using the Ninsiima Rehabilitation centre to assess patient satisfaction with services. A Report on this was presented to a meeting in Fort Portal attended by the Ministry of Health in November 2024. The Report included evidence of a progressive increase in the volume of patients and the distances they have travelled to receive free, high quality, public services.

PLANS FOR 2025

K4C is planning to continue and expand upon all aspects of our rehabilitation programme in 2025, working closely with the Uganda Ministry of Health to support the implementation of the Ugandan National Rehabilitation and Assistive Technology Strategic Plan and continue to identify ways of supporting the delivery of Universal Health Coverage for people with Physical Disabilities.

We will also continue to expand our Social Enterprise to include additional essential devices and componentry for rehabilitation, and potentially equipment and consumables for use within other areas of healthcare.

Example of spiral plots showing synchronous prosthesis wear/non-wear and physical behaviours

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Respectful Midwifery Care

SUMMARY

Uganda and Tanzania have some of the highest rates of maternal and neonatal mortality in the world. The Sustainable Development Goals framework focuses on improving Maternal Health through gender equality, human rights, empowerment and poverty reduction. Disrespectful care not only undermines women’s human rights and disempowers them; it also results in poor levels of engagement with public services and damaging delays in accessing them. 99% of all maternal mortality occurs in LMICs; much of this is due to delays in women seeking care. In Uganda and Tanzania, it is not uncommon for women to receive verbal or sometimes physical abuse whilst giving birth in health facilities. Through empowerment of women and collaboration between healthcare staff, stakeholders, families and communities, we aim to improve the health and well-being of mothers and their babies.

Our Respectful Care programme began in 2018 when we received a grant of £20,000 from the Wellbeing of Women Foundation to research the challenges faced by mothers and staff during pregnancy and birth, and how levels of quality and respect could be improved within maternity care settings (the ‘WeCare Project’). A publication containing the full WeCare project findings can be accessed for free using the following link:

name, allowing mothers their choice of birthing position, providing more information about procedures before beginning them and providing counselling and grieving care. Other interventions have included providing basic new equipment such as privacy screens and curtains, delivery beds and ward mattresses and supporting general maintenance of maternity units, including kitchen, toilet and hand washing facilities.

Implementing these simple, cost effective and sustainable interventions has greatly improved the provision of respectful and high-quality care received by mothers and has led to increasing numbers of women seeking care at our partner health facilities. For example, Kagote Health Centre now averages 45 births per month, compared to just 22 prior to our WeCare project.

We’ve also continued to integrate the findings from our original WeCare Project into other areas of care, for example our Neonatal Sepsis Project which includes a training focus on high quality maternity care to reduce infection risks for both mothers and their babies and advocates for improved post-natal health education. Within our Rehabilitation Programme, we’ve worked in partnership with Amputee Self-Help Uganda (ASNU) to improve access to high quality services and reduce disability related stigma for amputees.

Ackers et. al (2018) “What price a welcome? Understanding structure agency in the delivery of respectful midwifery care in Uganda” International Journal of Health Governance (2018), 23 (1): 46–59

ACTIVITIES IN 2024

Throughout 2024, we have continued to implement the findings of our original WeCare project across all our partner facilities in Uganda and Tanzania. Our staff and professional volunteers have provided ongoing training and mentoring to support simple changes in practice, for example urging staff to greet mothers respectfully and introduce themselves by

Tiggy (Midwife) following a successful triplet delivery, midway through her 2-year placement with K4C in Fort Portal (Uganda).

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Child Welfare, Education and

Supporting Local Community Based Organisations

BACKGROUND

Knowledge for Change not only runs its own projects but also supports several local, independent Community Based Organisations (CBOs) with similar organisational objectives to our own. Most of these CBOs are relatively small but are highly experienced in their respective fields and run extremely beneficial projects supporting the health and educational needs of local communities. The areas of focus of these CBOs are varied and include women and children’s empowerment, mental health services, family planning, HIV screening and counselling, caring for children with physical and mental disabilities, climate change and animal wellbeing.

In terms of education, over 57 million children of primary school age remain out of school worldwide, and more than half of these children live in subSahara Africa. According to Ugandan and Tanzanian legal frameworks, all children should be given free and accessible education, however there are significant discrepancies between policy and practice. For example, the 2024 Uganda Population Census suggests that 65% of adolescents (aged 10– 19) had only received ‘some primary education’ and 15.4% had received no education at all. 77% of girls aren’t enrolled in secondary school, and our own research in the Kabarole District of Uganda found that 82.4% of children with disabilities were reported to be out of school.

The reasons for poor school attendance and high drop-out rates are very complex and include political factors (such as lacking demographic data and

funding), physical barriers (such as inadequate infrastructure and a lack of assistive devices and transport) and social/cultural barriers (such as period poverty, gender disempowerment and lacking understanding and awareness of disabilities within wider society). The problem was exacerbated by the Covid pandemic, during which Uganda had the longest school closures in the world, which further increased drop-out rates, especially for disadvantaged girls and disabled children.

Despite being primarily a health focused organisation, K4C recognises the importance of education and the negative impact that poor access to education can have on a child’s life opportunities, economic empowerment and subsequently their health needs. We expanded our activities to include primary education in 2018, focusing initially on improving access to education for disabled children, in recognition of the additional challenges faced in this area and the closer link to our experience and capacity in physical and mental health.

