AHI - Trustees’ Annual Report for the period 06.06.2019 (Period start date) To 05.06.2020 (Period end date)
Charity name: Affordable Health initiative (AHi)
Charity registration number: 1183732
Objectives and Activities
Objective: For the public benefit, to preserve and protect the health and to advance the education of people throughout the world in such ways as the trustees see fit.
Vision: A world where every child has the necessary support to fulfil their full potential.
Mission: We empower families from low income communities to maximise the access to tools for their children to increase equality of outcomes, through providing support for good health and quality education.
Note: All policies are in place for the successful and safe running of the AHi mission; there is a specific focus and attention on safeguarding.
Summary of the main activities in relation to those purposes for the public benefit, in particular, the activities, projects or services identified in the accounts.
The AHi offers a comprehensive whole-school approach that reaches out beyond the school to the community. The initiative incorporates the principals of the Ottawa Charter and delivers a simple, scalable and sustainable operational model for the World Health Organisation’s Health Promoting School (HPS) initiative. AHi is aligned to two major United Nations and World Health Organisation policies: "Transforming our World: the 2030 Agenda for Sustainable Development" and “Making Every School a Health Promoting School.” We aim to make a significant contribution to leave a better planet for future generations.
The AHi HPS model consists of four interlinked components which are education, health promotion activities, health care services and community engagement. Activities complement each other and impact in a number of health and education outcomes. By example, those in low-income communities tend to have lower levels of education and income, which is associated with having less healthy dietary habits. This is, in part, because of their higher priority for price and familiarity, and their lower priority for health as a motive for food purchase. Poor food choice motives are clearly associated with low socio-economic position and level of education, access to and availability of healthy food in socially deprived areas. Furthermore, to adopt a healthy diet requires enormous determination, motivation and setting clear goals. Thus, adopting a healthy diet is also influenced by mental, emotional and spiritual challenges. AHi HPS model addresses all these central issues to adopt a healthy diet. AHi HPS model demonstrates the benefits of a healthy diet in the health coaching and tackle the socio-psychological barriers and motivators to adopt a healthy diet through the life coaching. AHi HPS model also address the socio-economic barriers through healthy food distribution to the families of the children enrolled in the programme. Healthy diet/Food distribution is delivered in collaboration with existing approaches, for example as adopted by members of the Global Foodbank Network (https://www.foodbanking.org/). A healthy diet impact on improving nutrition and on protecting against obesity and many chronic noncommunicable diseases, such as heart disease, diabetes, cancer and dental caries.
Hygiene practice provides another example. Good hygiene habits may be another challenging healthy behaviour to adopt for those living in areas characterised of high levels of social deprivation. In many areas of the world, practicing personal hygiene is difficult due to lack of resources such as clean water and soap. The knowledge and practice of personal hygiene are vital to schoolchildren. AHi HPS model demonstrates the health benefits of good personal hygiene in the health coaching and its aesthetic and social value in the life coaching. The practice of proper personal hygiene is addressed by running the UNICEF Wash, Sanitation and Hygiene (WASH) in schools (https://www.unicef.org/wash/) and by expanding it to include supervised tooth brushing with fluoridated toothpaste. The latter is the most effective approach to prevent dental caries - the most prevalent among all diseases in the globe – and is recommended by the World Health Organisation (see: http://www.who.int/oral_health/publications/effective-use-fluorides-prevention-caries-21st-century/en/). AHi facilitate this practice by equipping the schools with sinks for hand washing and toothbrushing, showers and soap. In addition, the school activities coordinator checks the general cleanness of the school once a day, and toilet cleanness before and after classes in the morning and afternoon. Good personal hygiene habits and a clean environment impact on a person and the community. A number of communicable diseases can be prevented by adopting good hygiene habits (i.e.: COVID-19, skin diseases, parasites related diseases and diarrheal disease-associated death. Poor hygiene habits can also affect noncommunicable diseases such as oral diseases. Good hygiene habits can also positively affect a person self-esteem (mental health). Looking and feeling presentable can give you a confidence boost and a sense of pride in your appearance and social acceptance. Poor hygiene leads to social exclusion and being bullied.
