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2025-06-30-accounts

2025 ANNUAL REPORT AND FINANCIAL STATEMENT

HIPZ

(Health Improvement Project Zanzibar)

Financial Statements

For the year ending 30[th] June 2025

Charity Number: 1171687

Company Number: 10168369

Table of Contents

1 Legal and Administrative Information .................................................................................... 4 Trustee’s Annual Report (Including Directors Report) 1.1 Background ....................................................................................................................... 5 1.2 The context ........................................................................................................................ 5 1.3 Our Aims and Objectives .................................................................................................. 6 1.4 How we work ..................................................................................................................... 7 1.5 Performance and Achievements .................................................................................... 9 2 Governance, Leadership and Health Financing ................................................................ 10 3 Infectious Diseases ................................................................................................................. 11 4 Infrastructure and supplies .................................................................................................... 15 5 Reproductive Maternal Newborn Child Adolescent Health .............................................. 15 5.1 Maternal Newborn and Child Health Phase – 2 ........................................................... 16 5.2 USAID Afya Yangu – Mama na Mtoto ........................................................................... 20 6 Non-communicable diseases ............................................................................................... 21 6.1 Cardiovascular Diseases ................................................................................................. 22 7 Mental Health ........................................................................................................................ 23 7.1 Pamoja Afya Bora Zanzibar ............................................................................................ 23 7.2 Dawati Rafiki .................................................................................................................... 25 7.3 Mental Health Clinics and Outreach services .............................................................. 25 8 Emergency Medicine ............................................................................................................ 26 9 Structure, Governance and Management ......................................................................... 26 9.1 Governing Document ..................................................................................................... 27 9.2 Directors/Trustees ............................................................................................................ 27 9.3 Risk Management ........................................................................................................... 28 10 References ........................................................................................................................... 28 11 Statement of Trustees’ Responsibilities …………………………………………………………. 29 12 Financial Review …………………………………………………………………………………… 30 13 Independent Auditor’s Report …………………………………………………………………... 32 14.1 Statement of Financial Position ……………………………………………………………. 36 14.2 Balance Sheet ………………………………………………………………………………… 37 14.3 Statement of Cashflows …………………………………………………………………….. 38 14.4 Notes to the Accounts ….…………………………………………………………………… 39

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List of Acronyms

Acronym Full Form Meaning / Use
AMR Antimicrobial Resistance Resistance of pathogens to
antibiotics/medicines
BNITM Bernhard-Nocht Institute for Tropical
Medicine		 Research partner in AMR
CHW Community Health Worker Frontline worker delivering community
health
**CRP-POCT ** C-ReactiveProtein Point-of-CareTest Diagnostictestusedin AMR research
CVD Cardiovascular Disease Heartand circulatory systemdiseases
E-MOTIVE Early detection & treatment bundle for PPH WHO package for postpartum
hemorrhage
FAGC Finance, Audit & Governance Committee Board subcommittee overseeing finances
&risk
GLASS Global AMRSurveillance System WHO global reporting platform for AMR
HCW Health Care Worker Includes doctors,nurses,midwives,etc.
HPAC Health ProgrammeAdvisory Committee Technicaladvisory subcommittee of HIPZ
IHP International Health Partners Partnersupportingmedicines/supply chain
**JKCI ** JakayaKikwete CardiacInstitute Tanzania’snationalcardiacreferralcentre
KAP Knowledge, Attitudes, Practices Study framework for AMR/health
behaviour
LFT Lady Fatemah Trust Charity partner in maternal & mental
health
MMR Maternal MortalityRatio Maternal deathsper 100,000 live births
MOFP Ministryof Finance & Planning (Zanzibar) Population/economic data source
**MOH ** Ministry of Health(Zanzibar) HIPZ’smaingovernmentpartner
NCD Non-Communicable Disease Chronic illnesses e.g. diabetes,
hypertension
PPH Postpartum Hemorrhage Severematernalbleeding afterbirth
RGoZ RevolutionaryGovernment of Zanzibar Zanzibar’sgovernment
RMNCAH Reproductive, Maternal, Newborn, Child &
Adolescent Health		 Key health service package
SBCC Social & Behaviour Change
Communication		 Community health education activities
SDG Sustainable Development Goal Global UN developmentgoals
SMT Senior Management Team HIPZ executive management
ToC Theory ofChange Framework linking activitiesto outcomes
UNICEF UnitedNations Children’sFund Partneron maternal/childhealth
USAID United States Agency for International
Development		 Partner on health systems strengthening
ZALIRI Zanzibar Agriculture and Livestock
Research Institute		 Government research institute for
agriculture andlivestock
ZHSF Zanzibar Health Service Fund Prepayment/insurance scheme for health

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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 2025. The Board of Directors presents its directors’ and trustees’ report and independently examined financial statements for the year ending 30 June 2025.

The Trustees have adopted the provisions of the Statement of Recommended Practice (SORP) “Accounting & Reporting by Charities” in preparing the annual report and financial statements of the charity. The directors of the charitable company are its trustees for the

Reference and Administrative Information

Senior Management Team

Charity Name: HIPZ (Health Improvement CEO (Zanzibar): Simon Kühnert Project Zanzibar) Finance Director (UK): Juliette Webb Charity registration number: 1171687 Fundraising Manager (UK): Kathryn Sheldon Company registration number: 10168369 Programme Director (Zanzibar): Jabir Ayindo Zanzibar registration number: Z0000007249 Partnerships Advisor (Zanzibar): Pamela Allard

Registered address:

External Auditors

Applecombe Cottage, UHY Ross Brooke Wild Oak Lane, Trull Suite I Taunton Abingdon Business Park TA3 7JS, UK Abingdon OX14 1SY

Board of Directors/ Trustees

Chair: Dr Ruaraidh MacDonagh BEM Bank Treasurer: Ian Franklin Royal Bank of Scotland (UK), Secretary: Dr Nicola Biggs Exim Bank (T) Ltd (Zanzibar) Dr Nicholas Campain Michael Sugden Susan Moore Dr. Lindsay Solera-Deuchar John Mahon CBE Ebun Atinmo purpose of charity law.

