2023-03-31-accounts

IMPACT Preventing disability. Transforming lives. 2022-23 Annual Report & Accounts

Contents

Contents
	PAGE 2 3 41 44 45 47 56
Foundation Information
Trustees’ Annual Report
Independent Auditors’ Report
Consolidated Statement of Financial Activities
Balance Sheet
Notes to the Accounts
How willyou makeyour IMPACT?

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Foundation information

Lady Wilson, OBE, FRCOphth (Hon)

Honorary President

Trustees who are Directors:

Brenda Luck, MB, Ch.B, DHC, DRCOG, MRCGP Chair John Scott Vice-Chair Peter Simons BBS MBA FCMA Honorary Treasurer / Company Secretary (appointed to the Board 01.12.22, appointed Honorary Treasurer and Company Secretary 01.04.23)

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 Robin d’O. Hope (Honorary Treasurer until 31.03.23) David Jameson Evans, FRCS, FRCS (C) John Mowbray, KC (retired 14.07.22) Michael O’Connell, MB, BS, BSc, MPhil, FRCS (Otol), FRCS (Orl) Lady Prance (retired 14.07.22) Sal Rassam MB BCh BAO LRCSI LRCPI DTM, DO MD FRCOphth Vinit Shah, MBBS, MRCP, FRCPCH David Walker, CMG, CVO Peter Webster, MA, FCA

Staff Team: Sarah Smith Co-Chief Executive (appointed 01.04.23) Pascale Noel Co-Chief Executive (appointed 01.04.23) Judi Stagg Special Advisor (CEO until 31.03.23) Tessa Brown Finance Manager Jackson Medlow-Stagg Fundraising Manager Julia Nottingham Office Manager Lisa Waller Development Manager (appointed 17.04.23, previously UK Programme Manager) Rosie Wiltshire UK Programme Co-ordinator (appointed 17.04.23)

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 in England and Wales and a company without share capital limited by guarantee 2

Trustees’ annual report

(Incorporating the Directors’ Report)

A message from our Chair

Each year throws up fresh challenges. At IMPACT our focus in these times of both economic and climate uncertainty is to be as costeffective as possible and to help the communities and partners with whom we work to develop their own resilience. We are hugely grateful to you, our donors, who continue to give generously despite pressure on household budgets in the UK too.

Last autumn, IMPACT’s appeal to help flood-affected families in Pakistan raised over £265,000. IMPACT is not a disaster organisation but when a crisis occurs we are well placed to assist the communities with whom we are already in contact. Houses were destroyed and families saw everything they possessed washed away. Having provided immediate assistance, IMPACT Pakistan is now building floodproof houses for 100 homeless families.

Brenda is a retired GP who has visited many overseas IMPACT programmes, including IMPACT Cambodia, at her own expense

Difficult economic and climate circumstances disproportionately affect communities already facing hunger, disease and poverty. In Cambodia the director of a primary school in a remote rural area told us, “we have never experienced this before, an organisation coming down to our school”. IMPACT Cambodia is offering eye and ear care, nutrition and hygiene guidance to these children - who with good health can be a future resource for their country. IMPACT strives to ensure that no one is left behind.

In Bangladesh at IMPACT’s Nursing Institute in Meherpur, six batches of students have so far completed their 3- year Diploma degree. They are now contributing to their communities and helping to tackle the country’s acute shortage of nurses. IMPACT always offers long-term solutions to challenges.

Here at home, IMPACT’s Tasty Team continues to help make family budgets go further by helping people prepare nutritious and enjoyable meals – skills to last a lifetime.

This year Judi, our CEO since 2009, steps down after nearly 40 years of service to IMPACT. We are looking forward to Pascale and Sarah, who also have long experience with IMPACT, taking over as joint-CEOs and delighted that Judi will remain involved with IMPACT.

We are well aware that it is harder than ever to afford giving. However, you can be assured that your generous donations will be well-used by IMPACT UK and our partners around the world to prevent needless disability and transform lives. This report shows how we make every pound donated go a very long way!

Dr Brenda Luck Chair, IMPACT Foundation UK 5[th] April 2023

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Making an IMPACT HOW & WHY

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

➔ Many of them were not born with a disability and live – unnecessarily - with a condition which could have been prevented or could be reversed

[Statistics source: WHO]

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 implementing partners in Africa and Asia)

BREAKING THE POVERTY CYCLE

People with disabilities often rank among the very poorest in society and lack equal opportunities to 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.

HOW IMPACT BEGAN

Needless disability is inextricably linked with poverty. The late Sir John Wilson (who was blind himself) founded IMPACT in 1985 as a means of sharing knowledge and supporting communities in rural Africa and Asia to prevent disabling conditions using practical, low-cost methods. Sir John worked with local people, such as surgeons, to establish multiple autonomous national IMPACTs - most of them in countries of the global south. IMPACT’s projects are straightforward, cost-effective and focus on community-led development to ensure that projects meet real needs and create long-lasting change.

Sir John Wilson campaigning for a Polio-free India during the 1980s

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IMPACT’s vision

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.

Living with a disability is a fact of life for more than a billion people around the world. It is estimated that a significant proportion of people with disabilities live with a condition that could have been prevented or could be treated. For example, permanent hearing loss caused by an untreated ear infection; cataracts causing sight loss that could be restored through surgery; or birth injuries caused to a mother giving birth alone or without trained assistance.

Needless disability and poverty are inextricably linked, each perpetuating the other. The poorest sections of society have least access to medical

services that could prevent needlessly disabling conditions and people with disabilities too often face discrimination and obstacles to employment or education – stepping stones to improved prosperity. IMPACT’s work to prevent and treat needless disability therefore also makes a vital contribution to the alleviation of poverty around the world.

A core part of our philosophy is the belief that local people are best placed to identify the needs in their own country and how to meet them in a culturally appropriate and cost-effective way. IMPACT UK never imposes ideas or action on our international partners but instead plays a supporting role to facilitate the programmes they have developed in consultation with beneficiaries. We also invest in training and equipping local medical and health workers to serve their communities for the longterm.

Kamwengi Primary School in Mwingi, Kenya benefited from a number of health improvement measures, including the installation of clean toilets, handwashing facilities and a rainwater harvesting system. The children are just some of the 46,900 people who have benefited from IMPACT projects to improve access to safe water and sanitation this year

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IMPACT’s vision

IMPACT has worked with 14 trusted and long-standing local partners in 11 countries of Africa and Asia during 2022-23. Each partner is autonomous and delivers a programme of action they have designed to prevent and treat needless disability; to promote health; and, as a consequence, to alleviate poverty. We always encourage partners to work with each other, as well as with IMPACT UK. We also run a successful project to promote healthy nutrition in our local community in the UK. Our shared 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 local health workers check people’s wellness and treat the early signs of needless disability. They also provide physiotherapy and assistive devices such as spectacles, hearing aids and prostheses

SAFER MOTHERHOOD & CHILD SURVIVAL

Medical support, straightforward monitoring and basic interventions such as vaccinations and 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, handwashing stations and toilets and the sharing of information about hygiene and sanitation

ENDING MALNUTRITION

Lack of vital vitamins and minerals is associated with visual and cognitive impairment, as well as increasing the risks during pregnancy, and compromising immunity so we help people to prevent deficiencies in cost-effective ways

HEALTH EDUCATION & TRAINING

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

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How each country programme contributes to our shared 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 public benefit of our work

IMPACT’s work makes a clear and valuable contribution to the public benefit and Trustees have due regard to the Charity Commission’s public benefit guidance when exercising any powers and duties to which the guidance is relevant. The rest of this report will demonstrate this in more detail.

Performance

IMPACT UK’s reach through our project in the UK and through funding for our international programme of action has extended to 700,000 people this year. This total includes adults and children living in some of the most challenging circumstances where it is often a daily struggle to meet basic needs. Everyone who participated was at risk of, or already living with, needless disability or compromised health.

While our outreach belies our small size, IMPACT UK’s founder Sir John Wilson, CBE, himself blind, reminded us that “People do not become disabled in their millions but as individuals, each in their own predicament”.

Behind every statistic in the table below is a real person with their own story to tell of how IMPACT’s work has changed their life; from mothers giving birth in the safety of a clean and well-equipped medical facility which means their baby has a greater chance of being born alive and ‘We have not stopped smiling since the well, to children who can now learn easily because their new spectacles surgeons on IMPACT’s floating hospital enable them to read and follow the lesson in class. From adults who can repaired my granddaughter’s cleft lip!’ earn a living following surgery to restore their sight or hearing, to health workers who are caring for their communities with the knowledge and equipment they need to do their job. And from parents and children who now have access to safe water and nutritious food, to members of Mothers’ Clubs who understand how to prevent needless disability and are a force for positive change in their villages. Thanks to our focus on sustainable, community-based comprehensive projects, many of those we have supported this year have benefited in multiple ways, which amplifies the lifechanging potential of our work.

‘We have not stopped smiling since the surgeons on IMPACT’s floating hospital repaired my granddaughter’s cleft lip!’

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In addition to our ‘Tasty Team’ project to promote healthy nutrition for vulnerable groups in West Sussex, IMPACT UK has supported 14 partners working in 11 countries of east Africa, south-east Asia and southern Asia to achieve the following:

Overall activity:

Action within on-going programme	2022-23	2021-22
People examined andprovided with treatment	282,097	202,364
Operations to restore sight, mobility or hearing, or to repair cleft lipor fistula	9,352	6,493
Immunisation against disabling disease (including activities to support Government vaccination programmes)	11,624	11,309
Mothers and babies receiving pre andpost-natal care	19,617	16,938
Combatting malnutrition, including home garden and micronutrient supplement beneficiaries	64,661	54,004
Healthprofessionals and communityvolunteers trained	3,512	2,606
People participating in health education or otherwise empowered within their communities	211,762	226,788
People benefiting from safe water and improved sanitation	46,900	369,582
Assistive devices given (hearing aids/orthotics/prostheses etc.)	25,276	23,084
Medical facilities upgraded/ provided with equipment	7	7
Other emergency relief
Flooding relief and rebuilding, Pakistan	Emergency food, clothing and other necessities plus medical care was provided to 12,693 people 102 brick homes and 46 small washrooms (WCs) built for 510 people made homeless	N/A

A more detailed description of these activities, broken down by country, can be found later in this report.

The return to more normal ways of working following the restrictions of the Covid-19 pandemic has shown in the figures above. Notably, the number of adults and children who have benefited from examination and treatment for a variety of medical conditions has increased by almost 40% and this is reflected in the corresponding increase in surgeries performed (up 44%) because people needing surgery are referred from the screening clinics and by school health teams – quite simply the more people who are examined, the more will be found who need surgery. Our local partners also gave out more bespoke assistive devices – spectacles, hearing aids, prosthetic limbs and the like (up 9.5%) than in the previous year; once again because more people were examined. The need for assistive technology is estimated to affect 2.5 billion people and is largely unmet, but according to the World Health Organisation, “Assistive technology enables people to live healthy, productive, independent, and dignified lives, and to participate in education, the labour market and civic life”.

Training for health workers and community leaders on needless disability prevention and treatment, or with specialist medical skills, increased by nearly 35% this year, once again due to the resumption of in person gatherings which made possible workshops and training courses.

The top deck of the Jibon Tari floating hospital serves as a training centre for community leaders and Traditional Birth Attendants

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We have been able to reach more people with action to prevent malnutrition (up 19.7% on the previous year) and more women and babies have benefited from our maternity care services (up 15.8%) thanks to the ability to run clinics and the growing confidence of people to return after Covid-19. Our field workers can also travel around communities freely now that restrictions on movement have ceased.

The number of people benefiting from immunisation (either from our medical teams vaccinating them or by health education which signposts how and where to receive vaccinations under Government schemes) and those participating in health education schemes has remained fairly level. We have built the infrastructure of the same number of health facilities as last year. This can take the form of construction, remodelling or the provision of medical equipment. Everything we help to provide is requested by the medical specialists running or working in our projects so we know it will be well-used, and is of the same standard you would find in hospitals in the UK.

