It’s all a bit knock-about, isn’t it? The Houses of Commons, I mean. Here’s the banks going bust, losses of unimaginable sums bandied about as though they were small change from buying a round at a bar, and the country going fast down the plug-hole, and all our rulers can do is to score school debating points off each other.
It’s always someone else’s – anyone else’s – fault when there is blame while anything positive sticks to the party in power.
This adversarial approach applies throughout our society. Take private medical insurance (PMI). There are only two articles about this in the consumer press. It’s either the “NHS is disease ridden/dirty/slow/uncaring (choose one or more of these or add your own)” argument with a bit on costs and bureaucracy for the more sophisticated on one side, or – often in letter or comment columns – the line that private medical facilities create a two tier health system where only those who are young and without a prior medical history can insure themselves without a second mortgage.
But what about a world where there is neither? Where paracetemol is considered a sophisticated designer drug, where a clean bandage is a luxury and, far from rival claims over MRSA, the very basic of clean running water is off the agenda for the majority?
That would certainly put our private vs state arguments into perspective.
So prepare to be humbled – and given some hope.
Late last month, I went to Sierra Leone, the West African state that is the one of the poorest countries in the world’s poorest continent. The gap between their living standards and ours – even after our banking crisis – is almost unimaginable. Some three out of four live on less than $1 a day.
By almost every measure, it’s in the bottom five. It was not helped by the civil war that ended seven years ago after a British army intervention – wherever you go, you see the amputees that resulted from that fight.
Life expectancy is half that of Western Europe at 41 and 28% of all children who survive birth die before their fifth birthday. One fifth of women of child bearing age are pregnant at any one time. A fifth of the population in rural areas is under five – not much better in the towns.
There are just 168 doctors for the near six million inhabitants. Even the Ministry of Health and Pubic Sanitation building lacks reliable running water in the lavatories. A women’s healthcare centre I visited in a rural area in the north of the country had a birth delivery room that would have shocked Florence Nightingale and a hole in the ground as a staff toilet. And water that had to be fetched in buckets.
What the country really needs to improve its health – and especially that of the children as a greater survival rate should help reduce the birth rate despite the antipathy of religious leaders to contraception – is the programme of clean water, efficient sewerage and hospital building which helped improve health so much in this part of the world in the nineteenth century.
The chances of that happening any time soon in Sierra Leone – or in the next 20 years for that matter – are as remote as your likelihood of flying to the moon. It’s theoretically possible but that’s it.
And it’s not much better in many of the other 71 countries where annual income is under $1,000 a year. Among these nations are some on fringes of Europe such as Moldova and Ukraine but most are in Africa.
The health solution is the quick fix of inoculation against killer diseases. Back in 2000, the Bill and Melinda Gates Foundation helped set up GAVI, the Global Alliance for Vaccination and Immunisation, a non-governmental organisation which organises programmes to immunise people.
Innoculation is quick, and relatively inexpensive as each shot of a pentavalent vaccine which protects against five diseases (including diphtheria, whooping cough, tenatus and meningitis) comes well within the annual $7 (£5) average health spend in Sierra Leone. Yes, that’s right – a fiver a head a year or less than the cost of one intermediary letter to a private medical insurance (PMI) provider questioning that month’s commission payments.
GAVI sources and provides the vaccines. Little if any cash is used, essential in a country where corruption is so endemic that posters exhort the population to reject it. The Geneva-based GAVI also oversees the follow up process of ensuring that mothers, who often have to walk 10 or more miles to their local health clinic, attend with their babies for follow-up treatment. Without “encouragement”, many would do nothing, reasoning there is no point in attending when their children appear well. Countries receiving this support have targets – a failure to meet percentages means programmes can be withdrawn.
In 2005, as part of the Gleneagles agreement, the UK government agreed to fund GAVI with £1.38bn. It’s a drop in the ocean compared with bank bailouts (I leave it to readers to work out the relative morality) and, because the money is spread over 20 years, it works out at around £1 per UK citizen per year.
Sierra Leone and the many other countries on the GAVI list can’t afford to wait. So – and this is where financial advisers come in – GAVI set up IFFIm, the International Finance Facility for Immunisation.
IFFIm “front-end loads” the money by selling bonds to investors. This enables the cash to be used now rather than wait for it to build up over the years. Investors effectively provide the money with their fixed return guaranteed by the UK and other governments backing GAVI.
The first bond, in 2006, was sold to institutional investors. Last year, Japanese retail savers took up two issues. Now, UK private investors can take part via an HSBC- sponsored Vaccine Isa Bond. It’s a fixed five years and one month term investment which pays 16.2% over its life. That equates to 3% a year tax free – not wonderful in other financial climates but a full 0.5% a year better than the equivalent National Savings five year certificates.
HSBC is doing this at cost price – it will make nothing. And many financial advisers are doing the same – offering it to clients at no cost. As IFFIm chairman Alan Gillespie told me: “This is not charity. It’s a rock-solid investment which offers a real market return.”
So even the most cynical client could invest – it’s not often they get the chance to have a guaranteed return that will do good without having to sacrifice themselves financially.