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2024-03-31-accounts

COMPASS-Ghana

Compassionate Palliative Services

(A charitable Incorporated Organisation)

Annual Report 01 April 2023 to 31 March 2024

Registered charity in England and Wales, charity number 1199633 W: www.compass-gh.org

COMPASS-Gh Annual Report 2024

Contents

Contents
Reference and Administrative Details………….………….……..………….…………..………….…………. 3
Report from Our Chair of Trustees………….………….……..………….…………..………….…………………… 4
Update for our Chief Executive………….………….……..………….…………..………….…………………………… 5
Trustees Report………….………….……..………….…………..………….………….………….………….……..………….…………… 7
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Purpose Objectives and Activities………….………….……..………….…………..………………		 7
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Our Vision, Mission and Values………….………….……..………….…………..……………………..		 8
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Our Journey Continues 2023 to 2024………….………….……..………….…………..………..		 10
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The Compelling Case for Palliative and End of Life Care……………….		 12
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The Credibility of the Asamang Pilot “Kerala” a Case
Study……….……….………….……..………….………………….………….……..………….………………….………….……..…… 14
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The Economic Argument for Palliative and End of Life Care………		 15
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The Commercial Case………….………….……..………….…………..………………………….……………….		 17
Our Theory of Change………….………….……..………….…………..………………………….………….……..……………… 18
The Objectives for Financial Year 2023 to 2024………….………….……..………….……………. 19
Our Impact – The Highlights………….………….……..………….…………..………………………….………….…….. 21
Our Objectives for Financial Year 2024 to 2025………….………….……..………….…………… 25
Trustees Financial Review, Governance and Oversight………….………….…………. 28
Our Plans for the Future 2024 to 2027………….………….……..………….…………..…………………….… 31
The Independent Examiners Report………….………….……..………….…………..………………………….. 33
Statement of Financial Activities………….………….……..………….…………..…………………………………. 33
Note to the Accounts Year Ending 31 March 2024………….………….……..………….……… 35

www.compass-gh.org

COMPASS-Gh Annual Report 2024

REFERENCE AND ADMINISTRATIVE DETAILS

The charity was registered with the Charity Commission as a Charitable Incorporated Organisation (CIO) on 12 July 2022

Charity Number 1199633

Trustees

The following trustees served during the year:

Dr Ernest K Ahiaku MB, FRCS, FGCPS, DL - Appointed 13 October 2021 Dr Cecilia Akrise Anim CBE, FRSA, FRCN (Chair) - Appointed 13 October 2021 Mr Peter M J Baxendell - Appointed 13 October 2021 Mr Andrew A P Elliot - Appointed 13 October 2021 Mr William Schiller - Appointed 13 October 2021

Key Management Personnel/Co-founders

Dr Yakubu Salifu Chief Executive Officer

Mr John Davies Chief Operating Officer

Ms Katie Eccles Chief Nursing Officer

Principal place of business

COMPASS-Ghana Room 15, Eastern House, 15-16 Silver Street Bradford on Avon Wiltshire BA15 lJZ

Registered Office

293 Bowerham Road Lancaster LAl 4AS

Independent Examiner

Paul Clarke, MGB Accountants, 18 Market Street, Wotton-Under-Edge Gloucester, GL 12 7AE

Bankers

Lloyds Bank, Lewisham, Branch, PO Box 1000, BXl lLT

www.compass-gh.org

COMPASS-Gh Annual Report 2024

REPORT FROM OUR CHAIR OF TRUSTEES

It is with immense pride and gratitude that I present the annual report for COMPASS-Ghana, reflecting on a year marked by significant achievements and unwavering commitment. Our key successes this year are a testament to the collective efforts of our dedicated executive team, and the invaluable contributions of our Trustees and the Board of Directors of our sister organisation in Ghana.

One of the most notable milestones was the establishment of the COMPASS-Ghana Institute and the strategic partnership with Asamang SDA Hospital, which has significantly expanded our capacity to provide compassionate care to those with life-limiting conditions.

The executive team's hard work has been instrumental in driving our programmes forward. They have tirelessly coordinated efforts to deliver integrated health services, develop bespoke training programmes in collaboration with Hospice Africa Uganda, and engage in impactful online learning initiatives with Lancaster University. Additionally, the strategic outreach to the Ghana Health Service and the Ghana Palliative Care Association has fortified our advocacy work, ensuring that our mission aligns with national health goals and policies.

Our trustees and the Board of Directors in Ghana have provided steadfast governance and strategic oversight, ensuring that our activities are not only impactful but also sustainable. Their dedication to upholding our values and guiding our strategic direction has been crucial in navigating the complexities of delivering palliative care in diverse communities. The collaborative efforts between our teams in the UK and Ghana have fostered a strong, unified approach to our mission, enabling us to effectively address the challenges and seize the opportunities in palliative care provision.

As we look to the future, we are excited about the possibilities that lie ahead. To continue and expand our vital work, we need the ongoing support of our generous donors and well-wishers, as well as attracting new charitable funding, both from the UK, Ghana and elsewhere. This kindness and generosity have enabled these initiatives and we call upon your continued kindness and selflessness to help us reach more communities and enhance our services.

With your support, we can advance our education and research programmes, strengthen our community outreach, and work towards achieving Universal Health Coverage in Ghana by 2030. Together, we can ensure that every individual facing life-limiting conditions receives the compassionate care they deserve. Thank you for being a part of this transformative journey.

Dr Cecilia Akrise Anim CBE, FRSA, FRCN

Chair of Trustees, COMPASS-Ghana 06.08.2024

www.compass-gh.org

COMPASS-Gh Annual Report 2024

UPDATE FROM OUR CEO:

I am pleased to present the annual report for COMPASS-Ghana for the financial year 1 April 2023 to 31 March 2024.

