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← Hipz (Health Improvement Project Zanzibar)

2024-06-30-accounts

Health Improvement Project Zanzibar

Report and Financial Statements For the Year Ending 30 June 2024

Charity number 1171687 Company number 10168369

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Health Improvement Project Zanzibar (A company limited by guarantee)

Financial Statements For the year ending 30[th] June 2024

Table of Contents

1 LEGAL ANDADMINISTRATIVEINFORMATION ............................................................................................................. 3
1.1 BACKGROUND ............................................................................................................................................................ 4
1.2 THE CONTEXT .......................................................................................................................................................... 4
1.3 OURAIMS ANDOBJECTIVES ................................................................................................................................ 5
1.4 HOW WE WORK ........................................................................................................................................................ 5
1.5 PERFORMANCE ANDACHIEVEMENTS ................................................................................................................. 7
GOVERNANCE, LEADERSHIP ANDHEALTHFINANCING ....................................................................................................... 7
INFECTIOUSDISEASES ............................................................................................................................................................ 8
INFRASTRUCTURE AND SUPPLIES .......................................................................................................................................... 9
REPRODUCTIVEMATERNALNEWBORNCHILDADOLESCENTHEALTH .......................................................................... 10
NON-COMMUNICABLE DISEASES ......................................................................................................................................... 13
Cardiovascular Diseases ................................................................................................................................ 13
Mental Health ................................................................................................................................................ 15
1.6 STRUCTURE, GOVERNANCE ANDMANAGEMENT .................................................................................................. 17
1.7 REFERENCES ........................................................................................................................................................ 18
1.8 FINANCIALREVIEW .............................................................................................................................................. 19
2 Independent Examiner’s Report to the trustees of HIPZ (Health Improvement Project
Zanzibar) for the year ended 30 June 2024 ........................................................................................ 21
3 Statement of Financial Activities including Income and Expenditure Account .................... 22
4 Balance Sheet ................................................................................................................................ 23
5 Statement of Cash Flows .............................................................................................................. 24
6 Notes to the Accounts .................................................................................................................. 25

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1 Legal and Administrative Information

HIPZ (Health Improvement Project Zanzibar)

Report of the Board of Directors for the year ending 30th June 2024. The Board of Directors presents its directors’ and trustees’ report and independently examined financial statements for the year ending 30 June 2024.

Reference and Administrative Information

Charity Name: HIPZ (Health Improvement Project Zanzibar) Charity registration number: 1171687 Company registration number: 10168369

Registered address:

Applecombe Cottage, Wild Oak Lane, Trull Taunton TA3 7JS, UK

Board of Directors/Trustees

Chair: Dr Ruaraidh MacDonagh Treasurer: Ian Franklin Secretary: Dr Nicola Biggs Caitlin Farrow (Stood down 31.12.2023) Dr Nicholas Campain Michael Sugden Susan Moore Helen Rafferty (Stood down 31.03.2024) Lindsay Solera-Deuchar (May 2024) John Mahon (May 2024) Ebun Atinmo (May 2024)

Senior Management Team

Finance Director (UK): Juliette Webb Fundraising Manager (UK): Kathryn Sheldon Programme Director (Zanzibar): Simon Kühnert Clinical Operations Director (Zanzibar): Jabir Ayindo Partnerships Advisor (Zanzibar): Pamela Allard

External Accountants

SPX Oxford Ltd Peace House 19 Paradise Street Oxford OX1 1LD

Bank

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Royal Bank of Scotland (UK), Exim Bank (T) Ltd (Zanzibar)

1.1 Background

Health Improvement Project Zanzibar (HIPZ) was founded in 2006. It is a Private Company Limited by Guarantee and a charity registered with the Charity Commission for England and Wales. In Zanzibar, HIPZ has a registered branch which is governed by the same Articles of Association and policies.

In the initial years the partnership between the Zanzibar Ministry of Health and HIPZ focused on the development and management of rural hospitals. With time the scope evolved to strengthen the wider health system in Zanzibar.

1.2 The context

Zanzibar is a semi-autonomous archipelago of the United Republic of Tanzania. It consists of two large islands, Unguja and Pemba and several small islands. Zanzibar has 5 administrative regions with 11 districts.

Zanzibar’s population stands at around 1.8 million people. Around half of the population is under 18 years old (MOFP, 2022). Basic needs poverty affects 26% of the population (30% of the under 17s) (World Bank, 2022).

The Ministry of Health Zanzibar provides overall stewardship of the health sector.

Zanzibar has made significant gains in human resources for health in recent years/over the last 10 years. Currently, one doctor serves a population of 4,445 and one nurse serves a population of 1,258. However, these ratios remain far below the World Health Organisation (WHO) recommendations (of 2.5 skilled =— 3 healthcare workers per 1000). Furthermore, 60% of the health workforce work in urban areas where only 18% of the population resides, meaning there is still significant disparity in accessing healthcare for the majority of the population who live in rural areas.

Zanzibar Performance towards SDG 3 targets

SDG Indicator Zanzibar SDG Target 2030
Under-five mortality rate per
1,000 live births		 47 per 1,000 live births (MOH,
2022)		 25 per 1,000 live births

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Neonatal mortality rate per
1,000 live births		 34 per 1,000 live births (MOH,
2022)		 12 per 1,000 live births
Maternal Mortality ratio per
100,000 live births		 133 per 100,000 live births (only
includes
institutional
mortality)
(MOH, 2022)		 70 per 100,000 live births

The total health expenditure is approximately 3% of the Gross Domestic Product, falling below the WHO recommendation of at least 5% to achieve Universal Healthcare Coverage. People are frequently forced to spend their own funds on healthcare and out of pocket expenditure on healthcare in Zanzibar is high. This creates a financial risk of pushing households into poverty.

1.3 Our Aims and Objectives

HIPZ aims to strengthen the Zanzibari healthcare system. It is our mission to make it possible for all people in Zanzibar to access high quality healthcare to achieve our vision of a healthy people in Zanzibar.

1.4 How we work

Our HIPZ model has been tried and tested over the past 18 years. This model is our blueprint for how healthcare can be transformed in resource-poor environments. We believe this has the potential to make a difference not just in Zanzibar, but can be replicated on a global scale.