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Trustee’s Annual Report (Including Directors Report)

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 investments into the health sector in recent years – especially in health infrastructure including the construction of 10 new district and regional hospitals. The Ministry of Health is in the process of formally training the CHW and professionalizing their cadre to bridge the gap between households and health facilities.

----- Start of picture text -----
Pemba
ZANZIBAR
Unguja
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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
Neonatal mortality rate per
1,000 live births		 34 per 1,000 live births 12 per 1,000 live births
Maternal Mortality ratio per
100,000 live births		 119 per 100,000 live births (only
includes institutional mortality)		 70 per 100,000 live births

Total health expenditure in Zanzibar is estimated at 11% of the Gross Domestic Product, which remains below the Abuja Declaration target (World Bank, 2023). Although health services are provided free of charge, out-of-pocket payments still account for approximately 19% of total health sector financing (MOH, 2025), creating a significant barrier to Universal Health Coverage. The Zanzibar Health Service Fund (ZHSF) is in its early stages of operation but is gradually expanding. Nevertheless, accreditation of public facilities remains limited, with the majority of accredited services delivered by private providers.

1.3 Our Aims and Objectives

HIPZ is committed to strengthening Zanzibar’s healthcare system by supporting all the building blocks. Our mission is to ensure that every person, regardless of background or circumstance, has access to safe, high-quality healthcare. In doing so, we are working toward our vision of a healthier, more resilient Zanzibar, where strong health systems empower communities to thrive.

The trustees have reviewed the outcomes and achievements of our objectives and activities over the past year. We confirm that we have complied with our duty under Section 17(5) of the Charities Act 2011 to have due regard to the public benefit guidance published by the Charity Commission.

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1.4 How we work

The HIPZ Model: Transforming Healthcare, Rooted in our Values

For 19 years, HIPZ has refined and proven a model that shows how healthcare can be transformed even in resource-limited settings. The HIPZ model—built on co-design, a scalable and replicable approach, local leadership, and a holistic health system perspective—sets a blueprint for how meaningful, lasting change can be achieved. This blueprint not only drives progress in Zanzibar but also offers lessons with the potential for global impact.

At the heart of the HIPZ model are the values that guide everything we do:

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 provision of 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 long- lasting change.

All this work is delivered in close partnership with the Revolutionary Government of Zanzibar (RGOZ) through the Ministry of Health, 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 successfully delivered our programmes across Zanzibar, reaching all 11 districts and directly supporting over 150 health facilities. Through these efforts, we strengthened health systems, enhanced service delivery and improved access to care for thousands of people. Our programmes also trained and mentored health workers, ensuring continuity of quality services at both primary and referral levels.

HIPZ works across all building blocks of the health system, adopting a collaborative approach that recognizes and reinforces the leadership of the Ministry of Health in steering the health sector towards achieving Universal Health Coverage for its people.

In this report, we provide a brief overview of the work and results achieved under the HIPZ strategic results Areas:

Below is a snapshot of results across all programs conducted during the reporting period. We track these internally as per the HIPZ core indicators:

• Through catalytic product introduction, we distributed calibrated blood collection drapes, anti-shock garments and uterine balloon tamponades for the diagnosis and management of postpartum hemorrhage. In total we distributed over 28,000 pieces of equipment and supplies (excluding medication), which strengthened facility readiness for service delivery.

• Capacity building was a major achievement. A total of 1,437 healthcare workers were trained and an additional 1,973 were mentored on-site to enhance their practical competencies. Furthermore, 336 end users were trained and mentored in proper utilization, equipment maintenance and repair, ensuring equipment uptime and sustainability of medical equipment investments.

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• Management capacity was strengthened with 106 health managers trained, equipping them with skills to improve planning, coordination, financial management and oversight of health services.

• Service availability expanded across all the 11 districts in Zanzibar. Utilization was high, with more than 100,000 people accessing essential health interventions in health facilities and via outreach services.

• Community engagement was promoted through 29 social and behavioral change communication (SBCC) events and radio & TV broadcasts, which contributed to improved knowledge and awareness, ultimately encouraging service uptake.

• At the policy and advocacy level, the program actively engaged in 18 policy platforms and events, ensuring representation and contribution to national health agendas.

Outcomes Across Strategic Result Areas:

2. 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 18 policy platforms and events contributing to the review and development of the NCD Strategy, RMNCAH Strategy, AMR National Action Plan, and the first ever Mental Health Action Plan for Zanzibar. Another key area of support is the development of the Minimum Intervention Package for Community Health Workers (CHW) and the corresponding curriculum. Now, CHW are not only providing health education but also curative services including NCD and mental health interventions. This is a crucial development to strengthen community health and linking households with health facilities.

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This year we have seconded 7 staff to various programmes and units 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 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 and the Health Financing Technical Working group which has delivered critical work towards Direct Health Facility Financing which will strengthen Primary Healthcare in Zanzibar.

3. 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 standardized methods in laboratories conducting the Antimicrobial Susceptibility Test (AST). Following this, the Zanzibar AMR Multisectoral Surveillance Framework was developed. After establishing the microbiology laboratory at Makunduchi Health Centre in partnership

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with the Bernhard-Nocht Institute for Tropical Medicine (BNITM), we strengthened the microbiology department at the Public Health Laboratory – Ivo de Carneri in Pemba. We provided equipment, consumables and capacity building and technical assistance. We also formalized this partnership by signing a Memorandum of Understanding.

_________

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).