The number of people benefiting from safe water and sanitation was exceptionally high in the previous year (2021-22) due to the installation of a water treatment plant in a hospital in Bangladesh which was used by very large numbers of staff and patients every day.

Monitoring the impact of our support is an important and continuous process. Our trusted local partners provide regular reports covering the projects we are collaborating on, and independent evaluations and programme visits from representatives of IMPACT UK provide added layers of oversight. We understand that when someone donates money to us a bond of trust is created, so we strive to ensure that those funds are always well-used.

IMPACT UK is funded entirely by voluntary contributions. Each and every gift is appreciated and without them, none of the work described in this report would be possible. Our income this year is £2,107,839 (down 2.4% on FY 2021-22). At the start of every year we set out to raise at least £1.5million in order to meet our commitments to partners and our modest operating costs, as well as one-off projects or requests for equipment as they arise.

Expenditure this year was £2,410,361 (up 4% on FY 2021-22) and 93% of this was spent on direct charitable purposes (projects and project development) compared to 94.3% in FY 2021-22. We strive for a minimum of 90 pence in every £1 expended being used for this purpose each year.

More detailed information about our financial performance can be found later in this report in the ‘Financial Review and Policies’ section on page 32.

– 2022/23 How every £1 was invested

----- Start of picture text -----
Administration
and Governance
4p
Fundraising 3p
93p
Direct
charitable
expenditure:
Projects and
project
development
----- End of picture text -----

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We always have ambitious plans to prevent and treat needless disability and last year set ourselves 14 goals – ‘Looking to the Future’ on page 31. We have made very good progress towards achieving these aims, as detailed below:

Goal	Achievement
Further expand the school-based safe water and menstrual hygiene work we have been developing with IMPACT Foundation Bangladesh in Chuadanga and Meherpur districts	This year, 3 SIDKO water treatment plants have been installed in schools in Chuadanga and Meherpur districts, 3 toilet blocks have been upgraded to provide private space, 2,200 pupils have participated in menstrual hygiene education and been given kits to support their menstrual health needs, which will help to keep them in school all month.
Build the infrastructure, and therefore capacity, of more health centres and hospitals in remote and underserved areas of Cambodia, to deliver quality medical care with a particular focus on maternity care	Our support made possible the construction of a new building for inpatients, A&E admissions and women delivering babies, at O’Chrov Referral Hospital, Banteay Meanchey, and the provision of 15 patient beds. This hospital has a catchment of more than 50,000 people; about 20% of whom are women of reproductive age. Due to overcrowding and lack of resources, patients had previously been accommodated outside.
Support the essential cost of dry dock maintenance for the Jibon Tari floating hospital in Bangladesh, which must be undertaken every four years to ensure the safety of the vessel and everyone using it	We paid for the cost of ‘dry dock’ maintenance and extensive repairs for the Jibon Tari floating hospital, which took place at Khulna dockyards from May 2022. Corroded steel plates were replaced throughout, the vessel was sandblasted and repainted, drainage systems and washrooms were repaired etc. On 12thAugust, shipyard workers and their families were thanked with an eye screening clinic which checked 216 people. In addition, we provided funding to overhaul the generators and install a new fire-fighting system. The Jibon Tari is fit and safe to continue its journey for the next four years.
Provide village communities in remote areas of Ratanakiri province (one of the least developed in Cambodia) with rice mills to ensure they can make use of their rice harvest as a sustainable source of food for hungry families	Despite our best efforts, we have been unable to raise the funds to provide more rice mills during this financial year but we remain committed to supporting innovative ways to reduce malnutrition around the world.
Upgrade surgical instruments at IMPACT Nepal’s Ear Care Centre in Birgunj, that we helped to establish	We raised funds for ENT care in Nepal in celebration of our President, Lady Wilson’s 100thbirthday in August. IMPACT Nepal chose to purchase an audiometer and a tympanometer for two Primary Ear Care Centres as the need for these was urgent.
Fund even more specialised treatment and/or operations for people with conditions including hydrocephalus, leprosy, burns and cleft lip	Specific funding has been provided to partners for 15 hydrocephalus operations in Bangladesh; 179 fistula/birth injury/gynaecological surgeries Bangladesh, Ethiopia and South Sudan; and 158 plastic surgeries (e.g. to repair cleft lip or burns) in Bangladesh and India.
Install ‘talking walls’ on school latrines in Kenya, to promote hygiene awareness messages	22 ‘Talking Walls’ (murals which hygiene and health messages) were installed in 11 schools with a potential audience of approximately 3,850 students and teachers.
Support three projects of IMPACT India’s award- winning Lifeline Express hospital train during	We paid for three projects of the Lifeline Express hospital train as a result of the matched funding 30thanniversary appeal, which took

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which 26,000 people will benefit from the services on offer, and 1,500 people will have their sight, hearing or mobility restored through surgery	place in Chhattisgarh, Odisha and Bihar states between April and July 2022. The fourth project we funded took place in Siddarth Nagar in early 2023. In total 41,237 people were screened or treated, 2,225 people underwent surgery to restore sight, hearing or mobility, and 5,936 assistive devices were provided.
Assist the new IMPACT Foundation Bangladesh hospital in Chuadanga to open and begin delivering services	We have provided funds for numerous items of much-needed, specialist medical equipment including a B-Scan and Retinoscopy set, an OCT Angiography machine, a digital X-ray machine, and a YAG laser machine.
Fund essential running costs for the ZOP Academy in Zanzibar, which provides specialist education and opportunities to hearing impaired children who might otherwise never go to school	We have once again provided significant funding for this specialist school which provides inclusive education to 30 students with significant hearing loss. Funding paid for essential running costs including the salaries of 25 members of staff from teachers and premises staff, to the onsite nurse and medical officer.
Invest in more families who want to start income generating micro-businesses with the provision of livestock such as goats, geese and chickens or seeds to grow fruit and vegetables (this helps to both feed members of the household and makes money to buy other essentials) and through entrepreneur training and business starter kits (hairdressing, baking etc.) for women leaving hospital following repair of obstetric fistula	Thanks to our ‘gift token’ fundraising scheme, our supporters have enabled the provision of geese to 15 families in Bangladesh while in Nepal, 27 families have received chickens and 14 families have received goats. 3,496 households and schools have been helped to start vegetable gardens. All of these initiatives have the dual benefit of reducing malnutrition and enabling families to generate income.
Provide scholarships for more student nurses in Bangladesh who should start their education in the new Nursing and Midwifery Institute building, which IMPACT UK has helped to construct	The support of IMPACT UK has paid for 30 student nurses at the Nursing and Midwifery Institute to study and live there this year. We also provided additional support for study materials to 19 nurses in particular hardship.
Continue to improve the resources (online and physical) available to volunteers and participants of the Tasty Team project in the UK and to explore opportunities to work with more local people to improve their food security, while building lifelong cooking skills and nutrition knowledge	734 people have taken part in the Tasty Team project this year, as participants learning to cook or as volunteers. A new opportunity arose to support Ukrainian refugees so ‘Ukrainian Fridays’ was born to help people forced to flee the war to meet local families and learn to eat healthily using sometimes unfamiliar ingredients. Online resources continue to grow with content regularly added to the Tasty Team YouTube channel. We have also supported users of local food banks to cook differently, swap ingredients for cheaper alternatives and reducing energy usage, through well attended workshops and distribution of slow cookers. In response to the cost-of-living crisis, we produced new recipe books for our beneficiaries, designed for cooking with slow cookers and microwaves.
Respond quickly and effectively to emergencies in our project areas should they arise	A rapid response to the devastating flooding in Pakistan through our local partner IMPACT Pakistan resulted in more than 13,000 people being supported with emergency food, clothes and other essential supplies, and medical care in the weeks that followed. 102 houses were built to provide long-term homes for the worst affected families.

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ASIA: Bangladesh

For almost three decades, IMPACT Foundation Bangladesh (IFB) has delivered an extensive programme of activities to prevent and treat needless disability for people living in remote and rural parts of the country, where medical services are vastly inadequate to meet the needs of the population.

Action is based at IFB’s thriving community hospitals in the districts of Chuadanga and Meherpur in south-western Bangladesh, and on the Jibon Tari (Boat of Life). The Jibon Tari is 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.

The Jibon Tari (Boat of Life) floating hospital has been ‘taking the hospital to the people’ since 1999

Construction of a new hospital in Chuadanga, to meet increasing patient demand, began in 2015 and we are delighted to report that the new premises were officially opened in October 2022. The hospital building has eight stories - with potential to add further floors as funds become available in the future. It houses five operating theatres; a maternity unit; A&E department; cardiac care clinic; and enhanced pathology and radiology facilities. The nearby former hospital building is now home to IFB’s orthopaedic services, including the Sir John Wilson Assistive Device Centre.

A mobile medical van, the Jibon Jatra, travels to remote villages to ensure that people do not miss out on vital care because they cannot travel into the town, and the hospital walls are pushed out even further by training community people such as teachers and members of Mothers’ Clubs to know the signs of disabling conditions and refer those affected to IFB’s health workers.

IFB’s second community hospital, in the neighbouring district of Meherpur, is also home to the prestigious IMPACT Nursing and Midwifery Institute, which was opened in 2014 to help meet the urgent need for professionally qualified nurses and midwives in the country. The Institute had an enrolment of 84 students during this year, and the Royal College of Nursing Foundation were among its generous UK supporters. We are supporting the construction of a standalone academic building in the hospital grounds.

Each IFB hospital is the base of a thriving community outreach programme which seeks to prevent a host of other causes of needless disability and ill-health, for example, malnutrition, lack of maternity care and services such as physiotherapy, and inadequate sanitation and safe water.

2022-23 Activities	Target	Achievement
People screened and treated for disabling and other health conditions in Outpatients Departments and clinics in the community	60,000	54,907
People attending health education and awareness sessions to learn how to protect themselves and their families	47,500	54,401
People who benefited from operations to restore their sight, hearing or movement or to ameliorate other disablingconditions	3,320	3,104
Peopleprovided with assistive devices and/orphysiotherapy	4,200	10,262
Women provided with ante and post natal care including micronutrient supplements (folic acid etc.)	3,100	4,289
Immunisations against infectious diseases and/or Vitamin A to protect eyesight, given to children	4,000	10,145

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Traditional Birth Attendants trained andprovided with a sterile equipment kit	600	600
Village Mothers’ Clubs meetingregularly	900	3,600
Primaryschool teachers trained to check their students’ vision and health	300	302
Children checked bytrained teachers	3,000	3,445
Home gardens established to provide families with nutritious fruit and vegetables to eat and thepotential togenerate income	750	750
Local health workers, rural medical practitioners, NGO workers and community leaders trained to understand and identifyneedless disability	700	701

Additional achievements… IMPACT UK’s support has also:

◼ Funded the training of 30 students at IFB’s Nursing and Midwifery Institute in Meherpur district, in order to help mitigate a critical shortfall in the profession locally. In addition to these scholarships, we provided uniforms and / or study aids for 19 student nurses in financial hardship and donated 15 textbooks.

◼ Upgraded IMPACT Foundation Bangladesh’s three hospitals with funds to purchase medical equipment and for essential maintenance. This included paying for the ‘dry docking’ of the Jibon Tari floating hospital – vital to ensure its safety and ‘seaworthiness’ – overhauling the generators and providing a fire fighting system; providing a digital X-ray machine and cardiac monitor for the hospital in Meherpur; and helping to establish an eye department at the new hospital in Chuadanga through provision of a YAG laser machine, OCT angiography machine, B-Scan, and retinoscopy set as well as a digital X-ray machine for general use and numerous items of equipment for maternity and female health care.

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

◼ 400 girls of reproductive age were vaccinated against Rubella to protect any future babies from a major cause of needless disablement and stillbirth, which can result if the mother is infected with Rubella during her

pregnancy.

◼ Installed 3 more SIDKO water treatment plants and upgraded toilet facilities for hygiene and privacy at schools in Chuadanga and Meherpur districts and accompanied this action with a programme to improve menstrual health which educated 2,000 students and provided them with menstrual hygiene kits.

◼ Installed 1 tube well in Madna, Dharmuda, Chuadanga; a village lacking accessible water and installed toilets in 12 households there.

