2023-12-31-accounts

This text was generated using OCR and may contain errors. Check the original PDF to see the document submitted to the regulator.

Trustees’ Annual Report and Financial Statements For the year ended 31[st] December 2023

Amref Health Africa Charity Number: 261488 Company Number: 00982544

Amref Health Africa UK

Reference and Administrative Details....................................................................................................................................3 Trustees’ Annual Report for the year ended 31st December 2023 ....................................................................................5 Who We Are .............................................................................................................................................................................5 Our Strategic Objectives...........................................................................................................................................................7 Our Achievements: Programme Development and Strategic Partnerships..........................................................................9 Our Achievements: Income-Generation ................................................................................................................................15 Financial Review .....................................................................................................................................................................20 Structure, Governance, and Management............................................................................................................................23 Risk Management Statement ................................................................................................................................................24 Statement of Trustees’ Responsibilities ...............................................................................................................................26 Independent Auditor’s Report ............................................................................................................................................... 27 Statement of Financial Activities…………………………………………………………………………………………….……………..………………32 Balance Sheet…………………………………………………………………………………………………………….………………..………………………33 Statement of Cash Flows………………………………………………………………………………………………………………………..…………....34 Principal Accounting Policies …………………………..………………………………………………………………………………..………………….35 Notes to the Financial Statements……………………………………….……………………………………………………………………………….40

Amref Health Africa UK

Reference and Administrative Details

Former Patron: HRH The Former Prince of Wales

Board of Trustees:

Chair: Mr Paul Davey

Treasurer: Dr Amanda Caine

Ms Jill Anderson (joined 30 May 2024)

Dr Tinashe Chandauka

Ms Jennifer Chimanga

Mr Simon Hammett (stepped down 1 September 2023)

Ms Beverley Jewell

Ms Bridie Layden

Dr Sally Nicholas

Mr Andrew Tuttle (joined 30 May 2024)

Ms Navita Yadav (joined 21 March 2024)

Internal Key Management Personnel:

Chief Executive: Ms Camilla Knox-Peebles

Head of Finance: Ms Helen Blake

Head of Supporter Engagement: Ms Sofeena Lalani (Interim) (until January 2023)

Director of Fundraising : Mr Matt Wenham (from March 2023)

Head of Programmes and Strategic Partnerships:

Dr Aneesa Ahmed (from November 2023)

This role was vacant from January to October 2023 but supported by Amref Health Africa, from Nairobi, during this time.

Company Secretary: Ms Helen Blake

Charity Number: 261488

Company Number: 00982544

Amref Health Africa UK

Registered Office

Until 28 February 2023: Lower Ground Floor 15-18 White Lion Street London N1 9PD

From 1 March 2023: 7-14 Great Dover Street London SE1 4YR

Bankers

C Hoare & Co

37 Fleet Street London EC4P 4DQ

Barclays Bank

7th Floor, United Kingdom House 180 Oxford Street London W1D 1EA

CCLA

Senator House 85 Queen Victoria Street London EC4V 4ET

Auditors

Buzzacott LLP, Chartered Accountants

130 Wood Street London EC2V 6DL

Amref Health Africa UK

Trustees’ Annual Report for the year ended 31st December 2023

The trustees, who are the directors for the purposes of company law, present their statutory report together with the financial statements of Amref Health Africa for the year ended 31 December 2023. This Trustees’ Annual Report has been prepared in accordance with the Companies Act 2006, the Charities Act 2011, and the Statement of Recommended Practice, Accounting and Reporting by Charities, 2019.

Who we are

Amref Health Africa is the largest Africa-based international health development organisation. We work to bring about lasting health change in Africa.

Amref Health Africa’s Headquarters are in Nairobi and Amref works in 35 countries to improve access to healthcare and to help create an environment that is conducive to good health. Our programmes align with our Global Strategy objectives: to increase primary healthcare access for all, and to address the social determinants of health. These are the factors that influence people’s health, from their access to education, to their gender, and their exposure to the impacts of climate change.

Amref’s programmes focus on: child health and nutrition; communicable and non-communicable diseases; health financing; family and reproductive health; neglected tropical diseases; sexual and reproductive health and rights; and water and sanitation and hygiene. We develop mobile and online learning solutions that make top-class training available to health workers across the continent. We operate a university that shapes the health workforce of the future. We run the continent’s leading air ambulance service. Our reach – and our relationships with the communities we support – is unparalleled.

As the world strives to meet the Sustainable Development Goal of Universal Health Coverage (UHC) by 2030, Amref Health Africa is committed to removing the barriers that impede access to healthcare, ensuring that no-one is left behind. The work of our UK office contributes to this ambitious goal.

Amref Health Africa UK

Amref Health Africa (trading or known, and referred to hereafter, as Amref Health Africa UK or Amref UK) is one of nine offices in Europe and North America that are responsible for mobilising resources to increase the reach and impact of our work in Africa.

Amref Health Africa UK is an independent charity registered in England and Wales that exists to support the programme and policy activities of Amref Health Africa. With a UK-based Board of Trustees, staff team, office and bank accounts, our main purpose in the UK is to develop and manage partnerships with UK donors who want to support Amref’s work in Africa. Our London-based team has skills spanning programme management and technical support, fundraising and supporter engagement, communications, human resources, finance, administration, and governance. With an annual income of around £6.5 million, we support a portfolio of innovative health programmes funded by a range of donors and partners including institutions, companies, trusts and foundations, and individual supporters.

Amref Health Africa UK

In 2023, Amref Health Africa UK supported 19 programmes in seven countries. We are proud of the progress we have made, collectively, towards expanding access to healthcare for some of Africa’s most remote and marginalised communities. We would like to extend our thanks to everyone who has been, and continues to be, a part of this important work.

Amref Health Africa UK

Strategic Focus and Objectives

We are delighted to have achieved around £6.5 million in income by the final year of our 20202023 Organisational Strategy, reaching the target we set out in the strategy.

This achievement was driven by a sharpened strategic focus on income-generation, with the support of communications and advocacy, as recommended in the Mid-Term Review we carried out in 2021. Our 2023 growth continued from the levels cemented in 2022; our workplans, budgets and monitoring and evaluation were shaped by this tighter focus outlined in the Mid-Term Review, as was our investment in our teams, tools and processes.

In 2023, we continued the work to set the foundations for work to achieve these aims. Specifically, we invested in the infrastructure and resources to build a robust individual giving programme for Amref UK. In March 2023, our new Director of Fundraising joined the Amref UK team, which was followed by the recruitment of a specialist role to support the work on digital acquisition—a Digital Fundraising Officer who joined the team in July 2023. With these appointments, we re-energised the work to build Amref UK’s first digital acquisition programme. You can read more about these initiatives from p. 15 onwards in Our Achievements: Income-Generation.

We have closely stewarded our key corporate partnerships, to launch new programmes and build on our strong relationships to foster new partnerships. Additionally, we continued to nurture our relationships in the strategically important areas of trusts and foundations, both restricted and unrestricted, attracting resources from new partners. See p. 15 onwards in Our Achievements: Income-Generation for more detail on these key highlights.

Support from corporate and trusts and foundations partnerships for existing programmes continued throughout 2023, helping to reach key impact milestones. This included for programmes addressing Human Resources for Health; Family and Reproductive Health; Disease Control and Prevention; WASH; Ending FGM/C. We launched new programmes with our strategic partners, in response to the needs identified by our in-country teams with communities (see Our Achievements: Programme Development and Strategic Partnerships, p. 9).

Amref Health Africa UK has continued to mobilise resources to support the vital work of the wider organisation, as well as providing technical support with programme implementation. We have also collaborated closely with our colleagues in Nairobi Headquarters and the Fundraising Markets Development team to progress our work on ethical storytelling and to embed the guidelines across functions. This work shapes our approach to content gathering, production and dissemination, to ensure we are amplifying African voices and perspectives to inspire UK supporters to engage with and invest in Amref Health Africa.

Throughout 2023, we have worked to determine our direction for the rest of the decade, through a highly collaborative process involving input from the UK Board of Trustees, Amref UK staff, Amref HQ staff, Country Office Directors as well as fundraising colleagues and CEOs of other European and North American offices. This work took place from March 2023 onwards, following the launch of the Amref Global Strategy which lays out the changes needed to realise a transformation of Africa’s health agenda, to create lasting change to improve the health of communities across the continent.

Amref Health Africa UK

The strategy focusses on two pillars: 1) investment in sustainable primary healthcare; 2) addressing the social determinants of health. These are the factors that influence people’s health, from their access to education, to their gender, and their exposure to the impacts of climate change.

Our UK strategy aims for transformational growth—to raise £50 million from UK donors between 2024 and 2030—to support the work towards Africa’s health transformation. We know that building transformational growth requires solid foundations and ambitious vision. To achieve this, we will focus on two clear aims: 1) Driving bold but balanced growth in unrestricted funding; 2) Focussing on value over volume to sustainably grow restricted funding.

Everything we do is guided by our commitment to being an anti-racist organisation. We know this is a journey of ongoing learning, and we are committed to taking forward the recommendations from our Anti-Racism Review (made in 2022) in the development of our strategy, workplans, budgets and personal development plans. This is explicitly shown in the 2024-2030 Strategy in our plans to transfer partner relationship management and stewardship to Africa-based teams.

Amref Health Africa UK ended the year in a strong financial position, thanks to our investment in infrastructure, resources, and the expertise and talent of our team to drive income-generation. The external environment remains challenging and we continue to monitor the situation closely (see Risk Management Statement and Principal Risks and Uncertainties, p.24).

Amref Health Africa UK

Statement on Public Benefit

In performing the above activities, the Trustees of Amref Health Africa UK have complied with their duty under section 17 of the Charities Act 2011 to have due regard to public benefit guidance as published by the Charity Commission for England and Wales.

Our Achievements

Programme Development and Strategic Partnerships

In 2023, Amref Health Africa UK supported 19 programmes across seven countries.

In line with our strategic objectives, we pursued an ambitious, tightly-focused programmatic agenda, responding to the greatest needs – as identified by our in-country colleagues – and supporting highimpact programmes spanning Human Resources for Health (HRH); Family and Reproductive Health (also referred to as Reproductive, Maternal, Neonatal, & Child Health (RMNCH) and including Sexual and Reproductive Health and Rights (SRHR)); prevention of Female Genital Mutilation and Cutting (FGM/C); Water, Sanitation and Hygiene (WASH); Disease Control and Prevention; and more.

The table below outlines the programmes that were part of Amref UK’s portfolio between 1 January and 31 December 2023. During this period, Amref UK provided support with programme implementation and management as well as partner stewardship.

