**Company number:** 09542896 **Charity number:** 1162031 


## **OPERATION FISTULA (UK) ANNUAL REPORT & FINANCIAL STATEMENTS** 

For the year ended 31 December 2021 



## **Operation Fistula (UK)** 

## **Contents** 


For the year ended 31 December 2021 

||Page:|
|---|---|
|Reference & Administrative Information|2|
|Trustees’ Annual Report|3-8|
|Independent Auditor’s Report|9-12|
|Statement of Financial Activities (incorporating an income and expenditure|13|
|account)||
|Balance Sheet|14|
|Statement of Cash Flows|15|
|Notes to the Financial Statements|16-23|



Company number: 09542896                                Charity number: 1162031                                  Page 1 of 23 



## **Operation Fistula (UK)** 

## **Reference & Administrative Information** 


For the year ended 31 December 2021 

**Company number** 09542896 **Charity number** 1162031 **Registered office** Shakespeare House 168 Lavender Hill London SW11 5TG **Trustees** Trustees, who are also directors under company law, who served during the year and up to the date of this report were as follows: Nicholas David Jenkins Carl Manlan (Resigned on 15[th] July 2021) Dr Martina Lukong Baye Dr Jerker Liljestrand (Appointed on 15[th] July 2021) **Key management Personnel** Seth Cochran, Founder & CEO **Bankers** CAF Bank 25 Kings Hill Ave Kings Hill West Malling ME19 4JQ **Auditors** Sophie Wheeler Accountants Ltd Rose Cottage High Street Rhosneigr LL64 5YJ 

Company number: 09542896                                Charity number: 1162031                                  Page 2 of 23 



## **Operation Fistula (UK)** 

## **Trustees’ Annual Report** 


For the year ended 31 December 2021 

The trustees present their report and the financial statements for the year ended 31 December 2021. 

Reference and administrative information set out on page 2 forms part of this report. The financial statements comply with current statutory requirements, the memorandum and articles of association, and the Statement of Recommended Practice - Accounting and Reporting by Charities: SORP applicable to charities preparing their accounts in accordance with FRS 102. 

## **Objectives and Activities** 

The objectives of the charity are for the public benefit: the advancement of health and in particular, without limitation, the funding of treatment and care for women suffering with obstetric fistula; and the advancement of education in particular, without limitation, in the subject of obstetric fistula. 

Obstetric fistula is a childbirth injury that results from obstructed labour. This terrible condition affects one million women in Africa and South Asia, and persists because women have no access to safe and timely emergency obstetric care. 

Operation Fistula’s mission is to end fistula for every woman, everywhere. We exist to create a fistula free world. 

The main activities undertaken in relation to those purposes, are: 

**We are working to end fistula across specific geographical locations.** As part of our work to end fistula for every woman, everywhere, we have spearheaded a large project in Madagascar, where we are aiming to eradicate obstetric fistula from 50 communes, in 10 districts, across two regions of the country. This means finding the patients who are most difficult to reach. Our work seeks to design a replicable and scalable delivery model that finds every woman living with fistula, and works to meet their needs. We call this programme FREE – Fistula Repair for Everyone Everywhere. 

**We have harnessed the power of technology and analytics to trigger collaboration** . Fistula organisations often work in silos, with best practices rarely being shared. Needless duplication, wasted resources, and gaps in coverage, result. To address this challenge Operation Fistula created GOFAR – the Global Obstetric Fistula Automated Registry. GOFAR is a data collection, analysis, and visualisation system that empowers providers working on the ground to monitor, track, and evaluate their efforts. This platform provides a shared measurement system and has the power to improve coordination, collaboration, and quality across our sector. This programme of work is known as ‘GOFAR together ’and aims to both support individual users in their data collection efforts, and strengthen health systems and NGO organisations working to end fistula, by providing them with a shared measurement system. 

**We empower local service providers with transformative funding.** Our funding model enables on-the-ground providers, who are historically beyond the reach of traditional funding 

Company number: 09542896                                Charity number: 1162031                                  Page 3 of 23 



## **Operation Fistula (UK)** 

## **Trustees’ Annual Report** 


For the year ended 31 December 2021 

models, to access the funding they need to deliver treatment to women needlessly suffering with fistula. This funding is performance-based, and conditional on data collection and input into GOFAR. It is focused on helping treatment providers serve the patients who are most easy to reach. The data we collect in the process enables us to verify the quality of that care, and monitor and track performance. At Operation Fistula, we call this programme of work ‘Kickstart, ’because this funding is the catalyst for quality treatment and patient care. 

**We identify and map the system failures and gender inequality that causes fistula.** We do this using data we have collected, and data from partners. We then visualise this data using Tableau data visualisation software. This visualised data empowers the global community with insights for impact - providing organisations with data advocacy tools, and revealing areas of extreme gender inequality and injustice. This data can then drive crosspartner collaboration and enable more targeted interventions in the work to achieve the SDGs. The goal of this programme is to Visualise Gender Equality. 

## **Achievements and Performance** 

2021 was a hugely impactful year for Operation Fistula. The charity built on the successes of 2020, further leveraging our robust pandemic response – which saw us heavily invest in local grassroots teams and targeted action to end fistula – and transforming it into a global scale strategy. 

Our Grand Challenges Canada ‘Transition to Scale’ grant continued to fuel program growth. The team in Madagascar has developed a national and global reputation for high-quality care and services – implementing programs with UNFPA, the Ministry of Health, and other private NGOs across the country. They are also spearheading opportunities for increased SouthSouth collaboration in a number of different countries to scale and replicate our innovative model for fistula care. 

## **2021: SUMMARY OF PERFORMANCE** 

2021 was the year in which Operation Fistula transitioned from building and testing our innovative programs, to implementing a professionalised and replicable model for innovation at scale. 

In 2021, the team in Madagascar acted swiftly to implement and test every element of the FREE program, while our global team took action to scale Kickstart, our performance-based funding program, to 77 surgeons operating across 22 countries. 