Currently AMR surveillance is ongoing in 10 facilities across Zanzibar, processing 2,113 samples.

AMR 10 facilities across Zanzibar

Samples collected and processed – July 2024 to June 2025

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Out of the 2,113 blood and urine samples collected and processed, 17.1% of blood samples and 31.6% of urine samples were positive. The most common isolates were Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Contaminated samples were 14.9% and 16.6% for blood and urine samples respectively.

HIPZ also serves as an advisor to the ZANTOTO implementation research project led by the Zanzibar Health Research Institute which focuses on optimizing antibiotic use among neonates and children and aims to design an implementation model for evidence-based AMR activities in Zanzibar. This year the study focused on the effectiveness of the C Reactive Protein (CRP) Point of Care Test (POCT) in clinical decision making on antibiotic treatment among neonates - an open-label, individual randomized controlled clinical trial in targeted hospitals in Unguja and Pemba. Our surveillance provided the culture and sensitivity results for the RCT.

We addressed another critical gap of the ZAP by conducting research into the knowledge attitudes and behaviour towards antimicrobial resistance within the general population, healthcare workers and farmers. This will inform the development of the behaviour change communication strategy under the National Action Plan on AMR and provide validated measurement instruments – in terms of reliability and validity – in Kiswahili which can be used by other stakeholders for future KAP studies.

The study was implemented in partnership with BNITM and the Zanzibar Livestock Research Institute (ZALIRI). The first set of measurement instruments were developed through a cross-sectional study (standardized questionnaire developed through Delphi process). The tools were previously psychometrically evaluated in a

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German pre-study (AMR knowledge, Attitude and Behaviour related questions). We triangulated the questions into Kiswahili and administered them to 1200 participants across all districts in Unguja. The participants were divided into three groups (Healthcare workers, general population and farmers)

Knowledge:

Attitudes:

workers perceived

antibiotics as less useful than other groups and reported slightly higher social pressure.

• Fear of negative consequences from improper antibiotic use was high, especially among healthcare workers.

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Behaviour:

The study identified key behavioral patterns across different groups:

General population: Self-medication without prescription is relatively common, and consulting doctors before taking antibiotics is not consistently practiced. Many individuals save leftover antibiotics, while returning them to pharmacies remains rare.

Healthcare workers: Challenges include limited diagnostics, inconsistent adherence to guidelines, delayed prescriptions, and occasional use of additional or prophylactic treatments.

Farmers: Antibiotics are frequently used for growth promotion, with preventive use more common than curative treatment, raising concerns for AMR. Additionally, 78% of farmers reported never having a field officer inspect their livestock, indicating gaps in oversight and guidance.

4. Infrastructure and supplies

We continue to supply essential health commodities to the Ministry of Health through our partnership with International Health Partners. During this reporting period we have handed over two consignments to the Ministry of Health. The medication was received, stored and distributed by the Central Medical Store of the Ministry of Health to 120 health facilities. As a result, this contributed to improved availability of essential health commodities at the primary level. Availability of Health Commodities (Essential Medicines and laboratory at Primary level) increased from 62.2% 2023/2024 to 78% (CMSA 2025)

5. 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 implementing community- based 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. Unfortunately, both RMNCAH projects came to an early end before realization of all project goals. The chart below highlights the leading causes of maternal mortality in Zanzibar.

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----- Start of picture text -----
Causes of Maternal deaths 2024
Anaemia Moderate ( 7-
8.9g/dl ), 10.9375
Ante partum
haemorrhage (APH) ,
Other causes of maternal 1.5625
deaths, 34.375
Eclampsia , 6.25
PPH trauma, 18.75
Severe pre-eclampsia,
6.25
PPH Uterine atony ,
Sepsis, 6.25 Pulmonary embolism, 1.5625
Rupture uterus, 4.6875 9.375
----- End of picture text -----

Source: Zanzibar Annual Health Information Bulletin 2024

5.1 Maternal Newborn and Child Health Phase – 2

The project in partnership with the Ministry of Health and funded by the LFT aimed to strengthen maternal, newborn and child health services and contribute towards a resilient and sustainable health system and ended in April 2025.

During this reporting period we put a lot of emphasis on tackling the leading cause of maternal death in Zanzibar – postpartum hemorrhage. We introduced the EMOTIVE bundle approach in Zanzibar in collaboration with the MOH and the LFT. This intervention has been proven to reduce maternal mortality due to PPH. We distributed more than 28,000 drapes, anti-shock garments and uterine balloon tamponades to all public health facilities providing delivery services. We trained 315 healthcare workers in 16 health facilities to provide the intervention. In collaboration with USAID Afya Yangu – Mama na Mtoto and the MOH we supported the review and dissemination of the clinical treatment guideline for uterotonics and PPH.

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This year we rolled out the leadership and management training which was previously developed together with the MOH and UNICEF. We trained 106 health managers, equipping them with skills to improve planning, coordination, financial management and oversight of health services. Whilst we focused on Pemba Island, UNICEF supported the rollout in Unguja.

During the reporting period we also started to address the critical gap in anesthesia provision across the new district hospitals by supporting 10 healthcare workers to attain professional training at Muhimbili Hospital in anesthesia for 1-year. After completion, they will return to their respective facilities to promote the availability of anesthesia and safe surgery services.

Further, we continued to strengthen the capacity of healthcare workers in the following areas:

During the reporting period 9,278 pregnant women attended ANC early. 1,085 women completed the recommended 8 ANC visits. 112,342 HB tests and 27,876 syphilis tests were conducted. 1710 were reported with anaemia at the ANC. 19,260 obstetric ultrasounds were done for women with various gestation ages.

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A total of 19,792 deliveries were conducted and 10.6% were by caesarian section. Among the morbidities reported were obstructed labour (289) and prolonged labour (350).