Country	No. of Programmes	Areas of Activity	Partners/Funders (N.B. Names not aligned with areas of activity)
Ethiopia	2	Disease Control and Prevention	ViiV Healthcare Positive Action GSK
Kenya	8	Disease Control and Prevention HRH: Health worker training SRHR: Ending FGM/C Adolescent SRHR	Wolfson College, Oxford University The Rabelais Trust Mercury Phoenix Trust The Croda Foundation The SOL Foundation People’s Postcode Lottery

Amref Health Africa UK

Malawi	2	Adolescent SRHR Disease Control & Prevention	Comic Relief People’s Postcode Lottery
Tanzania	1	Family & Reproductive Health	Donor wishing to remain anonymous
Uganda	3	Family & Reproductive Health Disease Control & Prevention WASH	Donor wishing to remain anonymous The Croda Foundation
Regional	3	HRH – Health worker training Disease Control & Prevention SRHR: Ending FGM/C	GSK UK Government: Foreign, Commonwealth and Development Office (FCDO)
TOTAL	19

Highlighted below are four examples of the work Amref Health Africa UK has supported during the reporting period. All four programmes are typical of our African-led, community-driven approach to securing lasting health change.

As stated in the introduction to this report, everything Amref UK does contributes to the goal of making Universal Health Coverage (UHC) a reality by 2030. For us, this translates to strengthening health systems, training health workers, creating the conditions in which good health can thrive, and improving access to vital services for some of the continent’s most remote and marginalised communities.

These are communities that are the most marginalised in the factors that influence health, from access to education, to gender, and their exposure to the impacts of climate change. Together, these continue to create further barriers to access, and deliver, quality health care.

Amref Health Africa UK

Mobile Vaccination Clinics for COVID-19 and Non-Communicable Diseases (NCDs) in Kenya

In partnership with: The Croda Foundation

Areas of activity: Primary Healthcare; Human Resources for Health

Amref’s mobile clinics model provides high-quality NCD healthcare and vaccination services direct to last-mile communities in remote areas that traditionally struggle to access healthcare at the facility level. To respond to urgent health needs and provide sustainable access to health services, the project is focussing on three complementary activities: community vaccination services; NCD screening, diagnosis and treatment; training health workers on NCDs.

The mobile clinics are significantly reducing the high burden that conditions such as hypertension and diabetes cause (NCDs account for 39% of deaths and 50% of all inpatient hospital admissions annually in Kenya), and are delivering lasting benefit for communities, families and individuals.

To date, the project has:

Trained more than 800 health workers on NCDs, to close skills gaps and improve quality of care;
Administered over 7,000 vaccinations to community members, including COVID-19, cholera, malaria and HPV, based on community needs and priorities;
Screened more than 33,000 community members for NCDs (hypertension, diabetes, cervical cancer);
Provided 500 service contacts of additional health services based on urgent community needs (family planning, HIV testing, child wellness centre outreaches).

The project and mobile clinics approach has received endorsements from several key leaders including the Governor of Homa Bay County, Kenya. The mobile clinics programme has received a no-cost extension to April 2024, to allow for additional time to increase vaccination reach (due to shortage in vaccines supply across Counties of operation). With the proven success of the model, plans are underway to expand the mobile clinics’ focus to include cancer screening, particularly for lung cancer, and prioritise HPV vaccinations.

----- Start of picture text -----
A mobile clinic
pictured on the way
to a vaccination
outreach activity in
Nyamira County,
Kenya
© AstraZeneca/Amref
Health Africa
----- End of picture text -----

Amref Health Africa UK

Sports for Health: Phase 2

In partnership with: People’s Postcode Lottery and The SOL Foundation

Areas of activity: Adolescent SRHR

The Sports for Health project, now in its second phase, aims to improve the sexual and reproductive health (SRHR) of 4,500 adolescent girls and boys (aged 10-19) in Dagoretti and Embakasi, Kenya. Through integration with local sports clubs (football, taekwondo and volleyball), the project delivers facility and community-based activities for young people on SRHR topics, life skills, and career guidance, to increase their demand for SRHR services and increase their access to personal, educational and employment opportunities.

Since the project commenced in April 2023, we have mapped and enrolled close to 3,000 boys and girls into sports clubs and trained 135 sports club coaches and 150 sports club SRHR Champions, who provide support to adolescents, linking them to SRHR, SGBV, mental health and/or HIV services. In 2024, the project is expanding to include career guidance for adolescent mothers.

Zahara Saidi, 18, started taekwondo in Phase 1 of the Amref Sport for Health programme in Dagoretti, Nairobi and has since fallen in love with the sport. Her dream is to make it her future: “It’s in my blood now! I would like to be in the national team and I would like to be the best coach ever!”

On the sidelines of tournaments and at practice, Zahara and her teammates have access to young people around their age - peer educators - who support them with knowledge about their sexual and reproductive rights. “The SRHR sessions have taught me about my body and reproductive system. Most of the people where I come from don’t have access to this kind of knowledge.” © Daisy Kiprop/Amref Health Africa

Amref Health Africa UK

Piwa Maleng (‘Our Clean Water’) Phase 2: Water Sanitation and Hygiene for Sexual and Reproductive Health and Rights

In partnership with: Donor wishing to remain anonymous

Areas of activity: WASH and Family and Reproductive Health (SRHR)

The project aims to reduce rates of teenage pregnancy and improve access to WASH for 39,000 people living in Lamogi and Pabbo sub-counties of Amuru District, Northern Uganda. More than 30% of people in these areas do not have access to a clean water source close to their homes. Girls and women walk an average of three kilometres to fetch water, which places them at high risk of sexual and genderbased violence (SGBV). As a result, teenage pregnancy rates across both sub-counties are the highest in the district.

The project activities include drilling or repairing boreholes, setting up pioneering solar-powered water systems to supply primary schools and villages with safe water, and providing SRHR training for the community, particularly young people, both in and out of school.

This approach will ensure that adolescent girls, women, and their communities can access water safely and equitably, while also gaining a better understanding of their sexual and reproductive rights and how to avoid unwanted pregnancies.

In 2023, the project key achievements include: connecting 4 solar powered mini water systems to production wells; drilling 7 new boreholes; constructing 11 public stand posts in villages; constructing 10 standpipes in schools; supporting school health activities that reached 4,375 pupils; and providing SRHR services for 6,209 young people. Combined with other project activities and achievements, the project has directly reached 24,387 people and 100,833 people indirectly to date. The current project phase will run until 2026.

A child drinks clean, safe water from a standpipe erected by the Piwa Maleng project in Amuru District, Uganda.

Amref Health Africa UK

Emergency Response for Nutrition and WASH in Somali, Ethiopia

In partnership with: GSK

Areas of activity: Maternal, Newborn and Child Health, Nutrition

The project’s main purpose, working closely with the Regional Health Bureau (RHB), is to increase access to safe, clean water and nutrition services for internally displaced persons (IDPs) and host communities in the Somali Region of Ethiopia to respond to the ongoing drought crisis due to climate change, and compounded by the consequences of conflict.

The need for lifesaving health assistance is urgent and is most acute for children under the age of five, pregnant women, and breastfeeding mothers. The project provides integrated health, nutrition and WASH interventions for these priority groups, and the wider community.

In 2023, a rapid assessment was undertaken to assess the latest situation and align need/priorities with the programme interventions. This showed that there was an ongoing, urgent need for nutrition and health services close to the community, especially those to treat severe acute malnutrition (SAM) in children, pregnant women and breastfeeding mothers. Also highlighted was the need for water trucking and water storage tankers to ensure a supply for safe, clean water for communities.

Over the year, the project: trained 56 frontline health workers on malnutrition and stabilisation centre (SC) case management; 100 community volunteers were trained as part of women’s groups to support community-level nutrition activities; essential medical supplies and commodities were procured for breastfeeding corners and SCs; breastfeeding corners were set up in health facilities; and water storage tankers were installed to improve access to safe, clean water. The project has to date reached 109,579 people with access to nutrition services and clean, safe water.

Amref Health Africa UK

Our Achievements

Income Generation

Amref UK raised a total of £2.0 million in unrestricted and £4.5 million in restricted funds in the year 2023. A significant portion of our income came, as in the previous year, from trusts and foundations, totalling £1.9 million in 2023.

2023 also marked the 35th year of our partnership with GSK and saw the launch of two new programmes: to address the malaria burden in Kenya and Zambia; and strengthen the regional response to Antimicrobial Resistance. The programme to address food insecurity in Ethiopia continued (see Income from Charitable Activities, p.9).

Approach and Stewardship

2023 was a busy and creative year for our income-generating teams at Amref Health Africa UK, with many initiatives continuing to develop as well as new ones launching.

The teams were supported by several volunteers through our partnership with the University of East Anglia, as well as Amref Health Africa HQ and country offices, Amref’s other European and North American offices, and the Board of Trustees.

Amref UK used a range of tools and processes to plan and deliver activities and monitor income and expenditure. Amref is investing in common systems across the global network to support fundraising and we will be migrating our UK supporter data to Microsoft Dynamics in 2024. In 2023, our Amref UK teams started work with Amref Health Africa HQ Information and Communication Technology (ICT) teams to plan and implement a migration to a new Customer Relationship Management (CRM) platform, as part of a wider Amref global network initiative to develop common systems across the Amref network.

This will streamline the processing of gifts and improve our stewardship of donors through automated, tailored donor communications, increasing engagement and retention of donors. Through powerful data analytics, we will be able to identify opportunities and improvements that will increase the effectiveness of our fundraising and control our expenditure appropriately.

The Charity also used internal risk management and key performance indicator documents to ensure we were on track to meet targets as well as complying with internal and external guidance and regulations.

Amref UK renewed its membership with the Fundraising Regulator and attended sector conferences and training to ensure best practice across income-generating activities. The Charity did not receive any complaints related to fundraising in 2023. There were no data protection breaches, and there were no reported instances of failures to comply with any schemes or standards including those of the Fundraising Regulator.

Treating supporters with respect and dignity remained a key priority in 2023. We reviewed our Privacy Policy and how we use our database as well as how we record and manage consent preferences, and our supporter journeys for individuals. We ensured that the Privacy Policy, Fundraising Regulator logo and other essential statements were displayed in online and printed fundraising materials. We undertook a regular review of our legitimate interest basis for contacting individuals as part of our GDPR compliance early in 2023, taking the appropriate actions.

Amref Health Africa UK

Within working hours, we responded to all supporter queries and requests within 24-48 hours (but often within a couple of hours of receiving the request) and we were efficient at updating consent preferences and opt-out requests.

