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Elrha is registered in England and Wales as a Charity (charity number 1177110) and as a private company limited by guarantee (company number 11142219). 



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CONTENTS
Message from the Chair................................................................................................................................
About Elrha........................................................................................................................................................
Trustees, Report..............................................................................................................................................
1. Strategic Report....................................................................................................................................
2. Financial Report..................................................................................................................................39
3. Structure, Governance and Management.................................................................................
Approval of the Trustees, Report...........................................................................................................
IndependentAuditor's Reportto the Members of Elrha...............................................................55
Financial Statements..................................................................................................................................60
Notes to Financial Statement&...............................................................................................................

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In the four years that I have been chair of Elrha’s Board of Trustees, humanitarian needs have risen at an alarming rate. By the end of 2023, nearly 300 million people[1] globally were in need of humanitarian assistance. It is estimated there are now more than 114 million people forcibly displaced due to persecution, conflict, violence and human rights violations, an increase of almost 40% since 2019[2] – yet international resources for humanitarian assistance have been falling. In the face of such widespread need how and where should we as a sector focus our efforts? How must we rethink and transform the ways we work to have maximum impact? 

This is where research and innovation (R&I) have a key role to play. Elrha’s work has continued to demonstrate the value of R&I as we fund and advocate for their combined potential to address some of the significant issues and challenges affecting humanitarian action today and into the future. Yet our research demonstrates that investments in humanitarian R&I still account for just a tiny fraction of global humanitarian spending. 

The change needed is substantial. It requires collective action from across the humanitarian community. To meet this challenge, I was delighted to launch Elrha’s new strategy this year. We are deliberately taking a long-term approach to deliver real and sustainable change. Our strategy looks to 2040 by which time we want to see a stronger and more equitable system, and one in which humanitarian R&I plays a transformative role. To achieve this, we need to seek out opportunities to collaborate and partner at all levels: with humanitarian actors, governments, the R&I communities, and, crucially, people affected by crises. 

In the last year we have continued to support pioneering projects to achieve results through our Research for Health in Humanitarian Crises (R2HC) programme and our Humanitarian Innovation Fund (HIF), targeting some of the most challenging problems in our areas of focus. It has been rewarding to see our investments deliver real results in humanitarian policy and practice. 

– – In Haiti, Problem Management plus (PM+) a mental health intervention will provide support to young adults and caregivers affected by trauma caused by the ongoing conflict and crisis; while in Somalia, Mali and Central African Republic, reusable antibacterial menstrual underwear and washing and drying bags will be introduced to address the need for quality, low-cost, culturally sensitive, environmentally-friendly menstrual health management (MHM) products. These are just highlights, and our annual report documents a wide array of exciting new evidence and solutions that are being developed by our programmes. 

Our long-term research approaches and convening have also made great progress this year. Work on the development of an intervention package(s) to prevent and address undernutrition resulting from the global food insecurity crisis gained widespread engagement, while our Global Prioritisation Exercise (GPE) for Humanitarian Research and 

> 1 Global Humanitarian Overview 2024, OCHA 

> 2 "Forced displacement at record levels as a cause and consequence of increased need", Global Humanitarian Overview 2024, OCHA 




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Innovation (HRI) continued to provide insights into the strengths and weaknesses of the global HRI system, consulting with humanitarian, research and innovation actors across the globe. 

Our new strategy builds on the solid foundation of Elrha’s work in the last decade. Importantly and appropriately, it raises our ambitions for the role of humanitarian research and innovation in the future. It also centres our values, and our three long-term commitments to become an anti-racist organisation, be climate responsible, and shift the power to researchers and innovators in low- and middle-income countries (LMICs). We are indebted to the experience and expertise of our staff, governing bodies, grantees, partners, and funders in continuing to propel our work forward. 

While 2023 was only the first step on a long road to realising our vision, we are proud of the progress made and confident in our future direction. On a more personal note, 2023 marks the end of my time as Chair of Elrha’s board. It has been an immense privilege to play this role, and it is with great pleasure that I hand over to Dr Jane Cocking as the new Chair from 2024 to guide us on the next leg of Elrha’s journey. 


## **Margie Buchanan-Smith** 

Chair of the Board of Trustees to 31 December 2023 




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**WE ARE ELRHA** A global organisation that finds solutions to complex humanitarian problems through research and innovation. 

**OUR PURPOSE** We work in partnership with a global community of humanitarian actors, researchers and innovators to improve the quality of humanitarian action and deliver better outcomes for people affected by crises. 

**OUR ROLE** We are a leading actor in humanitarian research and innovation. We bring people together to tackle some of the most complex problems and strengthen the humanitarian system. And we support and champion robust research and proven innovations to improve humanitarian response. 

**OUR SCOPE** We want to see the positive impact of our research and innovation in acute phases of emergencies and in complex and protracted conflict settings where it’s most needed, including work with internally displaced, refugee and host community populations. 


**STRENGTHEN AND CHALLENGE THE SYSTEM** A system in which policy and practice continuously improve through the sustainable and strategic resourcing and adoption of new evidence and innovative solutions. 

**ADDRESS THE CRITICAL CHALLENGES** We want to see an equitable and cohesive humanitarian system that routinely identifies and addresses critical humanitarian problems through research and innovation. 


We live by a clear set of values. They’re seen in our work within the humanitarian system and in how we operate and hold ourselves accountable as individuals and as an organisation and employer. 

**PUTTING PEOPLE AT THE CENTRE** We are committed to being a truly inclusive and empathetic organisation that supports, encourages and recognises its people. We seek out and value diverse knowledge, experience and perspectives, listening to understand before we act. We believe people and communities affected by crises should be deeply involved in research and innovation processes, driving the changes they want to see. 

**WORKING WITH OTHERS** We collaborate to bring about positive change. We build meaningful partnerships, investing in and nurturing our networks and creating space for open and honest dialogue. We understand the part we play in improving humanitarian response and we invite people to join our efforts, supporting others to lead where they are better placed to do so. 




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**ACTING RESPONSIBLY** We’re a responsible and principled organisation to our core. We champion ethical approaches in humanitarian research and innovation, calling out practices that fall short and partnering only with organisations that share our commitment. We make decisions based on the best available evidence. We listen to and act on feedback, and we take accountability for our actions. 

**COMMITTED TO LEARNING** We’re always looking to develop ourselves and our work; it makes us better at what we do and more effective in what we achieve. We are evidenceled in our decisions and actions. We take on board different views and ideas that will help shape the future of humanitarian response. This appetite for learning and for discussion, reflection and recognition of achievement is engrained in our culture and our practices. 

**INSPIRING CHANGE** We’re ambitious in our vision for the future of humanitarian action. Positive, energetic, undaunted, we’re committed to long-term investment in research and innovation that will deliver transformative change for people affected by crises. We generate momentum, motivating others to work with us and to support the positive differences we make. 


Our work is funded by: The UK Foreign, Commonwealth and Development Office (FCDO), The Netherlands Ministry of Foreign Affairs (MFA), the Norwegian Ministry of Foreign Affairs, Wellcome, and the Department of Health and Social Care (DHSC) through the National Institute for Health Research (NIHR). 


For their guidance, dedication, and support throughout the year, we would like to acknowledge and thank Elrha’s Board of Trustees. We would also like to thank the members of our Funding Committees, Advisory Groups, Technical Working Groups and GPE Reference Group, for continuing to provide invaluable expertise to our work. 

Finally, we would like to acknowledge all our incredible partners and grantees, and the organisations we have worked with in 2023 for their collaboration and partnership. 


The Trustees (who are also Directors of Elrha for company law purposes), have pleasure in submitting their Annual Report and audited financial statements of the company for the year ended 31 December 2023. 




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Underpinning our work at Elrha, is a drive to see a humanitarian sector that can deliver better outcomes for people affected by crises, and for nearly 15 years now we have funded vital research and innovation to this end. When we began, we were one of few working in these areas – now, we are one of many. This expansion is welcome but brings with it even greater responsibility to demonstrate impact. 

We know well that meaningful change takes time, which is why our new Strategy, finalised and launched this year, defines our work until 2040. Encapsulating our vision, values, our theory of change and long-term commitments, it lays out our plans to partner and collaborate with the wider community, to realise a collective vision for research and innovation, and to position them at the core of humanitarian practice. 

To ensure we continue to progress against our goals, commitments and resolutions, we set out six strategic priorities for the organisation in 2023. 

## **1. Meeting our donor commitments** 

We are committed to meeting the requirements of our donors, ensuring we deliver on our planned activities each year. In 2023, we delivered our commitments across all of our programmes and achieved strong satisfaction from our funding partners. Both HIF and R2HC received high ratings from FCDO for their work, with our R2HC programme receiving a top rating, noted for its timely, topical evidence, influence on humanitarian policy and practice, and significant contributions at outcome and impact level. 

## **2. Delivering effective tools to measure and communicate impact** 

This year saw us increase our focus on our monitoring, evaluation, accountability, and learning (MEAL) systems. We introduced a range of improvements to support our organisational understanding of impact and how to document and communicate it. A key objective was that all grants which ended during 2023 were assessed at closure against their intended objectives. While we did not achieve this goal in full, we were able to finalise and test our assessment framework, ready for use on grants closing in 2024. A second objective was to establish a system for tracking the continued impact of grants post-closure. This year we commissioned a scoping study to further explore possible methodologies for this work, the findings of which will be shared in 2024. 

## **3. Developing and progressing our new Strategy** 

We devised a launch to embed our new Strategy within our organisation, among our partners and throughout the wider humanitarian community. In line with our plans, we shared the Strategy internally in May. and created a system to capture our progress against it, developing a series of internal reporting cycles for the Strategy, alongside our three-year plan, annual plan and team plans. We launched the Strategy externally in June and continued to socialise it throughout the year among partners, donors and key stakeholders. As part of this, we also presented our work at 25 external engagements throughout the year. 




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## **4. Diversifying our funding** 

To ensure that we continue to be sustainable and resilient to shocks, we focused on developing new funding partnerships with a greater diversity of donors. In 2023, our main objectives were: 1) to secure funding for our 2024 activities, 2) to finalise our new Business Development Strategy and 3) to pursue at least two funding opportunities from new donors. 

We made progress against all these objectives, receiving an uplift from the FCDO to cover and expand activities for the HIF and the UK Humanitarian Innovation Hub (UKHIH) meaning that our full programme of work is fully financed for 2024. The uplift also allowed us to finalise our 2024 System Strengthening activities. We established a new Business Development Committee of our Board of Trustees to oversee the development and implementation of our Business Development (BD) Strategy. The BD Strategy was completed in December 2023, alongside a set of core indicators and recommendations from the Committee for its implementation. A shortlist of potential donors has been identified and agreed to. Finally, we submitted two new funding proposals, the first to the Lego Foundation in April and second the Netherlands MFA in December. 

## **5. Strengthening confidence in our leadership** 

Over the last year we have worked hard to strengthen engagement between our leadership and staff through the introduction of a staff representation group to improve how staff contribute to the overall organisation. In October 2023, we finalised a terms of reference and established ways of working, and three staff facilitators volunteered to support the group through a pilot year in 2024. 

## **6. Improving our processes** 

Our operational systems required updating to ensure they continue to be fit for purpose for our current and future work. In 2023 we mapped the ‘Minimum Viable Product’ IT solution for our grant management system. We have also taken steps to improve our internal information sharing and knowledge management planning by designing a new intranet and document management system which will roll out in 2024. 




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As a member of the international humanitarian community, we recognise the legacy of our sector and that, as an influential, UK-based organisation, we hold a position of power and privilege that others do not. To hold ourselves accountable to people affected by crises, as part of our new long-term strategy we established three commitments to formalise the things we believe in, and how they will steer what we do and how we do it. In 2023 we committed to developing two-year action plans for each, making the following progress: 

## **Commitment 1: Become an Anti-Racist Organisation** 

- We took the step as a whole organisation to acknowledge our role and our responsibility to address racism in our work and culture and formalised this as a long-term strategic commitment. 

- We continued to support our staff-led Anti-Racism Working Group (ARWG) to facilitate ongoing learning, reflection and action. 

- We co-developed draft terms of reference with our ARWG for an expert to support us to undertake an organisational self-assessment in 2024 and develop a tailored antiracism action plan to address areas of change and improvement. 

## **Commitment 2: Be Climate Responsible** 

- We signed the Climate and Environment Charter for Humanitarian Organisations in June 2023, and we are developing targets to measure our progress in meeting the commitments made when signing the charter. These will be accompanied by an action plan that outlines how we will meet these targets. 

- We began to form the vision for how Elrha will act, feel to its staff and be seen externally by 2040, in regard to being a climate and environmentally responsible organisation. This vision will be used as the basis for establishing the commitment’s long-term goals and outcomes. 

## **Commitment 3: Shift the Power to low- and middle-income countries** 

- We increased Global South leadership within our funded research. Since 2013, our research programme has been on a journey to increase low- and middle-income country (LMIC) participation and leadership. This year, an independent evaluation recognised that there has been considerable progress and learning, but many challenges remain. 

- We promoted and modelled locally-led innovation through dedicated funding opportunities and through our membership of the Community Led Innovation Partnership (CLIP). However, we noted that the approach has not yet been mainstreamed across our innovation funding work, where the majority of grantees continue to be from high income countries (HIC) – we will continue to strive towards achieving greater balance of local and international partnerships. 




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As part of our new long-term Strategy, we developed our new Theory of Change (TOC) which articulates how we aim to achieve our objectives, our strategy, and the changes we’d like to see in the sector. The remainder of this report sets out our progress and achievements against the first year of our new strategy. 





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Our combined focus on research and innovation is central to our belief that the humanitarian system urgently requires robust evidence-based solutions. This allows us to invest in both with confidence, knowledge, and expertise. 


The Humanitarian Innovation Fund (HIF) aims to improve outcomes for communities affected by humanitarian crises by identifying, nurturing, and sharing more effective and scalable solutions. The HIF is a leading actor in the development and testing of innovation in the humanitarian system. Through the HIF, we fund, support, and manage innovation at every stage of the innovation process. 

- We identify high quality innovation projects. 

- We provide flexible and responsible grant management for those projects. 

- We develop new tools and guidance to build the skills of our grantees and promote responsible innovation in the humanitarian system. 

- We explore and actively build pathways to scale for funded projects. 

## **2023 Highlights** 

The last 12 months have been busy for our innovation programme as it designed and launched 11 funding calls in addition to supporting 28 grants across its focus areas. We also continued to support five national organisations to facilitate locally-led innovation work ( **p31** ). 

The funding calls, while greatly varied, all focused on meeting emerging and present needs throughout the humanitarian sector. A set of adoption challenges ( **p18** ) piloted innovations in a range of new contexts, including high severity settings, while the Advancing Innovation grants ( **p26** ) provided financial support to previously HIF-funded grantees to further support the progression of their innovations. A Data-Driven Inclusion challenge ( **p25** ) is supporting projects that could change and improve the way we collect and use data for disability and older age inclusion in humanitarian action, and our Gender-based Violence (GBV) Tech Innovation Challenge ( **p27** ) sought proposals for forward-thinking interventions using technology to address violence against women and girls in humanitarian settings. 

In early 2023, the programme rolled out a flagship toolkit and background paper on participation in humanitarian innovation ( **p22** ). Developed in partnership with MIT D-Lab, the toolkit offers a robust approach to improving participation within HRI projects for, with, and by people affected by crisis. 

It was also a year of appraisal and improvement for the programme it underwent an evaluation to assess its impact and effectiveness ( **p16** ). 




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Our Research for Health in Humanitarian Crises (R2HC) programme aims to improve health outcomes for people affected by humanitarian crises by strengthening the evidence base for public health intervention and to bring about positive change in humanitarian response. It achieves this by: 

- Delivering world class research through collaboration between operational humanitarian agencies and research institutions. 

- Bridging the gap between research and practice for public health interventions in humanitarian crises. 

- Promoting equitable partnerships and ethical research practice. 

The R2HC programme has built a unique community across humanitarian public health practice and research. This community represents a wealth of expertise and experience. We work hard to maximise the potential of research for the humanitarian system by commissioning studies and facilitating critical conversations for the sharing of knowledge and experience. 

## **2023 Highlights** 

2023 was a landmark year for the R2HC as it celebrated ten years of funding humanitarian health research ( **p17** ). Recognising the milestone, the team turned an analytical lens on the programme, writing a series of articles on the evolution of their thinking, from how they fund to who they fund. 

In keeping with our commitment to bridge the gap between research and practice, 2023 saw the launch of not one, but two new priority research agendas ( **p21** ) focused on mental health and psychosocial support (MHPSS) and water, sanitation and hygiene (WASH). Directly informed by humanitarian practitioners, these agendas will guide future research questions to improve public health interventions. 

Demonstrating the value of research in humanitarian policy and practice is another core element of our work. This year we published 20 case studies focused on the impact of our funded research ( **p15** ). Insights from these studies laid the foundation for our guidance tool, the Research Impact Framework ( **p22** ), which illustrates the strategies and enabling factors for research to instigate change in humanitarian action. 

To further support sector engagement with evidence, we launched a round of funding specifically aimed at research dissemination and uptake ( **p24** ). Existing and former grantees were invited to apply for dedicated funding to support the delivery of activities such as media outreach, practitioner and policymaker engagement and public dissemination. 

To support our new research programme aimed at preventing undernutrition in regions affected by food insecurity, this year we funded a study identifying linkages between undernutrition and other health conditions in the Horn of Africa ( **p24** ). 

Our new long-term Strategy includes our core commitment to creating a more equitable HRI system with greater accountability to people affected by crisis. Understanding that a large part of this relates to not just what but who we fund, analysis of the outcome of our 2022 research call showed us that adaptations in the application process resulted in more grants awarded to successful research teams based in LMICs than in the past. ( **p29** ). 