From July - November 2021, COVID numbers were relatively low in Madagascar, meaning that work in the country was able to go ahead without the disruption of national restrictions on movement and travel. As a result, the final two quarters of 2021 were marked by a flurry of efficient and impactful activity. Globally, we saw huge surges in our impact as a result of our efficient and agile roll-out of the Kickstart program. 

Company number: 09542896                                Charity number: 1162031                                  Page 4 of 23 



## **Operation Fistula (UK)** 

## **Trustees’ Annual Report** 


For the year ended 31 December 2021 

In this report, we provide a summary of accomplishments realised in 2021 with support from Operation Fistula (UK): 

## **We reached, diagnosed, and treated almost 5x more women than in 2020.** 

In 2021 Operation Fistula funded treatment for 1,890 women — nearly five times the number of women we were able to treat in 2020. 

Out of this number, 571 women were treated via our FREE program in Madagascar, and 1,319 women were treated by the 77 activated Kickstart surgeons that were onboarded in 2021. 

## **We reached over 100,000 people via our community outreach and sensitisation work.** 

Finding women with fistula requires deep outreach with remote communities that may never have heard of fistula. In 2021 we completed outreach missions to 100+ communes. In total, we reached over 100K people (119,302) through our community engagement and outreach activities in Madagascar, this year. 

## **We expanded data-collection capabilities to 22 countries.** 

Since the global launch of our performance-based funding program in late 2020, we have onboarded 307 additional users onto the GOFAR platform. 2021 has seen a surge in GOFAR adoption globally. This is due to both the expansion of our work in Madagascar, and the rapid global growth in our Kickstart program. Since October 2020 we have onboarded 77 new surgeons across 22 countries. 

## **We mapped three regions of Madagascar.** 

In 2021, Operation Fistula mapped 100% its three target regions – SAVA, Vatovavy, and Fitovinany. This year, Operation Fistula’s mapping team mapped 171 communes and 35,191 KM[2] of Madagascar, putting 1.43M buildings on the map. Operation Fistula’s mapping team is now the most prolific mapping team in Madagascar and is emerging as one of the most efficient and accurate mapping efforts in the world. 

## **We launched our Quality of Life initiative with the goal of creating a tool that will ensure that patient voices sit at the core of all fistula work.** 

In every engagement with our patients, we place primacy on listening to them and incorporating their direct lived experiences, and individual hopes with regards to their treatment into our program. This work has been principally carried out at Hope Centers where social workers deliver counselling and psychosocial support to patients. In 2021, Operation Fistula launched the process of developing a Quality of Life (QoL) tool which will enshrine the patient voice in our program, enabling us to better understand each woman’s specific needs and deploy customised services to meet those needs. This year, we interviewed 146 patients and coded 30 interviews to form the basis of our QoL conceptual model. In 2022, we anticipate that we will continue to refine the QoL conceptual model and begin tool development, including question selection and preparation for field testing. When finished, this tool will belong to the million women living with fistula around the world. In a world where numbers define success and failure, and so little attention is given to these first-hand 

Company number: 09542896                                Charity number: 1162031                                  Page 5 of 23 



## **Operation Fistula (UK)** 

## **Trustees’ Annual Report** 


For the year ended 31 December 2021 

accounts, this simple tool may be the first step towards achieving a truly patient-centric model of fistula care. 

## **We completed a global partnership agreement with UNFPA.** 

The rapid growth of Kickstart - our performance-based funding model - in 2021 was supported in part by funding from UNFPA. We piloted innovative financing that can also improve the quality of care with them in 5 UNFPA Country Offices (COs): Burkina Faso, Cameroon, Madagascar, Nigeria, and Senegal. 

The success of this pilot gave us strong momentum with UNFPA, and in December 2021 we executed a global partnership agreement with them to expand the program across their global footprint over the next 5 years. 

## **We delivered more data visualisation offerings to our end users – building global data** 

## **analytics capacity.** 

In 2021 we implemented our cutting-edge visual data analytics into GOFAR’s end-user interface. This means that each one of our 77 partner surgeons can monitor, track, and get real-time, live insights into their patient care, patient demographics, and other core treatment trends and factors. By delivering the power of our visual analytics into the hands of direct service providers, we have been able to drive increased awareness of the quality of care and surgical outcomes to health providers. 

## **Capacity Building & Support** 

Operation Fistula has continued to develop the Madagascar team, which has proved both highly impactful and efficient in their national implementation of the fistula care program. Our global team sustained and supported the scaling of our innovative programs across 22 countries. 

In addition to this operational capacity building, Operation Fistula continues to invest time and resources into ensuring that its administrative and governance systems are optimally maintained and continuously improved. Every aspect of our work is regularly scrutinised, tracked with data, and validated, to ensure that we are delivering services in a maximally efficient and cost-effective way. In everything we do, Operation Fistula is relentlessly focused on how we can continue driving access to transformative, life-changing care and services to the women we serve, in the most innovative, efficient, and impactful way possible. 

## **Financial Review** 

Results for year ended 31 December 2021 are given in the Statement of Financial Activities. The assets and liabilities are given in the Balance Sheet. The financial statements should be read in conjunction with the related notes. The Trustees regard the financial position of the charity at 31 December 2021 to be satisfactory and they are content that the current unrestricted reserves position leaves it with a sound base from which future activity can be built. 

Company number: 09542896                                Charity number: 1162031                                  Page 6 of 23 



## **Operation Fistula (UK)** 

## **Trustees’ Annual Report** 


For the year ended 31 December 2021 

In summary, total income amounted to £352,836 (2020: £779,622) and total expenditure amounted to £514,111 (2019: £695,182) resulting in a deficit of £188,275 (2020 surplus: £84,440). The deficit in 2021 was predominately due to a fall in donations as a result of the COVID-19 pandemic. Despite this, work continued across our programs, utilising donations from previous years. Full details of income and expenditure are set out in notes to the financial statements. 

