2021-03-31-accounts

Annual Report and Accounts 2020-21

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Contents

Contents
	PAGE
Foundation Information	2
Trustees’ Annual Report	3
Independent Auditors’ Report	42
Consolidated Statement of Financial Activities	45
Balance Sheet	46
Notes to the Accounts	48
How will you make your IMPACT?	57

1 The IMPACT Foundation is a registered charity and a company without share capital limited by guarantee

Foundation Information

Trustees who are Directors:

Lady Wilson, OBE, FRCOphth (Hon) Honorary President Brenda Luck, MB, Ch.B, DHC, DRCOG, MRCGP Chair John Scott Vice-Chair Rob West, BA (Hons) Vice-Chair Robin d’O. Hope Honorary Treasurer

Nicholas Astbury FRCS, FRCOphth, FRCP Keith Barnard-Jones, MBBS, MRCS, LRCP, D.Obst.RCOG, MRCGP Gordon Bennett, LL.B (Hons), LL.M, Dip Int Law Claire Hicks, MBE David Jameson Evans, FRCS, FRCS (C) John Mowbray, QC Michael O’Connell, MB, BS, BSc, MPhil, FRCS (Otol), FRCS (Orl) Lady Prance Sal Rassam MB BCh BAO LRCSI LRCPI DTM, DO MD FRCOphth Vinit Shah, MBBS, MRCP, FRCPCH David Walker, CMG, CVO Peter Webster, MA, FCA

Senior Management Team: Judi Stagg Chief Executive/Company Secretary Sarah Smith Deputy Chief Executive Pascale Noel Funding and Development Director Registered Office: 151 Western Road Auditors: Carter Nicholls Haywards Heath Victoria House West Sussex Stanbridge Park RH16 3LH Staplefield Lane Telephone: [phone] Staplefield, Haywards Heath Email: [e-mail] West Sussex RH17 6AS Bankers: Barclays Bank plc Legal Colemans Solicitors 77 South Road Advisors: Paddockhall Chambers Haywards Heath Paddockhall Road West Sussex Haywards Heath RH16 4LB West Sussex RH16 1HF

Charity Number: 290992 Company Number: 1878297

The IMPACT Foundation is a registered charity and a company without share capital limited by guarantee

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Trustees’ Annual Report (Incorporating the Directors’ Report)

A message from our Chair

The past year has of course been dominated by the Covid-19 pandemic. The IMPACT team in Haywards Heath is always in close contact with our partners around the world and when the pandemic hit this enabled us to offer assistance rapidly, with particular emphasis on safe water and hygiene measures.

PPE, soap, disinfectant and medical equipment has been provided for health workers and food parcels delivered to desperate families whose income disappeared without warning in lockdowns.

At home in Sussex, the Tasty Team soon developed imaginative online ways to continue delivering healthy eating skills and hand-delivered more than 5,500 meals to people at risk of food poverty. IMPACT remains ready to assist, including with vaccination programmes if required.

Judi and the team immediately adapted to the new situation, setting up working from home and initiating a successful Covid-19 appeal to fund the urgent need for help and additional costs of delivering healthcare around the world.

Brenda was a GP partner in rural South Staffordshire from 1980 to 2006. During a sabbatical, she spent time with the IMPACT-supported PNR Society in Bhavnagar, India, and became a trustee on her return. Brenda has visited many IMPACT programmes overseas at her own expense and took over from David Walker as IMPACT UK’s Chair in April 2020.

Fundraising has gone well despite the pandemic, thanks to the enduring generosity of our donors, including those supporters who kindly left legacies in their wills, and the efforts of IMPACT’s small staff. We are sincerely grateful to everyone who has given so selflessly during this particularly challenging time.

A highlight was the BBC Radio 4 Appeal on Sunday 28[th] February 2021. We are immensely grateful to Nadiya Hussain who presented an engaging appeal based on IMPACT’s floating hospital the Jibon Tari , her own Bangladeshi heritage and her career as a cook. We are delighted to announce that this has been the BBC’s most successful charity radio appeal since they began broadcasting them in 1923!

In the coming year we look forward to the 30[th] anniversary of IMPACT India’s Lifeline Express hospital train. Plans for a matched funding appeal, to emulate the successful appeal for the 20[th] anniversary of IMPACT Bangladesh’s Jibon Tari floating hospital, are well under way.

The Board of Trustees of IMPACT UK has also had to adapt - and has risen to the challenge of online meetings! We miss face-to-face contact but this is trivial compared with the difficulties faced by our partners and beneficiaries around the world. At a recent online meeting we were heartened by plans to expand the Nursing Institute in Bangladesh established in 2013 - a real hope for the future – among other initiatives.

The consequences of Covid-19 will continue for the foreseeable future. At the same time the pandemic has highlighted pre-existing health inequalities between and within countries. IMPACT’s commitment to the continuation of our projects in partner countries to fulfil Sir John Wilson’s vision of a world without preventable disability is undiminished.

Dr Brenda Luck Chair, IMPACT Foundation UK 20[th] April 2021

Please note: These accounts were produced remotely during the Coronavirus pandemic.

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Making an IMPACT – how & why
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This year, IMPACT has worked with 12 trusted local partners working in 11 countries of Africa and Asia, who each run their own autonomous programme of action to prevent and treat needless disability; to promote health; and, as a consequence, to alleviate poverty. We also run a successful project to promote healthy nutrition in our local community in the UK.

WHY IMPACT’S WORK IS NEEDED

 15% of the world’s people live with a disability

 8O% live in lower-income countries

 One third are children

 Most were not born disabled and live with a condition which could have been prevented or could be reversed

BREAKING THE CYCLE

Disabled people often rank among the very poorest in society and too often lack opportunities to such as education or employment; many are kept in poverty by discrimination. IMPACT’s work to prevent and treat needless disability makes a vital contribution to the alleviation of poverty.

WHERE WE WORK

AFRICA: Ethiopia, Kenya, South Sudan, Tanzania, Zanzibar

ASIA: Bangladesh, Cambodia, India, Nepal, Pakistan, Sri Lanka

EUROPE: The UK, Norway, Switzerland (raise money to support IMPACT’s partners in Africa and Asia)

HOW IMPACT BEGAN

The late Sir John Wilson (who was blind himself) founded IMPACT in 1985 as a means of empowering local communities with simple, lowcost ways of taking action today to prevent disability tomorrow. Never wanting a top-down approach, Sir John helped to establish autonomous national IMPACTs - most of them in countries of the global south. IMPACT’s projects are straightforward and cost-effective. We support community-led development to ensure that projects meet real needs and work to create long-lasting change.

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IMPACT’s vision
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IMPACT’s vision is of a world free from needless disability. We believe that no one should become or remain needlessly disabled through disease, lack of knowledge or shortage of medical services.

It is no coincidence that the vast majority of disabled people live in lower-income countries. The knowledge, technology and skills to prevent and alleviate many disabling conditions have been available for years, yet access to them is still not shared equitably between rich and poor countries, or between rich and poor people within countries. The most marginalised men, women and children too often remain needlessly disabled by conditions that could be swiftly remedied if they had equal access to healthcare. This can hinder schooling or work; limiting opportunities for a lifetime and perpetuating a cycle of poverty and poor health.

The link between disability and poverty is well-established . IMPACT’s work to prevent and treat needless disability therefore also makes a vital contribution to the alleviation of poverty.

IMPACT believes that local people are best placed to know what needs to be done in their own country and how to do it in an appropriate and cost-effective way. Supporting training and resources for local medical professionals and health workers, and sharing knowledge and skills with people who have been marginalised, overcomes cultural and language barriers and helps communities to effect sustainable change. We therefore support the work of fellow IMPACT Foundations, and other long-standing partners, to implement projects that each has designed in consultation with target communities, in order to meet specific local needs.

BANGLADESH 2020/21

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OBJECTIVES AND STRATEGY
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IMPACT UK supports trusted and long-standing local partners working in 11 countries of Africa and Asia who each run their own autonomous programme of action to prevent and treat needless disability; to promote health; and, as a consequence, to alleviate poverty. We also run a successful project to promote healthy nutrition in our local community in the UK. Our priorities for action are:

ACCESSIBLE SURGERY

Medical teams operate to restore sight, hearing or mobility – or to treat other disabling conditions and injuries, often taking surgery into remote areas

EARLY IDENTIFICATION, TREATMENT & REHABILIATION

Prevention is better than cure so health workers check people’s health and treat the early signs of needless disability. They also provide rehabilitation and assistive devices such as spectacles, hearing aids and prostheses

SAFER MOTHERHOOD & CHILD SURVIVAL

Straightforward monitoring and simple interventions such as improving nutrition can keep women and their babies safe and healthy during pregnancy, childbirth and infancy

SAFE WATER & SANITATION

Safe water and sanitation are the foundations of good health so we support installation of clean water sources and toilets in communities, and the sharing of knowledge about hygiene and sanitation

ENDING MALNUTRITION

Lack of vital vitamins and minerals is associated with disabling conditions such as visual and cognitive impairment, as well as increasing the risks during pregnancy, and compromising immunity

HEALTH EDUCATION & TRAINING

Skills and knowledge are shared with communities so they can take action to protect the health of themselves and their families

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How each country programme contributes to our objectives

How each country programme contributes to our objectives	How each country programme contributes to our objectives	How each country programme contributes to our objectives	How each country programme contributes to our objectives	How each country programme contributes to our objectives	How each country programme contributes to our objectives	How each country programme contributes to our objectives	How each country programme contributes to our objectives
	Country	Accessible surgery	Early identification, treatment & rehabilitation	Safer motherhood & child survival	Safe water & sanitation	Ending Malnutrition	Health education & training
	Bangladesh						
	Cambodia						
	India						
	Kenya						
	Nepal						
	Pakistan						
	Sri Lanka		
	Tanzania (+ Ethiopia and South Sudan)						
	The UK						
	Zanzibar						

The lic benefit of our work pub

IMPACT’s work makes a clear and valuable contribution to the following three public benefit purposes as defined in the Charities Act 2011. The rest of this report will demonstrate how we do this in more detail.

1) The advancement of health or the saving of lives

2) The relief of those in need by reason of youth, age, ill-health, disability, financial hardship or other disadvantage

3) Prevention or relief of poverty

Performance

IMPACT UK has had a successful year by any measure of performance. This is remarkable considering the circumstances we – like so many others – have had to operate in this year. Adapting quickly to the seismic changes brought about by a global pandemic which has affected every element of our international programme, our operating environment in the UK, and directly threatened the lives of the people who deliver our projects - frontline health workers.

Despite swingeing restrictions to freedom of movement (which affected our partners’ ability to implement projects and prevented people leaving their homes to attend clinics etc.), school closures (which put on hold all of our schoolbased projects) and additional challenges to the delivery of medical services (extra cleaning and social distancing increasing costs and reducing the number of people who could be safely treated), in collaboration with our partners we have still benefited 425,661 people this year through our usual programme of healthcare, maternity care, health education, safe water and sanitation, and more.

Covid-19 has been a constant feature of everything we have done this year and has cast a heavy shadow but we are delighted that, while our usual work has been somewhat curtailed, we have been able to respond directly and immediately to the needs of vulnerable people in so many countries, helping them to better face the pandemic. As ever, marginalised people with the fewest resources are least able to weather such storms. Poverty and deprivation

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have been key factors in people’s chances of becoming infected, and then in their chances of survival. We have benefited more than 1.2 million members of the public through Covid-19 education and the provision of handwashing stations, soap, face coverings and emergency food parcels. In addition, we have protected health workers with almost 300,000 items of personal protective equipment (PPE) and built medical infrastructure to cope with the pandemic through the provision of equipment and extra cleaning products. Without this support, so many of those on the frontline of health and medical care delivery would have been inadequately protected.

In addition to our ‘Tasty Team’ project to promote healthy nutrition for vulnerable groups in West Sussex, IMPACT UK has supported 12 partners working in 11 countries of east Africa, south-east Asia and southern Asia.

Overall activity:

Action within on-going programme	2020 to 21	2019 to 2020
People examined andprovided with treatment	145,978	665,635
Operations to restore sight, mobility or hearing, or to repair cleft lip or fistula	6,262	14,037
Immunisation against disabling disease (including activities to support Government vaccinationprogrammes)	10,707	9,404
Mothers and babies receiving pre andpost-natal care	22,178	16,740
Combatting malnutrition, including home garden and micronutrient supplement beneficiaries	47,204	68,041
Healthprofessionals and communityvolunteers trained	1,948	3,875
People participating in health education or otherwise empowered within their communities	160,118	286,355
People benefitingfrom safe water and improved sanitation	18,213	61,335
Assistive devicesgiven(hearingaids/orthotics/prostheses etc.)	13,040	20,795
Medical facilities upgraded/ provided with equipment	13	7
Covid-19:
Hospitals / health centres’ infrastructure built to better cope with the pandemic	125	N/A
Items of medical equipmentpurchased	1,158	N/A
Items of PPEprovided to health workers	293,594	N/A
Soap, disinfectant and cleaning products for hospitals and health centres	16,985.5 litres
Public handwashingfacilities established	284	N/A
Participants in health education and awareness raisingre: Covid-19	1,147,146	N/A
Families receivingemergencyfoodparcels	1,876	N/A
Supplies for the public for infection control	37,903 face coverings 24,500 bars/litres of soap	N/A
Vaccination facilities set up	1 plus 3 nurses trained to give Covid-19 vaccines	N/A
Other Emergency Response:
Flooding relief, Cambodia	420 emergency kits (food, blankets, soap and water) to displaced families plus supply of basic medicines for healthposts	N/A

The table above collates the collective action which IMPACT UK has supported our local partners to deliver this year. It also includes the work of IMPACT UK’s ‘Tasty Team’, here at home in West Sussex. It can be clearly seen that Covid19 has had an enormous impact.

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Unlike many INGOs, IMPACT is not a ‘top-down’ organisation with UK headquarters and sub-offices run by ex-patriate staff in lower-income countries. Our dedicated and trusted partners around the world are autonomous charities and non-governmental organisations, which are registered in their own country and have their accounts independently audited. Each partner develops their projects in response to their deep understanding of local needs and culture; an understanding which comes from lived experience and strong roots embedded in the communities they serve.

This way of working has proved invaluable this year. Being truly local organisations, our partners have listened to the needs of people in the communities they work with, and asked us for assistance to purchase supplies for individuals and health facilities. There is minimal bureaucracy and no waste. Our small and nimble operation in the UK was able to adapt quickly to raising funds for Covid-19 relief to meet these requests for support.