Amref UK does not specifically work with children or other vulnerable groups, but we recognise vulnerable individuals will be included within our supporters and our database. We used our Safeguarding Policies to help ensure communications were appropriate and adjusted communications for any individuals who appeared to be in a vulnerable position. The most postal mailings any supporter received from Amref UK in 2023 was 6, with up to 29 emails for those who had opted into the mailing list. Our digital audience remains highly engaged, with open rates that consistently surpass industry standard. Our communications are designed to inform, inspire, and encourage.

Supporting Income Generation through Communications and Advocacy

In line with the Mid-Term Strategic Review, the Communications function focussed on supporting income-generation through the Supporter Engagement and Programmes and Strategic Partnerships teams. In 2023, our communications focussed on the ethical storytelling of impact, with a sharpened focus on building our digital and social media presence as well as our share of voice on African health and development issues at events and in mainstream media, in partnership with our key donors, to reach existing donors and their networks.

We continued to engage with sector peers and other partners on ethical storytelling, which is central to our anti-racism and ethical communications guidelines. This included securing guest speaker positions in several charitable fundraising and communications sector events and in sector media. The research continues to be organically quoted and referenced in these wider circles, demonstrating the research’s value both for sector knowledge and understanding and as a solid reputational asset for Amref.

We continued to profile and amplify the voices of African experts on African health issues. This included in sector events such as the Africa-UK Health Summit held in London in April 2023, where Dr Patrick Kagarusi, Country Director of Amref Uganda, was a panelist in a plenary session discussing health workforce development and digital skills capacity strengthening. We also participated in several podcasts with partners: Peter Claver, Head of Programmes at Amref South Sudan took part in a podcast on poverty in South Sudan with partner Mission Aviation Fellowship and Diana Mukami, in supporting Amref UK from Amref HQ in Nairobi, remotely recorded a podcast with GSK and Cognizant on Tech for Good which profiled the Amref/Cognizant/GSK work on digital training platform integrations.

We maintained our media visibility through thought leadership and news in key publications. These included a comment from Dr Githinji Gitahi in the Financial Times on malaria with partner GSK, and comment in The Guardian from Caroline Mbindyo, CEO of Amref Health Innovations, on the diabetes burden in Africa. We also secured UK media coverage for programmatic impact; The Girl Generation: Africa-Led Movement to End FGM/C was featured in this article on Positive News and Diana Mukami was interviewed about the Amref/Cognizant/GSK digital training platform integration project in Intelligent.Health magazine.

In line with our commitment to ethical story gathering and storytelling, we worked closely with the Amref Fundraising Markets Development team to amplify voices of community members, health workers and Amref country staff on health challenges and Amref programmes to address them. This content was centred in the UK warm appeals and ongoing external communications through 2023. In

Amref Health Africa UK

addition, the UK Communications Manager participated in a content gathering trip to Kenya in July 2023. Alongside partners from GSK communications, we developed and shared powerful stories on the Amref-GSK 35-year partnership, and on our work together to address the TB burden. Additionally, we worked with the Amref Health Innovations team to produce a short mobile clinics documentary (part 1) and stories from the People’s Postcode Lottery and SOL Foundation-funded Sport for Health project in Nairobi.

Our digital channel following across four social media platforms (Facebook, Instagram, LinkedIn, X/Twitter) saw steady growth, with more marked increase in engagement and followers during the first digital acquisition test on Meta platforms (Facebook and Instagram). Our social and digital platform presence, positioning and programming will continue to be a focus area for 2024 as we continue to invest in individual giving.

Income from Donations and Legacies

Donations and legacies income refers to the income received that is, in substance, a gift made on a voluntary basis. We raised £1.1 million (£0.9 million unrestricted and £0.2 million restricted) of income from Donations and Legacies in 2023. The majority related to income from individuals, including major donors, and trusts and foundations.

Fundraising from individuals was a key focus in 2023 as it forms the basis of our new strategy. Between 2024 and 2030, we aim to rapidly grow funds from Individual Giving to raise £20m in unrestricted income.

In 2023 we secured the expert support of specialist fundraising and digital agencies to accelerate the development of the acquisition programme. We were pleased to roll out the first digital acquisition test in late 2023, which will be followed by a further two tests in early 2024. The first test provided good quality leads; and the analysis of engagement and response data shows a clear direction for further digital acquisition tests. These tests are crucial for building our understanding of our existing supporter base, which will form the foundation of our donor acquisition strategy during the new strategy period. In 2024, this strategy will expand beyond digital to include Direct Response TV advertising as part of a collaboration with Amref Italy and Amref Netherlands.

Over time, we aim to reduce dependency upon external agencies as we develop the skills and knowledge of the team. We invested in this in 2023 with the recruitment and appointment of a Director of Fundraising and a Digital Fundraising Officer. We aim to further enhance the capacity of the team in 2024.

We continued to fundraise from individual donors with £428,000 being raised in 2023. Our quarterly direct mail appeals generally performed well, meeting or exceeding targets and raising a total of £153,000 from individual donors. We continued to segment data, offer different gift amounts, and use new case studies and supporting materials to engage our donors. Our website continued to be a key platform for information sharing and for donations. In 2023, we raised a total of £10,000 in online donations received through Amref UK’s website. This included a range of gift types from quarterly appeal gifts to those made online from major donors.

In March 2023, our BBC Radio 4 Appeal was broadcast, focussing on the story of the Amref mobile clinics bringing non-communicable disease care and essential health services to communities in Kenya. We were pleased to secure Nairobi-born film director, who also lives with Type 2 Diabetes, Gurinder Chadha as our Appeal presenter. This was the fourth time we have participated in this media appeal

Amref Health Africa UK

platform (a charity is eligible to apply once every four years), and we were delighted to receive generous match funding of £20,000 from the Hermitage Trust in support of this appeal. In total the appeal raised an incredible £115,000, which was one of the highest totals raised for all the BBC Radio 4 Appeals in our quarter cycle.

We also engaged with the Big Give Christmas Challenge Platform—a match-funding mechanism—once again to further encourage supporters to donate to Amref’s ‘Bringing Health Home’ campaign raising funds to support programmes that deliver health services to communities on the frontline of climate crisis. This secured a fantastic £101,000 in online and offline donations. We hosted an event at the Africa Centre, to mark the launch of the Big Give Challenge to engage existing major donors and partners, and to reach new High Net Worth Individuals (HNWIs). We were pleased to have exceeded the previous year’s income from the Big Give Christmas Challenge, and to unlock £15,515 in match funding from a new trust partner—the Aeonian Foundation.

In our new strategy period, we will continue to grow our pipeline of trusts and foundations, mid-level and major donors. In 2023 we started to re-focus resources to build supporter engagement journeys tailored to our different donor segments; this will continue in 2024. Gifts from major donors was a priority area in 2023 and we raised a total of £101,000 from around 20 major donors. We secured gifts from existing Mbele Movement members, through events and the BBC Radio 4 Appeal and the Big Give Christmas Challenge. In 2023, we grew our Mbele Movement major giving circle to ten members.

End of-year income from Individual Sponsorship & Events Donations stood at £26,000, raised by people running the London Marathon in support of Amref. In addition, we were grateful to receive the support of our longstanding community groups, and deepened our partnership with the University of East Anglia Raising and Giving (RAG) Society.

The migration to the Microsoft Dynamics CRM will support us to adopt a more structured approach to prospect and relationship management. This will support us to build supporter engagement journeys tailored to our different donor segments and ensure that we maximise the opportunities to increase Legacy income, among other sources. The legacy pipeline remains strong, and we recognised £196,000 in 2023.

Against the backdrop of an increasingly competitive and shrinking trusts and foundations market, we managed to generate a 97% year-on-year increase in unrestricted gifts from trusts and foundations. By the end of 2023 we had 35 active unrestricted trusts and foundations exceeding our target of 28 for the year. We received repeat annual gifts of £100 - £5,000 from many loyal small trust donors, for which we are very grateful. In addition, we secured gifts of £5,000-£20,000 from mid-size trusts.

Amref Health Africa UK receives on-going and impactful support from players of People's Postcode Lottery who have supported our work since 2018. Thanks to funds raised by players of People’s Postcode Lottery, in 2023 Amref was awarded a Regular Award of £400,000 (of which £220,000 was allocated to the Sports for Health programme in Dagoretti, Nairobi) and an additional one-off Bonus Extra Award of £100,000 by Postcode Global Trust to support our work.

Income from Charitable Activities

Income from charitable activities refers to income from contractual arrangements and performance-related grants which may have conditions that specify the provision of particular goods or services to be provided by Amref UK. We raised £5.3 million (£1.0 million unrestricted and £4.3 million restricted) of Income from Charitable Activities in 2023. Trusts and foundations

Amref Health Africa UK

continued to be a vital source of income in this area with £1.5 million raised. A further £2.6 million was received from GSK.

A key focus for 2023 has been excellent stewardship of existing donors, in line with our fundraising strategy to focus on increasing commitment from existing, loyal trust donors given the current competitive fundraising environment. In our new strategy period 2024-2030 we will continue this focus on value over volume to secure strategic partnerships that deliver £30m in restricted funding over the course of the strategic period between 2024 and 2030. We will continue to focus on oneyear and multi-year funding from three major sources: trusts and foundations, corporates and institutions (primarily UK Government and other development agencies) and we will look to diversify our funder base.

2023 marked the 35th year of our partnership with GSK. We secured an additional £5.0 million over three years from GSK to implement two new programmes: to address the malaria burden in Kenya and Zambia and to support the strengthening of the regional response to Antimicrobial Resistance (AMR). These programmes build on the long-term work Amref and GSK have done together aligned with our shared value and strategic priorities to increase access to healthcare.

Several programmes closed in 2023. The ViiV Healthcare Positive Action-funded programme in Ethiopia closed in August 2023, and the Stop the Spread programme funded by the Croda Foundation also closed after a no-cost extension to June 2023.

The Comic Relief-funded project Dance for Change in Mangochi District, Malawi and the People’s Postcode Lottery-funded Vaccine Equity project in Mangochi, Machinga and Zomba Districts, Malawi both closed in March 2023 (no-cost extension to Dance for Change January-March 2023). An end-term evaluation of the Dance for Change project showed young people engaged in the project demonstrated an increase in basic SRHR knowledge and an increase in confidence about seeking out SRH services. The Vaccine Equity project built the capacity of 1,570 frontline health workers and 130 influential community leaders on engaging and mobilising communities to get vaccinated. Through multichannel communications in partnership with the Ministry of Health, the project reached over 10 million people with COVID-19 vaccination messaging. The project also supported the administration of COVID-19 vaccines through outreaches and door-to-door campaigns, vaccinating a total of 213,318 people.