Our works is derived from our values:

Based on these values and our in-depth understanding we have developed our theory of change to improve health outcomes in Zanzibar.

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HIPZ Theory of Change

This model focuses around six pillars:

  1. Build workforces. We train healthcare workers in all areas, equipping them with the knowledge and skills to take ownership of their services.

  2. Expand Services. In line with the Zanzibar Essential Healthcare Package, we listen to the medical needs of the community and find cost-effective, evidence-based solutions to introduce impactful change.

  3. Develop Infrastructure. We improve the structural condition of health facilities and fill gaps in equipment and consumables.

  4. Work with the community. We learn from the community and share our experience to reduce barriers to positive health seeking behaviour.

  5. Invest in research. We invest in locally relevant health research and share it with the global health community to improve health services delivery not just in Zanzibar, but around the world.

  6. Strengthen systems. We co-develop processes, policies and strategies in collaboration with the government, health facilities and other development partners to improve care and create longlasting change.

All this work is delivered in close partnership with the Revolutionary Government of Zanzibar (RGOZ) to ensure local ownership, alignment with national policies and priorities as well as sustainability of our programmes.

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1.5 Performance and Achievements

This year we continued increasing the scope of our work across Zanzibar, working across all 11 districts and directly implementing initiatives in over 150 health facilities. We also opened a new sub-office in Chake-Chake, Pemba to better coordinate our work on the island.

HIPZ is working across all building blocks of the health system in a collaborative approach acknowledging and fostering the leadership role of the RGOZ to steer the health sector towards achieving Universal Health Coverage for its people. In the following report we will provide a brief overview of the work delivered across the HIPZ Strategic Results Areas:

  1. Governance, Leadership and Health Financing

  2. Infectious Diseases

  3. Infrastructure and supplies

  4. Reproductive Maternal Newborn Child and Adolescent Health (RMNCAH)

  5. Non-Communicable Disease

  6. Mental Health

  7. Emergency Medicine

Governance, Leadership and Health Financing

We are aiming to increase the resilience and sustainability of the Zanzibar health system by strengthening governance, leadership and health financing. We do this by providing technical assistance, financial support, and joint ventures with the Ministry of Health.

We provide technical assistance through participating in technical and governance platforms and seconding staff to the Ministry of Health. This year we participated in 8 Technical Working Groups, contributed to the review and development of national strategic plans in nutrition, antimicrobial resistance and health security. The latter is through a joint venture including the Ministry of Health, Resolve to Save Lives and the World Health Organization. Another key area of support is strengthening supply chain management through the Central Medical Store Agency (CMSA). We are supporting CMSA to pilot a new supply chain management system at the primary healthcare level which is a key building block to enable the operationalization of Zanzibar's Universal Health Insurance and facility-based financing model.

This year we have seconded 7 staff to various programs of the Ministry of Health to strengthen their institutional capacity and improve the alignment of HIPZ programmes with national priorities. We have seconded 3 staff to the Integrated Child Health Program, 1 to the Mental Health Program and 3 to Makunduchi Health Centre.

Through our Maternal Newborn and Child Health project we have partnered with the Ministry of Health, UNICEF and the Japan International Cooperation Agency to strengthen leadership and management within the health facilities in Zanzibar (see RMNCAH section). Strengthening the management and leadership of facilities is a critical aspect of our work to improve service provision and to prepare for the roll-out of facility-based financing modality envisioned by the Revolutionary Government of Zanzibar.

We also continued to participate in the Zanzibar Multisectoral Coordinating Committee on Antimicrobial Resistance as a member. The committee governs and oversees the implementation of the National Action Plan on Antimicrobial Resistance. Furthermore, we represent international non-governmental organizations as an

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alternate member to the Zanzibar Global Fund Country Coordinating Mechanism governing and overseeing the Global Fund initiatives in Zanzibar targeting HIV/AIDS, Tuberculosis, Malaria and the COVID response.

Lastly, we continue to contribute to health financing through the Zanzibar Health Basket Fund, which aims to strengthen Primary Healthcare in Zanzibar.

Infectious Diseases

The Joint External Evaluation report of International Health Regulations evaluated the core capacities of Zanzibar in 2023. The report indicated minimal capacity for AMR detection and surveillance of infections and scored level 2 for the antimicrobial resistance (AMR) surveillance system indicating limited capacity.[1] This was mostly related to a lack of standardised methods in laboratories conducting the Antimicrobial Susceptibility Test (AST). Following this, the Zanzibar AMR Multisectoral Surveillance Framework was developed. To strengthen the implementation of the AMR Surveillance Framework in human health we established a microbiology laboratory in the new laboratory building at Makunduchi Health Centre in partnership with the Bernhard-Nocht Institute for Tropical Medicine (BNITM). The microbiology laboratory is currently the only clinical laboratory in Zanzibar providing AST. Therefore, we have created a sample referral system together with the Zanzibar Health Research Institute to receive samples from across Zanzibar. This is embedded in an international AMR surveillance research project led by the BNITM. The current antimicrobial therapeutic options in Zanzibar are entirely based on a few studies, this AMR Surveillance will contribute to the establishment of local cumulative antibiograms for each facility to inform decision-making, drive local and national actions, and provide the evidence-base for national action and advocacy.

To achieve this, we have engaged two microbiologists who are staffing the microbiology laboratory and developed the necessary protocols. The laboratory team is engaged in a continuous knowledge exchange program with the BNITM as well as the National Institute for Medical Research in Tanga, Tanzania to ensure mutual learning and high quality of services. Starting February 2024, we have enrolled study sites and are currently providing AST for blood and urine samples from Makunduchi Health Centre, Mnazi Mmoja National Referral Hospital, Vitongoji District Hospital and Abdulla Mzee Regional Hospital. At the end of June we had collected 297 samples, as seen below in Figure 1.

1 A Joint External Evaluation (JEE) is a voluntary, collaborative, multisectoral process to assess country capacities to prevent, detect and rapidly respond to public health risks whether occurring naturally or due to deliberate or accidental events. The JEE helps countries identify the most critical gaps within their human and animal health systems in order to prioritize opportunities for enhanced preparedness and response. A level 2 indicates low capacity of a country (WHO, 2022).