COMPASS-Ghana enables the provision of holistic care for patients and their families, advocating for end-of-life care, and supporting education and research in palliative care. Our activities over the past year have focused on several key areas:

Establishing a strong foundation : We registered COMPASS-Ghana Institute LbG as a sister Non-Government Organisation (NGO) in Ghana. We also forged strategic partnerships, including a preferred supplier arrangement with Asamang SDA Hospital.

Relief and care : We enable integrated health programmes seeking to relieve symptoms and distress for patients with life-limiting illnesses. The construct of outpatient services with plans in place for inpatient services at Asamang SDA Hospital to support 315 end-of-life patients and their families over 2024/25.

Education and Research :

We partnered with Hospice Africa Uganda to deliver bespoke training programmes, with 35 participants graduating and a multi-disciplinary team established. Conducted online learning programmes in partnership with Lancaster University, engaging, for the first time, with 26 health professionals We are working with key stakeholders to design national palliative care guidelines for Ghana.

Advocacy and Community

Engagement : COMPASS-Ghana engaged with national and regional authorities, including the Ghana Health Service and the Ghana Palliative Care Association. Developed community outreach programmes with local leaders to promote palliative and end-of-life care.

Financial Stewardship : COMPASS-Ghana achieved unrestricted income of £37,247. We successfully operated a Just Giving Platform, raising £20,338 through 291 transactions.

Impact and Vision:

Our efforts have not only enabled direct care to patients, but have also empowered the hospitals’ communities and professional teams through education and support. We are committed to building a society were living and dying hold equal value, ensuring access to compassionate care for all, regardless of faith or financial status.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Now looking ahead for the next financial year, we aim to:

The previous year has been eventful and along with our partners in Ghana we have achieved a great deal. The programme is underway. I thank our partners, donors, and our community for their unwavering support. For the executive team and my co-founders, I say a BIG thank you. Together, we are making a significant impact on the lives of those facing life-limiting conditions in Ghana.

Dr Yakubu Salifu

Co-founder and CEO, COMPASS-Ghana

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Trustees’ Report

The Trustees present their annual report together with the financial statements of the Charity for the year ended 31 March 2024.

Public Benefit

The trustees confirm that they have complied with the duty in the Charities' Act 2011 to have due regard to public benefit guidance published by the Charity Commission.

The trustees consider that as all activities are open to potential beneficiaries living in Ghana, that the activities of the CIO provide significant public benefit.

PURPOSE, OBJECTIVES AND ACTIVITIES The Charitable Purpose

COMPASS-Ghana's purpose is for the public benefit of Ghana and the wider region. To operate and fund the advancement of health through the relief of symptoms, anguish, and distress among people with life-limiting conditions at the end of their life.

COMPASS-Ghana's core objectives include, but are not limited to, the provision of holistic care of patients and their families, their caregivers, provision of treatment, financial support, education, research, training, advocacy, and practical advice.

The scope of the charity includes the care of patient (Child to Adult) of all faiths and none, their families, dependents, caregivers, and communities. The Charity works alongside and supports conventional agencies and any further action that the trustees, from time to time, see fit and incidental or conducive to support and deliver any of those objectives.

We said we would deliver this Charitable Purpose through:

www.compass-gh.org

COMPASS-Gh Annual Report 2024

About Us

Founded by Dr Yakubu Salifu, John Davies and Katie Eccles, COMPASS-Ghana, number 1199633 was formerly registered with the Charities Commission 12 July 2022.

The focus - to support and enable the existing capability in Ghana to deliver a programme of palliative and end-of-life care for all, regardless of faith or the ability to pay.

Our Vision: A Society where living and dying hold equal value

Together with our healthcare and community partners of all faiths, cultures and traditions, we are on a journey of collaboration and empowerment to unlock universal palliative and end-of-life care for all of Ghana by 2030. This goal aligns directly with the Ghanaian Government’s roadmap for attaining universal health coverage this decade.

Our Mission:

To reduce suffering and hardship in resource-poor communities by enabling Ghanaians to embed end-of-life care excellence into their existing healthcare systems.

Strapline:

Enabling End of life care for all

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Our Values:

COMPASS-Ghana has six values that drive our collaborative approach and the way we work with our patients, their families and carers as well as our stakeholders and ourselves.

01Compassionate We strive to understand and identify the needs of our
patients, families and carers along with our partners
and the community we serve, in a manner that is
compassionate, non-judgemental and empathetic.
02Committed We place our patients, families and carers along with
our partners and community at the centre of
everything we do. We commit to work towards a
shared vision, and in our behaviours be adaptable
and inspiring.
03Accountable To manage expectations through open and
transparent communication, be accountable to the
communities and organisations that we serve and
hold partners accountable on behalf of these
communities.
04Impact To develop evidence-led evaluations to share
learnings and capture the clinical /social value and
impact and outcomes of our work.
05Innovative We will constantly challenge the status quo and seek
out new ways to deliver compassionate care. We will
be a centre of excellence, where innovation, research
and new methodologies of care will be the norm.
06Financial Stewardship We believe in open and strong governance, where
financial activity is transparent and accountable.
Our ambitions will be underpinned by sustainable
funding and strong stewardship.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

How we Operate:

As a charity we do not seek to build a Hospice or provide furniture or to paint buildings. We are about supporting, enabling and developing the existing health and social infrastructure. We seek to develop a sustainable model of care, one that is seamless in its approach towards the patient, their families and communities in which they live. An approach that is scalable and able to be replicated in time across Ghana.

Our “Whole System Approach” focuses on delivering an integrated pathway of care. Philosophically this places the patient, the family, caregiver and community in the centre of everything we do and deliver. The concept embraces the whole patient from demographic data – early diagnosis, a seamless transfer of care – community and inpatient care until death. At each and every stage it embraces the family, carers and community. It is an offer that is open to all faiths and none. The capability and services we support and enable are seamlessly integrated both vertically and horizontally within and outside of COMPASS-Ghana and its partners. Advocacy and effective health education, a key pillar in our theory of change – are delivered concurrently within our community engagement programmes.