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Our flagship initiative, the Global Prioritisation Exercise (GPE) for Humanitarian Research and Innovation (HRI) is the first of its kind in the research and innovation space. The GPE aims to improve outcomes for people affected by crisis and address gaps in knowledge about how HRI operates. Through understanding the landscape and highlighting changes that could improve things further it is hoped to amplify the impact of investments in HRI. 

Through a programme of global research, mapping, and consultations across the humanitarian system we aim to reveal investment trends and activities in HRI, to highlight successful examples, identify what humanitarians and communities affected by crisis believe are the most pressing areas for investment, and support the development of an inclusive coordinating mechanism that enable actors to target activity to the most pressing needs. 

## **2023 Highlights** 

This year we were able to share results from three of six regional consultations: South and Central Asia, Latin American and the Caribbean, and West Asia and North Africa ( **p14** ). The consultations examined the perspectives of HRI actors on how the ecosystem functions, and occasionally dysfunctions, identifying priority topics and attention areas. 

The initial findings were presented as part of an event at UNOCHA’s Humanitarian Networks and Partnerships Weeks (HNPW) where we explored a broader range of issues and challenges currently facing the sector ( **p18** ). 

As part of our commitment to strengthening the humanitarian system, we also published a research report outlining a set of indicators to assess return on investment (ROI) and valuefor-money (VfM) for innovation-focused investments ( **p29** ), and a case study on Ukraine ( **p15** ) which captured how the humanitarian community used and engaged with research, evidence and innovation in the first year of the response to the crisis in Ukraine. 




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The role of research and innovation at global, regional and national levels is crucial to ensuring a constant commitment to humanitarian work achieving the best possible outcomes for people affected by crisis. In 2023, we continued our work on a global, multi-level consultation to build an improved understanding of the strengths and weaknesses of the global HRI system and deepen our knowledge of priorities at all levels. 

Through key informant interviews, the consultations gathered invaluable insights from stakeholders across six geographic regions (South and Central Asia, Latin American and the Caribbean, West Asia and North Africa; South and East Africa; West and Central Africa; Oceania, East Asia and Southeast Asia) and three national settings (Indonesia, Kenya, and Lebanon). These consultations shared the perceptions of regional and national humanitarian actors, and shed light on priority topics and areas that need HRI attention. This exercise extended further, delving into how the HRI system functions (and occasionally dysfunctions) in complex environments, as well as how exploring how the system can be improved. 

We presented our initial findings at the 2023 Humanitarian Networks and Partnerships Week (HNPW) ( **p18** ), and later in the year, hosted a series of events to launch three regional reports. Here we shared takeaways with humanitarian practitioners and R&I actors from the – participating regions ( **p19** ) Latin America and the Caribbean, West Asia and North Africa and South and Central Asia, as well as publishing the first national report, Lebanon. 

Beyond the geographical consultations, we also delved into systemic and thematic areas, publishing ‘A Return on Investment and Value for Money Assessment Methodology for the Humanitarian Innovation Ecosystem’ ( **p29** ) which explores a model to assess ROI and VFM for innovation-focused investments to help increase alignment of methods that could be adopted by actors currently investing in humanitarian innovation. Our summary paper, ‘A Systematic Review of the Humanitarian Research and Innovation System ’ captures key HRI actors, where they are geographically located and geographic and thematic outputs of HRI. And our case study ‘Adaptive Innovation in the Ukraine Humanitarian Response: How Context, Leadership and Partnerships Matter’ ( **p15** ), painted a picture of how the humanitarian community has used and engaged with research, evidence and innovation in the first year of the response to the crisis in Ukraine. 

Our further regional and national reports will be published in 2024, alongside our flagship Global Insights Report which will be the culmination of all the research and consultation activity and provide the most comprehensive overview of the HRI landscape to date. 




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We have been at the forefront of HRI for more than 15 years, contributing to the improvement and advancement of humanitarian response. More than ever, researchers, innovators, and their funders – including us – are increasingly called upon to demonstrate the impact and value of their work so that evidence can reach humanitarian stakeholders who can use it to enhance programmes, policy and practice for people affected by crisis. 


As well as a tool to inspire and guide our grantees, case studies are central to how we assess and illustrate our impacts and that of the wider R&I community. Over the last year, we have produced 29 case studies and showcase videos that offer both best practice for researchers and innovators, and evidence for how R&I can continue to support and improve humanitarian response. 

## **Ukraine Report** 

Our Ukraine Case Study, published in April, paints a picture of how the humanitarian community has used and engaged with research, evidence and innovation in the first year of the response to the crisis in Ukraine. 

Russia’s re-invasion of Ukraine in February 2022 caused a humanitarian emergency with an estimated 17.7 million people in urgent need of aid. Ukraine was a new country of operation for most agencies, and for Ukrainian organisations the crisis presented a new context. This led to significant scaling up and uncertainty in the humanitarian response to the crisis. 

The case study found that innovation played a crucial role in the humanitarian response, albeit internal rules and procedures acted as brakes on innovation by limiting risk-taking in many cases. New technology, particularly in the health sector, was used at a scale never seen before in humanitarian action. Finally, flexible funding was a key enabler and the lack of this was deemed to be a major barrier. 

## **Research Impact** 

Our aim is for the research we fund to influence humanitarian policy and practice. This is often challenging in reality, and little evidence has been developed on how research **impact** happens in humanitarian contexts. To address this, the R2HC launched 20 case studies capturing the footprint of their funded research. The case studies detail impacts delivered, effective outreach and communication strategies used to engage stakeholders, and lessons learned about the contextual factors and enablers that aid the influence of research. 

The studies encompass a huge variety of countries, contexts and focus areas, from improving menstrual hygiene management in Lebanon, Myanmar and Tanzania, to prioritising the public health needs of Venezuelan migrants in Colombia and examining the role of radio in tackling COVID-19 misinformation in Burkina Faso – to name just a few. 

Alongside highlighting the value of research to influence humanitarian policy and practice, our case study collection helped form the foundations of our Research Impact Framework ( **p22** ). A subsequent webinar brought together experts to examine the lessons learned from the case studies and share their own experiences on the research-to-practice pathway ( **p30** ). 




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## **Innovation Impact** 

To mark the end of our second Journey to Scale (J2S) funding round, which closed in 2023, the HIF produced a set of pitch videos, intended to showcase the innovations to prospective applicants and donors. The videos have also served to demonstrate the value of investing in evidence-based innovation and strategy-driven approaches to scaling to the broader humanitarian community. Collectively the videos have been viewed nearly 2,000 times and have been widely shared and engaged with. 

## **Innovation Snapshot** 

**Medicapt: Technology in service of justice for sexual and gender-based violence** Physicians for Human Rights 

Every year, tens of thousands of adults and children experience sexual and gender-based violence (SGBV) in conflict zones worldwide. Too often, survivors of SGBV are unable to access justice because of lack of evidence – perpetuating a culture of impunity for crimes of sexual violence. 

MediCapt is a mobile application that converts a standardized medical intake form for forensic documentation of SGBV to a digital platform and combines it with a secure mobile camera to facilitate forensic photography. It enables clinicians to securely transmit data to police, lawyers, and judges involved in prosecuting SGBV crimes. 

Following the end of their grant with Elrha, Medicapt has continued to scale. As of the end of 2023, 4,180 cases of SGBV have been documented using MediCapt. In the DRC, of 55 judgments delivered in court cases where MediCapt was used, 49 cases resulted in convictions of perpetrators, bringing justice to survivors. 

- The HIF also commissioned a set of in depth case studies exploring the relevance, effectiveness and impact of innovations in Uganda. The innovations under examination were - the Safe Water Optimization Tool (SWOT) and Self Help Plus (SH+). 


It’s important to consider the impact we have already had on the humanitarian community, and how we adapt our thinking and approaches to ensure we continue to add value. Independent evaluations have been an objective and insightful way to highlight the successes and challenges of our programmes, and their contribution to the humanitarian sector. 

**HIF Evaluation** 

In February, we published the independent evaluation of our HIF programme. The findings underlined how our funding had delivered significant impact for the humanitarian community, spotlighting three projects in particular, Field Ready, Make Music Matter and the SWOT. The report found that the HIF’s hands-on approach to funding was a crucial success factor for grantees, who benefit from flexible grant-management and non-financial support, such as training, mentorship and partnership brokering. 




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The evaluation also surfaced seven areas for added attention, with recommendations for improvements and changes the HIF could make to strengthen its impact. These areas included more focus on end-to-end funding, the programme’s role as a convener for innovation actors, and the interconnection of their locally-led work through the CLIP. We welcomed these insights and learnings, and set out how we plan to address them in our management response. 

## **R2HC Evaluation** 

The first independent evaluation of our R2HC Programme was also undertaken this year. The evaluation, due to be published in 2024, highlights the critical role the programme plays as one of the only funders of rigorous research specifically addressing public health in humanitarian settings. It describes its evolution from a largely grant-making initiative to a programme that now supports research teams to achieve impact through influencing and collaborating with evidence users. The evaluation will be used to fine-tune and improve the focus and activities of our research programme in the years to come. 

## **10 Years of R2HC** 

2023 marked an important milestone for our R2HC programme as we celebrated its tenth birthday. The programme was set up in 2013 when the Department for International Development (DFID) – now the FCDO – and Wellcome partnered with Elrha to establish a new initiative to help increase the evidence base for public health response in humanitarian crises. 

Since then, it has funded more than 100 pieces of world-class research, providing grants for high quality, rigorous evidence, and offering specialised support and resources for partnering and impact. Our contribution helps equip the humanitarian community with evidence to reduce the impact of crises wherever and whenever they happen. 

The anniversary was an opportunity for us to reflect on how the programme has developed, as well as its contribution to improving humanitarian public health over the last decade. The story of the R2HC is captured in a reflective article series documenting the evolution of the programme across funding calls, convening opportunities and promoting equitable partnerships. 




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Engaging and collaborating with the humanitarian community is key to understanding the role HRI can play in crisis contexts, for embedding it into response programming and for driving conversations around change and improvements to the ecosystem. 


Since 2020, our Adoption Challenges have aimed to tackle barriers around the uptake of innovations by humanitarian organisations. The ambition of these challenges is to incentivise and support humanitarian response agencies to adopt promising solutions, adapt them to new settings and evaluate their effectiveness. 

Through our WASH Adoption Challenge, three projects began implementation in February 2023. Action Against Hunger are in the process of adopting Faircap Open Water Filter in Niger and Somalia, and WaterScope in Ethiopia and Kenya. In Bangladesh, the Village - Education Resource Center are adopting User centred Community Engagement for childfriendly sanitation design in emergencies. 

In June, we launched our High Severity Adoption Challenge. Three mature innovations from our funded portfolio were selected for use in high severity crises including Haiti, Yemen, and Somalia. The chosen innovations are a standardised mid upper arm circumference (MUAC) bracelet, Reemi zero waste menstrual products, and MHPSS intervention Problem Management Plus (PM+). 


Events, both on and offline, are another way we convene and support collaboration between the humanitarian actors and R&I communities. 

## **Humanitarian Networks and Partnerships Weeks** 

In April, we hosted an event at UNOCHA’s Humanitarian Networks and Partnerships Weeks (HNPW). It was a chance to share the initial findings from our GPE consultations ( **p14** ), and the event explored issues and challenges confronting the humanitarian sector, including: 

- Consideration of who has a seat at the decision-making table. 

- Factors influencing priority-setting decisions. 

- Why some issues and crises receive disproportionately more R&I attention than others. 

Alongside the main presentation, we also convened a round table event between donors (USAID, FCDO, Norway MFA) and humanitarian directors and heads of innovation from Oxfam, World Health Organization (WHO), International Organization of Migration (IOM), and International Committee of the Red Cross (ICRC). 




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## **GPE Regional Launches** 

Following further analysis of our GPE consultation insights, we hosted a series of events to share key takeaways with humanitarian practitioners and R&I actors from the participating regions. 

Throughout November, we hosted three events with over 200 people from the humanitarian community in attendance either in person or online. 

## **South and Central Asia** 

This was a roundtable event at the 7th IHSA Conference on Humanitarian Studies led by the All India Disaster Mitigation Institute (AIDMI). The panel featured representatives from UN Women, START Fund, the Alfred Deakin Institute, and the Institute of Disaster Management and Vulnerability Studies at the University of Dhaka, and was chaired by our Director of Impact and Engagement, Colette Fearon. 

## **Latin America and the Caribbean** 

This event was led by the research team from the University of São Paulo and a panel made up of professionals from the UN Office for Disaster Risk Reduction, Oxfam International, Erasmus University Rotterdam’s International Institute of Social Studies, Save the Children International and our own CEO, Jess Camburn. 

## **West Asia and North Africa** 

Led by the Eastern Mediterranean Public Health Network (EMPHNET), this event featured our largest panel where humanitarian actors from EMPHNET and the Asfari Foundation were brought into conversation with academics and researchers from across epidemiology, preventative medicine and citizenship, and globalisation. 

## **GBV Webinars** 

Our recent webinar series showcased pioneering projects tackling GBV in humanitarian settings. 

The webinar series was an opportunity to showcase past grantees and provide a platform to reach new audiences and discuss future aims. We hosted four webinars focused on a range of themes: 

1. New approaches that target the knowledge-attitude-behaviour of GBV programme and clinical staff 

2. Using monitoring and evaluation to improve GBV work 

3. Applying cross-cutting methods to GBV 

4. Using technology to drive change in GBV programming 

The series was attended by more than 800 people, and good participation in the live webinars made for rich discussions during each Q&A session. In a blog capturing the highlights, we called on the wider humanitarian community to provide greater investment in, and adoption of, innovations and research aimed at improving humanitarian responses to GBV. 

Alongside our own grantees, we also showcased a non-HIF funded project – Virtual Reality Exposure Therapy in Iraq – a Norwegian Church Aid project funded by Norway’s Humanitarian Innovation Programme. In doing this, we wanted to set a base for further work to foster connections across the humanitarian innovation community. 




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## **Research Snapshot** 

**Measuring independence after injury in humanitarian settings** 

Humanity & Inclusion, Médecins Sans Frontières and the Karolinska Institute 

Trauma care in humanitarian settings is usually focused on saving life and limbs, and less on how patients are living their daily life after injury, a critical aspect of their recovery. Assessing patients’ independence in daily life activities is therefore crucial to document. However, tools to measure this, tailored to humanitarian contexts, are lacking. 

This study developed The Activity Independence Measure-Trauma (AIM-T), a tool to measure independence in mobility activities of patients after injury, going beyond only understanding mortality and morbidity. Healthcare professionals observe and rate patients while performing 12 daily life activities and assess difficulties experienced, as well as any need for human or material assistance. 

This study demonstrated AIM-T is valid, reliable and could be applied in humanitarian contexts. The design and validation of the AIM-T is one component of broader research which is 1) assessing recovery of functioning up to six months after injury in humanitarian settings, and 2) identifying which patients recover best and their personal and care characteristics, including early physiotherapy. 




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For R&I to play a central role in improving humanitarian action, knowledge of best practice and a shared understanding of priorities is important for effective coordination. Over the year we’ve produced evidence-based tools to help researchers and innovators make their work more targeted, inclusive and impactful. 


Since 2019, our R2HC programme has supported research priority settings (RPS) to provide more nuanced understanding of the knowledge gaps and areas for expansion in selected thematic areas. Contributions for each RPS are sought via survey and in-person interviews from humanitarian practitioners, academics and stakeholders at all levels, to identify the most important questions in need of answering. 

The resulting research agendas are intended to guide humanitarian practitioners and academics who want to improve humanitarian interventions through research. We also use them – alongside priority research agendas generated by others in different thematic areas – to help define the focus of future research calls. 

In 2023 we progressed research agendas in the following areas: 

## **Mental Health and Psychosocial Support** 

In January, the MHPSS research priorities agenda was launched in collaboration with mhpss.net at an online event attended by almost 200 people. We commissioned this work in 2020 under the guidance of the IASC Reference Group for MHPSS, and the findings have - since been collated into an interactive data visualisation tool, alongside a methodology report and documented in a peer-reviewed article. 

## **Water, Sanitation and Hygiene** 

The WASH research priority setting was conducted by researchers from the London School of Hygiene & Tropical Medicine (LSHTM) and Tufts University in collaboration with the Global WASH cluster. It was launched in July at an online event attended by over 120 people. The - work was informed by the Humanitarian WASH Roadmap (2020 25) which called for an initiative focusing on R&I, highlighting the need for a more evidence-informed humanitarian WASH response. 

## **Non-Communicable Diseases** 

In 2022, the International Rescue Committee and the American University in Beirut were commissioned to generate a consensus on priorities for non-communicable disease (NCD) research in humanitarian settings. The consultations took place throughout 2023, and the results will be ready for sharing in Spring 2024. The focus is on cardio-metabolic syndrome, which was determined by a group of technical experts to be the most common cluster of NCDs experienced by people affected by crises. 


While humanitarian research and the evidence base has grown over the past decade the impact of that research on humanitarian policy and practice has not kept pace. There are multiple barriers for humanitarian researchers and their partners in translating evidence into 




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use. Practical guidance to produce research with greater impact is sought after by researchers and their partners. 

## **Expansion of Research Impact Toolkit** 

Another key activity was expanding our learning materials. Our Research Impact Toolkit is a set of resources available to R2HC grantees. In response to identified gaps and based on grantee demand, two new courses were added: 

1. Social Media for Research Communications 

2. Community Engagement for Research Uptake. 

These were soft launched in summer 2023 and will be revised in response to user feedback along with a review of the entire course library to inform future plans. A project to translate the resources into French is also underway, with four courses already available in French and shared with our French-speaking study teams. 