In 2023 we were pleased to continue Phase 2 activities for programmes including holistic support for survivors of obstetric fistula in Geita and Mwanza, Tanzania and West Nile Region, Uganda. We also continued Phase 2 programme activities for the Piwa Maleng (‘Our Clean Water’) programme in Amuru District, Uganda, and for the SOL Foundation and People’s Postcode Lottery-funded Sports for Health programme in Dagoretti and Embakasi East sub-counties in Nairobi, Kenya.

Phase 3 programme activities for the Alternative Rites of Passage / Water, Sanitation and Hygiene project in Kajiado, Kenya also commenced in 2023, funded by the Rabelais Trust. Additionally, with the ongoing UK Foreign and Commonwealth Development Office funding to the Girl Generation: Support to the Africa-Led Movement to End FGM/C consortium, in 2023 we started Year 3 implementation of programme activities in Kenya, and Year 2 programme activities in Senegal.

We also started implementation of new programmes in 2023. With £600,000 from GSK, we started implementing an emergency response programme addressing food insecurity and malnutrition in Somali Region, Ethiopia. A Croda Foundation grant of £250,000 enabled Amref to support mobile vaccination clinics in Kenya to reach last-mile communities with COVID-19 vaccinations and NCD prevention, screening and care services. With a £15,000 grant from the Mercury Phoenix Trust, we

Amref Health Africa UK

started implementation of a programme to provide HIV self-testing kits to communities in Turkana County, Kenya.

Financial Review

Amref Health Africa UK ends the four-year strategic period from 2020-2023 in a strong financial position. We close 2023 within our free reserves target range, with robust cash levels that stand us in good stead for the delivery of the new strategy from 2024-2030.

In spite of the COVD19 pandemic, the cost-of-living crisis and the effects of conflict and economic uncertainty within the broader global context, we have grown our income to around £6.5 million as set out in the 2020-2023 strategy. We have monitored and managed our cost base effectively over this time, adapting to new and unexpected challenges as they arose.

Unrestricted income was 80% higher in 2023 compared to the previous period with continued strength in Individual Giving and Trusts and Foundations – of particular note was an unrestricted contribution of £100,000 from the Postcode Global Trust, as well as significant legacy receipts in the year. However, the year-on-year increase was primarily due to higher income generated in relation to The Girl Generation: Support to the African-Led Movement to End Female Genital Mutilation / Cutting (FGM/C) programme funded by the UK Government (Foreign, Commonwealth and Development Office – FCDO). Due to the contractual nature of this income, it is classified as unrestricted. Unrestricted expenditure was 75% higher than the previous period primarily due to expenditure relating to The Girl Generation: Support to the African-Led Movement to End Female Genital Mutilation / Cutting (FGM/C) programme. Amref UK’s expenditure profile has been kept under continual review particularly in light of the inflationary pressures being experienced and there has been a sustained focus on cost recovery. Although there was a year-on-year increase in unrestricted expenditure, our 2023 investment in individual giving and the digital acquisition programme specifically was not at planned levels. The decision was taken early in the year to focus on developing the capacity of the Supporter Engagement team and bringing in the skills and expertise required to deliver the investment plan as well as addressing challenges around internals systems and online platforms, before investing heavily in acquisition activities.

There was an unrestricted surplus of £262,000 in 2023. £200,000 of unrestricted funds has been assigned to the Individual Giving Growth Designated Fund, created by the Board in March 2023. The effect of the unrestricted surplus is covered in more detail in the Reserves Policy section below.

Our restricted income was 12% higher than the previous period primarily due to £1.5 million of GSK funding being received for a regional malaria programme, focusing on Kenya and Zambia as well as a number of new grants being secured in 2023. GSK continues to be a much-valued partner with £2.6 million income recorded in 2023. Restricted expenditure in the period was 10% lower than the previous period. This is predominantly made up of transfers to Africa for programme implementation, the timing of which are determined by delivery progress and burn rate. However, it also includes the expenditure in individual giving that was covered by the flexible funding secured from the People’s Postcode Lottery allowing us to start building the critical infrastructure required to grow this area of income. This period’s restricted surplus of £1,372,000 primarily reflects the timing of receipt of grants compared to their disbursement to Amref Health Africa’s HQ in Nairobi.

Amref Health Africa UK

Reserves Policy

We end the year with funds of £5.3 million. 74% of this, however, is restricted, and therefore not available for the general purposes of the Charity. This is a result of timing differences and represents funds pending disbursement to Amref Health Africa’s HQ in line with programme implementation and progress. The remaining 26% is unrestricted with £0.2 million of this ringfenced within an Individual Giving Growth Designated Fund. The creation of the fund was approved by the Board in March 2023 to support planned investment in individual giving acquisition and growth. The decision to hold £0.2 million in the fund at 31 December 2023 was approved by the Board in November 2023.

The reserves calculations which underpin our policy are in line with Charity Commission guidance and are designed to ensure that we retain sufficient working capital, but that we are also well-equipped to address risks and opportunities faced, whilst also bearing in mind that we should only keep the reserves that are required, in order to use our funds most effectively. We aim to hold sufficient reserves to manage our financial risks and our working capital pressures which take account of our regular, more predictable financial activity as well as the current volatility and youth of some of our income streams and the fact that we are now part of a consortium to deliver a payment-by-results contract for the FCDO, the inherent nature of which increases the pressure on working capital of the organisation. We also have an element of our free reserves available to enable us to harness opportunities as they arise.

The calculations showed that as of the end of 2023 we should aim to hold £680,000 - £1,190,000 in unrestricted free reserves.

The unrestricted free reserves balance held as of 31 December 2023 was £1,146,000, made up of unrestricted reserves less the net book value of tangible fixed assets, less designated funds. This is within the target range. The unrestricted free reserves levels will continue to be monitored closely.

We will continue to review our reserves policy to ensure it meets the needs of the Charity.

Going Concern

The Trustees have undertaken a detailed review of income, costs, cash flow, reserves and external factors and considered that the Charity is a going concern. The Trustees believe that the Charity has adequate resources to continue in operational existence for the foreseeable future as expected funds receivable are anticipated to be sufficient to fund committed projects. Thus, they continue to adopt the going concern basis of accounting in preparing the annual financial statements. In the unlikely event of Amref UK no longer operating, any ongoing programmes would be transferred to Amref HQ and Country Offices ensuring that Amref UK’s charitable objects continued to be met.

Investments

All funds held in the UK for future use are held in deposit accounts with United Kingdom-based banks. The majority of funds are available on demand but as at 31 December 2023, £0.5 million was held in

Amref Health Africa UK

a 12-month fixed-term deposit, due to mature in August 2024. This is shown as a current asset investment in the financial statements.

Related Party Transactions

As set out in Note 14 of the Financial Statements, during the year, transactions were undertaken with Amref Health Africa’s HQ in Kenya. Donations were also received from a number of Trustees and Key Management Personnel.

Amref Health Africa UK

Structure, Governance, and Management Constitution and Governing Documents

Amref Health Africa UK is registered as a company in England, Company Number 00982544, whose members’ liability is limited by guarantee. The members are constituted solely of Trustees and all Trustees are members. The objects of the company, the powers of the Board of Directors and the regulations concerning the appointment of new Directors are set out in the Memorandum and Articles of Association, last amended on 9 June 2023 to better safeguard the key governance mechanisms of the organisation.

Amref Health Africa UK is also registered as a Charity with the Charity Commission in England and Wales, Charity Number 261488. The organisation’s Charitable Objects are “to support and foster the investigation and advancement in Africa of medical, scientific, educational and cultural knowledge and to apply the knowledge derived therefrom to the causes, prevention, relief and therapy of human diseases and misery for the relief of mankind in general”.

Governance

The Board of Trustees is responsible for the effective governance of the Charity. A steady renewal of Directors is provided by the maximum terms of office (three consecutive terms of three years totalling nine years) set out in the Memorandum and Articles. Succession planning arrangements ensure timely replacement of Trustees resigning or reaching the end of their terms of office.

There are two sub-committees of the Board; the Finance Committee and the Governance Committee. Both these sub-committees meet quarterly in advance of the full Board meeting. The Finance Committee’s remit includes internal control and risk management systems, financial planning and reporting, financial policies and procedures, fraud and whistleblowing of a financial nature, and external audit. The membership of the Finance Committee is drawn from existing Board members and must include the Treasurer and the Chair. The remit of the Governance Committee includes Board structure, focus and effectiveness, organisational structure and culture, the employment life cycle, policy review, and the broader governance considerations regarding the relationship with Amref Health Africa HQ. The membership of the Governance Committee is drawn from existing Board members and must include the Chair.

One Trustee, Simon Hammett, reached the end of his three-year term. We would like to extend our thanks and appreciation to Simon for his time, active engagement and the experience that he brought to the organisation. New Trustees are recruited through a formal process which includes external advertising of the vacancy, written applications, and formal interviews with current Trustees and the Chief Executive. Following appointment, new Trustees undertake an induction process which covers their formal and informal roles and responsibilities as Trustees and gives a detailed introduction to the aims and work of the organisation.

Good governance is supported through a suite of policies and procedures which are reviewed on an annual or biennial basis. Within this period, a number of policies and procedures were reviewed and amended to ensure they were fit for purpose.

Amref Health Africa UK

Pay Policy for Senior Staff

The Board of Trustees, together with the Senior Management Team, make up the key management personnel of the Charity. Trustees give their time freely and details of any expenses and related party transactions are disclosed in the Notes to the Accounts.

Remuneration of all staff including the Senior Management Team follows a clear policy which aims to find a balance between attracting and rewarding our staff for their incredible contribution and ensuring that we are financially responsible with the funding from our donors and supporters. Market data is considered for each individual position to ensure that each salary is set to within the acceptable range around the market median as set out in the policy. A percentage increase was applied across all salaries with effect from 1 January 2023 with a one-off discretionary payment being made to eligible staff below manager level at the start of the year in recognition of the pressures faced by our staff during the ongoing cost-of-living crisis.

Risk Management Statement

A robust risk management process is underpinned by a quarterly review using a Risk Register approach, involving staff and Trustees, which ensures the monitoring of all risks and identifies those material risks worthy of closer scrutiny. The Board delegates specific responsibility for risk management and mitigation to executive staff.