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Figure 1 Samples collected

HIPZ also serves as an advisor to the ZANTOTO implementation research project led by the Zanzibar Health Research Institute which focuses on optimize antibiotic use among neonates and children and aims to design an implementation model for evidence-based AMS activities in Zanzibar.

In the next year, we aim to continuously strengthen AMR Surveillance by expanding the number of sites enrolled in the study and the number of samples processed. The data will allow us to develop local antibiograms for each facility. Further, we aim to conduct research into the knowledge attitudes and behaviour towards antimicrobial resistance within the general population, healthcare workers and farmers to inform the development of the behaviour change communication strategy under the National Action Plan on AMR.

Infrastructure and supplies

We continued to supply essential health commodities to the Ministry of Health through our partnership with International Health Partners. During this year we have handed over two consignments to the Ministry of Health. The medication was distributed by the Central Medical Store of the Ministry of Health to 156 health facilities representing 82% of all public health facilities in Zanzibar.

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Our other infrastructure interventions focused on Makunduchi Health Centre in the South district of Unguja. We constructed an Emergency Medicine and Laboratory block with the generous support of the Lady Fatemah (a.s.) Charitable Trust (LFT) and the Jaffar Figure The President of Zanzibar is opening the Emergency Medicine and Family Foundation. This building Laboratory Block at Makunduchi addresses two key challenges: Firstly, the lack of a dedicated Emergency Medicine wiy=». re= Department at the hospital; Secondly, the hess (2 Se) NK , aed i lack of adequate laboratory diagnostic tyr Aw \ . a 4 ey e services to guide clinicians in the diagnosis and management of disease. The new Ad TS Oy * «Srae ino Seats laboratory hosts haematology, hi ik Se . y parasitology, clinical chemistry and f 1) (ORRe ee yyy microbiology departments as well as room | | yy, ee | ‘a ‘ A for quality control, sterilization and a NS 3g aga phlebotomy with dedicated waiting area c's | f on the ground floor decongesting the : PY ae x i} i ne me hospital. Through our partnership with the Bernhard-Nocht Institute for Tropical

Medicine, we fully equipped the microbiology department and supply consumables for culture and sensitivity tests. The laboratory has provided services for 16,114 patients.

The Emergency Department provides easy access, an improved patient flow, a dedicated resuscitation area, triage, a consultation room, a treatment area with up to 8 beds and an isolation room. Further we equipped the Emergency Department with the necessary equipment for emergency care.

We have renovated the old laboratory to become a satellite blood centre and procured the relevant equipment. The satellite blood centre will improve the supply of blood at the hospital which is crucial for service delivery at the hospital.

To ensure radiology services are available at Makunduchi Health Centre we have installed a power stabilizer. This was necessary due to the regional wide low voltage of the national grid which led to suspension of radiology services.

Reproductive Maternal Newborn Child Adolescent Health

In partnership with the Ministry of Health Zanzibar we improve Reproductive Maternal Newborn Child Adolescent Health (RMNCAH) services across health facilities in Zanzibar as well as implement communitybased activities in Unguja aiming to improve the ability of individuals to practice positive health-seeking and self-care behaviours. Our work supports Zanzibar's progress towards achieving the Sustainable Development Goals 3.1 and 3.2.

Maternal Newborn and Child Health Phase – 2

Following a successful Phase 1 in two districts in Unguja, we embarked on a nationwide scale up, termed as MNCH Phase 2 Project in partnership with the Ministry of Health and the LFT. This is a 3-year intervention aiming to strengthen maternal, newborn and child health services and contribute towards a resilient and sustainable health system. The project aims to achieve this by improving the capacity healthcare workers in RMNCAH,

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training leaders in leadership and management, strengthening infrastructure and supplies, improving the capacity of the MOH in data management, monitoring and evaluation.

The roll-out of the project is delivered in phases. In the initial phase we focused on 6 districts with 90 health facilities, 95% at the primary level.

We conducted a baseline survey to inform the scale up: highlights from the baseline are:

Based on these findings we are employing a strategy of on-the-job capacity building, continuous medical education utilizing skill labs. We supported 6 secondary level facilities by consultants seconded to the Ministry of Health.

This year we strengthened the capacity of healthcare workers in the following areas:

During the course of the implementation, the following outcomes were noted:

A total of 13,582 deliveries were conducted in the health facilities in the project areas. 1,142 caesarean sections were conducted (8%). The majority of women who delivered attended PNC within 2 days (12,974) (95%). However, follow up within 3 to 7 days post-delivery was very low, at 2,182 (16%) and this is one of most important visits for mother and newborn wellbeing.

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There were 4,889 early ANC (before 12 weeks) contacts. However, very few attended the recommended 8 ANC visits (994) (20%).

The most common condition amongst pregnant women is anaemia and postpartum haemorrhage.

In view of the above morbidity, we will focus on: Intensifying mentorship especially for primary level health facilities which are the closest and initial point of contact for most people. Each mentor is targeted to deliver 2 mentorship sessions per month.

At facilities providing delivery services we will operationalise the successful findings of the E-MOTIVE trial led from the University of Birmingham to address the high burden of morbidity and mortality from postpartum haemorrhage (PPH).[2]

In addition to rolling out the management and leadership package for the primary level we will train hospital management staff at the secondary level in basic hospital management and quality improvement.

USAID Afya Yangu – Mama na Mtoto

USAID Afya Yangu - Mama na Mtoto is a five-year project (2022–2027) aimed to increase the demand for and use of quality integrated RMNCAH services in target regions, particularly by women and youths. The project is implemented in 11 regions of Tanzania mainland and Zanzibar. HIPZ implements community-based activities in Unguja aiming to improve the ability of individuals to practice positive health-seeking and self-care behaviours. We deliver these activities in Kati district as an implementing partner for the consortium leading USAID Afya

Yangu – Mama na Mtoto in Tanzania. We promote community engagement and strengthen capacity to implement community-level activities by working with community leaders, community health workers, girl mentors and youth health champions (peer educators), healthcare workers and the district health management team. During the implementation period we have worked with 50 community health workers and 31 girl mentors/youth health champions. In previous years have trained them in the ‘Naweza’ and ‘Power to Girls’ methodologies. This year, we have built the capacity of the Community Health Workers (CHWs) by introducing new service packages focusing on:

To support CHWs, Girl Mentors and Youth Health Champions, we delivered 209 supportive supervision sessions and 9 meetings over the year. The CHWs, Girl Mentors and Youth Health Champions overseen by HIPZ managed

2 The E-MOTIVE trial is the early detection of Postpartum Haemorrhage and treatment using the WHO MOTIVE 'first response' bundle: a cluster randomised trial with health economic analysis and mixed methods evaluation (https://www.birmingham.ac.uk/research/bctu/trials/womens/emotive/e-motive)

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to deliver 2,273 sessions within the community, utilizing the USAID Afya Yangu Mama na Mtoto methodologies reaching 21,963 people and leading to 924 referrals.

