Company number: 09542896 Charity number: 1162031
OPERATION FISTULA (UK) ANNUAL REPORT & FINANCIAL STATEMENTS
For the year ended 31 December 2023
Operation Fistula (UK)
Contents
For the year ended 31 December 2023
| Page: | |
|---|---|
| Reference & Administrative Information | 2 |
| Trustees’ Annual Report | 3-11 |
| Independent Auditor’s Report | 12-15 |
| Statement of Financial Activities (incorporating an income and expenditure | 16 |
| account) | |
| Balance Sheet | 17 |
| Statement of Cash Flows | 18 |
| Notes to the Financial Statements | 19-25 |
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Operation Fistula (UK)
Reference & Administrative Information
For the year ended 31 December 2023
Company number 09542896 Charity number 1162031 Registered office Lambourne House 311-321 Banbury Road Oxford, OX2 7JH 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 Dr Jerker Liljestrand Akinyi Sagoe-Moses
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 27 Regent Grove Holly Walk Leamington Spa CV23 4NN
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Operation Fistula (UK)
Trustees’ Annual Report
For the year ended 31 December 2023
The trustees present their report and the financial statements for the year ended 31 December 2023.
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 more than 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 Operation Fistula’s purposes, are described in terms of the following programs:
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, locally lead, program in Madagascar, where we are aiming to eradicate obstetric fistula across targeted regions of the country. This means finding the patients who are most difficult to reach, mobilising them to care, delivering treatment and post operative support, and enabling rehabilitation and psychosocial care.
Our work seeks to design a replicable and scalable delivery model that finds every woman living with fistula, and works to meet their needs. This work is currently being implemented in Madagascar, but our future vision is to scale this work to other countries via South-South collaboration. We call this program Fistula Repair for Everyone Everywhere (FREE). The program is currently being implemented in Madagascar. Our vision is to scale this work to more countries and geographies, via South-South collaboration and replication.
We have harnessed the power of technology and analytics to trigger collaboration and
improve quality . 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
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Operation Fistula (UK)
Trustees’ Annual Report
For the year ended 31 December 2023
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 and quality insights that improve their care and strengthen the implementation of their interventions.
We empower local service providers with catalytic funding. Our funding model is the backbone of several programs. Our funding is catalytic – the goal is to enable grassroots providers, who cannot access traditional funding, to access the resources they need to be able to deliver free care to patients. Our catalytic funding is performance-based, and conditional on data collection and data entry into the GOFAR system.
The data we collect via the process enables us to verify the quality of care delivered, monitor and track performance of the surgeon, and deliver insights to improve care quality and increase care capacity moving forward.
This program currently has two components: the first, is surgical funding – this enables eligible providers (those with no access to other funding) to access the resource they need to bridge the gap and enable a fistula repair surgery to take place; the second is data funding – this is centred on incentivising high quality data collection, digitisation, and analysis across the global fistula care ecosystem. We know digitisation adds a layer of administrative burden
to frontline surgeons, who are already overwhelmed with demands. As a way of incentivising digitisation and accounting for this additional administrative burden we now offer our catalytic funding to all surgeons entering data to GOFAR on a per record basis. This funding is available to all surgeons working in the fistula ecosystem, regardless of their access to other funding.
At Operation Fistula, we call this programme of work ‘Kickstart’ because this funding is the catalyst - without it care would not occur, data would not be collected, and quality insights would not be collected and shared.
We identify and map the system failures that cause fistula so it can be prevented. We do this using data we have collected, and data from partners. We then visualise this data using data visualisation software. This visualised data empowers the global community with insights for impact and prevention - providing organisations with data advocacy tools, and revealing areas of extreme gender inequality, injustice, vulnerability, and system failure. The goal of this programme is fistula prevention and system strengthening. It works by providing governments and partners with national-level data dashboards that can enable them to identify trends that empower more targeted interventions, and better approaches to the prevention of both maternal morbidities (like fistula) and maternal death. This data can then also drive cross-partner collaboration and enable more efficient interventions in the work to achieve the United Nations Sustainable Development Goals (SDGs). The name of this programme summarises its goal, to: Visualise Gender Equality.
How We Frame the Work
In 2023, we began to think about updating the language we use to describe our work and programs. We are in the process of iterating new language for our programs that will better
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Operation Fistula (UK)
Trustees’ Annual Report
For the year ended 31 December 2023
captures the essence of our programmatic work. Our goal in this process is clarification and simplification. While our programmatic work, activities, and areas of focus have not changed, we believe that we can evolve the way we describe them to be more intuitive and illuminating. This work is ongoing, and we anticipate that this change will take place and be recorded before we file our 2024 Annual Report and Financial Statements.