Yet more than 425,000 men, women and children have still benefited from our usual programme of action to prevent and treat needless disability. We focus on the most under-resourced people who are least likely to be able to access the health and medical care they urgently need, and most likely to become needlessly disabled as a result.

We are particularly pleased that, despite the highly challenging operating environment, our collective action has provided quality maternity care to more women and babies this year (up 32.5% on FY 19/20) which the WHO acknowledges is the key to preventing deaths and injury; and that the number of people we have helped to be immunised against common diseases has increased by 13.9% on the previous financial year. The latter does not include Covid-19 vaccination.

In addition to the direct delivery of medical care, surgery and assistive devices through hospitals, clinics and health posts, IMPACT reaches people on their doorsteps with a host of initiatives that enhance their ability to protect their own health in many different ways. Multi-dimensional poverty needs wide-ranging action and the cumulative benefits are greater than the sum of their parts. This is a sustainable strategy that shares knowledge and information on topics including malnutrition, hygiene, immunisation and menstrual health; and meets basic needs for nutritious food, clean water and sanitation. The link between poverty and disability is well-established so by reducing or alleviating needless disability, our work makes a vital contribution to reducing poverty too.

Building local infrastructure and human resources also creates enduring benefits. This year, we have upgraded 13 health facilities with specialist medical equipment and / or construction of buildings such as maternity departments (up 85.7% on FY 19/20) and supported training for 1,948 medical professionals and health workers to enhance the care they give to their patients (down 49.8% on FY19/20 due to Covid-19 restrictions). This includes the students we support through scholarships at IMPACT Foundation Bangladesh’s Nursing Institute, who have been learning remotely but studying just as diligently, this year.

NEPAL 2020/21

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We set ourselves 10 goals in last year’s report – ‘Looking to the Future’ on page 28 – and we are pleased to report that despite very challenging circumstances, seven of these were achieved in full, two were partially achieved and only one was not possible at all. But for Covid-19 making international travel difficult and closing schools, we are confident that all 10 goals would have been achieved.

Goal	Achievement
Train even more nurses at the IMPACT Bangladesh Nursing Institute to meet the huge need for this profession locally	Funded the training of 10 nurses and provided additional support for uniforms and study materials for some of the poorest students.
Provide additional specialist operations including fistula surgery for women in Ethiopia and hydrocephalus surgery for children in Bangladesh	Ethiopia: a further 10 women received fistula repair surgery during a short visit to the Afar region by Dr Andrew Browning, the Australian specialist, following special dispensation from the Australian government to travel overseas on humanitarian grounds. Bangladesh: supported hydrocephalus surgery for 15 more children
Purchase the building which houses the ZOP Academy for hearing impaired children in Zanzibar and provide running costs to safeguard its future	Building purchased and running costs provided for the year.
Purchase an ultrasonogram machine, a portable ultrasound machine and essential items such as weighing scales and tape measures for monitoring pregnant women and newborn babies in Bangladesh	All items of equipment purchased and in use in Bangladesh.
Provide further support for the award-winning Lifeline Express hospital train in India	Funds were provided for the 209thand 211thLifeline Express projects at Ambassa, Tripura state and Sitamarhi, Bihar state respectively, and towards the cost of 94 operations in other projects.
More eye surgical camps in Sri Lanka	Not possible due to Covid-19 pandemic international travel restrictions
Construct and equip a dedicated delivery room at Rohat Teuk Health Centre in Banteay Meanchey province, and provide medical equipment and training for health workers at Banlung Referral Hospital in Ratanakiri province, Cambodia	Both achieved. The opening of the delivery room at Rohat Teuk health centre was delayed by flash flooding and then the imposition of a local lockdown during which pregnant women were directed by the Health Authority to go to the main referral hospital in order to manage the threat of Covid-19, but women are now receiving maternity care and giving birth in the new facility. Maternity equipment and specialist training for midwives and health workers provided at Banlung referral hospital is keeping women and babies safe. 787 deliveries took place between October 2020 and March 2021.
Extend the Auraiya nutrition project in Nepal by piloting a menstrual hygiene element, and expand the menstrual hygiene in schools work that has been successfully trialled in Chuadanga district, Bangladesh	Auraiya, Nepal: 2,000 women benefited from menstrual hygiene education; 800 kits containing reusable sanitary pads and soap were distributed to women aged 13-45 years; 25 women were trained to make reusable sanitary pads for income generation; and 15 health workers were trained in menstrual hygiene to give advice and sanitary supplies to local women. Bangladesh: it has not been possible to expand the menstrual health programme this year because schools have been shut for most of the period due to Covid-19. IMPACT Foundation Bangladesh has been working with school officials to begin installing water sources and renovating toilet blocks in readiness for schools to eventually reopen, when the menstrual health programme will commence.
Provide additional bio-sand filters for families in floating villages of the Tonlé Sap Lake, and further support for The Lake Clinic (TLC) which serves these vulnerable communities with primary and mental health care, Cambodia	Provided 11 bio-sand filters. Provided funds to support TLC’s mental health programme which benefited more than 60 people through intensive counselling around anxiety, depression and domestic abuse.
Continue our support for the PNR Society’s child blindness and deafness programme and vocational training for people with disabilities at the AT&T Technology Park, both in Bhavnagar, India	Support was provided but activities were limited by school closures in India which placed the work of the child blindness and deafness team on hold (since screening is conducted in schools) and moved learning at the AT&T Technology Park online.

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IMPACT has stringent monitoring guidelines which helps us to analyse the impact of our work. All our partners send regular activity, statistical and expenditure reports and these are carefully monitored against agreed targets, enabling adjustments to be made if necessary. IMPACT UK and our partners work collaboratively in order to deliver the best service we can to the people who rely on us, often as their only hope of healthcare or medical treatment. Independent project evaluations monitor the impact of many projects.

Starting the year with enormous financial uncertainty due to the pandemic, we are extremely pleased to report that thanks to the incredible generosity of our supporters, income has held up remarkably well and is down by just 1.4% on FY 19/20 to £1,688,896. Expenditure is down marginally (0.6%) at £1,741,098 but funds are earmarked to be sent to partners early in FY 21/22. Once again, more than 92% of expenditure was on charitable activities. We are able to operate so economically because IMPACT UK is small, lean and has low overheads. For example, the dedicated staff team comprises just seven long-standing employees (three full-time and four part-time) and we have a modest office which was gifted to us more than 25 years ago.

Further information can be found in the section ‘Financial Review and Policies’ on page 33.

How every £1 was invested

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Highlights of the year’s achievements
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Covid-19 Pandemic Res onse p

The world has been in the grip of the Covid-19 pandemic for the whole of this financial year, with no immediate end in sight, despite new weapons in our armoury in the form of treatments to lessen the worst effects for some people, and freshly developed vaccines. But just as the pandemic exposed gaping health inequalities between rich and poor within countries and between countries, so too has the vaccine roll-out.

In the UK and other high income nations, the programme to vaccinate entire adult populations has taken place at breakneck speed – an unprecedented achievement in modern public health. It has shown clearly what can be done with political will and investment. The challenge now is to share the vaccine equitably with the rest of the world and for the global community to extend what has been learned through this devastating pandemic into tackling

Remembering members of the IMPACT family lost to Covid-19

Like so many people around the world, we are mourning the loss of friends to Covid-19. Rest in peace:

Mr Yahya Al Sawafy (Chair of IMPACT Zanzibar) Mrs Kanyan (Wife of Mr Manzour Kanyan, Founder of IMPACT Pakistan) Mr Ramesh Sarin (Chair of IMPACT India Foundation)

other public health issues, such as needless disablement, maternal mortality or lack of clean water. By working together, the opportunity is within humanity’s grasp to change the health and prospects of future generations.

As soon as the threat from Covid-19 became clear in early 2020, IMPACT UK asked our local partners what they needed. The response was clear: funds to buy PPE for frontline health workers, items of medical equipment and cleaning products for health facilities and hospitals, and support for the communities in project areas to better face the pandemic. The latter took the form of making information about Covid-19 widely accessible, face coverings and handwashing supplies, and food parcels to support families who had had their ability to earn money and support themselves removed without warning by lockdowns.

Here in the UK, our Tasty Team worked with local community organisations to address food insecurity and deliver food parcels to families who suddenly found themselves with extra mouths to feed during the day when schools were closed, stretching already tight household budgets to their limits. 5,590 healthy meals were provided over the course of the year.

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2020/21
Across the IMPACT programme, we have protected health workers
with almost 300,000 items of personal protective equipment (PPE)
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Thanks to funds raised by IMPACT UK, it has been possible to deliver the following in countries of Africa, Asia and here in the UK, during 2020-21:

Item	Total
PPE kits	1,152
Shoe covers	3,520
Surgical masks/respirators	82,779
Pairs ofgloves	195,750
Head covers/fabric caps	5,116
Fabricgowns/scrubs	1,592
Disposablegowns	1,662
Goggles	1,277
Plastic face shields	726
Aprons	20
Health facilities/hospitalsgiven PPE	125
Health facilities/hospitalsgiven equipment	123
Isolation wards set up	3
Hand sanitiser / disinfectant / cleaning supplies(litres)	16,985.5
Detergent(kg)	100
Waste disposal bags(kg)	25
ICU beds	12
Hospital beds	60
Oxygen machines	4
Suction units	5
Patient monitors	2
Thermometers	798
IV fluids(bottles)	200
UV sterilisingmachines	5
Soapdispensers	71
Washingmachines	1
Vaccination facilities set up	1
Nurses trained toprovide vaccinations	3
Non-medical masks(public)	37,903
Bars or litres of soap (public)	24,500
Health education(people)	1,147,735
Handwashingstations set up	284
Foodparcels(families)	1,876

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Community handwashing tanks
KENYA
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Mask distribution & health
education
BANGLADESH
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Food parcels for vulnerable people
ZANZIBAR
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Vital medical equipment
INDIA
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Asia: Bangladesh

IMPACT Foundation Bangladesh (IFB)’s ambitious programme of activities delivers a wide-range of projects designed to prevent needless disability and treat disabling conditions for people living in remote and rural areas where medical services are vastly inadequate to meet the needs of the population.

Action is centred in the districts of Chuadanga and Meherpur in southwestern Bangladesh, and on the Jibon Tari (a modern hospital on a boat) which travels the many waterways that traverse the country; mooring at a rural riverbank for several months at a time to deliver hospital services and surgery to restore sight, hearing, mobility and more.

IFB has large community hospitals in both Chuadanga and Meherpur from which radiate inclusive outreach programmes of disability prevention including health screening, treatment, and maternity care, to ensure that no one is missed because they are unable to travel to the hospital. A wellequipped mobile medical van is able to conduct a host of diagnostic tests and people in need of specialist treatment are referred to the hospitals, with help to get there if needed. IFB’s specialist Sir John Wilson Orthotics and Prosthetics Centre in Chuadanga makes and fits bespoke mobility aids and prosthetic limbs and provides physiotherapy to improve mobility.

Suriya was born with childhood cataracts and her sight was deteriorating rapidly. In a country where there are few resources to treat the poorest children with disabilities, her parents were so grateful to IMPACT surgeons for restoring her sight. Suriya was excited to see the world clearly for the first time in years – “Right now I am very, very happy!’’

We also support IFB to take action which enhances the general health and wellbeing of the communities in which it works, for example safe water and sanitation, reducing malnutrition through home gardening or livestock rearing, health education and delivering on-going training for local medical professionals and health workers to fill skills gaps and ensure prevention of needless disability is central to their daily work.

IFB established a prestigious Nursing Institute in Meherpur in 2014 to train the next generation of nurses, and give young women from this rural region rare career opportunities. Despite Covid-19 forcing lessons online, the eighth cohort of new students was enrolled in January 2020. The Institute’s graduates are working as fully registered nurses in Bangladesh and playing a vital role in medical care delivery in their country.

2020-21 Activities	Target	Achievement
People screened and treated for disabling and other health conditions in Outpatients Departments and clinics in the community	60,000	54,946
People attending health education and awareness sessions to learn how to protect themselves and their families	47,500	62,628
People who benefited from operations to restore their sight, hearing or movement or to ameliorate other disablingconditions	3,320	3,385
Peopleprovided with assistive devices and/orphysiotherapy	4,200	9,836
Women provided with ante and post natal care including micronutrient supplements(folic acid etc.)	3,100	3,908
Immunisations against infectious diseases and/or Vitamin A to protect eyesight, given to children	4,000	8,279
Traditional Birth Attendants trained andprovided with a sterile equipment kit	600	615
Village Mothers’ Clubs meetingregularly	900	3600
Primaryschool teachers trained to check their students’ vision and health	300	300
Children checked bytrained teachers	3,000	1,594
Home gardens established to provide families with nutritious fruit and vegetables to eat and thepotential togenerate income	750	891
Local health workers, rural medical practitioners, NGO workers and communityleaders trained to understand and identifyneedless disability	700	728

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Additional achievements… IMPACT UK’s support has also:

 Funded the training of 10 students at IFB’s Nursing Institute in Meherpur district, in order to help meet the critical shortage of nurses in the country, provided uniforms and study aids for those in particular financial need, and refurbished the bathroom in the students’ accommodation

 Provided essential items of medical equipment to IFB’s hospitals to enhance service delivery including an eye surgery microscope, three autoclaves, an ultrasonogram machine, a portable ultrasound machine and other items for use in ante and postnatal care.

 Enabled specialist brain surgery for 15 more very young children with hydrocephalus

 Started work on a menstrual health programme at another school in Chuadanga district which will include a SIDKO water treatment plant, refurbishment of the toilet block to make it safe, hygienic and private, distribution of menstrual health kits and vaccinations against Rubella.

 Supported IFB in its work to run the Jibon Mela hospital and community based primary healthcare project in Meherpur district. Thanks to this project, 23,416 people have been screened for health conditions, 848 operations have been performed, 3,771 people have had physiotherapy and/or an assistive device to ease mobility, 137 patients with hypertension have been checked, 2,149 women have received quality pre and postnatal care including vaccinations and dietary supplements as required, 6,371 pathology tests have been undertaken, 1,923 people have attended health education sessions, 1,289 home gardens are yielding fresh produce to improve diets, and 300 Mothers’ Clubs are disseminating vital health education to their members. In addition, 201 local traditional birth attendants, teachers, community leaders and health workers have been trained to deliver better care to people in Meherpur.

 Given 22 pairs of chickens and 20 pairs of geese to families who struggled to meet their nutritional requirements. These not only provide essential protein in the diet, but can also be used to generate income.