ACTIVITIES IN 2024

Throughout this year, K4C has supported our partner CBOs in various ways including providing direct finance, building staff capacity, promoting joint research collaboration and offering use of our office facilities and human resources. Some key activities are listed below:

1) Assessing Adolescent Mental Health

Data on the mental health of adolescent children is very limited in Uganda and Tanzania, which inhibits our understanding of the problems that exist and the ability to establish appropriate and effective interventions. Therefore, working in partnership with the Liverpool School of Tropical Medicine (LSTM, UK) and a local NGO “Fort Healthy Minds”, we conducted a cross-sectional survey with 263 students aged 15 years and above from two secondary schools in Fort Portal (Uganda). The findings were astounding and highlighted a substantial mental health burden, exceeding previous national and regional estimates. Girls reported significantly higher levels of depression (64.5%) and anxiety (46.2%) than boys (51.0% and 33.0% respectively). Worryingly, in the past year, 22.6% of students had tried to harm themselves with

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the intention to end their lives. Novel insights were obtained with regards to differential developmental trajectories of mental health by sex: symptom levels of anxiety increased amongst girls after age 16, whilst they remained stable in boys.

The results of this pilot study highlighted the urgent need for contextually appropriate, gender-sensitive mental health interventions in Ugandan schools, informed by in-depth and longitudinal exploratory research. We are planning to use the findings to apply for funding to guide development of an effective intervention in 2025.

2) Efficacy of School Based HPV Vaccination Programmes

Human papillomavirus (HPV) is a common sexually transmitted virus which rarely has symptoms and usually clears up on its own. However, some strains are a key risk factor for certain types of cancers, most notably cervical cancer for women. HPV vaccination is an effective way of preventing HPV and cervical cancer, and is widely available worldwide including in Uganda and Tanzania. However, HPV vaccination rates remain relatively low despite both countries having active vaccination programmes. Existing (limited) research attributes this to poor health literacy/awareness, general attitudes to immunisation exacerbated by cultural/religious factors and growing vaccine hesitancy. Moreover, vaccination is mainly delivered through school-based outreaches, however many girls aren’t enrolled in a secondary school which greatly limits efficacy.

K4C is keen to develop interventions to increase HPV vaccination rates, as part of our wider efforts to prevent cervical cancer through our screening and treatment services. As a first step, we worked with one of our Masters students (Mari Wigaard) to conduct a qualitative study into the challenges facing the Zanzibari government’s HPV vaccination program. Our findings suggested complex cultural beliefs and substantial knowledge gaps among both health workers and local populations which increased parental hesitancy. We are planning to use this study to apply for grant funding to guide development of an effective intervention in 2025.

3) Rehabilitation and Assistive Devices

As part of our wider rehabilitation programme, we continued to provide essential rehabilitation services and assistive devices to children with physical disabilities to improve their quality of life and support them to return to school. The paediatric rehabilitation centre that we constructed at Fort Portal Regional Referral Hospital in 2023 has been a key element of this work, as well as our other partner rehabilitation departments at Katalemwa Cheshire Home (Kampala, Uganda) and Mnazi Mmoja Hospital (Zanzibar, Tanzania).

4) Domestic and Gender-Based Violence

Our ‘Fit-for-Purpose Prosthetics Project’ and wider Rehabilitation Programme highlighted that one of the main causes of upper-limb loss for women in Uganda was domestic and gender-based violence, largely due to the prevalence of machete attacks. We’ve previously reported on our work with Ninsiima, a double amputee who was herself a victim of a machete attack by her husband following a domestic dispute. We learnt through speaking to Ninsiima and other similar women that not only are such attacks worryingly common, but that they often go unpunished due to weak criminal courts, corruption, poor levels of community awareness and education, relatively disempowered women and deeply embedded ‘himpathy’ within the country’s patriarchal society.

Women that are victims of domestic or genderbased violence often lack essential physical and mental rehabilitation and support services. We established our ‘Ninsiima Centre for the Rehabilitation of People with Physical Disabilities’ in 2022 to provide physical rehabilitation services. In 2024, we have augmented this with psychosocial support services for women, working in partnership with ‘Fort Healthy Minds’.

PLANS FOR 2025

We will continue to support all of our existing CBO partners in Uganda throughout 2025. We are also planning to develop new partnerships with CBOs based in Zanzibar (Tanzania) with a particular focus on community based mental health.

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University Education and Teaching

BACKGROUND

For several years, Knowledge for Change has supported the development, delivery and continuous improvement of university diploma and degree level education programmes in both the UK and Uganda. In the UK, our trustees, staff and volunteers regularly deliver teaching sessions on several University degree and masters level programmes, based on the activities and research we undertake in Uganda and Tanzania.

In Uganda, we have worked closely with Makerere, Kyambogo, Mountains of the Moon and Great Lakes Universities to establish various degree programmes, for example the degree in Biomedical Engineering at Kyambogo University (Kampala) and the degrees in Nursing and Midwifery at Mountains of the Moon University (Fort Portal). Our staff and volunteers have been involved in curriculum development, the design of learning materials and co-delivering teaching sessions. They also supervise students completing practical placements at our partner health facilities.

----- Start of picture text -----
“We’re proud to work
with Knowledge for
Change to widen access
to the Professional
Diploma in Tropical
Nursing, supporting
nurses in low-resource
settings to strengthen
their skills and impact.
K4C staff have contributed extensively to the
programme – shaping content to reflect contemporary
nursing practice, teaching and facilitating sessions,
advising students on careers, and engaging in listening
events. We deeply value their expertise and
constructive input”.
----- End of picture text -----

Katie Beck, Director of Diploma in Tropical Nursing, London School Hygiene and Tropical Medicine

In Uganda, we’ve continued to support Mountains of the Moon University (MMU) in partnership with Salford University through our British Academy funded ‘Writing Workshops Programme’. This aims to improve the writing skills of academic staff and support their professional development, leading to successful grant applications and publications. It launched in September, with 4 staff from K4C and the University of Salford travelling to Fort Portal to run the 1[st] of 3 scheduled workshops, providing training to 12 academic staff from MMU.