Achievements and Performance
It’s a rare thing for a charitable organisation that has experienced swift scale to take time to reflect and self-scrutinise to determine where it is enabling the most positive, tangible impact, and adding the most value. In 2023, Operation Fistula did just that.
We knew that having experienced swift expansion and scale across our programs, we needed to pause and reflect on our accomplishments, the lessons we had learned, and the impact we had across our programs over the five-year period of 2018–2022.
This review and audit of Operation Fistula’s progress and performance was driven by a desire to ensure that the charity’s work and resources are being leveraged for maximal efficiency, effectiveness, and impact, while also considering where Operation Fistula can deliver the most sustainable and positive impact at scale in the future. The goal of this impact audit and report was to ensure that Operation Fistula’s service-delivery and programs are optimised by the learnings of the past, adapted to leverage future opportunities, and designed to ensure both the sustainability and future scalability of Operation Fistula programs.
We synthesised the learnings from this period of intense growth and change into a 5-year impact report, and used its findings to build the vision for Operation Fistula’s future strategy and work.
2023 was the perfect juncture for this reflective work. We knew that in the wake of the COVID pandemic there would be significant shifts in global philanthropy and bilateral funding. In 2023 we felt that shift – experiencing challenging fundraising environments and contexts, and shifts in donor priorities and strategies. It was the ideal time to slow down, reflect, and reevaluate.
We continued supporting our partners and implementing our programs throughout 2023, but we decided to shift our focus away from scaling output numbers, and towards understanding where we are driving the most impact and the highest quality outcomes. This decision not only resulted in Operation Fistula successfully navigating complex macroeconomic challenges and ensuring its sustainability, but has also enabled us to establish a strong foundation for our future vision and priorities, and grow a healthy pipeline of funders to support it.
2023: Summary of Performance
In this report, we provide a summary of the accomplishments realised in 2023 with support from Operation Fistula (UK).
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Operation Fistula (UK)
Trustees’ Annual Report
For the year ended 31 December 2023
Operation Fistula (UK) works in close collaboration with Operation Fistula’s US entity. As a result of their united approach to strategy, operations, activities, and program implementation, this report contains the consolidated global impact metrics and achievements of Operation Fistula (UK and USA):
We conducted an audit of our 5-year impact data and published a report to show our
progress
The process of auditing our impact to produce a 5-year impact report was powerful. The resulting report tells the story of how Operation Fistula has grown and developed as an organisation and how our programs have scaled to drive transformative impact and results. The story contained within the report is a powerful reminder that, regardless of how challenging the context might be, if you remain focused on the mission and the needs and wants of the people you exist to serve, there will always be opportunities to drive considerable impact and programmatic success. Here, we summarise some of the key findings of the 5-year Impact Report:
We knew unmet need would explode during the pandemic, and that services to women and girls around the world would face cuts and curtailment. We channelled our outrage into action and swiftly scaled our service-delivery to 17 countries. Process improvement accompanied the rapid growth and we iterated our way to delivering outstanding results:
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enabling more surgeries - scaling from 44 to 4,370 fistula repairs;
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leveraging economies of scale - reducing our costs from $2,361 per case to $196; and,
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driving quality improvements - increasing our success rate from 82% to 95%.
Alongside these impressive results, we also took steps to transform the organisation. Over this period (2018–2022) we shifted the nucleus of our global operations to Madagascar, building a 100% locally led leadership and program implementation team. This shift reflects our commitment to our core value and belief in the power of proximity – our goal is to empower and support those at the grassroots to deliver proven solutions at scale. In 2023, this local team is driving considerable impact and leading several South-South replication partnerships in other African countries.
This approach, combined with our scaled program delivery and process improvements, has been recognised by leaders at national, international, and multilateral levels. Read Operation Fistula’s 5-Year Impact Report on our website www.opfistula.org.
We scrutinised our past and developed a fresh strategy for future scale and sustainability
This strategy sees us leverage our unique value in the sector to strengthen and integrate our suite of programs into national health infrastructure, in partnership with government and multilateral agencies (like UNFPA) over the next 5-years. The next 12-months will be pivotal - we will leverage new partnerships and relationships for our future work and begin building the framework for scaled adoption of our suite of programs and interventions.