◼ Supported IFB in its work to run the Jibon Mela hospital and community-based primary healthcare project in Meherpur district. Thanks to this project, 29,211 people have been screened and treated for health conditions, 1,301 operations have been performed, 4,174 people have had physiotherapy and/or an assistive device to improve mobility, 3,732 women have received quality pre and postnatal care including ultrasounds, 1,787 vaccinations have been administered, 2,615 women and children received dietary supplements as required, and 2,593 people have attended health education sessions to learn more about preventing needless disability. ◼ Given 15 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 through the sale of eggs. ◼ Provided 4 arsenic filters to households at risk of drinking contaminated water.

IMPACT Foundation Bangladesh’s Nursing Institute was established in 2014 to help meet the country’s desperate skills shortage – on average 30 new nurses graduate each year

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Cambodia

IMPACT supports two long-standing partners in Cambodia: IMPACT Cambodia (IC) and The Lake Clinic (TLC). TLC is the only non-governmental organisation providing direct health services in the remote and underserved regions of the country’s vast Tonlé Sap Lake.

IMPACT Cambodia

IMPACT Cambodia’s programme encompasses initiatives to safeguard maternal and child health; widen access to ENT screening, treatment and surgery; improve the health of children in rural schools; make safe water more accessible; as well as care and advocate for people affected by leprosy. Additional activities, such as improving rural health infrastructure and plastic surgery to treat people with burn injuries are undertaken as funds allow. Activities are focussed in three provinces: Preah Vihear, Ratanakiri and Banteay Meanchey, as well as the capital, Phnom Penh and nearby Kandal province.

Much of the disease burden in the project areas that IC target is attributable to the consequences of poverty and resources are focused on working with communities where overcrowded living conditions, inadequate sanitation, malnutrition and low levels of education exact a heavy toll on people’s health and impact health seeking behaviour: ‘ We find the poorest people put off seeking help when they are sick and they become sicker. Or they borrow money to visit untrustworthy traditional healers. We at IMPACT Cambodia see an opportunity to shine as a beacon in such communities. Not only to help when people are sick but to spread basic health and nutrition knowledge, and normalise good health so to speak’. [IMPACT Cambodia]

IC’s programme of action has flourished this year, now that Covid restrictions have eased and the team can once again access schools and health centres and travel freely around the country.

IC also supports communities affected by leprosy. Nationally, government agencies have been successful in curbing the prevalence of the disease, and today there are less than a third of the patients seen two decades ago. This is good news but because the disease now exists only in small pockets, it is no longer a public health priority and knowledge of its symptoms and ease of cure are no longer widespread, including amongst health workers. IC works to raise awareness of symptoms, break down stigma and make drug therapy accessible to all who need it.

IMPACT Cambodia partners with government health workers to reduce disability through village leprosy screening programmes - ensuring that people with the disease are given early drug therapy to stop its progression

2022-23 Activities	Target	Achievement
Early identification and treatment
ENT screening and on the spot treatment (Banteay Meanchey Province)	300	746
ENT screening and on the spot treatment (Ratanakiri Province)	300	1,202
ENT screeningand on the spot treatment (Preah Vihear Province)	300	824
School healthprogramme
School children ENT screening, on the spot treatment and general hygiene education (Ratakaniri and Preah Vihearprovinces)	200	5,219
Screening / treatment sessions (one day, one school)	2	20
Safe water and sanitation
Water wells for schools (Ratanakiri Province)	1	3

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Beneficiaries	225	698
Water wells for schools (Preah Vihear Province)	2	0
Beneficiaries	450	0
Water wells for health centres(BanteayMeancheyProvince)	1	2
Beneficiaries	15,600	31,200
Water filters for families(Ratanakiri Province)	49	20
Beneficiaries	367	160
Water filters for schools(7per school) (Ratanakiri and Preah Vihearprovinces)	21	84
Beneficiaries	675	2,818
Water filters for health centres(2per health centre) (BanteayMeancheyProvince)	2	0
Beneficiaries	15,600	0
Leprosy programme
Support training sessions on leprosy (Mongkul Borei, Banteay Meanchey Province)	4	4
Health workers receive on-going training at above sessions	184	76
Community members benefiting from leprosy awareness raising (Banteay Meanchey and Battambang provinces)	962	3,066
People with leprosy identified and receiving treatment and support	10	34

Additional achievements… IMPACT UK’s support has also made possible:

◼ Construction of a new building at O’Chrov Referral Hospital in Banteay Meanchey and provided 15 hospital beds to accommodate inpatients and A&E patients with part of the ward reserved for women giving birth. Previously, patients were accommodated outdoors.

◼ Training for 3 midwives in the management of postpartum haemorrhage.

IMPACT Cambodia’s ENT screening clinics are held in schools, villages and rural health posts

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The Lake Clinic (TLC)

The Lake Clinic (TLC) provides primary healthcare and maternity care to people living often precarious lives in the floating villages of the Tonlé Sap Lake and its tributaries; many of which are only accessible at certain times. Developmental indicators suggest that people here are generally poorer, sicker, more malnourished and less educated than in other parts of the country due to their relative isolation and the additional challenges or creating infrastructure in an environment characterised by an enormous, fluctuating mass of water which can take days to traverse by boat.

The medical team travels on The Lake Clinic and holds regular clinics on board, on floating platforms which have been left in villages for this purpose, or on riverbanks; setting up pharmaceutical dispensaries and examination cubicles under canvas and the shady protection of trees. TLC aims to reach each of the villages it serves once a month but conditions mean this is not always possible, despite the medical team staying on the lake for several days at a time.

The ‘children at risk’ programme seeks out children under-five who are stunted, underweight and malnourished and works with their parents on a plan to meet their nutritional requirements. Regular follow-up

Making motherhood safer on the Tonlé Sap Lake

in conducted and households are helped to grow vegetables on their floating homes, to supplement the fish which makes up the main body of the local diet.

Mental healthcare should be a key component of primary healthcare delivery and this year we have both supported TLC’s general and school health clinics and enabled continuation of a pilot project which aims to reduce the incidence of domestic violence in lake communities.

Working in four villages, specially trained TLC medical staff have been raising awareness of the issue of domestic violence among the population and local agencies and working with perpetrators to address their issues. Many villagers had no idea that domestic violence was illegal and had become accustomed to it as a common part of life. 303 people participated in awareness raising sessions and 51 male perpetrators have undertaken multiple intensive workshops to help them understand and change their behaviour. The TLC team are supported by remote weekly sessions with a Sussex-based psychotherapist.

As part of a much wider programme of activities run by TLC, IMPACT UK’s support has achieved the following:

2022-23 Activities	Achievement
Peopleprovided with medical care	565
Children checked by the school health team and given toothbrushes, supplements, antiparasitic medicines etc.	500
Floating gardens set up	296
People benefitingfrom the Domestic Violencepreventionproject	354

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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 (IIF) was the first member of the international IMPACT family to be registered – in 1983 – and is best known for its trailblazing project, the Lifeline Express hospital train which was the world’s first modern hospital on a train. Travelling the enormous Indian railway network to pull up in station sidings across the country, the Lifeline Express epitomises IMPACT’s objective to take the hospital to the people in underserved areas.

Staying for around a month at a time, each project of IMPACT India Foundation’s Lifeline Express provides medical screening, surgery to restore sight, movement, hearing and repair conditions such as cleft lip, treats non-communicable diseases and provides dental care to some of the poorest people in India.

Thanks to the success of our 30[th] anniversary matched funding appeal, during which a philanthropic family matched everything donated by supporters pound-for-pound, we were able to support IMPACT India Foundation in running three Lifeline Express projects, which were held in Chhattisgargh, Odisha and Bihar states during 2022. We funded another project, which took place in early 2023 in Siddharth Nagar, Uttar Pradesh. More than 40,000 people benefited from the Lifeline Express’ services during these projects.

2022-23 Activities	Achievement
IMPACT India Foundation’s Lifeline Express:
Projects madepossible byIMPACT UK funding	4
People screened and treated for medical conditions	41,237
Operations to restore sight,hearingor mobility	2,225
Aids and appliances(e.g. spectacles,hearingaids and orthotic devices)supplied	5,936

IMPACT India Foundation’s Lifeline Express hospital train screened and treated 41,237 people

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Ahead of the hospital train’s arrival at each new location, IMPACT India’s health workers carry out screening for disabling conditions and conduct health checks in the surrounding rural areas. They also train local volunteers and advertise the hospital’s services via billboards and other forms of local advertisements

Disability Prevention Partnership, PNR Society, Bhavnagar District, Gujarat

Over our long-standing partnership, we have collaborated with the PNR Society – the largest body of organisations for disabled people in India – on a number of projects and today, our restricted funds are directed to supporting its Blindness and Deafness prevention project and the work of the AT&T Technology Park and Institute which provides inclusive vocational education for people with disabling conditions.

The Blindness and Deafness team visit schools and run community clinics and have used IMPACT’s support this year to run an eye treatment camp for senior citizens from rural areas. The camp took place between July and September 2022, and screened and treated 1,714 people with 169 of them undergoing cataract surgery to restore their vision. Everyone was treated completely free of charge and may never have been able to benefit from surgery otherwise.

Screening and treatment camps to restore vision

The AT&T Technology Park and Institute has taught 133 students this year, all of whom live with disabling conditions including hearing and visual loss, cerebral palsy, physical and development disabilities. The Institute enables students to take courses in a number of IT specialisms from hardware and networking to mobile phone repair and desktop publishing, so that they can find jobs or start up small businesses when they leave. This offers rare and invaluable opportunities to young people who may otherwise find it difficult to earn a living.

2022-23 Activities	Achievement
Olderpeople screened aspart of the Blindness/Deafnessprogramme	1,714
Olderpeopleprovided with cataract surgery	169
Young people with disablingconditions enrolled to studyat the AT&T TechnologyCollege	133

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Disability Prevention Partnership, KEM Hospital Research Centre, Pune, Maharashtra

The relationship between IMPACT UK and KEM Hospital Research Centre, part of the largest non-government hospital in Pune, has lasted more than 20 years and we continue to work together on joint projects when funding is available. A registered charity, the KEM Hospital is a 550-bed, tertiary level teaching hospital which serves the people of the city in which it stands, and the wider urban and rural environs. The affiliated Research Centre seeks to advance knowledge about health and development through scientific research and projects which provide a direct benefit to the local population.

This year we have partnered on a special project to help so-called ‘tribal’ populations in Soygaon Taluka, located in a hilly area of Maharashtra State where water runs off the igneous rock and creates water scarcity, to support five villages which have suffered significantly from the Delta wave of Covid-19 in 2021. Lack of access to safe water sources and the risk of wild animal attacks or sexual assaults while walking through forests to natural sources means many people do not have enough water to meet their basic needs for living, growing produce and hygiene.

Niyambati Village is one of the communities that the KEMHRC identified with a high proportion of people struggling to meet their basic needs for food, water and shelter: ‘There is a huge unmet need here to help starving families until they can pick themselves up with some more sustainable income post COVID. Currently a significant number of families are facing starvation on account of loss of wages and the sharp rise in the costs of food and other items. Nutrition wise, many are surviving by eating gum from trees, berries, wheat husk gruel and in desperation, animals like snakes, frogs and rats. Malnourished children are everywhere. There is no government help for people in these situations’ – Laila Garda, KEMHRC

Although ‘tribal’ groups make up only 8% of India’s population, according to the World Bank they account for over a quarter of the country’s poorest people, all too often facing societal discrimination as well as geographical isolation.

Covid-19 further devastated these communities and left a significant number of young widows and orphans

when husbands and fathers (the main breadwinners) died from the virus or took their own lives is desperation at the parlous financial situation the pandemic had left them in. Many families were forced to take loans from moneylenders at exorbitant rates to survive and were unable to afford both food and loan repayments; the latter taking precedence. When KEM Hospital Research Centre’s Director visited the project’s target villages, she reported malnourished children everywhere and people starving.

The aim of the project was to install accessible deep wells with pumps for at least five communities and emergency feeding support for up to 800 of the most vulnerable families to build their health and resilience, and to save lives. This would give people the mental breathing space to be able to take back control of their lives along with the long-term benefit of accessible water.