In addition, we have delivered 5 Health Outreach Days and 3 school sessions reaching 1,654 people.

To strengthen the sustainability of quality RMNCAH service delivery and respectful care we delivered an actionoriented community feedback and planning meeting utilizing the Community Score Card methodology at 7 communities in Kati district to identify challenges and develop solutions. We brought together over 300 community members, healthcare workers, district health management teams and local leaders. During the Community Score Card event action plans were delivered and the bi-annual follow up visit showed that most of the actions have been completed or are in progress.

Non-communicable diseases

Non-communicable diseases (NCDs) create the highest disease burden to the Zanzibari population. We work in partnership with the MOH NCD Unit and the Mental Health Program. We aim to address these challenges by increasing awareness and creating positive behavioural changes to minimise risk factors and promoting access and awareness of these services and ensuring the quality of these services.

Part of this integrated strategy is to integrate NCD and mental health service delivery and awareness raising by delivering integrated outreaches. This year, 1,149 people were screened and treated for NCDs including mental health during outreaches conducted in communities in Unguja and Pemba.

We also supported the RGOZ to conduct the NCD STEP Survey to generate evidence on the prevalence and risk factors of NCDs in Zanzibar.

Cardiovascular Diseases

Cardiovascular disease accounts for a massive 34 % of deaths of people over 13 years in Zanzibar, with stroke being the leading cause of death (20.5) and hypertension being a leading cause of morbidity among the population (MOH, 2022). Cardiovascular disease therefore poses both a significant morbidity and mortality risk to the population of Zanzibar, and a substantial strain on an already overburdened healthcare system.

Under our hypertension project, HIPZ continued to scale up hypertension screening, diagnosis, management and awareness in Zanzibar.

The services were provided in 32 health facilities in North A, North B and Urban West districts in Unguja, mainly in primary healthcare facilities. This year we trained 43 healthcare workers. Together with the NCD Unit of the MOH and the District Health Management Teams we provided 181 mentorship sessions to ensure adherence to the national protocol and procedures. In addition, we conducted 100 joint supportive supervisions to support the facility focal person with the project implementation in their facilities.

176,640 patients had their blood pressure measured surpassing the program’s target of 155,346 individuals. Among those screened, 7.4% (13,063) were found to have elevated blood pressure (BP). 3.5% (6,112) of all patients screened were diagnosed with hypertension and received treatment. On average, 1,220 new and known patients were treated for hypertension each month. 1,028 returned for follow up and routine management of hypertension as shown below.

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Figure 3 Number of patients treated and returning patients

The project also strengthened the referral pathways by improving communication across facilities and improving cardiovascular disease care at Kivunge District Hospital. On average 84 patients per month were referred for further treatment as shown below.

Figure 4 Monthly referrals - cardiovascular

We improved cardiovascular disease care at Kivunge District Hospital by providing clinical mentorship and specialist consultation through a seconded cardiologist placed at the hospital. We sent two of the resident doctors for a two-month cardiovascular training program at the Jakaya Kikwete Cardiac Institute in Dar es Salaam, Tanzania.

Lastly, to improve awareness of hypertension we delivered and participated in outreach services, delivered 14 health talks via the national media and aired 36 jingles throughout the year.

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Mental Health

We work with the Mental Health Program of the Ministry of Health to improve access to holistic and recoveryoriented mental health services and create awareness across the population.

Pamoja Afya Bora Zanzibar

Together with the LFT and the MOH we established the Pamoja Afya Bora Zanzibar project. Pamoja Afya Bora methodology builds on the mental health first aid concept which has been successfully implemented in various countries. We adapted the methodology to the local Zanzibar context and developed a Kiswahili training manual which was endorsed by the Ministry of Health. Pamoja Afya Bora aims to:

In total we aim to reach 90,000 youth and adults in Zanzibar. Pamoja Afya Bora is delivered by trained facilitators who conduct interpersonal communication group sessions within the community. The Pamoja Afya Bora package consist of 4 sessions covering:

We trained 56 healthcare workers to facilitate Pamoja Afya Bora sessions across Zanzibar. The interpersonal communication sessions are delivered in the communities, reaching a total of 16,901 people in the last year.

In addition to interpersonal sessions in the community we also utilize the mass media and leverage existing events to spread awareness.

General population reached via all means in Pamoja Afya Bora against monthly targets

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Figure 5 Pamoja Afya Bora Total Beneficiaries

We also supported the Ministry of Health to commemorate the Mental Health Week in Zanzibar. During the week the Pamoja Afya Bora facilitators increased the sessions offered (1,330 people reached) and in addition we:

Dawati Rafiki

We delivered problem solving therapy delivered by trained Community Health Workers across Zanzibar. This year, 2,734 community-based mental health sessions were conducted in Unguja and Pemba. A total of 170 CHWs received refresher training and were provided with regular support and mentorship from their local supervisors who have also been oriented in Dawati Rafiki.

New patients made up 41% of all the sessions. Each patient is supposed to undergo six session. There was good collaboration with patients as we noticed only 0.2% were lost to follow-up.

By district, most new cases were attended in Pemba (Wete District) as shown below.

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Figure 6 Dawati Rafiki - New patients by district

Mental Health Clinics

Our Mental Health Coordinator and the Pemba Coordinator continue to offer mentorship to strengthen the mental health clinics across the isles. In addition, we support the follow up of hard-to-reach patients by the clinicians running the mental health clinics.