List of individual interventions
Intervention 1: Life and Health Coaching
The main goal of running life and health coaching is to empower schoolchildren with enough cognitive processes that they are eventually confident enough to take control over their health and life circumstances. Life coaching aims promoting emotional intelligence, coping mechanism, good social behaviour, social capital and network leading to improved resilience. It promotes aspiration, self-esteem, social skills and prevent violence and radicalisation. Health coaching aims to provide access to health-related knowledge, attitudes, values, and developing a healthy lifestyle. Low health literacy is an obstacle to adopting a healthy lifestyle. AHi coaching approach is one where the schoolchild voice is placed at the centre, and a democracy is put into the classroom. Value is placed on discovering solutions together. Coaching starts with an E-learning presentation of a topic (life skill or health-related risk behaviour (traditional health education), followed by a school quiz game, a debate, a topical based group discussion and a concluding session when the schoolchildren set a goal. In the group discussion the instructor interacts with the children to address knowledge gaps identified in the quiz game and to identify solutions to the barriers identified in the debate. Goal setting is in the hands of the schoolchildren and they must set them. The coach may need to help them setting the goal through questions such as "what will you do?" or "what would you like to get out of this topic?" The same process adopted to deliver the health coaching is used to deliver the life coaching. The interaction with children is not authoritarian and blaming the victim is avoided. It is crucial to listening to their challenges in order to help them to identify solutions to the barriers to adopt good social and health behaviour, as well as, developing critical thinking among them. Coaching takes more time than teaching, and whether is a life coach or a health coach, it’s important to deliver it at the school environment. AHi coaches use their knowledge to motivate schoolchildren in developing cognitive processes and life skills leading to emotional evolvement, which in turn motivates them to adopt a healthy lifestyle leading to better mental and physical health. AHi coachers take on the role of a leader who helps the schoolchildren to set goals in their path through the life course. They are there to guide, motivate, encourage in addition to teach. The main goal is to empower schoolchildren with enough cognitive processes and life skills that they are eventually confident enough to take control over their own life circumstances.
Intervention 2: Evening Role Model Talks
Evening role model talks aim to motivate children and their parents to strive to uncover their true potential and overcome their weaknesses. It is in the form of a lecture delivered by an external speaker. Talks by positive role models may influence not only the school children actions but also the actions of the whole community. The speaker is asked to tell their life story and share their experience of growing up in a low-income community and overcoming challenges to prosper in life. These successful individuals may act as role models to inspire the school children and their parents. Talks by positive role models may influence the school children’s actions and also the actions of the whole community. Role models may motivate them striving to uncover their true potential and overcome their weaknesses. Having role models is natural, and having good role models is very important, as they influence how the children develop in the long term. People look up to a variety of role models to help shape how they behave in school, relationships, or when making difficult decisions. Role models set standards for a person’s behaviour, but they are chosen by the individual child. Thus, it is important to influence their choice by exposing them to good role models. Children must see a potential role model as relevant to them and their lives in some way. Young people tend to choose role models whom they know personally, and parents come first. Therefore, involving parents in this educational activity may enhance school children education. However, this does not mean they have to know a role model personally and nowadays rappers and ‘celebrities’ exert great influence in setting children’s behaviour. Role models come in many varieties. School children may admire everything about them, or just one quality.
Intervention 3: Community Quiz Game Night
Community quiz game nights aim to consolidate health knowledge and life skills among children and disseminate them to the community. Quiz game is a form of game, in which the players attempt to answer a series of questions correctly, to test their knowledge about specific subjects. AHi HPS model uses this game as a form of assessment that measures knowledge, skills, and abilities. Generally, an exam is a culminating assessment that evaluates a student over a large period of time and over a range of material. A quiz game is generally a frequent and short assessment that can gauge a participant’s retention and comprehension of a small amount of information. A quiz can function throughout a project as an informative feedback device allowing both the instructor and the participants to see if they are excelling or needing more focus. Quiz games are a stress-free way to assess and learn contrary to exams. It helps to retain information and build confidence in addition to identify gaps in knowledge. Most people find that quiz games are fun. This is because it feels like playing, contrary to being evaluated, which often generates anxiety in most people.
