Trustees' Report
The Trustees present their report and the financial statements for the year ended 31 March 2007.
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Report and Accounts 2007 - 2008 (image free pdf 125 KB)
Report and Accounts 2006 - 2007 (image free pdf 133 KB)
Review of charity activities
Financial statements
Auditor information
Objectives and activities, achievements and performance
The principal goal of Target Tuberculosis is to see an end to TB. This is, of course, an ambitious task and we recognise that it will take a long time, require a great deal of hard work, huge financial resources and, of great importance, co-operation between organisations. Target TB already has a number of project and funding partners and we aim to develop our network, support more projects and spread the work of preventing and curing TB and improving the lives of those affected.
TB is recognised by the World Health Organisation as a global emergency and it was in the light of this that Target TB was launched in 2003 as a focussed response. Target TB aims to ensure access to diagnosis and treatment, particularly for poor and marginalised people, to extend information about TB to those who may be affected, to address the socio-economic issues around TB such as poverty, stigma, poor housing and malnutrition and to integrate HIV/Aids into its TB programmes.
Goals of Target TB
The eradication of Tuberculosis is a long-term aim and Target TB sees its role within this great effort as working holistically – through both clinical and socio-economic paths – to address the disease and its effects. Target TB works with overseas partners in Southern Africa and South Asia to:
- Improve opportunities for treatment for people with TB
- Reduce the suffering caused by TB to patients and their families through the poverty associated with the disease
- Reduce the stigma associated with TB
- Address the particular problems caused by the co-existence of TB and HIV/Aids
Our objectives
- Working in Africa and Asia with and through local partner organisations
- Helping to strengthen the capacity of these organisations to undertake the work
- Seeking funds to support our work and that of our partner organisations
- Undertaking operational research to learn from the work of our partners and other organisations and using this to improve patient service and care
How Target TB makes a difference
We work with partner organisations in Africa and South Asia, currently Zambia, Malawi, India, Bangladesh, Pakistan, and East Timor. In all of the work that we support we aim to adhere to the World Health Organisation’s standard method of treatment for TB, the Directly Observed Therapy Short-course or DOTS, enshrined in the national TB control programmes of the countries in which we operate.
We target our assistance in areas where health facilities are poorly developed and government provision is overstretched. In many cases we aim to see the establishment and development of TB services which can later be integrated into government health provision.
Capacity building activities to support our partners is a vital component of Target TB’s approach, which aims to build more sustainable and effective local partner organisations. During the year we supported the placement of a VSO fundraiser at Zatulet in Zambia to improve their fundraising capacity. We also carried out two workshops on monitoring and evaluation, training local partner staff and volunteers in developing and implementing monitoring and evaluation systems. Target TB developed a TB knowledge, attitudes and practices (KAP) survey which we have already trialled in a few projects to help partners more effectively assess impact of health education activities. Whilst helping to strengthen our partners these capacity building activities also help Target TB to develop the impact of the project activities funded directly through grants.
We have a notable impact through the support we give. We estimate, for example, that a patient can be cured of non-drug-resistant TB for as little as £40. It is further estimated that curing one person of active TB prevents another 15 from becoming infected. Ensuring that proper treatment is used is vital to avoid the development of drug resistance to the antibiotics used – one of the greatest threats to the success of TB programmes. We also work to raise awareness of TB both overseas and in the United Kingdom and this is a major part of our work.
To mark World TB Day on 24 March we undertook a joint project with TB Alert, the only other dedicated TB organisation in the UK, to spread information about TB and the work of the two organisations. This took the form of an exhibition which was mounted at Brighton University, Brighton and Sussex Medical School and in Hove Library. We were privileged to be able to display a revised exhibition at the Houses of Parliament thanks to the MP for Brighton Pavilion, David Lepper.
TB appears to be receiving more attention in the media and, in the UK, this is being aided by the formation of the UK Coalition to Stop TB. Target TB and other TB-focused organisations have come together to raise awareness of TB and find ways of publicising the disease. The initiative grew out of the UK All-Party Parliamentary Group on Global Tuberculosis, which has held a number of meetings in the year and invited TB activists, representatives of the World Health Organisation (WHO) and others to speak on the disease and its impact. Target TB was invited to give evidence to the House of Lords Ad Hoc Committee on Inter-governmental Organisations in March 2008 and appeared alongside TB Alert, the Malaria Consortium, the International HIV/AIDS Alliance and the Terrence Higgins Trust.TB on the world stage
Last year we reported that the greatest development on the world stage was the emergence of XDR - or Extensively Drug Resistant - TB. XDR TB has continued to be of great concern, as has the more common Multiple-Drug Resistant, or MDR TB. At the Raphael TB Hospital and Outpatients Clinic which Target TB supports in Northern India, for example, there were 32 diagnosed cases of MDR TB registered at the time of our visit in October 2007. Raphael receives no free treatment from the National TB Control Programme for MDR TB. The Revised National TB Control Programme, whose budget for the whole of India only allows for treatment of 200 MDR cases, estimates that there are over 130,000 cases of MDR TB each year in the country.