Emergency Medicine

This year we established the Emergency Medicine Department at Makunduchi. The personnel received training in basic emergency care and advanced life support during the previous year. In addition, two doctors and two nurses were attached to the Emergency Department of the Muhimbili National Hospital in Dar es Salaam for two weeks. The department has already served over 400 patients.

1.6 Structure, Governance and Management

The Board of Trustees is supported by two committees, the Finance Audit and Governance Committee and the Health Programme Advisory Committee.

Our Senior Management Team consists of Programme Director, Clinical Operations Director, Finance Director, Programme Advisor and Fundraising Manager. The members of the Senior Management Team are located in the UK as well as Zanzibar.

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Governing Document

The charity is controlled by its governing document, a deed of trust, and constitutes a limited company, limited by guarantee, as defined by the Companies Act 2006.

Directors/Trustees

Our board of trustees consists of experienced professionals from a range of backgrounds, including senior clinicians, communications and marketing, finance, charity and business planning.

Since we were incorporated in 2016, the trustees of the charity are also Directors of the company. All Directors give their time voluntarily and received no benefits from the charity. There were no trustees' remuneration or other benefits paid for the year ended 30 June 2024 .

Recruitment to the board of trustees is skills-based, and we regularly review the skills and experience we have represented on the board. In the last financial year one trustee stood down and we have now recruited 3 new Trustees with different areas of expertise from both within and beyond the healthcare sector.

Trustees gain knowledge from each other and HIPZ staff and keep up to date with the role of the trustee using Charity Commission guidance. Individual Trustees oversee specific areas of interest, for example health, finance, Human resources and fundraising.

Risk Management

HIPZ manages risk according to our Risk Management Policy. Risks are discussed at all levels of the organisation, and at the strategic level is overseen by an organisational risk register. The risk register is discussed regularly at the Finance, Audit and Governance Committee and as a standing agenda item at all Board meetings.

1.7 References

Ministry of Finance and Planning, Tanzania National Bureau of Statistics and President’s Office Finance and Planning, Office of the Chief Government Statistician [Zanzibar]. The 2022 Population and Housing Census

Ministry of Health [Tanzania Mainland], Ministry of Health [Zanzibar], National Bureau of Ministry of Health [Zanzibar], 2022: Zanzibar Annual Health Bulletin 2021

Statistics, Office of the Chief Government Statistician, and ICF, 2022: Tanzania Demographic and Health Survey and Malaria Indicator Survey 2022 Final Report.

World Bank, 2022: Towards a more inclusive Zanzibar Economy. Zanzibar Poverty Assessment 2022. World Health Organization, 2022: Joint external evaluation tool: International Health Regulation (2005), third edition

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1.8 Financial Review

Financial Performance 2023-24

Income for the year at £994k was 32% lower than budgeted and represented a +11% increase from 2022-23. The majority of the additional income, compared to the previous year, came from Trusts and Foundations, and this includes income associated with donated goods in kind which became a material activity during this year.

Expenditure for the year at £1,033k was 28% lower than budgeted and represented a +17% increase compared to 2022-23. The spend continues to be mostly in the areas of capacity building and quality improvement as well as preventative services, with the increase vs prior year largely due to the value of donated goods in kind.

The small defecit of income vs expenditure of £39k was slightly higher than budgeted and resulted in a net asset position of £94k at the end of 2023-24

Principal Funding Sources

Our income sources for this financial year were:

We continue to work hard to build up a portfolio of long-term supporters from a range of funding sources.

Investment Policy

The charity does not have any investments.

Reserves Policy

The reserves policy is designed to maintain a sufficient level of unrestricted funds to enable the charity to close down should it be required to. It allows for six months of basic operations to continue and would give time for staff in Zanzibar to make alternative employment arrangements. It is based upon the cost of three months’ predictable liabilities.

The policy allows HIPZ to actively manage our finances and ensure we have the capacity to weather unforeseen financial problems.

Auditors / Independent examiner

UHY-Ross Brooke were appointed to conduct the independent examination of these accounts.

This report has been prepared in accordance with the Charities SORP (FRS 102) '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

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Ireland (FRS 102) (effective 1 January 2015)', Financial Reporting Standard 102 'The Financial Reporting Standard applicable in the UK and Republic of Ireland' and the Companies Act 2006.

In Zanzibar, Hybrid Assurance was appointed to conduct the audit of HIPZ in Zanzibar. The audit was conducted in accordance with International Standards on Auditing issued by the International Auditing and Assurance Standards Board of the International Federation of Accountants.

In the opinion of the auditor the financial statements presented for Zanzibar presented a true and fair view of the state of affairs of HIPZ, as at 30 June 2024 and for the period then ended, accordance with International Public Sector Accounting Standards issued by the Public Sector Committee of the International Accounting Standards issued by the International Accounting Standards Board.

The Trustees have complied with the duty in section 17(5) of the Charities Act 2011 and have given due regard to public benefit guidance published by the Charity Commission. This report has been prepared in accordance with the special provisions of Part 15 of the Companies Act 2006 relating to small companies.

Approved by the directors on 10[th] December 2024 and signed on its behalf by:

Dr Ruaraidh MacDonagh Chair of the Board of Trustees

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2 Independent Examiner’s Report to the trustees of HIPZ (Health Improvement Project Zanzibar) for the year ended 30 June 2024

FOR THE PERIOD ENDED 30 JUNE 2024

I report to the charity trustees on my examination of the accounts of the Company for the period ended 30 June 2024, which are set out in pages 22-34.

RESPECTIVE RESPONSIBILITIES OF TRUSTEES AND EXAMINER

As the charity’s trustees of the Company (who are also the directors of the company for the purposes of company law), you are responsible for the preparation of the accounts in accordance with the requirements of the Companies Act 2006 (“the 2006 Act”).

BASIS OF INDEPENDENT EXAMINER’S REPORT

Having satisfied myself that the accounts of the Company are not required to be audited for this period under Part 16 of the 2006 Act and are eligible for independent examination, I report in respect of my examination of your charity’s accounts as carried out under section 145 of the Charities Act 2011 (“the 2011 Act”). In carrying out my examination, I have followed the Directions given by the Charity Commission (under section 145(5)(b) of the 2011 Act.