## **Reserves Policy and Going Concern** 

The charity is dependent on donation income in order to maintain its core activities. The Trustees aim to maintain unrestricted reserves that will provide sufficient funds to cover charitable activities, support, and governance costs. After considering funds available from Operation Fistula USA, unrestricted reserves at the end of this period cover these costs for the foreseeable future. 

## **Structure, Governance, and Management** 

Operation Fistula (UK) is a charitable company limited by guarantee, incorporated and registered with Companies House and Charities Commission respectively on 15 April 2015. 

The company was established under a memorandum of association which established the objects and powers of the charitable company and is governed under its articles of association. 

All members of the Trustees give their time voluntarily and receive no benefits from the charity. Any expenses reclaimed from the charity are set out in notes to the financial statements. 

## **Appointment of Trustees** 

The trustees have regard to the skills, knowledge, and experience needed for the effective administration of the charitable company when selecting individuals for appointment as charity trustees. Trustees have been selected and appointed to ensure that the board has relevant background and skills which are considered important to enable the charity to achieve its charitable objectives. 

## **Related Parties and Relationships with Other Organisations** 

Operation Fistula (USA) is instrumental in raising donation income from US based donors to fund charitable activities. Operation Fistula (USA) and Operation Fistula (UK) were founded by Seth Cochran and he is also CEO of both charities. 

## **Statement of Responsibilities of the Trustees** 

The trustees (who are also directors of Operation Fistula (UK) for the purposes of company law) are responsible for preparing the trustees’ annual report, and the financial statements, in 

Company number: 09542896                                Charity number: 1162031                                  Page 7 of 23 



Operation Fistula IUK)
OPERATION
Trustees, Annual Report
For the year ended 3 1 December 2021
FISTULA
accordance with applicable law and United Kingdom Accounting Stsndards Iunited Kingdom
Generally Accepted Accounting Pratticel,
Company law requires the trustees to prepare financial Statements for each financtal year
which give 8 true and f31T view ol the state of alfairs of the charitable company, and of the
incoming resources ènd application of resouice5. including the income and expenditure of
the ch.aritable company for that period.
In preparing these financial statements, the trustees are required to..
Select suitable accounting pc>licies and then apply them consistently.
Observe the methods and principles in the Charities SORP.
Make judgements and e5titnates that are reasonable and prudent.
State whether applicable UK Accounting Standard5 and statement5 of recommended
practice have been followed, subject to any material departuies disclosed and explain¢d
in the financial ststements.
Prepare the financial statements on the going concem basis unless it is inappropriate to
presume that the charity will continue in operation.
The trustèes ère responsible for keeping proper accounting records that disclose with
reasonable accuracy at any time the financial position of the charitable company. and enèble
them to ensure th3t the financial statements comply with the Comp3nie5 Act 2006. They are
also responsible for s3fe9uardin9 the assets of the charitable company. ènd hence for taking
asonable steps for the prevention and detertion ol fraud and other irregularities.
The trustees are responsible for the maintenance and inte9rity of the corporate and financial
information included on the charit3ble company's web51te. Leg151ation in the Unitod Kin9aom
90veTnin9 the preparation and dissemination of f￿nanCIal statements may differ from
legislation in other jurisdiction5.
The trustees. annual report has been approved by the trustees on
signed o
behal
2022 and
Nicholas Da
Trustee
Id Jenkins
Company number.. 09542896
Charity number. 1162031
Pa9e 8 0123

## **Operation Fistula (UK)** 

**Independent Auditor's Report** For the year ended 31 December 2021 


## **Independent Auditor's Report to the Members of Operation Fistula (UK)** 

## **Opinion** 

We have audited the financial statements of Operation Fistula (UK) (the ‘charitable company’) for the year ended 31 December 2021 which comprise the Statement of Financial Activities, the Balance Sheet, the Statement of Cash Flows, and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice). 

In our opinion the financial statements: 

- give a true and fair view of the state of the charitable company’s affairs as at 31 December 2021 and of its incoming resources and application of resources, including its income and expenditure, for the year then ended; 

- have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and 

- have been prepared in accordance with the requirements of the Companies Act 2006. 

## **Basis for opinion** 

We conducted our audit in accordance with International Standards on Auditing (UK) (ISAs (UK)) and applicable law. Our responsibilities under those standards are further described in the Auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the charity in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements.  We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. 

## **Conclusions relating to going concern** 

In auditing the financial statements, we have concluded that the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate. 

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charitable company's ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue. 

Our responsibilities and the responsibilities of the trustees with respect to going concern are described in the relevant sections of this report. 

## **Other information** 

The other information comprises the information included in the trustees’ annual report, other than the financial statements and our auditor’s report thereon. The trustees are responsible for the other information contained within the annual report. Our opinion on the financial 

Company number: 09542896                                Charity number: 1162031                                  Page 9 of 23 



## **Operation Fistula (UK)** 

## **Independent Auditor's Report** 


For the year ended 31 December 2021 

statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. 

We have nothing to report in this regard. 

## **Opinions on other matters prescribed by the Companies Act 2006** 

In our opinion, based on the work undertaken in the course of the audit: 

- the information given in the trustees' report for the financial year for which the financial statements are prepared is consistent with the financial statements; and 

- the trustees’ report has been prepared in accordance with applicable legal requirements. 

## **Matters on which we are required to report by exception** 

In the light of the knowledge and understanding of the charitable company and its environment obtained in the course of the audit, we have not identified material misstatements in the trustees’ report. 

We have nothing to report in respect of the following matters in relation to which the Companies Act 2006 requires us to report to you if, in our opinion: 

- adequate accounting records have not been kept; or 

- the financial statements are not in agreement with the accounting records and returns; or 

- certain disclosures of directors’ remuneration specified by law are not made; or 

- we have not received all the information and explanations we require for our audit; or 

- • the trustees were not entitled to prepare the financial statements in accordance with the small companies’ regime and take advantage of the small companies’ exemptions in preparing the directors’ report and from the requirement to prepare a strategic report. 