2022-23 Activities	Achievement
Support for rural communities badly affected by the economic consequences of Covid-19 in Soygaon Taluka:
Villages assisted	5
Village wells installed/inprogress	5
Beneficiaries of wells	2,450
Emergencyfeeding programme to avert hunger and malnutrition(beneficiaries)	2,700

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Nepal

IMPACT Nepal has been working to prevent and treat

needless disability for three decades. Originally, the programme focused on ear and orthopaedic care, with surgical camps – often using a special operating theatre tent that could be taken across vast plains or up mountains into remote areas – to restore hearing and mobility. Treatment camps continue to be held and surgery is supplemented by bespoke aids and appliances to further enhance people’s ability to hear or move.

Over time, IMPACT Nepal has added multiple Primary Ear Care Centres across the country and built a dedicated Ear Care Centre with operating theatre in Birgunj, near the southern border with India. IMPACT UK’s funding has

IMPACT Nepal’s ENT surgeons at work

supported these facilities, which are delivering urgently needed ear care to local people with the aim of tackling one of the biggest causes of disability in the country – hearing loss.

IMPACT UK also supports IMPACT Nepal to deliver a safer motherhood and child health programme in Rautahat District. The baseline survey IMPACT conducted in the target area shows how necessary this is. Just 24% of women surveyed attended a health post for their baby’s birth, with just under 40% delivering at home with the help of skilled health attendant and just under 40% delivering at home without any trained support at all. This carries extreme risks for both mother and child. IMPACT Nepal is working to change this situation by helping women to deliver safely and ensuring mothers, babies and young children are monitored, well-nourished and immunised.

2022-23 Activities Target Achievement Primaryhealth care workers,ear assistants and rehabilitation technicians trained 12 8 Communityfield workers trained 1 1 Female communityhealth volunteers trained 81 90 Health centres/healthposts upgraded 3 5 Adults received screeningand treatment services 11,979 14,112 Children aged 0-16years received screeningand treatment services 1,500 6,424 Adults benefited from hearing-restoringsurgerythrough mobile camps or at hospital 1,120 1,410 Children aged 0-16 years benefited from hearing-restoring surgery through mobile camps or at hospital 193 528 Adults benefited from mobility-restoring orthopaedic surgery through mobile camps or at hospital 0 9 Children aged 6-18 years benefited from mobility-restoring orthopaedic surgery through mobile camps or at hospital 0 6 Adults received rehabilitation support/ physiotherapy 170 1,949 Children aged 0-16years received rehabilitation support/ physiotherapy 234 1,949 People benefited from theprovision of assistive devices such asprosthetic limbs 204 865 People benefited from theprovision of hearingaids 50 141 Womenprovided with ante andpostnatal care 2,330 5,542 Women motivated to take up immunisation for themselves and their 0-5 year old children 1,825 3,919 Pregnant women/new mothers received iron supplements 2,800 5,791 Pregnant women/new mothers received 30 eggs and 1kgchickpeas 200 144 Children aged 0-5years received Vitamin A supplements toprotect their vision 10,000 10,529 Women received de-wormingtablets 1,000 2,356 Children aged 0-5years received de-wormingtablets 10,000 6,750 People reached through a health awareness radioprogramme 50,000 60,000 People reached through health awareness raisingin the community 6,000 6,700 Homegardens established to feed families and reduce malnutrition 2,330 2,700

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IMPACT also invests in training local health workers to entrench skills and knowledge among communities for the long-term while the public are made aware of health issues and how they can take action themselves to prevent disability or seek treatment for existing conditions through a mass awareness programme, which reaches tens of thousands of people every year.

Additional achievements… IMPACT UK’s support has also:

◼ IMPACT UK’s honorary President, Lady Wilson, turned 100 in 2022 and to celebrate this wonderful milestone, birthday donations were used to purchase equipment for two ear care centres. It has been Lady Wilson’s life’s work to support action for the reduction of hearing impairment and she was delighted to know that we were able to provide an audiometer to Rautahat Ear Care Centre and a tympanometer to Rajbiraj Ear Care Centre on her behalf.

◼ Thanks to our supporters purchasing ‘gift tokens’ for their loved ones, we have been able to give 27 pairs of chickens and 14 goats to families which will both improve their diets with eggs and milk and provide them with a microbusiness to earn income. Gift tokens also enabled us to donate 13 menstrual hygiene kits to help women manage their monthly periods.

IMPACT Nepal delivers healthcare and nutrition support to rural mothers and their children. In addition, a health education campaign reaches members of the wider community

Pakistan

IMPACT Pakistan runs a network of 16 Mamta clinics in remote mountainous villages around Muzaffarabad and Mansehra, which were badly hit by the 2005 earthquake – indeed Muzaffarabad was the epicentre. We helped IMPACT Pakistan to establish the clinics as a permanent benefit to the local population who were trying to rebuild their lives following the hugely traumatic death and destruction they had suffered.

The clinics are each run by a female doctor with the help of a nurse/midwife and other health workers. They primarily deliver ante and post-natal care to women with the aim of supporting safe childbirth but in the absence of alternative facilities, they also serve the wider community with much-needed primary healthcare.

The people of Pakistan experienced natural disaster on a wide scale once again this year, when large swathes of the country were submerged by flood water. This destroyed homes, possessions and livelihoods and the unsanitary conditions spread disease. IMPACT Pakistan responded quickly with the provision of emergency supplies, reaching more than 11,000 people, and then followed up with a programme of house building for 102 families made homeless.

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2022-23 Activities	Target	Achievement
Women attending antenatal check-ups	3,200	3,332
Women and their babies attending postnatal check-ups	1,280	969
Babies delivered at a Mamta Clinic	860	412
Babies delivered at home assisted by a trained Female Health Volunteer	No more than 60	0
Babies delivered at home with noprofessional assistance	No target	0
Pregnant women experiencing complications who were referred to a hospital to give birth	No target	13
Men, women and children who benefited from general primary healthcare at the clinics	12,400	13,958
Health education sessions run	22	9
People who attended health education sessions	500	389
Local health workers who underwent continuing professional training to keep their skills up-to-date	64	152

Additional achievements… IMPACT UK’s support has also:

◼ Thanks to the rapid and generous response of our supporters, IMPACT was able act immediately when flooding swept across large parts of Pakistan in the second half of 2022. With our financial assistance, IMPACT Pakistan launched a package of emergency action which provided 5,755 people with food parcels, hygiene supplies and sanitary pads; delivered medical care to 2,238 people through pop-up clinics; provided tents for shelter to 3,500 people; and gave out 600 blankets and 600 coats to keep people who had been made homeless warm when the temperature dropped. After the initial emergency period, we funded the building of 102 brick (and flood-proof) permanent homes for 510 people who had lost everything to move into.

‘Generous UK supporters not only kept people warm and fed in their hour of need, it also let them know they had not been forgotten by the outside world’ Hamid Ali, IMPACT Pakistan

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Sri Lanka

The primary healthcare and wellbeing clinic that we helped IMPACT Sri Lanka to establish in Weerawila (a low-lying coastal district) to provide a lasting benefit for local people after the devastation wrought by the Indian Ocean tsunami in 2004 continues to serve its clientele of registered patients.

The local doctor who runs the clinic helps his patients to manage a host of chronic non-communicable diseases, for example, asthma, diabetes and heart disease, while also treating acute illnesses.

Patients at IMPACT Sri Lanka’s Weerawila Clinic

2022-23 Activities Achievement People receiving primary healthcare at the Weerawila Clinic 1,099

In addition, we sent 90 Intra Ocular Lenses to Sri Lanka via IMPACT UK Trustee Sal Rassam, an ophthalmologist, for insertion into the eyes of people undergoing cataract surgery.

AFRICA: Kenya

IMPACT East Africa (IEA) continues to support the local community in northern Mwingi, part of Kitui County; an area which is challenging to reach, arid and semi-arid (ASAL), with entrenched poverty and hunger, and lacking in basic services. Disease, ill-health and needless disability is the inevitable result for too many people.

IEA’s programme of action has got back on track following the enforced hiatus caused by Covid19 restrictions, when schools were closed for very long periods and travel around the area was forbidden, even for health workers. The School Health Team has screened, treated a variety of medical conditions, and provided de-

Children in 43 rural schools benefited from school health screening this year

worming medication to almost 12,000 children, whilst simultaneously training school health monitors to provide ongoing vigilance and administer First Aid. Trees have been planted to improve school compounds and water, latrines and ‘talking walls’ (murals with health messages) have been installed to improve hygiene.

In the wider community, clinics have checked the ears, noses and throats of nearly 2,000 adults and children, and provided treatment for commonly occurring conditions such as impacted wax or infection, which can result in hearing loss if neglected. Surgery has restored hearing to 34 people living with damaged ear drums, for example.

IEA’s nurse has also cared for pregnant women, new mothers and new-born babies, providing ante and postnatal monitoring, ensuring vaccinations are up-to-date and helping them choose a nourishing diet.

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2022-23 Activities	Target	Achievement
Water,Sanitation & Hygiene(WASH)
Install Pit Latrines in Schools(4 toiletsper school)	4 schools	9 schools benefiting3,150 students and teachers
Create ‘TalkingWalls’ for hygiene awareness	4 schools	11 schools benefiting3,850 students and teachers
Install Rainwater Harvesting systems in Schools	0 schools	3 schools received a 10,000 litre tank and associated pipework to store rainwater for ongoinguse.
Surgical Camps
Eye operations	50	0
ENT operations	20	34
Clinics – screeningand treatment
ENT clinics held	48	62
Adults screened and treated for ENT conditions		763
Children screened and treated for ENT conditions		1,116
School Health Programme
Schools benefitingfrom the School Health Programme	32	43
Children screened and treated by the IMPACT school health team,includingde-wormingtablets	2,800	11,258
Training provided to Teacher School Health Monitors	64	120
Training provided to Pupil School Health Monitors	640	671
Trees planted to provide shade, improve soil and prevent erosion,and retain water	450	800
Maternal and Child Health Services
Ongoing support for Mothers’ Clubs	1 Mothers’ Club	1 Mothers’ Club with 46 members
Provision of Ante and Postnatal monitoring for pregnant women and new mothers	300	293
Provision of health monitoring for children under 5 years	400	1,615
Provision of standard vaccinations to babies	125	1,173
Women supported to establish vegetablegrowing plots	30	46

Additional achievements… IMPACT UK’s support has also:

• Protected 39 girls against developing cervical cancer in the future by vaccinating them against Human Papilloma Virus (HPV)

• Vaccinated 138 people against the Covid-19 virus

• Celebrated World Hearing Day on 3[rd] March 2023 with a procession of primary schoolchildren promoting ear health in Mwingi North, a clinic which screened and treated 520 people, and raised awareness of World Hearing Day on social media – reaching around 6,000 people.

• We have provided general funds towards the work of Tumaini Children’s Charity, which provides safe accommodation, education and three nutritious meals a day to 500 parentless, homeless or refugee children aged 2-19 years.

The school toilets that IMPACT East Africa installs are colourfully painted to promote hygiene messages

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Tanzania

There are

an estimated 3,000 new cases of obstetric fistula every year in Tanzania. We support Maternity Africa in its work to eradicate this devastating but preventable condition through the provision of quality maternity care and support for women giving birth, and to provide surgical repair for women who are already living with birth injuries.

Maternity Africa runs a 48-bed maternity hospital (opened in 2018) in Kivulini, Arusha, which is also home to an obstetric fistula treatment unit and a midwife training centre, to enhance the skills and knowledge of local midwives working in government facilities in the region. With appropriate training to understand what to do if complications occur during labour and delivery, the risk of birth injuries – and usually the death of the baby – can be minimised.

IMPACT UK has assisted Maternity Africa’s work with the provision of a much-needed autoclave (used to sterilise medical instruments etc.) and funds to provide maternity care and to support particularly

----- Start of picture text -----
Maternity Africa prevents fistula by
providing quality maternal health
services in the Arusha region
----- End of picture text -----

vulnerable women leaving hospital after giving birth or fistula repair with a ‘care package’ of essential supplies to help them get back on their feet. This also gives the new-born baby the best chance to thrive.

