Barefoot doctors

Posted on by
Reply

The concept of “barefoot doctors” originated in China. Although the barefoot doctors programme was institutionalised after 1965, following Chairman Mao’s healthcare speech, and subsequently integrated into national policy, barefoot doctors had been around for a few decades before then.


What are, or were, barefoot doctors? According to Wikipedia, these were “farmers, folk healers, rural healthcare providers, and middle or secondary school graduates who received minimal basic medical and paramedical training and worked in rural villages in China. Their purpose was to bring healthcare to rural areas where urban-trained doctors would not settle. They promoted basic hygiene, preventive healthcare and family planning, and treated common illnesses…. Barefoot doctors continued to introduce Western medicine to rural areas by merging it with Chinese medicine. With the onset of market-oriented reforms after the Cultural Revolution, political support for barefoot doctors dissipated, and healthcare crises of peasants substantially increased after the system broke down in the 1980’s”.


Indeed, the success of the Chinese barefoot doctors’ programme was part of the inspiration behind the World Health Organisation (WHO) and its member countries adopting the Alma Ata Declaration (or Primary Health Care Initiative) in 1978.


It is clear that, particularly for emerging and poor nations, a programme of barefoot doctors can radically change the health and mortality outcomes for a nation. The programme could be further enhanced with Cuban-style home visits.


A policy and system of barefoot doctors can address a number of issues for a nation, such as:
·      Rapid production of primary healthcare providers.·      Cost-effectiveness at the training level.·      Cost-effectiveness at the provision level.·      Assistance with adherence to treatment regimens for debilitating illnesses, including HIV-AIDS, diabetes, TB, etc.·      Rapid improvement of the health status of the poorer sections of the population.·      Reduction of unemployment in poorer areas such as rural areas, townships and informal settlements.
The need, and potential benefits, of barefoot doctors, are particularly apparent during a pandemic such as Covid-19. If a country like South Africa had barefoot doctors, the response (and outcomes) to Covid-19 would have been radically different. Not only the population as a whole would have been better mobilised, the healthcare system would have had people in closer proximity to communities in townships, informal settlements and rural areas to immediately inform and encourage adherence to health guidelines such as hand-washing, social distancing, mask-wearing, and undertaking testing.


Given the experience of the lack of preparedness for Covid-19, it is perhaps time to consider a strategy to deal with emerging and future health crises and pandemics. In this regard, a system of barefoot doctors would greatly enhance the country’s preparedness, while being beneficial on an ongoing basis.

The Benefits of Financial Literacy

Posted on by
Reply

But it isn’t just a matter of scoring well on a test; financial literacy brings with it a host of benefits. Here’s a short list of the advantages you’ll gain.


Increased Ability to Intelligently Evaluate Your Organisation

Do you really know if your organisation has enough cash to make salary and wage payments? Do you know how profitable the products or services you work on really are? When it comes to capital expenditure proposals, is the return on investment analysis based on solid data? And is it even the right measure to base your decision on? And, by the way, how is it even calculated? Boost your financial intelligence, and you’ll gain more insight into questions like these. Or maybe you’ve had nightmares in which you worked or were on the board of Enron, or South African Airways, or maybe Steinhoff. Many of the people there, including board members, had no idea of their companies’ precarious situations.


Suppose, for instance, you worked at the big telecoms company WorldCom (later known as MCI) during the late 1990’s. WorldCom’s strategy was to grow through acquisition (that is, buying other companies). Trouble was, the company wasn’t generating enough cash for the acquisitions it wanted to make. So, it used shares as its currency, and paid for the companies it bought partly with WorldCom shares. That meant it had to keep its share price high; otherwise, the acquisitions would be too expensive. It also meant keeping profits high, so that Wall Street (the main financial district in the US) would give it a high valuation. WorldCom paid for the acquisitions through borrowing. A company doing a lot of borrowing has to keep its profits up; otherwise, the banks will stop lending it money. So, on two fronts WorldCom was under severe pressure to report high profits. Add to that the fact that top management are rewarded mainly for delivering on the corporate strategy.


That, of course, was the source of the fraud that was ultimately uncovered. The company artificially boosted profits “with a variety of accounting tricks, including understating expenses and treating operating costs as capital expenditures”, as BusinessWeek summarised the US Justice Department’s indictment. When everyone learned that WorldCom wasn’t as profitable as it had claimed, the house of cards came tumbling down. But even if there hadn’t been fraud, WorldCom’s ability to generate cash was out of step with its growth-by-acquisitions strategy. It could live on borrowing and stock for a while, but not forever.


