African Palliative Care Association◆Founding phase
Pain relief should not depend on next year's funding.
APCA is building a permanent endowment so that palliative care training across Africa is paid for by capital that is never spent, only the income it earns. One gift, working every year after it is made.
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Why permanence
Every year, the work starts from zero.
Since 2011, APCA has supported more than 25 African countries to integrate palliative care into their national health systems, and its membership now exceeds 5,000 individuals and 1,500 institutions across Africa and beyond. Almost all of that work is funded a year at a time.
Grant cycles end. Priorities shift. A training programme that took four years to build can lose its funding in a single budget round, and the clinicians it would have trained are simply not trained. The knowledge does not accumulate. It restarts.
An endowment breaks that cycle permanently. The capital is never spent. It is invested, and the income it earns is split each year between funding the work and growing the fund. The gift does not run out, and it never needs renewing.
The need
The shortage is not of willingness. It is of trained people.
APCA's Strategic Plan 2020-2030 names the gap plainly: across the continent, most pre-service courses still do not cover palliative care, and where trained staff do exist, many countries do not recognise them as specialists, so they are neither deployed nor paid as such.
14%
of people worldwide who need palliative care at the end of life actually receive it, on WHO figures cited in the plan. The shortfall is heaviest where training routes do not exist.
38
African countries have any form of palliative care service at all, and only 16 have a service for children. More than 40 countries have no overarching palliative care policy in place.
1.3bn
people live across a continent where over one million new cancer cases and 693,487 cancer deaths were recorded in a single year, alongside the burden of HIV, TB and ageing populations.
The plan's answer is workforce: support health worker development, pre-service, in-service, internship and postgraduate education, curriculum development, and accreditation of palliative care as a recognised medical speciality. That is the work this endowment is built to fund.
Read more about APCA's palliative care education and training work
It is also the work most exposed to funding cycles. The same plan lists the threats candidly: donor fatigue among long-term funders, a small pool of palliative care funding, major donors moving away from the field, and heavy reliance on project grants rather than unrestricted income. Training is precisely the line item that gets cut first and rebuilt slowest, because a cohort not trained this year is a cohort that never existed.
Under its fourth strategic objective, APCA committed to building reserves, developing mechanisms to receive support from individuals, and refining its investment portfolios. This endowment is that commitment, carried through.
The mechanism
What actually happens to an endowment gift.
Most people have never been asked to give this way before. It is worth being precise, because the difference from an ordinary donation is the whole point.
- Your giftmade once
- Permanent capitalinvested, never spent, held in perpetuity
- Annual income70% funds training, 30% goes back into capital
- Training fundedevery year, indefinitely
The capital remains, and the cycle repeats.
An ordinary donation
Spent within the year
Funds a specific activity now. Valuable, immediate, and gone. Next year the same need requires the same ask.
An endowment gift
Spends only what it earns
The capital stays intact and invested. Each year a defined share of the return funds the work. The principal outlives everyone involved in making the gift.
The purpose
The endowment funds people, not consumables.
This is a deliberate choice. Endowments are the right instrument for permanent capability, and in palliative care, capability means trained clinicians.
Income from the fund goes to palliative care education and training across the APCA network: clinician courses, nurse and physician certification pathways, teaching faculty, and scholarships for practitioners in countries where no training route currently exists.
A clinician trained once relieves suffering for the rest of their career, and teaches others while they do it. Training compounds in a way that year-to-year programme spending cannot, which is why it is the right thing to fund with capital that also compounds.
Founding recognition
The first gifts shape what the fund becomes.
Founding donors are recorded permanently in the fund's constituting documents. Beyond that, what a gift is named for, and what it is directed to, is settled in conversation rather than read off a table.
A named fund
A gift can be held as a named sub-fund inside the endowment, carrying your name, your family's name, or the name of someone you wish to honour. It can be directed to a particular kind of training or a particular part of the continent, within the fund's stated purpose, and it keeps that name and that purpose permanently.
A named scholarship
Income can be set aside to carry one practitioner through training each year, in perpetuity. Where a donor wishes it, we send the name and country of each clinician the scholarship supports, so the gift stays attached to specific people rather than to a line in an account.