Trend in PPH and eclampsia in the project areas

In addition, PPH (Postpartum Hemorrhage) and eclampsia (trend shown on the left) were among the reported conditions and key contributors to maternal deaths in Zanzibar.

After delivery, postnatal follow up visits are required, providing an opportunity for the early detection and treatment of life-threatening complications both for the mother and newborn. Health facility reports show few women attend (especially the 3 –7 days critical window).

Trend in health facility delivers and post-natal attendance in project areas

Poor follow-up care likely contributes to the mortality burden observed. On the right is a figure showing trends in delivery and postnatal attendance in project areas.

With regards to mortality, there were 12 maternal deaths, 33 neonatal deaths and 440 stillbirths occurring in the project areas as shown below.

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Reported mortality in the project areas:

Indicator Jul-24 Aug-24 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Total
Maternal
0 2 0 1 3 2 2 2 12
deaths
Neonatal
deaths		 1 5 1 7 6 4 2 7 33
Stillbirths-
25 18 13 40 48 51 52 50 297
Macerated
Stillbirth-Fresh 11 7 5 16 21 29 26 28 143

Reports show a concerning burden of stillbirths, neonatal deaths, and maternal deaths in the project areas. Late ANC initiation, lack of completion of recommended 8 ANC visits, complications like PPH and eclampsia and limited postnatal clinic attendance combined with inadequacies in the quality of MNCH services are drivers of the observed high mortality. In addition, seasonal variations and the quality of reporting may also influence the apparent trends shown above.

The Interventions contributed to the reduction of institutional maternal mortality in Zanzibar from 145/100,000 live births in 2023 to 119/100,000 live births in 2024 as per the Zanzibar Annual Health Information Bulletin 2024.

Trend of Institutional MMR from 2020 - 2024, Zanzibar

----- Start of picture text -----
160
145
140
120 134
120 119
100 99
80
60
40
20
0
2020 2021 2022 2023 2024
----- End of picture text -----

Note: The Global Maternal Mortality Ratio (MMR) SDG target is set to be less than 70 per 100,000 live births by 2030.

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5.2 USAID Afya Yangu – Mama na Mtoto

The project 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 healthseeking and self-care behaviour. We delivered these activities in Kati district as an implementing partner for the consortium leading USAID Afya Yangu – Mama na Mtoto in Tanzania. We handed over the community-based activities to the District Health Management Team of the MOH in September 2024 before the USAID Afya Yangu – Mama na Mtoto came to an end in February 2025.

We reached 5,972 people with interpersonal communication leading to 351 referrals to health facilities. We distributed over 4,000 social behaviour change communication materials in Kati district.

2 The E-MOTIVE trial is the early detection of Postpartum Haemorrhage and treatment using the WHO MOTIVE 'first response' bundle: a cluster randomized 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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6. Non-communicable diseases

Non-communicable diseases (NCDs) create the highest disease burden to the Zanzibari population. This year, the preliminary results from the NCD Step Survey from 2023 (supported by HIPZ) have been released by the Ministry of Health. The survey highlights the risk factors associated with NCDs - see Table 1. There has been a rapid increase in overweight and obesity, largely driven by urbanization, dietary shifts, and sedentary lifestyles.

We work in partnership with the MOH NCD and the Mental Health units. We aim to address these challenges by increasing awareness and creating positive behavioral changes to minimize risk factors and promoting access and awareness of these services and ensuring the quality of these services. This year we also supported the NCD Unit and Mental Health Program to develop the NCD Strategy and the first ever Mental Health Action Plan for Zanzibar. During the development of the Minimum Intervention Package for CHW we successfully advocated for the empowerment of CHWs to deliver health education and curative interventions for NCDs including mental health. This is a big milestone towards tackling the growing burden of NCDs in Zanzibar. Part of this strategy is to integrate NCD and mental health service delivery and awareness raising by delivering integrated outreaches. Through the NCD integrated outreaches, a total of 3428 beneficiaries were reached.

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6.1 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.

This year we have been building on the foundation laid by our hypertension project and continuously strengthened awareness, screening, diagnosis and management of cardiovascular diseases in Zanzibar.

Due to our close collaboration with the District Health Management Teams and the NCD Unit we have been able to transition the responsibilities for our hypertension project. During this reporting period, services were provided in 32 health facilities in North A, North B and Urban West districts in Unguja, mainly in primary healthcare facilities. With the HHA/AstraZeneca support, 24,864 people were screened in July and August 2024. The project came to completion with great achievement, screening a total of 226,519 people (140% of the target).

We trained four healthcare workers (HCWs) at JKCI on ECHO, equipping them to return to their respective workplaces and strengthen cardiology clinics. Their responsibilities extended beyond screening, diagnosis, and treatment of cardiovascular diseases (CVDs) to include on-the-job training of other clinicians—ensuring continuity of services even in their absence.

Building on this achievement at the primary level, we advanced to strengthening referral sites through on-site mentorship led by our Cardiologist and specialized professional courses in ECG and ECHO at Jakaya Kikwete Cardiac Institute (JKCI) and Muhimbili Hospital in Dar es Salaam. These initiatives enable referral centers to progressively establish dedicated cardiac clinics, while also serving as hubs that provide continuous mentorship and technical support to primary-level facilities.

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Our long-term goal is to sustain this hub-and-spoke model of care, ensuring that knowledge and expertise, flow from referral centres to the primary level, thereby improving access, quality, and continuity of CVD services across all levels of care.

7. Mental Health

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

7.1 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:

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56 Healthcare workers were trained to facilitate Pamoja Afya Bora sessions across Zanzibar. During this reporting period, the facilitators conducted 672 interpersonal communication sessions reaching 11,783 people, 43% being youths. A total of 500 people were

Trend in Interpersonal Pamoja Afya Bora Sessions uptake July 2024 and December 2024

referred for mental health services whereby 9% of referrals were youths.