The work of Target TB and its partner organisations has the diagnosis and proper treatment of TB to avoid such drug resistance developing as a principle focus. Drug resistance remains one of the greatest challenges faced by all who work in TB. Efforts to develop boosters to the BCG vaccine, other new vaccines and new drug treatments continue but until they can be tested and manufactured a vaccination that is over 80 years old, and drugs which are at least 43 years old, remain the main weapons against TB.
What we set out to do in 2007-2008
In our last Annual Report for the year 2006-2007 we set the following targets:
- To continue to support the work of our existing partners and examine the development of new partnerships
- Examine new research possibilities and the formation of formal research coalitions
- To develop organisational resources needed to manage our work as effectively as possible, including appointment of new staff and an office move
- Further develop fundraising to increase diversity of sources and reduce reliance on the Ryder-Cheshire Foundation
- Aim to form new links with other organisations working in the field of TB
And what we did:
Target 1: To continue to support the work of our existing partners and examine the development of new partnerships in Southern Africa and Pakistan
... in Malawi
This year saw the final year of our 3 year project with
Sue Ryder Foundation in Malawi which aimed to improve
levels of TB health information to actively detect TB cases.
School TB open days, pictured left, proved particularly popular
in engaging large numbers of people, including pupils,
parents and teachers, to spread information about TB. We
carried out a comprehensive evaluation of the project which
indicated a significant improvement in levels of TB knowledge,
as well as improved attitudes by the general public towards
people who are affected. However, the dual stigma of TB and
HIV proved a challenge with people being reluctant to go for TB
testing due to fears about also having an HIV test. As with
many Southern African countries with high levels of TB and HIV
co-infection, the Malawian Ministry of Health is promoting HIV
testing for all TB patients.
... in Zambia
This year saw the start of a 5 year project supported by the Big Lottery Fund with our partner Zatulet, which aims to empower communities to prevent and treat tuberculosis in Zambia. Within the first 9 months of the project 5,430 people were referred to TB diagnostic centres resulting in 1,262 TB cases being identified and put on to treatment. The network of over 120 volunteers at 8 branches across the country are providing outreach activities, health education, DOTS adherence, and other patient support activities to alleviate the burden of TB on local communities and encourage a more supportive environment for those affected.
Target TB also supported the placement, through VSO (Voluntary Service Overseas) of a volunteer fundraiser at Zatulet, to help improve the fundraising capacity of the organisation. This was in conjunction with other capacity building support provided for Zatulet including training in Monitoring and Evaluation systems and Mentoring of project staff.
The Bwafwano Mkushi project completed the first year of a 5 year programme funded by Comic Relief to provide community based care and support services for people affected by TB and HIV/AIDS in Mkushi district, Zambia. 3 local branches, staffed primarily by volunteers, such as Lydia pictured left, are providing high quality home-based care to 1,215 people affected by TB and HIV/AIDS. During the year we carried out a TB survey to assess knowledge, attitudes and practices around TB amongst the target communities. Responses revealed some good levels of knowledge about TB, however there still remained many areas of inaccurate information and myths surrounding the disease such as the belief that you shouldn’t share food or plates/cups with people with TB, and misunderstandings around the relationship between TB and HIV.
... in India
Network Theni continues to provide support services to people with TB, particularly in linking them up to community DOTS monitors to improve treatment adherence rates. Working closely with local government health staff this network of local organisations provides vital resources to support the goals of the Revised National TB Control Programme in India to achieve cure and completion rates of at least 85%.During the year we began operational research activities at Network Theni in collaboration with the Foundation for Research in Community Health, a unit of Maharashtra Association for Anthropological Science. This research aims to evolve evidence-based strategies for improving health care delivery for TB and TB/HIV co-infected people in Theni district.