Our Journey Continues: April 2023 to March 2024:

Our focus over the year has been to:

Head Office: In June 2023 the Chief Operating Officer and Chief Nursing Officer moved to Kumasi and established a transient head office until November 2023. During this period, partnerships were established, local clinics supported, pilot online learning delivered, and community outreached delivered.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

COMPASS-Ghana Institute: In November 2023 we registered our sister charity in Ghana called COMPASS-Ghana Institute. Operating as COMPASS-Ghana (NGO). It is registered with the Registrar General's Office, it has its own Board of Directors (Trustees) and shares the same vision, values, objectives and purpose of its sister UK charity. The executive team have joint responsibilities, avoiding unnecessary duplication of effort and cost to ensure alignment of the two boards. The Boards meet jointly four times a year, with due regard for the articles of governance governing - quorate and voting rights. The NGO will report as an individual entity at the end of this upcoming financial year 2024/2025, in line with its sister UK charity.

Strategic Partners: Over the reporting period we sought out and established a preferred supplier arrangement with Asamang SDA Hospital. Asamang SDA Hospital is a 134-bed primary health facility in the Sekyere South District of the Ashanti Region, a member of the Christian Health Association of Ghana (CHAG) and the Ghana Health Service. The hospital serves a population of 125,000, of all faiths and none, with an average of 55,000 out-patients each year. Our shared objective with Asamang SDA Hospital is to shape and develop a centre of excellence that will support 315 end-of-life patients and their families and care-givers in this financial year April 24 to March 25. This number of 315 includes children and adults of all faiths and is not dependent on the ability to pay, but on their need and diagnosis.

Patients will primarily be treated via community outreach and outpatient services. There will also be a dedicated inpatient capability, to care for those in urgent need.

Introduced into the relationships, albeit informally at this stage, are the palliative teams from Peace and Love Breast Care International (BCI) and Komfo Anokye Teaching Hospital (KATH).

Advocacy: Advocacy outreach and engagement with a community rich in culture, tradition and multi faith is an essential part of our mission. Over the reporting period COMPASS-Ghana sought to build relationships with the authorities at a National and Regional Level. The charity is engaging with the Ghana Health Service (GHS), The Ghana Palliative Care Association (GPCA), The college of Physicians and Surgeons, The Ghana College of Nursing and Midwives, the Directorate of Non-Communicable Disease (GHS).

Training and Development:

COMPASS-Ghana partnered with Hospice Africa Uganda (HAU) to deliver an inhouse bespoke programme for palliative care. This resulted in some 35 participants (Medical, Clinical Health and Administrators) graduating. This enabled a dedicated multi-disciplinary team to be established, and a continuum of learning agreed to be delivered throughout the Fy 24/25. Patient clinics will commence in May 2024.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Locally, the charity has embraced the innovative work delivered by Asamang SDA Hospital as it develops and delivers community programmes around breast, cervical and prostate screening. Programmes that demand consensus, support and engagement from the local leaders, elders, chiefs and “Queen Mothers” many of whom have now become local advocates for the programme, which will now include palliative and end of life care.

Alignment to the Strategic Goals of the Government of Ghana

On 10 May 2024 - The Government of Ghana reinforced its commitment to Universal Health Care (UHC) by 2030:

“Ghana is working towards achieving Universal Health Coverage by the year 2030. This effort has been supported by a strong political, legislative and fiscal commitment to health financing system reform. This is in line with attaining the Sustainable Development Goal (SDG). Principles of the African Union Agenda 2023, Global Action Plan for Healthy Lives and Well Being. The Declaration on Primary Health Care is Astana (2018) , UHC 2030 Compact, the initiative of Universal Health Care 30 and the political declaration of UHC adopted at the UN High Level meeting in September 2019.

( Health News of Friday, 10 May 2024 Source: www.ghanaweb.com Ministry of Health, WHO launch 2023-2030 Ghana Health Financing Strategy document )

The Compelling Case for End-of-Life Care

As a charity we seek to bring an essential health programme into resource-poor and hard to reach communities. We are acutely aware that End-of-Life-Care (EoLC) is a sensitive topic in Africa. Need extends far beyond cancer alone to include other life-limiting diagnoses such as respiratory distress, sepsis, heart failure, malaria, diabetes, HIV and more.

Working through preferred partners who are already active in the community, we strive to win the community’s trust and engagement and support for our work. Together we collectively deliver the psychological and emotional support needed to make the unbearable more bearable and help families and communities become more resilient.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Palliative Care is based on the needs of the patient, not on a patient’s prognosis. The application of palliative care is appropriate for any age and at any stage of a serious illness with an end-of-life diagnosis.

Within this pilot there has been prioritisation within the areas of end stage cancers, kidney disease, cerebrovascular accident (Stroke), HIV/AIDS (Terminal Stage) and respiratory diseases.

1% of Ghana’s population, some 350,000, die each year. The current provision of palliative care and EoLC is limited, ad hoc with no central coordination. The average age of death is 63. Demographics around deaths and causation of death in the

community are spurious as many do not refer to the Ghana Health Service due to stigma, tradition, poverty and location. Many patients die at home, within their church or shrine - divorced from professional care and denied basic pain relief and family support.

The lack of such care is devastating – not only for the dying and their families, but for the community. The physical and mental demands for caring for a patient with palliative care needs can result in emotional distress, deep anxiety, a loss of income, disruption and the break-up of family life and business. It often leads to the termination of a child’s education, personal uncertainty, anguish and distress within the home and in the wider community. By addressing these impacts, good-quality care has a direct positive impact on economic sustainability and growth.

A Patient Story:

Maybe a recent patient story is helpful:

In one of the leading teaching hospitals in Ghana Katie Eccles, our Chief Nursing Officer witnessed a young mother (23) being taken for further diagnostic tests, for which her family (parents) had to pay despite the fact she was clearly dying. If palliative skills had been available these unnecessary and futile interventions would have been avoided. Instead, a sensitive conversation would have been held with the patient and her family, symptom control of her pain assessed and managed with the limited funds available to her family.