Intervention 4: Health Detective Game
The aim of running this game is to consolidate health knowledge among school children and disseminate the knowledge to the community. The health detective game is an epidemiological exercise. The game promotes not only an understanding of the proximal causes of diseases (e.g. bacteria is the proximal cause of infectious diseases) but also insight and problem solving into the ‘causes of the causes’ of diseases (e.g.: transmission of bacteria) and how to prevent it (sanitation, clean water and hygiene such as hand washing with soap. This educational activity attended by schoolchildren and their parents also promotes higher reasoning, decision-making, problem-solving, creative and critical thinking, communication and interpersonal skills, self-awareness and empathy, assertiveness and self-control, resilience and coping with emotions and stress. Developing these attributes improves health and social behaviour (e.g.: caring for oneself and others, trust, attachment, tolerance of others, reciprocity), social capital (e.g.: family ties, friends/friendship ties, and social networks) prevents violence and radicalisation among community members.
Intervention 5: ‘Classroom-based Physical Activity Breaks’
‘Classroom-based physical activity breaks’ is an emerging strategy that aims to increase daily participation in physical activity in schools, which in addition improves academic performance. AHi adopted somatic education as the main practice in this activity. Somatic education is defined as the use of sensory-motor learning to gain greater voluntary control of one’s physiological process. It is "somatic" in the sense that the learning occurs within the individual as an internalized process. Teaching greater self-awareness to schoolchildren may increasingly free them from unconscious restraints of the brain. Somatic education consists of movement patterns, which could be performed by school children at classrooms, aiming creating awareness of their own body sensations to guide them toward self-improvement and the positive changes we seek.
Intervention 6: Gardening
Gardening aims to provide opportunities for increasing physical activities, as well as, scientific knowledge and understanding, and improving literacy and numeracy, pupils’ confidence, resilience and self-esteem. Gardening gives children a sense of responsibility and fosters positive behaviour. It provides opportunities for increasing scientific knowledge and understanding of the natural world and climate change, and improving literacy and numeracy, pupils’ confidence, resilience and self-esteem. It gives children a sense of responsibility, and fosters positive behaviour, particularly for those with behavioural and learning difficulties. This activity helps to keep the school a healthier place to learn, in addition to contributing to the 60 minutes of required physical exercise per day and improve learning. Work is a purposeful activity that may include physical and mental effort to perform a task, overcome an obstacle, or achieve a desired outcome.
Intervention 7: Sport Training and Tournaments
Sport, including martial arts, is a physical activity with special characteristics that aim to increase physical activities. It involves physical movement and skill and is an institutionalised competition under formal rules. Therefore, is an ideal physical activity for inclusion in tournaments. Physical activities have a significant positive effect on physical and mental health, are free, easy to take, and can be fun (https://www.nhs.uk/live-well/exercise/exercise-health-benefits/). Physical activities are not only about fitness. It boosts self-esteem, mood, sleep quality and energy, as well as reducing the risk of stress, depression, dementia and many other health issues (https://www.rcpsych.ac.uk/mentalhealthinfo/treatments/physicalactivity.aspx). It may include individual or team sports. Parents are invited to attend the weekend competitions as spectators to support their children, which improve community-school engagement and community and family ties.
Intervention 8: Active Commuting
Active commuting is an ideal low-cost strategy aiming to increase physical activity and may account for the 30 minutes daily physical activities, representing 50% of a child’s recommended total 60 minutes minimum physical activities a day. Active transport or active commuting refers to the use of brisk walking, biking, or other human-powered methods (e.g., skateboarding and rollerblading), and equates to moderate-intensity physical activity. In addition, active commuting address competition for time during the school hours because is run before and after classes.