ACTIVITIES IN 2024

We continued our drive to deliver high quality University level education programmes throughout 2024. In the UK, our trustees, staff and volunteers have taught on the following programmes:

----- Start of picture text -----
K4C, University of Salford and MMU staff attending
our first ‘Writing Workshop’ in September 2024.
----- End of picture text -----

PLANS FOR 2025

We plan to continue developing our existing University partnerships throughout 2025, as well as establishing new University partnerships in Zanzibar (Tanzania). We also look forward to progressing our British Academy funded ‘Writing Workshop’ project.

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Publication and Dissemination of Global Health Research

SUMMARY

Our experience of designing and implementing the above projects, along with their respective impacts, outcomes and findings, are used to inform our research. This research enables us to constantly analyse and refine our charity’s activities to maximise our efficiency and effectiveness.

We also present our research at national and international conferences and policy meetings and publish findings in Open Access books and articles. This helps us lobby for positive changes to policies at organisational, regional and national levels in the UK Uganda and Tanzania to improve the way organisations and governments carry out global health and international development activities.

ACTIVITIES

preprint) “Antibiotic resistance profiles and population structure of disease-associated Staphylococcus aureus infecting patients in Fort Portal Regional Referral Hospital, Western Uganda” . https://doi.org/10.1101/2020.11.20.371203

Welsh J and Ackers L. (2022) “An exploration of midwives’ understanding of antibiotic resistance and stewardship in Uganda” African Journal of Midwifery and Women’s Health. https://doi.org/10.12968/ajmw.2020.0028

Biomedical Engineering:

Oshabaheebwa, S., Ssekitoleko, R.T., Namuli, L.K., Tusable, M., Nantume, J., Ackers, H.L. (2020) “Enhancing skills to promote the utilization of medical laboratory equipment in low resource settings”. Health Policy and Technology https://doi.org/10.1016/j.hlpt.2020.01.001

Cervical Screening:

Auma, J; Ndawula, N; Ackers-Johnson, J; Horder, C; Seekles, M; Kaul, V; Ackers, H (2023) “Task-shifting for point-of-care cervical cancer prevention in low- and middle-income countries: a case study from Uganda” Frontiers in Public Health, 11. (https://doi.org/10.3389/fpubh.2023.1105559)

Family Planning:

Gualeni, B. et al. (2021) “Human-centred design of a new microneedle-based hormonal contraceptive delivery system [version 2; peer review: awaiting peer review]” Gates Open Research, 5:96.

https://doi.org/10.12688/gatesopenres.13233.2

Infection Prevention & Control:

In collaboration with various partners, we’ve published several books and journal articles in recent years, some of which are detailed here, and most can be accessed for free online:

Antimicrobial Stewardship:

Ackers, H.L., Ackers-Johnson, G., Welsh, J., Kibombo, D. and Opio, S. (2020) “Anti-Microbial Resistance in Global Perspective” , Palgrave.

(https://link.springer.com/book/10.1007/978-3-030-626624)

Ackers, H.L., Ackers-Johnson, G., Seekles, M., Odur, J. and Opio, S. (2020) “Opportunities and Challenges for Improving Anti-Microbial Stewardship in Low- and MiddleIncome Countries; Lessons learnt from the Maternal Sepsis Intervention in Western Uganda”. Antibiotics 2020, 9, 315; doi:10.3390/antibiotics9060315. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7345100/)

Ackers-Johnson, G; Kibombo, D; Kusiima, B; Nsubuga, M. L; Kigozi, E; Kajumbula, H. M; Kateete, D.P. Walwema, R; Ackers, H. L; Goodhead, I B; Birtles, R. J. & James C. (2020 –

Ackers, H. L.; Ackers-Johnson, G.; Mugahi, R.; Namiiro, R. (2024) "Compassion versus Infection Prevention and Control in Hospital Visiting; a False Dichotomy? A Case Study of Informal Caregiving in a Ugandan Regional Referral Hospital" Open Journal of Social Sciences, 12 (6) DOI: 10.4236/jss.2024.126020

International Development:

Ackers, H.L., Seekles, M., Horder, C. and Nantamu, M. (2019) “The Impact of Research Council Funding on International Development” (Unpublished Report), UK Research and Innovation

Professional Volunteering:

Tyler, N., Ackers, H.L., Ahmed, A., Byrne, G. and Byrne-Davis, L. (2020) “A questionnaire study of the negative outcomes for UK health professional volunteers in low- and middleincome countries” , BMJ Open (doi:10.1136/bmjopen-2020037647)

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Horder, C. & Ackers, H.L., (2024) "Global Engagement and Cultural Competence in the NHS Workforce: An Evidence Review for NHS England" University of Salford

Stephens, M. et al. (2023) “Frugal innovation in wound management within a low resource inpatient setting: a case series” Wounds UK, Vol. 19, No. 3. https://doi.org/10.12968/bjhc.2023.0061

Prosthetics, Orthotics and Rehabilitation

Kenney L., Ssekitoleko R., Mwaka E., Donovan-Hall M., Morgado Ramirez D., Chadwell A., Kyberd P., Sobuh M., Ackers L., Howard D., Holloway C. and Miodownik, M. (2018) “Upper-limb prostheses for low- and middle-income countries” . Scope, 27(4): 38-40.

Ssekitoleko R., Byamukama, S. and Wanda, S., (2019) “Clinical Engineering in Uganda (Handbook)” Academic Press. ISBN: 9780128134689.