In order to achieve our mission, we know we need to expand our reach to serve and connect with a broader community of actors. We can’t end fistula alone - fistula is deeply connected with other issues across public health, Maternal Newborn, and Child Health (MNCH), and
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Trustees’ Annual Report
For the year ended 31 December 2023
Sexual and Reproductive Health & Rights (SRHR) environments. Our new strategy prioritises actions and activities that will enable us to connect and partner with this broader community of actors and build energy and enthusiasm for our work and mission. The challenge here is also an opportunity - balancing our focus on ending fistula with the need to adapt to a global environment that demands broad intersectional solutions.
We expanded access to our surgical quality systems
Fistula lacks actionable, high-quality data. Quality of care and outcomes are not consistently tracked. Patients do not have complete records of their care, and surgeons lack access to insights to improve the quality of their care and treatment capacity.
In 2023, we launched a pilot to see if we could adapt our Kickstart program to incentivise data collection by funding surgeons for each record they input into our data collection system. Our primary goal was to see if this resulted in more continuous engagement in digitisation across a broader community of surgeons in the fistula ecosystem. The secondary goal of this new offering was to engage with surgeons who want to access our GOFAR system and visual data analytics, but who are not eligible to receive our surgical funding because they receive funding support from other fistula organisations or funders. We know that having access to digitised patient records, and Operation Fistula’s aggregate analytics dashboards can drive insights that can improve patient care and surgical quality. It became clear to us that limiting access to these insights, to only those partners who are eligible to receive our surgical funding, was also limiting our ability to drive quality improvement and insights across the broader fistula care ecosystem. We know that our catalytic Kickstart funding can transform treatment capacity and change behaviour, so we wanted to see if we could incentivise engagement in data collection and patient record digitisation by providing a small incentive for every patient record entered into GOFAR.
This new data funding approach has been successful. We have a core group of surgeons that are very active, and we have received patient records in every month of 2023. We are also working to reach new surgeons who have not previously interacted with our data collection and the GOFAR system. Several potential partner organisations have emerged. We are still testing different approaches and methodologies to enable broader adoption so that we can enable more shared measurement and digitisation across the fistula ecosystem as we move into 2024.
We continued to drive catalytic funding to grassroots providers
In 2023 our Kickstart program supported 760 patients. This is a smaller figure than 2022, but as we have mentioned, 2023 was a pivotal year – we took a strategic pause to reflect and plan for future scale and sustainability. We are now better positioned to add outsized impact and value in the work to end fistula.
We are also mindful that the fistula ecosystem is changing. The majority of other fistula organisations are exclusively focused on funding surgeries. Operation Fistula is funding surgeries, but we are also driving innovation in high-quality digital case management, incentivising data collection and digitisation, producing powerful data analytics, and
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Operation Fistula (UK)
Trustees’ Annual Report
For the year ended 31 December 2023
developing new and improved metrics for calculating the true impact of fistula care interventions. Our Kickstart funding program is a core component of much of this work, but we’re also keenly aware that we offer a broader suite of solutions to the fistula care ecosystem, and that these solutions have the potential to drive positive impact across a more intersectional set of challenges connected to improving MNCH and SRHR, and delivering on the 2030 Sustainable Development Goal agenda.
We built a pipeline for new funding and a pathway to sustainability
Our internal review, impact audit, and publication of our 5-year impact report, combined with the development and communication of our future strategy, enabled us to generate fresh funding leads and new relationships with funders in 2023.
The fundraising environment in 2022-2023 was extremely challenging. We saw post-COVID shifts in philanthropic and bilateral funding and priorities negatively affect fistula funding, and also reduce funding streams to support improved MNCH and SRHR. Our keen awareness of this challenging environment, spurred us on to take action to diversify our funding pipeline and revitalise our funding relationships. We started implementing a new fundraising strategy that prioritised building relationships with other organisations experiencing this volatile and unpredictable economic environment – we believed that by reaching out and connecting we would create space for new opportunities to emerge. So far, this new strategy has been successful, with several new funders emerging for Operation Fistula. We anticipate this will continue in 2024, and have several exciting opportunities on the horizon.