Recognition and reporting
Founding donors are listed in the fund's founding register and, where they wish, in APCA's annual report, with an invitation to the annual endowment briefing. Donors who prefer to give without recognition are recorded privately instead. Every donor receives an annual statement showing the fund's value, the income drawn and the training it paid for.
How a gift is sized
An endowed gift is sized so that its annual income covers a recurring cost rather than a one-off. Training costs vary widely across the continent, from a short clinical course to a full diploma, so we work out with each donor what their gift can sustainably carry every year. Gifts of any size go into the same permanent capital, and pledges are commonly spread over three to five years.
The prospectus sets out the naming conventions, the pledge documentation and the minimum levels at which a fund or scholarship can be separately named and reported on.
Stewardship
Who holds the money, and what stops it being spent.
Nobody should make a permanent gift without knowing exactly how it is protected.
Who holds it
The African Palliative Care Association, a pan-African membership organisation registered in Uganda as an NGO since 2003 (registration number 4231), with its secretariat in Kampala. The endowment is held as a restricted fund, separate from operating income, under its own deed.
Highest authority
The General Assembly, made up of APCA's individual and institutional members. It meets every three years alongside the Triennial International African Palliative Care Conference, appoints the Board of Directors and approves the external auditors.
Board oversight
A ten-member Board of Directors drawn from across Africa, Europe and North America, nominated on skills with regional and language representation, serving up to two three-year terms and meeting quarterly. The Honorary Treasurer is a Certified Public Accountant.
Committee responsible
A Board committee carries dedicated oversight of the endowment, chaired on the basis of expertise and reporting to the full Board. Its remit covers the investment mandate, the annual draw and the ethical screens applied to holdings.
Spending rule
Only income is spent, never capital. Of the net income the fund earns each year, 70% is applied to training and 30% is reinvested into the capital, so the fund keeps pace with inflation and grows as it works.
Capital protection
The deed prohibits spending principal. Lifting that restriction would require a resolution of the full Board and, for a named fund, the written consent of the donor or their representative.
Financial control
The Board reviews and approves audit reports, annual budgets and financial statements quarterly. The endowment appears as a separate line in those statements, so the capital balance and the amount drawn are visible on their own.
What you receive
An annual statement showing the fund's value, the income drawn and the training that income paid for. External auditors are approved by the membership, not appointed by management.
Request the endowment prospectus
The prospectus sets out the fund's purpose, governance, investment policy, gift levels and tax treatment by country. Requesting it commits you to nothing.
Before you ask
The questions donors actually ask first.
Can I give to the endowment in instalments?
Yes. Founding gifts are commonly pledged over three to five years, with recognition set at the total pledged rather than the first payment. The prospectus sets out the pledge documentation.
What happens to my gift if APCA ceases to operate?
This is the right question to ask of any endowment, and the answer belongs in the fund's constituting document rather than on a web page, so the trust deed states it directly. If APCA were to wind up, the endowment does not pass to creditors. The capital transfers, intact and with its purpose unchanged, to a successor organisation working in palliative care education in Africa, chosen by the Board and approved by the Investment Committee. Named funds keep their names and their designated purpose through any such transfer.
Is my gift tax-deductible?
It depends on where you are resident and how the gift is routed. The prospectus includes country-by-country treatment for the jurisdictions where APCA can receive gifts. We cannot give tax advice, so please confirm the position with your own adviser.
Can I direct the income to a specific country?
Within the fund's stated purpose, yes, subject to APCA having active programmes there and to a minimum gift level. Restrictions that are too narrow can leave income unspendable, so this is agreed in conversation rather than set unilaterally.
Why endow rather than simply donate now?
If the need is immediate, donate. It will be spent on patients this year, and that is a good outcome. Endow when what you want is for the work to continue after you have stopped paying attention to it. Most donors who give substantially do both.
Can I leave the gift in my will instead?
Yes, and bequests are a common route into an endowment. The prospectus includes suggested wording for your solicitor. A pledged bequest can be recognised in the founding register during your lifetime.