An estimated 11,600 more people were reached via mass media outlets and events making a total of more than 23,000 beneficiaries in Zanzibar.

Furthermore, the PAB Project aimed to provide the full course to selected participants particularly in institutions of higher education. A total of 422 college students have been trained in various sessions aiming to complete the course. These will further educate and create awareness on mental health to their peers and communities.

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:

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7.2 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 sessions. 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.

Dawati Rafiki - New patients by district

7.3 Mental Health Clinics and Outreach services

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.

This year, 706 people (60% being women) in the communities were screened and treated for NCDs including those affecting their mental health via support from Evan Cornish.

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8. Emergency Medicine

In collaboration with various stakeholders in Zanzibar and abroad, HIPZ established an emergency medicine department at Makunduchi Hospital, as part of efforts to strengthen emergency care services in Zanzibar. During this reporting period, 1,019 patients of all ages benefited from lifesaving services. Most patients were provided with treatment for injuries due to road traffic accidents (adults) and falls and burns (children).

9. Structure, Governance and Management

HIPZ is governed by a Board of Trustees, led by the Chair and supported by the Vice-Chair and Treasurer. The Board convenes on a quarterly basis and is supported by three standing committees:

Each committee comprises both trustees and staff members. Meetings are held quarterly, with minutes formally recorded and shared with the Board.

The Finance, Audit and Governance Committee oversees financial management and the intersections between finance, audit, and governance.

The Health Programme Advisory Committee ensures HIPZ delivers interventions that are relevant, evidence-based, and aligned with both HIPZ and RGoZ strategies. It also provides technical advice and guidance to the Programme Team.

The Fundraising and External Communication Committee provides oversight, guidance, and recommendations on fundraising, development, marketing, partnerships, and external communications. It works to ensure the charity’s fundraising goals are achieved in alignment with its mission and strategic objectives, while fostering strong relationships with donors, partners, and the wider community.

To further strengthen governance, the Board of Trustees resolved at its meeting on 5 December 2024 to establish a timebound Governance Working Group. This group provides

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2024-2025 HIPZ ANNUAL REPORT

oversight, guidance, and recommendations on governance structures, policies, and practices during the organization’s transition phase. With the appointment of a Chief Executive Officer (CEO) and the creation of additional senior roles, the Board recognizes the importance of reinforcing governance and ensuring robust change management practices at this critical stage.

The Governance Working Group is reviewing and proposing improvements to HIPZ’s governance framework, skills, and capacity, with the aim of aligning with best practices, enhancing accountability, and strengthening the organization’s overall effectiveness. The Senior Management Team (SMT) comprises the CEO, Programme Director, Finance Director, Partnerships Manager, and Fundraising Manager. The SMT meets weekly, and its meetings are formally minuted, including the documentation of all decisions taken and actions required.

9.1 Governing Document

HIPZ as a charity is governed by its founding document, a deed of trust, and is established as a Company Limited by Guarantee under the Companies Act 2006.

9.2 Directors/Trustees

Our board of trustees consists of experienced professionals from diverse 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 receive no benefits from the charity. There were no trustees' remuneration or other benefits paid for the year ending 30 June 2025.

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.

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9.3 Risk Management

HIPZ takes a proactive and structured approach to risk management, guided by our Risk Management Policy. Risks are identified, assessed, and discussed at all levels of the organization, with strategic risks captured in a comprehensive organizational risk register. This register is reviewed regularly by the Finance, Audit, and Governance Committee and is a standing agenda item at all Board meetings, ensuring that risk oversight is embedded into our governance and decision-making processes.

10. 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

11. Statement of Trustees’ Responsibilities

FOR THE YEAR ENDED 30 June 2025

The Trustees, who are also the directors of Health Improvement Project Zanzibar (HIPZ) for the purpose of company law, are responsible for preparing the Trustees' 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 HIPZ and of the incoming resources and application of resources, including the income and expenditure, of the charitable company for that year.

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2024-2025 HIPZ ANNUAL REPORT

In preparing these accounts, the trustees are required to:

The Trustees are responsible for keeping adequate accounting records that disclose with reasonable accuracy at any time the financial position of HIPZ and enable them to ensure that the accounts comply with the Companies Act 2006. They are also responsible for safeguarding the assets of HIPZ and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

In so far as the Trustees are aware:

The Trustees' report was approved by the Board of Trustees.

This report has been prepared in accordance with the small companies regime under Section 419(2) of the Companies Act.

----- Start of picture text -----
…………………………………………………..
----- End of picture text -----

Dr Ruaraidh MacDonagh BEM (Chair)

Trustee

Dated: 20[th] Aug 2026

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12. Financial Review

Financial Performance 2024-25

Income for the year at £1.1m was 22% lower than budgeted and represented a +11% increase from 2023-24. 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.

Expenditure for the year at £1.1m was 23% lower than budgeted and represented a +10% increase compared to 2023-24. The spend continues to be mostly in the areas of capacity building and quality improvement as well as preventative services and equipment, consumables and pharmaceuticals (mostly goods in kind)

The net income/expenditure for the year is a loss of £32k due to a £50k provision made for a bad debt against contractually owed sums from a partner. This results is a net asset position of £62k at the end of 2024-25.

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

HIPZ defines reserves as that part of the fixed and current assets less liabilities that are unrestricted funds and are freely available to spend on any of the charity’s purposes. HIPZ keeps reserves to:

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2024-2025 HIPZ ANNUAL REPORT

HIPZ targets to hold it’s reserves within the range of 2-4 months of net unrestricted expenditure, defined as planned expenditure not covered either as direct spending attributable to a specific project by a specific donor (restricted expenditure) or as indirect costs covered by an allowable charge to a current signed restricted project contract/donor agreement.