Or look at Tyco International. For all the news stories about Dennis Kozlowski’s (former CEO of Tyco, who was later convicted in 2005 of crimes related to his receipt of $81 million in unauthorised payments, and so on) elaborate birthday party and zillion-dollar umbrella stand, there is another story that wasn’t widely reported. During the 1990’s, Tyco also was a big buyer of companies. In fact, it acquired some six hundred companies in just two years, or more than one every working day. With all those acquisitions, the goodwill[1] number on Tyco’s balance sheet[2] grew to the point where bankers began to get nervous. Bankers and investors don’t like to see too much goodwill on a balance sheet; they prefer assets that you can touch (and in a pinch, sell off). So, when word spread that there might be some accounting irregularities at Tyco, they effectively shut off Tyco off from further acquisitions.


Now, I’m not arguing that every financially intelligent manager would have been able to spot WorldCom’s or Tyco’s or Steinhoff’s precarious situations. Plenty of seemingly savvy Wall Street or JSE types were fooled by the three companies. Still, a little more knowledge will give you the tools to watch trends at your organisation and understand more of the stories behind the numbers. While you might not have all of the answers, you should know what questions to ask when you don’t. It’s always worth your while to assess your company’s performance and prospects. You’ll learn to gauge how it’s doing and to figure out how you can best support those goals and be successful yourself.


Better Understanding of the Bias in the Numbers

What will understanding the bias do for you? One very big thing: it will give you the knowledge and the confidence – the financial intelligence – to challenge the data provided by your finance and accounting department. You will be able to identify the hard data, the assumptions, and the estimates. You will know when your decisions and actions are based on solid ground.
Let’s say you work in operations, and you are proposing the purchase of some new equipment. Your boss says he’ll listen, but he wants you to justify the purchase. That means digging up data from finance, including cash flow analysis for the machine, working capital requirements, and depreciation schedules.  All these numbers – surprise! – are based on assumptions and estimates. If you know what they are, you can examine them to see if they make sense. If they don’t, you can change the assumptions, modify the estimates, and put together an analysis that is more realistic and that (hopefully) supports your proposal. Sibongile, for example, likes to say that she’s a veteran finance professional and could easily come up with an analysis showing how her company should buy her a R30,000 computer. She would assume that she could save an hour a day because of the computer’s features and processing speed; she would calculate the value of an hour per day of her time over a year; and presto, she would show that buying the computer is a no-brainer. A financially intelligent boss, however, would take a look at those assumptions and propose some alternatives, such as that Sibongile might actually lose an hour of work a day because it was now so easy for her to surf the net and be on social media.


It’s amazing, in fact, how easily a financially knowledgeable manager can change the terms of discussion, so that better decisions get made. When he worked for Ford, Khaya had an experience that underlined just that lesson. He and several other finance people were presenting financial results to a senior marketing executive. After they sat down, she looked straight at them and said, “Before I open these finance reports, I need to know… for how long and at what temperature?” Khaya and the others had no idea what she was talking about. Then the light went on and Khaya replied, “Yes, Ma’am, they were in for two hours at 400 degrees”. She said, “Ok, now that I know how long you cooked them, let’s begin”. She was telling the finance people that she knew there were assumptions and estimates in the numbers and that she was going to ask questions. When she asked in the meeting how solid a given number was, the finance people were comfortable explaining where the number came from and the assumptions, if any, they had had to make. The executive could then take the numbers and use them to make decisions she felt comfortable with.


Absent such knowledge, what happens? Simple: the people from accounting and finance control the decisions. I use the word control because when decisions are made based on numbers, and when the numbers are based on accountants’ assumptions and estimates, then the accountants and finance people have effective control (even if they aren’t trying to control anything). That’s why you need to know what questions to ask.


The Ability to Use Numbers and Financial Tools to Make and Analyse Decisions

What is the ROI of that project? Why can’t we spend money when our company is profitable? Why do I have to focus on accounts receivable when I am not in the accounting department? You ask yourself these and other questions every day (or someone else asks them – and assumes you know the answers!) You are expected to use financial knowledge to make decisions, to direct your subordinates, and to plan the future of your department. I will show you how to do this, give you useful examples, and discuss what to do with the results. In the process I will try to use as little financial jargon as possible.


For example, let’s look at why the finance department might tell you not to spend any money, even though the company is profitable. I’ll start with the basic fact that cash and profit are different. I’ll explain later why, but right now let’s just focus on the basics. Profit is based on revenue. Revenue, remember, is recognised when a product or service is delivered, not when the bill is paid. So, the top line of the income statement, the line from which you subtract expenses to determine profit, is often no more than a promise. Customers have not paid yet, so the revenue number does not reflect real money and neither does the profit line at the bottom. If everything goes well, the company will eventually collect its receivables and will have cash corresponding to that profit. In the meantime, it doesn’t.