Principal Risks and Uncertainties

The principal risks for the Charity relate to our planned investment in Individual Giving with a view to enhancing the level of regular, unrestricted income generated in the medium to longer term as well as the payment-by-results contract in which we are a sub-contractor within a consortium delivering The Girl Generation: Support to the African-Led Movement to End Female Genital Mutilation / Cutting (FGM/C) programme, funded by the UK Government’s Foreign, Commonwealth and Development Office (FCDO). Whilst this brings a great opportunity for Amref UK and the global Amref family, the inherent nature of such arrangements raises risks regarding unrestricted cashflow management with the need to pre-finance activities and the need to achieve specified milestones and performance levels in order to receive payment in full and as scheduled. Our unrestricted cashflow in particular continues to be monitored extremely carefully.

More generally, the competitiveness of the external funding environment and the resultant pressure on income, particularly unrestricted, is a continued area of risk and uncertainty (as it is for our peers across the UK charity sector). Fundraising from the public, be it mass volume or high-value, is very competitive. Our focus on Trusts and Foundations continues to bring in significant income and as mentioned in the Income Generation section above, there will be continued focus on and investment in developing the Individual Giving and Major Giving income streams in 2024.

Amref Health Africa UK

GSK continues to be a much-valued partner with £2.6 million income recorded in 2023 which equated to 41% of total income. On the face of it, this would seem to indicate a high-risk reliance on GSK as a funder. However, the majority of GSK funding is transferred to the implementing Country Offices, with the element retained by Amref UK to cover programme-related UK costs the more relevant in terms of Amref UK financial exposure. £91,000 of GSK funding was retained by Amref UK in 2023 for related programme costs which equated to 1% of the total income recorded and 7% of total income retained in the UK for UK costs. Decisions around programmatic strategic direction as well as the design and delivery of individual programmes are made at Amref Health Africa HQ and Country Offices by skilled and experienced staff (including health / medical professionals) and are not influenced by GSK hence ensuring autonomy of decision-making by suitably qualified personnel separate to and independent of GSK.

Recruitment, retention and motivation of staff continues to be a key risk against a backdrop of prolonged uncertainty in the world beyond Amref UK. We seek to mitigate this through a culture of staff engagement and development, an emphasis on staff wellbeing, and by ensuring that we are paying the market rate to our people – along with competitive benefits. The work around our commitment to anti-racist values continued into 2023. We know this is a journey of ongoing learning, and we are committed to taking forward the recommendations from our Anti-Racism Review (made in 2022) in the development of our strategy, workplans, budgets and personal development plans. We have also retained a hybrid-working approach which is reaping benefits with the flexibility it offers staff. This also prompted a review of the office space we need as an organisation and the decision was taken in 2022 to relocate in March 2023 to a more flexible, shared working environment. This also has the benefit of delivering better value for money which is aligned with the continuous monitoring of our unrestricted expenditure base against a backdrop of economic uncertainty and high levels of inflation.

Amref UK continues to prioritise safeguarding as an essential part of our work. Risks regarding safeguarding are mitigated by the adoption of best practice policies, mandatory staff and contractor safeguarding training, the appointment of a Trustee safeguarding lead, and regular risk monitoring, including within our work in Africa. We continue to engage with Bond to ensure that we are informed by best practice in the sector.

We continue to monitor risks about the protection of data, in line with the General Data Protection Regulation (GDPR). The main risk identified is that the organisation might inadvertently store data about donors, and the Supporter Engagement team rigorously monitor their systems and records to ensure that no unnecessary or prohibited data is stored.

As the UK office of an African NGO, we are responsible for ensuring that funds sent to our HQ in Nairobi for onward transmission to African country offices are spent well and reported against. We mitigate the risks associated with this through formal agreements with other Amref Health Africa offices, robust internal processes, and regular contact with colleagues across the Amref Health Africa family, including support and monitoring visits by UK staff to the actual programmes.

Amref Health Africa UK

Statement of Trustees’ Responsibilities

The Trustees (who are also Directors of Amref Health Africa UK for the purposes of company law) are responsible for preparing the Trustees’ Annual Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice).

Company law requires the Trustees to prepare financial statements for each financial year, which give a true and fair view of the state of affairs of the charitable company and of the income and expenditure of the charitable company for that period. In preparing these financial statements, the Trustees are required to:

Select suitable accounting policies and then apply them consistently;
observe the methods and principles in 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);
Make judgements and estimates that are reasonable and prudent;
State whether applicable UK Accounting Standards, including FRS 102, have been followed, subject to any material departures disclosed and explained in the financial statements;
Prepare the financial statements on the going concern basis unless it is inappropriate to presume that the charitable company will continue in operation.

The Trustees have overall responsibility for ensuring that the Charity has an appropriate system of controls, financial and otherwise.

The Trustees are also responsible for keeping proper accounting records that disclose with reasonable accuracy and are sufficient to show and explain the Charity’s transactions and the financial position of the Charity at any time to enable the Board members to ensure that the financial statements comply with the Companies Act 2006. They are also responsible for safeguarding the assets of the charitable company and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

In so far as the Trustees are aware:

There is no relevant audit information of which the charitable company’s auditor is unaware;
The Trustees have taken all steps that they ought to have taken to make themselves aware of any relevant audit information and to establish that the auditor is aware of that information.

This confirmation is given and should be interpreted in accordance with the provisions of s418 of the Companies Act 2006.

This report was approved and authorised for issue by the Board of Trustees on 30 May 2024 and signed on its behalf by:

Mr Paul Davey, Chair of the Board of Trustees

Amref Health Africa UK

Independent Auditor’s Report to the Members of Amref Health Africa

Opinion

We have audited the financial statements of the Amref Health Africa (the ‘charitable company’) for the year ended 31 December 2023 which comprise the statement of financial activities, the balance sheet, and statement of cash flows, the principal accounting policies and the notes to the financial statements. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102 ‘The Financial Reporting Standard applicable in the UK and Republic of Ireland’ (United Kingdom Generally Accepted Accounting Practice).

In our opinion, the financial statements:

give a true and fair view of the state of the charitable company’s affairs as at 31 December 2023 and of its income and expenditure for the year then ended;
have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice; 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 under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of our report. We are independent of the charitable company in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK, including the FRC’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion.

Conclusions relating to going concern

In auditing the financial statements, we have concluded that the trustees’ use of the going concern basis of accounting in the preparation of the financial statements is appropriate.

Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the charitable company’s ability to continue as a going concern for a period of at least twelve months from when the financial statements are authorised for issue.

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

Amref Health Africa UK

Other information

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

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

We have nothing to report in this regard.

Opinions on other matters prescribed by the Companies Act 2006

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

the information given in the trustees’ report, which is also the directors’ report for the purposes of company law, for the financial year for which the financial statements are prepared is consistent with the financial statements; and
the trustees’ report, which is also the directors’ report for the purposes of company law, has been prepared in accordance with applicable legal requirements.

Matters on which we are required to report by exception

In the light of the knowledge and understanding of the charitable company and its environment obtained in the course of the audit, we have not identified material misstatements in the trustees’ report. We have nothing to report in respect of the following matters in relation to which the Companies Act 2006 requires us to report to you if, in our opinion:

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 prepare the financial statements in accordance with the small companies regime and take advantage of the small companies’ exemptions in preparing the trustees’ report and from the requirement to prepare a strategic report.

Amref Health Africa UK

Responsibilities of trustees

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

In preparing the financial statements, the trustees are responsible for assessing the charitable company’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless the trustees either intend to liquidate the charitable company or to cease operations, or have no realistic alternative but to do so.

Auditor’s responsibilities for the audit of the financial statements

Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements.

Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, outlined above, to detect material misstatements in respect of irregularities, including fraud. The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below:

How the audit was considered capable of detecting irregularities including fraud

Our approach to identifying and assessing the risks of material misstatement in respect of irregularities, including fraud and non-compliance with laws and regulations, was as follows:

the engagement partner ensured that the engagement team collectively had the appropriate competence, capabilities and skills to identify or recognise non-compliance with applicable laws and regulations;
we identified the laws and regulations applicable to the charitable company through discussions with management, and from our commercial knowledge and experience of the sector;
we focused on specific laws and regulations which we considered may have a direct material effect on the financial statements or the operations of the charitable company, including the Charities Act 2011, Companies Act 2006, data protection legislation, anti-bribery, employment, safeguarding principles and health and safety legislation;
we assessed the extent of compliance with the laws and regulations identified above through making enquiries of management and inspecting legal correspondence; and
identified laws and regulations were communicated within the audit team regularly and the team remained alert to instances of non-compliance throughout the audit.

Amref Health Africa UK

We assessed the susceptibility of the company’s financial statements to material misstatement, including obtaining an understanding of how fraud might occur, by:

making enquiries of management as to where they considered there was susceptibility to fraud, their knowledge of actual, suspected and alleged fraud; and
considering the internal controls in place to mitigate risks of fraud and non-compliance with laws and regulations.

To address the risk of fraud through management bias and override of controls, we:

performed analytical procedures to identify any unusual or unexpected relationships;
tested journal entries to identify unusual transactions;
assessed whether judgements and assumptions made in determining the accounting estimates set out in the accounting policies (note 1a) were indicative of potential bias; and
used data analytics to identify any significant or unusual transactions and identify the rationale for them.

In response to the risk of irregularities and non-compliance with laws and regulations, we designed procedures which included, but were not limited to:

agreeing financial statement disclosures to underlying supporting documentation;
reading the minutes of trustee meetings;
enquiring of management as to actual and potential litigation and claims; and
reviewing any available correspondence with HMRC and the company’s legal advisors (although none was noted as being received by the charitable company).

There are inherent limitations in our audit procedures described above. The more removed that laws and regulations are from financial transactions, the less likely it is that we would become aware of non-compliance. Auditing standards also limit the audit procedures required to identify noncompliance with laws and regulations to enquiry of the directors and other management and the inspection of regulatory and legal correspondence, if any.

Material misstatements that arise due to fraud can be harder to detect than those that arise from error as they may involve deliberate concealment or collusion.

A further description of our responsibilities is available on the Financial Reporting Council’s website at www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report.

Amref Health Africa UK

Use of our report

This report is made solely to the charitable company’s members, as a body, in accordance with Chapter 3 of Part 16 of the Companies Act 2006. Our audit work has been undertaken so that we might state to the charitable company's members those matters we are required to state to them in an auditor's report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the charitable company and the charitable company's members as a body, for our audit work, for this report, or for the opinions we have formed.