Target TB’s work in the Eastern States of India with Alternative for India Development has continued to develop and show a high degree of success, despite the difficulties of working with very remote communities, many of whom are from different tribes with different languages and cultures. The mobile TB clinic, pictured right, is equipped with sputum microscopy and x-ray facilities for TB diagnosis, as well as audio-visual equipment for health education. It reaches out to isolated communities with information and health education about TB, as well as on the spot diagnosis and referral to treatment centres. We continued to raise funds to support the excellent specialist TB hospital and Out Patients Department being provided by Raphael, in Uttarkhand. As one of the very few specialist facilities of this type in India, acutely ill TB patients travel from a large area, including the adjoining states of Uttar Pradesh and Himachal Pradesh, to access the high quality care services being offered here. We also developed our work with Blossom Trust, and now plan to expand the reach of the project from 5 to all 11 blocks of Virudhunagar district in Tamil Nadu, thereby reaching over 1.8 million people with information on how to prevent and treat TB. Blossom Trust’s existing links with a large number of local women’s self help groups have proved extremely valuable to the programme, providing an immediate network of local volunteers who are committed to providing DOTS monitoring for TB patients, as well as participating in health education campaigns.
... in Bangladesh
We are continuing to work with Lepra Bangladesh, and during the year supported sputum camp activities in Rajshahi division (pictured right), bringing TB diagnosis to isolated communities and ensuring people are able to access life saving treatment. 307 camps have been held across this large region of Bangladesh during the year. Whilst providing on the spot diagnostic services to over 6,000 people with TB symptoms, the camps have also played a major role in providing health education to the large number of people who attend. Local government health staff also participate in the camps and encourage patients to link up with the nearest health centre for onward treatment.
…in Pakistan
Tamir Welfare Organisation has continued to develop its work in TB control. In 2007 and 2008 we supported TB control training programmes for lady health workers in Faisalabad district. These women are a vital resource in the Pakistan health sector, working both privately and in government health centres. For many people lady health workers are the first point of contact on health matters and therefore are ideally placed to identify people with TB symptoms at the earliest point and ensure they are referred on to recognised diagnostic and treatment centres. Pictured left a lady health worker gives a testimony on her experiences working on TB control at a conference held in September 2007.
…in Timor-Leste (East Timor)
Despite continued political and civil un-rest disrupting the country, our local partner Klibur Domin has continued working on its TB outreach programme in Liquica and Ermera district. The programme has trained local volunteers to carry out health education, identify people with TB, and act as DOTS monitors to improve treatment adherence rates. The programme’s TB resource nurse has provided training and mentoring to village health post nurses, the most basic level of government health staff in Timor-Leste, to ensure they are equipped with the necessary knowledge and skills to recognise people with TB symptoms and help them access testing and treatment.
New partnerships
We have established links with 3 new organisations during the year that have subsequently become full partners of Target TB since the year end.
…in Tanzania
TANOPHA (Tanzania Network of Organisations of People living with HIV/AIDS), a network for positive people’s organisations in Tanzania, will be looking to develop levels of knowledge about TB within its member groups. With 60% of TB patients in Tanzania being co-infected with HIV, it is vital that HIV focused organisations actively integrate TB control activities into their programmes. Target TB and TANOPHA are aiming to do that by supporting positive people’s groups in Tanzania to be informed about the risks of TB, how to help prevent it, and where to go to access diagnosis and treatment.
…in Uganda
In Uganda Target TB has established links with International Medical Foundation in order to address the difficulties of diagnosing TB in low resource, high HIV prevalent settings. Most countries rely on sputum microscopy as the most cost-effective and reliable method of diagnosing TB. However sputum microscopy has poor sensitivity, particularly in patients with HIV co-infection, and requires significant labour and training. We hope to be able to support this project to trial a new diagnostic technique, Microscopic Observation Technique, to enable faster, cheaper and more accurate TB diagnosis which may then be replicated in other countries.
…in India
Target TB has also developed a partnership with the Agnes Kunze Society (AKS) in Uttarkhand, India. This small, developing organisation is doing vital work on the ground to support people affected by TB in urban slum areas. Target TB is planning to work with AKS to develop their TB control activities, whilst also providing capacity building support to assist the development of this emerging community organisation.
Target 2: Examine new research possibilities and the formation of formal research coalitions
We have formed a research coalition with Network Theni and the Maharashtra Association of Anthropological Sciences of Pune. Research commenced in April 2007 after representatives had been to assess the project and decide how the research should progress as well as train staff. This research aims to evolve evidence-based strategies for improving health care delivery for TB and TB/HIV co-infected people in Theni district. A visit to Network Theni in October showed that the research was progressing well during the first year of what is scheduled to be a two year data collection period.
Target TB provided some financial support for two medical students at Birmingham Medical School for their elective study which examined TB control in Vanuatu. Sarah Burns, a fourth year medical student at Brighton and Sussex Medical School, became the first person to take up a medical elective with a Target Tuberculosis supported partner when she spent 6 weeks at Raphael in September and October 2007. It was a great success and her presence was much appreciated by the Medical Officer, Dr Gupta, and other staff. As part of its continuing support of medical education and promotion of an interest in TB amongst young doctors Target TB has voted funding of £1,000 to support students of Brighton and Sussex Medical School who undertake a medical elective in the field of TB.