## **Tool Snapshot** 

## **The Research Impact Framework** 

Based on what we have learned from our Impact Case Studies ( **p15** ) and relevant literature, we developed the Research Impact Framework. This tool outlines a set of strategies and enablers that are characteristics of high-impact studies in humanitarian health. The Framework is designed to aid those looking to improve the impact of their research, and to prompt further dialogue around improvements to the Framework itself and the development of further useful tools for the humanitarian health research community. The framework and its accompanying briefing note were downloaded nearly 90 times between its launch in September and the end of the reporting period. 

## **Tool Snapshot** 

## **Participation Toolkit for Humanitarian Innovation** 

In early 2023, we rolled out our flagship toolkit and background paper on Participation for Humanitarian Innovation. Developed in partnership with MIT D-Lab, the toolkit sets out a robust approach to setting expectations for and monitoring the degree of participation within research and innovation projects for, with, and by people affected by crisis. The background paper presents the vast evidence and approaches underpinning the toolkit, laying out the strong case for participatory processes to make humanitarian innovation more ethical and impactful. The two resources were downloaded almost 500 times between March and December. 

The toolkit has been shared directly with key external stakeholders, and we received helpful feedback on how it can be practically applied. For example, we ran a participation training session for Lebanese researchers working with PositiveNegatives, War Child and Goal on co-developing better approaches to consent in MHPSS-related research in collaboration with communities affected by crisis. The group found the toolkit so helpful that they are planning to translate it to Arabic. UNICEF have also adopted the toolkit, using it for the training of staff and partners across its work with young refugees in the Czech Republic. This has resulted in the participation of over 18,000 refugees in local programme design. UNICEF shared their hope to expand the use of the tool to other countries and responses. 




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As global conflicts and the increasing effects of the climate crisis continue to drive humanitarian need, our funding must remain reactive to emerging crises, as well as to the existing priorities of practitioners and communities in affected regions. 


The Prevention of Undernutrition programme was developed by our R2HC programme in response to the hunger crisis in the Horn of Africa. In 2023, almost 50 million people in Eastern Africa were affected, a number that has increased year-on-year since 2019, with women and children under five being among the most vulnerable to malnutrition, subsequent illness, and death. 

A responsive research call was not appropriate, as the short-term nature of such a call would not address the cyclical and compounded nature of the crisis – whose drivers include extreme weather, conflict, economic shocks and the ongoing impacts of COVID-19. After consultation with stakeholders across humanitarian public health, we identified the need for a multi-year programme of research to compile a package of interventions aimed at preventing food insecurity and malnutrition, rather than once the crisis is underway. 

NutritionWorks is developing the core deliverable from this programme – to develop and test of a package of interventions aimed at preventing undernutrition in pregnant and lactating women and children under five. For the first phase of the work (2023-2025) the consultants will be identifying the most effective interventions for preventing undernutrition in humanitarian settings for future testing. 

Focused on addressing the impacts of undernutrition on other aspects of health, we also funded a scoping review. Completed in spring 2023, it explored the links between food insecurity, undernutrition, ill health and mortality among pregnant and lactating women and children under five. Highlighting the need for a more collaborative approach between nutrition and health, the review put forward recommendations for developing preventative solutions to food insecurity drivers and their impact on health and nutrition. 


We want the research we fund to have real-world impact – to improve the lives of people affected by crisis. Research uptake, the process of ensuring that research users engage with research findings, is critical to achieving this impact. In humanitarian contexts there is a significant funding gap hindering effective research uptake activities, such as media outreach, practitioner and policymaker engagement and public dissemination. To address this gap, our R2HC programme invited existing and former grantees to apply for dedicated funding to support the delivery of these activities. 

We funded seven study teams to undertake activities for one year, starting in 2023. These projects aim to engage a diverse range of stakeholders, including journalists, local authorities, elected representatives, refugee communities, national policymakers, and NGOs. (Read more in our Funding Snapshot on the next page). 




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## **Funding Snapshot** 

## **R2HC Uptake and Impact Small Grants** 

In 2023, we invited existing and previous R2HC-funded study teams to apply for dedicated funding to deliver new research uptake activities. Following a competitive process, seven projects were selected. They will deliver a range of uptake activities to disseminate the findings of their research with the goal of informing policy and practice. Specific activities include: 

- Training journalists in the Central African Republic to generate simplified messages for national print and radio audiences on contraception, abortion care and safe abortion. 

- Creating videos, TikToks, radio shows and success stories to document the lived experiences of people who have benefitted from a combined mental health and substance misuse intervention in Uganda. 

- Hosting a user-centred design workshop to create campaign materials and develop local expertise on self-managed abortion in Kakuma Refugee Camp, Kenya. 

- Creating a short video to educate adults living in urban areas of Pakistan on heatrelated illness. 

- Producing short videos on pneumococcal infection, its transmission dynamics, and the benefits of vaccination to drive behaviour change among implementing organisation staff. 

- Engaging key government and humanitarian stakeholders in Kenya through workshops, a presentation, video, and policy brief to raise awareness of the new National Adolescent Health Policy and encourage adoption of components of the multisectoral cash intervention, found to be effective in reducing adolescent childbearing and early marriage. 

- Hosting an event with the Government of Niger to encourage uptake of simplified nutrition protocols and creating policy briefs to share with stakeholders regionally. 


Our Data Driven Inclusion Challenge was devised to fund projects that could change and improve the way we collect and use data for disability and older age inclusion (DOAI) in humanitarian action. 

Humanitarian settings are some of the most challenging contexts for inclusive and responsible data collection – our 2020 DOAI Gap Analysis noted that common qualitative data collection methods can actually create barriers to inclusion for older people and people living with disabilities. It also found little evidence of consideration for how older age and disability intersect with each other and other identity characteristics (eg, gender, ethnicity, religion), and many cases where older people are absent from important datasets altogether. 

In 2023 we supported six innovations, and in November, the three teams demonstrating the most promising and impactful approach were awarded additional funding to further develop and pilot their work. In response to feedback from the grantees, each team was matched 




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with mentors with specific skills in research, data collection and MEAL, and we hosted two workshops focused on our Participation and Ethics toolkits. 

Our DOAI grantees – both within this cohort and other funding rounds – offer leading examples in considering equitable partnership, diverse representation, and participatory innovation processes. 



Throughout the year, we continued to support the development and scaling of previously funded innovations and were able to offer four dissemination grants for this purpose. One was awarded to the previous cohort of incontinence grantees to pool together the learnings from their initial grants to design a training on incontinence management for practitioners. This is now being scaled through our DOAI Advancing Innovation Challenge (see below). Three further grants were awarded to our former Evidence Innovation Challenge grantees (WaterScope, Safe Water Optimization Tool, Filter Selection Manual/Evaluation). 

## **Innovation Snapshot** 

## **Evaluating Household Water Filters in Emergency Contexts** 

University of Applied Sciences and Arts Northwestern Switzerland (FHNW) 

In many humanitarian responses, poor household water quality poses a significant public health risk. And yet, often water quality testing can be a politically sensitive issue and response plans often focus on water quantity over quality. To tackle this issue, FHNW recently convened a workshop in the West Bank with 30 actors from the WASH Cluster and local authorities to explain the findings of a HIF funded filter evaluation, which documents solid evidence of water quality issues and importance of household water treatment, as well as another study examining the health impacts of different types of water treatment. As a result of this workshop, the cluster has added water quality and household water treatment into consideration for the Humanitarian Needs Overview and Response Plan for 2024. 

## **Advancing Innovation** 

We launched two Advancing Innovation challenges across our DOAI and GBV focus areas. 

Two project teams received further funding through the DOAI stream. One team was awarded for their innovation delivering tailored disability data solutions for shelter professionals to better meet the needs of older people and people with disabilities during their response. The other was aimed at prioritising the input of older people and their caregivers in managing incontinence during humanitarian crises. 

Two grantees were also selected for our GBV cohort, including a project seeking to advance data interpretation to provide better outcomes for GBV survivors, and an intervention to address intimate partner violence and support reproductive autonomy in refugee settings. 




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The GBV Tech challenge attracted significant attention, with over 250 expressions of interest and was one of the most visited pages on our website during 2023. We received over 50 proposals and our HIF Funding Committee selected projects that stood out for empowering frontline workers, addressing critical gaps from our 2021 GBV Gap Analysis, offering improvement on existing alternatives, and having strong potential for replication and scale. Full details of the chosen projects will be announced in 2024. 


Throughout 2023, we continued to support a new technical area for innovation grants – faecal sludge management (FSM). In this area, we are funding two projects (2022–24), one on the optimisation of lime treatment of sludge and the other on solar-powered sludge treatment, both in Bangladesh. 


In October 2023, the HIF developed the AI for Humanitarians: Shaping Future Innovation funding call, which was launched in December. This call will support a cohort of up to ten grantees to take a problem-led approach and explore the opportunities and risks associated with AI to identify future areas of impact for further investigation and potential investment. 


This year we wanted to further explore the feasibility of developing a responsive funding mechanism to support impact at scale in a complex and acute crisis. In late 2023, we gathered the learnings from the High Severity Adoption Challenge ( **p18** ) and a previous unsuccessful attempt to respond to the Pakistan Flood in 2022 to develop our Rapid Response Challenge. 

Our objective for this is to break new ground in the humanitarian sector and explore, test and map pathways for adoption and scale of innovation in responding to humanitarian problems in rapid onset and acute crisis settings. We will incentivise adoption by large, multinational organisations, and their local or national partners, to support the integration of innovations at scale into response plans in these contexts. 

In November 2023 we reached out to well-evidenced innovations in our network to invite them to be part of a shortlisting process. Three teams submitted an initial proposal which went through a technical review process. The comments from the technical review were relayed to applicants to support the development of a final proposal due in January 2024. 



Since our inception, we have championed R&I that aims to break down barriers to water, sanitation and hygiene (WASH), from identifying key gaps in humanitarian WASH programming, to supporting innovations to reach communities affected by crisis. 

This year we embarked on a key piece of joint R&I work, bringing the HIF’s 2019 WASH Gap Analysis into dialogue with R2HC’s 2023 WASH Research Priority Setting ( **p21** ). We 




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commissioned an analysis of these publications to identify and document synergies and commonly identified areas of WASH for further exploration. 

In May we hosted a side event at the Emergency Environmental Health Forum to discuss how to advance the WASH research agenda, which also included presentation of the findings. 

In 2024 we hope to undertake further analysis and more in-depth consultation that digs deeper into the identified areas and will help to inform a joint funding call. 




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For our work to have impact, we can’t keep it to ourselves. Sharing updates and insights from both funded projects and our own research is a big part of what we do at Elrha, from promoting high-level reports aimed at strengthening the humanitarian system, to highlighting the most useful guidance for our grantees and their partners. 


Access to evidence is a critical aspect of system strengthening. With rising needs and stretched resources, there is an increasing demand to demonstrate that innovation investments are bringing about high returns. However, the practicalities of the humanitarian system make calculations of the return on investment (ROI) and judgements on value for money (VFM) complex. 

In June, we published the ‘A Return on Investment and Value for Money Assessment Methodology for the Humanitarian Innovation Ecosystem’. This report outlines a set of indicators to assess ROI and VfM for innovation-focused investments to help improve the alignment of methods that could be adopted by actors currently investing in humanitarian innovation. 


Lessons learnt about how we increased LMIC grant leadership in our R2HC funding call in 2022 were published this year in a two-part blog series. 

In the first blog, co-authored with Gloria Seruwagi, a member of our R2HC Funding Committee, we outlined the need for greater equity in grant-making and why it felt like an imperative for the programme. Our second blog captured our experiences of adapting our processes to better facilitate and increase the instances of LMIC leadership within the grants we fund. 

## **Research Snapshot** 

**The impact of attacks on Syrian health systems** 

University of California Berkeley, Johns Hopkins University, Syrian American Medical Association Foundation, and Assistance Coordination Unit, Turkey 

Violent attacks on the Syrian healthcare system have been a characteristic of a decade of conflict. This mixed-methods study aimed to describe their impacts, addressing a global evidence gap. 

The findings demonstrate that long-lasting, cumulative impacts result from attacks. These are found at every level of the health system including the health workforce, and health service utilisation by communities. Stronger support for health workers and hospitals and protection from future attacks is critical to mitigate these impacts, and increased international resources should be targeted at this issue. Local stakeholders should be consulted on resource allocation within health systems. 




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Our research impact case studies ( **p15** ) provide evidence and learning of best practice, but key to embedding that knowledge is bringing it to an audience who can use it. 

In September we hosted an online event to discuss the lessons drawn from the 20 published case studies and share our new Research Impact Framework. Nearly 200 people from 26 countries attended, with many representing donor organisations, INGOs, think tanks, UN agencies and international academia. The panellists, most of who have worked on one or more the case studies, shared their experiences of influencing policy and practice with evidence. Key takeaways were captured and shared with attendees after the event. 

Similarly, our Innovation Catalogue for Disability and Older Age Inclusion in Humanitarian Action profiles the range of innovations generated through this area of work. Many focused on gaining a deeper understanding of the problem to underpin further innovation and provide evidence of the experiences and barriers to inclusion that older people and people with disabilities face, across a range of humanitarian themes and contexts. In 2023, we were able to share it through our networks and at events, including presenting it as part of the Disability Reference Group’s side event at HNPW – ‘Disability inclusion: translating guidance into action’ – and at the UNDESA Expert Group Meeting, ‘Knowledge and capacities on disability inclusion in situations of risk’. 

One of our scale grantees, HealthRight International, who scaled up MHPSS intervention Self-Help Plus (SH+), received a small HIF grant to help with uptake of the evidence produced during their Journey to Scale grant. They published two academic publications summarising the learnings and produced two videos documenting their experience of scaling the innovation with a range of stakeholders in Uganda. They also shared their findings at a webinar with over 100 attendees and at a mental health summit in Nairobi. 


Sharing evidence of best practice with grantees is one of our main areas of non-financial support. Over the last year we’ve collated and conveyed guidance through a number of different channels and formats, such as our Research Impact and Participation toolkits ( **p22** ), blogs, case studies, workshops and events. 

Of note were R2HC’s Participation Case Studies. As noted in our R2HC Research Ethics Toolkit, we want researchers to consider the extent of community consultation, the importance of community collaboration in data collection and the extent of risks and potential benefits to people and their communities following their participation in research. Eight case studies were produced on the theme of community participation in research and published as a resource to support grantees. They have also been utilised in the development of the online learning materials. 




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## **Research Snapshot** 

**The impacts of providing cooking fuel in refugee camps** 

Stanford University; International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b); International Organization for Migration (IOM); United Nations High Commission for Refugees (UNHCR); and the Energy and Environment Technical Working Group in Cox’s Bazar 

Refugees often harvest firewood to meet their needs for cooking fuel. This mixed methods study in Cox’s Bazar, Bangladesh found a range of social, health, and environmental benefits were achieved by providing cooking fuel to refugees. 

The study showed that provision of free liquified petroleum gas (LPG) to Rohingya refugees, to replace firewood for cooking, was associated with reduced deaths and disease due to indoor air pollution, increased carbon storage, improved food security and mental health, and reduced inter-group and domestic conflict. 

Long-term provision of LPG could be a feasible and cost-effective strategy to support the food security, nutrition, health, and safety of refugees while protecting the environment, reducing tension with host communities, and advancing sustainable development goals on clean energy. 




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As part of our long-term commitment to shifting the power and promoting a more equitable humanitarian system, we have supported locally-led innovation projects around the world. 

- As a member of the Community Led Innovation Partnership (CLIP), we work with partners in Indonesia, the Philippines, Guatemala and, as of 2023, South Sudan, to develop locallyrooted networks and hubs that support the development of locally-driven solutions to humanitarian problems, identified by people affected by crises. 

The consortium is made up of eight organisations who share the same vision of supporting community-led innovation. These organisations are: Elrha, Start Network, Asia Disaster Reduction and Response Network (ADRRN), Yakkum Emergency Unit (YEU) in Indonesia, the Center for Disaster Preparedness (CDP) in the Philippines, Asociación de Servicios - Comunitarios de Salud (ASECSA) in Guatemala, and the Titi Foundation and the CAFOD Trocaire in partnership in South Sudan. 

## Find out more about the projects below and explore the CLIP’s collection of case studies. 

## **Indonesia / YEU** 

YEU’s IDEASKI innovation lab is focused on disability and the inclusion of older people in humanitarian response. From an initial cohort of 15 projects, nine innovation teams have continued to receive funding and/or non-financial support through their growth phase, which began in April 2022. 

## **Philippines / CDP** 

This year, CDP completed Phase 1 of their initiative, the Pinnovation Academy, supporting 15 teams across nutrition, food security and water scarcity to early warning systems and flood mitigation. A total of 1,801 people are reported to have directly benefited from these innovations during the project period, with a total of 25,510 people indirectly benefiting. 

## **Guatemala / Start Network Hub Guatemala, hosted by ASECSA** 

In the past year, ASECSA has continued to work with 21 local teams across three regions. Their approach centres community dynamics and the indigenous cosmovision in the process, using art installations and other creative approaches to engage communities in the exploration of problems and solutions. 

**South Sudan / Start Network Hub South Sudan, hosted by the Titi Foundation and CAFOD-Trocaire** 

The Start Network Hub in South Sudan began developing a new CLIP programme in March 2023, and officially joined the partnership in June. The initiative will be implemented by the Titi Foundation and the CAFOD-Trocaire partnership, and the programme will focus on supporting the emergence and development of community-led innovations of food security, women’s empowerment, and access to safe water. 




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In January, we joined our CLIP colleagues for the first in-person meeting of all the partner organisations in the project’s history. Hosted by YEU in Yogyakarta, Indonesia, the five-day workshop was an opportunity to exchange learning experiences and ideas, reflect on the first three years of the project and plan for the next two years. The partner organisations were also joined by colleagues from the Sustainable Environment and Ecological Development Society of India (SEEDS India). 