Hugh Swainson (Senior Statutory Auditor) For and on behalf of Buzzacott LLP, Statutory Auditor 130 Wood Street London EC2V 6DL

03 June 2024

Amref Health Africa UK

Statement of financial activities (including income and expenditure account) Year to 31 December 2023

Notes	2023			2022
	Unrestricted fund £	Restricted funds £	Total £	Unrestricted fund £	Restricted funds £	Total £
Income from: Donations and legacies 1 Charitable activities 2 Other trading activities Investments Other income Total Expenditure on: Raising funds 3 Charitable activities 3 Total Net income and net movement in funds Transfers between funds 15 Net movement in funds after transfers Total funds brought forward Total funds carried forward 15	869,448 1,041,729 42 48,794 —	230,366 4,284,468 — — 3	1,099,814 5,326,197 42 48,794 3	531,771 543,664 1,171 1,548 7,737	575,949 3,443,481 — — 11	1,107,720 3,987,145 1,171 1,548 7,748
	1,960,013	4,514,837	6,474,850	1,085,891	4,019,441	5,105,332
	385,431 1,312,140	237,467 2,905,032	622,898 4,217,172	330,958 638,527	157,703 3,325,173	488,661 3,963,700
	1,697,571	3,142,499	4,840,070	969,485	3,482,876	4,452,361
	262,442 —	1,372,338 —	1,634,780 —	116,406 6,000	536,565 (6,000)	652,971 —
	262,442 1,097,438	1,372,338 2,537,012	1,634,780 3,634,450	122,406 975,032	530,565 2,006,447	652,971 2,981,479
	1,359,880	3,909,350	5,269,230	1,097,438	2,537,012	3,634,450

All income and expenditure derives from continuing activities.

The statement of financial activities includes all gains and losses recognised during the year.

The notes on pages 40 to 49 form part of these financial statements.

Amref Health Africa UK

Balance sheet 31 December 2023

Notes	2023 £	2023 £	2022 £	2022 £
Fixed assets Tangible fixed assets 8 Current assets Debtors 9 Current asset investments Cash at bank and in hand Liabilities Creditors: amounts falling due within one year 10a Net current assets Total assets less current liabilities Creditors: amounts falling due after more than one year 10b Net assets Funds Unrestricted fund – general 15 Unrestricted fund – designated 15 Restricted funds 15 Total funds	394,411 500,000 5,528,778	14,338	629,955 — 4,080,072	11,525
		5,459,892		3,827,925
	6,423,189 (963,297)		4,710,027 (882,102)
	1,159,880 200,000 3,909,350		1,097,438 — 2,537,012
		5,474,230 (205,000)		3,839,450 (205,000)
		5,269,230		3,634,450
		5,269,230		3,634,450

The financial statements were approved by the Trustees and authorised for issue on 30 May 2024 and signed on their behalf by:

Paul Davey, Chair

Company number: 00982544

The notes on pages 40 to 49 form part of these financial statements.

Amref Health Africa UK

Statement of cash flows Year to 31 December 2023

Note	2023 £	2022 £
Net cash inflow from operating activities A Cash flows from investing activities Interest income Purchase of tangible fixed assets Disposal of tangible fixed assets Purchase of current asset investments Net cash flow (used in) investing activities Change in cash and cash equivalents in the year Reconciliation of net cash flow to movement in net funds: Cash and cash equivalents at beginning of year Cash and cash equivalents at end ofyear	1,908,649 48,794 (9,300) 563 (500,000)	418,200 1,548 (8,874) 1,078 —
	(459,943)	(6,248)

	1,448,706	411,952
	4,080,072	3,668,120
	5,528,778	4,080,072

A Reconciliation of net movement in funds to net cash flow from operating activities

	2023	2022
	£	£
Net movement in funds (as per statement of financial activities)	1,634,780	652,971
Adjustments for:
Depreciation charge	5,924	4,477
Interest income	(48,794)	(1,548)
Decrease / (increase) in debtors	235,544	(274,706)
Increase in creditors	81,195	37,006
Net cashprovided by operating activities	1,908,649	418,200

B Analysis of changes in net debt

	At 1 January 2023 £ 4,080,072 (205,000) 3,875,072	Cash flows £	At 31 December 2023 £
Cash and cash equivalents Cash at bank and in hand Borrowings Debt due after one year Total		1,448,706 —	5,528,778 (205,000)
		1,448,706	5,323,778

Amref Health Africa UK

Principal accounting policies 31 December 2023

General information and basis of preparation

Amref Health Africa is a company limited by guarantee registered in England. In the event of the charity being wound up, the liability in respect of the guarantee is limited to £10 per member of the charity. The address of the registered office is given in the charity information on page 3 of these financial statements. The nature of the charity’s operations and principal activities are to engage, inspire, and influence people to invest in lasting health change across Africa.

The charity constitutes a public benefit entity as defined by FRS 102. The financial statements have been prepared in accordance with Accounting and Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK and Republic of Ireland (Charities SORP (FRS 102)), the Charities Act 2011 and the Companies Act 2006 and UK Generally Accepted Practice.

The financial statements are prepared on a going concern basis under the historical cost convention, modified to include certain items at fair value. The financial statements are presented in sterling which is the functional currency of the charity, and rounded to the nearest pound.

The significant accounting policies applied in the preparation of these financial statements are set out below. These policies have been consistently applied to all years presented unless otherwise stated.

Critical accounting estimates and areas of judgement

Preparation of the financial statements requires the trustees and senior management to make significant judgements and estimates.

The items in the financial statements where these judgements and estimates have been made include:

the estimation of the useful economic life of tangible fixed assets;
the estimation of the amount receivable in respect of legacies where the charity has been notified of its entitlement; and
the estimation of the amounts recognised as donated goods or services as gift in kind income;
the basis on which the support costs are allocated across the various categories of charitable expenditure.

Going concern

The financial statements have been prepared on a going concern basis as the Trustees believe that no material uncertainties exist. The Trustees have considered the expected level of income and expenditure for 12 months from authorising these financial statements. The projected income and expenditure is sufficient with the level of reserves for the charity to be able to continue as a going concern.

Amref Health Africa UK

Principal accounting policies 31 December 2023

Income recognition

All income is included in the Statement of Financial Activities (SoFA) when the charity is legally entitled to the income after any performance conditions have been met, the amount can be measured reliably and it is probable that the income will be received.

Donations and legacies

For donations to be recognised the charity will have been notified of the amounts and the settlement date in writing. If there are conditions attached to the donation and this requires a level of performance before entitlement can be obtained then income is deferred until those conditions are fully met or the fulfilment of those conditions is within the control of the charity and it is probable that they will be fulfilled. For legacies, income is recognised upon receipt, or before receipt if there is sufficient evidence to provide the necessary certainty that the legacy will be received and the value of the income can be measured with sufficient certainty.

Gifts in Kind

Donated facilities and donated professional services (Gifts in Kind) which the Charity would otherwise have purchased are recognised in income at their fair value when their economic benefit is probable, it can be measured reliably and the charity has control over the item. Fair value is determined on the basis of the value of the gift to the charity; that is the amount the charity would be willing to pay in the open market for the equivalent benefit of such facilities and services. A corresponding amount is recognised in expenditure. A threshold of £500 is applied for each facility or service.

No amount is included in the financial statements for volunteer time in line with the Charities SORP (FRS 102).

Charitable activities

Income from charitable activities includes income earned both from the supply of goods and services under contractual arrangements and from performance-related grants which have conditions that specify the provision of particular goods or services to be provided by the charity. The contracts or performance-related grants have been included as “Income from charitable activities” where these contracts or grants specifically outline the good and services to be provided to the communities we partner which are within the charitable purposes of the charity.

For performance-related grants, where there are no donor-imposed conditions (e.g. in respect of fee-related measurable outputs or the time period over which expenditure of resources can take place) or if there is sufficient precedent for the charity to assume that the funder in question is likely to approve the reallocation of any unspent funds, income is recognised upon receipt. Where performance conditions including time-related conditions exist, income from such grants is recognised when the charity deems the entitlement criteria is satisfied, which is typically based on the extent of confirmed programme delivery. As such, expenditure incurred to date is seen to be the most reasonable estimate or approximation of the charity's performance and therefore income entitlement. In this case, cash received in excess of expenditure is included as a creditor (deferred income) and expenditure in excess of cash received is included as a debtor (as accrued income).

Amref Health Africa UK

Principal accounting policies 31 December 2023

Income recognition (continued)

The charity receives government contract income in respect of its charitable work. Due to its nature, this income is classified as unrestricted and is subject to VAT. There are payment-byresults elements within the contract. Contract income is only recognised when the charity has entitlement and the payment-by-results related income is only recognised once the specific criteria have been met and approved as such by the funder.

Trading activities

Income from trading activities relates to income earned from trading activities to raise funds for the charity. Income is received in exchange for supplying goods and services in order to raise funds and is recognised when entitlement has occurred.

Other income

Other unrestricted income includes gains arising from foreign exchange transactions which do not relate to restricted funds. Any material unrealised foreign exchange gains are included below net income and realised gains are included within other income.

Expenditure recognition

Expenditure is accounted for on an accruals basis with the exception of expenditure transactions below £500. Expenditure has been classified under headings that aggregate all costs related to the category. Expenditure is recognised where there is a legal or constructive obligation to make payments to third parties, it is probable that the settlement will be required and the amount of the obligation can be measured reliably. It is categorised under the following headings:

Costs of raising funds includes those costs incurred in seeking potential funders and applying for funding.
Expenditure on charitable activities includes granting funds to Amref HQ in respect of our charitable work, and our own associated costs. Where there is sufficient precedent for the charity to assume that the funder in question is likely to approve the reallocation of any unspent funds, grant expenditure is recognised upon payment. Where this precedent does not exist, grant expenditure is recognised once the transferred funds have been spent on the specified programme.

Irrecoverable VAT is charged as an expense against the activity for which expenditure arose.

Support costs allocation

Support costs are those that assist the work of the charity but do not directly represent charitable activities and include office costs, governance costs and administrative costs. They are incurred directly in support of expenditure on the objects of the charity. Where support costs cannot be directly attributed to particular headings they have been allocated to Costs of Raising Funds and Expenditure on Charitable Activities on a basis consistent with use of the resources. Overheads have been allocated on the basis of staff time. The analysis of these costs is included in note 4.

Funds

Unrestricted funds are available for use at the discretion of the Trustees in furtherance of the general objectives of the charity and which have not been designated for other purposes.

Amref Health Africa UK

Principal accounting policies 31 December 2023

Designated funds comprise unrestricted funds that have been set aside by the Trustees for particular purposes. The aim and use of each designated fund is set out in the notes to the financial statements.

Restricted funds are funds which are to be used in accordance with specific restrictions imposed by donors or which have been raised by the charity for particular purposes. A summary of restricted funds by geographical area is set out in the notes to the financial statements.

Transfers between funds take place in accordance with funding agreements or with the express permission of the funder.