 Provided two arsenic filters to households at risk of drinking contaminated water

 Provided funds for essential repairs to the Jibon Tari’s access bridge following a tropical storm

 Responded to the COVID-19 pandemic through the provision of 700 full sets of PPE and 30 sets of scrubs for frontline health professionals at 11 hospitals and health centres, medical equipment and hand washing stations for three hospitals, establishment of two isolation wards, 1,247 litres of hand sanitiser, 25,330 face coverings and 23,180 bars of soap for the public, health education for 41,537 people, emergency food parcels for 850 families facing hunger due to loss of income, and set up one Covid-19 vaccination facility with three specially trained nurses.

BANGLADESH 2020/21

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Cambodia

We supported two partners in Cambodia once again this year: IMPACT Cambodia and The Lake Clinic (TLC), based on the Tonlé Sap lake, which is the largest freshwater lake in southeast Asia, and a UNESCO biosphere reserve due to its biodiversity.

IMPACT Cambodia

IMPACT Cambodia (IC) has extended its reach into two new and highly impoverished provinces this year (Ratanakiri and Preah Vihear) whilst continuing to operate in Banteay Meanchey province. These are underserved areas with majority indigenous ethnic populations and are among the least developed in the country with poor infrastructure and worrying health indicators. For example, the life expectancy of men in Ratanakiri is just 39 years while women can expect to live for just 43 years. It is a sparsely populated area where people live in small villages of 20-60 households and most eke out a living as subsistence farmers or sell their produce at the local market.

The local conditions create enormous challenges to delivering health care so IMPACT Cambodia works through schools and health posts to screen and treat people for ENT conditions, although this work has been seriously hindered by the Covid-19 pandemic (for example, the school health programme has had to be put on hold this year due to school closures).

‘This new equipment from IMPACT makes our work easier, faster and safer because it is all new and upto-date. Previously, all the medical equipment in our maternity unit was old and dull. Some machines needed to be repaired many times. We also had to pay for repairmen fee by ourselves.’ Sok Kheng, Midwife at Banlung Referral Hospital

IC is also working to improve access to safe water, providing health education and supporting the local population of people with leprosy through treatment and work to de-stigmatise the condition.

Leprosy remains hidden and shrouded in myth in rural Cambodia, with affected people discriminated against and often refused treatment by scared health workers. Caused by a bacteria (and curable with medication) if left untreated leprosy results in a host of needlessly disabling conditions from visual impairment to nerve damage.

We work with Mr Chhun Bunda, a government health worker employed specifically to support people with leprosy, to go into areas where there are high concentrations of affected people, to identify them, provide treatment and educate the community and health workers about the condition. Through Mr Bunda we have also been able to provide his clients with water filters. This removes the need to boil water on open fires which is far more dangerous for people with nerve damage and the consequent inability to feel pain, and often results in burns or scalds and fused limbs.

----- Start of picture text -----
CAMBODIA 2020/21
2,956 people
benefited from
leprosy awareness
raising and health
education. 24 people
identified with the
disease received
treatment and
support
----- End of picture text -----

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2020-21 Activities	Target	Achievement
Early identification and treatment
ENT screeningand on the spot treatment(BanteayMeanchey province)	300	0
ENT screeningand on the spot treatment(Ratanakiriprovince)	300	604
ENT screeningand on the spot treatment(Preah Vihearprovince)	300	236
School healthprogramme
School children ENT screening, on the spot treatment and general hygiene education(Ratakaniri and Preah Vihearprovinces)	200	0
Screening /treatment sessions(one day,one school)	2	0
Safe water and sanitation
Water filters for families(Ratanakiriprovince)	24	20
Beneficiaries of familywater filters	180	135
Leprosy programme
Support training sessions on leprosy (Mongkul Borei, Banteay Meanchey province)	4	4
Health workers receive on-goingtrainingat above sessions	184	112
Community members benefiting from leprosy awareness raising (Banteay Meancheyand Battambang provinces)	962	2,956
People with leprosyidentified and receivingtreatment and support	10	24
Water filtersprovided topeople with leprosy	No target	27

Additional achievements… IMPACT UK’s support has also:

 Enabled emergency support when flash flooding hit our project areas in Banteay Meanchey province, displacing families, washing away homes and belongings, engulfing health centres and destroying 90% of medical supplies. This entailed giving out 420 emergency food, water, soap and blanket kits to devastated families (including 20 families with an acid burns survivor member and 20 families affected by leprosy) and basic medicines such as antibiotics to the local health department who were caring for the homeless families.

 Constructed and equipped a delivery room at Rohat Teuk Medical Centre in Banteay Meanchey province, to provide a safe environment for pregnant women to give birth. The operation of the new delivery room was hampered first by the flash flooding and then by Covid-19 lockdown which limited the number of deliveries and meant mothers were referred to bigger hospitals to delivery. However, the facility has already seen 118 babies delivered, antenatal care provided for 196 pregnant women, postnatal care for 133 new mothers and 1,954 vaccinations against common diseases and will be well-used into the future.

 Provided essential medical equipment to upgrade the maternity facilities at Banlung Referral Hospital and Ou Chum Health Centre in Ratanakiri province and training for 26 health workers, including 17 midwives, in preventing post-partum haemorrhage, resuscitation and infant CPR. Both the equipment and training will make services safer for mothers and babies, and have already benefited 820 deliveries. Ou Chum Health Centre was particularly under-resourced; it had no delivery chair and the two delivery beds were more than 20 years old. In addition to safe deliveries, the health centre has provided antenatal care to 213 mothers and 458 vaccinations. The number of women and babies using the facilities at Ou Chum will increase once Covid-19 restrictions ease as most are being referred to one of the larger hospitals which are better able to cope with patients who are also infected (or suspected to be infected) with Covid-19.

 Provided funds for 20 water filters for mothers through the 1,000 Days programme which is designed to support women from conception to their child’s second birthday and ensures the child has the healthiest possible start in life. Filtering water protects the whole family from waterborne disease.

 Supported surgery for another person with burn injuries. These operations are paid for as specific funds are raised for each operation.

 In response to the Covid-19 pandemic, IMPACT UK supported IMPACT Cambodia to supply 11 local hospitals and health posts with urgently needed items including more than 45,000 pieces of medical grade PPE (surgical masks, gloves, goggles etc.), 12 ICU beds, 20 hospital beds, four oxygen production machines, five suction machines, two patient monitors, 20 thermometers, 200 bottles of IV fluid, 100kg of detergent and nearly 2,200 litres of disinfectant

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The Lake Clinic (TLC)

Founded in 2007, The Lake Clinic (TLC) takes primary medical care,

vaccinations, antenatal care, eye care, dentistry and health education by boat to nine villages located in remote and isolated regions of the Tonlé Sap Lake area, reaching some of the poorest and most vulnerable communities in the country. Over time, the project has grown to include the TLC main vessel plus five floating clinics and a small fleet of boats to get doctors and nurses out to really remote places. Generally, each village is visited once per month unless water levels are so low that boats cannot reach them and the team stays on the water for a few days at a time due to the distance of the villages from the nearest town, Siem Reap, which can be up to a day’s travel. People in need of more serious medical treatment are helped to access it in hospital at Siem Reap. In line with WHO’s recommendation to incorporate mental health care with primary health care delivery, TLC has been expanding its work to deliver mental health care to the people living in floating villages, who face a great many additional challenges due to their particular living environment.

More than one million people live on and around the Tonlé Sap Lake and most survive on an average family income of $2.50 per day.

The work of TLC has been significantly disrupted by Covid-19. The team were family income of $2.50 per day. unable to travel for six weeks from early April 2020 and when clinics resumed in May it was at 50% capacity. Travel was made harder still by environmental factors such as the abundance of water hyacinth choking up the lake.

This year, IMPACT UK’s support of TLC has been for the purchase and dispersal of bio-sand filters (a small, household water filter which purifies the lake water that people use for all their needs and which help to prevent sickness from waterborne disease) and for the mental health programme, which has never been more needed.

Jenny Shepherd, a British psychotherapist, works as a volunteer to train and support two members of the TLC team, Dr Rida Hun and midwife Ky Kolyan, to deliver mental health counselling within the lake villages. Domestic abuse is a regular problem which has increased during the pandemic, and as people have lost their jobs due to Covid-19 and returned home, the economic burden on families has grown along with poverty and debt. All of which negatively impacts mental wellbeing.

One-to-one counselling for the most vulnerable people with conditions such as depression and anxiety is supplemented with therapeutic gardening, which has the additional benefit of helping to improve the limited diets of people living on the lake.

Four domestic abuse workshops have been run, attended by approximately 40 people, to help men and women understand why abuse is perpetrated, that it is unacceptable, and anger management techniques for perpetrators. In pre-Covid times the workshops were a regular occurrence but have had to be curtailed. It is clear, however, that the subject is being talked about more widely within the community and tolerance of domestic abuse is diminishing.

When schools are not closed because of Covid-19, the TLC team visits the school on Moat Kla (a floating village accessible only by water) to educate teachers and teenage students about domestic abuse and gender equality in order to prevent a culture that tolerates domestic abuse continuing into the next generation. Regular health and dental checks are also carried out and these resumed in March 2021 for the 134 children and five teachers at Moat Kla school.

IMPACT UK’s support for TLC contributed to the following:

2020-21 Activities	Achievement
Domestic abuse workshops held	4
Participants at domestic abuse workshops	40
People benefitingfrom one-to-one mental health counselling	21
Peopleparticipatingin therapeuticgardening	15
Bio-sand water filtersprovided to families to make lake water safe to use	11
Health checks at Moat Kla school	139

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India

We work with three long-standing partners in India: IMPACT India Foundation, the PNR Society based in Bhavnagar, Gujarat State; and KEM Hospital based in Pune, Maharashtra State.

IMPACT India Foundation

IMPACT India Foundation’s Lifeline Express hospital train is the world’s first modern hospital on a train and was the ideal solution to the challenge of delivering medical care and surgery to remote and underserved people in this enormous country, due to the famous farreaching rail network. The Lifeline Express has been rolling into stations across India since 1991 to restore sight, hearing and mobility to people who believed they would remain disabled for life. Screening and treatment for non-communicable diseases such as cancer and heart disease, and dentistry, are essential services which prevent needless disability, death and chronic pain.

Lifeline Express hospital train:

IMPACT UK has supported IMPACT India Foundation to conduct two Lifeline Express projects this year: the 209[th] project at Ambassa, Tripura State and the 211[th] at Sitamarhi, Bihar State.

Mr and Mrs Devi were two of the 341 people who underwent sightrestoring cataract surgery during the 211[th] Lifeline Express project in Sitamarhi, Bihar State. “When we discharged them, they were so happy and showered their blessings on the medical team’”– IMPACT India

Tripura State has one of the lowest population densities in India and most of the residents live in impoverished and remote hilly areas with very little access to transport. It was therefore necessary for the Lifeline Express team to adapt working practices in order to reach them. The medical team worked closely with local health workers who covered the villages as part of their role, to identify potential patients, while screening for conditions such as cataract was carried out door-to-door. Transportation was also laid on so that people in need of surgery could get to the hospital train, which was parked in a siding at the station.

The COVID-19 pandemic has also altered the way in which the Lifeline Express operates, with additional precautions required for staff and patients alike. It was impossible to host huge crowds on the site of projects as before, so much more use was made of outreach into communities. Social distancing has been employed when patients do come to the Lifeline Express and PPE, extra cleaning and face coverings have helped to control the spread of infection.

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INDIA 2020/21
The Lifeline Express hospital train
provided medical services to 31,949
people during the projects we
supported
----- End of picture text -----

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2020-21 Activities	Achievement
Lifeline Express:
Project areas visited	2
People examined for sight, hearing, orthopaedic, dental, heart, neurological, cancer and general health conditions(and treatmentprovided as necessary)	27,595
Operations provided to restore sight, hearing or mobility, or to repair cleft lip or another condition	1,528
People provided with assistive devices such as hearing aids, spectacles, callipers and prosthetic limbs	2,826
People who have benefited from health education	769

Additional achievements… IMPACT UK’s support has also:

 Helped with the medical response to Covid-19. Our support purchased 300 thermal scanners, 10,000 disposable surgical masks and 100 N95 masks which were distributed to two sub-district hospitals, 10 rural hospitals and 46 primary health centres in Palghar District, Maharashtra State. The population of this area is approximately three million.

Disability Prevention Partnership, PNR Society, Bhavnagar District, Gujarat

The PNR Society is a coalition of organisations which together form the largest body for disabled people in India. IMPACT’s ongoing support for its Blindness and Deafness Team which goes into local schools to screen children and provide treatment to students with signs of visual or hearing impairment has had to be rolled over due to Covid-19 school closures for the period, meaning the team could not undertake its usual activities.

We have once again supported the PNR Society’s AT&T Technology Park which provides vocational training and IT skills to people with disabilities, putting them on the path to employment and independence. Like other schools, the Technology Park has been closed due to Covid-19, however, it has been possible to move learning online without too much disruption to students’ education. 57 enrolled students were provided with laptops, wi-fi connections, scanners and books so that they could learn via Zoom lessons and have been studying hard at home.

2020-21 Activities	Achievement
Students with disabilities provided with computer equipment and undertaking vocational and IT courses at home,via the AT&T TechnologyPark	57

Vrunda (18) faced many health issues throughout her childhood, resulting in the amputation of her left leg and reduced mobility. She had to learn to use a prosthetic limb and missed much of her early schooling. Despite these challenges, she has worked hard and was delighted to be accepted to study for a bachelor’s degree in commerce. Vrunda has been attending IT courses at the AT&T Technology Park in preparation and has also been loaned a computer as her father lost his job during the pandemic and has been unable to support her studies.

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Disability Prevention Partnership, KEM Research Hospital, Pune, Maharashtra

We have worked with the KEM Research Hospital in Pune, Maharashtra State on a number of initiatives for more than two decades. Our current focus is supporting additional training and equipment for ASHA (Accredited Social Health Attendance) workers, as funds allow.

ASHA workers (or informally ‘barefoot doctors’) are employed by the Government to provide very basic healthcare and to be health information activists in their own communities. They are married, widowed or divorced women who reside in the village they serve and must have basic literacy and numeracy skills. ASHA workers are the first port of call for the poorest populations and are particularly beneficial for women and children who often struggle to access health or reproductive care. Each ASHA worker visits 10 -15 households a day to assess medical conditions and provide treatment on-the-spot or referral to a primary health centre or the KEM Hospital. They also provide ongoing monitoring and medication for pregnant women or people with chronic conditions such as heart disease and diabetes.