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

At the 2024-2025 year end £30.6k was held in unrestricted funds and £31.5k in restricted funds. Total free reserves are £31.5k, no designated funds are held.

Auditors

Following a competitive procurement process, UHY-Ross Brooke were appointed to conduct the external audit 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 Ireland (FRS 102) (effective 1 January 2019)', 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 2025 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 20[th] Aug 2026 and signed on its behalf by:

Dr Ruaraidh MacDonagh

Chair of the Board of Trustee

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13. Independent auditor’s report

Independent Auditor’s Report to the Members of Health Improvement Project Zanzibar(“HIPZ”)

Opinion

We have audited the financial statements of Health Improvement Project Zanzibar (“HIPZ”) (the ‘charitable company’) for the year ended 30 June 2025 which comprise Statement of Financial Activities, Balance Sheet and Cash Flow Statement 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:

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 charitable company 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.

Other matters

The financial statements for the year ended 30 June 2025 include comparative figures for the year ended 30 June 2024. The charity took advantage of the audit exemption available for that year under section 477 of the Companies Act 2006, and accordingly, the comparative figures are unaudited.

Conclusion 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.

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2024-2025 HIPZ ANNUAL REPORT

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

Other information

The other information comprises the information included in the trustees annual report, other than the financial statements and our auditor’s report thereon. The trustees are responsible for the other information contained within the annual report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon.

Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.

We have nothing to report in this regard.

Opinions on other matters prescribed by the Companies Act 2006

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

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 directors’ report included within 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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2024-2025 HIPZ ANNUAL REPORT

Responsibilities of trustees

As explained more fully in the trustees’ responsibilities statement set out on page 29, the trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and for such internal control as the trustees determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error.

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 specific procedures for this engagement and the extent to which these are capable of detecting irregularities, including fraud is detailed below:

We have considered:

As a result of these procedures, we considered the opportunities and incentives that may exist within the organisation for fraud and identified the greatest potential for fraud in the areas in which management is required to exercise significant judgement, such as the

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2024-2025 HIPZ ANNUAL REPORT

recognition of income. In common with all audits under ISAs (UK), we are also required to perform specific procedures to respond to the risk of management override.

We also obtained an understanding of the legal and regulatory framework that the company operates in, focusing on provisions of those laws and regulations that had a direct effect on the determination of material amounts and disclosures in the financial statements. The key laws and regulations we considered in this context were the Companies Act and tax legislation.

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.

A further description of our responsibilities is available on the Financial Reporting Council’s website at: https://www.frc.org.uk/Our-Work/Audit/Audit-and-assurance/Standards-andguidance/Standards-and-guidance-for-auditors/Auditors-responsibilities-foraudit/Description-of-auditors-responsibilities-for-audit.aspx. This description forms part of our auditor’s report.

Use of our report

This report is made solely to the charitable company’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.

Caroline Webster FCA (Senior Statutory Auditor) For and on behalf of Ross Brooke Limited Statutory Auditor Suite I Windrush Court Abingdon Business Park Oxfordshire OX14 1SY Date: 20/08/2026

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2024-2025 HIPZ ANNUAL REPORT

14.1 Statement of Financial Activities including Income and Expenditure Account

FOR THE PERIOD ENDED 30 JUNE 2025

Note
Income
Donations and
legacies
3
Charitable activities
4
Investments
Total income
Expenditure
Fundraising costs
5
Charitable activities
6
Total expenditure
Net income/ -
expenditure
Transfers between
funds
Net movement in
funds
Reconciliation of
funds:
Total funds
brought forward
Total funds carried
forward		 Unrestricted
£
113,928
17,642
232
131,802
51,088
61,851
112,939
18,863
-16,596
2,267
28,346
30,613		 Restricted
£
980,667
-
-
980,667
50,090
981,549
1,031,639
- 50,972
16,596
- 34,376
65,862
31,486		 Total
2025
£
1,094,595
17,642
232
1,112,469
101,178
1,043,400
1,144,578
- 32,109
-
- 32,109
94,208
62,099		 Unrestricted
£
81,207
9,900
248
91,355
24,923
60,832
85,755
5,600
905
6,505
21,841
28,346		 Restricted
£
902,684
-
-
902,684
33,217
914,433
947,650
- 44,966
- 905
- 45,871
111,733
65,862		 Total
2024
£
983,891
9,900
248
994,039
58,140
975,265
1,033,405
- 39,366
-
- 39,366
133,574
94,208

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 39-48 form part of these financial statements.

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2024-2025 HIPZ ANNUAL REPORT

14.2 Balance Sheet

AS AT 30 JUNE 2025

Note
Tangible fixed assets
8
Current assets
Debtors
9
Cash at bank and in hand
Creditors: amounts falling due
within one year
10
Net current assets
Creditors: amounts falling due in
more than one year
Net assets
Funds
Restricted funds
11
Unrestricted funds general
12
Total charity funds		 2025
£
14,501
76,037
90,538
- 40,287		 2025
£
11,848
50,251
-
62,099
31,486
30,613
62,099		 2024
£
67,675
49,044
116,719
- 38,386		 2024
£
15,875
78,333
-
94,208
65,862
28,346
94,208

These financial statements have been prepared in accordance with the provisions applicable to companies subject to the small companies regime.

These financial statements were approved by the members of the committee and authorised for issue on 20[th] Aug 2026 and are signed on their behalf by Dr Ruaraidh MacDonagh, Chairman and Trustee.

Trustee:

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2024-2025 HIPZ ANNUAL REPORT

14.3 Statement of Cash Flows

FOR THE PERIOD ENDED 30 JUNE 2025

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		 2025
£
28,462
232
-
- 1,701
- 1,469
26,993
49,044
76,037		 2024
£
- 52,776
248
-
- 9,760
- 9,512
- 62,288
111,332
49,044

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2024-2025 HIPZ ANNUAL REPORT

FOR THE PERIOD ENDED 30 JUNE 2025

14.4 Notes to the Accounts

1. ORGANISATION STATUS

HIPZ (Health Improvement Project Zanzibar) is a Charitable Company limited by guarantee in England and Wales.