Tangible fixed assets

Tangible fixed assets costing less than £500 are not capitalised and are written off in the year of purchase. Tangible fixed assets which are capitalised are stated at cost (or deemed cost) or valuation less accumulated depreciation and accumulated impairment losses. Cost includes costs directly attributable to making the asset capable of operating as intended.

Depreciation is provided on all tangible fixed assets, at rates calculated to write off the cost, less estimated residual value, of each asset on a systematic basis over its expected useful life which for equipment and computers is three years.

Debtors

Debtors are recognised at the settlement amount, less any provision for non-recoverability. Prepayments are valued at the amount prepaid.

Current asset investments

Current asset investments are held at fair value with movements recognised in the Statement of Financial Activities (SOFA). Any cash investment with a maturity date of more than three months but less than a year is classified as a short term deposit, whilst any cash investment with a maturity of a year or more is classified as a current asset investment.

Cash at bank and in hand

Cash at bank and in hand includes cash and short term highly liquid investments with a short maturity of three months or less from the date of acquisition or opening of the deposit or similar account.

Liabilities and provisions

Liabilities are recognised when there is an obligation at the balance sheet date as a result of a past event, it is probable that a transfer of economic benefit will be required in settlement, and the amount of the settlement can be estimated reliably. Liabilities are recognised at the amount that the charity anticipates it will pay to settle the debt or the amount it has received as advanced payments for the goods or services it must provide.

Leases

Rentals payable and receivable under operating leases are charged to the SoFA on a straight line basis over the period of the lease.

Amref Health Africa UK

Principal accounting policies 31 December 2023

Foreign currency

Foreign currency transactions are initially recognised using the monthly exchange rate.

Monetary assets and liabilities denominated in a foreign currency at the balance sheet date are translated using the closing rate. Gains and losses on exchange are allocated to the appropriate resource.

Employee benefits

When employees have rendered service to the charity, short-term employee benefits to which the employees are entitled are recognised at the undiscounted amount expected to be paid in exchange for that service.

Employee benefits (continued)

The charity operates a defined contribution plan for the benefit of its employees. Contributions are expensed as they become payable.

Tax

The charity is considered to pass the tests set out in Paragraph 1 Schedule 6 Finance Act 2010 and therefore it meets the definition of a charitable company for UK corporation tax purposes. It therefore does not suffer tax on income or gains applied for charitable purposes.

Financial instruments

The charity only holds basic Financial Instruments. The financial assets and financial liabilities of the Charity and their measurement basis are as follows:

Financial assets – trade and other debtors (including accrued legacy and gift aid income) are basic financial instruments and are debt instruments measured at amortised cost as detailed in note 9. Prepayments are not financial instruments. Amounts due from Amref HQ are held at face value less any impairment.

Cash at bank – is classified as a basic financial instrument and is measured at face value.

Financial liabilities – trade creditors, accruals and other creditors are financial instruments, and are measured at amortised cost as detailed in note 10. Taxation and social security are not included in the financial instruments disclosure. Deferred income is not deemed to be a financial liability, as the cash settlement has already taken place and there is an obligation to deliver charitable services rather than cash or another financial instrument. Amounts due to Amref HQ are held at face value less any impairment.

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

1. Income from donations and legacies

	Unrestricted funds £	Restricted funds £	2023 Total £
Individual sponsorship/event donations Individual donors Legacies Trusts and Foundations Donated services	26,095 393,969 184,264 197,120 68,000	— 33,600 11,546 185,220 —	26,095 427,569 195,810 382,340 68,000
	869,448	230,366	1,099,814

	Unrestricted funds £	Restricted funds £	2022 Total £
Individual sponsorship/event donations Individual donors Legacies Corporate donors Trusts and Foundations Donated services	22,205 394,664 3,743 5,960 100,199 5,000	— — — — 265,000 310,949	22,205 394,664 3,743 5,960 365,199 315,949
	531,771	575,949	1,107,720

2. Income from charitable activities

Income from charitable activities
	Unrestricted funds £	Restricted funds £	2023 Total £
Corporates GlaxoSmithKline ViiV Healthcare Total Corporates Governments FCDO Total Governments Other Institutional donors Comic Relief Total Other Institutional donors Trusts and Foundations Donor wishing to remain anonymous Croda Foundation People’s Postcode Lottery The Rabelais Trust The SOL Foundation Save the Children Other Trusts < £15k Total Trusts & Foundations	8,205 —	2,620,703 161,981	2,628,908 161,981
	8,205 1,033,524	2,782,684 —	2,790,889 1,033,524
	1,033,524 —	— 3,105	1,033,524 3,105
	— — — — — — — —	3,105 883,300 273,399 186,287 73,920 43,445 18,442 19,886	3,105 883,300 273,399 186,287 73,920 43,445 18,442 19,886
	—	1,498,679	1,498,679
	1,041,729	4,284,468	5,326,197

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

2. Income from charitable activities (continued)

	Unrestricted funds £	Restricted funds £	2022 Total £
*Corporates* GlaxoSmithKline ViiV Healthcare *Total Corporates* *Governments* FCDO *Total Governments* *Other Institutional donors* The National Lottery Community Fund Comic Relief *Total Other Institutional donors* *Trusts and Foundations* Donor wishing to remain anonymous Croda Foundation People’s Postcode Lottery The Rabelais Trust The Schroder Foundation The Waterloo Foundation The SOL Foundation Other Trusts < £15k *Total Trusts and Foundations*	— —	761,085 131,920	761,085 131,920
	— 543,664	893,005 —	893,005 543,664
	543,664 — —	— 210,646 5,758	543,664 210,646 5,758
	— — — — — — — — —	216,404 1,776,024 179,288 178,901 146,451 25,000 24,770 588 3,000	216,404 1,776,024 179,288 178,901 146,451 25,000 24,770 588 3,000
	—	2,334,072	2,334,072
	543,664	3,443,481	3,987,145

3. Expenditure

	Raising funds £	Charitable activities £	2023 Total £
Staff costs Direct costs Support costs	345,566 168,951 108,381	486,357 3,624,404 106,411	831,923 3,793,355 214,792
	622,898	4,217,172	4,840,070
	Raising funds £	Charitable activities £	2022 Total £
Staff costs Direct costs Support costs	305,903 87,462 95,296	456,608 3,406,297 100,795	762,511 3,493,759 196,091
	488,661	3,963,700	4,452,361

Direct costs of charitable activities are predominantly £3,521,014 (2022: £3,257,116) made up of grants remitted to Amref HQ for core objectives.

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

4. Support costs allocation

	Raising funds £	Charitable activities £	2023 Total £
Premises costs Governance costs Other office and operational costs Total	26,952 39,511 41,918	26,462 38,793 41,156	53,414 78,304 83,074
	108,381	106,411	214,792

	Raising funds £	Charitable activities £	2022 Total £
Premises costs Governance costs Other office and operational costs Total	36,292 9,360 49,644	38,386 9,900 52,509	74,678 19,260 102,153
	95,296	100,795	196,091

5. Governance costs

	2023 £	2022 £
Auditor’s remuneration – current period audit fee Auditor’s remuneration – audit fee in respect of prior years Strategy development Legal Fees on governance matters Trustee recruitment & skills analysis Other costs	17,100 — 13,247 23,114 23,000 1,843	15,480 (600) — — 2,400 1,980
	78,304	19,260

£488 was reimbursed or paid by the charity for one Trustee during the year for travel and other expenses incurred on the charity’s business (2022: £108).

6. Staff costs and numbers

The aggregate payroll costs comprised:

	2023 £	2022 £
Wages and salaries Social security costs Employer’s pension costs Other staff costs	651,966 64,992 47,190 67,775*	628,116 65,117 46,554 22,724
	831,923	762,511

*From January to October 2023, the Head of Programmes & Strategic Partnerships role was vacant but was supported by Amref Health Africa, from Nairobi, during this time. This support has been recognised as donated services within income with the corresponding expenditure reflected here as part of Other staff costs.

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

6. Staff costs and numbers (continued)

Average number of staff during the year by function:

	2023		2022
	Headcount	FTE	Headcount	FTE
Fundraising Programmes Governance and administrative support	5 6 5	4.7 5.7 3.8	5 7 6	4.2 6.2 4.6
	16	14.2	18	15.0

The employee benefits for key management personnel, who are detailed on page 3, (including employer’s National Insurance costs and pensions contributions) were £263,045 (2022: £286,014).

In the year ended 31 December 2023, there were the following number of employees with remuneration in excess of £60,000:

	2023 No.	2022 No.
£60,001 - £70,000 £80,001 - £90,000 £90,001 - £100,000	— — 1	1 1 —

During the year, no Trustee received any remuneration (2022: none).

7. Net income

Is stated after charging:

	2023 £	2022 £
Auditor’s remuneration: . Current year audit fee . Audit fee in respect of prior years Non-audit fees – taxation advice Depreciation of fixed assets Lease rentals	17,100 — 5,700 5,924 11,925	15,480 (600) 2,980 4,477 52,982

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

8. Fixed assets

Costs As at 1 January 2023 Additions Disposals As at 31 December 2023 Depreciation As at 1 January 2023 Charge during the year Disposals As at 31 December 2023 Net book value As at 1 January 2023 As at 31 December 2023	Equipment and computers £
	82,989 9,300 (58,598)
	33,691
	71,464 5,924 (58,035)
	19,353
	11,525
	14,338

9. Debtors

	2023 £	2022 £ 315,408 128,936 7,080 178,531 629,955
Trade debtors Accrued income Prepayments and other debtors Amounts due from Amref HQ	164,022 178,701 20,295 31,393
	394,411

10.a Creditors: amounts falling due within one year

	2023 £	2022 £ 799 53,644 253,078 46,487 523,294 4,800 882,102 613,058 (613,058) 523,294 523,294
Trade creditors Taxation and social security Amounts due to Amref HQ Accruals and other creditors Deferred income Leasing liability Deferred income Balance brought forward as at 1 January 2023 Released in the year Income received and deferred in the year Balance carried forward as at 31 December 2023	3,022 66,205 183,774 60,482 649,814 —
	963,297
	523,294 (523,294) 649,814
	649,814

Deferred income relates to grant income received before the year-end for programme delivery in 2024 and beyond.

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

10.b Creditors: amounts falling due after more than one year

Loan from Amref NL*	2023 £	2022 £
	205,000	205,000
	205,000	205,000

*This loan is interest-free and is due for repayment on 31 March 2026. The loan is to be used exclusively for pre-financing the delivery of the “Support to the African Led Movement to End FGM/C” programme.