This would have bought her a precious window of time that would have been spent with her two-year-old son, who was sitting uncomfortably, confused and bewildered, beside her, on the bed.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

The Credibility of The Asamang Pilot – Kerala, Southern India A Supporting Case Study

The Ghana Health Service and the African Palliative Care Association are aware of the Kerala Model.

Kerala is located in the Southern part of India and shares many similarities with Ghana. It has a population of 35m similar to that of Ghana, a move to urbanisation with many remote and hard to reach communities. It has a diverse population in terms of religion, and a gender balance is circa 50/50 male to female. It is one of the most densely populated states in India.

Kerala's model of community palliative care is renowned for its community-based approach, which emphasizes the role of community participation and integration of services across different levels of care.

Community Involvement: The Kerala model heavily relies heavily on community volunteers who are trained to provide basic palliative care and support to patients and their families. Local organisations and community groups are mobilised to create a support network, ensuring that palliative care services reach those in need. Volunteering is not the norm in Ghana so in developing our capability emphasis is placed on enhancing the competencies of all clinical and health workers regardless of their core discipline.

Primary Healthcare Integration:

In Kerala Palliative care is integrated into the primary healthcare system, allowing for the early identification and management of patients who present requiring palliative care. This integration ensures that palliative care is accessible at the grassroots level, making it available even in remote areas.

Home-Based Care: A significant part of the palliative care services across Kerala is provided in patients' homes. This benefits patients who are confined to bed or have limited mobility or access to transport. Home visits by healthcare professionals and trained volunteers ensure continuous care, support, comfort and cost effectiveness.

Multi-Disciplinary Teams: Palliative care teams in Kerala are multi-disciplinary, including doctors, nurses, social workers, and volunteers. This team approach addresses the medical, emotional, social, and spiritual needs of patients. The involvement of diverse professionals ensures comprehensive care tailored to individual needs. As well as a cascade of learning across disciplines.

Training and Education: Extensive training programs are conducted for

all healthcare professionals, volunteers, and community members, equipping them with the necessary skills to provide palliative care. A continuous continuum of learning ensures that the care provided is up-to-date and effective.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Government and NGO Collaboration: There is a strong collaboration between the government and non-governmental organisations (NGOs) in Kerala, which helps in pooling resources and expertise and ensures a consistency of care both in approach and in standards.

Accessibility and Affordability: The model ensures that palliative care services are affordable and accessible to all, including the economically disadvantaged. Many services are provided free of cost or at a minimal charge, supported by community donations and government funding. In Ghana the National Health Insurance Service – may be a potential provider and beneficiary of our programme.

Awareness and Advocacy: Proactive messaging and direct advocacy at various levels ensures that palliative care is recognised as a crucial component of the healthcare system.

The Economic Argument for Palliative Care

In a nation where the demands to develop and deliver an effective health care system are enormous and often conflicting, there are many opportunity costs, and conflicting demands and priorities.

Improved End-of-Life Care: Palliative care focuses on aligning treatment plans with patients' goals and preferences, often leading to a preference for less intensive and less costly care settings, such as community and home care.

The New England Journal of Medicine published research infers that patients who receive palliative care are more likely to die at home, which is typically less costly than hospital or emergency care.

Enhanced Coordination of Care: Good palliative care programs enhance coordination among healthcare providers, leading to the more efficient use of resources. This coordination helps avoid duplicative tests and procedures, as well as unnecessary hospital readmissions, contributing to overall cost savings, both to the service and the patient.

Lower Healthcare Costs: Palliative care has been associated with lower healthcare costs, particularly by reducing the use of intensive care units (ICUs), emergency departments, and other high-cost services. According to a study in the Health Affairs journal , hospitals with palliative care programs saved approximately $3,237 per patient admission for patients discharged alive and $4,251 for those who died in the hospital.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Reduction in Hospital Admissions and

Length of Stay: Studies have also shown that palliative care can reduce the number of hospital admissions and the length of hospital stays. A study published in the Journal of Palliative Medicine found that patients receiving palliative care have significantly fewer hospitalisations and shorter lengths of stay compared to those not receiving palliative care.

Decreased Utilisation of Intensive

Treatments: Palliative care often leads to a decrease in the utilisation of intensive treatments that are expensive and may not significantly extend life. Research published in the Journal of Clinical Oncology highlights that patients receiving palliative care were less likely to undergo aggressive treatments, such as chemotherapy, in the last stages of life.

References:

Morrison, R. S., et al. (2008). "Cost Savings Associated With US Hospital Palliative Care Consultation Programs." Archives of Internal Medicine.

Penrod, J. D., et al. (2006). "Cost and Utilization Outcomes of Patients Receiving Hospital-Based Palliative Care Consultation." Journal of Palliative Medicine.

Morrison, R. S., et al. (2011). "Palliative Care Consultation Teams Cut Hospital Costs For Medicaid Beneficiaries." Health Affairs. Greer, J. A., et al. (2012). "Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer." New England Journal of Medicine. Smith, T. J., et al. (2003). "A High-Volume Specialist Palliative Care Unit and Team May Reduce In-Hospital End-of-Life Care Costs." Journal of Palliative Medicine.

May, P., et al. (2015). "Palliative Care Teams’ Cost-Saving Effect Is Larger For Cancer Patients With Higher Numbers Of Comorbidities." Health Affairs.

Temel, J. S., et al. (2010). "Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer." New England Journal of Medicine. Wright, A. A., et al. (2008). "Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment." JAMA.