On a special request, we also helped Maternity Africa to provide Loveness, who had just left hospital following fistula repair, with a water well at her home. Loveness uses crutches and due to limited mobility and was unable to carry water collected from the local well used by her community, some distance from her home.

Ethiopia & South Sudan

We have once again supported the work our local partner carries out at the Barbara May Maternity Hospital in Mille, Ethiopia and at Reconciliation Hospital in Referendum, Juba, South Sudan to repair women injured during long and obstructed childbirth. Many women have lived with their injuries, pain, and the socially isolating consequences of urinary and/or faecal incontinence, for many years – sometimes even decades. IMPACT UK has supported Maternity Africa and the Barbara May Foundation in the following ways:

2022-23 Activities	Achievement
Kivulini Maternity Hospital, Arusha, Tanzania:
Purchase of Autoclave sterilisingmachine	1
Safe deliveries and aftercare supported toprevent birth injuries,disablement and death	9
Carepackagesprovided to new mothers leavinghospital	4
Carepackagesprovided to women leavinghospital followingbirth injurysurgery	7
Home well installation toprovide water for Loveness,a fistulapatient who uses crutches	1
Barbara May Maternity Hospital, Mille, Ethiopia:
Provided fundingfor fistula operations to repair women injured duringchildbirth	20
Reconciliation Hospital, Juba, South Sudan:
Provided fundingfor fistula operations to repair women injured duringchildbirth	35

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Zanzibar

IMPACT UK has been working in partnership with Dr Naufal Kassim, who runs IMPACT Zanzibar, since 2002 when we funded his training in Kenya to become an ENT surgeon – the first on the islands! Prior to this, people with ENT disorders were forced to travel to Tanzania for surgery, which was out of reach for most people, or to live with an untreated condition. As a result, many lost their hearing and livelihoods.

From its base at Mnazi Moja hospital in the capital, Stone Town, IMPACT Zanzibar has expanded its programme of disability prevention clinics into the community, travelling across the two main islands of Unguja and Pemba, with annual visits to more remote islands that can only be reached by boat; delivering the only healthcare available to the local residents in situ . Noncommunicable diseases such as hypertension and diabetes are managed and women are provided with ante and post-natal care.

----- Start of picture text -----
Mobile clinics take healthcare across the
two main islands of Zanzibar
----- End of picture text -----

IMPACT Zanzibar identified that taking healthcare into schools was a time and cost-effective way to reach large numbers of children, with the aim of preventing needlessly disabling conditions developing from neglected, but common, conditions such as impacted ear wax or infection. Skin infections are also prevalent, but medication can clear them up and keep children in school. Treating children while they are young means their education is not hindered by long absences or impaired sight or hearing. This removes obstacles to fulfilling their academic potential and puts them on the road to economic independence when they grow up.

IMPACT established the first neonatal hearing screening programme on Zanzibar with the aim of detecting infants with impaired hearing. Providing a hearing aid and specialist interventions early (including support for parents in how to care for a hearing-impaired baby), along with a pathway to education, means children have a chance to develop communication and attend school. We helped to establish and continue to fund the costs of the ZOP Academy – a highly specialised school which enrols hearing-impaired children identified by the screening programme and through the ear care centre at Mnazi Moja hospital. Profoundly hearing-impaired children are commonly kept at home, especially in rural areas, because they are unable to attend mainstream schools.

2022-23 Activities	Target	Achievement
ENT outreach camps	6	15
People screened/treated at outreach ENT camps	600	1,248
ENT operations to restore hearing	120	496
Mobile ENT and eye clinics held	6	18
People screened/treated at mobile ENT and eye clinics on Unguja island	900	4,429
Communitycamps held on Pemba island	3	8
People screened/treated at Communitycamps held on Pemba island	450	1,980
Schoolsparticipatingin the School Health Project	70	85
Children screened through the School Health Project	10,000	75,967
Children treated through the School Health Project	1,000	1,632
Babies reached by the Neonatal Hearing Screening team to identify hearing impairment as soon aspossible	3,000	3,083

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Additional achievements… IMPACT UK’s support has also:

◼ Provided essential running costs for the ZOP Academy - a school for 30 young children with severe hearing impairment, and the salaries of 25 members of staff including teachers, maintenance staff, a medical officer and onsite nurse. In addition, we have funded specialist training in paediatric audiology for Dr Naufal Kassim, ENT surgeon and school governor. The ZOP Academy enrols young children identified by our neonatal hearing screening programme who are given hearing aids and provided with a safe and nurturing environment in which to learn maths, Swahili, speech, sign language, lip reading, English and more. The school also builds confidence, sociability and self-worth while older students are taught practical skills from which they will eventually be able to earn a living. Many profoundly hearing-impaired children are kept at home and never learn to communicate so the opportunity to attend the ZOP Academy is life-changing for its students.

IMPACT Zanzibar has been running a School for Deaf Children since 2009. It provides quality education, speech therapy and sign language to children with hearing impairments, most of whom would not go to school if it did not exist. Many of the children have complex needs and so this year we have supported the recruitment of a full-time, onsite Medical Officer.

United Kingdom

IMPACT’s Tasty Team support young families and local residents in Mid Sussex with cooking sessions focussed on developing their skills and confidence in the kitchen whilst encouraging the reduction of food waste through batch cooking and meal planning.

As the increasing cost of living presents greater challenges for families struggling on tight budgets, we also focus on using nutritious low-cost ingredients and cheaper methods of cooking including microwaves and slow cookers.

The pandemic has highlighted more than ever the importance of a healthy diet and reducing levels of obesity. With one-fifth of children and teenagers’ vegetable intake coming from ultra-processed foods (Peas Please Veg Facts 2021), we strive to improve the diet of our communities, ensuring they have the knowledge and ability to make healthier food choices. It is our aim that in doing so, we enable them to live heathier, happier lives free from diet related illness such as diabetes.

Our sessions allow participants to cook collectively in a fun and relaxed environment, learning skills that they can replicate themselves at home. Each participant receives recipes for them to use time and time again. We aim to overcome barriers to eating healthily by improving cooking skills, understanding how to budget and using food swaps to bring down food costs, reducing loneliness and social isolation by enabling people to cook and eat together and making dietary changes to reduce reliance on ultra-processed food.

During the year we have worked with schools, local community hubs, residents in supported housing, very young mothers living in shared accommodation, and older residents. We have also supported Ukrainian refugees by hosting our ‘Ukrainian Fridays’ sessions facilitating new social networks through cooking.

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Lisa Waller, UK Programme Manager.

As a resident within supported housing in Mid Sussex, Alefa joined our sessions with the intention of improving her diet;

“I’ve always just eaten whatever I felt like at the time, I’ve never planned meals nor have I enjoyed cooking. Today I made a chicken fricassee with a creamy mushroom sauce and I made my first ever omelette that didn’t turn into scrambled egg. It’s easy to get lazy when you live on your own and it’s made me think I can do more and cook fresher meals. It’s also been nice to get out and talk to others in the lesson, especially during these colder winter months when you don’t see many people.”

2022-23 Activities	Achievement
TastySessions inprimaryschools to introduce healthyfoods	13
TastySession beneficiaries	413
Get Cooking Sessions with adults and children to develop the cooking skills and nutritional awareness ofpeople in need of extra support	77
Get Cookingbeneficiaries	239
Other events	2
Number ofpeople benefitingfrom other events	64
CookeryLeader and Volunteer trainingsessions	3
CookeryLeader and Volunteers trained	18

Tasty Team cooking sessions develop cooking skills and nutritional awareness

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International

Advocacy & Networking

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 Global Club Foot Initiative and World Hearing Forum. We are members 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 Finance Manager is a member of the Association of Accounting Technicians (AAT).

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. By preventing and treating needlessly disabling conditions and providing assistive devices such as hearing aids, spectacles and prosthetic limbs to overcome physical barriers, obstacles to training, education and employment are also removed. Our projects also directly seek to overcome other barriers to accessing health and medical care, for example, poverty, geographical remoteness and difficulty accessing information. While we always seek to benefit those most in need, there are no restrictions on who may benefit from IMPACT’s work and discrimination against people with protected characteristics is never practiced nor tolerated in any part of our programme in any part of the world.

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) to be achieved by 2030 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.

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Training and capacity building for community-led development

IMPACT believes strongly in the power of education and training to bring about sustainable, beneficial change. We support skill development and awareness so that people in our project areas are able to deal with the specific challenges faced by their families and communities. 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 many miles away over unmade roads. This is keeping mothers and babies safe during a time of elevated risk.

We also support 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. 3,512 people have participated in training this year, from paediatric audiology and nursing to visual acuity checking. All are local people who make huge contributions to their communities as a result.

‘The clubfoot treatment that I received from IMPACT Bangladesh as a child left a lasting impression on me. That I am now studying at their Nursing Institute and will one day be able to help others in turn, really is a dream come true!’ Jasmine – second year nursing student

Raising awareness of health matters is vital so people can take action themselves to prevent needless disability. Health education takes many forms across our international programme and this year 236,962 adults and children have taken part and gained helpful information and skills. For example, understanding the link between

health and what you eat and then being supported to grow fruit and vegetables to enhance your family’s diet is simple, low-cost and long-lasting. It can help to prevent a host of nutrition-related conditions such as Vitamin A deficiency – one of the major causes of child blindness around the world.

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 relevant documents including Child Protection policy and procedure; Code of Behaviour for Working with Children and Vulnerable Adults; Lone Worker and Lone Volunteer policy and procedure; Safeguarding Adults policy and our general Volunteer policy. They are regularly reminded of their responsibilities under these codes.

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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Looking to the future

IMPACT UK remains as ambitious and committed as ever to nurturing the growth of our trusted local partners in order that they can prevent and treat needless disability within some of the world’s most marginalised communities. If we are able to raise the necessary funds, we plan to support the following action:

❖ Further expand the school-based safe water and menstrual hygiene work we have been developing with IMPACT Foundation Bangladesh in Chuadanga and Meherpur districts

❖ Build the infrastructure, and therefore capacity, of more health centres and hospitals in remote and underserved areas

❖ Fund even more specialised treatment and/or operations for people living with a variety of needlessly disabling conditions whenever funds and specialist surgeons are available

❖ Support three projects of IMPACT India’s award-winning Lifeline Express hospital train during which approximately 26,000 people will benefit from the services on offer, and 1,500 people will have their sight, hearing or mobility restored through surgery

❖ Assist the new IMPACT Foundation Bangladesh hospital in Chuadanga to meet the need for new equipment and other support ❖ Fund essential running costs for the ZOP Academy in Zanzibar, which provides specialist education and opportunities to hearing impaired children who might otherwise never go to school

We hope to fund more school-based safe water projects in Bangladesh

❖ Purchase motorbikes for health workers in Zanzibar to provide health screening in schools and purchase and equip a mobile clinic in Zanzibar to take medical care to underserved communities across the country

❖ Provide scholarships for more student nurses in Bangladesh and continue to support the construction of a new academic building for the IMPACT Nursing Institute

❖ Continue to improve the resources (online and physical) available to volunteers and participants of the Tasty Team project in the UK and to explore opportunities to work with more groups of local people to improve their food security, while building lifelong cooking skills and nutrition knowledge

• ❖ Respond quickly and effectively to emergencies in our project areas should they arise

• ❖ Create a new multi-year strategy to guide the organisation from 2023.

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 – particularly making use of digital technology - where possible

And much more as opportunities arise.

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Financial review and policies

• We generated incoming resources of £2,107,839 (down 2.4% on last year)

• Legacies: £270,484 (up 121.4% on last year)

• Gift Aided donations: £212,897 (down 10.8% on last year)

• Donations not eligible for Gift Aid: £1,592,357 (down 9% on last year)

• Gifts in Kind: £10,800 (down 41% on last year)

• We expended £2,410,361 (down 3.6% on last year)

Fundraising – how we raise funds

Our income is £2,107,839 this year and aside from £16,968 of investment income, it all came from fundraising, including legacies. We receive no statutory grants and do not have contracts to deliver Government projects.