We co-hosted a session as part of the 2023 Regional Humanitarian Partnership Week in Bangkok which focused on showcasing best practices for promoting local adaptation. The session was attended by more than 300 people, and featured discussions on how local innovators and communities have come to combine their existing assets and new technology, and how we could better support innovators in articulating and leveraging local, indigenous and traditional knowledge, and communicating with local and national governments in future. In particular, the event highlighted work being carried out by our partners in Indonesia and the Philippines. 


The consortium developed an Innovation Catalogue showcasing 45 projects from locally-led teams focused on early warning and emergency response, and disaster risk reduction in humanitarian settings. These innovators have been part of Phase 1 of the CLIP (2020–2023) in Guatemala, Indonesia, and the Philippines. We’ll be updating this catalogue as we move into Phase 2, expanding our work to include innovators from South Sudan and supporting existing grantees in their next phase of growth. 


In 2023, the CLIP commissioned an independent evaluation, led by Start Network. Conducted by Catalystas Consulting, the evaluation reviewed Phase 1 of the CLIP, providing insights into the successes and challenges faced during its first three years. The evaluation found a range of areas in which the CLIP effectively combined humanitarian innovation with localised approaches and laid a strong foundation of collaboration – both between CLIP organisations, and between country partners, local innovators and national stakeholders. This enabled each country partner to approach innovation in the way that was most appropriate and effective for their own unique contexts, needs and realities. These insights and further recommendations have been used as an evidence base to develop the second phase of its work (2023-2025). 



Outside of the CLIP, we also work with SEEDS, an NGO based in India that enables community resilience through practical solutions in the areas of disaster readiness, response and rehabilitation. 

In February, the SEEDS Scaling Phase was launched in collaboration with the ADRRN Tokyo Innovation Hub. Two teams were selected to receive funding to scale their innovations: **Urmul** , for their project establishing privately managed Common Facility Centres along traditional pastoral routes to provide basic support services for transhumant pastoralists 




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during extreme climate events; and **Words, Rhythms, Images** for their participatory mobile video making method which enables people living in slums to create impactful advocacy videos raising awareness of water stress issues. The **Leh Nutrition Project** was also awarded a research grant for their work on artificial glacier construction to mitigate the impacts of glacial melt and water shortages in the Himalayan cold desert region of LehLadakh. 




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Since 2020, Elrha has hosted the UK Humanitarian Innovation Hub (UKHIH), an FCDO-funded mechanism which aims to harness UK and international capabilities to support problem-led, systems innovation in the humanitarian sector. 

In 2023 the UKHIH conducted its work through three main modalities: Accelerated Innovation Collaborations, the Humanitarian Rapid Research initiative, and ecosystem research. 


The UKHIH funds and facilitates Accelerated Innovation Collaborations (AICs), convening research, operational, and innovation partners, to explore and develop solutions for key humanitarian innovation challenges. AICs focus on thematic topics where there is real potential for change but where progress has been slow, learning has been siloed or innovation has been led by technical experts rather than humanitarians and the real-world challenges they face. 

Over the course of 2023 the UKHIH continued to provide support to three existing AICs: 

**1. Beyond Borders: Satellite technology for humanitarian decision-making:** 

**Partners** : Caribou Space, Satellite Applications Catapult, and the United Nations Institute for Training and Research (UNITAR). 

## **2023 Achievements:** 

- The partners published a landscape analysis which mapped satellite applications in humanitarian settings, and explored barriers and opportunities to expand access and use to earth observational data. 

- Built a library of case studies, developed guidance for humanitarians and a policy brief. 

- • Facilitated several in person and virtual workshops to identify what actions are needed to create a supportive ecosystem that would allow satellite data to be used as part of standard humanitarian practice. Through this collaborative ideation process they developed a set of co-designed prioritised ideas. 

**What’s next** : In the next phase of work, the partners will be supporting diverse stakeholders to take these ideas forward. Ideas include everything from AI chatbots to direct people to existing resources, to data sharing mechanisms and organisational capacity strengthening. 

**2. Collective crisis intelligence for frontline responders:** 

**Partners** : Nesta, the International Federation of the Red Cross, Solferino Academy, and the Nepal and Cameroon Red Cross National Societies. 

## **2023 Achievements:** 

- Explored the potential for collective crisis intelligence tools (CCI) to inform the programmatic decision-making of frontline humanitarian staff. CCI tools combine crowdsourced community data with AI analysis to allow for informed decision-making in real time. Initial outputs of this work included a landscaping report demonstrating potential use cases across the humanitarian programme cycle and describing challenges and opportunities for adoption. It also led to the piloting of novel CCI applications in Nepal and Cameroon. 

- Led a process to better understand barriers to tech-based innovation adoption within the humanitarian sector. They used interviews, creative CCI tools and in-person events, to 




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learn from and convene humanitarian stakeholders. This resulted in a set of prioritised ideas for future CCI applications including a community-developed AI safety label, a tool for crowdsourcing imagery of infrastructural damage in the wake of a conflict or disaster, and a CCI needs assessment tool. 

## **3. The Humanitarian Surgery Initiative (HSI):** 

**Partners:** The Royal College of Surgeons of England, Médecins Sans Frontières, the Centre for Innovation in Global Health, Stanford University and the Global Surgery Policy Unit. 

## **2023 Achievements** 

- Continued to explore opportunities to map and align resources to support surgical training and delivery in war zones, crisis prone regions and low-resource settings. They used a Delphi process to develop a definition of humanitarian surgery, conducted qualitative interviews with surgeons in conflict zones to understand their experiences, mapped training resources, identified technologies that could support capacity strengthening in these contexts and developed a webinar series highlighting global surgical voices. 

- In the most recent phase of work, the partners collaborated with the Humanitarian Conflict and Response Institute at the University of Manchester to review literature on humanitarian surgery, bring together findings across the project so far and conduct an ideation process to build consensus around what is needed to support an aligned strategy related to global humanitarian surgery. 

The UKHIH also initiated two new AICs in 2023: 

**4. The Pulse Project: Strengthening community engagement around vaccine delivery in humanitarian contexts** 

**Partners:** The Geneva Centre of Humanitarian Studies, the London School of Hygiene and Tropical Medicine, Addis Ababa University School of Public Health (Ethiopia), Childcare and Wellness Clinics (Nigeria), the International Federation of the Red Cross and the Nigerian and Ethiopian Red Cross National Societies. 

**Aim:** to explore the opportunity for doing community engagement more systematically around vaccine deployment in humanitarian settings. In 2023 the partners commenced a literature review, a process for mapping current tools used for community engagement, and set up methodologies to do real-time and retrospective learning from vaccine roll outs in crisis-affected regions of Nigeria and Ethiopia. Learning from these components will be used to build a sustainable community of practice. 

## **5. Estimating Mortality in Humanitarian Crises** 

2023 saw the UKHIH lay the groundwork for a new AIC on mortality estimation which will launch in early 2024. This work will explore the opportunity for a sustainable mechanism to support systematic mortality estimation in humanitarian settings. Many humanitarians consider mortality estimation to be one of the most significant metrics to define the severity and magnitude of a crisis and a critical measure for tracking the impact of humanitarian responses. However, in practice mortality estimation is rarely accurate or comprehensive, if attempted at all. Commonly, mortality estimates are met with methodological critiques of validity and there is little consensus on how credible estimates are. Consequently, mortality evidence is frequently 




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contested and viewed as lacking sufficient rigour and credibility to reliably guide if, when and how to respond to a crisis. 

The development of the scope of work was, as always, consultative, with 30 in-depth interviews with academics and humanitarians working on this topic. The UKHIH also sought to align this work to a complementary initiative being undertaken by USAID’s Bureau of Humanitarian Assistance and the Centres for Disease Control. 


The Humanitarian Rapid Research Initiative (HRRI) facilitates real-time research and convening around emerging crises. The UKHIH works in partnership with Humanitarian Outcomes to develop a collaborative process of research and learning to strengthen humanitarian policy and operational responses. Typically, this process involves analysis of available data and 

documentation, interviews with humanitarian actors and polling of affected populations. The last year was a busy one for this initiative with the following four reports being published. 

**1. Slipping Away? A review of Humanitarian Capabilities in cholera response:** The report looks at the complex causes behind the increase in cholera deaths, and areas where the humanitarian sector can better coordinate and invest to prevent and respond to outbreaks. 

**2. Solidarity at Scale: Local responder perspectives and learning from the first week of the earthquake response in Syria and Türkiye:** This was a ‘mini-report’ which provided a snapshot of issues and challenges humanitarian responders faced during the first ten days of the response to the devastating 7.8 magnitude earthquake that affected southern Turkey and northwest Syria in February 2023. 

**3. Navigating Ethical Dilemmas for Humanitarian Action in Afghanistan:** The international aid sector faced a wrenching decision in Afghanistan: uphold universal human rights values by refusing to comply with the Taliban's edicts against employing women, or prioritise the humanitarian imperative to continue providing what aid they can to millions in need. The report explored the ethical challenges faced by humanitarians and populations in navigating this situation. The findings of this report highlighted there was no tool to help humanitarian actors navigate ethical dilemmas or situations where humanitarian principles may be in conflict. Based on this, the UKHIH began work with Humanitarian Outcomes to co-design a tool to fit this purpose and pilot it across a range of crises settings. 

**4. Somali Capacities to Respond to Crisis are Changing** In the decade since the 2011 famine, Somali capacities to respond to crisis have grown, and international aid needs to support those capacities more effectively. This report focused on the resilience of the country’s citizens and systems, and how the humanitarian sector has engaged with these. It offers a forward-looking perspective on how humanitarian aid might better engage with the changing Somali context to do better and cause less harm in the face of accelerating climate change and ongoing conflict. One outcome was a series of roundtables with humanitarian stakeholders to take forward the conversation around specific aspects of the findings. 




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The UKHIH’s ecosystem research is designed to explore thematic areas where future investment and collaboration may be strategically useful for the humanitarian sector. Three new ecosystem research commissions were initiated in 2023: 

## **AI Solutions for Humanitarian Challenges: foundational research and technical expertise** 

For the first time, UKHIH is collaborating directly with our Humanitarian Innovation Fund on AI ( **p27** ). This work leverages the respective roles, experience, networks, and capacities of both partners. The UKHIH is leading on the foundational research to understand the opportunities and challenges related to the use of AI technologies by the humanitarian sector, and will be mapping existing AI initiatives and expertise. This work is being undertaken by a consortium led by University College London and including representatives from the International Artificial Intelligence Research Centre (IRCAI), the University of Cape Coast (Ghana), the Data Scientists Network Foundation (Nigeria), Kathmandu University (Nepal) and UNOCHA. 

Using findings from the first stage of this work, these partners will then be facilitating a learning journey for a cohort of our grantees who will explore a particular humanitarian challenge and the potential for this to be addressed though AI applications. 

## **UKHIH Foresight Initiative: Emerging Technologies** 

In the humanitarian sector, there has been much promise of improvements in efficiency and reach, through the utilisation of new technologies. However, there are numerous challenges related to emerging technologies including around ethics, the process of adoption, equitable access, governance and capacity strengthening. There is also often a mismatch between those developing technologies or holding technological expertise and humanitarians and the issues they face. 

The UKHIH is aiming to help bridge this gap with this initiative which will use a problems-led approach to understand the types of challenge the humanitarian sector is likely to face in the coming ten years and conduct a systems-level review of potential emerging technologies that could contribute to addressing these issues. The UKHIH is supporting a consortium of partners to undertake this work including RAND Europe, glass.ai and Athena Infonomics. They are using a mix of traditional and AI-enabled foresight methodologies to undertake this landscaping and mapping work, as well as consultations with humanitarian stakeholders. 

## **Strengthening collaboration and leveraging UK and global expertise to support humanitarian research, innovation and practice** 

The UKHIH is working with Science Practice to understand how and why humanitarian problemowners might connect with, or seek support from, UK and global expertise. Currently there is often a disconnect between the way that innovators or academics operate and the way that the humanitarian sector operates – this creates challenges for collaboration. At present, most collaborations arise as a result of trusted existing relationships, and grant-funded partnerships. However, this marginalises those without these connections and prevents other types of collaboration or knowledge-sharing that might more effectively meet humanitarian needs. Science Practice are exploring a set of possible ideas that could make collaboration more transparent, equitable and suitable for the kinds of challenges humanitarians face, such as a collaboration platform and a directory to map relevant expertise. 




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Heading into 2024, we will continue to make progress against our long-term Strategy, building on our position as the leading actor in HRI, and using our learning, expertise, and global networks to address critical humanitarian challenges and drive for a more effective, inclusive, and impactful system. 

We will continue our work as a responsible funder in the humanitarian sector, and use our available funding, expertise, and convening abilities to identify and support pioneering R&I solutions to ongoing and emerging crises. Next year, we will embark on our exploration of the potential of AI, both through our funded learning journey, and its subsequent outputs. We will also progress our Rapid Response work, to better understand the pathways for innovation adoption and scale in rapid onset and acute crisis settings. Through the GPE we will also publish our Global Insights report, the most comprehensive overview of the HRI landscape to date. Culminating from two years of research and consultation at regional, country-level, and thematic activities, it takes a deep dive into the humanitarian research and innovation ecosystem, capturing the principal findings and recommendations. 

We will create new tools and guidance to support effective and responsible HRI. A new study will highlight the evidence needed to improve future policy and practice around sexual and reproductive health and rights, while the public launch of our Humanitarian Innovation Support Library will offer an inventory of guidance and resources for individuals and organisations developing innovative solutions to the challenges facing people affected by crisis. 

We will identify more opportunities for collaboration between researchers, innovators and humanitarian actors, starting by exploring what a joint R&I WASH funding call might look like, through consultation with WASH experts. Moreover, we will bring these groups together through events and conferences, including our Innovation Forum which will take place towards the end of 2024, and plan for our humanitarian health research Forum in early 2025. 




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The financial statements have been prepared in accordance with the accounting policies set out in notes to the accounts and comply with the charity’s governing document, the Charities Act 2011 and the second edition of 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), published in October 2019. 

The financial overview for 2023 is set out in the Statement of Financial Activities on **page 60** . 



When compared to the previous year, total income in 2023 increased by 32% to £12.7m (2022: £9.6m), of which over 99.99% was restricted (2022: 99.99%). Income received in the form of grants from institutional donors includes, the UK Foreign, Commonwealth and Development Office (FCDO), the Netherlands Ministry of Foreign Affairs (NL MFA), the Department for Health and Social care (DHSC) and the Norwegian Ministry of Foreign Affairs. Elrha also received income from Wellcome, in the form of a grant. 

As all restricted income is recognised on a performance basis, the amount recognised in the financial statements is determined by expenditure on the relevant charitable activities. 

Three unrestricted donations totalling £24 were received during the year (2022: £5). No gifts in kind were received during 2023 (2022: £0). 


Total expenditure also increased in 2023 by an equivalent level to the rise in income, to £12.5m (2022: £9.4m). Within the main cost categories of Elrha’s activities, the level of grant disbursements made in 2023 rose by £2.5m to £8.6m (2022: £6.1m) representing 69% of the total spent (2022: 65%). This is due to new grant commitments made in 2023, primarily within the Research for Health in Humanitarian Crises (R2HC) programme. Direct activity costs in 2023 also increased from the amount spent in the previous year, reaching £2.5m (2022: £2.1m), representing 20% of the total expenditure (2022: 22%). 

## **Humanitarian Innovation Fund (HIF) expenditure** 

Expenditure by the HIF programme constituted 42% of Elrha’s total spend in 2023 and was at an overall level 4% lower than that incurred in 2022, at £5.2m (2022: £5.4m). This reduction is primarily due to the amount expended in grants disbursements during 2023 being 5% lower at £3.6m (2022: £3.8m). Whilst a number of new cohorts were launched during the year, most of the current active grantees are moving towards the latter stages of their project timelines, thus requiring lower value disbursements. 




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Programme support costs fell by 6% to £725k (2022: £775k), however the costs associated with directly implemented activity rose by 6% to £879k (2022: £830k) consistent with an increase in the work undertaken to offer non-financial support to active grantees and to demonstrate the impact of their work. 

**Research for Health in Humanitarian Crises (R2HC) expenditure** 

Total spend by the R2HC programme rose significantly during 2023 to £5.1m (2022: £2.5m) and represents 41% of the total Elrha spend for the year. The main factors contributing to this increase are: 

- a) Grant disbursements totalled £4.0m (2022: £1.7m), i.e. 135% higher than 2022 levels, due to a significant new cohort being launched, and first disbursements made (which cover the highest value tranche payments), in early 2023. This funding round had been postponed from previous years due to delays in donor funding decisions. 

- b) Direct implemented activity costs increased by 34% to £768k (2022: £574k), with expenditure including costs associated with initiatives in child and nutrition health research and food insecurity, and producing the R2HC impact evaluation report. 

- c) Support costs increased by £94k (33%) to £378k (2022: £284k) reflecting the additional resource required to support higher levels of programme activity. 

**Global Prioritisation Exercise (GPE) and the UK Humanitarian Innovation Hub (UKHIH) expenditure** 

Spend on the GPE totalled £626k, a 28% increase from last year (2022: £490k) driven by the completion of several research studies that constitute the core activities of this programme. Subsequently, support costs have also increased during this period. Further details on the GPE activities are provided on **page 13** and throughout the report. 

The UKHIH spent a total of £1.5m (2022: £1.0m) during 2023, an increase of 54% from 2022. Grants to other organisations increased to £1.0m (2022: £0.6m), and in 2023, the UKHIH increased its level of non-grant making activities, by 21% to £322k (2022: £267k), as explained in more detail on **page 34** . 