## **Responsibilities of trustees** 

As explained more fully in the trustees’ responsibilities statement, the trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. 

Company number: 09542896                                Charity number: 1162031                                  Page 10 of 23 



## **Operation Fistula (UK)** 

## **Independent Auditor's Report** 


For the year ended 31 December 2021 

In preparing the financial statements, the trustees are responsible for assessing the charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the charitable company or to cease operations, or have no realistic alternative but to do so. 

## **Auditor’s responsibilities for the audit of the financial statements** 

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. 

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below: 

Because of the inherent limitations of an audit, there is a risk that we will not detect all irregularities, including those leading to a material misstatement in the financial statements or non-compliance with regulation. This risk increases the more that compliance with a law or regulation is removed from the events and transactions reflected in the financial statements, as we will be less likely to become aware of instances of non-compliance. The risk is also greater regarding irregularities occurring due to fraud rather than error, as fraud involves intentional concealment, forgery, collusion, omission or misrepresentation. 

As part of an audit in accordance with ISAs (UK), we exercise professional judgment and maintain professional scepticism throughout the audit. We also: 

- Identify and assess the risks of material misstatement of the financial statements, whether due to fraud or error, design and perform audit procedures responsive to those risks, and obtain audit evidence that is sufficient and appropriate to provide a basis for our opinion. The risk of not detecting a material misstatement resulting from fraud is higher than for one resulting from error, as fraud may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal control. 

- Obtain an understanding of internal control relevant to the audit in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the charitable company’s internal control. 

- Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the trustees. 

- Conclude on the appropriateness of the trustees’ use of the going concern basis of accounting and, based on the audit evidence obtained, whether a material uncertainty exists related to events or conditions that may cast significant doubt on 

Company number: 09542896                                Charity number: 1162031                                  Page 11 of 23 



Operation Fistula (UK)
OPERATION
Independent Auditor's Report
For the year ended 31 December 2021
FISTULA
the charitable company's ability to continue as a going concern. If we conclude that
a material uncertainty exists, we are required to draw attention in our auditor's report
to the related disclosures in the financial statements or, if such disclosures are
inadequate, to modify our opinion. Our conclusions are based on the audit evidence
obtsined up to the date of our auditols report. However, future events or conditions
may cause the charitabl8 company to cease to contir)ue as a going concern.
Evaluate the overall presentation, structure and content of the financial statements,
including the disclosures, and whether the financial statements represent the
underlying transactions and events in a manner that achieves fair presentation li.e.
gives a true and fair view).
We commLJnicate with those charged with governance regarding, among other matters, the
planned scope and timing of the audit and significant audit findings, including any significant
deficiencies in intemal control that we identify during our audit.
Use of our report
This report is made solely to the charity's members, as a body, in accordance ￿￿th Chapter 3
of Part 16 ofthe Companies Act 2W6. Our auditwork has been undertaken so that we might
state to the charitable company's members those matters we are required to state to them
in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do
not accept or assume responsibility to anyone other than thè charitable company and the
charitable company's members as a body, lor our audit work, for this report, or for the
opinion5 we have formed.
Sophie Wheeler- Senior Statutory Auditor
For and on behalf of Sophie Wheeler
Accountants Limited
27, October 2022
Company number. 09542896
Charity number. 1162031
Page 12of23

## **OPERATION FISTULA (UK)** 

**Statement of financial activities** (incorporating an income and expenditure account) 

For the year ended 31 December 2021 

|For theyear ended 31 December 2021|||||||
|---|---|---|---|---|---|---|
|Note<br>**Income from:**<br>2<br>3<br>4<br>5<br>5<br>5<br>5<br>5<br>**Reconciliation of funds:**<br>Donations and legacies<br>Charitable activities<br>Investments<br>Other<br>**Total income**<br>**Total expenditure**<br>Charitable activities:<br>Visualise Gender Equality (Viz5 formerly VGE)<br>KICKSTART<br>**Expenditure on:**<br>Fistula Repair For Every Woman Everywhere<br>(FREE)<br>Global Obstetric Fistula Automated Registry<br>(GOFAR)<br>Raising funds<br>Transfers between funds<br>**Net movement in funds**<br>Total funds brought forward<br>**Total funds carried forward**<br>**Net income / (expenditure) for the year**<br>6|Unrestricted<br><br>£<br>200,602<br>-<br>9<br>-|Restricted<br>£<br>152,225<br>-<br>-<br>-|**2021**<br>**Total**<br>**£**<br>**352,827**<br>**-**<br>**9**<br>**-**|Unrestricted<br>£<br>319,779<br>43,581<br>-<br>140|Restricted<br>£<br>416,028<br>-<br>94<br>-|2020<br>Total<br>£<br>735,807<br>43,581<br>94<br>140|
||200,611|152,225|**352,836**|363,500|416,122|779,622|
||33,886<br>44,967<br>29,349<br>19,329<br>28,013|-<br>223,966<br>95,410<br>-<br>66,191|**33,886**<br>**268,933**<br>**124,759**<br>**19,329**<br>**94,204**|47,114<br>107,687<br>101,926<br>66,843<br>13,477|-<br>348,695<br>9,440<br>-<br>-|47,114<br>456,382<br>111,366<br>66,843<br>13,477|
||155,544|385,567|**541,111**|337,047|358,135|695,182|
||45,067|(233,342)|**(188,275)**|26,453|57,987|84,440|
||-|-|**-**|-|-|-|
||45,067<br>94,941|(233,342)<br>259,734|(188,275)<br>**354,675**|26,453<br>68,488|57,987<br>201,747|84,440<br>270,235|
||140,008|26,392|**166,400**|94,941|259,734|354,675|



All of the above results are derived from continuing activities. There were no other recognised gains or losses other than those stated above. Movements in funds are disclosed in Note 16 to the financial statements. 