Being a very small organisation, we also have a very small fundraising team which is both dedicated and extremely efficient. As a charity, IMPACT has a legal duty to raise funds effectively in order to deliver public benefit and this year, we generated £20.17 of income for every £1 spent on fundraising (FY21-22 £27.68: £1) – the charity average is £8.61 for £1 invested in fundraising (‘Unchartered Territory; Fundraising’s ROI 2021’ a benchmarking study by LarkOwl).

We prioritise fundraising in ways that maximise the return on our investment of money, time and human resources. For this reason, we rarely run events (although supporters sometimes organise events themselves and send us the proceeds) and never engage in cold direct mailings or ‘face to face’ fundraising on the street.

We actively write to individual donors, targeted charitable trusts, companies and community service organisations to showcase our work and detail how their support can make our programme of action possible. We pride ourselves on sending thanks for gifts and reporting back on how supporters’ money has been spent within projects (if the gift was restricted) or our international programme generally (if the gift was unrestricted). IMPACT is a partnership between those who provide financial resources to power our programme, and those who deliver it in so many ways and such relationships are nurtured.

We are grateful for the legacies we have received this year as we know that leaving a bequest to IMPACT in your will is always a carefully considered act. Almost all of the legacies we receive are from people already known to us through a lifetime of their generous giving and who we have built a trusting relationship with. If unrestricted, we endeavour to use legacies in ways that we hope the legator would approve of and which honours their generous final gift while adhering to the terms of restricted legacies.

Underpinning all this is a social media presence which enables us to reach new audiences without the cost of paying for advertising or marketing lists. We hope that our supporters are sufficiently invested in our work that they spread the word to their contacts too!

We have a specific Fundraising Policy and Procedure which is readily available and lays out our promise to our supporters and the general public that our fundraising, in all its forms, is legal, open, transparent and respectful. This policy covers in detail: legal requirements, fundraising compliance, staff responsibilities, vulnerable people, accepting donations, restricted donations, responding to donations, gifts in memoriam, cash donations and resolving complaints.

Our online shop has small gifts available, such as IMPACT-branded shopping bags and water bottles, plus Christmas cards, to generate unrestricted income and our ever popular ‘gift tokens’ enable supporters to give their friends and relatives meaningful presents that in reality change someone else’s life. For example, a gaggle of geese for a family in Bangladesh at risk of malnutrition or a care package for a woman in Tanzania leaving

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hospital with her new-born baby. These funds are restricted and used only as described on the gift token purchased.

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.

Three 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 committed and long-standing supporters. We have a Complaints Handling Policy in place.

When a supporter engages with a charity, it frequently 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 industry-leading database and stored on its secure servers, with multi-factor authentication for access. This further protects records from access by illegitimate parties. Hard copy data is kept in locked filing cabinets within our locked office and when no longer needed, is securely destroyed by shredding.

We have Data Protection/Confidentiality and Fundraising policies which set out and formalise the good practice we use every day, and which are reviewed annually by Council and staff. A Whistleblowing policy provides a framework for staff and volunteers to escalate concerns and a policy on Foreign Income ensures that due diligence is carried out to guard against the risk of money laundering.

Supporting others to raise funds for our work

We are enormously grateful to volunteers who raise money in numerous ways, including sponsored events or by asking for donations to IMPACT to mark life events such as marriages or when saying goodbye to loved ones at funerals. The team is always happy to provide support so please do get in touch.

The Sussex-based IMPACT Luncheon Club meets monthly to share a meal and listen to a speaker, whilst also raising essential funds for IMPACT’s programme of action. Profit this year has totalled £14,936; up 28.6% on the previous year. The money raised this year is being used to help install safe water sources for villages in Soygaon Taluka, Aurangabad district, Maharashtra State, India. Many of the families living in the villages were suffering increased hardship due to the death of the main breadwinner from Covid-19 and the need to take out loans to get through lockdowns, when much income-generating work was prohibited. Having access to water will help them to meet one of their basic needs and relieve some of the pressure they are facing.

Our sincere thanks also go out to the community service organisations that support IMPACT. Rotary Clubs in Great Britain and Ireland have been raising funds for our project work for more than three decades. Rotary clubs’ generous gifts totalled £4,333 this year (FY 2021-22 £21,941).

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.

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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 (including Disclosure and Barring Service) are made before they have any contact with beneficiaries. IMPACT staff members also undergo a regular DBS check. Working practices are also designed with safeguarding in mind. Our autonomous international partners adhere to local legislation and we encourage them to consider safeguarding at all points of their projects from design to implementation.

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 and they will refer to the Board of Trustees to consider the information and make a final decision on how to proceed. While investigations are being conducted, the funds are ring-fenced and unspent. 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, investments and expenditure

The Foundation generated income of £2,107,839 this year, which is only slightly down on last year’s figure of £2,158,975.

We are grateful that our donors continue to invest in our programme of international action to prevent and treat needless disability so generously either with restricted funding to support specific projects or unrestricted gifts which they entrust to us to use where and how the need is greatest. Their partnership is absolutely vital.

This year saw the climax of the 30[th] anniversary matched funding appeal for IMPACT India Foundation’s Lifeline Express hospital train which enabled us to provide nearly £400,000 for three projects. Other notable income included an emergency appeal to help flood-affected people in Pakistan, which enabled us to send more than £200,000 to meet immediate basic needs followed by a house construction programme to provide simple brick built dwellings for some of those who had lost homes, possessions and livelihoods. We were pleased to be able to support IMPACT Foundation Bangladesh’s excellent medical facilities with more than £100,000 for specialist medical equipment, including items to help establish the eye clinic at IFB’s new hospital in Chuadanga.

Our ongoing efforts to keep essential running costs low so that we can spend as much of every penny donated on projects has resulted in 93% of expenditure this year being used for ‘direct charitable expenditure’ (projects and project development). This is above our strategic aim of 90p in every £1 expended. The remaining expenditure was used for fundraising (4%) and administration and governance (3%). We sincerely hope that our generous supporters feel that the gifts they entrust to our care are used appropriately and judiciously; with a careful balance struck between benefiting people in need and ensuring the organisation is well-run and can maximise income from fundraising.

Our investment policy is set out in Note 5 of the Notes to the Accounts, below. Generating returns with very low risk underpins the decisions made by the Council’s Investment Sub-Committee. This year, investment income was £16,968, an increase of 91.3% on the previous year (FY 2021-22 £8,872). This reflects the gradual increase in interest rates offered by banks and building societies.

Balances on restricted and designated funds (notes 19 and 20 in the accounts) show that significant commitments are made towards future programme expenditure. We may 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, while standalone projects often take more than one year from receipt of funding to implement and funds are frequently sent in tranches.

We 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

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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.

Expenditure of £2,410,361 this year was an increase of 3.6% on the previous financial year (£2,326,796 FY 202122) and the funds expended by country (excluding support costs) are analysed in the table below.

Gifts of goods and services make our limited funds stretch even further and we are grateful to Rayner Intraocular Lenses for providing IOLs with a market value of £10,800. These have been sent to a partner hospital in Sri Lanka for use during cataract surgery.

Thank you to the 12 volunteers who make the Tasty Team project in mid Sussex both fun and valuable for the people participating.

Location	Amount expended on charitable activities (£)	Proportion of the	Proportion of the
		Foundation’s total	Foundation’s total
		expenditure 2022-23	expenditure 2021-22
Bangladesh	£793,273	38.7%	24.2%
Cambodia	£69,733	3.4%	8.4%
India	£590,606	28.8%	30.2%
Kenya	£84,657	4.1%	5.6%
Nepal	£84,866	4.1%	8.7%
Pakistan	£231,774	11.3%	1.7%
Sri Lanka	£10,800	0.5%	0%
Tanzania / Ethiopia / South Sudan	£70,683	3.4%	3%
Zanzibar	£109,976	5.4%	4.8%
The UK(nutritionproject)	£5,289	0.3%	0.7%

Every partner we work with is autonomous and completely independent of IMPACT UK and produces audited accounts which are entirely separate from IMPACT UK’s. We encourage partners to become increasingly selfreliant, with most of our larger and more established partners generating significant funding from sources other than IMPACT UK. This underscores our relationships as equal partners and enables us to free up funds to pilot new projects and work with new partners.

Our partners raise money from charitable trusts and individuals, and additionally generate income from the provision of medical services to people who can afford to pay and from renting out premises or spare operating theatre capacity.

In the early 1990s, IMPACT Foundation was provided with an interest-free loan (subsequently written off) with which to purchase an office building. We still own and work out of this building meaning we do not have to meet mortgage repayments or rental costs and this helps up to keep running costs to a minimum.

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 £205,848.

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Structure, governance & management

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 12-20 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. The Council of Trustees comprises people with relevant skills and experience, including the law.

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, strategy etc. 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 and an Investment Committee to consider investments. Recognising the need to keep up with the raft of new regulations and employment legislation, the Trustees retain the services of a Human Resources Consultant. All staff and members of the Advisory Council are invited to attend Trustees’ meetings.

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.

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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.

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 £17,546 (£14,312 in FY 2021-22).

Recruitment and appointment of Trustees

The appointment of Trustees is conducted in line with the IMPACT Foundation’s Articles of Association and the terms of service were amended in 2021 to include a maximum length of service. 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, from the 1[st] January 2022, a Trustee may serve for a maximum term of three years and is then eligible for re-election by secret ballot. A Trustee may serve no more than three consecutive three year terms, although may be appointed anew after an interval of at least six months.

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 Chair to act as mentors to new Trustees. Prospective new Trustees may be invited to first become members of the Advisory Council, which has no powers, in order to gain a better understanding of the Foundation.

Advisory Council

The Advisory Council is made up of people with an interest in the Foundation and its work, and with relevant skills and experience on which the Board and staff may draw. Members do not have voting or decision-making rights but are encouraged to attend meetings and participate fully in discussions. It is a valuable resource and repository of knowledge.

The Advisory Council currently has seven members. It is anticipated that the Advisory Council’s membership will expand in the future and that members may move from the Advisory Council onto the Board, while it will also provide a means for retiring Board members who wish to stay involved with the Foundation to do so, thus retaining their experience and expertise for the benefit of the Foundation.

Strategic review

A meeting was held on 20[th] June 2018 to review the previous five-year strategy and plan for 2018-2023. This new strategy confirmed IMPACT’s six priority areas and set out a number of goals.

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Progress towards meeting strategic goals:

• 1) GOAL: Ongoing funding to partners will be reduced by 25% from its baseline level (FY2017-8), excluding support costs, by as soon as feasible

• In FY 2017-18 (baseline year), we had MOU commitments totalling £948,564 while in 2022-23 this figure was £561,867. This is a reduction over the period of 40.8%.

• 2) GOAL: Funding for new initiatives will increase by 25% (FY2017-8), excluding support costs, by 2023. All new initiatives will be required to be self-sustaining in the medium term and will have a clear end date at which point UK funding will cease. We will work with partners to improve their fundraising capacity with a view to them contributing a greater share of projects costs.

In FY 2017-18, 98% of the funds expended on charitable activities were used to meet our commitments to partners under ongoing MOUs (£948,564 of £968,895), with £20,331 for other and/or new initiatives.

In FY 2022-23, MOU funding accounted for 27% expenditure on charitable activities (£561,867 of £2,044,191), with £1,482,324 for other and/or new initiatives. These initiatives are specific and timelimited.

This is an increase in funding for non-MOU initiatives of 7,191% from the start to the end of the period covered by the strategy. A conscious effort was made to reduce MOU-based expenditure either by steadily reducing the amounts pledged within them over time or by not renewing MOUs with some partners when they expired, while at the same time working with partners to enhance their ability to raise funds. For example, just 31.6% of IMPACT Foundation Bangladesh income came from IMPACT UK in 2021-22.

The large increase in funding for non-MOU expenditure can also be explained by some very large one-off grants and fundraising appeals in 2022-23 (e.g. the 30[th] anniversary of IMPACT India’s Lifeline Express hospital train matched funding appeal which enabled a grant of nearly £400,000 to IMPACT India Foundation and further funding of approximately £120,000 for another Lifeline Express project, the emergency appeal to help flood-affected people in Pakistan which enabled us to send more than £200,000 for emergency support and rebuilding, and in excess of £100,000 for items of medical equipment for IMPACT Foundation Bangladesh’s hospitals).