Morgado, R., Nakandi, B., Ssekitoleko, R., Ackers, L., Mwaka, E., Kenney, L., et al. (2022) “The lived experience of people with upper limb absence living in Uganda: A qualitative study” , African Journal of Disability 11(0), a890. https://doi.org/10.4102/ajod.v11i0.890

Mulindwa, B., Nalwoga, R., Nakandi, B., Mwaka, E., Kenney, L., Ackers, H.L. and Ssekitoleko, R. (2023) “Evaluation of the current status of prosthetic rehabilitation services for major limb loss: a descriptive study in Ugandan Referral hospitals” Disability and Rehabilitation, DOI: 10.1080/09638288.2023.2188266

Oldfrey, B., Holloway, C., Walker, J., McCormack, S., Deere, B., Kenney, L., Ssekitoleko, R., Ackers, H.L. & Miodownik, M. (2023) “Repair strategies for assistive technology in low resource settings” . Disability and Rehabilitation: Assistive Technology, DOI: 10.1080/17483107.2023.2236142

Ackers, H.L. et al. (2025) “Delivering Universal Health Care to People with Major Limb Loss or Damage in Low- and Middle-Income Countries” , Palgrave Macmillan, https://doi.org/10.1007/978-3-031-85423-1_1

Student Placements:

Ackers, H.L., Ackers-Johnson, J., Ahmed, A. and Tate, N. (2019) “Optimising student learning on international placements in Low Income Settings” , Open Journal of Social Science; Volume 7.

Brownie, S., Ackers, H.L., Murphy, G. and Shumba, C. (2023) “Editorial: Transforming health and social education to include a greater focus on public health education in the curriculum” , Frontiers in Public Health 11:1306124. DOI: 10.3389/fpubh.2023.1306124

Wound Management:

Stephens, M., Wynn, M., Pradeep, S. et al. (2023) “Frugal innovation in wound care: the five Rs” British Journal of Healthcare Management. https://doi.org/10.12968/bjhc.2023.0061

”I am delighted to see the outcomes of the health partnership interventions reported on in this book and the evidence base this has generated. In 2023, the Ugandan Ministry of Health started an ambitious planning process to develop and implement the first Ugandan National Rehabilitation and Assistive Technology Strategic Plan. This represented an immediate response to the World Health Organisation’s Rehabilitation 2030 Call for Action. The initiatives supported by the partnership between Fort Portal Regional Referral Hospital, Knowledge for Change and the University of Salford (UK) respond directly to 3 Key Actions of the Strategic Plan. Namely, enhancing information systems, building research capacity and expanding the availability of robust evidence and establishing and strengthening partnerships between low-, middle- and high-income countries. Complementing multi-stakeholder, sectoral collaboration and partnerships with practitioners, this research has actively engaged Ugandan early career researchers and people with disabilities.

The book emphasises the inefficiencies and damaging impacts associated with poorly aligned overseas contributions, particularly the development of parallel systems. Through its projects, Knowledge for Change works closely with the Ministry of Health to support the delivery of Universal Health Coverage to benefit all the Ugandan people.

The work represented here contributes a significant and unique evidence-base to support our future Rehabilitation and Assistive Technology service planning and implementation processes”.

Andrew Mubangizi, Assistant Commissioner, Disability and Rehabilitation Division, Uganda Ministry of Health

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Key Stakeholder Testimonials

DR AHLAAM AMOUR

DIRECTOR OF TRAINING, EDUCATION & RESEARCH MNAZI MMOJA HOSPITAL, ZANZIBAR

Our collaboration with Knowledge for Change has strengthened Mnazi Mmoja Hospital’s capacity to deliver high-quality patient care. By combining their international expertise with our local knowledge, we are not only exchanging skills but also building sustainable systems that benefit the people of Zanzibar.

Through professional volunteer and student placements, our teams from the |] ‘h f\ wards (especially Medical, Paediatrics, Surgical, Maternity, Mental Health and Prosthetics and Orthotics departments) have benefited from fresh perspectives, innovative practices, and a spirit of shared learning. This exchange has enriched both our staff and the visiting professionals, fostering a truly global approach to healthcare delivery in Zanzibar.

Furthermore, Knowledge for Change’s Professional Fellowship Programme (sponsored by the Commonwealth Scholarship Commission) has been a catalyst for professional growth, enabling us to gain advanced skills, broaden our networking, and bring back evidence-based solutions to improve patient outcomes in our hospital.

In addition to that, with Knowledge for Change’s support, we are planning to introduce targeted interventions in Diabetic Foot Care (through diabetic foot clinic) that will significantly reduce preventable amputations, unnecessary deaths and improve the quality of life for patients living with diabetes in Zanzibar.

Lastly, and most importantly, this partnership is not just about training and projects - it’s about creating a lasting impact. Together, we are investing in people, systems and innovations that will sustainably transform healthcare in Zanzibar.

Dr Ahlaam Amour 30[th] September 2025

DR RICHARD MUGAHI

ASSISTANT COMMISSIONER FOR REPRODUCTIVE HEALTH UGANDA MINISTRY OF HEALTH

“The continued presence of K4C’s volunteers, working alongside my health workers, has transformed Kagote Health Centre into one of the best performing Community Health Centres in Uganda”

Dr Richard Mugahi 15[th] July 2025

Governance and Accountability b f•

Structure, Governance & Management

CHARITY REGISTRATION IN THE UK

Knowledge for Change was registered with the Charity Commission in England and Wales on 17th April 2012, charity number 1146911. Our working names are ‘Knowledge for Change’, ‘Knowledge 4 Change’ and ‘K4C’. Our official address is 11 Newmarket Street, Skipton, North Yorkshire, BD23 2HX. Our current working and correspondence address is: Room L530, Allerton Building, University of Salford, Manchester, M6 6PU.