IMPACT’s support adds value to this scheme by providing additional equipment and training for ASHA workers in the hilltop ‘tribal’ communities of Pune. For example, through training on nutrition and the provision of health education materials to help when they are talking to their patients, glucometers, blood pressure machines, haemoglobinometers and First Aid kits.

In addition, ASHA workers are helped to promote IMPACT initiatives such as kitchen gardening to improve nutrition and stave off hunger, and safe water and sanitation.

IMPACT has supported one ASHA worker this year but we hope to assist more as specific funds become available. She lives and works in Kharoshi village, and cares for 1,055 people living in 229 households. 70% of the population here is classified as ‘tribal’ which makes them among the poorest – and most disenfranchised - of the poor in India.

INDIA 2020/21

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Nepal

We support IMPACT Nepal to implement projects which aim to reduce and ameliorate needless disability, build local health infrastructure and human healthcare resources, and support people in the target areas to understand and take action to prevent needless disability for themselves and their families. Action takes place in Kathmandu, Rautahat district and, when not prevented by Covid-19 restrictions, locations around the country to hold mobile ENT and orthopaedic surgical ‘camps’.

This year has seen significant disruption to projects but IMPACT Nepal has adapted to challenging circumstances, including national lockdowns, enforced closure of its rural Primary Ear Care Clinics, and border closures with India hindering supplies, and kept its programme going to benefit as many people as possible.

Manmaya (55) was fitted with a hearing aid at IMPACT Nepal’s Ear Care Centre: “Before I used to have difficulty in my daily activities. My neighbours used to tease me and I could not attend religious ceremonies. I could not hear the horn of vehicles and used to be scolded by drivers on the road. I could not hear family members in conversation and I used to wonder whether they are talking against me and so we used to quarrel. Now I can hear, my neighbours are friendlier and we do not quarrel in the family home. I have even started becoming involved in social activities.”

2020-21 Activities	Target	Achievement
Primaryhealth care workers,ear assistants and rehabilitation technicians trained	4	0
Communityfield workers trained	1	1
Female communityhealth volunteers trained	72	36
Health centres/healthposts upgraded	4	4
Adults received screeningand treatment services	9,879	6,618
Children aged 0-16years received screeningand treatment services	1,221	2,843
Ear surgical camps held in remote locations	5	2
Orthopaedic surgical camps held in remote locations	1	0
Adults benefited from hearing-restoring surgery through mobile camps or at hospital	1,071	249
Children aged 0-16 years benefited from hearing-restoring surgery through mobile camps or at hospital	179	57
Adults benefited from mobility-restoring orthopaedic surgery through mobile camps or at hospital	20	0
Children aged 6-18 years benefited from mobility-restoring orthopaedic surgery through mobile camps or at hospital	5	0
Adults received rehabilitation support/ physiotherapy	174	46
Children aged 0-16years received rehabilitation support/ physiotherapy	6	7
People benefited from theprovision of assistive devices such asprosthetic limbs	200	53
People benefited from theprovision of hearingaids	40	61
Womenprovided with ante andpostnatal care	2,000	2,417
Women motivated to take up immunisation for themselves and their 0-5 year old children	1,000	3,050
Pregnant women/new mothers received iron supplements	2,000	2,326
Children aged 0-5years received Vitamin A supplements toprotect their vision	7,000	8,144
Women received de-wormingtablets	1,000	744
Children aged 0-5years received de-wormingtablets	7,000	7,388
People reached through a health awareness radioprogramme	50,000	64,500
People reached through health awareness raisingin the community	6,000	1,650
Homegardens established to feed families and reduce malnutrition	2,200	1,275

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Additional achievements… IMPACT UK’s support has also:

 Extended the nutrition pilot project in Auraiya district, through provision of 70 laying chickens and 40 mother goats to families with young children to improve diets and generate income; agricultural and animal husbandry training and tools for 75 families (benefiting 375 people); iron supplements for 1,000 pregnant or new mothers; vitamin A and de-worming tablets to 3,000 children under the age of five years; the formation of five new Mothers’ Clubs with 125 members and continuing support for 10 existing Mothers’ Clubs with almost 2,500 members; menstrual hygiene education for 2,000 women and older girls with distribution of 800 menstrual hygiene kits and training for 25 women in making reusable sanitary pads. 15 local Female Health Volunteers and staff at the Auraiya Birthing Centre have been fully trained and equipped with resources to carry out training in the future and stocked with reusable pads to distribute.

 Provided an additional 12 goats thanks to our supporters purchasing ‘gift tokens’.

 Provided restricted funds to help meet additional needs created by the Covid-19 pandemic. This included supplying 39 health centres with 1,070 gowns, 1,703 respirators, 20,000 surgical masks, 132,300 pairs of surgical gloves, 854 googles, 2,752 shoe covers, 1,376 head covers, 122.5 litres of hand sanitiser, 106 infrared thermometers, and five UV sterilising machines. The public were given 1,180 bars of soap and 290 families were provided with emergency food parcels due to the immediate risk of hunger. 300,000 people had their awareness raised about Covid-19 through health education.

NEPAL 2020/21

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Pakistan

Like IMPACT Sri Lanka’s Clinic in Weerawila described below, the 16 ‘Mamta’ (mother and baby) clinics IMPACT established in mountainous villages of the Kashmir region in Pakistan were borne out of disaster. The Kashmiri earthquake which struck the area in 2005 and killed more than 86,000 people highlighted the vulnerability of people in remote places to both natural emergencies and the privations caused by poverty.

IMPACT’s strong desire was to rebuild hope after devastation for the local communities and to meet their ongoing need for primary and reproductive healthcare. The health of women and babies is often of low priority where resources are lacking and because pregnancy and childbirth are seen as ‘natural’, it is often not well-understood that monitoring and straightforward care can prevent death and disability.

Despite their name, the clinics also provide general primary healthcare to the wider community. Each clinic is run by a fully trained Female Health Volunteer, with regular visits (at least once a month) from a General Practitioner. Any conditions that cannot be managed at the clinics are referred to hospitals and health posts in the region for further treatment. They are a lifeline to people in this hard-to-reach region, especially during the pandemic.

2020-21 Activities	Target	Achievement
Women attendingantenatal check-ups	3,200	3,026
Women and their babies attending postnatal check-ups	1,280	699
Babies delivered at a Mamta Clinic	860	510
Babies delivered at home assisted bya trained Female Health Volunteer	60	4
Pregnant women experiencing complications who were referred to a hospital to give birth	No target	15
Men, women and children who benefited from general primary healthcare at the clinics	8,000	9,793
Health education sessions run	22	0
People who attended health education sessions	500	0
Local health workers who underwent continuing professional training to keep their skills up-to-date	64	0

Additional achievements… IMPACT Pakistan set up an emergency kitchen to feed hungry people when Covid-19 lockdowns caused loss of income overnight for many people. This fed approximately 300 families in dire need. 200 face coverings were given to the public and 300 people benefited from Covid-19 related health education to reduce the risk of infection.

PAKISTAN 2020/21

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Sri Lanka

IMPACT UK helped IMPACT Sri Lanka to establish a community healthcare clinic in Weerawila following the 2004 Indian Ocean tsunami. This was believed to be the deadliest tsunami in history; killing almost 230,000 people and devastating towns and cities in many countries of the region.

The clinic is run by a local doctor and provides primary health care to people living in the surrounding villages. Covid-19 lockdowns have impacted the running of the clinic this year with some periods of closure but where possible, patients have still been medically served at their homes when they have been unable to attend the clinic. Despite the clinic being closed during April, May and November 2020, almost 2,500 people were served during the remaining months of the year. Health care has never been more crucial.

International travel restrictions have meant that cataract ‘camps’ run by IMPACT UK trustee and eye surgeon Mr Sal Rassam, have not been able to take place this year but these will resume as soon as it is safe.

2020-21 Activities	Achievement
People receiving primary healthcare:
 Men	730
 Women	1,226
 Children aged 0-16years	528
 TOTAL	2,484

Additional achievements… IMPACT UK’s support has:

 Provided restricted funds for Covid-19 response work which helped to feed 200 vulnerable families through the distribution of food parcels.

----- Start of picture text -----
SRI LANKA
2020/21
200 vulnerable
families received
food parcels to
support them
during the
pandemic
----- End of picture text -----

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Africa: Kenya

Our local partner in Kenya, IMPACT East Africa (IEA), works in Mwingi, Kitui County, and the surrounding rural areas to improve basic health and prevent and treat needless disability.

Much of this work centres on primary schools which are at the heart of the community, but the Kenyan Government closed all schools and sent children home for most of the period due to Covid-19 causing IEA’s School Health programme to be put on hold. In addition, restrictions on physical movement around the target area and the Government asking all NGOs to limit their contact with patients, meant outreach ear and maternal health clinics were also unable to go ahead for large parts of the year, although action took place whenever possible.

So the focus this year has been on moving ahead with efforts to install water sources in schools grounds (this has not been impacted by schools being closed to students) which are now ahead of schedule, tree planting to provide shade and reduce soil erosion, meeting the need for medical equipment, vaccination against common childhood diseases and Human Papilloma Virus, and working to mitigate the risks

“Thank you IMPACT East Africa for donating a borehole to our school. Before you donated it, we had to walk sometimes for 8 km to fetch for water. We will be using the borehole for drinking and for washing our hands’”. Abiel (12) Kivula Primary School

of Covid-19 for the local community. Before travel restrictions were put in place, the latter reached 26 villages, which were places where other NGOs had not ventured due to poor roads.

IEA is confident that work can press ahead quickly once schools and society open up again.

2020-21 Activities	Target	Achievement
Children undergoingregular health checks and de-worming	11,200	0
Children received primary care and /or referral for specialist treatment to IMPACT’s health team or a Government facility	2,520	0
Children received specialist treatment or surgery	280	0
Children received spectacles	20	0
Teachers and school health monitors trained in First Aid	704	0
People have sight or hearingrestored at an IMPACT surgical camp	115	0
Women receive ante andpostnatal care	300	0
Babies and children under 5 monitored forgrowth and development	400	49
Mothers immunised against common diseases	75	0
Children under 5 immunised against common diseases	125	21
Mothers’ Clubs establised	2	0
Large vegetableplots established	4	0
Children learn how togrow vegetables	400	0
Boreholes installed for safe water in schools	4	8
Rainwater harvestingsystems installed for safe water in schools	5	5
Handwashingstations installed inprimaryschools	2	0
Treesplanted in schoolgrounds	225	300

Additional achievements… IMPACT UK’s support has also:

 Provided ear screening and treatment equipment including headlights, nasal speculums, forceps, otoscopes, stethoscopes and ear syringes which will benefit approximately 3,000 people per year.

 Vaccinated 49 girls (aged 9-12 years) against Human Papilloma Virus which is the cause of most cervical cancers and some other cancers. In Kenya, HPV is the number one cause of cancer in women aged 15-44 and the lack of

26

cancer screening and treatment services means that vaccines save lives by protecting girls before they are exposed to this highly transmissible virus.

 Helped to stop Covid-19 infections through the provision of non-medical face coverings and health education to 5,577 people in the community, and setting up 26 hand washing stations in public areas with 40 litres of soap. 40 destitute families were given emergency food parcels to mitigate the immediate risk of hunger.

----- Start of picture text -----
KENYA 2020/21
Kivula Primary is one of eight schools to have received an IMPACT borehole
----- End of picture text -----

Tanzania, Ethiopia & South Sudan

“Some measures introduced to restrict the virus [Covid-19] have had serious knock-on effects…Teenage pregnancies have shot up as have home deliveries and transport costs have increased. Maternal and neonatal deaths have increased and we expect more fistulas too.” Dr Andrew Browning, fistula surgeon

Tanzania

IMPACT works with our trusted partner Maternity Africa, a local organisation in Arusha, dedicated to making motherhood safer for women and their babies through its specialist Kivulini hospital and outreach work. Maternity Africa not only supports women and babies to safe outcomes throughout pregnancy, childbirth and the post-partum period, but also trains local midwives to provide safe and compassionate support to the women in their care and surgical repair for women who have been severely damaged during childbirth. Many such women have lived with their injuries for years and also suffered social ostracism and abject poverty due to the unpleasant consequences (incontinence being a common issue).

This year, IMPACT’s support in Tanzania has been focused on the provision of care packs for the most destitute mothers who constitute many of Maternity Africa’s patients. On discharge, they face acute social and economic problems whilst nursing their babies but care packs can make a crucial difference to the health of them both.

Each pack contains items such as cornflour, sugar, rice, cooking oil and some clothes, or a blanket for the new baby. The packs take away some of their immediate worries and help the new mothers to concentrate on getting their strength back and meeting their babies’ needs. Many are teenage mothers who are not being supported by their families and without the support they receive from the Kivulini team would have nothing.

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Ethiopia

IMPACT’s support for maternity healthcare now extends to Ethiopia and South Sudan through Dr Andrew Browning, who is also instrumental in Maternity Africa’s programme at Kivulini, Tanzania.

This year, we have provided general funds to support the work of Vision Maternity Care Hospital in Bahirdar, which has already contributed to care for almost 3,500 women and babies, and to help provide supplementary feeding for 2,300 severely malnourished pregnant or lactating women in Mille, Afar. Conflict is creating huge numbers of internally displaced people in the region and this combined with locust infestations is causing widespread food shortages. People are dying of hunger. It is vital for pregnant and lactating mothers to have enough to eat in order to nourish their babies and stay well themselves.

10 obstetric fistula operations which were scheduled to take place at the end of the financial year 2019-20 but had to be postponed due to Covid-19 were done during a surgical camp in October, restoring to health women who were living in pain and discomfort.

South Sudan

In March 2021, Dr Browning finally had the opportunity to use the fistula sets provided in financial year 2019-20. During a short visit he carried out 37 operations on 35 women.

IMPACT UK has supported Maternity Africa with funds to provide:

2020-21 Activities	Achievement
Carepackagesprovided to new mothers,Arusha,Tanzania	9
Care packages provided to women leaving hospital following birth injury surgery, Arusha, Tanzania	1
Birth injuryoperations for women in Afar,Ethiopia	10 women
Maternity care delivered at Vision Maternity Care Hospital, Bahirdar, Ethiopia: Deliveries Caesarean Section deliveries Antenatal clinic visits Neonatal referrals	553 65 2,763 29
Supplementaryfeedingfor malnourishedpregnant and lactatingwomen	2,300 women
Birth injuryoperations for women in Juba,South Sudan	35 women

Jane (21) grew up in Arusha and moved to Tanzania’s capital, Dar es Salaam, to work as a housekeeper when she was still a young girl. There she married a man who neglected her, refused to speak to her, or provide her with any food or care. When she became pregnant, she scraped together enough money for the bus fare and returned to Arusha. Her family brought her to Maternity Africa’s Kivulini Maternity Centre when she went into premature labour. She was weak and anaemic on arrival and had not undergone any antenatal check-ups. Her baby boy was born gravely ill, with his organs on the outside of his tiny body. Sadly he died a few minutes after birth. Jane also had medical problems that the team at Kivulini healed. Maternity Africa’s onsite social worker helped Jane in her grief, and provided a care package to help with some of her basic needs on leaving Kivulini. For now, Jane is staying with her family as she recovers, physically and emotionally.

