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Sierra Leone has only 168 doctors and an annual health spend of £5 per head. Tony Levene went there to see how cash from a unique Vaccine Isa makes a direct difference
It can be a 10, 12 or even 15-mile walk in the blazing sun for mothers in the Bombali district of northern Sierra Leone to the Binkolo health centre. Once there, they often face a wait of many hours. Then they have to walk back to their villages – perhaps not arriving before nightfall – where their menfolk then expect them to cook.
But as I found, here in one of the most deprived parts of the world's second-poorest country, they think it is all worthwhile. The community health centre gives babies vital innoculations – 280 out of every 1,000 Sierra Leone children who survive childbirth die before their fifth birthday.
The innoculation project is funded by the UK and other western governments as well as other sources, such as the Bill & Melinda Gates Foundation.
And from this week, thanks to a unique Isa bond backed by the UK government, British investors can help with the vaccines that will give children – around 20% of Sierra Leone's population is under five – a better chance of reaching healthy adulthood.
There is no other financial product quite like the Vaccine Investment Isa. It guarantees a fixed 16.2% return over the next five years and a month, to savers who can afford to lock up their cash for the full period. The gain equates to 3% a year – and as an Isa, it's tax free.
It's available through HSBC branches across the UK or on the website *(tinyurl.com/dnkhfa). The bank says the charges in the bond will only cover its expenses and will not be taken from the return to investors.
My visit to the health centres and other facilities across the country showed just how desperate for help are the people of Sierra Leone are. Extreme poverty stares you in the face, partly as a result of a violent civil war over diamonds which was only ended after British military intervention in 2001.
The country sits next to bottom in the UN human development index. The statistics are depressing. There are only 168 doctors for the 5.7 million population, with the annual health spend estimated at $7 (£5) per head.
There is no clean water in many health centres, especially in rural areas. The Bombali centre I visited relied on buckets from a "guarded well" while its birth delivery room would have been regarded as scandalous in the UK a century ago.
Sierra Leone's health minister, Dr Soccoh Kabia, is aware that immunisation is not the whole answer to his country's health problems.
He told Guardian Money that it was "difficult sometimes to know where to start. We have multiple problems, and clean water and drainage would be a big advantage. But that will take much time and money. We have protected wells, although this is not really where we want to be. In the meantime, the internationally aided immunisation programme is a quick way to help prevent many childhood deaths".
The immunisation used in Sierra Leone is a five-in-one – or pentavalent – shot which protects against diphtheria, tetanus, pertussis (whooping cough), heptatis B and Hib (Haemophilus influenzae B, a bacterium that can cause meningitis and pneumonia among other diseases). These are all diseases which have largely been wiped out in more prosperous countries.
Each pentavalent shot costs $3.80 from the manufacturer. They are purchased under the auspices of Unicef and imported into the country ready to use. The price is falling towards $2.
Little money for the programme enters Sierra Leone, an important consideration for a country which displays "fight corruption" posters on streets and which is widely regarded as a staging post for cocaine shipments from South America on their way to Europe.
But closely monitored funds are made available for local health centres and the all-important follow-up work.
"Some immunisations need boosters. It can be hard to convince women to return – they may not understand the importance of attending a health centre if their child appears well. We do chase them when necessary, otherwise the first treatment could be wasted," says Ishata Conteh, a senior Sierra Leone community nursing officer.
Conteh knows success rates must stay high – if targets slip, international agreements state the country will no longer receive aid for hepatitis B and Hib vaccines.
Geneva-based Gavi, the Global Alliance for Vaccines and Immunisation, is masterminding the life-saving innoculations in Sierra Leone – and in a further 70 poor countries (defined as having an annual income of less than $1,000 a head), of which the majority are in Africa. Gavi was set up in 2000 as a public-private partnership with the sole aim of increasing immunisation rates. Its members include donors, developing countries, the World Health Organisation, the World Bank, Unicef, the Gates Foundation and vaccine manufacturers. Gavi says its activities have prevented more than 3.4m premature deaths since 2000.
Gavi's finances are arranged through Iffim – the International Finance Facility for Immunisation – whose role is to bring together investors and children in the world's poorest countries.
Iffim chairman Alan Gillespie, says: "It started with $1.5bn from the Gates Foundation. Then the British and other governments pledged money as part of the 2005 Gleneagles [G8] agreement – the UK promised £1.38bn in instalments between 2006 and 2026.
"Our role is to turn this long-term funding, via 'front-end loading', into money that can be used at once.
"We issue bonds, which are backed by our guaranteed cashflow from the donor nations, to investors, who can then have a market rate of return.
"This is not charity – it's a rock-solid investment which offers a real market return."
• Tony Levene travelled to Sierra Leone as a guest of Gavi
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