Intervention 9: Basic Hygiene Practices
Basic hygiene practices aim to provide a training exercise associated with health coaching to consolidate good personal hygiene. AHi HPS model implements the UNICEF Wash, Sanitation and Hygiene (WASH) in schools, a well-established health initiative designed to improve the effectiveness of hygiene behaviour change programmes, supported by UNICEF. Supervised tooth brushing with fluoridated toothpaste was added to WASH practices in the AHi HPS model, as recommended by the WHO. Hygiene may be defined as conditions or practices conducive to maintaining health and preventing disease, especially through cleanliness. It refers to personal acts that can lead to good health and cleanliness. Personal hygiene includes body hygiene (skin care), oral hygiene (oral care), hand washing (hand care), face hygiene, fingernail and toenail hygiene (nail care), ear hygiene, hair hygiene (hair care), foot hygiene (foot care), armpit and bottom hygiene, clothes hygiene, menstrual hygiene (personal hygiene for women). Frequent hand washing, face washing, and bathing with soap and water are one of the most important ways to prevent the spread of infection and illness. Many diseases can be spread when hands, face, and body are not washed appropriately at the key times. Hands should be washed before eating or handling food; after using the toilet; blowing the nose, coughing or sneezing; touching animals or animal waste; handling rubbish; changing a nappy and before and after touching a sick or injured person. The prevention of communicable diseases, like diarrhoea, trachoma and many others are possible through the application of basic hygiene practices. Keeping hands, head and body clean stop the spread of germs and illness, thus minimise the incidence of communicable diseases. It benefits one own health and has a positive impact on the health of others in the locality. Good personal hygiene is a major determinant of health and an important public health action. Good personal hygiene also has aesthetic and social value. A schoolchild with poor personal hygiene might be isolated from friendship, be teased and bullied. Generally, cleaning oneself produces pride, comfort and dignity at home and in public places. Caring about the way one look is important to improve self-esteem.
Intervention 10: Healthy Food Distribution
This intervention aims to support a healthy diet behaviour change. As defined by the World Health Organisation, a healthy diet is one that helps to maintain or improve overall health. A healthy diet provides the body with essential fluids, macronutrients, micronutrients and adequate calories. Ideally the diet contains mostly fruits, vegetables, and whole grains, and limits the amount of processed foods and sweet items. Food distribution is delivered in collaboration with existing approaches, for example as adopted by members of the Global Foodbank Network (see: https://www.foodbanking.org/). This component of AHI will not only improve the diet in low-income communities but also reduce food waste and the impact of food waste in the environment.
Intervention 11: Health Care Services
This intervention addresses the disabilities caused by common diseases in low-income communities. AHI HPS model includes dental, medical and mental primary health care.
Statement confirming whether the trustees have had regard to the guidance issued by the Charity Commission on public benefit
The trustees have had regard to the guidance issued by the Charity Commission on public benefit.
Policy on grant making
The AHi is a newly formed organisation, with no funds or employees. Fundraising strategy will have two tiers – AHi local committees will fundraise for themselves to afford to run the programme, any money raised locally will be invested locally. Local committees may accept donations to fit the school to run the AHi HPS model. This includes construction of low-cost sinks, refurbishment of toilets and consumables. They may also employ a person to run the AHi HPS model in each school.
AHi will also fundraise to provide the support services (i.e. IT services), and the very low core costs incurred by AHi centrally in the future. AHi intents to have a very small virtual central office, thus minimum funds will be required.
Financial systems and processes will be put in place soon to fundraise, report and facilitate spending, including auditing process, following the recruitment of a fundraising Trustee;
Reserves and spending policies will be in place to avoid political dependency and assure sustainability;
School programmes centrally funded will only be initiated after studies have demonstrated the programme is cost-effective and the financial resources have been secured to deliver it in full.
The schools enrolled in the implementation studies are running the AHi HPS model through a collaborative work with local Departments of Education and Health using their internal funds. Public Universities are assessing the implementation and impact in each locality. Local post-graduate institutions are funding the pilot studies. Universities staff were allowed to dedicate time to assess the implementation and impact of the AHi HPS model.
Policy on social investment including program related investment
AHi HPS model, the school intervention advocated and delivered by the charity represents a major social investment highly beneficial to those living in low-income areas as described
Contribution made by volunteers
A number of volunteers have been recruited to implement the AHi HPS model as soon as the schools reopen. They have been trained and empowered to deliver AHi health promoting school model in their locality. The training included learn about the AHi code of governance, conduct, ethics and safeguard policies to assure a successful and safe running of AHI mission. There is a specific focus and attention on safeguarding during the training.