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Zanzibar

IMPACT Zanzibar delivers a broad-range of health and medical care initiatives from its base - the ENT department at Mnazi Moja hospital in Stone Town – but which are actively taken into remote communities across the two main islands of Zanzibar in order to reach the most vulnerable and excluded people.

Activities have been hampered this year due to Covid-19 restrictions and additional requirements for social distancing / sanitising etc. meaning fewer people can be helped at each clinic. It has been impossible to carry out any of the programme work based around schools because they have been closed for the duration of the pandemic.

2020-21 Activities	Target	Achievement
Nurses trained in early years hearingscreening	30	30
Doctors trained in early years hearingscreening	9	9
Babies screened for signs of hearing impairment as part of a neonatal screening programme	4,400	3,171
Children aged under 12 screened and treated bythe mobile ENT clinic	1,200	0
Children screened and treated at the ENT outpatients clinics of Mnazi Moja hospital	2,400	2,206
Primaryschools reached bythe mobile ENT clinic	16	0
Children screened and treated bythe mobile ENT clinic	6,816	0
Children screened byschool health monitors through the School Health Project	29,820	0
Children aged under 8 undergoingsurgeryto restore their hearing	70	134
Children aged under 12 receivinghearingaids and batteries	150	115
Parents and hearing impaired children attending sign language and speech therapysessions	50	67

Additional achievements… IMPACT UK’s support has also:

 Purchased the building housing the ZOP Academy to ensure its long-term security, finished renovations and provided running costs, training for teachers and a workshop where students can learn practical skills to help them in later life . This special school takes very young children with serious hearing impairments who are often unable to make sounds, and provides basic schooling with additional classes in speech, sign language, lip reading and more. Many of the children who attend would be kept at home, unable to communicate, and have no schooling without it. The school builds confidence, sociability and self-worth along with communication, literacy and numeracy for its profoundly hearing impaired students. The school premises also house a hearing test centre and ear mould laboratory to provide the children with hearing aids since the earlier they get one, the better their chances of developing communication skills and learning.

 Helped with the Covid-19 response by providing funds that enabled delivery of 452 PPE kits, 371 thermometers, 40 hospital beds, 71 soap dispensers, 2,200 litres of liquid soap/disinfectant and a washing machine to a total of 13 hospitals and health facilities. The funds were also used to distribute 11,000 face coverings to the public, set up 255 handwashing stations, feed 123 very hungry families, and raise awareness of Covid-19 with 800,000 people.

‘”The emphasis at the ZOP Academy has evolved from sign language to pronunciation and articulation (“MATAMSHI NA SAUTI” in Swahili). The aim of this new learning strategy is to better prepare children to communicate with the wider Zanzibar community and help them transition to mainstream schooling when they are older. Every interaction we have with a child is an opportunity, and learning through play is an important way to help the children to improve their skills in speaking. Four Social Workers have been recruited to help us enact our new vision and support the teaching staff” - Dr Naufal Kassim (Director, IMPACT Zanzibar)

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United Kingdom

The Tasty Team aims to help local residents cook healthy meals on a budget. A valuable part of our work is ensuring families have essential cooking skills and confidence in the kitchen, we also focus on reducing food waste through utilising leftovers and safe food storage. This year, we have worked hard to alleviate some of the challenges of the pandemic for local families suffering from food poverty and isolation. By collaborating with our local food bank we have been delivering Recipe Boxes to vulnerable, local families. These boxes include all the ingredients necessary to make three healthy meals for the family, plenty of fruit and vegetables are always included along with recipe cards. We have supplemented this with an array of online resources, including Zoom cooking classes to help families cook together.

Going forward, we are focusing on developing our online resources including producing a growing bank of cooking videos on the ‘IMPACT Tasty Team’ YouTube channel to supplement our Zoom cooking sessions and online training resources for our volunteers. We hope to

“IMPACT is a significant stakeholder in the alleviation of food poverty in the area and we know what an amazing job you have been doing over the last year and for years before that!” Lauren Lloyd (Chief Executive Officer, Mid Sussex Voluntary Action )

“I love how we all have a role to play during the cooking sessions and how we get the recipes sent to us as well. I learnt skills I will take with me when I move into my own place to be able to cook meals on my own and independently”. Young parent living in hostel accommodation

start face-to-face cooking sessions again soon. We are busy preparing for the opening of after-school cooking clubs as well as returning to schools with our Tasty Sessions. We are also collaborating with other local community organisations to deliver cooking sessions to those who have suffered most over the last year, including elderly people.

2020-21 Activities	Achievement
Recipe box deliveries	426
Number ofpeople benefitingfrom recipe boxes	321
Total number of meals delivered	5,590

UK 2020/21

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International
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Advocacy

IMPACT works at the national and international level in partnership with many other governmental and civil society organisations, with the corporate sector and with community service organisations such as Rotary, Inner Wheel and Lions. We are members of Vision 2020/International Agency for the Prevention of Blindness, Sound Hearing 2030, Global Club Foot Initiative, Walk for Life and World Hearing Forum. We support, and are a member of, the Fundraising Regulator, and several staff are members of the Chartered Institute of Fundraising; both organisations are designed to promote ethical standards and good practice in fundraising.

Our philosophy is shared with our many partners around the world through the International Federation of IMPACT Organisations and in practice through our working culture. We encourage our local partners (which are autonomous organisations in their own countries) to work with other NGOs and to collaborate with relevant stakeholders to influence policy on a local and national scale. Individuals from IMPACT Foundations are often asked to speak at professional conferences and to share ideas and practices more widely within their networks.

However, it is at the grass-roots level that our advocacy work makes the most impact by sharing knowledge and skills with often very marginalised communities, so that people can make informed decisions about their own health and take steps to minimise their – and their family’s - risk of needless disability. In turn, they become our best advocates by sharing learning with their neighbours and spreading the word about IMPACT so those who need us can make use of our services.

Accessibility

IMPACT is committed to equality and the creation of a barrier-free environment for all in accordance with British legislation (the Human Rights Act 1998, the Equality Act 2010) and international treaty obligations (the UN Convention on the Rights of Persons with Disabilities).

Accessibility for everyone is the keystone of IMPACT’s international programme of action. We work hard to reduce the obstacles that people with disabilities face so that they can fulfil their potential through training and education and by providing assistive devices such as hearing aids, spectacles and prosthetic limbs to overcome physical barriers that may prevent education or employment. Our projects also directly seek to overcome other barriers to accessing health and medical care, for example, poverty, geographical remoteness and difficulty accessing information.

Recognising that there is no ‘one size fits all’ when it comes to accessibility and that people with different disabling conditions require different solutions, we make best efforts to accommodate everyone within the physical constraints of our small office, regardless of needs. IMPACT UK’s website has been carefully designed to be accessible. Please see www.IMPACT.org.uk/accessibility for further details.

Disability is a human rights issue. The 17 ‘Sustainable Development Goals’ (SDGs) were adopted in September 2015 to shape the post-Millennium Development Goals (MDGs 2000-2015) international development framework. People with disabilities are specifically referenced in five of the SDGs which is an important milestone, since disability was conspicuous by its absence in the MDGs.

Training and capacity building for community-led development

IMPACT believes strongly in the power of education and training as a driver of long-term beneficial change. We work with local people to develop skills and gain knowledge that enables them to deal with the specific challenges they, and their communities, face. For example, we fund training and equipment for female health workers to meet women’s need for care during pregnancy, birth and in the post-natal period in areas where the nearest health post may be hard to access. This is keeping mothers and babies safe during a time of elevated risk.

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We also work with our local partners to train health and nutrition volunteers, ear care workers, teachers to check their students’ health, and specialists such as nurses, surgeons and audiologists to deliver the best possible medical treatment – 1,948 of them in total this year, despite the challenges posed by the Covid-19 pandemic. All are local people who make huge contributions to their communities as a result.

People with sound knowledge are better able to make informed decisions about their own health behaviours and 160,118 people have participated in health education sessions or tuned into IMPACT’s health-based radio programmes this year. These focus on the steps everyone can take to protect themselves and their families and also give practical information about what health and medical services are available through their local IMPACT or IMPACT partner, or via Government programmes (e.g. vaccination or micronutrient supplement delivery).

IMPACT is firmly committed to community-led development and by ensuring knowledge and skills are widely shared, we are working with marginalised people to make sustainable improvement in their lives and in the lives of others.

Safeguarding

IMPACT UK takes the safeguarding of children and vulnerable adults extremely seriously. We are committed to ensuring safeguarding practice reflects statutory responsibilities, government guidance and complies with best practice and requirements of the Charity Commission. Our policies are regularly reviewed by IMPACT UK’s senior management team and board of Trustees. Every member of IMPACT UK staff regularly undergoes a Disclosure and Barring Service (DBS) check and we have ‘whistleblowing’ structures in place, should these be needed by staff or volunteers.

Here in the UK, our Tasty Team project works in primary schools and with vulnerable adults and children in our local community. Each of our volunteers is carefully vetted, undergoes a Disclosure and Barring Service check, receives full training and careful monitoring, and signs up to a raft of relevant policies including Child Protection; Code of Behaviour for Working with Children and Vulnerable Adults; Lone Worker; and Safeguarding Adults. They are regularly reminded of their responsibilities under these policies.

Our partners overseas are all autonomous organisations but we share safeguarding policies and best practice with them and strongly encourage them to ensure they have policies and practices in place to comply with safeguarding rules in their own country.

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2020/21
Mothers’ Clubs feature across IMPACT’s programme and are a powerful force for change
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Looking to the Future
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There is so much to do in the fight against needless disability around the world. IMPACT has ambitious plans for the future and continues to raise vital voluntary contributions from the public, charitable trusts, community services organisations and businesses.

As resources become available we hope to:

 Begin construction of a new building which will eventually become a standalone IMPACT Nursing Institute and replace the current facility located within IMPACT Bangladesh’s hospital in Meherpur. This would enable more nurses to be trained each year and better help to meet the acute shortage in Bangladesh

 Provide even more specialist surgery including burns operations in Cambodia and hydrocephalus operations for children in Bangladesh

The IMPACT Nursing Institute in Bangladesh

 Install additional SIDKO water filtration plants for safe, accessible water, and renovate toilet blocks in more schools in Bangladesh, to improve sanitation and menstrual hygiene and dignity to keep girls in school all month

• Develop the skills of more local healthcare professionals by supporting training, which is a long-term solution to

• ensure delivery of quality health services

• Provide further support for IMPACT India’s award-winning Lifeline Express hospital train through a very special

• matched funding appeal to mark its 30[th] anniversary

• Provide running costs and staff training for the ZOP Academy in Zanzibar, which provides specialist education

• and opportunities to hearing impaired children who might otherwise never go to school

• Work with The Lake Clinic (TLC) to deliver on-going mental healthcare services for vulnerable people living in

• the floating villages of the Tonlé Sap Lake, with a particular focus on tackling domestic abuse and violence

• Increase access to safe water sources and sanitation for rural communities in Kenya through infrastructure

• building and health education

• Respond to the extra needs of our partners to meet the challenges of operating safely in the face of Covid-19

• and help to ensure that vulnerable people do not go hungry due to loss of income as a result of the pandemic

 Expand the reach of the Tasty Team project in the UK through online resources (e.g. cooking videos on a dedicated YouTube channel); restart face-to-face cooking sessions when it is safe to do so; launch after-school cooking clubs and work with more of the people who have really struggled during the pandemic, for example elderly people, to improve their food security and nutrition

• Respond to emergencies in our project areas should they arise

To achieve the above, we will:

• Work hard to secure unrestricted funds, which will enable us to expand our programme and rapidly meet need

• wherever it is identified

• Continue to identify projects which meet donors’ needs and work with both donors and partners to ensure

• satisfactory delivery of them

• Continue to improve the way we collect and analyse data for routine monitoring and reporting as well as

• identify ways to demonstrate our impact and lessons learnt

• Support the exchange of information, experiences and good practice, between partners

• Share new ideas and encourage innovation in programmes where possible

And much more as opportunities arise.

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Financial review and policies
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• We generated incoming resources of £1,688,896 (down 1.4% on last year)

• Legacies: £161,340 (up 119% on last year)

• Gift Aided donations: £252,126 (down 2.6% on last year)

• Gifts in Kind: £90,554 (down 16.2% on last year)

• We expended £1,741,098 (down 0.6% on last year)

Fundraising

We start each year with the goal of generating at least £1.5 million of incoming resources to drive our programme of international action to prevent and treat needless disability for some of the most vulnerable people in our world. This amount enables us to meet the commitments we have made to international project partners for ongoing work, and more besides for new initiatives or partners, pilot projects and the emergency situations that sometimes arise and to which we can respond rapidly. It also makes our ‘Tasty Team’ project possible, here at home in the UK.

The start of the new financial year coincided with the very early days IMPACT’s BBC Radio 4 appeal in of the Covid-19 pandemic amid the first, and most stringent, national February 2021 was in aid of the Jibon lockdown as the staff team rapidly adapted to working from home and Tari floating hospital and presented by the TV cook and former ‘Great British the economy looked to be in a perilous position. This created Bake Off’ winner Nadiya Hussain: “My enormous uncertainty about our ability to both raise funds and deliver family are from Bangladesh, where programme activities but due to the unwavering generosity of our medical care is hard to reach for the supporters, income is only marginally lower than the previous year poorest people, and treatable health (down 1.4%). Total income is 12.6% above our target. Many of issues can turn into long-term these funds have come about as the result of specific appeals to help disability, trapping people in poverty. A mitigate the effects of the pandemic by protecting health workers and floating hospital is the perfect way to supporting community people at risk of infection or hunger caused by reach remote rural communities.” lack of money to purchase food. However, we were also surprised and delighted to raise almost £145,000 from our Radio 4 appeal on 27[th] February 2021; £122,594 of which was received before year end of 31[st] March 2021. This will be invested in the future of the Jibon Tari floating hospital in Bangladesh.