Target 3: To develop organisational resources needed to manage our work as effectively as possible, including the appointment of new staff and an office move
During the year review of staffing took place to meet the growing needs of the organisation and a full-time Programme Assistant and part-time Fundraiser and Administrator were recruited.
By the end of the financial year Target TB was in the advanced stages of negotiating to move to new office premises and this was completed in July 2008. The organisation also enhanced its capacity by investing in its IT system.
Target TB is fortunate to be supported by a number of very committed and highly effective volunteers who assist with our work in programme development, fundraising, advocacy and general administration. One volunteer organised our involvement in the Brighton 10km Run in November 2007 in which 10 people ran for the charity, raising over £3,500.
Target 4: To develop fundraising to increase diversity of sources and reduce reliance on Ryder-Cheshire Foundation
Considerable progress was made in developing fundraising with several notable successes. In the last annual report we recorded that Target TB had been successful in securing funding from Comic Relief to support Bwafwano in Zambia. In June 2007 Target TB was notified that it had been successful in its bid for funds from the Big Lottery Fund and that £454,000 had been granted over 5 years for Zatulet in Zambia.
Target TB also developed its fundraising from grant-making trusts, including a single grant to cover the full cost of our work in partnership with Lepra Bangladesh. It was also privileged to receive further funds from the States of Jersey and States of Guernsey. There has been great emphasis on raising funds from grant-making trusts and this will continue alongside efforts to develop new income streams, most notably innovative means of raising money from individuals. Raising money from individuals has been a feature of our regular fundraising and the Target TB newsletter is a fundraising tool as well as a source of information and a means of advocacy. Target TB continues to work on raising money from statutory sources, in which we include large funds such as Comic Relief and the Big Lottery Fund, to whom new bids will be submitted when appropriate. Other statutory sources, such as DfID are kept in mind and bids will be made for appropriate projects.
Target TB was successful in reducing its dependence on the Ryder-Cheshire Foundation, its founding organisation which has provided seed funding for the establishment of Target TB. In 2007-2008 the grant from the Ryder-Cheshire Foundation was reduced by more than 30% compared to the previous year due to our success in raising funds from other donors. In the year to come we expect this to be further reduced. Target TB is immensely grateful to all of its donors without whom none of the work of the organisation would be possible.
Target 5: Aim to form new links with other organisations working in the field of TB
Target TB has been undertaking joint work with TB Alert in promoting knowledge and understanding of TB and the joint exhibitions at Parliament and in Brighton and Hove. Target TB has been fully involved in the All Party Parliamentary Group on Global Tuberculosis and this has brought us not only into contact with Parliamentarians but also into further contact with organisations such as Results, which works in Health Advocacy, and the International HIV/AIDS Alliance. In March 2008 Target TB was invited to present evidence to the House of Lords Ad Hoc Committee on Intergovernmental Organisations alongside TB Alert, HIV bodies and the Malaria Consortium.
In its overseas programme work Target TB has made further links with new organisations leading to new partnerships with TANOPHA in Tanzania and IMF in Uganda.
What we intend to do in 2008-2009
- To continue to support the work of our existing partners
- To examine the possibility of developing new partnerships in the broad geographical area in which we currently work and support and develop our most recent partners
- To move to a larget and more suitable office and further develop the capacity of the organisation to respond to the demands placed on its services
- To continue to develop our fundraising capacity and expertise
- To continue to seek opportunities to advocate on the issue of TB and publicise the work of Target TB
- To evaluate our wok to date in operational research and develop new research opportunities if approppriate
FINANCIAL REVIEW
| Incoming resources | £451,908 |
| Costs of generating funds | £44,332 |
| Direct Charitable Expenditure | £362,163 |
| Governance costs | £16,859 |
| Total resources expended | £423,354 |
| Net incoming resources for the year were | £28,554 |
While incoming resources for the year were lower than in the previous year this is mainly due to reducing dependence on funding from the Ryder-Cheshire Foundation as indicated in the Trustees’ Report (Page 10) in line with the strategic objectives of the charity. Direct charitable expenditure rose between 2007 and 2008.
RESERVE POLICY
Target Tuberculosis intends to maintain reserves sufficient to cover up to six months’ running costs. Funds in excess of this requirement will be invested in the expansion of services provided by the charity.