The Need for Further Empirical Evidence: COMPASS-Ghana is acutely aware that any cost benefit argument to support the implementation and funding of a national programme, must be supported by clear evidence. Evidence that articulates not only the benefit of good care for the patient, their family and the community, but also the socio economic impact, so evident in Western Models of care. COMPASS-Ghana has a responsibility to make such arguments cogent and relevant for Ghana. This is why we have embraced a whole system approach where data, the patient, their family and pathway are core to all our activity.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

The Commercial Evidence:

Improved Productivity: Effective palliative care enables family members, especially women, to remain economically active by reducing the time and emotional burden associated with caregiving. This can lead to improved household income and economic stability. In households where palliative care services are available, primary caregivers can return to work or engage in income-generating activities, boosting overall economic productivity. By addressing gender issues in palliative care, it ensures that women, who might otherwise be overwhelmed by caregiving duties, can participate more fully in economic activities. This can lead to enhanced productivity and economic stability for families.

Educational Attainment: By reducing the caregiving burden on children, especially girls, palliative care services allows them to continue their education. Higher educational attainment can lead to better economic opportunities in the future, breaking cycles of poverty.

Healthcare Resource Allocation: Effective palliative care can optimise the use of healthcare resources, ensuring that they are allocated more efficiently. This can free up resources for other critical health services and reduce overall strain on the healthcare system.

Community and Long-term Benefits:

Strengthened Healthcare Systems : The integration of palliative care into the broader health system can lead to the development of more resilient healthcare infrastructures. Training healthcare professionals in palliative care principles enhances the overall capacity of the health system to manage chronic and terminal illnesses. Community-based palliative care programs can mobilise local resources and foster community involvement, leading to more sustainable and culturally appropriate care models.

Long-term and Community Benefits:

Strengthened Social Support Systems: By integrating gender-sensitive approaches into palliative care, communities can develop stronger support systems that recognise and address the unique needs of men and women. This can foster community resilience and economic stability. Improved community health outcomes can lead to a more productive workforce and reduced public health expenditure in the long term.

Policy and Advocacy: Evidence of the economic benefits of palliative care can inform policy making, leading to increased funding and support for palliative care programs. This can result in the establishment of national palliative care policies, ensuring long-term sustainability and integration into public health strategies.

The economic evidence from various African countries underscores the value of palliative care in reducing healthcare costs, improving economic productivity, and supporting sustainable healthcare systems. COMPASS-Ghana will argue that these benefits highlight the importance of integrating palliative care into national health policies and ensuring its accessibility to all patients in need.

Kerala has been a pioneer in this field, with a robust model that integrates community participation and professional healthcare services.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Our Theory of Change

Over the year in partnership with Asamang SDA Hospital we have developed our thinking to develop a contemporary Theory of Change to evidence our thinking and provide a coherent approach towards our strategic development:

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COMPASS-Gh Annual Report 2024

Objectives for FY 2023 to 2024:

In 2023 when we registered our first report, we set out the following objectives for this reporting period 1 April 2023 to 2024.

Objective One: We Said We Would:

We Delivered:

Objective Two: We Said We Would:

We Delivered:

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COMPASS-Gh Annual Report 2024

Objective Three: We Said We Would:

Objective Four: We Said We Would:

We Delivered:

We Delivered:

Objective Five: We Said We Would:

We Delivered:

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COMPASS-Gh Annual Report 2024

Objective Six: We Said We Would:

We Delivered:

Membership of:

Impact Highlights

Health

Advice Line – Supported 10 patients providing advice on care, intervention and signposting patients to centres of advice and support.

Consultancy – Supported Matthew 25 House in the construction of its Hospice – advising on lay out, facilities and ergonomics for staff and patient care. Advised Asamang SDA Hospital on facilities, services and resource.

Clinics – Directly supported 16 outpatient clinics for patients with fungating breast tumours – advising on patient assessments protocols and remedy.

Direct Patient Care – Provided advice, direction on the treatment and dressing of malodorous wounds, including the funding of care and dressings.

“

You and your partner are amazing people to work with. I learnt a lot from you in the few months we worked together. I pray you receive more funds to come back to Ghana to continue the good work you have started…long Live COMPASS. ”

(Lead Nurse Rita Achiaa – Peace and Love Breast Care International – Palliative Team)

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COMPASS-Gh Annual Report 2024

Relief of Pain – Rehearsed the concept and debate around prescribing and access to Morphine Liquid Medication. As in Africa many clinicians are opiophobic, presenting a key barrier to access.

Workshops – Conducted workshops on outreach and community engagement, identification and prioritisation of disease profile for End-of-Life care, policy on admission and discharge “ t he palliative outpatient clinic and in-patient ward” , the compilation of patient data and demographics, and a review on how to measure effect and effectiveness.

Outpatient Clinics Asamang SDA Hospital :

Support Line: Established Whats App forum bringing the clinical teams and our Clinical Nursing Officer together.

Quality and Clinical Excellence: Asamang SDA recognised for its Quality Improvement Journey

Training and Education

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COMPASS-Gh Annual Report 2024

Advocacy

Research

COMPASS-Ghana in partnership with Lancaster University have conducted studies that are relevant is serving as an evidence-base for the practical operation of COMPASS-Ghana.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Governance

Funding

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COMPASS-Gh Annual Report 2024

Objectives for FY 2024 to 2025:

The Year Ahead - our priorities and key objectives setting the pathway and foundations for the next three years

Throughout the next year and beyond COMPASS-Ghana will ensure an agile approach to its thinking and responsiveness. Mindful of its core mission and objectives, the charity will always respond to changing scenarios and opportunities that will inevitably present themselves as expertise, knowledge, influence and relationships develop.

Objective One: Effective and Compassionate End of life and Palliative Care

Objective Two: Credible and Sustainable Governance

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COMPASS-Gh Annual Report 2024

Objective Three: To establish credible funding streams delivering a minimum Income of £140K by 31 March 2025 and £300k by 2026/7

Objective Four: Banking and Financial Reporting

Sources:

Objective Five: Strategic Partnership SDA Asamang

Objective Six: Scalability: The Identification and Engagement with the Second Strategic Hub

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COMPASS-Gh Annual Report 2024

Objective Seven: Appropriate Resourcing and Technology

To develop a resilient full-time leadership & Operational team, able to deliver the growth and development of the project through to 2027 . One that is remunerated appropriately, where duplication of role is avoided, enabling the charities to move forward in a sustainable manner.