**Operational support costs** 

Across all programmes, Elrha’s operational support costs, totalled £1.42m (2022: £1.25m), and include spending on items that are related to: 

- organisation-wide management, facilitating the smooth running of day-to-day activities and ensuring the decision-making is based on accurate information and the efficient and charitable use of our resources 

- essential infrastructure, including management of premises and facilities, information technology (IT) services, and corporate communication 

- governance and ensuring internal and external compliance with policies and regulations 

- employment costs not directly attributable to our programmes 




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Whilst the total value spent on operational support has risen during 2023, this is reflective of the additional support required to meet the increased programme activity for the year. In percentage terms, spending on operational support has fallen to 11% of the overall organisational spend (2022: 13%) demonstrating achievement of economies of scale. 


Our total reserves as of 31 December 2023 were £693k (2022: £471k), of which £454k relates to restricted funds (2022: £232k), which means Elrha’s restricted reserves increased by £222k in 2023. There were no designated reserves. 

In order to commit the maximum possible resource to further our charitable objectives, it is Elrha’s policy to retain sufficient reserves to safeguard the continuity of operations, when there is a temporary loss of income or to achieve an orderly wind-down if continuation is not possible. As per the Delegation of Authority, any use of Elrha’s reserves must be approved by the Chair of the Board of Trustees or the Board Treasurer. 

The Trustees are confident that future incoming resources to the charity will be adequate to support the continuation of existing projects and activities, as well as to meet other needs that may arise under reasonably possible downside scenarios, for at least 12 months following the approval of this report. Accordingly, Elrha continues to adopt the ‘going concern’ basis in preparing the financial statements. 

The Trustees are also taking steps to seek and secure additional funding, from both current and new sources of income, with a view to protect Elrha’s sustainability in the longer-term future. 

## **Investments** 

Elrha held no investments during the period. 



The major risks to which Elrha is exposed have been identified by the Directors Group and reviewed by the Board of Trustees as part of the annual risk review process. Appropriate systems and procedures are in place to manage these risks and provide reasonable but not absolute assurance against occurrence. 


## **Programme Funding** 

One of the highest risks identified in 2023 was not having secured, by the end of the year, sufficient funding to cover Elrha programme activities and associated costs in 2024. This risk 




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has only partially materialised as additional funding secured by the end of 2023 allowed us to fully cover costs for planned and additional innovation activities (HIF, CLIP and UKHIH) in 2024. However, there is a funding gap from mid-2024 in implementing the System Strengthening component of our strategy, which is critical for our ambition. R2HC activities are fully funded for 2024. 

To manage the ongoing sustainability of our System Strengthening work we are exploring ways to integrate these objectives into the ongoing programmes, so that we can progress on the goals and objectives set in the Three-Year Plan and Strategy. At the same time, there are ongoing fundraising activities for this critical pillar of our Strategy, as reflected in our business development priorities, including early conversations with current donors to identify common areas of interest. 

There is also a continuing risk in not securing funding for innovation activities after mid2025, when the current awards funding these programmes finalise. This is a high-level risk for 2024, as the impact of not having secured follow-up grants beyond current donor commitments will involve pausing these programmes, with consequences not only for the relevant teams and Elrha’s operational capacity, but also for our contribution to the sector. Furthermore, if additional funding for R2HC in 2025 and beyond is not secured, level of activities and expenditure are likely to be significantly reduced from 2024, affecting our capacity to meet overhead costs. 

Nonetheless, our long-term and positive relationship with current funders leads us to consider that the likelihood for innovation activities to continue after March 2025 remains high. To this end, we are in early conversations with our funders to understand their expectations and timelines for the next phase of funding. Seeking new funding is an organisational priority, and we are implementing business development activities to achieve results in more effective ways. 

Additionally, during 2024 we will carry out business planning against likely future funding scenarios for 2025 onwards. 

## **Funding diversification** 

Elrha’s dependency on a few donors (more than 80% of 2024 budget is funded by one donor) makes Elrha extensively vulnerable to donor policy changes and budget reductions, with limited resilience to offset funding shocks from one donor with other sources of income. 

Identified as a high-level risk for 2023, Elrha still had the same donors as in 2022, as of December 2023. Nonetheless, the 2023-finalised Business Development Strategy has provided a clear framework and tools to concentrate our fundraising efforts. The donor prioritisation exercise and engagement of new donors are central pieces in the Business Development Strategy. Work has been in place during 2023 to engage new institutional donors and non-institutional donors. Attendance of networking and engagement events have been prioritised, and a more targeted approach is in place, with core assets to support donor outreach under development. 


While most teams remain stable during 2023, one of the programme teams was affected by a high staff turnover. This had been a high-level risk identified at the start of 2023, and mitigation actions were put in place, particularly around reviewing the job descriptions and 




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working on the team culture. Nonetheless, resourcing of this team in 2024 continues to be an organisational risk that needs monitoring. 

Workplans will thus be regularly reviewed in order to identify critical activities and minimum requirements, so that workload across the team can be prioritised and kept at acceptable levels. And we will strive for quick recruitment processes and induction programmes. 


Lastly, a high organisational risk identified at the start of 2023 was related to the establishment of the Staff Representation Group, and the possibility of tensions among the staff and/or with management resulting in the initiative not being implemented. 

This risk was not materialised, and engagement was sufficient for the staff body approving the final terms of reference for the group, with three members of staff volunteering to constitute the SRG. By early 2024, the SRG is well established and with a clear mandate, so identified risks did not materialise and no further risk has been identified in this area. 




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Elrha is registered at 1 St. John’s Lane, London EC1M 4AR under the laws of England and Wales as both a private limited company by guarantee (11142219) and a charity (1177110). A second office is located at 8 Cathedral Road, Cardiff, CF11 9LJ. 

The charity was incorporated on 10 January 2018, although its activities had commenced in 2009, hosted by Save the Children Fund. At time of incorporation, the related assets were transferred to the separate legal entity on 1 May 2018 for nil consideration. The sole member of Elrha is the Save the Children Fund, of which Elrha therefore acts as a wholly owned subsidiary. 

Under Elrha’s Articles of Association, dated at incorporation, certain decisions are reserved for the Member. These include, but are not limited to: 

- i) any changes to the Articles of Association, 

- ii) any alteration to the Charity name or registered office, 

- iii) any structural change to the organisation e.g., setting up of subsidiaries mergers, sales, disposals, and liquidations, and 

- iv) the appointment and removal of all Trustees. 


The following individuals were members of the Board of Trustees (and also Directors of Elrha for company law purposes), at the date on which the financial statements were approved and during the year: 

- Margie Buchanan-Smith (end of tenure as Chair on 31 December 2023) 

- Dr. Jane Cocking OBE (appointed as Trustee on 24 February 2023, and as Chair from 1 January 2024) 

- Andrew Toby Smith (Deputy Chair, appointed on 6 March 2023) 

- Andrew Shellard (Treasurer, tenure as Trustee ended on 12 February 2024) 

- Andy Katz (tenure as trustee ended on 18 April 2024) 

- Ebrima Saidy 

- Genevieve Kiff (appointed as Trustee on 5 March 2024, and as Treasurer on 11 March 2024) 

- Karen Twining Fooks 

- Dr. Marta Tufet Bayona 

- Rhea Tariq (appointed as Trustee on 24 February 2023) 

- Sorcha O’Callaghan (appointed as Trustee on 5 March 2024) 

- Wendy Fenton (tenure as Trustee and Deputy Chair ended on 6 March 2023) 




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Day-to-day management of the charity is delegated by the Trustees to Elrha’s Directors Group. As at the date of approval of this report and during the year, the members of the Directors Group were: 

- Jessica Camburn – Chief Executive Officer 

- Colette Fearon – Director of Impact and Engagement 

- Thaïs Méndez de Andés Aldama – Director of Finance and Operations 


**Auditor:** KPMG LLP, 15 Canada Square, London E14 5GL 

**Bankers:** National Westminster Bank, PO Box 83, Tavistock House, Tavistock Square, London WC1H 9NA 


Elrha’s governance structure is formed by three categories of governing bodies: 

(a) Elrha Board of Trustees:  its main purpose is providing strategic direction to the organisation, holding overall responsibility for how Elrha implements its strategy, safeguarding, the responsible use of its resources, and ensuring governance standards are upheld. 

(b) Programme-based advisory groups and committees: depending on the scope of work defined in their terms of references, this category of governance bodies would (a) advise the Board of Trustees on the strategic direction of their programmes; and/or (b) provide technical advice to the programme teams and make recommendations regarding programmatic priorities; and/or (c) provide independent assessment and recommendation of funding decisions. 

(c) Directors Group: they are responsible for day-to-day management of Elrha’s business, as delegated by the Board. The Director Group is formed by Elrha’s CEO, the Director of Impact and Engagement, and the Director of Finance & Operations. 

As mentioned above ( **p34** ), the UK Humanitarian Innovation Hub (UKHIH) is a hosted initiative within Elrha. Whilst subject to oversight from the Elrha Board of Trustees, UKHIH has a distinct governance structure, the UKHIH Steering Committee (SC), comprised of Elrha, donor representatives and Chair of the UKHIH Advisory Group. 

UKHIH functions with an autonomous strategy, annual workplans and annual budgets from those of Elrha., which are approved -in first instance- by their Steering Committee. UKHIH’s Governance paper clearly captures roles and responsibilities of the different stakeholders (SC, UKHIH Director, Advisory Group, Elrha Board of Trustees and staff) and their different scope and level of authority in regard to UKHIH’s activities and operations. 

The UKHIH is, however, legally part of Elrha and, as set in the Memorandum of Understanding (MoU) describing the hosting arrangement, UKHIH follows Elrha’s operating policies and procedures, unless otherwise agreed. 




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As part of Elrha, UKHIIH is under the mandate of Elrha Board of Trustees, who has the final authority to ratify UKHIH governance structure and annual budgets (approved as part of Elrha overall annual budget), and in overseeing risks and potential liabilities of UKHIH activities that could significantly impact Elrha. Progress on UKHIH activities and budget execution is regularly reported to the Board of Trustees. 


As indicated above, Elrha is a limited company, and all Trustees are also full Directors of Elrha for company law purposes. 

‑ Trustees, all of whom are non executive, have been drawn from diverse backgrounds in business and professional life, and bring a broad range of experience and skills to Board deliberations. The Trustees have been appointed in accordance with the provisions of the Articles of Association for Elrha. Trustees are recruited through open and competitive processes (except for one trustee appointed by Save the Children), against relevant skills and experience identified by the existing Trustees as needed for the Board to perform their duties. 

All Trustees have received a full induction, including meeting with members of the Directors Group, aiming at getting familiar with their statutory responsibilities, their role as Board members, the governance framework within Elrha, Elrha’s work, and the risk environment. Ongoing training is arranged as and when a need is identified. 

There are clear distinctions between the role of the Board and the Directors Group, to which day-to-day management is delegated. The principles of ‘management proposes’ / ‘Board decides’; ‘management implements’ / ‘Board monitors’ form the basis of the Board and executive management team interaction. Items such as Elrha’s policies, strategic annual plan, budget and risk assessments are prepared by the Directors Group for consideration and approved by the Trustees. The members of the Board cannot, under the governance regulations of the charity, receive remuneration for services to Elrha and may only be reimbursed for incidental expenses claimed. 

As part of Elrha’s governance review, it undertook an analysis of Elrha’s governance practices against the Charity Governance Code in 2021 and developed an action plan for strengthening governance, which it has implemented over the following two years. The Board also carries out an informal annual self-assessment, wherein the Chair of the Board meets with each individual Trustee and writes up a report identifying areas of strength and improvement in the functioning of the Board. 

As per the Board’s terms of reference, Trustees met four times in 2023 and held an extraordinary meeting in April to approve Elrha’s new Strategy 2023-2040. 




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|**Board attendance was as follows:**||
|---|---|
|**Name**|**Meetings**|
|Margie Buchanan-Smith (Chair)|5/5|
|Andrew Toby Smith (Deputy Chair)|5/5|
|Andrew Shellard (Treasurer)|4/5|
|Andy Katz|3/5|
|Ebrima Saidy|3/5|
|Dr. Jane Cocking OBE|4/5|
|Karen Twining Fooks|5/5|
|Dr. Marta Tufet Bayona|4/5|
|Rhea Tariq|4/5|
|Wendy Fenton|1/1*|
|*Tenure ended 6 March 2023.||




## **Risk & Audit Committee** 

In March 2022, the Board agreed to set up the Risk & Audit Committee (RAC) as a permanent committee to strengthen and provide advice to the Board on its oversight of risk and audit review.  The committee comprises, the Treasurer to the Board, the Deputy Chair and Elrha’s Director of Finance and Operations.  A meeting of the RAC took place in early September 2023 to consider a new risk management framework, including a new template for Elrha’s risk register, before recommending approval to the Board. The Board approved the new approach to risk management at its meeting in September. Additionally, the RAC, after review and consideration, recommends to the Board whether to approve the Annual Report and Accounts. 

## **Strategy Development Committee** 

Since March 2022, the Strategy Development Committee (SDC), an ad hoc committee of the Board, had provided strategic support to Elrha’s management with the development of Elrha’s new Strategy (2023-2040). The SDC met once in January this year and, following Board approval of the new Strategy and 3-Year Plan in May, the SDC was dissolved as its purpose had been achieved. 

## **Business Development Committee** 

The Business Development Committee (BDC was created in June, being responsible for providing advice to the Board on fundraising in support of the implementation of the Strategy and the ongoing effective and sustainable resourcing of the organisation.  The Business Development Committee (BDC) does not hold any delegated authority from the Board, but provides advice and assurance to the Board and Elrha’s management in three key areas: 




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- Developing a strategy for business development and plans for its implementation 

- Fundraising, donor engagement and income generation 

- Organisational profiling and marketing 

The BDC held its first meeting in August to consider an outline draft of the new BD Strategy and met again in early December to consider a final version and plans for its implementation before a final draft was approved by the Board at its meeting on 12 December. 


Each governing body described below has a clear term of reference that sets out their roles and responsibilities. It also sets out the process to avoid and manage potential conflict of interests, ensuring that the bodies uphold the highest standards of transparency and accountability. 

## **Programme Advisory Groups** 

The HIF and R2HC Advisory Groups advise Elrha on the strategic direction of our grantmaking programmes. These groups provide advice to the programme teams and make recommendations regarding programmatic priorities, set the direction and framework for grant-making, and are involved in the selection of Funding Committee members. The Chairs of the Advisory Groups report to the Elrha Board on an annual basis. 

## **Programme Funding Committees** 

The function of our two Funding Committees, one for HIF and one for R2HC, is to provide independent assessment and recommendation of funding decisions. The Chairs of the Funding Committees report to their respective Advisory Group. 

## **Technical Working Groups** 

The Technical Working Groups provide a greater depth of technical expertise for the focus areas on our HIF programme. The Chairs of the Technical Working Groups report to the HIF Advisory Group. 

Our HIF Technical Working Groups for 2023 were in WASH, GBV, and DOAI. 

## **Our Funders** 

Our programme funders retain the ability to veto the funding of a particular proposal before a final decision is made to grant restricted funds to a third party. However, programme funders cannot require that a third party receive a grant, and any final decision on whether a grant should be made remains with Elrha. 

In addition, Elrha’s funders may have observer status on the advisory groups and/or funding committees. This may be an ad-hoc or a regular arrangement and is agreed on a case-bycase basis. 


Elrha seeks to apply the Charity Governance Code as its standard for good governance. Following the completion of a review of governance practices against the code at the end of 2021, the Board approved an action plan to address key areas identified for improvement. The areas of improvement for planned action in 2023 were as follows: 




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- Work on a new Risk Management Framework started in 2022 and the RAC met in September 2023 to consider a more developed version of the framework.  Following some suggested improvements to the framework, the RAC recommended approval of the new framework and a more robust template for monitoring risk to the Board. The new framework and register will facilitate the assessment and monitoring of organisational risks, under the Board and Elrha’s management remits, on an ongoing basis. The DFO will be responsible for socialising the new framework into Elrha’s daily working practices in 2024. 

- Strengthening key policies, specifically Delegations of Authority (DOA) and staff rewards: 

   - A new DOA was approved by the Board in March 2023 and budget-holders and relevant staff trained. 

   - A new organisation salary structure was developed and published in 2022 and new salary progression principles were approved by the Board in March 2023 and applied to the annual salary increase for April 2023. 

The Board also strengthened its own oversight and expertise by: 

- The establishment of a new committee in June to develop a Business Development Strategy in support of Elrha’s new Strategy and plans for its implementation and to provide guidance and assurance to the Board on Elrha’s plans for fundraising, donor engagement, income generation and Elrha’s positioning in the sector. 

- Reviewing skills/expertise gaps on the Board and recruiting two additional trustees to replace the Treasurer and strengthen expertise on aspects of humanitarian policy. Recruitment took place between September and November 2023 through an open and competitive process. Two new trustees joined part of the December Board meeting proceedings as observers and joined the March 2024 as fully appointed trustees. A further recruitment is planned in early 2024 to strengthen fundraising/philanthropic expertise on the Board. 


Statement of Trustees' responsibilities in respect of the Trustees’ Annual Report and the financial statements 

The Trustees are responsible for preparing the Trustees’ Annual Report and the financial statements in accordance with applicable law and regulations. 

Company law requires the Trustees to prepare financial statements for each financial year. Under that law they are required to prepare the financial statements in accordance with UK Accounting Standards and applicable law (UK Generally Accepted Accounting Practice), including FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland. 

Under company law the Trustees must not approve the financial statements unless they are satisfied that they give a true and fair view of the state of affairs of the charitable company and of the income and expenditure for that period.  In preparing these financial statements, the Trustees are required to: 




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- select suitable accounting policies and then apply them consistently; 

- make judgements and estimates that are reasonable and prudent; 

- state whether applicable UK accounting standards have been followed, subject to any material departures disclosed and explained in the financial statements; 

- assess the charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern; and 

- use the going concern basis of accounting unless they either intend to liquidate the charitable company or to cease operations or have no realistic alternative but to do so. 