Statement of Financtial Activities for the year ended 31 March 2008
To be read in conjunction with Notes to the Financial Statements for year ended 31 March 2008 (pdf 112KB)
INCOME AND EXPENDITURE:
Donations £13,340
Legacies £17,500
Investment income £3,075
Grants received £417,993
TOTAL INCOMING RESOURCES £451,908
Resources expended
Costs of generating funds £44,332
Charitable activities £ 362,163
Governance costs £ 16,859
TOTAL RESOURCES EXPENDED £423,354
NET INCOMING RESOURCES FOR THE YEAR £28,554
Fund balances brought forward at 1 April 2007 £150,350
FUND BALANCES CARRIED FORWARD AT 31 MARCH 2008 £178,904
There were no recognised gains or losses other than the net movement in funds for the year.
The incoming resources and net movement in funds for both years arise from continuing operations.
BALANCE SHEET 31 MARCH 2008
| CURRENT ASSETS | |
| Debtors | £ 92,981 |
| Cash at bank | £ 96,389 |
| £ 189,370 | |
| Creditors - amounts due within one year | (£11,645) |
| TOTAL NET ASSETS | £ 178,904 |
| REPRESENTING | |
| Unrestricted General Funds | £ 96,856 |
| Restricted Funds | £ 82,048 |
| £ 178,904 |
These financial statements have been prepared in accordance with the special provisions of Part VII of the Companies Act 1985 relating to small companies.
Approved by the Trustees on 01 August 2008
and signed on their behalf by DICK BIRD OBE, CHAIRMAN
STRUCTURE, GOVERNANCE AND MANAGEMENT
TRUSTEES
The Trustees set out below have held office during the whole of the period from 1 April 2006 to date unless otherwise stated:
Dick Bird OBE - Chairman
Sir Christopher France GCB - Vice-Chairman
Martin Long
Dr Melanie Newport MBBS PhD FRCP
Christa Paxton (appointed 17 November 2006)
Andrew Russell FCA - Treasurer
Dr Maya Unnithan
Patsy Wright-Warren CBE
INDEPENDENT AUDITORS' REPORT TO THE MEMBERS OF TARGET TB
We have audited the financial statements of Target Tuberculosis for the year ended 31 March 2008 which comprise the Statement of Financial Activities, the Balance Sheet and related notes. These financial statements have been prepared under the accounting policies set out therein.This report is made solely to the company’s members, as a body, in accordance with Section 235 of the Companies Act 1985. Our audit work has been undertaken so that we might state to the company’s members those matters we are required to state to them in an auditors’ 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 company and the company’s members as a body, for our audit work, for this report, or for the opinions we have formed.
Respective responsibilities of trustees/directors of auditors
As described in the Statement of Trustees’ Responsibilities the trustees, who are also the directors of Target Tuberculosis for the purposes of company law, are responsible for the preparation of financial statements in accordance with applicable law and United Kingdom Accounting Standards (United Kingdom Generally Accepted Accounting Practice). Our responsibility is to audit the financial statements in accordance with relevant legal and regulatory requirements and International Standards on Auditing (UK and Ireland).We report to you our opinion as to whether the financial statements give a true and fair view, whether the financial statements are properly prepared in accordance with the Companies Act 1985 and whether the information given in the Trustees’ Report is consistent with the financial statements. We also report to you if, in our opinion, the company has not kept proper accounting records, if we have not received all the information and explanations we require for our audit, or if information specified by law regarding trustees’ remuneration and transactions with the charity is not disclosed.
Basis of audit opinion
We conducted our audit in accordance with International Standards on Auditing (UK and Ireland) issued by the Auditing Practices Board. An audit includes examination, on a test basis, of evidence relevant to the amounts and disclosures in the financial statements. It also includes an assessment of the judgements made by the trustees in the preparation of the financial statements, and of whether the accounting policies are appropriate to the charitable company's circumstances, consistently applied and adequately disclosed.
We planned and performed our audit so as to obtain all information and explanations which we considered necessary in order to provide us with sufficient evidence to give reasonable assurance as to whether the financial statements are free from material misstatement, whether caused by fraud or other irregularity or error. In forming our opinion we also evaluated the overall adequacy of the presentation of information in the financial statements.
Opinion
In our opinion
- the financial statements give a true and fair view, in accordance with United Kingdom Generally Accepted Accounting Practice of the state of the charitable company’s affairs as at 31 March 2008 and of its incoming resources and application of resources in the year then ended;
- the financial statements have been properly prepared in accordance with the Companies Act 1985; and
- the information given in the Trustees’ Report is consistent with the financial statements.
Mazars LLP
Chartered Accountants and Registered Auditors
37 Frederick Place
Brighton BN1 4EA