OUR TRUSTEES IN 2024

Knowledge for Change had 9 trustees on its board throughout 2024:

RECRUITMENT, APPOINTMENT & INDUCTION OF CHARITY TRUSTEES

The Trust Deed states that there must be a minimum of 4 trustees acting on behalf of K4C. There is no maximum term of appointment and

trustees can serve until they resign should they continue to fulfil the terms stated in the Trust Deed. Mechanisms for the removal of trustees do exist and are also detailed in the Trust deed. All existing trustees have long experience of the nature of the charitable activity of K4C and, aside from expenses, were not remunerated for their trusteeship. Where new trustees are appointed, they are given a formal induction to the work of the trust and provided with the information they need to fulfil their roles, which include information about the role of trustees and charity law. New trustees are nominated by members of the board of trustees, interviewed by the board of trustees and appointed where they have the necessary skills to contribute to the charity’s management and development. Trustees are responsible for monitoring all of the charity’s activities and are bound by the terms stated within K4C’s Declaration of Trust and amendments.

AMENDMENTS TO THE BOARD OF TRUSTEES

During this year, Eileen Cunningham retired from her trusteeship, having made substantial contributions to the charity as a trustee over the last 10-years. There were no new appointments to the board during 2024, however K4C is actively seeking to recruit new trustees in 2025.

ORGANISATIONAL GOVERNANCE

The mechanisms for organisational governance within K4C have remained largely unchanged throughout 2024. The Board of Trustees remains responsible for making decisions on all matters of general concern and importance to K4C including strategic, operational and financial decisions. Many of the K4C trustees are based near the University of Salford and are able to meet on at least a quarterly basis or often more regularly. Uganda based trustees are engaged virtually.

Comprehensive policies are in place to ensure good governance within K4C, including:

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All policies are formally reviewed and updated on an annual basis, or more frequently as required. They are also subject to regular external review by our funding bodies.

The trustees confirm that there were no cases of breaches of K4C policies in 2024 that require notification to the Charity Commission.

OBJECTIVES, STRATEGY AND PUBLIC BENEFIT

The official charitable objectives of Knowledge for Change are as follows:

Knowledge for Change works in close partnership with the University of Salford (UK), as well as several other Universities, Royal Colleges, funding bodies, the Ugandan, Tanzanian and Zanzibari Ministries of Health and other stakeholder organisations. The trustees endeavour to ensure that all our partners adhere to strict, positive and ethical practice.

The trustees are aware of the Charity Commission’s Guidance on Public Benefit. They have reviewed the objectives of the charity, its activities in 2024 and its future plans in the light of this guidance and find that all of these comply.

The activities described in this report have primarily benefited the people who live in the catchment areas of the universities, hospitals and communitybased organisations in which K4C operates. More generally, all professional volunteers, students and Commonwealth Scholarship Commission funded fellows that have completed placements through K4C will have gained new skills and experience which will benefit the public in the UK, Uganda and Tanzania more widely depending on where they go on to work. All benefits are related to the objectives of the charity, as stated above. The trustees are not aware of any harm arising from the activities of the charity, nor of any private benefit, directly or indirectly.

NGO REGISTRATIONS IN UGANDA, TANZANIA AND ZANZIBAR

Knowledge for Change is registered as separate Non-Governmental Organisations (NGOs) in Uganda (no. 3592), Tanzania (00NGO/12/4270) and Zanzibar (0000210165). Their respective registered office addresses are listed below:

Each organisation has an independent board of directors and is accountable to applicable national laws, regulations and reporting requirements. They also relate and report closely to K4C UK, as specified within comprehensive Memorandums of Understanding (MOUs). Some trustees for K4C UK also sit on the Board of Directors of K4C Uganda, K4C Tanzania and K4C Zanzibar to facilitate transparency, streamline activities and support effective decision making and communications.

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EXTENDING OUR ETHICAL COMMITMENT TO ENVIRONMENTAL STARDARDS

Knowledge for Change has always committed to making all of its project activities and outcomes as ethical and sustainable as possible. This year, we decided to expand this commitment to better account for the indirect impacts of our projects and activities on the wider environment. This has involved developing a new initiative titled ‘Value for Carbon’, which includes a mechanism for measuring, reducing and offsetting our organisational carbon emissions.

By far, our biggest contribution to carbon emissions results from international flights taken by our staff, volunteers and students. In order to mitigate this impact, we have continued to grow and expand our Virtual Volunteering Programme which greatly reduces our overall carbon emissions per volunteer. We’ve also reduced the number of individual international trips between the UK, Uganda and Tanzania undertaken by our staff and improved their impact and efficacy by increasing each trip’s duration; our staff now travel for as long as possible, and for a minimum of 2 weeks.

We are also actively reviewing options for carbon offsetting, including established schemes offered by airlines; partnerships with environmental NGOs to promote tree planting; and expanding our direct provision of cost effective and environmentally friendly cooking stoves to families in Uganda and Tanzania.

COMMUNICATIONS

One of Knowledge for Change’s main organisational weaknesses identified relates to our communications strategy. We are very proud of the hugely positive impacts our projects have on local communities. However, with the exception of our academic publications, we often fail to effectively relay this positive news and information to our stakeholders, supporters and the wider public. Such communications are of increasing importance in the ever more competitive global environment, supporting awareness raising, fundraising, engagement and networking.