We continued to drive innovation in impact measurement for fistula care
In general, the fistula care ecosystem defines “success” in strictly clinical terms. Patients are rarely consulted on their individual needs and goals for their care. Whether a fistula is closed during surgery, and whether a patient resumes continence, are the most common indicators of success in fistula treatment. We know, however, that for patients there are myriad other factors that determine their feelings regarding the outcome of their treatment, but currently there is no means of quantifying their experiences as data which can be analysed to improve interventions. This means the way that data has been collected and represented in the past does not present the full picture. To begin rectifying this, we have launched work to develop and deliver the first ever fistula-specific Quality of Life (QoL) Tool for use across the fistula care ecosystem. This work is currently being validated through an ambitious research project. This new tool will help us to improve sector-wide understanding of what patients think about their condition, and how it affects their everyday lives.
In 2023, our focus has been delivering the first stage of QoL Tool validation. Our talented team in Madagascar has trained a number of Data Agents, who have administered the tool to 128 fistula patients across the country. As we continue collecting participants’ responses, we will analyse the data to strengthen the tool. We plan to publish the results of our research, and make the tool free and accessible to all fistula care providers, providing new opportunities to conduct research and publish further articles as we validate the tool in new contexts. Beyond these research and replication opportunities, we believe this tool will
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Operation Fistula (UK)
Trustees’ Annual Report
For the year ended 31 December 2023
enable us to become better patient advocates, increasing the efficiency and efficacy of interventions, and even potentially improving the cost-effectiveness of care delivery.
Our QoL Tool will also give us deep insight into the myriad system failures that resulted in a patient developing a fistula. Collecting and sharing data on the system failures and inequities that affect women living with fistula is a key part of our prevention work and Visualise Gender Equality strategy.
Capacity Building & Support
In terms of organisational strengthening and capacity building, 2023 saw Operation Fistula continue supporting its program implementation and operations teams to Madagascar. The global staff, who are based in the UK, are focused on providing support to local leadership, as well as ensuring fundraising and resource mobilisation keep pace with planned programmatic expansion and scale. Our UK staff also ensure excellent governance of the global organisation, and ensure the polices, protocols, and procedures are followed. They also provide financial oversight and administer the accounts. The Madagascar team continues to thrive – their leadership and program implementation continues to be of an extremely high standard. We continue to invest in staff capacity building a training across all entities.
In addition to this organisational strengthening and staff capacity building, we continue to prioritise regular reviews and health-checks of our administrative and governance systems.
As we look ahead to 2024, we are keen to continue our evolution into a sector-leading global organisation with robust systems, processes, and protocols that ensure optimal people, program, and partnership management, and excellent governance structures.
Ensuring that 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, is a fundamental part of Operation Fistula’s ethos.
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 2023 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 2023 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.
In summary, total income amounted to £269,706 (2022: £530,678) and total expenditure amounted to £255,493 (2022: £586,750) resulting in a surplus of £14,213 (2022 deficit:
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Trustees’ Annual Report
For the year ended 31 December 2023
£56,072). 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’s US entity, 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 the 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’s US entity is instrumental in raising donation income from US based donors to fund charitable activities. Operation Fistula’s US entity and Operation Fistula (UK) were both founded by Seth Cochran. 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 accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).
Company law requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charitable company, and of the
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Operation Fistula (UK) OPERATION Trustees, Annual Report For the year ended 31 December 23 FISTULA incoming resources and application of resources. including the income and expenditure of the charitable company for that period. In preparin9 these financial statements, the trustees are required to.. Select suitsble accounting policie5 and then apply them consistently. Observe the methods and principles in the Charitie5 SORP. Make iud9ements and e5timate5 that are reasonable and prudent. State whether applicable UK Accounting Standards and statements of recornmended practice have been followed, subject to èny Material departure5 disclosed and explained in the financial statements. Prepare the financial statements on the 90ing concem ba&$ unless it is inappropriate to presume that the charity will continue in operation. The trustees are responsible for keeping proper accounting records that disclose with asonèble accuracy at any time the financial position ol the charitable company. and enbble thèm to ensure that the financial statements comply with the Companies Act 2006. Thcy are Iso responsible for safe9uardin9 the assets of the charitable company, and hence for takin9 reasonable steps for the prevention and detettion of fraud and other irregularities. The trustges are responsible lor the maintenance and integrity of the corporate and financial information included on the charitèble company's website. Le9isla:ion In the United Kingdom governing the preparation and dissemination of financial statcments may dilfcr from legislation in other ju ictions. Thc trust signe r)ua port has been approved by the trustees on 18109 the 2024 and Nich Trust89 as vid Jenki Company numiEr. 09542896 Charity number 1162031 Pa17 0125
Operation Fistula (UK) Independent Auditor's Report
For the year ended 31 December 2023
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 2023 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:
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give a true and fair view of the state of the charitable company’s affairs as at 31 December 2023 and of its incoming resources and application of resources, including its income and expenditure, for the year then ended;
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have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; and
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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.