Achievements and Performance
AHi CIO was successfully registered on 5th June 2019. In the first year, the AHi has developed a health promoting school intervention to address the objective of the charity; protocols to guide implementing the intervention and research protocols to assess the implementation process and impact of the intervention on the whole school community.
Following, the AHi has successfully identified collaborators and volunteers to pilot test the implementation of the intervention in schools serving low-income communities in three cities in Brazil; Federal District (Brasilia), Bauru and Belo Horizonte.
A typical AHi strategy to transform schools in HPS and implement the AHi HPS model includes obtaining support from the local department of health and department of education to implement and run the school activities associated with the AHi HPS model and identifying a local University to assess the implementation and impact of the intervention. Therefore, AHi has established a collaborative work with the Department of Health and Department of Education in Federal District (Brasilia), Bauru and Belo Horizonte. Also, University of Brasilia, University of São Paulo and Federal University of Minas Gerais, respectively. A total of 11 schools serving low-income communities in the localities listed above were identified, invited and have agreed to implement the intervention. Seven will implement the intervention starting in August 2020. The other four schools have agreed to implement the intervention in 2021. Implementation research carried out in these three localities. The acceptability of the Affordable Health Initiative (AHI) Health Promotion School (HPS) model among stakeholders was agreeable. The Department of Health (DoH) and the Department of Education (DoE) in the localities agreed implementing the AHI HPS model and showed great enthusiasm in supporting the initiative. The headteachers of the schools invited to implement the AHi HPS model enthusiastically agreed to run the AHI HPS model in their schools. The AHI HPS model was considered relevant and suitable to be implemented in school settings in the localities as perceived by providers and consumers. The adoption of the AHi HPS model among stakeholders was phenomenal. All showed strong interest to support and contribute to the implementation of the AHI HPS model. The Department of Education took the decision to allow school educators to use their time to contribute to delivering the health promotion activities included in the AHi HPS model
Achievements against objectives set
AHi has developed a comprehensive HPS model to address the objective of the charity and identified volunteers to implement it in three low-income communities.
Performance of fundraising activities against objectives set
AHi is a new charity and has not applied for funds yet. The strategy in the first year was disseminating and advocating for the implementation of the AHi HPS model by Departments of Health and Education in several localities.
Investment policy and objectives including any social investment policy adopted
AHi has developed a robust social investment policy. It is well known that diseases tend to concentrate in low-income communities, thus to improve population health it is crucial to address the challenging ‘inverse care law’ proposed thirty years ago by Julian Tudor Hart; those who most need medical care are least likely to receive it. Conversely, those with least need of health care tend to use health services more (and more effectively).
Health, education and income are strongly interconnected. In early life, healthier children achieve better results at school. Later in life, educated people are more likely to understand their health needs, follow health instructions, advocate for themselves and their families, and communicate effectively with health providers. Poor health and low education are associated with lack of job opportunities and lower income, which has a major negative effect on health. Having sufficient income enables adoption of a healthy lifestyle. Furthermore, low income and fewer resources force people to live in socially deprived neighbourhoods. These neighbourhoods are often economically marginalised. They congregate and amplify health risk factors. These are lack of safe drinking water, lack of sanitation, fewer high-quality schools, less access to sources of healthy food with an oversupply of fast food restaurants and outlets that promote unhealthy foods. Furthermore, they are more prone to environmental hazards such as higher levels of toxins, air and water pollution, hazardous waste, pesticides, and industrial chemicals.
The AHi offers a comprehensive whole-school approach that reaches out beyond the school to the community. The initiative incorporates the principals of the Ottawa Charter and delivers a simple, scalable and sustainable operational model for the World Health Organisation’s Health Promoting School initiative. Affordable health Initiative is aligned to two major United Nations and World Health Organisation policies: "Transforming our World: the 2030 Agenda for Sustainable Development" and “Making Every School a Health Promoting School.”