IMPACT’s BBC Radio 4 appeal in February 2021 was in aid of the Jibon Tari floating hospital and presented by the TV cook and former ‘Great British Bake Off’ winner Nadiya Hussain: “My family are from Bangladesh, where medical care is hard to reach for the poorest people, and treatable health issues can turn into long-term disability, trapping people in poverty. A floating hospital is the perfect way to reach remote rural communities.”

How we raise funds

Without fundraising, the work described in this annual report would have been impossible. As a charity, IMPACT has a legal duty to raise funds effectively in order to deliver public benefit. We have a nimble and highly efficient fundraising operation and results belie its small size. This year we have generated £21.73 of income for every £1 expended on fundraising (FY19/20 £18.68:£1).

We have never paid a third-party organisation to raise funds or send appeals on our behalf and we never share supporters’ information with other charities or purchase mailing lists. We believe that our fundraising is so successful because we keep it all ‘in house’ and only contact people who have already shown an interest in or commitment to our work. Perhaps most importantly, we work hard to develop personal relationships with the people who contribute to our work and make it easy for them to contact any member of the team, including the Chief Executive and Trustees. We understand that our supporters are essential partners who drive forward our work as much as the people on the ground delivering healthcare in remote villages of Africa and Asia.

We only pay for services where we cannot do it ourselves (for example graphic design and print) or where using a trusted supplier is more cost-effective.

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Our fundraising almost exclusively takes the form of applications to charitable trusts, foundations and community service organisations, and appeals to individuals by letter or email, in strict adherence to rules governing data protection. Recipients are given ample opportunity to ‘unsubscribe’ so that we do not write to them again. However, we occasionally undertake events (when not under restrictions) and support members of the public in their efforts to raise funds for us.

Legacies are an essential source of funds (£161,340 this year) and whilst we receive some legacies from people we have not had a prior relationship with, most come from people who have supported our work during their lifetime. We are humbled that so many supporters choose to remember us in their wills and strive to ensure that their legacy makes a real difference for the next generation.

We take every opportunity to reach new audiences without buying lists of charity supporters, and to convert respondents into long-term supporters. For example, as mentioned above, we successfully applied to the BBC for one of their coveted appeal slots. Our BBC Radio 4 appeal was presented by the TV cook and former Great British Bake Off winner Nadiya Hussain on 28[th] February, 2021. We are delighted to report that, at the time of writing, it was the most successful BBC radio appeal in an illustrious history stretching back to the 1920s!

Adhering to good fundraising practice

IMPACT is fully signed up to and regulated by the Fundraising Regulator, an independent non-governmental organisation which exists to maintain standards and public confidence in fundraising within England, Wales and Northern Ireland. It provides guidance and a Code of Conduct for charities and acts as an investigator and arbiter where complaints about fundraising cannot be resolved between the charity and complainant directly.

Members of IMPACT’s fundraising team are individual members of the Chartered Institute of Fundraising and have completed the CIoF’s professional qualification. They are bound to adhere to its codes of conduct and practice.

As required by regulators, we maintain a log to record any complaints about our fundraising activity and we also receive a weekly summary of any complaints made against us to the Fundraising Regulator directly. There have been no complaints again this year and we attribute this to our very considered approach; sending careful appeals in a targeted manner to ensure that we only contact people we believe are genuinely interested in our work. We ensure that supporters’ contact preferences are recorded and respected so if a person requests no further contact, they will not hear from us again. Our policy is never to bombard supporters with appeals, and this has served to engender a large core of long-standing supporters.

When a supporter engages with a charity, it usually involves the provision of personal data. This is an act of trust and IMPACT takes its protection very seriously. We regularly review data protection legislation and adhere to the relevant rules (General Data Protection Regulation (GDPR) etc.) All personal data is recorded on an industryleading database (Blackbaud’s Raiser’s Edge) and stored by Blackbaud on its secure servers. Hard copy data is kept in locked filing cabinets within our locked office and when no longer needed, is securely destroyed by shredding.

We already have a Data Protection policy and are in the process of adopting a Fundraising policy to set out and formalise the good practice we use every day.

Supporting others to raise funds for our work

We are immensely grateful to the individuals and organisations who raise money on behalf of IMPACT. Without them our fundraising efforts would be far less effective. For example, the IMPACT ‘Luncheon Club’ which is run entirely by volunteers and has been raising vital funds for more than two decades. This year the Luncheon Club has contributed £5,555 (FY19/20 £24,840) despite national restrictions on social events meaning it could not operate as in other years and we are immensely grateful.

Thank you also to the many community service organisations that support IMPACT. Rotary Clubs in Great Britain and Ireland have been fundraising for us since we were established in 1985, and Rotary gifts have totalled

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£22,100 this year (FY19/20 £7,824). Like the Luncheon Club, their efforts have been made immeasurably more difficult by Covid-19 restrictions.

We are grateful to people who have undertaken events – such as Sushma Puri’s ascent of Mount Snowden in aid of IMPACT India’s work – or used their skills to support us – such as Issi Hyams of Mont Blanc Yoga who has been running online yoga classes with proceeds to many parts of our programme. Our supporters have adapted to the ‘new normal’ to ensure that IMPACT still receives essential funds.

We work with people fundraising on our behalf to ensure they are also adhering to good practice in fundraising, data protection, and safeguarding vulnerable people in the same way our small team in Haywards Heath does.

Protecting vulnerable people

IMPACT has safeguarding policies to ensure vulnerable people are protected within our project activity, for example, the Tasty Team’s in the UK works with children and vulnerable adults and all volunteers are issued with a copy of the policy and stringent checks are made before they have any contact with beneficiaries. Working practices are also designed with safeguarding in mind.

However, vulnerable people must also be protected as part of good fundraising practice. Our high standards and good practice in fundraising generally also protects vulnerable people. For example, we never exert pressure on people to donate and our contact is only with people who have come to us, rather than been contacted ‘cold’. We respect requests not to be contacted whether they come from the individual or someone acting on their behalf, and because all gifts are processed by our team, we know many donors personally and are alert to gifts which might appear unusual. Any suspicions must be reported to the management team for further investigation. Our complaints procedure and membership of regulatory bodies provide a fall-back for vulnerable people, or those acting for them, in respect of IMPACT’s fundraising.

Income and investments

We know that our supporters entrust their gifts to us because the maximum possible will be invested in our charitable activities in Africa, Asia and the UK – 92.4% for every £1 expended this year was used for this purpose. The remaining expenditure was split between our effective fundraising which powers the projects (4.4%) and essential Governance costs (3.2%) which ensure the Foundation is well run and meets legal obligations.

In an on-going low interest rate environment, making returns on investment while maintaining a low risk strategy remains challenging. Income from investments was £10,265 this year and was down 60% on the previous year (FY19/20 £25,655). Our investment policy is regularly reviewed by our Investment Committee and is described in the next section.

Balances on restricted and designated funds (notes 20 and 21 in the accounts) show that significant commitments are made towards future programme expenditure. We pledge funding for up to three years so that implementing partners can plan their work and in turn avoid letting down the people who rely on the healthcare they deliver. Longer-term projects also allow greater depth in service delivery. This strategy will be more important than ever in the coming months as our local partners recover from the pandemic which forced a rapid change in their work and prevented some of the activities which they rely on to generate income for their programme, causing gaps in their finances.

We continue to actively fundraise and explore new sources of income in order to meet any shortfall on specific projects and if restricted funds are subsequently raised and received, designated funds are released to be used elsewhere. Balances are held by the Foundation on interest-bearing deposit until and whilst the project is implemented.

Rigorous financial controls are in place and our cash position remains healthy.

The Foundation expended £1,741,098 this year; down 0.6% on the previous year (FY19/20 £1,752,354). 92.4% of expenditure was on direct charitable activities. The table below shows expenditure by country within our international programme with a comparison to last year.

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In addition to keeping our ongoing commitments to overseas partners going, it has been necessary to respond quickly to the challenges of the Covid-19 crisis to keep frontline health workers in our projects and project areas safe, and to provide urgent relief to community people at risk of infection and hunger. Thanks to the unstinting support of our donors, we have been able to provide substantial funds for this purpose, amounting to almost £250,000 expended during the period from both restricted and unrestricted funds. Sadly, the pandemic looks set to be an ongoing feature of IMPACT’s work for the foreseeable future.

‘Gifts in kind’ of goods and services are invaluable and help us stretch every penny as far as possible. We thank Rayner Intraocular Lenses Limited for its enduring support through regular donations of IOLs which are sent to our local partners for use in sight-restoring cataract surgery. During FY 2020-21, the value of donated IOLs was a magnificent £86,400.

We also received generous gifts in kind of food and other supplies to support the UK Tasty Team healthy meal box scheme with a value of £4,154. Thank you to Booker Wholesale, Tesco Burgess Hill, Plawhatch Farm Shop and its customers, Michelle Frost and the friends and family who contributed so generously.

Thank you also to Jenny Stone CIPD, who provides Human Resources advice at no charge, and to the many volunteers, coordinated by Lucinda Meagher, who gave up so much of their time to work with the Tasty Team to deliver the healthy meal boxes to people in need of improved food security in the area surrounding IMPACT UK’s office in Haywards Heath, West Sussex.

Country	Amount expended on charitable activities (£)	Proportion of the	Proportion of the
		Foundation’s total	Foundation’s total
		expenditure 2020-21	expenditure 2019-20
Bangladesh	458,698	26.2%	21.4%
Cambodia	194,481	11%	11.2%
India	234,074	13.4%	6.4%
Kenya(East Africa)	118,624	6.8%	14.2%
Nepal	102,280	5.8%	4.4%
Africa (Ethiopia, South Sudan and Tanzania)	35,120	2%	1.2%
Zanzibar	169,379	9.7%	7.3%
The UK(nutritionproject)	24,239	1.4%	0.8%
International	108,819	6.2%	11.4%

In addition to the essential funds raised by IMPACT UK for our local partners to run their disability-prevention programmes, each successfully raises funds from within their own countries or internationally from supporters in many countries including the USA and Australia.

Since every partner is fully independent of IMPACT Foundation UK, these funds are not included here, but on top of charitable gifts, income is generated in resourceful ways including rental from unused office space or spare operating theatre capacity, selling produce from farms, and cost-recovery from the delivery of medical care or pharmacy services to patients who can afford to pay. These streams of local income have been hit hard by Covid19, however, and we will need to work closely with every partner to find ways to plug gaps in budgets going forward so that projects do not suffer. It is a key principle that our services will always be free to the very poorest people.

Thanks to a Sussex-based charitable trust gifting us our premises in the early 1990s, we have no mortgage or office rental costs, and this enables us to keep our running costs very low.

It will be seen from the Balance Sheet that all our investments are represented by cash and short-term deposits. The balance on unrestricted, non-designated reserves is £182,576.

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Structure, governance & management
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Organisational structure

The IMPACT Foundation is a registered charity (number 290992, July 1985) and a public benefit company without share capital limited by guarantee (number 1878297). The Foundation is organised under the direction of its governing body, which is the Council of 17 Trustees who, for the purposes of company law, are also Directors of the Company. They are responsible for determining the policies and strategic direction of the IMPACT Foundation but, as there is no share capital, the Trustees have no interest in the IMPACT Foundation as defined by the Companies Act 2006.

The IMPACT Foundation operates in accordance with its constitutional mandate, the Articles of Association, and subject to relevant legislation. We are aware of the Directors’ duties under the Companies Act 2006.

Trustees and their responsibilities

The Trustees hold meetings at least three times a year to review detailed financial and progress reports and discuss new project proposals. The Trustees delegate the IMPACT Foundation’s day-to-day operations to the Chief Executive and the senior management team. Other meetings by sub-committees and task forces appointed for specific purposes take place on a regular basis. For example, a Staff Committee is delegated to consider human resource issues, policies and remuneration. Recognising the need to keep up with the raft of new regulations and employment legislation, the Trustees retain the services of a volunteer Human Resources Consultant. All staff are invited to attend Trustees’ meetings. This year, meetings have been held by ‘Zoom’ video-conference due to the Covid-19 panic.

The Trustees are responsible for preparing the Trustees’ Report and the financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice). They prepare accounts for each financial year which give a true and fair view of the state of affairs of the charitable company; of the incoming resources; and of the application of resources, including the income and expenditure of the charitable company, for that period.

In preparing those accounts the Trustees are required to:

• Select suitable accounting policies and apply them consistently

• Observe the methods and principles in the Charities SORP

• Make judgements and estimates that are reasonable and prudent

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

• Prepare the financial statements on the going concern basis, unless it is inappropriate to presume that the charitable company will continue in business

The Trustees are responsible for keeping proper accounting records that disclose with reasonable accuracy, at any time, the financial position of the charitable company and enable them to ensure that the financial statements comply with the Companies Act 2006. They are 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.

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

In so far as the Trustees are aware: there is no relevant audit information of which the charitable company’s auditors are unaware; and the Trustees have taken all appropriate steps to make themselves aware of any relevant audit information and to establish that the auditors are aware of that information.

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The Board of Trustees’ other responsibilities include:

• Setting policy and overseeing strategic direction

• Complying with relevant laws and regulations

• Ensuring that charitable objects are met

• Promoting the IMPACT Foundation’s reputation, values and integrity

• Taking appropriate care and advice when investing money

• Making sure charitable funds and assets are used to further IMPACT Foundation’s charitable aims and fulfil its public benefit duty

Trustees are asked each year at the beginning of a meeting to declare any conflicts of interest. A policy is in place to manage any conflicts which might arise.

Trustees serving during this period are listed on page 2. Trustees have no financial interest in the IMPACT Foundation and receive no remuneration for their services. Our Governance costs this year were £13,969 (FY19/20: £15,767). This saving can be attributed to hosting virtual Trustee meetings, rather than hiring venues and refreshments.

Recruitment and appointment of Trustees

The appointment of Trustees is conducted in line with the IMPACT Foundation’s Articles of Association. Trustees collectively have the power to appoint any person to be a Trustee but the Board of Trustees must consist of not less than 12 and not more than 20 people. The skills mix and diversity of the Board of Trustees is also considered. As set out in the Articles of Association, a Trustee serves for a maximum term of three years and is then eligible for re-election.

Policies apply for the recruitment, selection, induction and training of Trustees and members of staff, all of whom have agreed job descriptions.

We recognise the importance of providing new Trustees with sufficient information to equip them to become effective members of Council. All new Trustees receive a comprehensive induction pack of background material. They are invited to spend time with the staff team and visit project activities. Fellow Trustees are invited by the Chairman to act as mentors to new Trustees.