To rectify this, we have revamped our website and social media channels in 2024 including Facebook, Twitter, Instagram and YouTube. We also plan to draft a new comprehensive communications strategy in early 2025 to improve the way in which we share our organisational activities and achievements with external stakeholders.

www.knowledge4change.org

@Know4Change

@Knowledge4Change

@Know4Change

@Knowledge4Change114

+44 (0) 7894 938 538

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Risk Assessment & Mitigation

Knowledge for Change reviews its comprehensive risk assessment annually, which covers all aspects of risk for all partner organisations and stakeholders involved in our activities. Only 1 risk was classified as being a ‘major’ organisational risk for the next (2025) financial year. This has been summarised below:

below:
Major Risks and
Uncertainties		 Potential Impacts Planned Mitigating Actions
Further drastic cuts to
Official
Development
Assistance
(ODA)
funding
by
the
incoming
Trump
administration in the
USA and potential for
replication by other
governments in the UK
and elsewhere.		 Financial:
- Reduction in the number of
funding streams available to
support
global
health
research and international
development projects.
- Increased
competition
for
remaining funding streams.		 - Diversification of funding sources,
including increased engagement
with
the
private
sector
and
expansion of our student placement
programme.
- Strengthening
and
diversifying
partnerships to widen networks and
promote
new
research
collaborations.
- Conservative financial management
to reduce expenditure and maximise
efficiency of interventions.
Human Resource:
- Risk to K4C staffing levels, and
the health and wellbeing of
current staff.		 - Continued assessment of risks and
effective mitigating actions taken as
required.
- Provision of enhanced health and
wellbeing
support
for
staff,
especially any that become at risk of
redundancy.
Strategic:
- Changing needs and priorities
of partners
- Restricted
organisational
growth		 - Continued
assessment
of
the
priorities and needs of stakeholders
and beneficiaries.
- Maintaining current and building
new
networks
to
ensure
organisational growth can continue
as quickly as possible.
Operational:
- Inability
to
achieve
organisational objectives due
to restricted project funding.		 - Continue to review and adapt all
current and future activities to
maximise sustainability.

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Financial review (2024)

~ 49 ~

Financial Summary

This Annual Report covers the 12-month period from 1st January 2024 to 31st December 2024. Total receipts on Knowledge for Change (UK) funds for this period were £511,059. These receipts included all income from public donations, various sources of project funding, bank interest payments and income provided by various partner organisations and funding bodies.

Total payments of Knowledge for Change (UK) funds for the 12-month period from 1st January 2024 to 31st December 2024 totalled £501,823. This included payments made for all projects including those in the UK, Uganda and Tanzania; those run in partnership with the University of Salford and those funded by other external sources.

The total balance brought forward at the beginning of the financial year was £178,270. Over the course of the 12-month period, there was an excess of receipts over payments of £9,236. This gave Knowledge for Change (UK) a combined total fund available on 1st January 2025 of £187,506.

Throughout the year, Knowledge for Change (UK) granted a total of £116,539 to ‘Knowledge for Change (Uganda)’ and £29,000 to ‘Knowledge for Change (Tanzania)’. As detailed in our previous (2023) Trustees Annual Report, both of these organisations are now fully established as independent NGOs in their respective countries. They were setup to streamline governance, promote local ownership and ensure full compliance with local laws and financial regulations in Uganda and Tanzania, and have their own governance and management systems in place. As such, they now serve as independent suppliers and downstream partners to Knowledge for Change (UK) and are granted direct funding to support their operations. Memorandums of Understanding (MOUs) are in place to govern the tripartite relationship between the organisations, and both K4C (Uganda) and K4C (Tanzania) are subject to regular stringent financial audit and due diligence checks by K4C (UK). Several trustees for K4C (UK) are also board members for K4C (Uganda) and K4C (Tanzania) to support effective and streamlined governance, management and accountability.

The accounts below differentiate between payments made directly by Knowledge for Change (UK) and any funding granted to Knowledge for Change (Uganda) and Knowledge for Change (Tanzania). Notes 5a and 5b provide more specific details by differentiating between the expenditures made by each of the 3 separate organisations.

Overall, the K4C trustees are highly confident in the financial standing of the charity, and are proud of the level of sustainability we continue to achieve despite unforeseen macro factors relating to the UK and other international governments’ decisions to cut their overseas development budgets. We do not anticipate any reversal of the global funding landscape within the next 5 years, and will therefore maintain our innovative but cautious approach to generating and managing our funding over the coming year.

~ 50 ~

Financial Statements for the Year Ended 31[st] December 2024

Reference
Note		 Total Funds
(31/12/24)		 Total Funds
(31/12/23)
RECEIPTS AND PAYMENTS ACCOUNT 1 £ £
Receipts
Public Donations 2a 343,413 291,603
Income from Organisations 2b 166,035 141,207
Refunds 1,330 178
Miscellaneous Funding - -
Sub-total 3 510,778 432,988
Bank Interest/Charge Reversals 281 837
511,059 433,825
Payments 4
Professional VolunteeringProgramme 42,730 24,243
Ethical Student Placement Programme 169,680 210,794
Wound Management Programme 9,612 2,254
Cervical ScreeningProgramme 10,489 1,978
Rehabilitation Programme 15,684 3,169
Diabetes(NEEDS)Project 16,004 11,856
Neonatal Sepsis Project 17,465 1,673
Cultural CompetencyProject 2,430 2,000
General Health System StrengtheningActivities 681 1,917
British Commonwealth Fellowships Programme 11,580 10,018
British AcademyWritingWorkshops Project 36 -
Knowledge for Change(Uganda)Grant Funding 5 116,539 80,108
Knowledge for Change(Tanzania)Grant Funding 5 29,000 11,000
Website Development 120 204
Bank Charges 502 85
Administrative Expenditure 578 23,206
Research and Project Management Staffing (UK) 58,693 25,378
Administrative Staffing& Expenditure(Uganda) - 49
501,823 409,932
Excess of Receipts over Payments 9,236 23,893
STATEMENT OF ASSETS & LIABILITIES
Cash Funds
Bank Current Account 1(Current) 174,926 166,203
Bank Current Account 2(Savings) 11,461 11,180
GBP CurrencyCards 1,119 887
Cash in Hand - -
187,506 178,270
Liabilities 6
Expenses due - -
Invoices/Payments due - -

~ 51 ~

Other liabilities - -
- -
Net Total(Assets – Liabilities) 187,506 178,270

~ 52 ~

Notes to the Financial Statement for the Year Ended 31[st] December 2024

  1. The financial statements of Knowledge for Change have been prepared in accordance with the Charities Act, 2011, and the Charities (Accounts & Reports) Regulations, 2008, using the Receipts & Payments basis.