Now, suppose you’re working for a fast-growing business-services company. The company is selling a lot of services at a good price, so its revenues and profits are high. It is hiring people as fast as it can, and of course it has to pay them as soon as they come on board. But all the profit that these people are earning won’t turn into cash until thirty days or maybe sixty days after it is billed out! That’s one reason why even the CFO of a highly profitable company may sometimes say, don’t spend any money right now because cash is tight.


Although this course focuses on increasing your financial intelligence in business or in a not-for-profit, you can also apply what you’ll learn in your personal life. Consider your decisions to purchase a house, a car, or a boat. The knowledge you’ll gain can apply to those decisions as well. Or consider how you plan for the future and decide how to invest. This course if not about investing, but it is about understanding company financials, which will help you analyse possible investment opportunities.


Better Career Prospects

A demonstrably better understanding of the numbers can’t hurt your career prospects. Imagine the shock on your boss’s face if you made a case for a raise – and part of your case included a detailed analysis of the company’s financial picture, showing exactly how your unit has contributed. Far-fetched? Not really. The same goes for when you apply for that next job. Hiring experts always job seekers to ask questions of the interviewer – and if you ask financial questions, you’ll show that you understand the financial side of the business. You might also save yourself some pain by analysing the financial position of your next employer, and perhaps finding out that its not such an attractive prospect after all.

[1] Goodwill comes into play when one company acquires another company. It is the difference between the net assets acquired (that is, the fair market value of the assets less the assumed liabilities) and the amount of money the acquiring company pays for them. For example, if a company’s net assets are valued at R1 million and the acquirer pays R3 million, then goodwill of R2 million goes onto the acquirer’s balance sheet. That R2 million reflects all the value that is not reflected in the bought company’s tangible assets – for example, its name, reputation, customer lists, and so on.

[2] You’ll learn about a balance sheet later, but it is part of the financial statements of a company and reflects the assets, liabilities and owner’s equity at a point in time. The balance sheet is called such because it balances – assets always must equal liabilities plus owner’s equity.

No More Thumb Suck – Estimating the Cost of Capital

Posted on by
Reply

The Risk-Free Rate

Most risk and return models in finance start off with an asset that is defined as risk free and use the expected return on that asset as the risk-free rate. The expected returns on risky investments are then measured relative to the risk-free rate. But what makes an asset risk free? And what do we do when we cannot find such an asset? These are the questions we will deal with next.


The Cost of Equity

Firms raise money from both equity investors and lenders to fund investments. Both groups of investors make their investments expecting to make a return. The expected return for equity investors would include a premium for the equity risk in the investment. We label this expected return the cost of equity. In other words, the cost of equity is the rate of return investors require on an equity investment in a firm.
As you may know, the risk and return models need a riskless rate and a risk premium. They also need measures of a firm’s exposure to market risk in the form of betas. These inputs are used to arrive at an expected return on an equity investment:


Expected return = Riskless rate + Beta(Risk premium)


This expected return to equity investors includes compensation for the market risk in the investment and is the cost of equity.


In the Capital Asset Pricing Model (CAPM), the beta of an investment is the risk that the investment adds to a market portfolio. There are three approaches available for estimating these parameters: one is to use historical data on market prices for individual investments; the second is to estimate the betas from the fundamental characteristics of the investment; and the third is to use accounting data. We will look at all three approaches next.


Calculating the Cost of Debt

The cost of debt measures the current cost to the firm of borrowing funds to finance projects. In general terms, it is determined by the following variables:


•   The riskless rate. As the riskless rate increases, the cost of debt for firms will also increase.

•   The default risk (and associated default spread) of the company. As the default risk of a firm increases, the cost of borrowing money will also increase.

•   The tax advantage associated with debt. Since interest is tax deductible, the after-tax cost of debt is a function of the tax rate. The tax benefit that accrues from paying interest makes the after-tax cost of debt lower than the pre-tax cost. Furthermore, this benefit increases as the tax rate increases:


After-tax cost of debt = Pre-tax cost of debt(1 – Tax rate)


Estimating the Default Risk and the Default Spread of a Firm

The simplest scenario for estimating the cost of debt occurs when a firm has long-term bonds outstanding that are widely traded. The market price of the bond in conjunction with its coupon and maturity can serve to compute a yield that is used as the cost of debt. For instance, this approach works for a firm like AT&T that has dozens of outstanding bonds that are liquid and trade frequently.


Many firms have bonds outstanding that do not trade regularly. Since these firms are usually rated, we can estimate their costs of debt by using their ratings and associated default spreads. Thus, Boeing with an AA rating can be expected to have a cost of debt approximately 1.00 percent higher than the Treasury bond rate, since this is the spread typically paid by AA-rated firms.