2. ACCOUNTING POLICIES

Basis of accounting

The financial statements of the charitable company, which is a public benefit entity under FRS 102, have 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 Ireland (FRS 102) (effective 1 January 2019)’, Financial Reporting Standard 102 ‘The Financial Reporting Standard applicable in the UK and Republic of Ireland’ and the Companies Act 2006. The financial statements have been prepared under the historical cost convention.

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. Monetary amounts in these financial statements are rounded to the nearest £1.

Going concern

The trustees have assessed the charity's ability to continue as a going concern for a period of at least twelve months from the date of approval of these financial statements.

The HIPZ budget for the financial year 2025–26 was prepared and approved as a balanced budget, consistent with the organisation's reserves policy. At the time the budget was approved, management anticipated the commencement of a major new donor contract in October 2025, based on the best information available at that date.

During the year, the commencement of this donor contract was delayed due to circumstances outside the control of HIPZ. In addition, the organisation recognised a provision for a bad debt relating to a donor receivable where expenditure had been incurred under a valid contract but payment had not been received. These matters created temporary pressure on cash flow and working capital during the period.

Management and the trustees responded proactively through enhanced cash flow monitoring, careful cost management and ongoing engagement with donors and other stakeholders. Subsequent to the year end, the funding position has improved significantly, including the progression of the major donor contract and implementation of other mitigating actions. The trustees are satisfied that the charity has adequate resources to continue its operations and meet its obligations as they fall due.

Having considered the charity's financial forecasts, available funding, cash flow projections and the actions taken by management, the trustees have a reasonable expectation that HIPZ will continue in operational existence for the foreseeable future. Accordingly, the financial statements have been prepared on the going concern basis.

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2024-2025 HIPZ ANNUAL REPORT

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2025 (continued)

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.

Donated goods

Donated goods for the year were medical consumables, equivalent to £158k, and were donated by IHP.

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.

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)

Debtors

Trade and other debtors are recognised at the settlement amount due. Prepayments are valued at the amount prepaid.

Creditors

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

Taxation

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

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2024-2025 HIPZ ANNUAL REPORT

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2025 (continued)

3. DONATIONS AND LEGACIES

Unrestricted Restricted 2025 Unrestricted Restricted 2024
£ £ £ £ £ £
Individual Giving 36,359 - 36,359 40,369 - 40,369
Corporate 19,329 26,875 46,204 12,200 44,652 56,852
Major Donors 16,000 - 16,000 20,000 - 20,000
Statutory - - - - 26,984 26,984
Community and events 39,258 - 39,258 7,880 - 7,880
Trusts and Foundations 2,982 953,792 956,774 758 831,048 831,806
113,928 980,667 1,094,595 81,207 902,684 983,891

4. INCOME FROM CHARITABLE ACTIVITIES

Unrestricted Restricted 2025 Unrestricted Restricted 2024
£ £ £ £ £ £
Electives 17,642 - 17,642 9,900 - 9,900
17,642 - 17,642 9,900 - 9,900

5. FUNDRAISING COSTS

Fundraiser salaries
Other fundraising costs		 Unrestricted
£
36,509
14,579
51,088		 Restricted
£
16,730
33,360
50,090		 2025
£
53,239
47,939
101,178		 Unrestricted
£
11,513
13,410
24,923		 Restricted
£
18,026
15,191
33,217		 2024
£
29,539
28,601
58,140

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2024-2025 HIPZ ANNUAL REPORT

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2025 (continued)

6. EXPENDITURE ON CHARITABLE ACTIVITIES

Unrestricted Restricted 2025 Unrestricted Restricted 2024
£ £ £ £ £ £
Operational costs 40,450 16,579 57,029 2,863 43,929 46,792
Capacity building and quality
improvement		 8,659 456,091 464,750
18,387		 300,175 318,562
Equipment and consumables, 34,249 123,411 157,660
Infrastructure development and 18,412 288,843 307,255
Pharmaceuticals
Policy advocacy / government
liaison		 6,753 174,153 180,906
11,809		 76,942 88,751
Preventive Services 1,945 123,306 125,251 4,436 141,163 145,599
Administration - 17,597 71,338 53,741 7,205 63,381 70,586
Exchange rate differences - 12,608 16,671 4,063 - 2,280 - - 2,280
61,851 981,549 1,043,400 60,832 914,433 975,265

7. STAFF COSTS

. STAFF COSTS
Wages and salaries
Social security costs
Pension costs
Fundraising
Programme management & admin
Total		 2025
£
283,109
15,612
28,345
327,066
2025
2.0
16.1
18.1		 2024
£
244,144
34,631
1,063
279,838
2024
2.0
12.6
14.6

No employee received benefits exceeding £60,000

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2024-2025 HIPZ ANNUAL REPORT

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2025 (continued)

8. TANGIBLE FIXED ASSETS

Cost
Cost at 1 July 2024
Additions
Exchange adjustment and other adjustments
to align to Zanzibar accounts
At 30 June 2025
Depreciation
At 1 July 2024
Charge for the period
Exchange adjustment
At 30 June 2025
Net book value
At 30 June 2025
At 30 June 2024		 Motor
vehicles
£
7,387
-
- 598
6,789
6,679
185
- 541
6,323
466
708		 Equipment
£
28,771
1,701
- 2,328
28,144
13,604
4,258
- 1,100
16,762
11,382
15,167		 Total cost
£
36,158
1,701
- 2,926
34,933
20,283
4,443
- 1,641
23,085
11,848
15,875