During the course of this financial year, a group of Trustees (collectively the ‘Sub Committee, Board Management and Future’) were tasked with undertaking a thorough review of board composition and succession planning. Trustees were all asked to make a written submission highlighting what they thought the Sub Committee’s remit should include. This exercise identified eight main issues for consideration. Due to Covid-19 restrictions on meeting, it was agreed to look at three issues (timing of the process, the re-election of existing trustees and reinvigorating the Advisory Council) until such a time as Council could meet face-to-face. This process is ongoing.

Strategic review

A meeting was held on 20[th] June 2018 to review the previous five-year strategy and plan for 2018-2023.

The new strategy confirmed IMPACT’s six priority areas and set out funding goals including maintaining at least 90% of expenditure on direct charitable activities; greater emphasis on funding new projects; and helping partners to contribute a greater proportion of funds themselves. In addition, some wider goals were agreed including seeking new partners to work with and new countries in which to work; pursuing the possibility of digital initiatives to deliver our work; and greater emphasis on malnutrition, obesity and diabetes within our work.

Progress towards meeting the objectives of the strategy is reviewed regularly by the Senior Management Team and discussed at Council level at least once per year.

It is anticipated that the effects of the global Covid-19 coronavirus pandemic may affect delivery of the strategy significantly.

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Employees

During FY20/21, IMPACT Foundation had a small team of just seven people (three full-time and four part-time) who, under the direction of the Chief Executive, assisted by the Deputy Chief Executive and Funding and Development Director, are responsible for the day-to-day management of the charity. Having clearly defined roles enables the organisation to be run efficiently and to fulfil our core function of raising funds, supporting our local partners to deliver action to prevent and treat needless disability, and implementing a healthy nutrition project in Sussex. Every staff member has access to a copy of our comprehensive Employee Handbook and policies, which are reviewed and updated regularly and there is an ‘open door’ policy for all team members with the Chief Executive, Deputy Chief Executive and Funding and Development Director to discuss everything from ideas for the running of the Foundation to personal development. National lockdown was imposed in late March 2020 so staff members have been working remotely in their homes due to the Covid-19 pandemic for most of this financial year. Regular virtual team meetings have been enormously beneficial and investment was made to ensure the security of all technology being used remotely. Productivity has been undiminished.

Volunteers

Volunteers, like Gifts in Kind, add enormous value to IMPACT’s work and stretch limited financial resources as far as possible. Together, so much is achieved in our collective fight against needless disability.

In more normal times, medical volunteers from around the world including surgeons, anaesthetists and nurses, visit IMPACT programmes to use their skills, but Covid-19 restrictions on international travel have made this almost impossible. For example, the ENT team from IMPACT Nepal would usually travel to IMPACT Cambodia to conduct surgery to restore hearing at least once per year. Wherever possible, our programmes are carried out by people resident in that country, but where specific skills gaps are identified by our local partners, we help to facilitate these short sabbaticals during which medical care is delivered and training for local medical teams is carried out to reduce the need for visits in the future. We hope that this will resume again as soon as it is safe to do so because it is immensely valuable for both patients and medical professionals, and contributes to local sustainability over time.

The Tasty Team in the UK could not operate effectively or reach so many people without the team of 10 volunteers who give their time so freely to implement it. Once again, Covid-19 caused changes to the usual work volunteers carry out (for example, teaching basic cooking skills and sharing information about nutrition with children and vulnerable adults) and they were quickly re-deployed to making healthy meal boxes and delivering them to people in their homes in Mid Sussex. They were joined by a further 30 volunteers in this endeavour which helped to ensure that vulnerable people had reliable access to healthy produce, despite lockdowns.

We are also hugely grateful to the people who run our successful fundraising Luncheon Club, help out in our office (when possible) and raise funds or awareness about our work.

In addition, approximately 950 local volunteers work within our projects around the world; invaluable contributors to the health and wellbeing of their communities.

Relationships with partners

Our 14 partner organisations in Africa, Asia and Europe (IMPACTs Norway and Switzerland which are both income generating organisations) all share the same aim – a world free from disability. These partners are autonomous, registered not-for-profit organisations in their own country whose accounts are fully audited. Most of them are IMPACT Foundations although we do work closely with other organisations where we share aims and a longstanding relationship, and where is it more efficacious to partner with them than to set up an IMPACT Foundation which would duplicate effort.

The ‘IMPACT family’ usually meets every two years to exchange good practice and reaffirm our mission. Our most recent International Federation of IMPACT Organisations conference took place in India in October 2019.

The main role of IMPACT UK is to raise funds, and provide the financial support and other assistance needed to enable our partners in Africa and Asia to implement projects for the treatment and alleviation of needlessly

40

disabling conditions. We also run a nutrition programme in Sussex which is based on lessons learned in our partners’ projects in other countries; and foster collaboration between IMPACT Foundations around the world.

Data protection

We are aware of our responsibilities under the Data Protection Act 1998 and the General Data Protection Regulation (GDPR) which came into force on 25[th] May 2018. It has never been our policy to sell or exchange names and addresses with other organisations, or to disclose such data to a third party. We use an industryrespected database to store data safely. Confidentiality agreements and normal security procedures are in place. We keep Data Protection under regular review.

Risk assessment

The Charity Commission requires the Trustees to identify and review the risks faced by the IMPACT Foundation and this has been in place since 2001. Because IMPACT works mainly in developing countries where working conditions are often challenging, the review identifies and analyses strategic, operational, regulatory, human resources, reputation, political and environmental risks by prioritising and setting out how to mitigate them.

The risk assessment is reviewed each year by representatives of the Trustees and the Management team. Council is satisfied that the appropriate systems are in place to monitor these risks and to mitigate any impact they may have on the charity. Specific risks are considered throughout the year by relevant stakeholders, for example, the Investment Committee, Staffing Sub-Committee, Honorary Officers of the Foundation or Senior Management Team.

----- Start of picture text -----
2020/21
IMPACT’s staff and trustees conducted virtual meetings throughout the pandemic
----- End of picture text -----

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INDEPENDENT AUDITORS’ REPORT TO THE MEMBERS AND TRUSTEES OF IMPACT FOUNDATION

OPINION

We have audited the financial statements of Impact Foundation Limited for the year ended 31st March 2021 which comprise the Statement of Financial Activities, the Summary Income and Expenditure Account, the Balance Sheet, and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards, including Financial Reporting Standard 102, the Financial Reporting Standard applicable in the UK and Republic of Ireland (United Kingdom Generally Accepted Accounting Practice).

In our opinion the financial statements:

• give a true and fair view of the state of the charitable company's affairs as at 31st March 2021 and of its incoming resources and application of resources, including its income and expenditure, for the year then ended;

• have been properly prepared in accordance with 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.

OTHER INFORMATION

The other information comprises the information included in the trustees’ annual report, other than the financial statements and our auditor’s report thereon. The trustees are responsible for the other information contained within the annual report. Our opinion on the financial statements does not cover the other information and, except to the extent otherwise explicitly stated in our report, we do not express any form of assurance conclusion thereon. Our responsibility is to read the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact.

We have nothing to report in this regard.

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OPINION 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' annual report (incorporating the directors’ report) for the financial year for which the financial statements are prepared is consistent with the financial statements; and

• the directors’ report 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 directors’ report.

We have nothing to report in respect of the following matters where 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.

RESPONSIBILITIES OF TRUSTEES

As explained more fully in the trustees' responsibilities statement (set out on page 38, 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:

• Because of the inherent limitations of an audit, there is a risk that we will not detect all irregularities, including those leading to a material misstatement in the financial statements or non-compliance with regulation. This risk increases the more that compliance with a law or regulation is removed from the events and transactions reflected in the financial

43

statements, as we will be less likely to become aware of instances of non-compliance. The risk is also greater regarding irregularities occurring due to fraud rather than error, as fraud involves intentional concealment, forgery, collusion, omission or misrepresentation.

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

USE OF OUR REPORT

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

STEPHEN POTTER FCA (Senior Statutory Auditor)

For and on behalf of CARTER NICHOLLS LIMITED Chartered Accountants Victoria House Stanbridge Park Staplefield Lane Staplefield West Sussex RH17 6AS

Dated:

44

IMPACT FOUNDATION STATEMENT OF FINANCIAL ACTIVITIES (including income and expenditure account) FOR THE YEAR ENDED 31ST MARCH 2021

				Expendable
		Unrestricted	Restricted	Endowment	Total Funds	Total Funds
	Not
	e	Funds	Funds	Funds	2021	2020
		£	£	£	£	£
INCOME AND ENDOWMENTS FROM :
Donations and Legacies	6	258,854	1,392,122	-	1,650,976	1,654,537
Income from Charitable Activities	7	5,555	22,100	-	27,655	32,664
Income from Investments	5	3,794	2,796	3,675	10,265	25,655
Total Income and Endowments		268,203	1,417,018	3,675	1,688,896	1,712,856
EXPENDITURE ON :
Expenditure on Raising Funds	8	77,232	-	-	77,232	90,311
Expenditure on Charitable
Activities	9	262,569	1,385,161	16,136	1,663,866	1,662,043
Total Expenditure		339,801	1,385,161	16,136	1,741,098	1,752,354
Net gains / (losses) on					63,829
investments	12		-	63,829		-
					11,627	(39,498)
Net Income / (Expenditure)		(71,598)	31,857	51,368
					11,627	(39,498)
NET MOVEMENT IN FUNDS		(71,598)	31,857	51,368
RECONCILIATION OF FUNDS
Total Funds brought Forward		737,010	497,513	935,431	2,169,954	2,209,452
Total Funds Carried Forward		£ 665,412	£ 529,370	£ 986,799	£ 2,181,581	£ 2,169,954

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

All income and expenditure derive from continuing activities.

The notes on pages 48 to 56 form part of these accounts.

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IMPACT FOUNDATION

BALANCE SHEET AS AT 31ST MARCH 2021

BALANCE SHEET AS AT 31ST MARCH 2021
Note FIXED ASSETS Tangible assets 11 Property Investment 12 CURRENT ASSETS Debtors 13 Short term deposits Cash at bank and in hand CREDITORS : amounts falling due within one year 14 NET CURRENT ASSETS TOTAL ASSETS LESS CURRENT LIABILITIES NET ASSETS FUNDS 2 Expendable Endowment 19 Restricted 20 Unrestricted Designated 21 Fixed Assets replacement 19 Other 19 Total Funds	2021 £ 115,167 - 115,167 22,696 1,854,677 198,977 2,076,350 9,936 2,066,414 2,181,581 £ 2,181,581 986,798 529,370 1,516,168 367,670 115,167 182,576 665,413 2,181,581	2020 £ 120,067 256,000
		376,067
		14,534 1,456,648 333,273
		1,804,455 10,568
		1,793,887
		2,169,954
		£ 2,169,954
		935,431 497,512
		1,432,943 435,505 120,066 181,440
		737,011
		2,169,954

The notes on pages 48 to 56 form part of these accounts

The above accounts have been prepared in accordance with the special provisions of Part 15 of the Companies Act 2006 relating to small companies

Signed on behalf of the board of Directors/Trustees

Director/Trustee:

Director/Trustee:

Robin d’O. Hope (Honorary Treasurer)

Peter Webster, Ma, FCA (Trustee)

Approved and authorised by the Board:

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IMPACT FOUNDATION STATEMENT OF CASH FLOWS FOR YEAR ENDING 31ST MARCH 2021

Note Net cash used in operating activities 22 Cash Flows from investing activities 5 Increase / (decrease) in cash and cash equivalents in the year Cash and cash equivalents at the beginning of the year Total cash and cash equivalents at the end of the year	2021 £ 253,468 10,265 263,733 1,789,921 2,053,654	2020 £ (64,666) 25,655 (39,011)
		1,828,932
		1,789,921

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IMPACT FOUNDATION NOTES TO THE ACCOUNTS FOR THE YEAR ENDED 31ST MARCH 2021

1 ACCOUNTING POLICIES

Accounting Convention

The financial statements have been prepared in accordance with Accounting & Reporting by Charities: Statement of Recommended Practice applicable to charities preparing their accounts in accordance with the Financial Reporting Standard applicable in the UK (FRS 102) (effective 1 January 2015) - (charities SORP (FRS 102) and the Companies Act 2006.

Reconciliation with previous Generally Accepted Accounting Practice

In preparing the accounts the trustees have considered whether in applying the accounting policies required by FRS102 and the Charities SORP FRS102 the restatement of comparative items was required. At the date of transition no items were identified that required restatement.

Capital Expenditure

Items of an enduring nature are treated as fixed assets. Other items are written off in the year of purchase.

Depreciation

Depreciation is provided on tangible assets, at a rate calculated to write off the cost less estimated residual value, of each asset over its useful life as follows:

Buildings Over 50 Years Computers and Equipment Over 4 Years

Investments

Investments are included in the accounts at market value at the year end.

Income

Income is accounted for on a receivable basis taking account of entitlement, probability and measurement as defined within current accounting regulations.

Gifts in Kind

Gifts in kind of assets held as stock for distribution by the charity are recognised as incoming resources within "voluntary Income" only when distributed with an equivalent amount being included as resources expended under the appropriate category of the Statement of Financial Activities to reflect its distribution. The assets are valued at the open market cost for equivalent items.

Expenditure

Liabilities are recognised as soon as they become known. Expenditure on Charitable Activities includes the proportion of salaries, secretarial costs and other relevant expenses which relate to the planning, development and administration of these activities. Staff costs are allocated proportionally on a time spent basis. Other indirect costs are apportioned as the trustees deem appropriate from time to time.

Pension Costs

By agreement with the Trustees, the Foundation makes defined contributions to personal pension arrangements chosen by the relevant staff, and administers an auto enrolment pension. The costs of such contributions are charged to expenditure as they fall due.

Public Benefit Company

Impact Foundation is a public benefit company.

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2 FUNDS

These accounts include four categories of fund within the general headings of restricted and unrestricted.

Restricted Funds may be used for specific purposes and may not be used by the charity for any other purposes, without the prior consent of the donor.

Expendable endowment is a fund where the donor wishes income to be used for limited charitable purposes. The Trustees have power to convert the fund to income. This is also a restricted fund.

Unrestricted funds are expendable at the discretion of the Trustees who have designated funds which are earmarked for particular projects. Such designation is not a binding restriction - the Council can re-designate such money if they consider it appropriate.

Fixed Assets fund is an amount equal to the net value of functional fixed assets. This is treated as an unrestricted fund.

3 RESERVES

Unrestricted reserves are needed:

a) to provide funds which can be designated to specific projects to enable these projects to be undertaken at short notice, and

b) to cover administration, fund-raising and support costs without which the charity could not function.

The Trustees consider it prudent that other funds within unrestricted reserves excluding designated and fixed asset replacement should be sufficient to cover six months administration, fund-raising, governance and support costs.