  2. Receipts Analysis

Total Funds
(31/12/24)		 Total Funds
(31/12/23)
£ £
a.Public Donations
Direct Donations 314,694 253,840
KindLink 17,934 15,771
Wonderful 10,785 21,991
HMRC Gift Aid - -
343,413 291,602
b.Funding from Organisations
Universityof Salford 7,223 36,193
Liverpool School of Tropical Medicine 942 -
Birmingham CityUniversity 950 -
Universityof Greater Manchester 11,000 -
Commonwealth ScholarshipCommission 28,540 18,462
Liverpool John Moore’s University 25,995 55,979
Tropical Health Education Trust(now GHP) 40,271 -
Legs for Africa(now STAND) 21,666 1,125
Burdett Trust for Nursing 29,448 29,448
166,035 141,207
  1. A summary of the public donations and income from organisations intended for specific projects is provided below:
Specified Project Income (£) to 31/12/24: Income (£) to 31/12/23:
Ethical Student Placement Programme 359,438 336,122
Cervical Screening Programme - 7,045
Diabetes Related Programmes 29,448 35,241
Neonatal Sepsis Project 36,771 -
Wound Management Programmes - 2,668
Virtual Volunteering Project (RIMPS) 3,500 -
Biomedical Engineering / UBTS Programmes 600 -
Respectful Care Programme 8,970 3,081

~ 53 ~

Children’s Education Programmes 942 -
Commonwealth Scholarship Commission Fellowships 19,000 18,462
Professional Volunteering Programme 1,103 3,430
Rehabilitation Related Programmes 25,849 15,680
Climate Change Related Programmes - 5,000
Miscellaneous/Non-Project Specific* 23,827 6,260
Total 509,448 432,988

*Miscellaneous/Non-Project Specific income refers to income that is unrestricted and not tied to a specific project. A further breakdown is provided below:

Source of Income Income (£) to 31/12/24: Income (£) to 31/12/23:
Direct donations (general public donations) 23,827 6,260
Total 23,827 6,260
  1. An alternative breakdown of payments in terms of categories, as opposed to project expenditure, is provided below:
Line Item: Expenditure (£) to
31/12/2024:		 Expenditure (£) to
31/12/2023:
Professional Volunteering
Stipend Payments 15,747 16,633
Accommodation Costs 7,786 5,582
International Travel Costs 3,357 584
Sub-Total: 26,890 22,799
Student Placements
International Travel Costs 127,793 158,188
Local Travel Costs - 484
Accommodation Costs 20,577 41,649
Administrative Costs 45 -
Sub-Total: 148,415 200,321
Training Workshops/Conferences
Training Programmes in Uganda - 11,612
Training Programmes in Tanzania - -
Training Programmes in the UK 14,582 10,018
Research (Uganda) 681 -
Research (UK) 3,310 -
Publishing / Project Dissemination 1,589 -
Sub-Total: 20,162 21,630
International Travel
Project Management Travel Costs 3,045 8,853
Project Management Subsistence Costs 1,256 -
Sub-Total: 4,301 8,853
UK Admin/Staffing

~ 54 ~

Admin/Management Staff Salaries 72,054 23,206
Research Staff Salaries 72,054 31,201
Local UK Travel 974 -
Sub-Total: 145,082 54,407
Uganda Staffing
Clinical Staff Salaries - 300
Local Uganda Travel - 1,540
Sub-Total: - 1,840
Tanzania Staffing
Clinical Staff Salaries - 785
Sub-Total: - 785
Direct Investments/Infrastructural Developments
Student Hosting Contributions - 1,917
Provision of Medical Equipment 10,811 5,982
Sub-Total: 10,811 7,899
Other
Banking Costs 502 85
Website Costs15 120 204
K4C (Uganda) Grant Funding (see note 5) 116,539 80,108
K4C (Tanzania) Grant Funding (see note 5) 29,000 11,000
Sub-Total: 146,161 91,397
Total Expenditure: 501,823 409,931
  1. Over the course of the 2024 financial year, K4C UK has granted a total of £116,539 to K4C Uganda and £29,000 to K4C Tanzania. The two tables below provide a combined breakdown of all Knowledge for Change expenditure, including the funding granted to Knowledge for Change (Uganda) and Knowledge for Change (Tanzania). Table 5a contains a breakdown of expenditure by project, whereas table 5b contains a breakdown of expenditure by defined payment categories.

Table 5a (all K4C UK, K4C Uganda and K4C Tanzania expenditure categorised by project):

All Payments Combined for 01/01/2024 - 31/12/2024
(Categorised by Project)		 K4C
UK		 K4C
Uganda		 K4C
Tanzania		 Total
Funds
Professional VolunteeringProgramme 26,890 3,639 1,170 31,699
Ethical Student Placement Programme 153,401 27,929 9,883 191,213
Hand Hygiene, Infection Control & Antimicrobial
Resistance Programmes		 - 168 - 168
Commonwealth ScholarshipCommission Fellowships 11,580 - - 11,580
British AcademyWritingWorkshopProject 36 581 - 617
Cervical ScreeningProgramme 1,808 20,187 - 21,995
Cultural CompetencyProject 2,430 - - 2,430
Diabetes(NEEDS)Project 5,005 10,161 3,555 18,721
Domestic Violence Programme - 878 - 878
Fort Portal Regional Referral Hospital Direct Investment - 600 - 600
Kataraka Health Centre Direct Investment - 390 - 390