• 3) GOAL: Conversion of UK income to direct charitable funding will be 90% or higher

• 2018-19: 90%

• 2019-20: 92%

• 2020-21: 92.4%

• 2021-22: 94.31%

• 2022-23: 92.5%

• 4) GOAL: We will strive to increase UK fundraising year on year with a focus on funding new initiatives, and at the same time, seek to ensure funds raised by local IMPACTs increase, thus reflecting the shift for local IMPACTs to fund and sustain the costs of ongoing projects. To achieve this, IMPACT UK will devise and implement a new fund-raising strategy

Income from fundraising has increased from £1,590,936 in FY 2017-18 to £2,090,871 in FY 2022-23 – an increase of 31.4% from the start to the end of the five-year period.

IMPACT partners around the world had their ability to raise income in-country disrupted by the Covid-19 pandemic due to lockdowns and restrictions on the work they can undertake (some of which was income generating). This meant fewer paying patients overall. However, partners are increasingly successful at fundraising from donors around the world to pay for the ongoing running costs of their work and one-off items such as equipment or vehicles. For example, IMPACT Foundation Bangladesh raised 68% of its income from sources other than IMPACT UK in 2021-22.

Our ‘Fundraising Strategy 2018-23’ has been reviewed yearly and is very much a living document; added to as new opportunities arise.

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• 5) GOAL: We will actively explore opportunities to work with new partners and in new countries, particularly in Africa

• We have worked with new partners in Ethiopia and South Sudan to provide maternal healthcare, birth injury repair and emergency feeding for women and children displaced by civil conflict.

• 6) GOAL: Opportunities to collaborate with partners to test and prove new digital methods to achieve IMPACT’s goals will be sought, and lessons from these will be communicated effectively to the broader NGO world

• Digital methods have been embraced by many partners and became particularly important during the Covid-19 pandemic. For example, IMPACT India Foundation has developed and uses software to capture data at the point of patient contact onboard the Lifeline Express hospital train on an app, which was showcased at the IFIO Conference in 2019. ENT experts at IMPACT Nepal and IMPACT Zanzibar share knowledge of digital hearing aid technology with other organisations. We funded the KEM Hospital in Pune, India to provide computer tablets to village health workers to raise awareness of Covid-19, and during the Delta wave of Covid-19 which swept India in the summer of 2021, we funded IMPACT India Foundation to test digital technology on a vast scale by enabling the TTT (Trace, Track and Treat) programme in Palghar District, which is home to 92,000 people. Using bespoke software on computer tablets, a small army of volunteers went door-to-door completing questionnaires about people’s health which enabled the identification of probable Covid cases for a real-time dashboard of infections, and to note those likely to be most vulnerable to serious infection. The information was shared with local government health bodies and provided vital data in a fast-moving situation. It also helped to support the vaccination drive by recording people’s vaccination status.

We have increased use of digital means of communication (Whatsapp, Telegram, Zoom etc.) to work smarter with partners - enabling us to monitor projects in real time, enhancing the timeliness with which we keep donors informed, and to find solutions to challenges or respond to needs as they arise.

• 7) GOAL: IMPACT UK will encourage our partners to respond to the growing problems of obesity and diabetes in locally appropriate ways

• IMPACT’s response to the global rise in diabetes and its associated risk factors, such as obesity, was a key theme at the IFIO conference in September 2019. It was agreed that positive action could best be achieved by integrating action on obesity, diabetes and other non-communicable diseases into established projects where human and other resources already exist. For example, within screening clinics, maternity care and pre-operative checks to routinely look for obesity and diabetes and provide patients with treatment. Diagnostic equipment has been provided where needed and work is ongoing. The subject will be revisited at the next IFIO conference.

• 8) GOAL: The UK project will introduce clearer signposting to the IMPACT brand and best efforts will be made to use this project to build awareness and synergies with international efforts in the area of nutrition

• We have reviewed The Tasty Team’s branding to ensure it is in line with IMPACT’s wider branding for consistency of visual messaging. Increased cross-posting on social media between IMPACT and Tasty Team strengthens the link. The Tasty Team’s growing profile in Sussex through networking with other organisations, receiving The Queen’s Award for Voluntary Service (‘The MBE for volunteer groups’) and support from the Lord Lieutenant of West Sussex leads people to our wider work.

A new strategy will cover the period 2023-2028.

Employees

The staff team remains remarkably lean and effective and its achievements belie its small size. This year there were seven employees (three full-time and four part-time). The team is led by the Chief Executive who, with the Deputy Chief Executive and Funding and Development Director, form the management team which is tasked with implementing the strategic vision of the Board of Trustees and responsibility for the day-to-day running of the charity. The senior management team is ably assisted by the Finance Manager, Fundraising Manager, Office Manager and UK Programme Manager. All employees have access to the Employee Handbook and policies, both of which are reviewed and approved annually by the Staffing Committee of Trustees, with input from an external Human Resources consultant.

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Volunteers

Volunteers add enormous value to IMPACT’s work and stretch limited financial resources as far as possible. Together, we achieve more and reach many more people in our collective fight against needless disability.

The Tasty Team in the UK is powered by volunteers from our local community in and around Mid Sussex – 12 people have given their time and skills freely this year to work with people who are learning cooking skills and understanding more about nutrition; always with a strong focus on budget. We are indebted to them all for making our limited funds and human resources go further and for making a positive difference to our beneficiaries’ lives.

We are also immensely grateful to the people who run our successful fundraising Luncheon Club, help with mailings, and raise funds or awareness about our work through events and giving talks.

In addition, almost 1,000 local volunteers work within our projects around the world; invaluable contributors to the health and wellbeing of their communities enabling IMPACT to reach more people than we possibly could otherwise.

Relationships with partners

Our 14 partner organisations in Africa, Asia and Europe (IMPACTs Norway and Switzerland are income generating organisation that exists to fund project work in communities of Africa and Asia) all share the same aim – a world free from needless disability.

When IMPACT was established in the 1980s, the organisation was set up not as a British head office with regional offices around the world run by expatriate British staff, but rather as a coalition of equal partners; each led and staffed by local people who initiate and drive the work in their country. Sir John Wilson, IMPACT’s visionary founder, was almost unique at the time in understanding that local people know best what is needed and how to meet those needs, therefore the role of the UK foundation should be to support them.

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 long-standing relationship, and where is it more efficacious to partner with them than to set up an IMPACT Foundation which would duplicate effort.

The International Federation of IMPACT Organisations (IFIO) meets approximately every two years to exchange good practice and ideas, reaffirm our shared mission and ensure our priorities for action are still relevant.

Data protection

We follow the law as set out currently in the Data Protection Act 2018, which is the UK’s implementation of the General Data Protection Regulation (GDPR). 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 industry-respected database to store data safely. Confidentiality agreements and normal security procedures are in place for Trustees, staff and volunteers. We review our Data Protection and Confidentiality policy annually and keep changes in the law under constant watch. We adhere to individuals’ rights to find out what information we hold about them and how we use their data, as set out by the 2018 Act, and would respond to requests in a timely manner.

Risk assessment

The Charity Commission requires the Trustees to identify and review the risks faced by the IMPACT Foundation. A full risk assessment is kept up-to-date and also reviewed annually by the Management team and the sub-committee on staffing. It is then approved by the Board of Trustees. The assessment covers risks under the following categories: reputation, financial, legislative/compliance, governance, staff/volunteers, infrastructure (property and assets), operational and fire, and sets out mitigations.

The UK Programme Manager conducts risk assessments for every part of the Tasty Team project before implementation.

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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 (the 'charity') for the year ended 31st March 2023 which comprise the Statement of Financial Activities, the Summary Income and Expenditure Account, the Balance Sheet, and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and United Kingdom Accounting Standards (United Kingdom Financial Reporting Standard 102).

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 2023 and of its incoming resources and application of resources, including its income and expenditure, for the year then ended;

⚫ have been properly prepared in accordance with United Kingdom Generally Accepted Accounting Practice, and

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

BASIS OF 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 responsibilities for the audit of the financial statements section of our report. We are independent of the charity 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 the provisions available for small entities, in the circumstances set out in note to the financial statements, 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 charity's ability to continue as a going concern for a period of at least twelve months from when the original financial statements were 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 trustees are responsible for the other information. The other information comprises the information included in the annual report, other than the financial statements and our auditor’s report thereon. 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.

In connection with our audit of the financial statements, 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 audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. 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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RESPECTIVE RESPONSIBILITIES OF TRUSTEES AND AUDITORS

As explained more fully in the Trustees' Responsibilities Statement, the trustees (who are also the directors of the charitable company for the purposes of company law) are responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view.

Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland). Those standards require us to comply with the Auditing Practices Board's (APB's) Ethical Standards for Auditors.

SCOPE OF THE AUDIT OF THE FINANCIAL STATEMENTS

An audit involves obtaining evidence about the amounts and disclosures in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of whether the accounting policies are appropriate to the charitable company's circumstances and have been consistently applied and adequately disclosed, the reasonableness of significant accounting estimates made by the trustees, and the overall presentation of the financial statements. In addition we read all the financial and non financial information in the Annual Report to identify material inconsistencies with the audited financial statements. If we become aware of any apparent material misstatements or inconsistencies, we consider the implications for our report.

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' Report for the financial year for which the financial statements are prepared is consistent with the financial statements; and

• the Trustees' Report has been prepared in accordance with applicable legal requirements.

MATTERS ON WHICH WE ARE REQUIRED TO REPORT BY EXCEPTION

In the light of our knowledge and understanding of the charity and its environment obtained in the course of the audit, we have not identified material misstatements in the Trustees' Report.

We have nothing to report in respect of the following matters 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;

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

• 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.

• the directors were not entitled to prepare the financial statements in accordance with the small companies regime and take advantage of the small companies’ exemptions in preparing the directors’ report and from the requirement to prepare a strategic report.

RESPONSIBILITIES OF TRUSTEES

As explained more fully in the Statement of Trustees' Responsibilities (set out on page 4), the trustees 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.

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In preparing the financial statements, the trustees are responsible for assessing the charity'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 charity or to cease operations, or have no realistic alternative but to do so.

AUDITOR 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.

The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below:

Based on our understanding of the Charity, we identified that the principal risks of non-compliance with laws and regulations related to breaches of UK regulatory principles, and we considered the extent to which non-compliance might have a material effect on the financial statements. We also considered those laws and regulations that have a direct impact on the financial statements such as the Companies Act 2006. We evaluated management’s incentives and opportunities for fraudulent manipulation of the financial statements (including the risk of override of controls), and determined that the principal risks were related to management bias in accounting estimates. Audit procedures performed included:

• validating the appropriateness of journal entries identified based on our fraud risk criteria;

• designing audit procedures to incorporate unpredictability around the nature, timing or extent of our testing; and

• assessing the impact of COVID-19 on the inherent risk of fraud, including potential opportunities for fraud with more remote working and where internal controls may not be operating the way they usually do.

Because of the inherent limitations of an audit, there is a risk that we will not detect all irregularities, including those leading to a material misstatement in the financial statements or non-compliance with regulation. This risk increases the more that compliance with a law or regulation is removed from the events and transactions reflected in the financial statements, as we will be less likely to become aware of instances of non-compliance. The risk is also greater regarding irregularities occurring due to fraud rather than error, as fraud involves intentional concealment, forgery, collusion, omission or misrepresentation.