UK:

1 x Joint CEO (Part Time)

1 x Joint COO

Ghana:

1 x Head of Country/Fund Raiser

Objective Eight: Development of Wider Partnerships, Research Education and Training

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Financial Review

Income and expenditure

In the year ended 31 March 2023 our income was £37,247, comprised of in-kind donations of £34,722 and gift aid totalling £2,525. Our funding sources included charitable foundations, the public, private donors, and events.

At the year-end net current assets stood at £4,206 compared to £2,501 in 2023. We were generously supported:

Financial position at year end

At the year-end, current assets stood at £7,510 compared to £4,286 in 2023. There are no Restricted Funds. Net fixed assets stood at £3,334 compared to £3,612 in 2023. This represents the value of office equipment and the COMPASS-Ghana web site.

The charity has no salaried staff, entirely supported by volunteers. Liabilities repayable in more than three years after the balance sheet date stood at £21,495 compared to £19,882 in 2023. No repayment was made to any creditor falling due after more than one year.

Risk management objectives and policies

The trustees have overall responsibility for ensuring that COMPASS-Ghana has an appropriate system of controls to identify financial and other risks and to respond appropriately to manage them. Risks are recorded on the Risk Matrix (Policy July 2022) and reviewed quarterly by the Board. The trustees have assessed the risks and are satisfied that the systems are in place to mitigate exposure to the major risks.

Structure, Governance, and Management

Constitution

COMPASS-Ghana was established by its constitution and registered as a charitable incorporated organisation (CIO) in England & Wales on 12[th] July 2022. It is registered at the Charities Commission for England and Wales.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Methods of appointment or election of Trustees

The management of the Charity is the responsibility of the Trustees. The first trustees were appointed by the constitution and subsequent trustees are appointed for a term of three years by a properly convened trustees' meeting. The minimum number of trustees is three and there is no maximum number that may be appointed.

Trustees are appointed for a term of three years by a resolution passed at a properly convened meeting of the charity trustees. After this term the trustee is eligible for reappointment, but if they have served for three consecutive terms they may only be reappointed again after an interval of one year.

Our trustees are selected with due regard to the skills, knowledge and experience needed for the effective administration of COMPASS-Ghana and once appointed are required to:

Declare the nature and extent of any interest, direct or indirect, which he or she has in a proposed transaction or arrangement with COMPASS-Ghana or in any transaction or arrangement entered into by COMPASS-Ghana which has not previously been declared; and

Absent themselves from any discussions of the charity trustees in which it is possible that a conflict of interest will arise between his or her duty to act solely in the interests of COMPASS-Ghana and any personal interest including but not limited to any financial interest). A charity trustee absenting themselves from any discussions accordingly does not vote nor is counted as part of the quorum in any decision of the charity trustees on the matter.

Organisational structure and decision-making policies

COMPASS-Ghana’s Board of Trustees meet between four and five times a year and together with the CEO and the Leadership Team, are responsible for the strategic direction and policy of the Charity.

The key management personnel of COMPASS Ghana are the Chief Executive Officer, the Chief Operating Officer and the Chief Nursing Officer. Together they also assume Joint Roles for the Ghana NGO.

The Charity greatly values the substantial donation of time and expertise by members of our board above and beyond their duties as trustees, and by our volunteers who have supported various functions within COMPASS-Ghana.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Policies adopted for the induction and training of Trustees

On appointment, new trustees are provided with a current version of COMPASS-Ghana’s constitution, a copy of all polices which are revised and renewed on an annual basis (July of each year or when appropriate re a change in legislation) and the latest set of accounts. They are also briefed on their legal obligations under charity law, the Charity Commission guidance on public benefit, the content of the constitution, the Charity's decision-making processes, strategic goals, method of operation and financial activities and status.

Trustees are encouraged to visit COMPASS-Ghana’s projects (self-funded) in order to understand our beneficiary communities and work. These visits are part of a monitoring and evaluation activity or to accompany high value donors.

Pay policy for key management personnel

No member of staff received remuneration during the Financial Year 2023/24. In Financial Year 2024/2025 it will be an objective to provide some remuneration for the leadership team (the founders). The appropriate remuneration will be set by the Board of Trustees in closed session, giving due regard to the recommendation of the Leadership Team. In setting this figure the expectation will be for a nominal figure rather than a sector norm. Other staff, when appointed, will be remunerated against a comparable sector benchmark against the agreed budget figure.

Reserves policy

It is the trustees' policy to ensure a readily realisable reserve is maintained in unrestricted funds to be used in the event of a significant drop in funding to enable continuation of current activities while ways in which additional funds may be raised are considered. Currently the policy is for 3 months as a guiding figure or £2,500 whichever is the greater.

Investment policy

Surplus funds will be retained in a bank deposit account at the best rate possible whilst retaining instant access to the deposits as required.

Going concern

The Trustees are aware of the current cash flow challenges facing COMPASS-Ghana. It is regularly reviewed within the Risk Register. When externally reviewed, cash at the bank and in hand is £5,729 representing six months of operating costs. independently/externally reviewed or similar.

There is no liability to any creditors, outside liabilities repayable in more than three years (see note 14), which cannot be ceased and reconciled with one months’ notice.

www.compass-gh.org

COMPASS-Gh Annual Report 2024

The Trustees are aware that the Charity is very much at “second stage funding”, requiring ongoing injection of short-term unrestricted funds.

To secure this source of income the Trustees are aware that the charity must demonstrate evidence of good governance and an ability to demonstrate effective delivery and outcomes on the ground.

They are confident that the Leadership Team are engaged and have measures in place to secure a sustainable and credible income stream.