The Trustees are responsible for keeping adequate accounting records that are sufficient to show and explain the charitable company’s transactions and disclose with reasonable accuracy at any time the financial position of the charitable company and enable them to ensure that the financial statements comply with the Companies Act 2006. They are responsible for such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error, and have general responsibility for taking such steps as are reasonably open to them to safeguard the assets of the charitable company and to prevent and detect fraud and other irregularities. 

The Trustees are responsible for the maintenance and integrity of the corporate and financial information included on the charitable company’s website. Legislation in the UK governing the preparation and dissemination of financial statements may differ from legislation in other jurisdictions. 


KPMG LLP have expressed their willingness to continue to act as auditors. A resolution to reappoint them, under section 485 of the Companies Act 2006, is pending shareholder approval. 


Trustees have a duty to develop strategic plans to ensure that Elrha provide public benefit and achieve the charitable objectives as set out in our governing document. These objectives include the relief of hardship in cases of war, natural disaster, or catastrophe anywhere in the world; the promotion of education and training, and of research for the public benefit concerning these matters; and making publicly available the results of such research. These objectives fall under the purposes defined by the Charities Act 2011. We have referred to the Charity Commission’s general guidance on public benefit when reviewing our aims and objectives and in planning our future activities. In particular, the Trustees consider how planned activities will contribute to the aims and objectives they have set. 




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No political donations were made during the period. 


Elrha’s fundraising activities are currently limited to institutional donors and trusts, as well as occasional consultancy work for peer organisations. Elrha does not engage in fundraising from members of the public. 


Elrha designs its grant-making funding calls to ensure maximum contribution from any funded project to its strategic aims. Any registered legal entity may apply for grant funding from one of Elrha’s programmes, although particular funding calls may have additional eligibility requirements, depending on the nature of the challenge being set or other needs. 

Proposals submitted to Elrha go through the following process: 

- 1) Elrha staff screen the proposal to ensure it is eligible for funding. In addition, for some funding calls, expressions of interest are short-listed by the Funding Committee, with successful applicants being asked to submit a full proposal. 

- 2) Proposals that pass the screening/short-listing stage are reviewed technically by: 

   - a. At least two independent technical reviewers with subject area expertise 

   - b. Elrha staff, who will review the proposal budget 

Comments from these reviews are passed to the Funding Committee for consideration alongside the proposal. 

The Funding Committee has the authority to make funding recommendations up to the amounts agreed in the budget. For the R2HC programme, these recommendations are then agreed by the donors. 

Once the Funding Committee has made a decision on the quality of a project, the applicant organisation is subjected to Elrha’s due diligence process, which is an integral part of Elrha’s risk management and part of our established Mandatory Operating Procedures. As part of our due diligence process, implementing organisations and key staff members for the project or study are vetted against sanctions, anti-terrorism, and other international risk monitoring lists. The policies of the lead organisation are checked against our safeguarding and financial control principles to ensure they are of sufficient quality. Elrha then weighs the risk of granting to the lead organisation, and only when Elrha is comfortable that risks are within its appetite, or that sufficient mitigations have been put in place to achieve this, will a grant be confirmed. 




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Maintaining the safety and protection of those we work with and our staff is highly important across Elrha. This includes staff, governance groups, grantees, and the people our grantees work with. We have a zero-tolerance approach towards all forms of unethical behaviour, including bribery, facilitation payments, tax evasion and money laundering. 

Criminal record checks are completed for all staff and trustees, and more enhanced checks are performed following a risk-based approach. As part of our due diligence process for grantees, we review their safeguarding policies to make sure they are in line with our policies. 

We have an Incident Prevention and Management Policy – with a wide definition of vulnerable groups – and clear organisational values. These policies set out the standards of behaviour expected from all staff, trustees, grantees, and all others that we work with, particularly in relation to safeguarding. R2HC research studies are subject to review by an Institutional Review Board (IRB) to ensure they achieve recognised ethical approval before research is funded. 

We have an incident reporting mechanism and are committed to investigating any potential breaches of our policies, whether within Elrha or the projects and studies we fund. All complaints are investigated, following established investigation guidelines, and should internal breaches be substantiated, disciplinary action would be taken, up to and including dismissal. With our grantees, substantiated breaches may result in us withdrawing funding and any other support. 

We are committed to openness, and to keeping our donors informed of any complaints and the progress of any investigations. We are also committed to inform and work with our regulators and any relevant law enforcement agency where the complaint warrants this. 

While we believe that our systems are effective, we are committed to their ongoing review and development. We will continue to identify and implement measures that will enhance policy and practice to ensure our standards meet or exceed best practice in the sector. 


Our 2023 staff engagement survey once again demonstrated that our staff are inspired by our vision and purpose and can clearly see the positive impact they are making through their roles. 

Our staff experience good relationships with their line managers, are clear about their expectations and how they contribute to wider aims, and feel that achievements are recognised. 

Our staff enjoy positive working relationships with team members across the organisation and feel respected and comfortable voicing their opinions and concerns. We have supported strong connection and belonging through intentional opportunities to meet in person. 

Our staff feel their wellbeing is positively supported at Elrha, in particular through our commitment to offering flexibility with a good balance between working from home and the office. We continue to offer internal activities and resources to support good mental health, 




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resilience and connection with colleagues, and our staff can access wellbeing support through an established Employee Assistance Programme (EAP). 


Elrha is an equal opportunities employer, as reflected in our HR policies and practices, which are underpinned by the Equity, Diversity & Inclusion (EDI) principles approved by our Board in 2021 and the provisions of the Equality Act 2010. 

We see our inclusion principles as interdependent with staff engagement and wellbeing. Kindness and fairness are embedded into our culture and values. We champion employee wellbeing, recognition and appreciation, and make sure our supportive and flexible working environment keeps staff connected, motivated and well informed. 

We are committed to creating an inclusive and supportive working environment, free from discrimination, harassment, and victimisation. We promote and provide equal opportunities and respect diversity. These commitments are formally captured in our EDI principles, which are reflected in our policies and procedures. 

With recruitment, our ambition continues to be increasing the diversity of our staff to better represent and reflect the people and communities we support. Positive steps have been taken in achieving this goal, including using a wide range of recruitment websites and platforms to ensure a broad pool of candidates, as well as reinforcing a notice on our job advertisements to encourage applicants from a wider range of backgrounds. We recruit and promote staff on merit and continue to seek more internal routes to staff progression and succession planning. 


We want our staff to feel valued and appropriately rewarded and recognised for the work they do, and put ourselves in the best position to attract, retain and inspire exceptional individuals to help us achieve our purpose. We aim to reward our staff fairly and consistently relative to their level of work and to ensure our processes to manage pay are simple and easy to understand. 

In 2023, we introduced new Annual Salary Increase Principles to allow for pay progression for staff who remain in the same role over time, rewarding their increasing proficiency and expertise in that role. In addition, the increase will seek to mitigate any impact of cost-of-living increases when and if relevant. The new approach has provided Elrha with a clear framework to set salary levels for new positions, and to consistently establish the salary offer made to new staff starting with our organisation. 

Our salary structure ensures that our staff are paid competitively according to the role that they do. Our salary bands are benchmarked externally against those of similar sized charities. We are fully transparent about pay when we advertise for any role, sharing the starting salary in all instances. We are proud to continue to support the charity sector’s call for salary transparency. 

We also aim to offer an attractive benefits package including pension, life cover, organisational sick pay and family friendly pay and leave schemes; incremental increase in annual leave depending on length of service; opportunities for learning and development; a comprehensive EAP and a strong ethos of flexible working. 





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Like many other organisations we have been through a period of staff turnover at a higher rate than usual. Having reviewed the data available, the reasons for this do not seem to point conclusively to any one particular issue and are reflective of the situation across the wider job market. However, the impact has been felt keenly in terms of loss of knowledge within teams and needing to postpone certain activities and deliverables. We are committed to listening to staff to understand where improvements can be made to improve retention rates. 

This issue has led to increased recruitment activity and costs as we have needed to replace our leavers, alongside creating new roles to support growing organisational needs. Fortunately, we have attracted excellent candidates through our recruitment campaigns with all vacancies filled promptly. Our new starters benefit from a comprehensive induction programme to support the start of a successful journey with Elrha. 


The Trustee’s Report ( **pp7-54** ) was approved by the Board of Trustees on 24 June 2024 and signed on its behalf by: 


**Dr Jane Cocking** 

Chair of the Board of Trustees 


**Genny Kiff** 

Treasurer 




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We have audited the financial statements of Elrha (“the charitable company”) for the year ended 31 December 2023 which comprise the Balance Sheet, the Statement of Financial Activities, and the Cash Flow Statement and related notes, including the accounting policies in note 1. 

In our opinion the financial statements: 

- give a true and fair view of the state of the charitable company’s affairs as at 31 December 2023 and of its incoming resources and application of resources, including its income and expenditure, for the year then ended; 

- have been properly prepared in accordance with UK accounting standards, including FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland; and 

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

## **Basis for Opinion** 

We conducted our audit in accordance with International Standards on Auditing (UK) (“ISAs (UK)”) and applicable law. Our responsibilities are described below. We have fulfilled our ethical responsibilities under, and are independent of the charitable company in accordance with, UK ethical requirements including the FRC Ethical Standard.  We believe that the audit evidence we have obtained is a sufficient and appropriate basis for our opinion. 

## **Going concern** 

The trustees have prepared the financial statements on the going concern basis as they do not intend to liquidate the charitable company or to cease its operations, and as they have concluded that the charitable company’s financial position means that this is realistic. They have also concluded that there are no material uncertainties that could have cast significant doubt over its ability to continue as a going concern for at least a year from the date of approval of the financial statements (“the going concern period”). 

In our evaluation of the trustees’ conclusions, we considered the inherent risks to the charitable company’s business model and analysed how those risks might affect the charitable company’s financial resources or ability to continue operations over the going concern period. 

Our conclusions based on this work: 

- we consider that the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate; 

- we have not identified, and concur with the trustees’ assessment that there is not, a material uncertainty related to events or conditions that, individually or collectively, may 




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cast significant doubt on the charitable company's ability to continue as a going concern for the going concern period. 

However, as we cannot predict all future events or conditions and as subsequent events may result in outcomes that are inconsistent with judgements that were reasonable at the time they were made, the above conclusions are not a guarantee that the charitable company will continue in operation. 

**Fraud and breaches of laws and regulations – ability to detect** 

Identifying and responding to risks of material misstatement due to fraud 

To identify risks of material misstatement due to fraud (“fraud risks”) we assessed events or conditions that could indicate an incentive or pressure to commit fraud or provide an opportunity to commit fraud. Our risk assessment procedures included: 

- Enquiring of Trustees and management, and inspection of policy documentation as to the Charitable Company’s high-level policies and procedures to prevent and detect fraud, as well as whether they have knowledge of any actual, suspected or alleged fraud. 

- Reading Trustees Board minutes 

- Using analytical procedures to identify any unusual or unexpected relationships. 

We communicated identified fraud risks throughout the audit team and remained alert to any indications of fraud throughout the audit. 

As required by auditing standards, we perform procedures to address the risk of management override of controls and the risk of fraudulent revenue recognition, in particular the risk that charitable income is recorded in the incorrect accounting period, and the risk that management may be in a position to make inappropriate accounting entries. 

We also performed procedures including: 

- Identifying journal entries and other adjustments to test based on risk criteria and comparing the identified entries to supporting documentation. These included journals posted by individuals that do not post frequently, and unusual journal pairings for cash and borrowing. 

- Inspecting grant agreements to determine if income has been recognised in line with accounting policy. 

**Identifying and responding to risks of material misstatement due to noncompliance with laws and regulations** 

We identified areas of laws and regulations that could reasonably be expected to have a material effect on the financial statements from our general commercial and sector experience, and through discussion with management as required by auditing standards. Additionally, we discussed with management the relevant policies and procedures regarding compliance with laws and regulations. 

We communicated identified laws and regulations throughout our team and remained alert to any indications of non-compliance throughout the audit. 




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The potential effect of these laws and regulations on the financial statements varies considerably. 

The charitable company is subject to laws and regulations that directly affect the financial statements including financial reporting legislation (including related companies’ legislation) and taxation legislation and we assessed the extent of compliance with these laws and regulations as part of our procedures on the related financial statement items. 

Whilst the charitable company is subject to many other laws and regulations, we did not identify any others where the consequences of non-compliance alone could have a material effect on amounts or disclosures in the financial statements. 

## **Context of the ability of the audit to detect fraud or breaches of law or regulation** 

Owing to the inherent limitations of an audit, there is an unavoidable risk that we may not have detected some material misstatements in the financial statements, even though we have properly planned and performed our audit in accordance with auditing standards. For example, the further removed non-compliance with laws and regulations is from the events and transactions reflected in the financial statements, the less likely the inherently limited procedures required by auditing standards would identify it. 

In addition, as with any audit, there remained a higher risk of non-detection of fraud, as these may involve collusion, forgery, intentional omissions, misrepresentations, or the override of internal controls. Our audit procedures are designed to detect material misstatement. We are not responsible for preventing non-compliance or fraud and cannot be expected to detect non-compliance with all laws and regulations. 


The trustees are responsible for the other information, which comprises the Trustees' Annual Report.  Our opinion on the financial statements does not cover the other information and, accordingly, we do not express an audit opinion or, except as explicitly stated below, any form of assurance conclusion thereon. 

Our responsibility is to read the other information and, in doing so, consider whether, based on our financial statements audit work, the information therein is materially misstated or inconsistent with the financial statements or our audit knowledge. Based solely on that work: 

- we have not identified material misstatements in the other information; 

- in our opinion the information given in the Trustees' Annual Report, which constitutes 

- [the strategic report for the financial year, is consistent with the financial statements; and 

• in our opinion that report has been prepared in accordance with the Companies Act 2006. 




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Under the Companies Act 2006 we are required to report to you if, in our opinion: 

- adequate accounting records have not been kept, or returns adequate for our audit have not been received from branches not visited by us; or 

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

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

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

- the trustees were not entitled to take advantage of the small companies exemption from the requirement to prepare a strategic report 

We have nothing to report in these respects. 


As explained more fully in their statement set out on **page 49** , the trustees are responsible for: the preparation of the financial statements and for being satisfied that they give a true and fair view; such internal control as they determine is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error; 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 they either intend to liquidate the charitable company or to cease operations, or have no realistic alternative but to do so. 


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 our opinion in an auditor’s report.  Reasonable assurance is a high level of assurance, but does not 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 aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of the financial statements. 

A fuller description of our responsibilities is provided on the FRC’s website at www.frc.org.uk/auditorsresponsibilities. 

## **The purpose of our audit work and to whom we owe our responsibilities** 

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 




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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. 


## **Joanne Lees** 

## **for and on behalf of KPMG LLP, Statutory Auditor** 

Chartered Accountants 

15 Canada Square, London, E14 5GL 

Date:  01 July 2024 




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## **For the year ended 31 December 2023** 

|**For the year ended 31 December 2023**||
|---|---|
|**Notes**<br>Donations<br>3<br>Charitable Activities<br>4<br>**Total Income**<br>Charitable Activities<br>5<br>**Total Expenditure**<br>**Net Income and net movement in funds**<br>**Reconciliation of Funds:**<br>Total Funds Brought Forward<br>Movement in Funds|**Unrestricted**<br>**funds**<br>**Restricted**<br>**funds**<br>**Total funds for the**<br>**year to**<br>**31/12/2023**<br>**Total funds for**<br>**the**<br>**year to**<br>**31/12/2022**<br>**£**<br>**£**<br>**£**<br>**£**<br>24<br>-<br>24<br>5<br>-<br>12,717,716<br>12,717,716<br>9,608,532|
||**24**<br>**12,717,716**<br>**12,717,740**<br>**9,608,537**<br>(12,495,974)<br>(12,495,974)<br>(9,413,082)|
||**-**<br>**(12,495,974)**<br>**(**12,495,974)<br>(9,413,082)<br>**24**<br>**221,742                       221,766**<br>195,455<br>239,519<br>231,962<br>471,481<br>276,026<br>24<br>221,742<br>221,766<br>195,455|
|**Total Funds Carried Forward**|**239,543**<br>**453,704**<br>**693,247**<br>**471,481**|



The statement of financial activities includes all gains and losses recognised in the period 




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## **As at 31 December 2023** 

|**Notes**<br>**Current Assets**<br>Debtors: amounts falling due within one year<br>11<br>Cash at bank and in hand<br>16<br>**Liabilities:**<br>Creditors: amounts falling due within one year<br>12|**31/12/2023 31/12/2022**<br>**£**<br>**£**<br>2,327,607<br>1,409,218<br>55,743<br>101,911|
|---|---|
||**2,383,350**<br>**1,511,129**<br>(1,690,103)<br>(1,039,647)|
||**(1,690,103)**<br>**(1,039,647)**|
|**Net assets**|**693,247**<br>**471,481**|
|**The funds of the charity:**<br>Restricted income funds<br>15,16<br>Unrestricted funds<br>16|453,704<br>231,962<br>239,543<br>239,519|
|**Total Funds**|**693,247**<br>**471,481**|



The notes on **pages 63-83** form part of the financial statements. 