Page 13 of 23 

Company number: 09542896 

Charity number: 1162031 



OPERATION FISTULA (UK)
Balance sheet
Company no. O9542B96
31 Decem
?021
2021
2020
ix•d
T￿gible assets
1.292
2,853
1.29Z
Cuff•rbt assets:
2,853
t>ebio
Cath a.. baTrk and in hand
167,310
57.138
264.556
139.530
214.448
￿4￿11*1+$.
Credi'.ors.' amounts falling due Within year
404,086
159.3401
152.2641
165.108
351,822
￿et 45s•ts 1 IllabilitlV51
166.400
354,675
Th• ol th• %h¥ity-
ReYLnc'Rd Income lunds
unrestr￿lL.d inr.ome lunds.
Gene￿1 luads
14.15.t6
26.392
259,734
1410,008
94,941
Total chwity fvTrth
3S4,675
These financia smornents have been prepgrod in aCCOrthnce Vdith the provk5O)s applic&>le to companEs under the swall ctsiHwie5'
regine.
Aoorovcd by th trust
50n
and $iontd on thc'jr beidf bv
Mr NLhola5 D3vid J¢nkinS
Twstee
Cornpèny number 09542896
Chanty nlJrDber.. 1162031
Page14of23

## **OPERATION FISTULA (UK)** 

## **Statement of cash flows** 

|**OPERATION FISTULA (UK)**<br>**Statement of cash flows**|||||
|---|---|---|---|---|
|For the year ended 31 December 2021|||||
|Note<br>a<br>b<br>**Cash flows from operating activities:**<br>**Cash flows from financing activities**<br>**Net cash provided by / (used in) investing activities**<br>**Net cash provided by / (used in) operating activities**<br>**Cash flows from investing activities**<br>Purchase of fixed assets<br>Proceeds from the sale of fixed assets<br>Cash and cash equivalents at the beginning of the year<br>**Cash and cash equivalents at the end of the year**<br>**Change in cash and cash equivalents in the year**|**£**<br>**£**<br>**(82,392)**<br>**-**<br>**-**<br>**-**<br>**-**<br>**(82,392)**<br>**139,530**<br>**57,138**<br>**2021**||**£**<br>**£**<br>114,955<br>-<br>1,032<br>1,032<br>-<br>115,987<br>23,543<br>139,530<br>2020||
||||||
|||**(82,392)**<br>**139,530**||115,987<br>23,543|
|||**57,138**||139,530|



## **a) Reconciliation of net income / (expenditure) to net cash flow from operating activities** 

|**Net income / (expenditure) for the reporting period**<br>**(as per the statement of financial activities)**<br>Depreciation charges<br>Loss/(profit) on the sale of fixed assets<br>(Increase)/decrease in debtors<br>Increase/(decrease) in creditors<br>**Net cash provided by / (used in) operating activities**<br>**b)**<br>Cash in hand and at bank<br>**Total cash and cash equivalents**<br>**Analysis of cash and cash equivalents**|At 1 January<br>2021<br>£<br>139,530|Cash flows<br>**£**<br>(82,392)|**2021**<br>**£**<br>**(188,275)**<br>**1,560**<br>**-**<br>**97,246**<br>**7,076**|2020<br>£<br>84,440<br>1,638<br>(140)<br>(3,068)<br>32,085|
|---|---|---|---|---|
||||**(82,392)**|114,955|
||||Other<br>changes<br>£<br>-|**At 31**<br>**December**<br>**2021**<br>**£**<br>**57,138**|
||139,530|(82,392)|-|**57,138**|



Page 15 of 23 

Company number: 09542896 

Charity number: 1162031 



## **OPERATION FISTULA (UK)** 

## **Notes to the financial statements** 

- For the year ended 31 December 2021 **1 Accounting policies** 

## **Statutory information** 

Operation Fistula (UK) is a charitable company limited by guarantee and is incorporated in England and Wales. The registered office address is Shakespeare House, 168 Lavender Hill, London, SW11 5TG 

## **Basis of preparation** 

The financial statements have been prepared in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) - (Charities SORP FRS 102), the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Companies Act 2006. Assets and liabilities are initially recognised at historical cost or transaction value unless otherwise stated in the relevant accounting policy or note. 

## **Public benefit entity** 

The charitable company meets the definition of a public benefit entity under FRS 102. 

## **Going concern** 

The trustees considers that there are no material uncertainties about the charity’s ability to continue as a going concern. The COVID-19 pandemic has had an impact on the charity’s fundraising income. This has been offset by grants from Operation Fistula (US). As a project-based charity with few long term commitments, this will impact on new activity overseas that can made in the short term rather than affecting the charity’s ability to continue as a going concern. There are no material uncertainties affecting the current year’s accounts. 

## **Income** 

Income is recognised when the charity has entitlement to the funds, any performance conditions attached to the income have been met, it is probable that the income will be received and that the amount can be measured reliably. 

Income from government and other grants, whether ‘capital’ grants or ‘revenue’ grants, is recognised when the charity has entitlement to the funds, any performance conditions attached to the grants have been met, it is probable that the income will be received and the amount can be measured reliably and is not deferred. 

Income received in advance of the provision of a specified service is deferred until the criteria for income recognition are met. 

## **Donations of gifts, services and facilities** 

Donated services and donated facilities are recognised as income when the charity has control over the item or received the service, any conditions associated with the donation have been met, the receipt of economic benefit from the use by the charity of the item is probable and that economic benefit can be measured reliably. In accordance with the Charities SORP (FRS 102), volunteer time is not recognised so refer to the trustees’ annual report for more information about their contribution. 

On receipt, donated gifts, services and donated facilities are recognised on the basis of the value of the gift to the charity which is the amount the charity would have been willing to pay to obtain services or facilities of equivalent economic benefit on the open market; a corresponding amount is then recognised in expenditure in the period of receipt. 