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Operation Fistula (UK)
Independent Auditor's Report
For the year ended 31 December 2023
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 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.
In connection with our audit of the financial statements, 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 or a material misstatement of the other information. 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:
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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
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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:
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adequate and proper accounting records have not been kept; or
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the financial statements are not in agreement with the accounting records; or
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certain disclosures of trustees’ remuneration specified by law are not made; or
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we have not received all the information and explanations we require for our audit ; or
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• 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 trustees’ 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
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Independent Auditor's Report
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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.
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:
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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.
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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.
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Independent Auditor's Report
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Evaluate the appropriateness of accounting policies used and the reasonableness of accounting estimates and related disclosures made by the trustees.
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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 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 obtained up to the date of our auditor’s report. However, future events or conditions may cause the charitable company to cease to continue as a going concern.
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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 (ie. gives a true and fair view).
We communicate 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 internal 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 with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work 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 the charitable company and the charitable company’s members as a body, for our audit work, for this report, or for the opinions we have formed.
Sophie Wheeler - Senior Statutory Auditor
20[th] September 2024
For and on behalf of Sophie Wheeler Accountants Limited 27 Regent Grove Holly Walk Leamington Spa CV23 4NN
Company number: 09542896 Charity number: 1162031 Page 15 of 25
OPERATION FISTULA (UK)
Statement of financial activities (incorporating an income and expenditure account)
For the year ended 31 December 2023
| Note Income from: 2 3 4 4 4 4 4 Reconciliation of funds: Donations and legacies Investments (Bank Interest Receivable) Total income Expenditure on: Raising funds Charitable activities: Fistula Repair For Every Woman Everywhere (FREE) Global Obstetric Fistula Automated Registry (GOFAR) Visualise Gender Equality (Viz5 formerly VGE) KICKSTART Total expenditure Net movement in funds Total funds brought forward Total funds carried forward 5 Net income / (expenditure) for the year |
Unrestricted £ 216,224 208 |
Restricted £ 53,274 |
2023 Total £ 269,498 208 |
Unrestricted £ 263,935 119 |
Restricted £ 266,624 |
2022 Total £ 530,559 119 |
|---|---|---|---|---|---|---|
| 216,432 | 53,274 | 269,706 | 264,054 | 266,624 | 530,678 | |
| 15,304 25,292 65,580 18,167 85,517 |
- 12,101 33,531 - - |
15,304 37,393 99,111 18,167 85,517 |
33,302 160,196 68,326 17,669 16,331 |
- 69,168 6,858 214,899 |
33,302 229,364 75,184 17,669 231,230 |
|
| 209,861 | 45,632 | 255,493 | 295,824 | 290,926 | 586,750 | |
| 6,571 | 7,642 | 14,213 | (31,771) | (24,301) | (56,072) | |
| 6,571 108,237 |
7,642 2,091 |
14,213 110,328 |
(31,771) 140,008 |
(24,301) 26,392 |
(56,072) 166,400 |
|
| 114,808 | 9,733 | 124,541 | 108,237 | 2,091 | 110,328 |
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 13 to the financial statements.