Approved by the Board on 24 June 2024 and signed on its behalf by: 



**Dr Jane Cocking Genny Kiff** Chair of the Board of Trustees Treasurer 




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|**For the year ended 31 December 2023**||||
|---|---|---|---|
|||**Year to**|**Year to**|
||**Notes**|**31/12/2023**|**31/12/2022**|
|||**£**|£|
|**Cash flows from operating activities**||||
|Net cash provided by operating activities|a)|**(46,168)**|3,162|
|**Change in cash and cash equivalents in**||||
|**the reporting period**||**(46,168)**|3,162|
|Cash and cash equivalents at the beginning||||
|of the reporting period||**101,911**|98,749|
|**Cash and cash equivalents at the end of**||||
|**the reporting period**|b)|**55,743**|101,911|
|NOTES TO THE CASH FLOW STATEMENT||||
|**(a) Reconciliation of net income to net**||**Year to**|**Year to**|
|**cash flow from operating activities**||**31/12/2023**|**31/12/2022**|
|||**£**|£|
|**Net income**||**221,766**|195,455|
|**Adjustments for:**||||
|Decrease/(increase) in debtors||**(918,389)**|1,458,146|
|Increase in creditors||**650,456**|(1,650,440)|
|**Net cash provided by operating**||||
|**activities**||**(46,168)**|3,162|
|**(b) Analysis of cash and cash**||**Year to**|**Year to**|
|**equivalents**||**31/12/2023**|**31/12/2022**|
|||**£**|£|
|Cash at bank and in hand||**55,743**|101,911|
|**Total cash and cash equivalents**||**55,743**|101,911|






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## **General Information and Basis of Accounting** 

Elrha is a charitable company incorporated in England and Wales and domiciled in the United Kingdom under the Companies Act 2006. The address of the registered office is: 1 St. John's Lane 

London 

EC1M 4AR 

Elrha is a public benefit entity. The nature of Elrha's operations and its principal activities are set out in the trustees' report (including the strategic report) on **pages 7–54** . 

Save the Children UK (company number 00178159; charity numbers 213890 (England and Wales) and SC039570 (Scotland)) is the sole member of Elrha. Save the Children UK's principal purpose is to save children's lives and tackle global child poverty. Elrha's results will be consolidated with those of Save the Children UK and the consolidated accounts can be obtained by the public at the registered office address given above. 

## **Basis of Preparation** 

The accounts have been prepared in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) (effective 1 January 2019) - (Charities SORP (FRS 102)), the Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS 102) and the Companies Act 2006. 

The functional currency of Elrha is pounds sterling because that is the currency of the primary economic environment in which Elrha operates. 

## **Going Concern** 

The financial statements have been prepared on a going concern basis, which the Trustees consider to be appropriate for the following reasons. 

The Trustees have prepared financial forecasts for a period of 12 months from the date of approval of these financial statements, and these indicate that the Charitable Company will have sufficient funds to meet its liabilities as they fall due for that period. 

With funding being secured until March 2026, Elrha will be able to continue its activities in the medium-term, although at a much-reduced scale, should new funding not be committed by March 2025, when the main award for the Humanitarian Innovation Fund (HIF) and UK Humanitarian Innovation Hub (UKHIH) programmes end. 

Fundraising efforts are on-going, particularly aiming at diversifying the donor portfolio, and current donors have showed their interest to continue their support to Elrha however, the main risk to our going concern status, as at the reporting date, is our ability to maintain 




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sufficient operational capacity to support programmes and activities that are funded beyond March 2025, as well as to meet reporting and award closure for those ending at this time. 

For the purposes of assessing Elrha’s going concern status under alternative scenarios, the Trustees have considered a worse-case scenario in which no new income is made available until June 2025, in order to test whether current funds during this time are sufficient to cover necessary operational costs. The going concern assessment demonstrated that existing funding commitments by donors and the use of reserves will be sufficient to cover forecast expenditure until that date. 

Should this scenario materialise careful workforce planning and renewal of recurrent fixed costs (such as subscriptions and license fees) will be required, in order to maximise the available financial resources. This will be possible due to Elrha’s operating model, which allows the organisation to scale up or down in response to the availability of funding. The ability to meet liabilities as they fall due rests upon ensuring that funding from Elrha’s donors is sufficient to cover the costs of running the programmes. As such, Elrha does not make commitments to third parties unless donor funding is secured, and ensuring fixed operational costs are covered as a priority over the flexible operational and programme costs. 

With respect to cash liquidity, Elrha receives incoming cash through claims submitted to each of its donors on an agreed schedule, and it also has access to a flexible credit facility provided by Save the Children UK (SCUK). This interest free credit facility is available up to a value of £2.5 million. Furthermore, most of our donors provide funding in advance of expenditure being incurred, as a result, Elrha has typically remained in a positive cash position and has not needed to draw upon the credit facility for the last two years (2022 and 2023). 

Consequently, the Trustees are confident that the Charitable Company will have sufficient funds to continue to meet its liabilities as they fall due for at least 12 months from the date of approval of the financial statements and therefore have prepared the financial statements on a going concern basis. 

## **Fund Accounting** 

Unrestricted funds are those which are available for the general purposes of Elrha at the discretion of the trustees. The trustees may elect to dedicate some funds for specific purposes. No funds have been dedicated in this way during the period. 

Restricted funds are funds that are to be used in accordance with specific restrictions imposed by donors or that have been raised by the charity for particular purposes. Costs are charged against the specific fund in line with donor wishes. An analysis of each restricted fund is set out in note 15. 

In case of a deficit or surplus in restricted funds, the following approach is applied: 

- if there is a deficit in restricted funds at the end of the year, the likelihood of future income being received which could cover this shortfall is assessed. A deficit is considered acceptable to the extent there is a realistic expectation of future income to cover the shortfall. If this condition does not apply, any shortfall must be immediately made up through a transfer from unrestricted funds. 




DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

- the restricted funds balance will be assessed at the end of each funding arrangement with a donor. If the balance is in deficit and the end of the funding arrangement means the prospect of future income to make up the shortfall is now unlikely, a transfer from unrestricted funds will be made. If the balance is a surplus, the implications will be assessed in light of donor restrictions, which may require that surplus income is repaid to the relevant donor. 

## **Income** 

Income is recognised in the statement of financial activities when Elrha is legally entitled to the income, receipt is probable, and it can be effectively measured. 

## **Grant income** 

Most of Elrha's income is donor funding, which is granted either directly from donors, or via Save the Children UK. In general, grants represent restricted income from governments, agencies and foundations, corporates and trusts and have been included as 'Incoming resources from charitable activities' where these grants specifically outline the goods and services to be provided to beneficiaries. For these performance related grants, in the absence of specific milestones to determine entitlement, income is recognised to the extent that resources have been committed to the agreed outcomes and outputs as this is deemed to be a reliable estimate of the right to receive payment for the work performed. In this case cash received in excess of expenditure is included as a creditor (as deferred income) and expenditure in excess of cash included as a debtor (as accrued income). Unless otherwise specified by donors, restricted funds are not held in separate bank accounts. 

## **Consulting income** 

Consulting income is income arising from services provided by Elrha to other humanitarian organisations. Such services are closely aligned with Elrha's charitable objectives and expertise and include activities such as training and research to support other organisations with which Elrha shares common goals. Income from these contracts is unrestricted and any profits generated are used to fund Elrha's other charitable activities. As with grant income, consulting income is recognised either upon the achievement of specific milestones, or in the absence of such milestones, income is recognised to the extent that resources have been committed to the agreed outcomes and outputs, until contract completion allows for a final and accurate accounting of profit or loss. 

## **Gifts in Kind income (GIK)** 

GIK (Gifts in Kind) include goods for project distributions or resale, pro-bono services and supplies. GIK must be included in the accounts as income and expenditure and valued at market value by management and/or the donor. No monetary value is attributed to volunteer work. 




DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

## **Expenditure** 

All expenses are recognised on an accruals basis. 

Expenditure on charitable activities is any that relates directly to fulfilling the charitable objects of Elrha. 

Grant funding expenditure comprises the direct value of sub-grants made by Elrha to partner organisations during the year, as detailed in note 7. Grants funding costs are reported against the programme to which they relate. 

Expenditure on 'activities undertaken directly' includes all costs of activities directly attributable to specific programmes or projects. 

Support costs represent core activities and services, such as general management, governance, human resources, communications, financial management and premises costs, and are allocated across the categories of charitable activities in proportion to the services provided. 

Staff costs are analysed and apportioned on the basis of management's estimation of the time spent on each activity and are allocated to activities undertaken directly or support costs according to the role of the staff concerned. 

## **Termination Benefits** 

Termination benefits are payable when employment is terminated, or whenever an employee accepts voluntary redundancy in exchange for these benefits. Termination costs are recognised at the point at which Elrha is committed to incur these costs. 

## **Provisions** 

Provisions for liabilities are recognised when there is a legal or constructive obligation for which a measurable future outflow of funds is probable. Elrha held no provisions at the balance sheet date. (2022: nil) 

## **Financial Instruments** 

Financial assets and financial liabilities are recognised when Elrha becomes a party to the contractual provisions of the instrument. All financial assets and liabilities are initially measured at transaction price (including transaction costs). Elrha only has financial assets and financial liabilities of a kind that qualify as basic financial instruments. 

Trade and other debtors are recognised at the settlement amount due after any discount offered. Prepayments are valued at the amount prepaid, net of any trade discounts due. Creditors and provisions are recognised where Elrha has a present obligation resulting from a past event that will probably result in the transfer of funds to a third party, and the amount due to settle the obligation can be measured or estimated reliably. Creditors and provisions are normally recognised at their settlement amount after allowing for any trade discounts due. 




DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

## **Defined Pension Contribution Scheme** 

Save the Children UK operates a defined contribution retirement benefit scheme for all qualifying employees of group entities, including Elrha. For all schemes the amount charged to the statement of financial activities is in respect of the pension contributions payable in the year. Differences between contributions payable in the year and contributions actually paid are shown as either accruals or prepayments in the balance sheet. 




In the application of Elrha's accounting policies, which are described in note 1, the trustees are required to make judgements, estimates and assumptions about the carrying amounts of assets and liabilities that are not readily apparent from other sources. The estimates and associated assumptions are based on historical experience and other factors that are considered to be relevant. Actual results may differ from these estimates. 

The estimates and underlying assumptions are reviewed on an ongoing basis. Revisions to accounting estimates are recognised in the period in which the estimate is revised if the revision affects only that period, or in the period of the revision and future periods if the revision affects both current and future periods. 

The trustees do not consider there are any critical judgements or sources of estimation uncertainty requiring disclosure, with the exception of income recognition. In light of the guidance set out in the Charities SORP (FRS 102) all awards have been reviewed to determine their performance related conditions, see Accounting Policies (Grant income). 



**Year ended 31 December 2023** 

||**Unrestricted**|**Restricted**|<br>**Year to**<br>**31/12/2022**|
|---|---|---|---|
||**£**|**£**|**£**|
|Gift in kind income|-|<br>-|<br>**-**|
|Other|24|<br>-|**24**|
|**Total**|**24**|<br>**-**|<br>**24**|



**Year ended 31 December 2022** 

||**Unrestricted**|**Restricted**|<br>**Year to**<br>**31/12/2021**|
|---|---|---|---|
||**£**|**£**|**£**|
|Gift in kind income||-||
|Other|5|-|**5**|
|**Total**|**5**|**-**|<br>**5**|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 



|Humanitarian Innovation Fund<br>(HIF)<br>Research for Health in<br>Humanitarian Crises (R2HC)<br>Global Prioritisation Exercise (GPE)<br>UK Humanitarian Innovation Hub<br>(UKHIH)<br>Other Charitable Activities<br>**Total**|**Unrestricted**<br>**Restricted**<br>**Year to**<br>**31/12/2023**<br>**Year to**<br>**31/12/2022**<br>**£**<br>**£**<br>**£**<br>**£**<br>-<br>5,671,817<br>**5,671,817**<br>6,691,453<br>-<br>5,143,093<br>**5,143,093**<br>2,520,442<br>-<br>280,156<br>**280,156**<br>128,215<br>-<br>1,622,650<br>**1,622,650**<br>268,422<br>-<br>-<br>**-**<br>-|
|---|---|
||**-  12,717,716**<br>**12,717,716**<br>**9,608,532**|





|**Raising funds**<br>**Charitable activities**<br>Humanitarian Innovation Fund<br>(HIF)<br>Research for Health in<br>Humanitarian Crises (R2HC)<br>Global Prioritisation Exercise<br>(GPE)<br>UK Humanitarian Innovation<br>Hub (UKHIH)<br>Other Charitable Activities|**Grant**<br>**funding**<br>**Activities**<br>**undertaken**<br>**directly**<br>**Support**<br>**Costs**<br>**Year to**<br>**31/12/2023**<br>**Year to**<br>**31/12/2022**<br>£<br>£<br>£<br>**£**<br>**£**|
|---|---|
||3,583,833<br>879,011<br>724,937<br>**5,187,781**<br>**5,405,648**<br>3,996,848<br>768,057<br>378,188<br>**5,143,093**<br>**2,520,442**<br>-<br>501,008<br>125,142<br>**626,150**<br>**489,899**<br>1,025,695<br>321,780<br>191,475<br>**1,538,950**<br>**997,093**<br>-<br>587<br>(587)<br>**-**<br>**-**|
||**8,606,376**<br>**2,470,443  1,419,155**<br>**12,495,974**<br>**9,413,082**|



Total resources expended include the following: 

## **Fees payable to the auditor** 

|**Fees payable to the auditor**|||
|---|---|---|
||**Year to**|**Year to**|
||**31/12/2023**|**31/12/2022**|
||**£**|**£**|
|Audit of financialstatements|28,200|23,500|
|**Total audit fees**|**28,200**|**23,500**|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 



|Governance<br>General Management<br>Financial Management<br>Communications Support<br>Human Resources<br>Information Technology<br>Premises and Facilities|**Year to**<br>**31/12/2023**<br>**£**<br>**Year to**<br>**31/12/2022**<br>**£**<br>60,215<br>44,536<br>530,258<br>422,827<br>226,727<br>252,576<br>269,603<br>224,346<br>90,592<br>78,970<br>122,401<br>128,577<br>119,359<br>99,740|
|---|---|
||**1,419,155**<br>**1,251,572**|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 



||**HIF**|**R2HC**|**UKHIH**|**2023 Total**|**2022 Total**|
|---|---|---|---|---|---|
||**£**|**£**|**£**|<br>**£**|**£**|
|ACTION AGAINST HUNGER|155,033|-|-|<br>**155,033**|105,109|
|ALLIANCE FOR INTERNATIONAL MEDICAL ACTION (ALIMA)|-|407,821|-|<br>**407,821**|-|
|AMERICAN UNIVERSITY OF BEIRUT (AUB) - (GBP)|-|97,850|-|<br>**97,850**|-|
|AMREF HEALTH AFRICA|44,953|151,629|-|<br>**196,582**|-|
|ARBEITER-SAMARITER-BUND DEUTSCHLAND E.V.|45,000|-|-|<br>**45,000**|75,000|
|BRANDEIS UNIVERSITY|-|49,729|-|<br>**49,729**|1,664|
|BUSARA CENTER FOR BEHAVIORAL ECONOMICS INC|-|-|-|<br>**-**|8,278|
|CARIBOU DIGITAL (UK) LTD|-|-|79,159|<br>**79,159**|124,710|
|CENTER FOR GLOBAL DEVELOPMENT|-|-|-|<br>**-**|30,609|
|CHATHAM HOUSE|-|-|-|<br>**-**|15,931|
|COLUMBIA UNIVERSITY|-|153,591|-|<br>**153,591**|309,095|
|COMMUNITY PARTNERS INTERNATIONAL|-|139,945|-|<br>**139,945**|-|
|CONSILIENT LIMITED|66,603|-|-|<br>**66,603**|-|
|CWS JAPAN|733,976|-|-|<br>**733,976**|656,325|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

||**HIF**|**R2HC**|**UKHIH**|**2023 Total**|**2022 Total**|
|---|---|---|---|---|---|
||**£**|**£**|**£**|<br>**£**|**£**|
|DANIELE LANTAGNE|-|-|-|<br>**-**|2,141|
|EAWAG|-|-|-|<br>**-**|2,863|
|ECOLE D'ECONOMIE DE PARIS (GBP)|37,498|-|-|<br>**37,498**|62,497|
|EPICENTRE|-|162,578|-|<br>**162,578**|-|
|ETHIOPIAN PUBLIC HEALTH ASSOCIATION|-|134,550|-|<br>**134,550**|-|
|GONDAR UNIVERSITY HOSPITAL|-|250|-|<br>**250**|-|
|GUJARAT MAHILA HOUSING SEWA TRUST|3,837|-|-|<br>**3,837**|6,104|
|HANDICAP INTERNATIONAL|-|-|-|<br>**-**|70,077|
|HEALTHRIGHT INTERNATIONAL|57,143|9,498|-|<br>**66,641**|396,118|
|HEARTLAND ALLIANCE INTERNATIONAL|-|-|-|<br>**-**|493|
|HUMANITARIAN OUTCOMES LTD|-|-|498,646|<br>**498,646**|124,230|
|IBIS REPRODUCTIVE HEALTH INC|-|19,250|-|<br>**19,250**|242,103|
|IDINSIGHT INC|-|-|-|<br>**-**|3,012|
|IMPACT INITIATIVES|-|-|-|<br>**-**|8,160|
|INDO GLOBAL SOCIAL SERVICE SOCIETY|1,863|-|-|<br>**1,863**|5,923|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