Plans for future periods

The Strategic Plan 2024-2025 sets out the key strategic priorities for the next financial year. COMPASS- Ghana is mindful of the environment in which it operates. The raising of funds is a challenging prospect. The Trustees are therefore conscious of the risk of planning in the long term.

COMPASS-Ghana recently launched the Ashanti Appeal “ Bringing Compassionate Palliative Care to Ashanti: Our £50,000 Mission”.

The Charity seeks to develop a sustainable and scalable model of care, one that is seamless in its approach towards the patient, their families and communities in which they live. An approach that is able to be replicated across Ghana year on year, region by region.

Our shared objective with Asamang SDA Hospital is to shape and develop a centre of excellence that will support 315 end-of-life patients in this financial year, April 24 to March 25. This number includes children and adults of all faiths and none or the ability to pay. Patients will primarily be treated via outpatient services, there will also be a dedicated inpatient unit, to care for those in urgent need.

The Board is committed to developing and replicating the proven model year on year to ensure Universal coverage by 2030.

Over the next three years, by 2027 we aspire to:

www.compass-gh.org

COMPASS-Gh Annual Report 2024

Statement of Trustees' Responsibilities

The charity trustees’ are responsible for preparing a trustee’s annual report and financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).

The law applicable to charities in England and Wales requires the trustees to prepare financial statements for each financial year which give a true and fair view of the state of affairs of the charity and of the incoming resources and application of resources of the charity for that period.

In preparing these financial statements, the trustees are required to:

The trustees are responsible for keeping proper accounting records that disclose with reasonable accuracy at any time the financial position of the charity and to enable them to ensure that the financial statements comply with the Charities Act 2011, the applicable Charities (Accounts and Reports) Regulations, and the provisions of the Trust deed. The Trustees are also responsible for safeguarding the assets of the charity and hence taking reasonable steps for the prevention and detection of fraud and other irregularities.

Signed on behalf of the charity’s trustees

Signed.............................................................................

Dr Cecilia Akrise Anim CBE, FRSA, FRCN

Chair, Compass-Ghana Compassionate Palliative Services

Date: 06 August 2024

www.compass-gh.org

COMPASS-GHANA (Compassionate Palliative Services) Independent Examiners Report

Independent Examiner's Report to the trustees of COMPASS-GHANA (Compassionate Palliative Services)

I report to the trustees on my examination of the financial statements of COMPASS-GHANA (Compassionate Palliative Services) for the year ended 31 March 2024.

Responsibilities and basis of report

As the charity's trustees you are responsible for the preparation of the financial statements in accordance with the requirements of the Charities Act 2011 ('the Act').

I report in respect of my examination of the charity's financial statements carried out under section 145 of the 2011 Act and in carrying out my examination I have followed all the applicable Directions given by the Charity Commission under section 145(5)(b) of the Act.

Independent examiner's statement

I have completed my examination. I can confirm that no material matters have come to my attention in connection with the examination giving me cause to believe that in any material respect:

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

Paul Clarke MGB Accountants 18 Market Street Wotton Under Edge Glos GL12 7AE

31 July 2024

33

COMPASS-GHANA (Compassionate Palliative Services) Statement of Financial Activities

for the year ended 31 March 2024

Notes
Income and endowments
from:
Donations and legacies
2
Other
3
Total
Expenditure on:
Raising funds
4
Charitable activities
5
Other
6
Total
Net gains on investments
Net expenditure
7
Transfers between funds
Net expenditure before other
gains/(losses)
Other gains and losses
Net movement in funds
Reconciliation of funds:
Total funds brought forward
Total funds carried forward		 Unrestricted
funds		 Total funds Total funds
2024 2024 2023
£ £ £
37,247 37,247 4,298
- - 40
37,247 37,247 4,338
866 866 428
28,198 28,198 3,974
8,369 8,369 13,705
37,433 37,433 18,107
- - -
(186) (186) (13,769)
- - -
(186) (186) (13,769)
(186) (186) (13,769)
(13,769) (13,769) -
(13,955) (13,955) (13,769)

34

COMPASS-GHANA (Compassionate Palliative Services) Balance Sheet

at 31 March 2024

Charity No. 1199633
Fixed assets
Tangible assets
10
Current assets
Debtors
11
Cash at bank and in hand
Creditors:Amount falling due within one year
12
Net current assets
Total assets less current liabilities
Creditors:Amounts falling due after more than one year
13
Net liabilities excluding pension asset or liability
Total net liabilities
The funds of the charity
Restricted funds
14
Unrestricted funds
14
General funds
Reserves
14
Total funds		 2024
£
3,334
3,334
1,781
5,729
7,510
(3,304)
4,206
7,540
(21,495)
(13,955)
(13,955)
(13,955)
(13,955)
(13,955)		 2023
£
3,612
3,612
712
3,574
4,286
(1,785)
2,501
6,113
(19,882)
(13,769)
(13,769)
(13,769)
(13,769)
(13,769)

Approved by the trustees on 06 August 2024

And signed on their behalf by:

W. Schiller Trustee 07 August 2024

35

COMPASS-GHANA (Compassionate Palliative Services) Notes to the Accounts

for the year ended 31 March 2024

Basis of preparation

The financial statements have been prepared in accordance with the Accounting and Reporting by Charities: Statement of Recommended Practice (SORP), Financial Reporting Standard 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (FRS102) and the Charities Act 2011.

Change in basis of accounting or to previous accounts

There has been no change to the accounting policies (valuation rules and method of accounting) since last year and no changes have been made to accounts for previous years.

Fund accounting

36

COMPASS-GHANA (Compassionate Palliative Services) Notes to the Accounts

Expenditure

Recognition of Expenditure is recognised on an accruals basis. Expenditure includes any VAT expenditure which cannot be fully recovered, and is reported as part of the expenditure to which it relates.