## **Interest receivable** 

Interest on funds held on deposit is included when receivable and the amount can be measured reliably by the charity; this is normally upon notification of the interest paid or payable by the bank. 

## **Fund accounting** 

Funds are designated as restricted or unrestricted. Where there is a legal restriction on the purpose to which a fund may be put, the fund is classified as a restricted fund. Restricted funds are those where the donor has provided for the donation to be spent in furtherance of a specified charitable purpose. 

Page 16 of 23 

Company number: 09542896 

Charity number: 1162031 



## **OPERATION FISTULA (UK)** 

## **Notes to the financial statements** 

For the year ended 31 December 2021 

## **1 Accounting policies (continued)** 

## **Expenditure** 

Expenditure is recognised once there is a legal or constructive obligation to make a payment to a third party, it is probable that settlement will be required and the amount of the obligation can be measured reliably. Expenditure is classified under the following activity headings: 

- Costs of raising funds relate to the costs incurred by the charitable company in inducing third parties to make voluntary contributions to it, as well as the cost of any activities with a fundraising purpose 

- Expenditure on charitable activities includes the costs of delivering services undertaken to further the purposes of the charity and their associated support costs. 

## **Allocation of support costs** 

Resources expended are allocated to the particular activity where the cost relates directly to that activity. However, the cost of overall direction and administration of each activity, comprising the salary and overhead costs of the central function, is apportioned on the basis of staff time. 

Governance costs are the costs associated with the governance arrangements of the charity. These costs are associated with constitutional and statutory requirements and include any costs associated with the strategic management of the charity’s activities. Governance costs are allocated to each activity based on staff time. 

## **Tangible fixed assets** 

Items of equipment are capitalised and depreciation costs are allocated to activities on the basis of the use of the related assets in those activities. 

Depreciation is provided at rates calculated to write down the cost of each asset to its estimated residual value over its expected useful life. 

## **Debtors** 

Trade and other debtors are recognised at the settlement amount due after any trade discount offered. Prepayments are valued at the amount prepaid net of any trade discounts due. 

## **Cash at bank and in hand** 

Cash at bank and cash in hand includes cash and short term highly liquid investments with a short maturity of three months or less from the date of acquisition or opening of the deposit or similar account. Cash balances exclude any funds held on behalf of service users. 

## **Creditors and provisions** 

Creditors and provisions are recognised where the charity has a present obligation resulting from a past event that will probably result in the transfer of funds to a third party and the amount due to settle the obligation can be measured or estimated reliably. Creditors and provisions are normally recognised at their settlement amount after allowing for any trade discounts due. 

## **Financial instruments** 

The charity only has financial assets and financial liabilities of a kind that qualify as basic financial instruments. Basic financial instruments are initially recognised at transaction value and subsequently measured at their settlement value. 

## **Pensions** 

The charity operates a defined contribution pension scheme. Costs are allocated between restricted and unrestricted funds in accordance with the time spent on restricted and unrestricted work by staff members. 

Page 17 of 23 

Company number: 09542896 

Charity number: 1162031 



## **OPERATION FISTULA (UK)** 

## **Notes to the financial statements** 

## For the year ended 31 December 2021 

## **2 Income from donations and legacies** 

|**Income from donations and legacies**|||||
|---|---|---|---|---|
|Anonymous donor via IG Partners<br>UNFPA HQ<br>Grand Challenges Canada<br>Covid 19 grant from UK government<br>Operation Fistula US<br>Others<br>Tableau Foundation<br>Donations:<br>Donated services|Unrestricted<br>£<br>153,758<br>-<br>-<br>40,000<br>5,164<br>1,680<br>-|£<br>54,858<br>68,905<br>-<br>-<br>-<br>-<br>28,462<br>Restricted|**2021**<br>**Total**<br>**£**<br>**208,616**<br>**68,905**<br>**-**<br>**40,000**<br>**5,164**<br>**1,680**<br>**28,462**|2020<br>Total<br>£<br>265,898<br>-<br>355,705<br>40,000<br>67,303<br>942<br>5,959|
||200,602|152,225|**352,827**|735,807|



## **3 Income from charitable activities** 

|**Income from charitable activities**|||||
|---|---|---|---|---|
|Total income from charitable activities<br>UNFPA Mozambique|Unrestricted<br>£<br>-|£<br>-<br>Restricted|**2021**<br>**Total**<br>**£**<br>**-**|2020<br>Total<br>£<br>43,581|
||-|-|**-**|43,581|



## **4 Income from investments** 

|Bank interest receivable|Unrestricted<br>£<br>9|£<br>-<br>Restricted|**2021**<br>**Total**<br>**£**<br>**9**|2020<br>Total<br>£<br>94|
|---|---|---|---|---|
||9|-|**9**|94|