Page 16 of 25
Company number: 09542896
Charity number: 1162031
OPERATION FISTULA (UK) Balance sheet Company no. 095428 For th 2023 20 No Curr•nt w••tr: D8bnrs Jt bank in hand 10 lo?n JU13 7?.252 46,334 125.585 U•bllltl•¥: Creditors.. amounts lalln9 du• With one y•r 110.3461 115.2581 124541 110.3 n•t Mi•ts I W•bllltl•sl 124,$41 110.3 Th• lund• d th• ¢h•dty: RAiJKto¢J Incomè funds Unrg%triCt•d incorn• lun0> Gen¢r•l lund$ 12. 13 9.733 114401 108,2 T•tal chvlty funth 124.541 110.3 Approved ttyé tS on li I I - •nJ siqngd on they h• I* Mr Nichola$ Tw5tee J$nkiPIS Company number 09542896 Charity number. 1162031 Page 17of25
OPERATION FISTULA (UK)
Statement of cash flows
For the year ended 31 December 2023
| Note | 2023 | 2022 | |||
|---|---|---|---|---|---|
| £ | £ | £ | £ | ||
| Cash flows from operating activities: | a | ||||
| Change in cash and cash equivalents in the year | (12,520) | (10,804) | |||
| Cash and cash equivalents at the beginning of the year | 46,334 | 57,138 | |||
| Cash and cash equivalents at the end of the year | b | 33,813 | 46,334 |
a) Reconciliation of net income / (expenditure) to net cash flow from operating activities
| Net income / (expenditure) for the reporting period (as per the statement of financial activities) Depreciation charges Loss/(profit) on the sale of fixed assets (Increase)/decrease in debtors Increase/(decrease) in creditors Net cash provided by / (used in) operating activities |
2023 £ 14,213 - - (29,821) 3,088 |
2022 £ (56,072) 1,292 - 88,058 (44,082) |
|---|---|---|
| (12,520) | (10,804) |
b) Analysis of cash and cash equivalents
| Cash in hand and at bank Total cash and cash equivalents |
At 1 January 2023 £ 46,334 |
Cash flows £ (12,520) |
At 31 December 2023 £ 33,813 |
|---|---|---|---|
| 46,334 | (12,520) | 33,813 |
Page 18 of 25
Company number: 09542896
Charity number: 1162031
OPERATION FISTULA (UK)
Notes to the financial statements
For the year ended 31 December 2023 1 Accounting policies
General information and basis of preparation
Operation Fistula (UK) is a charitable company limited by guarantee (Company No. 09542896) and is incorporated in England and Wales. The registered office address is Lambourne House, 311-321 Banbury Road, Oxford, OX2 7JH. The nature of the charity's operations and principal activities are noted in the Trustee's report.
The charitable company constitutes a public benefit entity as defined by FRS 102.
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 issued in October 2019, the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102), the Charities Act 2011, and the Companies Act 2006, and UK Generally Accepted Accounting Practice.
The financial statements are prepared on a going concern basis under the historical cost convention, modified to include certain items at fair value. The financial statements are prepared in sterling which is the functional currency of the charity.
The significant accounting policies applied in the preparation of these financial statements are set out below. These policies have been consistently applied to all years presented unless otherwise stated.
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
General funds are unrestricted funds which are available for use at the discretion of the Trustees in furtherance of the general objectives of the charity and which have not been designated for other purposes.
Designated funds comprise unrestricted funds that have been set aside by the Trustees for particular purposes.
Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised by the charity for particular purposes.
Page 19 of 25
Company number: 09542896
Charity number: 1162031
OPERATION FISTULA (UK)
Notes to the financial statements
For the year ended 31 December 2023
1 Accounting policies (continued)
Expenditure
All expenditure is accounted for on an accruals basis and has been classified under headings that aggregate all costs related to the category.
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. Irrecoverable VAT is charged as an expense against the activity for which expenditure arose.
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
Support costs are those that assist the work of the charity but do not directly represent charitable activities and include office costs, governance costs and administrative payroll costs. They are incurred directly in support of expenditure on the objects of the charity and include project management.
The analysis of these costs is included in note 7.
Tangible fixed assets
Tangible fixed assets (costing more than £1,000) are stated at cost (or deemed cost) or valuation less accumulated depreciation and accumulated impairment losses.
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 and creditors receivable/payable within one year
Debtors and creditors with no stated interest rate and receivable or payable within one year are recorded at transaction price. Any losses arising from the impairment are recognised in expenditure.
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.
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.
Going concern
The financial statements have been prepared on a going concern basis as the Trustees believe that no material uncertainties exist. The Trustees have considered the level of funds held and the expected level of income and expenditure for 12 months from authorising these financial statements. They have concluded that the budgeted income and expenditure is sufficient with the level of reserves held for the charity to be able to continue as a going concern.