Other unrestricted reserves as defined above currently equate to the minimum considered prudent.

The level of reserves is monitored and reviewed by the Trustees three times a year.

4 CAPITAL COMMITMENTS AND FINANCIAL LEASES

There were no capital commitments at the year end. There were no material commitments in respect of financial leases.

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5 INVESTMENT POLICY

The Foundation's policy is to invest with careful consideration of the following:

a) SECURITY

• b) REALISABILITY

The need to avoid incurring losses and to take into account what level of risk is acceptable.

• The need for easy and speedy realisation without incurring material loss.

• c) PERIOD OF INVESTMENT The minimum period for which the investment can be made before proceeds are required.

• d) ETHICAL Need to avoid unethical investment.

e) INCOME FROM INVESTMENTS

e) INCOME FROM INVESTMENTS
Bank and deposit interest Property net income	2021 £ 11,975 (1,710) 10,265	2020 £ 18,492 7,163
		25,655

6 DONATIONS AND LEGACIES

DONATIONS AND LEGACIES
Gift Aided Donations Legacies Other Donations Sub-total Gifts in Kind	Unrestricted Restricted Expendable Funds Funds Endowment 72,371 179,755 - 109,340 52,000 - 77,143 1,069,813 - 258,854 1,301,568 - - 90,554 - 258,854 1,392,122 -	Total Prior Year Funds Total Funds 252,126 258,989 161,340 73,667 1,146,956 1,213,881
		1,560,422 1,546,537 90,554 108,000
		1,650,976 1,654,537

Gifts in kind of £90,554 represents the open market value of intraocular lenses and associated equipment received from Rayner Intraocular Lenses Limited which have been sent to Cambodia in accordance with the donor's wishes for use by IMPACT Foundation in that country, and donations of food and other goods for the UK Tasty Team's healthy meal boxes.

7 INCOME FROM CHARITABLE ACTIVITIES

INCOME FROM CHARITABLE ACTIVITIES
Supporters Lunch Club Rotary EXPENDITURE ON RAISING FUNDS Supporters Luncheon Club Staff Costs Other Costs	2021 £ 5,555 22,100 27,655 £ - 65,643 11,589 77,232	2020 £ 24,840 7,824
		32,664
		£ 11,248 67,436 11,627
		90,311

8 EXPENDITURE ON RAISING FUNDS

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9 EXPENDITURE ON CHARITABLE ACTIVITIES

Bangladesh Cambodia East Africa India Nepal Sri Lanka Tanzania Zanzibar Other International United Kingdom Support Costs	Unrestricted Restricted Expendable Funds Funds Endowment £ £ 65,210 393,488 - 15,506 178,975 - - 118,624 - - 234,074 - 48,115 54,165 - - - - - 35,120 - 3,540 165,839 - 5,768 103,051 - - 8,103 16,136 138,139 1,291,439 16,136 124,430 93,722 - 262,569 1,385,161 16,136	2021 2020 £ £ 458,698 375,660 194,481 196,684 118,624 249,848 234,074 112,056 102,280 76,729 - 54,000 35,120 21,221 169,379 128,176 108,819 199,211 24,239 4,764 1,445,714 1,418,349 218,152 243,694
		1,663,866 1,662,043

Included in the Restricted Fund resources expended is the sum of £90,554 which represents the value of Gifts in Kind as shown within note 6 to the accounts.

Support Costs are further analysed Note International Research International United Kingdom Administration Governance Costs 10 10 GOVERNANCE COSTS Audit Staff Costs Other	Staff Other 22,795 1,828 93,843 20,769 20,104 3,901 33,091 7,852 7,037 6,932	Total Expenditure 2021 2020 £ £ 24,623 27,152 114,612 131,821 24,005 25,993 40,943 42,960 13,969 15,767 218,152 243,693 2021 2020 £ £ 4,507 4,657 7,037 8,023 2,425 3,087 13,969 15,767	Total Expenditure 2021 2020 £ £ 24,623 27,152 114,612 131,821 24,005 25,993 40,943 42,960 13,969 15,767 218,152 243,693 2021 2020 £ £ 4,507 4,657 7,037 8,023 2,425 3,087 13,969 15,767
	176,870 41,282		243,693
			2020 £ 4,657 8,023 3,087
			15,767

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11 TANGIBLE FIXED ASSETS

11 TANGIBLE FIXED ASSETS
Cost At 01.04.20 Additions during year At 31.03.21 Depreciation At 01.04.20 Charge for year At 31.03.21 Net Book Value At 31.03.21 At 31.03.20 12 PROPERTY INVESTMENT At 01.04.20 Disposal At 31.03.21	Land and Buildings £ 167,725 -	Computers other equip. £ 8,581 -	Total £ 176,306 -
	167,725	8,581	176,306
	50,458 2,755	5,781 2,145 7,926 655 2,800 2021 £ 256,000 (256,000) 0	56,239 4,900
	53,213		61,139
	114,512		115,167
	117,267		120,067
			2020 £ 256,000 -
			256,000

The property investment represents a bungalow donated to the Impact Foundation which is shown in the accounts at a professionally assessed market value (per Graham Butt Estate Agents) of £256,000. As the property was sold during the year the gain in excess of the previous valuation is included within net gains on investments.

13 DEBTORS Accrued Interest Income tax recoverable 14 CREDITORS - amounts falling due within one year Sundry Creditors and Accruals	2021 £ 6,794 15,902 22,696 2021 £ 9,936 9,936	2020 £ 13,017 1,517
		14,534
		2020 £ 10,568
		10,568

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15 EMPLOYEES

2021

2020

The average number of persons employed by the

Foundation was: Full time employees Part time employees Staff costs during the year were as follows:- Salaries and wages Social Security costs Pension contributions	3 4 7 209,402 14,776 18,334 242,512	3 4
		7
		223,262 16,662 18,179
		258,103

Employees received emoluments including pension contributions as follows:

between £60,000 and £70,000 - between £40,000 and £50,000 1

A Staffing sub-committee of Trustees review the arrangement for setting the pay and remuneration of personnel in consultation with the Chief Executive at least once each year.

16 DIRECTORS / TRUSTEES

There were seventeen trustees, all of whom are members of the Executive Council and none of whom receive any remuneration from the Foundation.

Trustees did not claim reimbursement for expenses

17 AUDITOR'S REMUNERATION

The auditor's remuneration for audit work was £2,587 (2020- £2,637).

18 FUND MOVEMENT

FUND MOVEMENT
At 01.04.20 Income and Endowments Expenditure Other - Designated Asset replacement At 31.03.21	RESTRICTED UNRESTRICTED RESERVES Expendable Other Fixed Asset Designated General Total Endowment 2021 935,431 497,512 120,066 435,505 181,440 2,169,954 67,504 1,417,018 - - 268,203 1,752,725 (16,137) (1,385,160) - (183,035) (156,766) (1,741,098) - - - 115,200 (115,200) - - - (4,899) - 4,899 -
	986,798 529,370 115,167 367,670 182,576 2,181,581

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19 ASSETS AND LIABILITIES SPLIT BY FUND

Fixed assets Current assets Current Liabilities Fund Balances	RESTRICTED UNRESTRICTED RESERVES Expendable Other Fixed Asset Designated General Total Endowment 2021 - - 115,167 - - 115,167 986,798 529,370 - 367,670 192,512 2,076,350 - - - - (9,936) (9,936)
	986,798 529,370 115,167 367,670 182,576 2,181,581

See Income and investments on Page 36 for the planned use of designated funds.

20 RESTRICTED FUNDS

RESTRICTED FUNDS
	Balance	Increase	Decrease	Balance
	01.04.20			31.03.21
Bangladesh
Riverboat Hospital and Prevention
Project	7,071	29,070	36,141	-
Coronavirus
support	60	76,565	76,625	-
General	-	131,143	131,143	-
Nurses Institute	16,224	141,421	17,283	140,362
Community Health Care Centre	12,896	22,362	15,215	20,043
20th Anniversary
Appeal	242,246	18,730	162,037	98,939
Fistula &
Hydrocephalus	-	9,600		9,600
Equipment	-	29,051	29,051	-
Water Appeal	252	15,650	12,673	3,229
BBC Radio 4 Jibon Tari Appeal 2021	-	122,594	16,609	105,985
Cambodia
General	52	72,576	72,628	-
Lake Clinic	1,578	8,067	1,110	8,535
Water	-	2,500	2,500	-
Lake Clinic Mental Health	-	2,975	2,600	375
Coronavirus support	-	32,125	32,125	-
East Africa
Disability
Prevention	390	122,039	121,555	874
Tumaini Children's Charity	571	563	-	1,134
Water Projects	396	300	-	696

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RESTRICTED FUNDS - Cont. India

Disability Prevention Bhavnagar	-	50,576	1,607	48,969
Integrated
Project Pune	-	2,375	1,959	416
Lifeline Express Hospital Train	1,046	245,938	243,752	3,232
General	438	1,325	66	1,697
Pakistan
Safer Motherhood	4,670	-	-	4,670
Nepal
General	390	61,100	61,490	-
Rautahat - Safer Motherhood	533			533
Surgical Camps	-	25,000	22,000	3,000
Coronavirus support	-	22,942	22,942	-
Africa
Maternity	1,491	390	320	1,561
Fistula	155	161	-	316
Ethiopia	-	35,000	35,000	-
Zanzibar
Water	775	575	1,170	180
General	18,809	3,647	22,456	-
School For The Deaf	101,846	10,000	111,846	-
Coronavirus support	-	50,051	39,500	10,551
Sir John Wilson
Memorial Fund	3,256	-	-	3,256
International
General	27,456	69,931	97,387	-
Eye Care	51,931	2,819		54,750
Hearing	-	2,401	2,401	-
Coronavirus support	-	28,656	27,597	1,059
United Kingdom
Tasty Team Project	2,980	30,211	27,783	5,408
	497,512	1,480,429	1,448,571	529,370

All the above balances are held in cash.

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21 DESIGNATED FUNDS

21 DESIGNATED FUNDS
Balance Designated 01.04.20 during year Bangladesh Riverboat Hospital & Prevention Project 39,509 General 59,880 Nurses Institute 9,000 - Cambodia General - 48,000 East Africa Disability Prevention 54,487 - Water projects 269 - India Disability Prevention Bhavnagar 14,587 - Nepal General 33,966 85,200 Pakistan Safer Motherhood 26,807 - Sri Lanka Clinics 10,192 - Zanzibar General 46,299 International General 90,509 - Contingency Fund 50,000 - 435,505 133,200 22 RECONCILIATION OF NET MOVEMENT IN FUNDS TO NET CASH FLOW FROM OPERATING ACTIVITIES Net movement in funds Adjustments for : Depreciation charges /(purchase fixed assets) Interest and rent from investments Cash flow on investment disposal (Increase) / decrease in debtors Increase / (decrease) in creditors Net cash used in operating activities	Balance Designated 01.04.20 during year	Expended during year	Balance 31.03.21
	39,509 59,880 9,000 -	29,816 54,661 -	9,693 5,219 9,000
	- 48,000	24,326	23,674
	54,487 - 269 -	- -	54,487 269
	14,587 -	10,000	4,587
	33,966 85,200	51,746	67,420
	26,807 -	-	26,807
	10,192 -	8,000	2,192
	46,299	8,540	37,759
	90,509 - 50,000 -	13,846 - 200,935 2021 £ 11,627 4,900 (10,265) 256,000 (8,162) (632) 253,468	76,663 50,000
	435,505 133,200		367,770
			2020 £ (39,498) 4,900 (25,655) - (4,729) 316
			(64,666)

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How will you make your IMPACT?

The work you have read about in this report is only made possible by the generosity of our supporters. Funds are urgently needed to continue and expand our projects so that even more people benefit in the coming years. Please send us a donation using the Gift Form provided. Alternatively, telephone [phone] or visit our website to make your gift. Thank you.

Increase your gift at no extra cost

UK taxpayers can add more to their gift without it costing them an extra penny. Please tick the Gift Aid box on the Gift Form, return it to us and we will do the rest. This will also enable us to claim Gift Aid on donations you have made to IMPACT in the past four years. Higher rate taxpayers also benefit from additional tax relief on their gifts.

Regular giving

Setting up a standing order using the regular giving form makes supporting IMPACT’s work simple and knowing that we can depend on regular gifts enables us to implement long-term projects. Ticking the Gift Aid box on the Gift Form means we can reclaim tax on your generous donations too.

Legacies

Remembering IMPACT in your will gives a gift to future generations. Donations to charity are currently free of inheritance tax which can help to reduce the tax burden on your estate. Our special leaflet provides more details and is available upon request or online: www. IMPACT.org.uk/donate/remember-us-in-your-will

You can change lives

Shares

Tax relief is available on gifts of shares.

Fundraising events

Holding a fundraising event or sponsored challenge to support IMPACT’s work is now even easier thanks to Virgin Money Giving, an online service which enables fundraisers to set up dedicated pages for their event and to process credit and debit card donations. Please visit www.virginmoneygiving.com and search for IMPACT Foundation.

Further information

Please visit our website at www.IMPACT.org.uk. We publish regular newsletters and reviews and you can sign up for our e-newsletter online. You can also follow us on Twitter @IMPACT_UK_ and Facebook www.facebook.com/IMPACTFoundationUK and Instagram @impactfoundation_uk

Please contact us

We are only a telephone call away on 01444 457080 and would love to hear from you.

IMPACT Foundation, 151 Western Road, Haywards Heath, West Sussex, RH16 3LH Email: [e-mail] Registered Charity No. 290992

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MAKE AN IMPACT TODAY
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£25

Could establish a garden to feed another family

£43

Could help to restore sight, hearing or mobility; or repair another child’s cleft lip

£100

Could help train and equip a local health worker or traditional birth attendant

£1,700

brings clean water to a whole community

Regular giving

Knowing that we can depend on regular gifts enables us to implement long-term projects. You can set up a standing order to IMPACT using the regular giving form (right).

Legacies

Remembering IMPACT in your will can make a difference long into the future. When the time is right, please consider leaving us a legacy.

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IMPACT Gift Tokens
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IMPACT’s unique range of gift tokens make a heart-warming gift and can be personalised and sent directly to your loved ones.

Visit our website to see the full range - www.IMPACT.org.uk

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IMPACT Bangladesh’s Jibon Tari (Boat of Life) floating hospital
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IMPACT Foundation, 151 Western Road, Haywards Heath, West Sussex, RH16 3LH, UK Tel: [phone] Email: [e-mail] www.IMPACT.org.uk

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