Page 18 of 23 

Company number: 09542896 

Charity number: 1162031 



|||||||2020|Total|£|280,757||49|2,452||4,707|440|334,799|-|24,687|16,397|22,512|772|2,400|3,572|1,638|695,182|-|-|695,182|
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|||||||Support|costs||41,293||-|348||2,663|420|-|-|18,938|601|22,512|747|-|562|1,638|89,722|(89,722)|-|-|
|||||||Governance|costs||6,953||-|-||-|-|-|-|-|-|-|-|2,400|3,005|-|12,358|-|(12,358)|-|
||||||||KICKSTART||5,856||-|-||-|-|-|-|1,949|-|-|-|-|-|-|7,805|4,985|687|13,477|
||Charitable activities|Global<br>Visualise|Obstetric<br>Gender|Fistula<br>Equality|Automated<br>(Viz5|Registry<br>formerly|(GOFAR)<br>VGE)||53,564<br>47,599||-<br>21|1,073<br>674||1,971<br>73|-<br>20|-<br>-|-<br>-|3,800<br>-|13,387<br>-|-<br>-|-<br>25|-<br>-|-<br>-|-<br>-|73,795<br>48,412|33,023<br>16,200|4,548<br>2,231|111,366<br>66,843|
||||Fistula Repair|For Every|Woman|Everywhere|(FREE)||86,427||-|232||-|-|334,799|-|-|2,310|-|-|-|5|-|423,773|28,661|3,948|456,382|
||||||Cost of|raising|funds||39,065||28|125||-|-|-|-|-|99|-|-|-|-|-|39,317|6,853|944|47,114|
||||||||**2021 Total**|**£**|**321,889**||**-**|**1,644**||**1,256**|**256**|**150,313**|**-**|**6,700**|**45,493**|**3,100**|**6,132**|**2,400**|**368**|**1,560**|**541,111**|**()**|**-**|**541,111**|
|||||||Support|costs|£|52,406||-|433||1,230|246|-|-|3,400|3,269|3,100|6,132|-|320|1,560|72,096|(72,096)|-|**-**|
|||||||Governance|costs|£|13,229||-|-||-|-|-|-|-|-|-|-|2,400|-|-|15,629|-|(15,629)|**-**|
||||||||KICKSTART|£|66,191||-|-||-|-|-|-|-|-|-|-|-|-|-|66,191|23,022|4,991|**94,204**|
||Charitable activities|Global<br>Visualise|Obstetric<br>Gender|Fistula<br>Equality|Automated<br>(Viz5|Registry<br>formerly|(GOFAR)<br>VGE)|£<br>£|60,502<br>14,896||-<br>-|1,190<br>-||26<br>-|-<br>10|-<br>-|-<br>-|750<br>-|37,227<br>-|-<br>-|-<br>-|-<br>-|-<br>-|-<br>-|99,695<br>14,906|20,599<br>3,635|4,465<br>788|**124,759**<br>**19,329**|
||||Fistula Repair|For Every|Woman|Everywhere|(FREE)|£|88,511||-|-||-|-|150,313|-|-|4,997|-|-|-|48|-|243,869|20,599|4,465|**268,933**|
|**5**<br>**Analysis of expenditure**|||||Cost of|raising|funds|£|Staff costs (Note 7)<br>26,154||Publicity<br>-|Travel and subsistence<br>21|Training, workshops &|conferences<br>-|Other staff costs<br>-|Grant to partners<br>-|Surgeons fee<br>-|Consultancy<br>2,550|Software<br>-|Premises expenses<br>-|General office costs<br>-|Audit fee<br>-|Sundry expenses<br>-|Depreciation<br>-|28,725|Support costs<br>4,241|Governance costs<br>920|**Total expenditure 2021**<br>**33,886**|





## **OPERATION FISTULA (UK)** 

## **Notes to the financial statements** 

For the year ended 31 December 2021 

## **6 Net incoming resources for the year** 

This is stated after charging / crediting: 

|This is stated after charging / crediting:|||
|---|---|---|
||**2021**|2020|
||**£**|£|
|Depreciation|**1,560**|1,638|
|Audit fees inc. VAT|**2,400**|2,400|



## **7 Analysis of staff costs, trustee remuneration and expenses, and the cost of key management personnel** 

Staff costs were as follows: 

|Salaries and wages<br>Social security costs<br>Employer’s contribution to defined contribution pension schemes|**2021**<br>2020<br>**£**<br>£<br>**287,499**<br>251,134<br>**28,263**<br>24,222<br>**6,128**<br>5,401|
|---|---|
||**321,890**<br>280,757|



One employee earned between £90,000 - £99,000 during the year (2020: £80,000 - £89,000: 1). 

The total employee benefits including pension contributions of the key management personnel were £143,047 (2020: £135,327). 

The charity trustees were not paid or received any other benefits from employment with the charity in the year (2020: £nil). No charity trustee received payment for professional or other services supplied to the charity (2020: £nil). 

There are no trustee expenses incurred this year (2020: £3,005) 

## **8 Staff numbers** 

The average number of employees (head count based on number of staff employed) during the year was as follows: 

|Average staff|**2021**<br>2020<br>**No.**<br>No.<br>**6.1**<br>5.3|
|---|---|
||**6.1**<br>5.3|



## **9 Related party transactions** 

During the year Operation Fistula USA made grants totaling of £208,615 (2020: £265,898) to Operation Fistula (UK ). Operation Fistula (UK) sent funding in the amount of £150,313 (2020: £334,799) to support the FREE project in Madagascar (administrated by Operation Fistula USA). Operation Fistula USA and Operation Fistula (UK) are founded by Seth Cochran and he is also the CEO of both charities. 

## **10 Taxation** 

The company has been recognised by HM Revenue & Customs as a charity and does not pay Corporation Tax as income received is used for charitable purposes. 

Page 20 of 23 

Company number: 09542896 

Charity number: 1162031 



## **OPERATION FISTULA (UK)** 

## **Notes to the financial statements** 

For the year ended 31 December 2021 

## **11 Tangible fixed assets** 

|**12**<br>**13**<br>**Debtors**<br>**Creditors: amounts falling due within one year**<br>Accruals<br>Taxation and social security<br>Other creditors<br>At the end of the year<br>At the end of the year<br>At the start of the year<br>Charge for the year<br>At the start of the year<br>Additions in year<br>**Cost**<br>**Depreciation**<br>**Net book value**<br>**At the end of the year**<br>At the start of the year<br>Disposal in year<br>Disposal in year<br>All of the above assets are used for charitable purposes.<br>Other debtors<br>Prepayments<br>Accrued grant|Computer<br>and office<br>equipment<br>**Total**<br>£<br>**£**<br>8,370<br>**8,370**<br>-<br>**-**<br>-<br>**-**|
|---|---|
||8,370<br>**8,370**|
||5,517<br>**5,517**<br>1,560<br>**1,560**<br>-<br>**-**|
||7,078<br>**7,078**|
||1,292<br>**1,292**|
||2,853<br>2,853|
||**2021**<br>2020<br>**£**<br>£<br>**167,310**<br>262,681<br>**-**<br>-<br>**-**<br>1,875|
||**167,310**<br>264,556|
||**2021**<br>2020<br>**£**<br>£<br>**9,054**<br>45,283<br>**47,141**<br>-<br>**3,146**<br>6,981|
||**59,341**<br>52,264|