9. DEBTORS

Trade debtors
Staff loans
Other debtors
Prepayments		 2025
£
9,369
-
1,946
3,186
14,501		 2024
£
51,542
393
11,833
3,907
67,675
10. CREDITORS
Trade creditors
Accruals
Income in advance
Other creditors		 2025
£
540
16,510
8,650
14,587
40,287		 2024
£
1,315
15,024
8,833
13,214
38,386

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2024-2025 HIPZ ANNUAL REPORT

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2025 (continued)

11. RESTRICTED INCOME FUNDS

Restricted funds
AstraZenaca
BNITM
CM Lemos Foundation
Evan Cornish
Festival Medical Services
Geoff Harrington Foundation
IHP donated goods
James Tudor Foundation
The Lady Fatemah Charitable
Trust
PN Pharmanovia
Resolve to Save Lives
USAID		 Balance
at 30 June
2024
£
16,863
8,362
-
3,745
12,015
19,705
-
-
-
-
5,088
84
65,862		 Income
£
-
125,922
220,000
-
-
-
171,385
4,995
404,992
14,056
22,450
16,867
980,667		 Expenditure
£
- 16,853
- 134,309
- 219,970
- 1,794
- 8,090
- 19,287
- 158,550
- 3,634
-423,191
- 11,260
-17,112
- 17,589
- 1,031,639		 Transfer
(to) / from
unrestricted
funds
£
- 10
3,059
-30
- 1,951
-
-418
-16
-252
18,199
-2,796
173
638
16,596		 Balance
at 30
June
2025
£
-
3,034
-
-
3,925
-
12,819
1,109
-
-
10,599
-
31,486

Purpose of restricted funds :

AstraZenaca – hypertension and non-communicable diseases

BNITM (Bernhard Nocht Institute for Tropical Medicine) - surveillance of antimicrobial resistance The CM Lemos Foundation - supporting fundraising and operational functions

Evan Cornish Foundation - delivering mental health community outreach days Festival Medical Services - strengthening cardiology services Geoff Herrington Foundation – mental health support work

IHP (International Health Partners) – donations of good is kind are medical consumables, supporting supply

chains

The James Tudor Foundation - enhancing cardiovascular disease diagnostics capabilities

The Lady Fatemah Charitable Trust - maternal and new-born health programme in hospitals and Primary

Health Care Units Pharmanovia – supporting transportation costs for donated good

Resolve to Save Lives - strengthening the national health security in Zanzibar

44

2024-2025 HIPZ ANNUAL REPORT

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2025 (continued)

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

45

2024-2025 HIPZ ANNUAL REPORT

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2025 (continued)

12. UNRESTRICTED INCOME FUNDS

Unrestricted funds
General unrestricted funds
Previous year
Unrestricted funds
General unrestricted funds		 Balance
at 30
June
2024
£
28,346
28,346
Balance
at 30
June
2023
£
21,841
Income
£
131,802
131,802
Income
£
91,355		 Expenditure
£
- 112,939
- 112,939
Expenditure
£

- 85,755

- 85,755		 Expenditure
£
- 112,939
- 112,939
Expenditure
£

- 85,755

- 85,755		 Transfer
(to) / from
unrestricted
funds
£
-16,596
-16,596

Transfer
(to) / from
unrestricted
funds
£

905

905		 Transfer
(to) / from
unrestricted
funds
£
-16,596
-16,596

Transfer
(to) / from
unrestricted
funds
£

905

905		 Balance
at 30
June
2025
£
30,613
30,613
Balance
at 30
June 2024
£
28,346





21,841 91,355 - 85,755 905 28,346

13. ANALYSIS OF FUNDS BY ASSET TYPE

Fixed assets
Net current assets		 Restricted
£
-
31,486
31,486		 Unrestricted
£
11,848
18,765
30,613		 Total cost
£
11,848
50,251
62,099

46

2024-2025 HIPZ ANNUAL REPORT

Notes to the Accounts

FOR THE PERIOD ENDED 30 JUNE 2025 (continued)

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

No member of the board of trustees received any remuneration or we reimburses 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.

During the year, donations totalling £1600 were received from trustees of the charity. These donations were made without any conditions attached and were in line with the charity’s objectives.

Other related party transactions also totalled £12,000.

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		 2025
£
- 32,109
4,443
- 232
1,285
-
53,174
1,901
28,462		 2024
£
- 39,366
6,332
- 248
1,060
-
- 36,096
15,541
- 52,776

47

2024-2025 HIPZ ANNUAL REPORT

COMPARATIVE STATEMENT OF FINANCIAL ACTIVITIES FOR THE PERIOD ENDED 30 JUNE 2024

Note
Income
Donations and
legacies
3
Charitable activities
4
Investments
Other
Total income
Expenditure
Fundraising costs
5
Charitable activities
6
Total expenditure
Net income/ -
expenditure
Transfers between
funds
Net movement in
funds
Reconciliation of
funds:
Total funds
brought forward
Total funds carried
forward		 Unrestricted
£
81,207
9,900
248
-
91,355
24,923
60,832
85,755
5,600
905
6,505
21,841
28,346		 Restricted
£
902,684
-
-
-
902,684
33,217
914,433
947,650
- 44,966
- 905
- 45,871
111,733
65,862		 Total
2024
£
983,891
9,900
248
-
994,039
58,140
975,265
1,033,405
- 39,366
-
- 39,366
133,574
94,208		 Unrestricted
£
122,236
-
-
3,331
125,567
17,430
152,171
169,601
- 44,034
702
- 43,332
65,173
21,841		 Restricted
£
772,691
-
-
-
772,691
33,442
676,472
709,914
62,777
- 702
62,075
49,658
111,733		 Total
2023
£
894,927
-
-
3,331
898,258
50,872
828,643
879,515
18,743
-
18,743
114,831
133,574

48

2024-2025 HIPZ ANNUAL REPORT