USE OF OUR REPORT

This report is made solely to the charity'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 charity'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 charity and the charity'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, STATUTORY AUDITOR

Chartered Accountants, Victoria House, Stanbridge Park, Staplefield Lane, Staplefield, West Sussex, RH17 6AS

Dated:

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IMPACT FOUNDATION STATEMENT OF FINANCIAL ACTIVITIES (including income and expenditure account) FOR THE YEAR ENDED 31ST MARCH 2023

Note INCOME AND ENDOWMENTS FROM : Donations and Legacies 6 Income from Charitable Activities 7 Income from Investments 5	Expendable Unrestricted Restricted Endowment Total Funds Total Funds Funds Funds Funds 2023 2022 £ £ £ £ £ 354,061 1,732,477 - 2,086,538 2,128,162 - 4,333 - 4,333 21,941 3,040 4,833 9,095 16,968 8,872
Total Income and Endowments	357,101 1,741,643 9,095 2,107,839 2,158,975
EXPENDITURE ON : Expenditure on Raising Funds 8 Expenditure on Charitable Activities 9	103,680 - - 103,680 77,670 140,343 2,157,243 9,095 2,306,681 2,249,126
Total Expenditure	244,023 2,157,243 9,095 2,410,361 2,326,796
Net Income / (Expenditure)	113,078 (415,600) - (302,522) (167,821)
NET MOVEMENT IN FUNDS RECONCILIATION OF FUNDS Total Funds brought Forward	113,078 (415,600) - (302,522) (167,821) 375,754 646,888 991,117 2,013,759 2,181,581
Total Funds Carried Forward	488,832 £ 231,288 £ 991,117 £ 1,711,237 £ 2,013,760 £

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 47 to 55 form part of these accounts

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IMPACT FOUNDATION BALANCE SHEET AS AT 31ST MARCH 2023

Note FIXED ASSETS Tangible assets 11 CURRENT ASSETS Debtors 12 Short term deposits Cash at bank and in hand CREDITORS : amounts falling due within one year 13 NET CURRENT ASSETS TOTAL ASSETS LESS CURRENT LIABILITIES NET ASSETS FUNDS 2 Expendable Endowment 18 Restricted 19 Unrestricted Designated 20 Fixed Assets replacement 21 Other 18 Total Funds	2023 £ 115,155 115,155 18,953 1,565,618 22,325 1,606,896 10,814 1,596,082 1,711,237 1,711,237 £ 991,117 231,288 1,222,405 167,829 115,155 205,848 488,832 1,711,237	2022 £ 111,758
		111,758
		9,156 1,840,126 62,870
		1,912,152 10,150
		1,902,002
		2,013,760
		2,013,760 £
		991,117 646,888
		1,638,005 99,029 111,758 164,968
		375,755
		2,013,760

The notes on pages 47 to 55 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)

Approved and authorised by the Board:

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IMPACT FOUNDATION STATEMENT OF CASH FLOWS FOR YEAR ENDING 31ST MARCH 2023

Note Net cash used in operating activities 21 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	2023 2022 £ £ (332,020) (159,529) 16,968 8,872 (315,052) (150,657) 1,902,997 2,053,654 1,587,945 1,902,997

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IMPACT FOUNDATION NOTES TO THE ACCOUNTS FOR THE YEAR ENDED 31ST MARCH 2023

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.

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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 redesignate 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

• c) PERIOD OF INVESTMENT

• d) ETHICAL

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.

The minimum period for which the investment can be made before proceeds are required.

Need to avoid unethical investment.

e) INCOME FROM INVESTMENTS

Bank and deposit interest	2023 2022 £ £ 16,968 8,872 16,968 8,872

6 DONATIONS AND LEGACIES

Gift Aided Donations Legacies Other Donations Sub-total Gifts in Kind	Unrestricted Restricted Expendable Total Prior Year Funds Funds Endowment Funds Total Funds 89,532 123,365 - 212,897 238,617 170,484 100,000 - 270,484 122,190 94,045 1,498,312 - 1,592,357 1,749,049 354,061 1,721,677 - 2,075,738 2,109,856 - 10,800 - 10,800 18,306 354,061 1,732,477 - 2,086,538 2,128,162

Gifts in kind of £10,800 represents the open market value of introcular lenses and associated equipment received from Rayner Intraocular Lenses Limited.

7 INCOME FROM CHARITABLE ACTIVITIES

Rotary	2023 2022 £ £ 4,333 21,941 4,333 21,941

Profit from the Supporters Luncheon Club in 2022-23 totalled £14,936, which were used in the support of a programme to install wells and fund a feeding programme in rural Maharashtra.

8 EXPENDITURE ON RAISING FUNDS

Staff Costs Other Costs	£ £ 78,302 67,761 25,378 9,909 103,680 77,670

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9 EXPENDITURE ON CHARITABLE ACTIVITIES

Unrestricted Restricted Expendable Funds Funds Endowment £ £ Bangladesh - 784,178 9,095 Cambodia 21,826 47,907 - Kenya - 84,657 - India - 590,606 - Nepal 12,028 72,838 - Tanzania/Ethiopia/South Sudan - 70,683 - Zanzibar 20,135 89,841 - Pakistan - 231,774 - Sri Lanka - 10,800 - United Kingdom - 5,289 - 53,989 1,988,573 9,095 Support Costs 86,354 168,670 - 140,343 2,157,243 9,095	2023 2022 £ £ 793,273 563,616 69,733 195,798 84,657 130,320 590,606 702,342 84,866 201,744 70,683 69,832 109,976 111,316 231,774 38,977 10,800 1,245 5,289 15,287
	2,051,657 2,030,477 255,024 218,649
	2,306,681 2,249,126

Included in the Restricted Fund resources expended is the sum of £10,800 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 24,369 2,713 111,188 28,827 13,814 5,674 40,053 10,840 8,086 9,460	2023 2022 £ £ 27,082 24,853 140,015 114,094 19,488 24,964 50,893 40,426 17,546 14,312 255,024 218,649 2023 2022 £ £ 4,819 4,687 8,086 7,183 4,641 2,442 17,546 14,312 Total Expenditure	2023 2022 £ £ 27,082 24,853 140,015 114,094 19,488 24,964 50,893 40,426 17,546 14,312 255,024 218,649 2023 2022 £ £ 4,819 4,687 8,086 7,183 4,641 2,442 17,546 14,312 Total Expenditure
	197,510 57,514		218,649
			2022 £ 4,687 7,183 2,442
			14,312

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11 TANGIBLE FIXED ASSETS

Cost At 01.04.22 Additions during year At 31.03.23 Depreciation At 01.04.22 Charge for year At 31.03.23 Net Book Value At 31.03.23 At 31.03.22 12 DEBTORS Accrued Interest Income tax recoverable 13 CREDITORS - amounts falling due within one year Tax and social security Accruals	Freehold Land and Buildings £ 167,725 -	Computers Total other equip. £ £ 8,581 176,306 8,202 8,202
	167,725	16,783 184,508
	55,967 2,754	8,581 64,548 2,051 4,805
	58,721	10,632 69,353
	109,004	6,151 115,155
	111,758	- 111,758
		2023 2022 £ £ 12,180 5,189 6,773 3,967
		18,953 9,156
		2023 2022 £ £ 6,339 5,675 4,475 4,475
		10,814 10,150

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14 EMPLOYEES

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	2023 2022 3 3 4 4 7 7 222,743 214,275 17,860 15,347 35,209 18,702 275,812 248,324

One employee received emoluments including pension contributions totalling more than £60,000

15 DIRECTORS / TRUSTEES

There were fourteen 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

16 AUDITOR'S REMUNERATION

The auditor's remuneration for audit work was £2,587 (2022- £2,587).

17 FUND MOVEMENT

At 01.04.22 Income and Endowments Expenditure Other - Designated Asset replacement	RESERVES Expendable Other Fixed Asset Designated General Total Endowment 2023 991,117 646,888 111,758 99,029 164,968 2,013,760 9,095 1,741,643 - - 357,101 2,107,839 (9,095) (2,157,243) - (69,169) (174,855) (2,410,362) - - - 137,969 (137,969) - - - 3,397 - (3,397) - UNRESTRICTED RESTRICTED
At 31.03.23	991,117 231,288 115,155 167,829 205,848 1,711,237

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18 ASSETS AND LIABILITIES SPLIT BY FUND

Fixed assets Current assets Current Liabilities Fund Balances 19 RESTRICTED FUNDS	RESERVES Expendable Other Fixed Asset Designated General Total Endowment 2023 - - 115,155 - - 115,155 991,117 231,288 - 167,829 216,662 1,606,896 - - - - (10,814) (10,814) UNRESTRICTED RESTRICTED
	991,117 231,288 115,155 167,829 205,848 1,711,237
	Balance Increase Decrease Balance 01.04.22 31.03.23
Bangladesh Riverboat Hospital and Prevention Projec 10,897 242,308 220,130 33,075 General 32,048 7,117 37,490 1,675 Nurses Institute 159,919 118,241 260,694 17,466 Community Health Care Centre 15,099 87,409 84,257 18,251 Fistula & Hydrocephalus 9,600 24,480 34,080 - Equipment 4,050 150,670 139,900 14,820 Water Appeal 13,229 6,500 17,000 2,729 BBC Radio 4 Jibon Tari Appeal 2021 2,775 1,933 4,708 - Cambodia General - 30,328 30,328 - Lake Clinic 423 11,950 12,180 193 Lake Clinic Mental Health 38 12,063 11,788 313 Coronavirus support 1,574 - 1,574 - East Africa Disability Prevention 59,511 76,043 68,493 67,061 Tumaini Children's Charity 94 546 600 40 Water Projects 2,690 376 3,066 - India
Disability Prevention Bhavnagar - 15,050 15,050 - Integrated Project Pune 2,044 70,152 63,588 8,608 Lifeline Express Hospital Train 3,943 131,758 134,917 784 Lifeline Express 30th Anniversary Appeal 156,549 207,764 364,313 - General 4,838 1,199 6,037 -
Pakistan Safer Motherhood - 196 - 196 Pakistan Flooding - 265,914 265,914 -

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RESTRICTED FUNDS - Cont.

----- Start of picture text -----
Nepal
General 11,615 33,025 44,640 -
Rautahat - Safer Motherhood - 12,954 12,954 -
- -
Surgical Camps 37,500 37,500
Africa
Africa General 3,113 31,250 33,403 960
Africa Fistula 33 36,747 36,780 -
Zanzibar
Water 822 - 822 -
General - 28,324 28,324 -
School For The Deaf 42,167 45,020 86,978 209
International
General 49,444 103,360 144,553 8,251
Eye Care 55,372 675 - 56,047
United Kingdom
Tasty Team Project 5,001 14,962 19,353 610
646,888 1,805,814 2,221,414 231,288
----- End of picture text -----

All the above balances are held in cash.

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20 DESIGNATED FUNDS

----- Start of picture text -----
Balance Designated Expended Balance
01.04.22 during year during year 31.03.23
Bangladesh
General 3,869 - - 3,869
Cambodia
General - 65,000 29,416 35,584
East Africa
Water projects 269 - - 269
Nepal
General 26,270 40,000 12,028 54,242
Pakistan
Safer Motherhood - 12,969 - 12,969
Sri Lanka
Clinics 1,692 - - 1,692
Zanzibar
General 7,929 20,000 27,725 204
International
General 9,000 - - 9,000
- -
Contingency Fund 50,000 50,000
99,029 137,969 69,169 167,829
All of the above funds are held in cash.
----- End of picture text -----

21 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 from investments (Increase) / decrease in debtors Increase / (decrease) in creditors Net cash used in operating activities	2023 £ (302,522) (3,397) (16,968) (9,797) 664 (332,020)	2022 £ (167,821) 3,410 (8,872) 13,540 214
		(159,529)

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How will you make your IMPACT? 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 can also benefit from additional tax relief on their gifts which can be claimed via their self-assessment tax return or by asking HMRC to change their tax code.

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

Shares

Tax relief is available on gifts of shares.

Fundraising events and Gifts in Memory

It is simple to support IMPACT using Just Giving, an online service which enables fundraisers to set up dedicated pages for their event or to collect gifts in memory of a loved one by debit or credit card. Please visit www.justgiving.com/impactfoundation

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!

£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 Could bring clean water to a whole community

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IMPACT Gift tokens

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 Foundation, 151 Western Road, Haywards Heath West Sussex, RH16 3LH, UK Tel: [phone] Email: [e-mail] Website: www.IMPACT.org.uk @IMPACT_UK_ IMPACTFoundationUK impactfoundation_uk

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