~ 55 ~

General Health System StrengtheningActivities 681 - - 681
Neonatal Sepsis Project 1,378 14,986 3,591 19,955
Rehabilitation Project 7,188 18,977 3,688 29,853
Respectful Care(Maternity) - 199 - 199
SupplyChains Social Enterprise - 397 - 397
Wound Management Programme 1,547 243 3,555 5,345
Misc/Non-Project Specific - 1,925 2,953 4,878
Bank Charges 502 23 - 525
Website 120 - - 120
All Staffing& Related Expenditure(UK) 143,718 - - 143,718
Administrative Staffing& Expenditure(Uganda) - 14,160 - 14,160
Administrative Staffing& Expenditure(Tanzania) - - - -
Total Payments: 356,284 115,433 28,394 500,122
Reserve/Unspent Funding (incl. at bank and in-hand) N/A 14,565 606 15,171
Total Payments + Reserve Funding 356,284 129,998 29,000 515,282

Table 5b (all K4C UK, K4C Uganda and K4C Tanzania expenditure categorised by defined payment categories):

All Payments Combined for 01/01/2024– 31/12/2024
(Categorised by Defined Payment Categories)		 K4C UK K4C K4C Total
Funds
Uganda Tanzania
Professional Volunteering
Stipend Payments 15,747 - - 15,747
Accommodation Costs 7,786 136 471 8,371
International Travel Costs 3,357 - 3,357
Local Travel Costs - 603 78 585
Clinical Registration Costs - 2,826 601 2,976
Admin Costs - 55 19 65
Sub-Total: 26,890 3620 1,169 31,101
Student Placements 0
International Travel Costs 127,793 - 127,793
Local Travel Costs - 4,455 1,709 5,461
Accommodation Costs 20,577 14,950 5,927 39,067
Hosting contributions - 5,649 1,087 5,834
Admin Costs 45 1,182 967 2,005
Sub-Total: 148,415 26,245 9,690 180,160
Training Workshops/Conferences 0
Training Programmes in the UK 3002 - 3002
Training Programmes in the UK - 2,506 - 2106
Research (Uganda) 681 - 681
Research (UK) 3310 - 3310
Publishing/Project Dissemination 1,589 - 1,589
Project Admin Costs - 2,817 486 2,853
Project Subsistence - 1,562 33 1,346
Project Accommodation - 619 - 520
Project Local Costs - 2,555 - 2,147

~ 56 ~

Sub-Total: 8,582 10,059 519 17,554
International Travel
Project Management 3,045 - - 3,045
Project Stipend 1,256 - - 1,256
Sub-Total: 4,301 - - 4,301
UK Staffing
Admin/Management Staff Salaries 144,109 - - 144,109
Local UK Travel 974 - - 974
Sub-Total: 145,083 - - 145,083
Uganda Staffing
Admin/Management Staff Salaries - 16,115 - 13,542
Clinical Staff Salaries - 53,527 - 44,981
Sub-Total: - 69,642 - 58,523
Tanzania Staffing
Admin/Management Staff Salaries - - 90 90
Clinical Staff Salaries - - 13,838 13,838
Sub-Total: - - 13,928 13,928
Direct Investments/Infrastructural Developments
Provision of Medical Equipment 10,811 4,885 133 15,049
Sub-Total: 10,811 4,885 133 15,049
Other 0
British Commonwealth Fellowships 11,580 0 11,580
Banking Costs 502 23 146 667
Website Costs 120 - 120
Miscellaneous - 35,479 2,808 32,622
Sub-Total: 12,202 35,501 2,954 44,989
Total Payments: 356,284 115,443 28,394 481,690
Reserve/Unspent Funding (incl. at bank and in-hand) N/A 14,565 606 26,560
Total Payments + Reserve Funding 356,284 129,998 29,000 515,282
  1. Knowledge for Change does not possess any fixed assets or short or long-term liabilities; only current assets in the form of cash within the two separate current accounts, several currency cards and the small amount of cash in hand as noted.

~ 57 ~

Independent Examiner’s Report

I report on the accounts for Knowledge for Change for the year ended 31 December 2024, which are set out on pages 49-57 of the Charity’s 2024 Trustee’s Annual Report and cover a 12-month period.

Respective responsibilities of trustees and examiner

The Charity’s Trustees are responsible for the preparation of the accounts. The Charity’s Trustees consider that an audit is not required for this year under section 144(2) of the Charities Act 2011 (the 2011 Act) and that an independent examination is needed.

It is my responsibility to:

Basis of independent examiner's statement

My examination was carried out in accordance with the general directions given by HMRC and the Charity Commission. An examination includes a review of the accounting records kept by the Charity and a comparison of the accounts presented with those records. It also includes consideration of any unusual items or disclosures in the accounts, and seeking explanations from you as trustees concerning any such matters. The procedures undertaken do not provide all the evidence that would be required in an audit, and consequently no opinion is given as to whether the accounts present a ‘true and fair view’. The report is limited to those matters set out in the statement below.

Independent examiner's statement

In connection with my examination, no matters have come to my attention:

(1) which gives me reasonable cause to believe that in any material respect the requirements:

(2) to which, in my opinion, attention should be drawn in order to enable a proper understanding of the accounts to be reached.

Francesca Waller Independent Examiner Nestegg Financial Services 11 Newmarket Street Skipton, North Yorkshire BD23 2HX

Date:

~ 58 ~

Knowledge for Change is a registered charity in England and Wales (no. 1146911). Its registered address is 11 Newmarket Street, Skipton, North Yorkshire, BD23 2HX.

Please Recycle

~ 59 ~