INDEPENDENT EXAMINER’S STATEMENT

The company’s gross income exceeded £250,000 and I am qualified to undertake the examination by being a qualified member of the Institute of Chartered Accountants in England and Wales.

I have completed my examination. I confirm that no material matters have come to my attention which gives me cause to believe that:

I have no concerns and have come across no other matters in connection with the examination to which attention should be drawn in this report in order to enable a proper understanding of the accounts to be reached.

Caroline Webster FCA

UHY Ross Brooke Windrush Court Abingdon Business Park Suite I Bucklands Way Abingdon OX14 1SY

Date 12[th] December 2024

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3 Statement of Financial Activities including Income and Expenditure Account

FOR THE PERIOD ENDED 30 JUNE 2024

Total Total
Note Unrestricted Restricted 2024 Unrestricted Restricted 2023
£ £ £ £ £ £
Income
Donations and
legacies		 3 81,207 902,684 983,891 122,236 772,691 894,927
Charitable activities 4 9,900 - 9,900 - - -
Investments 248 - 248 - - -
Other - - - 3,331 - 3,331
Total income 91,355 902,684 994,039 125,567 772,691 898,258
Expenditure
Fundraising costs 5 24,923 33,217 58,150 17,430 33,442 50,872
Charitable activities 6 60,832 914,433 975,265 152,171 676,472 828,643
Total expenditure 85,755 947,650 1,033,405 169,601 709,914 879,515
Net income/ -
expenditure		 5,600 - 44,966 - 39,366 - 44,034 62,777 18,743
Transfers between
funds		 905 - 905 - 702 - 702 -
Net movement in
funds		 6,505 - 45,871 - 39,366 - 43,332 62,075 18,743
Reconciliation of
funds:
Total funds
brought forward		 21,841 111,733 133,574 65,173 49,658 114,831
Total funds carried
forward		 28,346 65,862 94,208 21,841 111,733 133,574

The Statement of Financial Activities includes all gains and losses in the period and therefore a statement of total recognised gains and losses has not been prepared. All of the above amounts relate to continuing activities. The notes on pages 25-34 form part of these financial statements.

22

4 Balance Sheet

AS AT 30 JUNE 2024

Note 2024 2024 2023 2023
£ £ £ £
Tangible fixed assets 8 15,875 13,506
Current assets
Debtors 9 67,675 31,580
Cash at bank and in hand 49,044 111,332
116,719 142,912
Creditors: amounts falling due
within one year		 10 - 38,386 - 22,844
Net current assets 78,333 120,068
Creditors: amounts falling due in
more than one year - -
Net assets 94,208 133,574
Funds
Restricted funds 11 65,862 111,733
Unrestricted funds general 12 28,346 21,841
Total charity funds 94,208 133,574

For the period ended 30 June 2024 the charitable company was entitled to exemption from audit under section 477 of the Companies Act 2006. Trustees responsibilities:

These financial statements were approved by the members of the committee and authorised for issue on 10[th] December 2024. and are signed on their behalf by Dr Ruaraidh MacDonagh, Chairman and Trustee.

23

5 Statement of Cash Flows

FOR THE PERIOD ENDED 30 JUNE 2024

Note
Cash used in operating activities
15
Cash flows from investing activities
Dividends and interest from investments
Proceeds from the sale of fixed assets
Purchase of fixed assets
Cash provided by (used in) investing activities
Increase (decrease) in cash and cash equivalents in the
year
Cash and cash equivalents at the beginning of the year
Total cash and cash equivalents at the end of the year		 2024
£
- 52,776
248
-
- 9,760
- 9,512
- 62,288
111,332
49,044		 2023
£
11,687
-
-
- 9,077
- 9,077
2,610
108,722
111,332

24

FOR THE PERIOD ENDED 30 JUNE 2024

6 Notes to the Accounts

1. ORGANISATION STATUS

HIPZ (Health Improvement Project Zanzibar) is a Charitable Incorporated Organisation.

2. ACCOUNTING POLICIES

Basis of accounting

The charity constitutes a public benefit entity as defined by FRS102. 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 (FRS102) Statement of recommended practice: Accounting and Reporting by Charities (effective 1 January 2019) applicable to charities preparing their accounts in accordance with FRS 102 (Charities SORP (FRS102)).

Fund accounting

Unrestricted funds are available for use at the discretion of the trustees in furtherance of the general objectives of the charity.

Restricted funds can only be used for particular restricted purposes within the objects of the charity. Restrictions arise when specified by the donor or when funds are raised for particular restricted purposes.

Income

All income is included in the statement of financial activities when the charity is legally entitled to the income and the amount can be quantified with reasonable accuracy.

Fixed assets

Fixed assets (excluding investments) are stated at cost less accumulated depreciation. The costs of minor additions or those costing below £1,000 in the UK, or £300 in Zanzibar are not capitalised.

Depreciation

Depreciation is calculated so as to write off the cost of an asset, less its estimated residual value, over the useful economic life of that asset. There are currently no assets held in the UK. Our depreciation rates in Zanzibar are based on the Tanzanian Revenue Authority rates and are therefore as follows:

Depreciation rates - Zanzibar

Computers and accessories and motor cycles– 37.5% (reducing balance) Furniture and fixings, office equipment and motor vehicles – 12.5% (reducing balance)

Expenditure

Expenditure is accounted for on an accruals basis and has been classified under headings that aggregate all costs related to the category. Expenditure represents amounts invoiced, including value added tax.

25

FOR THE PERIOD ENDED 30 JUNE 2024 (continued)

6 Notes to the Accounts

Taxation

The Charity is exempt from corporation tax on its charitable activities.

Going concern

The trustees consider that there are no material uncertainties as to the charity’s ability to continue as a going concern.

Currency

The accounts are presented in GBP although the functional currency is TZS (Tanzanian Shillings). This is because most of the transactions occur in Zanzibar and are in TZS.