The AHi HPS model moves beyond the naive and traditional focus of developing risk awareness to promote individual behaviour change. It addresses the socio-psychological and socio-economic barriers to behaviour change towards a healthy lifestyle. AHI HPS model enables schoolchildren and their parents to take control over, and to improve, their health. AHI HPS model concentrate efforts on the major health related behaviour risk influences such as hygiene, diet, physical activities, tobacco and drug use, and responsible alcohol consumption.
Promoting healthy lifestyle alone will not address the disabilities caused by common diseases in low-income communities. AHI HPS model includes dental, medical and mental health care. Dental health care includes screening for dental diseases and provision of dental treatment at the school setting. Medical health care includes screening to identify the need for immunisation or treatment, and organising referrals. Health screening includes stool sample analysis and screening questionnaires for common diseases and need for immunisation, clinical preventive and treatment services. Mental health care is provided mainly by promoting mental health and wellbeing but also through professional counselling.
The AHi HPS model represents a major social investment because:
· Children benefits from enjoying better social, physical, intellectual, mental and emotional wellbeing, and the ability to take full advantage of every opportunity for education. They improve their social behaviour, family ties and develop a healthier life style, which in turn leads to higher school achievements, better health, better capacity for work and wellbeing throughout the life course;
· Parents benefit from gaining a broader knowledge base about local health problems, learning important new health information and life skills by taking part in their children’s education;
· Schools benefit from establishing links to important international organisations such as UNICEF and World Health Organisation, local health services and by having additional resources, as well as parents’ active participation in school activities and involvement;
· Community benefits from better educated and healthier people, which is an asset to community as a whole;
· Local business benefits from better-educated and more productive employees;
· The neighbourhood benefits from a stronger basis for economic development.
The AHi HPS model improve education in low-income communities because:
· Children who are ill, hungry, weakened by parasitic disease, malnourished and scared are not capable of learning well,
· School staff who experience improved health, morale and skills can do their jobs more effectively - educate children well;
· Children and teachers are more productive when the school is clean, equipped with suitable sanitary facilities and safe water, protected from infectious diseases and from discrimination, harassment, abuse and violence, and have policies and actions that aim to prevent tobacco use, alcohol and substance abuse, and sexual behaviours that are likely to result in less sexually transmitted infections and unintended pregnancy, and conditions that are conducive to better mental health.
· Reduces absenteeism among children as their attendance drops when they or their family members are ill, or when students fear violence or abuse on the way to, from or in school;
· Reduces absenteeism among school staff as their attendance drops when they are ill;
A description of the principal risks facing the charity
The key risks, apart from the Charity being only a year old are:
· The need to create a full and operational Trustee Board
o AHi managed to attract a new Trustee with expertise in law and continue the process of recruiting new Trustees in accordance with the 2019-2020 strategy document.
· The Covid19 pandemic altering the operational delivery of the AHi HPS programme as schools are closed.
o While there was a delay in the implementation due to schools being closed due to the COVID-19 pandemic, there was also an increase in interest to implement the AHi HPS model. This was because improving hygiene and preventing transmission of germs are major components of the AHi HPS model.
· The need to register the AHi CIO in Brazil to fundraising and implement at large scale the AHi HPS model in Brazil.
o Currently, AHi is in the process of application for operation in Brazil at the Ministry of Justice and Public Security.
Structure, Governance and Management
Charitable Incorporated Organisation - foundation registered 05 June 2019
Appointment of charity trustees
(1) Apart from the first charity trustees, every trustee must be appointed for a term by a resolution passed at a properly convened meeting of the charity trustees.
(2) In selecting individuals for appointment as charity trustees, the charity trustees must have regard to the skills, knowledge and experience needed for the effective administration of the AHi CIO.
Reference and Administrative details
Charity name: Affordable Health initiative
Other name the charity uses: none
Registered charity number: 1183732
Charity’s principal address: 125 Plimsoll road, London N4 2ED, UK
Names of the charity trustees who manage the charity
Mr Kristoff Gibbon-Walsh, Board of Trustees
Ms Zoe Herington, Board of Trustees
Professor Wagner Marcenes, Chair of Board of Trustees
Dr Caroline Pankhurst, Board of Trustees
Mr Felipe Tirado, Board of Trustees (From 07.08.2019)