Page 21 of 23 

Company number: 09542896 

Charity number: 1162031 



## **OPERATION FISTULA (UK)** 

## **Notes to the financial statements** 

For the year ended 31 December 2021 

|**14**|**Prior year adjustment**||**2021**|2020|
|---|---|---|---|---|
||Adjustment has been made to prior year figures in relation to reclassification of unrestricted fund to||||
||restricted fund and accrued income||**£**|£|
||**Unrestricted funds:**||||
||Opening unrestricted fund balance at the start of the year (as previously stated)||94,941|168,488|
||Prior year adjustment to reclassify unrestricted fund to restricted fund||-|(100,000)|
||Prior year adjustment for change in methodology of recognising in-kind support||-|-|
||Opening unrestricted fund balance at the start of the year (as restated)||**94,941**|68,488|
||||**£**|£|
||**Restricted funds:**||||
||Opening restricted fund balance at the start of the year (as previously stated)||259,734|101,747|
||Prior year adjustment to reclassify unrestricted fund to restricted fund||-|100,000|
||Opening restricted fund balance at the start of the year (as restated)||**259,734**|201,747|
|**15**|**Analysis of net assets between funds (current year)**||||
|||General|||
|||unrestricted|Restricted|**Total funds**|
|||£|£|**£**|
||Tangible fixed assets|1,292|-|**1,292**|
||Net current assets / (liabilities)|138,716|26,392|**165,108**|
||**Net assets at the end of the year**|**140,008**|**26,392**|**166,400**|
||**Analysis of net assets between funds (prior year)**||||
|||General|||
|||unrestricted|Restricted|Total funds|
|||£|£|£|
||Tangible fixed assets|2,853|-|2,853|
||Net current assets|92,088|259,734|351,822|
||Net assets at the end of the year|94,941|259,734|354,675|



Page 22 of 23 

Company number: 09542896 

Charity number: 1162031 



## **OPERATION FISTULA (UK)** 

## **Notes to the financial statements** 

For the year ended 31 December 2021 

## **16 Movements in funds (current year)** 

|**Restricted funds**<br>**Restricted funds**<br>**Movements in funds (prior year)**<br>**Unrestricted funds**<br>**Total funds**<br>**Total funds**<br>**Unrestricted funds**|the year (as<br>previously<br>stated)<br>Prior year<br>adjustment<br>(Note 14 )<br>At the start<br>of the year<br>Incoming<br>resources &<br>gains<br>Outgoing<br>resources &<br>losses<br>**At the end of**<br>**the year**<br>£<br>£<br>£<br>£<br>**£**<br>259,734<br>-<br>259,734<br>152,225<br>(385,567)<br>**26,392**<br>94,941<br>94,941<br>200,611<br>(155,544)<br>**140,008**<br>354,675<br>-<br>354,675<br>352,836<br>(541,111)<br>**166,400**<br>At the start of<br>the year<br>Prior year<br>adjustment<br>(Note 14 )<br>At the start<br>of the year<br>(as restated)<br>Incoming<br>resources &<br>gains<br>Outgoing<br>resources &<br>losses<br>At the end of<br>the year<br>£<br>£<br>£<br>£<br>£<br>£<br>101,747<br>100,000<br>201,747<br>416,122<br>(358,135)<br>259,734<br>168,488<br>(100,000)<br>68,488<br>363,500<br>(337,047)<br>94,941|the year (as<br>previously<br>stated)<br>Prior year<br>adjustment<br>(Note 14 )<br>At the start<br>of the year<br>Incoming<br>resources &<br>gains<br>Outgoing<br>resources &<br>losses<br>**At the end of**<br>**the year**<br>£<br>£<br>£<br>£<br>**£**<br>259,734<br>-<br>259,734<br>152,225<br>(385,567)<br>**26,392**<br>94,941<br>94,941<br>200,611<br>(155,544)<br>**140,008**<br>354,675<br>-<br>354,675<br>352,836<br>(541,111)<br>**166,400**<br>At the start of<br>the year<br>Prior year<br>adjustment<br>(Note 14 )<br>At the start<br>of the year<br>(as restated)<br>Incoming<br>resources &<br>gains<br>Outgoing<br>resources &<br>losses<br>At the end of<br>the year<br>£<br>£<br>£<br>£<br>£<br>£<br>101,747<br>100,000<br>201,747<br>416,122<br>(358,135)<br>259,734<br>168,488<br>(100,000)<br>68,488<br>363,500<br>(337,047)<br>94,941|
|---|---|---|
|||354,675<br>352,836<br>(541,111)<br>**166,400**|
|||At the start<br>of the year<br>(as restated)<br>Incoming<br>resources &<br>gains<br>Outgoing<br>resources &<br>losses<br>At the end of<br>the year<br>£<br>£<br>£<br>£<br>201,747<br>416,122<br>(358,135)<br>259,734<br>68,488<br>363,500<br>(337,047)<br>94,941|
||270,235<br>-|270,235<br>779,622<br>(695,182)<br>354,675|



## **Purposes of restricted funds** 

Fistula Repair For Every Woman Everywhere (FREE) funds are received and allocated for use of Madagascar project (please refer trustees Report for further details). Global Obstetric Fistula Automated Registry (GOFAR) funds are in-kind software support and allocated for use for GOFAR together project (please refer trustees report for further details). 

## **17 Legal status of the charity** 

The charity is a company limited by guarantee and has no share capital. 

Page 23 of 23 

Company number: 09542896 

Charity number: 1162031