3. DONATIONS AND LEGACIES

Unrestricted Restricted 2024 Unrestricted Restricted 2023
£ £ £ £ £ £
Individual Giving 40,369 - 40,369 52,106 125 52,231
Corporate 12,200 44,652 56,852 10,910 78,954 89,864
Major Donors 20,000 - 20,000 26,500 - 26,500
Statutory - 26,984 26,984 - 26,987 26,987
Community and events 7,880 - 7,880 27,173 - 27,173
Trusts and Foundations 758 831,048 831,806 5,547 666,625 672,172
81,207 902,684 983,891 122,236 772,691 894,927

4. INCOME FROM CHARITABLE ACTIVITIES

Unrestricted Restricted 2024 Unrestricted Restricted 2023
£ £ £ £ £ £
Electives 9,900 - 9,900 -
9,900 - 9,900 - - -

5. FUNDRAISING COSTS

Fundraiser salaries
Other fundraising costs		 Unrestricted
£
11,513
13,410
24,923		 Restricted
£
18,026
15,191
33,217		 2024
£
29,539
28,601
58,140		 Unrestricted
£
8,573
8,857
17,430		 Restricted
£
14,887
18,555
33,442		 2023
£
23,460
27,412
50,872

26

FOR THE PERIOD ENDED 30 JUNE 2024 (continued)

6 Notes to the Accounts

6. EXPENDITURE ON CHARITABLE ACTIVITIES

Unrestricted Restricted 2024 Unrestricted Restricted 2023
£ £ £ £ £ £
Operational costs 2,863 43,929 46,792 28,787 18,799 47,586
Capacity building and quality
improvement		 18,387 300,175 318,562 36,314 233,966 270,280
Equipment and consumables,
Infrastructure development and 18,412 288,843 307,255 18,672 254,885 273,557
Pharmaceuticals
Policy advocacy / government
liaison		 11,809 76,942 88,751 8,549 17,951 26,500
Preventive Services 4,436 141,163 145,599 3,919 141,785 145,704
Administration 7,205 63,381 70,586 48,016 9,086 57,102
Exchange rate differences - 2,280 - - 2,280 7,914 - 7,914
60,832 914,433 975,265 152,171 676,472 828,643

7. STAFF COSTS

. STAFF COSTS
Wages and salaries
Social security costs
Pension costs
Fundraising
Programme management & admin
Total		 2024
£
244,144
34,631
1,063
279,838
2024
2.0
12.6
14.6		 2023
£
212,257
36,590
818
249,665
2023
2.0
9.6
11.6

No employee received benefits exceeding £60,000

27

6 Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2024 (continued)

8. TANGIBLE FIXED ASSETS

Cost
Cost at 1 July 2023
Additions
Exchange adjustment and other adjustments
to align to Zanzibar accounts
At 30 June 2024
Depreciation
At 1 July 2023
Charge for the period
Exchange adjustment
At 30 June 2024
Net book value
At 30 June 2024
At 30 June 2023		 Motor
vehicles
£
8,016
-
- 629
7,387
6,915
307
- 543
6,679
708
1,101		 Equipment
£
20,631
9,761
- 1,621
28,771
8,226
6,025
- 647
13,604
15,167
12,405		 Total cost
£
28,647
9,761
- 2,250
36,158
15,141
6,332
- 1,190
20,283
15,875
13,506
9. DEBTORS
Trade debtors
Staff loans
Other debtors
Prepayments
10. CREDITORS
Trade creditors
Accruals
Income in advance
Other creditors		 2024
£
51,542
393
11,833
3,907
67,675
2024
£
1,315
15,024
8,833
13,214
38,386		 2023
£
16,810
761
10,782
3,227
31,580
2023
£
1,594
9,804
-
11,446
22,844

28

FOR THE PERIOD ENDED 30 JUNE 2024 (continued)

6 Notes to the Accounts

11. RESTRICTED INCOME FUNDS

Restricted funds
AstraZenaca
BNITM
CM Lemos Foundation
Ethicall
Evan Cornish
Festival Medical Services
Grant Bradley Foundation
Geoff Harrington Foundation
Guernsey Overseas Aid
IHP donated goods
James Tudor Foundation
The Lady Fatemah Charitable
Trust
PN Pharmanovia
Rotary Club of Stone Town
Rotary Global Grant (Makunduchi)
Radiology Partners Foundation
Resolve to Save Lives
St James Place Foundation
Todos Juntos
USAID
ZAHRI
ZIDO
Other		 Balance
at 30 June
2023
£
26,238
40,510
-
2,407
-
8,194
139
331
- 16,481
-
4,120
22,519
-
3,068
-
-
-
2,500
1,472
6,886
-
9,830
-
111,733		 Income
£
32,261
24,852
182,631
-
10,000
13,170
-
27,383
26,984
210,152
-
294,008
12,391
-
-
11,530
9,805
-
-
43,290
1,866
2,361
-
902,684		 Expenditure
£
- 41,580
- 56,449
- 182,631
- 2,407
- 6,235
- 9,358
- 139
- 7,987
- 10,505
- 210,152
- 4,192
- 316,126
- 12,391
- 3,052
5
- 11,533
- 4,759
- 2,483
- 1,471
- 50,350
- 1,866
- 12,187
198
- 947,650		 Transfer
(to) / from
unrestricted
funds
£
- 56
- 551
-
-
- 20
9
-
- 22
2
-
72
- 401
-
- 16
- 5
3
42
- 17
- 1
258
-
- 4
- 198
- 905		 Balance
at 30
June
2024
£
16,863
8,362
-
-
3,745
12,015
-
19,705
-
-
-
-
-
-
-
-
5,088
-
-
84
-
-
-
65,862

There is a negative fund balance on the Guernsey Overseas Aid Commission. This is due to the funds being paid in arrears. In this case, an invoice to GOAC for £22k was raised in July and paid by the donor in July.

29

FOR THE PERIOD ENDED 30 JUNE 2024 (continued)

6 Notes to the Accounts

Purpose of restricted funds:

ZIDO is registered non-profit charitable organisation based in Canada. The registered name is Reaching out to Zanzibar International Development Organization and its mission is to improve the lives of the people of Zanzibar

Rotary Zanzibar is the short form of Rotary Club of Zanzibar - Stone Town based in Zanzibar Town, Tanzania. It is an organisation to bring together business and professional leaders in order to provide humanitarian services and to advance goodwill and peace. It is a non-political and non-religious organisation open to all.

Comic Relief. Comic Relief is supporting us to implement a mental health project in North A and South Districts benefiting 180,000 people with the aim of improving access to mental health services in the community, improving quality of mental health services, improving awareness of mental health in the community.