Expenditure on These comprise the costs associated with attracting voluntary income, raising funds fundraising trading costs and investment management costs. Expenditure on These comprise the costs incurred by the Charity in the delivery of its activities charitable activities and services in the furtherance of its objects, including the making of grants and governance costs. Grants payable All grant expenditure is accounted for on an actual paid basis plus an accrual for grants that have been approved by the trustees at the end of the year but not yet paid.

Taxation

The charity is exempt from tax on its charitable activities.

Tangible fixed assets and depreciation

Depreciation is provided at the following annual rates in order to write off each asset over its estimated useful life:

Office Equipment 20% Straight line

Trade and other debtors

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

Cash and cash equivalents

Cash and cash equivalents comprise cash at bank and on hand.

Trade and other creditors

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

Foreign currencies

Monetary assets and liabilities denominated in currencies other than the functional currency of the charity are translated at the rates of exchange prevailing at the end of the reporting period. Transactions in currencies other than the functional currency of the charity are recorded at the rate of exchange on the date that the transaction occurred.

All exchange differences are are taken into account in arriving at net income/expenditure.

37

COMPASS-GHANA (Compassionate Palliative Services) Notes to the Accounts

2 Income from donations and legacies

2
Income from donations and legacies
Donations
Gift Aid		 Unrestricted
£
34,722
2,525
37,247		 Total
2024
£
34,722
2,525
37,247		 Total
2023
£
3,941
357
4,298
Donations received
Events
Campaigns
Donations
Trusts & Funds
3
Other income
Misc Income
4
Expenditure on raising funds
Costs of generating voluntary
income
Promotion
Fund Raising Costs		 Unrestricted
£
306
560
866		 Total
2024
£
8,147
23,625
1,450
1,500
34,722
Total
2024
£
-
-		 Total
2023
£
1,692
-
1,250
1,000
3,942
Total
2023
£
40
40
Total
2024
£
306
560
866		 Total
2023
£
373
55
428

38

COMPASS-GHANA (Compassionate Palliative Services) Notes to the Accounts

5 Expenditure on charitable activities

Expenditure on charitable
activities
Ghana - Set up activity
Charity Partner Support
Ghana Operations - UK
support
Project Ashanti - set up and
delivery
Governance costs
Board meeting & expenses
Accounting & Administration
6
Other expenditure
Advertising & Promotion
Employee costs
Motor and travel costs
Premises costs
Amortisation, depreciation,
impairment, profit/loss on
disposal of fixed assets
General administrative costs
Legal and professional costs
7
Net expenditure before transfers
This is stated after charging:
Depreciation of owned fixed assets		 Unrestricted
£
-
6,694
7,094
11,591
807
2,012
28,198
Unrestricted
£
513
-
-
1,307
811
2,916
2,822
8,369
2024
£
811		 Total
2024
£
-
6,694
7,094
11,591
807
2,012
28,198
Total
2024
£
513
-
-
1,307
811
2,916
2,822
8,369		 Total
2023
£
1,862
-
-
-
2,112
-
3,974
Total
2023
£
-
-
6,850
-
258
2,907
3,690
13,705
2023
£
258

39

COMPASS-GHANA (Compassionate Palliative Services) Notes to the Accounts

8 Trustee remuneration and expenses

One or more of the trustees has been paid expenses in the current or prior periods.

2024 2023 Number Number Number of trustees paid expenses - 2 The nature of the reimbursed expenses No trustees were paid expenses during this accounting period (2023, 2) £ £ Total expenses reimbursed to trustees - 358

9 Staff costs

The charity had no payrolled staff in the reporting period (2023, NIL). It was entirely supported by volunteers.

10 Tangible fixed assets

Tangible fixed assets
Cost or revaluation
At 1 April 2023
Additions
At 31 March 2024
Depreciation and impairment
At 1 April 2023
Depreciation charge for the
year
At 31 March 2024
Net book values
At 31 March 2024
At 31 March 2023
Debtors
Trade debtors
Other debtors
Prepayments and accrued income		 2024
£
-
518
1,263
1,781		 Office
Equipment
£
3,870
533
4,403
258
811
1,069
3,334
3,612		 Total
£
3,870
533
4,403
258
811
1,069
3,334
3,612
2023
£
387
-
325
712

11 Debtors

40

COMPASS-GHANA (Compassionate Palliative Services) Notes to the Accounts

12 Creditors:

amounts falling due within one year

2024
2023
£
£
Trade creditors
2,324
134
Accruals
980
1,651
3,304
1,785
13 Creditors:
amounts falling due after more than one
year
2024
2023
£
£
Other creditors
21,495
19,882
21,495
19,882
Liabilities repayable in more than five
years after the balance sheet date
Other creditors represents amounts the charity owed to its members for start up activities: Mr John
Davies £17,088; Ms Katie Eccles £1,043; Dr Yakubu Salifu £3,006; Dr Ernest Ahaiku £340 & Mr W
Schiller £18 (2023: Mr John Davies £15,774, Ms KatieEccles £733, Dr Yakubu Salifu £3,016, Dr Ernest
Ahaiku £340 & Mr W Schiller £18).		 2024
£
2,324		 2023
£
134
980 1,651
3,304
2024
£
21,495
21,495		 1,785
2023
£
19,882
19,882

14 Movement in funds

Restricted funds:
Unrestricted funds:
General funds
Total funds
Analysis of net assets between funds
Fixed assets
Net current assets
Creditors due in more than one year and
provisions		 At 1 April
2023
(13,769)
(13,769)		 Incoming
resources
(including
other
gains/losses
)
£
37,247
37,247		 Resources
expended
£
(37,433)
(37,433)
Unrestricted
funds
£
3,334
4,206
(21,495)
(13,955)		 At 31
March
2024
£
(13,955)
(13,955)
Total
£
3,334
4,206
(21,495)
(13,955)

15 Analysis of net assets between funds

41

Signature Certificate

Reference number: WMZU4-CPZXN-6L6WC-6CBWF

Signer Timestamp

Signature

Paul Clarke

Email: paul@mgb.email Shared via link

Sent: Viewed: Signed:

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