Page 20 of 25
Company number: 09542896
Charity number: 1162031
OPERATION FISTULA (UK)
Notes to the financial statements
For the year ended 31 December 2023 2 Income from donations and legacies
| Income from donations and legacies | ||||
|---|---|---|---|---|
| Donations: Operation Fistula USA Grand Challenges Canada Anonymous donor via IG Partners Others Donated services Tableau Foundation |
Unrestricted £ 168,419 - 40,000 7,805 - |
£ 19,743 - - 33,531 Restricted |
2023 Total £ 188,162 - 40,000 7,805 33,531 |
2022 Total £ 363,573 96,421 40,000 23,707 6,858 |
| 216,224 | 53,274 | 269,498 | 530,559 |
3 Income from investments
| Income from investments | ||||
|---|---|---|---|---|
| Bank interest receivable | Unrestricted £ 208 |
£ Restricted |
2023 Total £ 208 |
2022 Total £ 119 |
| 208 | 208 | 119 |
Page 21 of 25
Company number: 09542896
Charity number: 1162031
| Total expenditure 2023 | Governance costs | Support costs | Depreciation | Sundry expenses | Audit fee | General office costs | Premises expenses | Software | Consultancy | Surgeons fee | Grant to partners | Other staff costs | conferences | Training, workshops & | Travel and subsistence | Publicity | Staff costs (Note 6) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 15,304 | 1,266 | 2,784 | 11,254 | - | - | - | - | - | - | - | - | - | - | - | - | - | 11,254 | £ | funds | raising | Cost of | |||||
| 37,393 | 3,799 | 8,353 | 25,242 | - | - | - | - | - | - | - | - | - | - | - | - | - | 25,242 | £ | (FREE) | Everywhere | Woman | For Every | Fistula Repair | |||
| 99,111 18,167 |
3,799 1,266 |
8,353 2,784 |
86,960 14,117 |
- - |
- - |
- - |
- - |
- - |
43,177 - |
- - |
- - |
- - |
- - |
- - |
- - |
- - |
43,783 14,117 |
£ £ |
(GOFAR) VGE) |
Registry formerly |
Automated (Viz5 |
Fistula Equality |
Obstetric Gender |
Global Visualise |
Charitable activities | |
| 85,517 | 2,532 | 5,568 | 77,416 | - | - | - | - | - | - | - | - | - | - | - | - | - | 77,416 | £ | KICKSTART | |||||||
| - | (12,662) | - | 12,662 | - | 733 | 2,400 | - | - | - | - | - | - | 1,284 | - | - | - | 8,245 | £ | costs | Governance | ||||||
| - | - | (27,842) | 27,842 | - | 190 | - | 1,884 | 4,354 | 2,841 | 2,600 | - | - | 961 | - | 621 | 909 | 13,482 | £ | costs | Support | ||||||
| 255,493 | () | - | 255,493 | - | 923 | 2,400 | 1,884 | 4,354 | 46,018 | 2,600 | - | - | 2,245 | - | 621 | 909 | 193,539 | £ | 2023 Total | |||||||
| 33,302 | 908 | 2,401 | 29,993 | - | - | - | 197 | - | - | 6,500 | - | - | - | - | 1,877 | - | 21,419 | funds | raising | Cost of | ||||||
| 229,364 | 3,764 | 9,947 | 215,653 | - | 24 | - | - | - | 64 | - | - | 168,719 | - | 45 | 2,807 | - | 43,994 | (FREE) | Everywhere | Woman | For Every | Fistula Repair | ||||
| 75,184 17,669 |
3,115 779 |
8,232 2,058 |
63,837 14,832 |
- - |
- - |
- - |
- - |
- - |
13,243 - |
- - |
- - |
- - |
- - |
- - |
- 88 |
- - |
50,594 14,744 |
(GOFAR) VGE) |
Registry formerly |
Automated (Viz5 |
Fistula Equality |
Obstetric Gender |
Global Visualise |
Charitable activities | ||
| 231,230 | 8,307 | 21,953 | 200,970 | - | - | - | - | - | 534 | - | - | 68,905 | - | - | - | - | 131,531 | KICKSTART | ||||||||
| - | (16,873) | - | 16,873 | - | 749 | 2,400 | - | - | - | - | - | - | - | - | - | - | 13,724 | costs | Governance | |||||||
| - | - | (44,591) | 44,591 | 1,292 | 389 | - | 5,833 | 3,092 | 3,838 | 3,839 | - | - | 699 | 2,299 | 1,184 | - | 22,126 | costs | Support | |||||||
| 586,750 | - | 1 | 586,749 | 1,292 | 1,162 | 2,400 | 6,030 | 3,092 | 17,679 | 10,339 | - | 237,624 | 699 | 2,344 | 5,956 | - | 298,132 | £ | Total | 2022 |
OPERATION FISTULA (UK)
Notes to the financial statements
For the year ended 31 December 2023
5 Net incoming resources for the year
This is stated after charging / crediting:
| This is stated after charging / crediting: | ||
|---|---|---|
| 2023 | 2022 | |
| £ | £ | |
| Depreciation | - | 1,292 |
| Audit fees inc. VAT | 2,400 | 2,400 |
Auditor's remuneration charged during the year amounted to £2,000 plus VAT for audit and £300 plus VAT for other services. (2022: £2,000 plus VAT for audit and £300 plus VAT for other services).