11. Reconciliation of funds

Reconciliation of funds
	Unrestricted		Restricted funds £	2023 £
	General	Designated
	funds £	funds £
Analysis of reserves Tangible fixed assets Net current assets Creditors of more than one year	14,338 1,350,542 (205,000)	— 200,000 —	— 3,909,350 —	14,338 5,459,892 (205,000)
	1,159,880	200,000	3,909,350	5,269,230

	Unrestricted		Restricted funds £	2022 £
	General	Designated
	funds £	funds £
Analysis of reserves Tangible fixed assets Net current assets Creditors of more than one year	11,525 1,290,913 (205,000)	— — —	— 2,537,012 —	11,525 3,827,925 (205,000)
	1,097,438	—	2,537,012	3,634,450

During the period, our reserves calculations were updated in line with our policy as detailed in the Trustees’ report. The closing level of unrestricted free reserves is within target range. £200,000 of unrestricted funds has been ringfenced within a designated fund as at 31 December 2023 to ensure sufficient funds are available for the Individual Giving investment in future years. Further information is provided in the Trustees’ Annual Report.

The closing level of restricted reserves reflects the timing of grant receipts compared to their disbursement to Amref HQ in Nairobi.

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

12. Capital and financial commitments

At 31 December 2023, the charity committed to subscribe to a London Marathon Golden Bond during the next year at £1,980 per annum including VAT (2022: £1,980).

At 31 December 2023 the Charity had future minimum lease payments under noncancellable operating leases due in the periods below as follows:

	2023		2022
	Leasehold		Leasehold property £	Equipment £
	property £	Equipment £
Within one year Between two to fiveyears	— —	2,274 4,864	11,767 —	2,115 6,640

In March 2023, the charity relocated from its former leased property at Lower Ground Floor, White Lion Street, London, N1 9PD to 7-14 Great Dover Street, London, SE1 4YR.

A license to occupy agreement for shared office space within the building at 7-14 Great Dover Street, London, SE1 4YR was signed in January 2023 and took effect from 1 March 2023. The license agreement can be terminated with three months written notice and the license fee is to be reviewed on an annual basis. This arrangement is not considered to constitute an operating lease.

Lease payments of £11,925 (2022: £52,982) have been recognised as an expense.

There are no contingent liabilities at the end of December 2023.

13. Liability of Members

At 31 December 2023 the charity had 7 members (2022: 8 members). The liability of each member to contribute to the assets of the charity in the event of winding up is limited to £10.

14. Related party transactions

a) Amref Health Africa (“Amref UK”) is a national office of the Amref global network, coordinated through a company of the same name based in Nairobi, Kenya (“Amref HQ”).

The arrangement between the two organisations, and the responsibilities of both organisations, is summarised in a written Association Agreement signed by both parties. This does not supersede the respective autonomy of each organisation.

Paul Davey, Chair of Amref UK, also sits on the Amref HQ Board of Trustees.

From January to October 2023, the Head of Programmes & Strategic Partnerships role was vacant but was supported by Amref Health Africa, from Nairobi, during this time. This support has been recognised as donated services valued at £51,000 within income with the corresponding expenditure reflected within Other staff costs.

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

14. Related party transactions (continued)

The transactions with Amref HQ were as follows:

	2023 £	2022 £
Net balances due (from) / to Amref UK at the start of the year Grants and other payments payable from Amref UK to Amref HQ in the year Net payments made from Amref UK to Amref HQ Net balances due from Amref UK at the end of theyear	(74,547) (3,521,014) 3,443,180	55,438 (3,257,116) 3,127,131
	(152,381)	(74,547)

b) In 2021, Amref UK received a loan of £205,000 from Amref NL. The loan is on an interestfree basis and is for a 5 year period, payable by 31 March 2026. The loan arrangement is in place to support Amref UK’s management of unrestricted cashflow in light of the prefinancing requirements of the contract funding by FCDO.
c) During the year, £nil (2022: £174) was spent on coffee beans with Capital Coffee Roasters Ltd., a company owned by the parents of one of the Key Management Personnel (until August 2022). There was no balance due at the year end. Amref UK has also entered into a loan agreement without charge with this company for the provision of a coffee machine. However, this arrangement came to an end in March 2023.
d) Donations from related parties
£4,745 of donations were recorded from 7 Key Management Personnel, Trustees and their connected entities in the year (£2,809 from 8 Trustees and KMP in 2022).

15. Funds

The income of the charity includes both restricted and unrestricted funds. The table below summarises the funds balances held at 31 December 2023.

	1 January 2023 £	Income £	Expenditure £	Transfers* £	31 December 2023 £**
Restricted Ethiopia Kenya Tanzania Uganda Amref HQ & regional work UK office Malawi Unrestricted General Designated *Total	3,516 44,342 728,044 1,610,118 45,992 105,000 —	761,981 521,078 397,171 523,893 2,053,373 192,820 64,521	(587,646) (521,078) (558,053) (1,078,516) (85,654) (247,031) (64,521)	(3,516) (32,687) — — 36,203 — —	174,335 11,655 567,162 1,055,495 2,049,914 50,789 —
	2,537,012	4,514,837	(3,142,499)	—	3,909,350
	1,097,438 —	1,960,013 —	(1,611,265) (86,306)	(286,306) 286,306	1,159,880 200,000
	1,097,438	1,960,013	(1,697,571)	—	1,359,880

	3,634,450	6,474,850	(4,840,070)	—	5,269,230

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

15. Funds (continued)

Details of the programmes delivered in the year under our four thematic areas can be found in the table on page 9 of the Trustees’ Annual Report.

*The transfer of funds within restricted funds relates to an agreement reached with GSK to reassign and repurpose some funding received in previous financial years for the TB & Malaria programme in Ethiopia and Kenya to support Amref HQ and regional work.

**The year-on-year increase in restricted funds held, particularly pertaining to Amref HQ and regional work, relates to programmes where funds were received and recognised just before 31 December 2023 which are to be spent in the following year.

*** Designated Fund relates to the Individual Giving Growth Designated Fund (IGGDF) created in 2023 to support planned investment in individual giving acquisition.

	1 January 2022 £	Income £	Expenditure £	Transfers* £	31 December 2022** £
Restricted Ethiopia Kenya Tanzania Uganda Amref HQ & regional work UK office Malawi *Unrestricted* General Total	400,000 239,046 — 1,260,354 107,047 — —	131,920 697,038 939,164 1,251,625 525,034 290,000 184,660	(528,404) (886,742) (211,120) (901,861) (586,089) (184,000) (184,660)	— (5,000) — — — (1,000) —	3,516 44,342 728,044 1,610,118 45,992 105,000 —
	2,006,447	4,019,441	(3,482,876)	(6,000)	2,537,012
	975,032	1,085,891	(969,485)	6,000	1,097,438
	975,032	1,085,891	(969,485)	6,000	1,097,438

	2,981,479	5,105,332	(4,452,361)	—	3,634,450

*The charity has reassessed the purpose of funding and this presentation better presents the way in which the charity is able to use the funds.

**The year-on-year increase in restricted funds held, particularly pertaining to Tanzania and Uganda, relates to programmes where funds were received and recognised just before 31 December 2022 to be spent in the following year.

Amref Health Africa UK

Notes to the financial statements Year to 31 December 2023

16. Support to the African-Led Movement to End Female Genital Mutilation / Cutting (FGM/C) funded by UK Government (FCDO)

In accordance with the contract between Amref UK and Options Consultancy Services Ltd for the Support to the African-Led Movement to End Female Genital Mutilation / Cutting (FGM/C) programme funded by the UK Government (FCDO), the following note has been included. The note shows the amounts due to Amref UK in relation to the programme which form part of the trade debtor and accrued income balances in Note 9 as well as the claimable amounts arising and payments received during the year (including VAT where applicable). The VAT elements are included here as part of the total amounts claimed from Options Consultancy Services Ltd and due to Amref UK. The income recognised in Note 2 from FCDO in relation to this programme does not include these VAT elements are they are not considered to be recognisable as such.

	2023 £	2022 £
Balances due to Amref UK at the start of the year Claimable amounts incurred by Amref UK in the year Payments received by Amref UK in the year Balances due to Amref UK at the end of theyear	391,720 1,235,706 (1,347,854)	102,419 656,920 (367,619)
	279,572	391,720

Amref Health Africa UK

Contents

Reference and Administrative Details

Board of Trustees:

Internal Key Management Personnel:

Company Secretary: Ms Helen Blake

Charity Number: 261488

Company Number: 00982544

Registered Office

Bankers

C Hoare & Co

Barclays Bank

CCLA

Auditors

Buzzacott LLP, Chartered Accountants

Trustees’ Annual Report for the year ended 31st December 2023

Who we are

Amref Health Africa UK

Strategic Focus and Objectives

Statement on Public Benefit

Our Achievements

Programme Development and Strategic Partnerships

Sports for Health: Phase 2

In partnership with: People’s Postcode Lottery and The SOL Foundation

Areas of activity: Adolescent SRHR

In partnership with: Donor wishing to remain anonymous

Areas of activity: WASH and Family and Reproductive Health (SRHR)

Emergency Response for Nutrition and WASH in Somali, Ethiopia

In partnership with: GSK

Areas of activity: Maternal, Newborn and Child Health, Nutrition

Our Achievements

Income Generation

Approach and Stewardship

Supporting Income Generation through Communications and Advocacy

Income from Donations and Legacies

Income from Charitable Activities

Financial Review

Reserves Policy

Going Concern

Investments

Related Party Transactions

Structure, Governance, and Management Constitution and Governing Documents

Governance

Pay Policy for Senior Staff

Risk Management Statement

Principal Risks and Uncertainties

Statement of Trustees’ Responsibilities

Mr Paul Davey, Chair of the Board of Trustees

Independent Auditor’s Report to the Members of Amref Health Africa

Opinion

Basis for opinion

Conclusions relating to going concern

Other information

Opinions on other matters prescribed by the Companies Act 2006

Matters on which we are required to report by exception

Responsibilities of trustees

Auditor’s responsibilities for the audit of the financial statements

How the audit was considered capable of detecting irregularities including fraud

Use of our report

Balance sheet 31 December 2023

Paul Davey, Chair

Statement of cash flows Year to 31 December 2023

A Reconciliation of net movement in funds to net cash flow from operating activities

B Analysis of changes in net debt

General information and basis of preparation

Critical accounting estimates and areas of judgement

Going concern

Income recognition

Donations and legacies

Gifts in Kind

Charitable activities

Income recognition (continued)

Trading activities

Other income

Expenditure recognition

Support costs allocation

Funds

Tangible fixed assets

Debtors

Current asset investments