Dorenburg Stiftung is a private family foundation funding medication and consumables for our paediatric work.

Evan Cornish Foundation is a UK based grant-giving organisation. They awarded HIPZ funding to deliver mental health community outreach days.

Ethicall i s a historic partner of HIPZ and they reached back out to us in 2020, and generously offered to support our work. They donated £17,000 towards our surgical work which included renovating and equipping the operating theatre in Kivunge Hospital and purchasing a new theatre bed for Makunduchi Hospital.

The Lady Fatemah Charitable Trust is funding HIPZ to deliver a new maternal and new-born health programme in the hospitals and Primary Health Care Units we work in.

The Costas M Lemos Foundation is a private foundation supporting HIPZ’s fundraising and operations functions.

30

6 Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2024 (continued)

Previous year Balance
at 30 June
2022		 Income Expenditure Transfer
(to) / from
unrestricted
funds		 Balance
at 30 June
2023
£ £ £ £ £
Restricted funds
AstraZeneca - 54,054 - 27,816 - 26,238
BNITM - 46,758 - 6,248 - 40,510
CM Lemos Foundation - 43,165 181,318 - 138,153 - -
Dornenburg Stiftung 702 - - - 702 -
Ethicall 16,729 - - 14,322 - 2,407
Evan Cornish - 925 9,916 - 8,991 - -
Festival Medical Services 20,400 - - 12,206 - 8,194
Grant Bradley Foundation - 6,000 - 5,861 - 139
Geoff Harrington Foundation - 5,060 - 4,729 - 331
Guernsey Overseas Aid
Commission		 10,169 26,987 - 53,637 - - 16,481
ICARS - 8,171 - 8,171 - -
IHP donated goods - 35,414 - 35,414 - -
James Tudor Foundation - 4,120 - - 4,120
The Lady Fatemah Charitable Trust 14,595 302,404 - 294,480 - 22,519
Pharmanovia 5,925 24,900 - 30,825 - -
Rotary Club of Stone Town - 3,068 - - 3,068
Rotary Global Grant (Makunduchi) - 2,272 1,971 301 - -
Scott Bader - 4,000 - 4,000 - -
St James Place Foundation - 2,500 - - 2,500
Todos Juntos 5,000 - - 3,528 - 1,472
USAID - 51,326 - 44,440 - 6,886
HIPZ Christmas Fundraiser 5,969 125 - 6,094 - -
ZIDO 16,531 3,929 - 10,630 - 9,830
Other - 670 - 670 - -
49,658 772,691 - 709,914 - 702 111,733

31

FOR THE PERIOD ENDED 30 JUNE 2024 (continued)

6 Notes to the Accounts

12. UNRESTRICTED INCOME FUNDS

Balance Transfer Balance
at 30
June		 Income Expenditure (to) / from
unrestricted		 at 30
June
2023 funds 2024
Unrestricted funds £ £ £ £ £
General unrestricted funds 21,841 91,355 - 85,755 905 28,346
21,841 91,355 - 85,755 905 28,346
Previous year Balance
at 30
June
2022		 Income Expenditure
Transfer
(to) / from
unrestricted
funds		 Balance
at 30
June 2023
Unrestricted funds £ £ £ £ £
General unrestricted funds 65,173 125,567 - 169,601 702 21,841
65,173 125,567 - 169,601 702 21,841

13. ANALYSIS OF FUNDS BY ASSET TYPE

Fixed assets
Net current assets		 Restricted
£
-
65,862
65,862		 Unrestricted
£
15,875
12,471
28,346		 Total cost
£
15,875
78,333
94,208

32

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2024 (continued)

14. TRUSTEE REMUNERATION, KEY MANAGEMENT PERSONNEL & RELATED PARTY TRANSACTIONS

No member of the board of trustees received any remuneration or were reimbursed for any expenses during the reporting period.

The key management personnel are the voluntary trustees and so there is no expenditure on key management personnel during the reporting period.

There were the following related party transactions during There were the following related party transactions during the reporting period.
Related party and relationship Amount Nature of transaction
£
Michael Sugden, trustee and senior employee
of VCCP Group LLP		 1,200 Donation
Dr Nicola Biggs, Secretary 415 Sponsorship collected for
bike ride
Caitlin Farrow, Trustee 1,695 Sponsorship collected for
bike ride
Dr Nicholas Campain 240 Donation

15. RECONCILIATION OF NET MOVEMENT IN FUNDS TO CASH FLOW FROM OPERATING ACTIVITIES

Net income/expenditure for the year (as per
the Statement of Financial Activities)
Add back depreciation charge
Investment income
Loss on disposal of fixed assets and exchange
adjustments
Decrease (increase) in stock
Decrease (increase) in debtors
Increase (decrease) in creditors
Net cash used in operating activities		 2024
£
- 39,366
6,332
- 248
1,060
-
- 36,096
15,541
- 52,776		 2023
£
18,743
6,890
-
1,959
-
- 26,053
10,148
11,687

33

COMPARATIVE STATEMENT OF FINANCIAL ACTIVITIES FOR THE PERIOD ENDED 30 JUNE 2023

Total Total
Note Unrestricted Restricted Unrestricted Restricted
2023 2022
£ £ £ £ £ £
Income
Donations and
legacies		 3 122,236 772,691 894,927 100,604 398,414 499,018
Other 3,331 - 3,331 1,636 1 1,637
Total income 125,567 772,691 898,258 102,240 398,415 500,655
Expenditure
Fundraising costs 5 17,430 33,442 50,872 26,823 47,462 74,285
Charitable activities 6 152,171 676,472 828,643 122,176 323,812 445,988
Total expenditure 169,601 709,914 879,515 148,999 371,274 520,273
Net income/ -
expenditure		 - 44,034 62,777 18,743 - 46,759 27,141 - 19,618
Transfers between
funds		 702 - 702 - 22,806 - 22,806 -
Net movement in
funds		 - 43,332 62,075 18,743 - 23,953 4,335 - 19,618
Reconciliation of
funds:
Total funds brought
forward		 65,173 49,658 114,831 89,126 45,323 134,449
Total funds carried
forward		 21,841 111,733 133,574 65,173 49,658 114,831

34