6 Analysis of staff costs, trustee remuneration and expenses, and the cost of key management personnel
Staff costs were as follows:
| Salaries and wages Social security costs Employer’s contribution to defined contribution pension schemes |
2023 2022 £ £ 175,024 266,948 15,908 26,192 2,608 4,992 |
|---|---|
| 193,540 298,132 |
| The number of employees who recived total employee benefits (excluding employer pension costs) of more than | The number of employees who recived total employee benefits (excluding employer pension costs) of more than | The number of employees who recived total employee benefits (excluding employer pension costs) of more than |
|---|---|---|
| £60,000 is as follows: | ||
| 2023 | 2022 | |
| £70,0001 - £80,000 | 1 | - |
| £90.0001 to £100,000 | - | 1 |
The total employee benefits including pension contributions of the key management personnel were £148,972 (2022: £168,030).
The trustees neither received nor waived and remuneration during the year (2022: £Nil) for performing their duties as trustees.
No Trustee expenses incurred this year (2022: £749.01)
7 Staff numbers
The average number of employees (head count based on number of staff employed) during the year was as follows:
| Average staff | 2023 2022 No. No. 3 5 |
|---|---|
| 3 5 |
8 Related party transactions
During the year Operation Fistula USA made grants totaling of £188,162.03 (2022: £363,573) to Operation Fistula (UK). Operation Fistula's US entity and Operation Fistula (UK) are founded by Seth Cochran and he is also the CEO of both charities.
Page 23 of 25
Company number: 09542896
Charity number: 1162031
OPERATION FISTULA (UK)
Notes to the financial statements
For the year ended 31 December 2023
9 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.
10 Debtors
| 10 Debtors |
|
|---|---|
| 11 Due from Operation Fistula USA Creditors: amounts falling due within one year Taxation and social security Other creditors Accruals |
2023 2022 £ £ 109,073 79,252 |
| 109,073 79,252 |
|
| 2023 2022 £ £ 13,553 12,858 514 - 4,279 2,400 |
|
| 18,346 15,258 |
12 Analysis of net assets between funds (current year)
| Net current assets / (liabilities) Net assets at the end of the year Analysis of net assets between funds (prior year) Net current assets Net assets at the end of the year |
General unrestricted Restricted Total funds £ £ £ 114,808 9,733 124,541 |
|---|---|
| 114,808 9,733 124,541 |
|
| General unrestricted Restricted Total funds £ £ £ 108,236 2,091 110,327 |
|
| 108,236 2,091 110,327 |
Page 24 of 25
Company number: 09542896
Charity number: 1162031
OPERATION FISTULA (UK)
Notes to the financial statements
For the year ended 31 December 2023
13 Movements in funds (current year)
| Incoming | Outgoing | ||||
|---|---|---|---|---|---|
| At the start of | At the start | resources & | resources & | At the end of | |
| the year | of the year | gains | losses | the year | |
| £ | £ | £ | £ | £ | |
| Restricted Funds: | |||||
| Total Restricted Funds | 2,091 | 2,091 | 53,274 | (45,632) | 9,733 |
| Unrestricted Funds: | |||||
| Total Unrestricted Funds | 108,237 | 108,237 | 216,432 | (209,861) | 114,808 |
| Total Funds | 110,328 | 110,328 | 269,706 | (255,493) | 124,541 |
| Movements in funds (prior year) | |||||
| Incoming | Outgoing | ||||
| At the start of | At the start | resources & | resources & | At the end of | |
| the year | of the year | gains | losses | the year | |
| £ | £ | £ | £ | £ | |
| Restricted Funds: | |||||
| Total restricted funds | 26,392 | 26,392 | 266,624 | (290,926) | 2,091 |
| Unrestricted Funds: | |||||
| Total Unrestricted Funds | 140,008 | 140,008 | 264,054 | (295,824) | 108,237 |
| Total Funds | 166,400 | 166,400 | 530,678 | (586,750) | 110,328 |
Purposes of restricted funds
Restricted funds were allocated to specific programmatic activities as follows:
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).
Page 25 of 25
Company number: 09542896
Charity number: 1162031