||**HIF**|**R2HC**|**UKHIH**|**2023 Total**|**2022 Total**|
|---|---|---|---|---|---|
||**£**|**£**|**£**|<br>**£**|**£**|
|INNOVATIONS FOR POVERTY ACTION|-|283,210|-|<br>**283,210**|-|
|INSTITUTE OF DEVELOPMENT STUDIES|-|-|-|<br>**-**|29,876|
|INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH||||||
|BANGLADESH (ICDDR,B)|89,999|-|-|<br>**89,999**|-|
|INTERNATIONAL ORGANISATION FOR MIGRATION (GENEVA)|102,000|-|-|<br>**102,000**|-|
|INTERNATIONAL RESCUE COMMITTEE UK|50,000|196,629|-|<br>**246,629**|(5,476)|
|IPAS|55,154|74,123|-|<br>**129,277**|92,453|
|ISLAMIC RELIEF WORLWIDE|44,250|-|-|<br>**44,250**|-|
|JOHN HOPKINS UNIVERSITY (US BANK)|-|2,247|-|<br>**2,247**|2,955|
|JOHNS HOPKINS UNIVERSITY|-|87,757|-|<br>**87,757**|-|
|KAROLINSKA INSTITUTET, INSTITUTION OF PUBLIC HEALTH||||||
|SCIENCES|-|197,099|-|<br>**197,099**|-|
|KHI BUSINESS DEVELOPMENTS LTD|-|-|-|<br>**-**|22,619|
|LEH NUTRITION PROJECT|6,790|-|-|<br>**6,790**|20,192|
|LEONARD CHESHIRE DISABILITY|-|-|-|<br>**-**|36,534|
|LIGHT FOR THE WORLD INTERNATIONAL|65,046|-|-|<br>**65,046**|7,699|
|LONDON SCHOOL OF HYGIENE & TROPICAL|36,447|50,761|-|<br>**87,208**|62,137|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

||**HIF**|**R2HC**|**UKHIH**|**2023 Total**|**2022 Total**|
|---|---|---|---|---|---|
||**£**|**£**|**£**|<br>**£**|**£**|
|MCGILL UNIVERSITY|-|2,258|-|<br>**2,258**|-|
|MONASH UNIVERSITY|-|53,438|-|<br>**53,438**|-|
|MUSLIM AID UK|-|-|-|<br>**-**|59,409|
|NESTA|-|-|26,436|<br>**26,436**|112,000|
|NORWEGIAN REFUGEE COUNCIL|-|-|-|<br>**-**|7,653|
|NOSAL INSTITUTE LIMITED|121,547|-|-|<br>**121,547**|6,131|
|ODI|-|-|-|<br>**-**|69,259|
|ON OUR RADAR LTD|-|-|-|<br>**-**|12,000|
|Orebro University|-|-|-|<br>**-**|(2,120)|
|OXFAM (OXFORD)|2,448|-|-|<br>**2,448**|-|
|OXFAM GB|261,131|-|-|<br>**261,131**|168,478|
|PESITHO HOLDING ApS|57,718|-|-|<br>**57,718**|202,014|
|PHILIPPINE GEOGRAPHICAL SOCIETY|3,269|-|-|<br>**3,269**|10,146|
|PHYSICIANS FOR HUMAN RIGHTS|43,411|-|-|<br>**43,411**|192,500|
|PLAN INTERNATIONAL UK|67,500|-|-|<br>**67,500**|-|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

||**HIF**|**R2HC**|**UKHIH**|**2023 Total**|**2022 Total**|
|---|---|---|---|---|---|
||**£**|**£**|**£**|<br>**£**|**£**|
|PRAGYA|85,768|-|-|<br>**85,768**|200,125|
|QUEEN MARGARET UNIVERSITY EDINBURGH|-|2,568|-|<br>**2,568**|-|
|QUEENS UNIVERSITY AT KINGSTON|28,872|-|-|<br>**28,872**|67,368|
|REACH OUT CAMEROON|-|-|-|<br>**-**|39,961|
|REEMI CHARITABLE TRUST|-|-|-|<br>**-**|20,212|
|RESEARCH AND GRANT INSTITUTE OF GHANA|-|-|-|<br>**-**|17,156|
|ROYAL COLLEGE OF SURGEONS ENGLAND|-|-|88,200|<br>**88,200**|139,999|
|SAVE THE CHILDREN (UK)|-|180,659|-|<br>**180,659**|-|
|SAVE THE CHILDREN DENMARK GBP (RED BARNET)|-|-|-|<br>**-**|1,713|
|SOS CHILDREN S VILLAGES UK|89,792|-|-|<br>**89,792**|-|
|STANFORD UNIVERSITY|-|-|-|<br>**-**|100,723|
|START NETWORK|740,160|-|-|<br>**740,160**|464,008|
|STONEWALL EQUALITY LTD|89,100|-|-|<br>**89,100**|-|
|SWISS TROPICAL AND PUBLIC HEALTH INSTITUTE (SWISS TPH)|-|79,597|-|<br>**79,597**|-|
|TEARFUND|19,808|-|-|<br>**19,808**|120,455|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

||**HIF**|**R2HC**|**UKHIH**|**2023 Total**|**2022 Total**|
|---|---|---|---|---|---|
||**£**|**£**|**£**|<br>**£**|**£**|
|TERRE DES HOMMES FOUNDATION|86,987|-|-|<br>**86,987**|290,000|
|THE AGA KHAN UNIVERSITY|-|12,936|-|<br>**12,936**|-|
|THE GEORGE WASHINGTON UNIVERSITY|34,479|-|-|<br>**34,479**|62,411|
|THE LONDON SCHOOL OF ECONOMICS|-|174,713|-|<br>**174,713**|-|
|THE INTERNATIONAL FEDERATION OF RED CROS|-|-|-|<br>**-**|77,352|
|Trustees of Boston College|-|208,790|-|<br>**208,790**|-|
|THE POPULATION COUNCIL (KENYA)|-|-|-|<br>**-**|325,444|
|THE UNIVERSITY OF SYDNEY|-|-|-|<br>**-**|49,922|
|UNIVERSITY NEW SOUTH WALES|-|143,982|-|<br>**143,982**|-|
|UNIVERSITY OF APPLIED SCIENCES AND ARTS NORTHWESTERN||||||
|SWITZERLAND|13,488|-|-|<br>**13,488**|29,998|
|University of Brighton Academies Trust|151,986|-|-|<br>**151,986**|-|
|UNIVERSITY OF CALIFORNIA REGENTS|-|-|-|<br>**-**|40,000|
|UNIVERSITY OF COPENHAGEN|-|5,186|-|<br>**5,186**|-|
|UNIVERSITY OF GENEVA, FACULTY OF MEDICINE|-|-|333,254|<br>**333,254**|-|
|UNIVERSITY OF LEEDS|3,772|-|-|<br>**3,772**|18,532|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

||**HIF**|**R2HC**|**UKHIH**|**2023 Total**|**2022 Total**|
|---|---|---|---|---|---|
||**£**|**£**|**£**|<br>**£**|**£**|
|UNIVERSITY OF SHEFFIELD|-|-|-|<br>**-**|5,186|
|UNIVERSITY OF WASHINGTON|-|130,867|-|<br>**130,867**|35,134|
|UNIVERSITY OF WESTERN ONTARIO|-|-|-|<br>**-**|2,761|
|URMUL SEEMANT SAMITI|4,056|-|-|<br>**4,056**|6,084|
|USTTB- FMOS-R2CH PROGRAMM|-|152,943|-|<br>**152,943**|-|
|WATERSCOPE|27,118|-|-|<br>**27,118**|61,651|
|WOMEN'S REFUGEE COMMISSION|-|-|-|<br>**-**|114,477|
|WORDS RHYTHMS IMAGES|9,769|-|-|<br>**9,769**|19,539|
|WORLD ALLIANCE FOR LUNG AND INTENSIVE CARE MEDICINE IN||||||
|UGANDA (WALIMU)|-|139,710|-|<br>**139,710**|-|
|WORLD HEALTH ORGANIZATION|-|490,684|-|<br>**490,684**|-|
|WORLD VISION INTERNATIONAL|-|-|-|<br>**-**|90,000|
|WORLD VISION UK|-|-|-|<br>**-**|44,918|
|WORLD VISION VANUATU|-|-|-|<br>**-**|138,968|
|YALE UNIVERSITY (0050296726)|-|-|-|<br>**-**|2,988|
|YORK UNIVERSITY|46,063|-|-|<br>**46,063**|158,774|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

YOUTH DEVELOPMENT LABS INC 

|**HIF**|**R2HC**|**UKHIH**|**2023 Total**|**2022 Total**|
|---|---|---|---|---|
|**£**|**£**|**£**|<br>**£**|**£**|
|-|-|-|<br>**-**|6,638|
|**3,583,833**|**3,996,848**|**1,025,695**|**8,606,376**|**6,109,398**|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 



The trustees received no remuneration during the year. 

During the year £658 (2022: £25) was expended on travel and accommodation expenses for 3 trustees (2022: 1) to attend and participate in meetings of the Board of Trustees. 

No donations were received from trustees during the year (2022: nil). 



Payroll costs were as follows: 

|Wages and salaries<br>Social security costs<br>Pension costs<br>Other staff costs|**Year to**<br>**31/12/2023**<br>**Year to**<br>**31/12/2022**<br>**£**<br>**£**<br>1,857,201<br>1,682,550<br>197,346<br>184,303<br>108,028<br>93,441<br>32,234<br>10,202|
|---|---|
||**2,194,809**<br>**1,970,496 **|



Payroll costs are included under Expenditure as ‘Activities undertaken directly’ in Note 5 to these financial statements. No redundancy costs were incurred in 2023 (2022: nil). 

The average monthly number of employees during the year was: 

|Elrha|**Average headcount1**<br>**Average FTE**<br>**headcount2**<br>**2023**<br>**2022**<br>**2023**<br>**2022**<br>44<br>38<br>43<br>37|
|---|---|
||**44**<br>**38**<br>**43**<br>**37**|



1 Headcount is defined as the number of roles filled by employees. 

2 FTE headcount is defined as headcount adjusted to take into account hours worked, where employees do not work on a full-time basis. 

During the year the following number of employees received employee benefits (excluding employer pensions costs) within the bands shown below. 

||**Year to**|<br>**Year to**|
|---|---|---|
||**31/12/2023**|**31/12/2022**|
|£60,001-£70,000|1|1|
|£70,001-£80,000|2|-|
|£80,001-£90,000|1|1|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

£90,001-£100,000 - 1 **4 3** 

The total amount of employee benefits received by key management personnel during the year was £316,773 (2022: £361,531). 


Elrha is a registered charity and as such is not liable to United Kingdom income or corporation tax on charitable activities or primary purpose trading activities. 



||**31/12/2023**|**31/12/2022**|
|---|---|---|
||**£**|**£**|
|Trade debtors|89,844|<br>4,232|
|Amounts due from parent company|1,791,327|<br>907,815|
|Grant debtors|434,223|<br>489,475|
|Prepayments and accrued income|2,908|<br>3,095|
|Other debtors|9,305|<br>4,601|
||**2,327,607**|<br>**1,409,218**|



There are no debtors expected to pay after a period of longer than one year. 


||**31/12/2023**|**31/12/2022**|
|---|---|---|
||**£**|**£**|
|Trade creditors|358,304|<br>128,771|
|Taxes and social security costs|50,258|<br>45,022|
|Accruals|436,418|<br>387,819|
|Deferred income|845,113|<br>478,026|
|Other creditors|10|<br>10|
||**1,690,103**|<br>**1,039,647**|




The table below shows the charity's commitment to donors in delivering projects on their behalf, which are expected to be completed over a number of years. Elrha’s obligation to deliver on these projects is conditional upon donor funding being received in accordance with grants agreements. 




DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

|Within one year<br>In years two to five<br>After five years|**31/12/2023**<br>**31/12/2022**<br>**£**<br>**£**<br>15,696,996<br>16,968,973<br>3,916,266<br>12,234,348<br>-<br>-|
|---|---|
||**19,613,262**<br>**29,203,321**|



## **Sub Grant Commitments** 

The table below shows the charity's commitment to donors in delivering projects on their behalf, which are expected to be completed over a number of years. 

A proportion of the funds needed for these programmes has already been received and is included within deferred income in note 12. For those not yet received, there are legal agreements with donors to ensure that Elrha will be reimbursed for completion of those projects. As described in note 1 (Going concern), Elrha retains the right to withdraw from these commitments in the event that donor funding is cut unexpectedly. 

|Within one year<br>In years two to<br>five<br>After five years|**HIF**<br>**R2HC**<br>**UKHIH 31/12/2023**<br>**31/12/2022**<br>**£**<br>**£**<br>**£**<br>**£**<br>**£**<br>3,632,255<br>4,186,546<br>1,167,849<br>8,986,650<br>5,296,897<br>316,311<br>1,636,548<br>120,386<br>2,073,245<br>2,810,507<br>-<br>-<br>**-**<br>-<br>-|
|---|---|
||**3,948,566**<br>**5,823,094**<br>**1,288,235**<br>**11,059,895**<br>**8,107,404**|




## **Year ended 31 December 2023** 

|Unrestricted funds<br>Restricted funds|Opening<br>balance<br>Income<br>Expenditure<br>**At**<br>**31/12/2023**<br>£<br>£<br>£<br>**£**<br>239,519<br>24<br>239,543<br>231,962<br>12,717,716<br> (12,495,974)<br>453,704|
|---|---|
||**471,48112,717,740(12,495,974)**<br>**693,247**|



## **Year ended 31 December 2022** 

|Unrestricted funds<br>Restricted funds|Opening<br>balance<br>Income<br>Expenditure<br>**At**<br>**31/12/2022**<br>£<br>£<br>£<br>**£**<br>239,514<br>5<br>239,519<br>36,512<br>9,608,532<br> (9,413,082)<br>231,962|
|---|---|
||**276,026  9,608,537(9,413,082)**<br>**471,481**|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 


|**HIF**<br>FCDO - UK Foreign Commonwealth and<br>Development Office<br>MFA Netherlands<br>Government of Norway<br>Swiss Agency for Development and Cooperation<br>**R2HC**<br>Wellcome Trust<br>Department of Health (UK)<br>FCDO - UK Foreign Commonwealth and<br>Development Office<br>**Global Prioritisation Exercise (GPE)**<br>FCDO - UK Foreign Commonwealth and<br>Development Office<br>MFA Netherlands<br>**UK Humanitarian Innovation Hub (UKHIH)**|**Opening**<br>**balance**<br>**Income**<br>**Expenditure**<br>**Transfers**<br>**At**<br>**31/12/2023**<br>£<br>£<br>£<br>**£**<br>**£**<br>(67,936)<br>3,613,389<br>(3,595,631)<br>(77,028)<br>**(127,206)**<br>(705,068)<br>1,671,716<br>(1,205,438)<br>(62,688)<br>**(301,478)**<br>-          386,106<br>(386,106)<br>-<br>**0**<br>-<br>606<br>(606)<br>-<br>**-**|
|---|---|
||(773,004)<br>5,671,817<br>(5,187,781)<br>(139,716)<br>**(428,684)**<br>-          990,951<br>(990,951)<br>-<br>**0**<br>-       1,062,220<br>(1,062,220)<br>-<br>**(0)**<br>-3,089,922<br>(3,089,922)<br>-<br>**(0)**|
||-       5,143,093<br>(5,143,093)<br>-<br>**(0)**<br>(7,887)         280,156<br>(243,911)<br>(13,310)<br>**15,048**<br>705,068<br>-<br>(382,239)<br>(21,351)<br>**301,478**|
||697,181          280,156<br>(626,150)<br>(34,661)<br>**316,526**|






DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 

|FCDO - UK Foreign Commonwealth and<br>Development Office<br>**Other**<br>Other movements in restricted funds<br>**Total restricted funds**|75,823       1,622,650<br>(1,538,951)<br>(47,365)<br>**112,157**|
|---|---|
||75,823       1,622,650<br>(1,538,951)<br>(47,365)<br>**112,157**<br>231,962<br>-<br>-<br>221,742<br>**453,704**|
||**231,962**<br>**12,717,716**<br>**(12,495,974)**<br>**-**<br>**453,704**|



Effective on 2 September 2020, the Department for International Development (DFID) merged with the Foreign and Commonwealth Office to create the Foreign, Commonwealth and Development Office (FCDO). 

All arrangements previously entered into with DFID transferred to the FCDO as of the date of the merger. 

Since Elrha's establishment in 2018, funding arrangements have been in a process of transition, going via SCUK subgrants, to funding agreements directly between Elrha and external donors. In 2023, all Elrha’s funding was received directly from donors with the exception of funding from Wellcome, which continues to be provided via SCUK. 




DocuSign Envelope ID: EA48ECC4-66A9-4195-A523-136BFFE6F334 


|Debtors: amounts falling due within one year<br>Cash at bank and in hand<br>Creditors: amounts falling due within one year|**Unrestricted**<br>**funds**<br>**Restricted**<br>**funds**<br>**At**<br>**31/12/2023**<br>**£**<br>**£**<br>**£**<br>238,476<br>2,089,131<br>2,327,607<br>1,067<br>54,676<br>55,743<br>  -<br>(1,690,103)<br>(1,690,103)|
|---|---|
||**239,543**<br>**453,704**<br>**693,247**|




Save the Children UK operates a defined contribution retirement benefit scheme for all qualifying employees of group companies, including Elrha.  The total expense charged to the statement of financial activities in the year ended 31 December 2023 was £108,028 (2022: £93,441). Pension contributions are included under Expenditure as 'Activities undertaken directly' in Note 5 to these financial statements. 

The contributions outstanding at 31 December 2023 were £0 (2022: £0). 


Save the Children UK (company number 00178159; charity numbers 213890 (England and Wales) and SC039570 (Scotland), registered address; 1 St John's Lane, London, EC1M 4AR is the sole member of Elrha. 

During 2023 Elrha received sub-grant income from Save the Children UK (SCUK) of £990,951 in relation to awards where SCUK maintain the relationship with the donor. SCUK received sub-grant income from Elrha of £180,659 in relation to an award for deliverables under the R2HC programme, as shown in Note 7. Under the shared services agreement Elrha paid SCUK £342,272 for the support services provided during the year, including use of office space. In addition, SCUK paid £41,187 for one staff position within Elrha. As at the 31 December 2023 the amount due from the parent company, SCUK, to Elrha was £1,791,327 as shown in Note 11. 


There are no post balance sheet events to report.