Some companies choose not to get rated. Many smaller firms and most private businesses fall into this category. While ratings agencies have sprung up in many emerging markets, there are still a number of markets where companies are not rated on the basis of default risk. When there is no rating available to estimate the cost of debt, there are two alternatives:


1.     Recent borrowing history. Many firms that are not rated still borrow money from banks and other financial institutions. By looking at the most recent borrowings made by a firm, we can get a sense of the types of default spreads being charged the firm and use these spreads to come up with a cost of debt.

2.     Estimate a synthetic rating. An alternative is to play the role of a ratings agency and assign a rating to a firm based on its financial ratios; this rating is called a synthetic rating. To make this assessment, we begin with rated firms and examine the financial characteristics shared by firms within each ratings class. For instance, the Altman Z score, which is used as a proxy for default risk, is a function of five financial ratios that are weighted to generate a Z score. The ratios used and their relative weights are usually based on empirical evidence on past defaults. The second step is to relate the level of the score to a bond rating.


What is Debt?The answer to this question may seem obvious since the balance sheet for a firm shows the outstanding liabilities of a firm. There are, however, limitations with using these liabilities as debt in the cost of capital computation. The first is that some of the liabilities on a firm’s balance sheet, such as accounts payable and supplier credit, are not interest-bearing. Consequently, applying an after-tax cost of debt to these items can provide a misleading view of the true cost of capital for a firm. The second is that there are items off the balance sheet that create fixed commitments for the firm and provide the same tax deductions that interest payments on debt do. The most prominent of these off-balance sheet items are operating leases. Consider what an operating lease involves. A retail firm leases a store space for 12 years and enters into a lease agreement with the owner of the space agreeing to pay a fixed amount each year for that period. We do not see much difference between this commitment and borrowing money from a bank and agreeing to pay off the bank loan over 12 years in equal annual instalments.


There are therefore two adjustments we can make when we estimate how much debt a firm has outstanding.


1.     We can consider only interest-bearing debt rather than all liabilities. We would include both short-term and long-term borrowings in debt.

2.     We can also capitalise operating leases and treat them as debt.


Weighted Average Cost of Capital (WACC) or Cost of Capital

Since a firm can raise its money from three sources – equity, debt, and preferred stock – the cost of capital is defined as the weighted average of each of these costs. The cost of equity (ke) reflects the riskiness of the equity investment in the firm, the after-tax cost of debt (kd) is a function of the default risk of the firm, and the cost of preferred stock (kps) is a function of its intermediate standing in terms of risk between debt and equity. The weights on each of these components should reflect their market value proportions, since these proportions best measure how the existing firm is being financed. Thus, if E, D, and PS are the market values of equity, debt, and preferred stock, respectively, the cost of capital can be written as follows:


Cost of Capital = ke[E/(D + E + PS)] + kd[D/(D + E + PS)] + kps[PS/(D + E + PS)]

How Bank Reserves Are Distributed Matters. How You Measure Their Distribution Matters Too. -Liberty Street Economics

Posted on by
Reply

Changes in the distribution of banks’ reserve balances are important since they may impact conditions in the federal funds market and alter trading dynamics in money markets more generally. In this post, we propose using the Lorenz curve and Gini coefficient as a new approach to measuring reserve concentration. Since 2013, concentration, as captured by the Lorenz curve and the Gini coefficient, has co-moved with aggregate reserves, decreasing as aggregate reserves declined (such as in 2015-18) and increasing as aggregate reserves increased (such as at the onset of the COVID-19 pandemic).
— Read on libertystreeteconomics.newyorkfed.org/2020/11/how-bank-reserves-are-distributed-matters-how-you-measure-their-distribution-matters-too.html

Preserving culture – an oxymoron

Posted on by
Reply

Is there anything cultural that should be preserved? An artifact perhaps? Or a dance style? What about food, or norms and practices (like ilobolo) etc.?
I suppose the answer depends on your definition or understanding of what culture is. I guess a simple definition is that culture is a way of life of a people, be it a nation, an ethnic group or a tribe. But it is clearly deeper than that, and encompasses a whole lot of things – language, technology and tools, indeed norms and behaviours, ‘education’/learning, etc. Technology and tools and ‘education’/learning play very significant roles.
In a sense I would see a river as a good metaphor for culture. Sometimes people talk about “traditions” as culture, and vice versa. In a deeper and stricter sense, this is incorrect. Traditions, which is what people usually mean by ‘preserving our culture’, are almost akin to a dam or stagnant water, to culture’s flowing river. Just as a river flows, culture may at times flow fast or slow, go over rocky terrain, have flotsam and jetsam, have deep or shallow points, etc. The key, however, is that it keeps flowing forwards. Because people sometimes fear the discomfort of change, or vested interests find certain current practices to their advantage, from time to time there is pressure and agitation to keep or preserve certain aspects of current culture. Although there may be some limited value in this, hanging on for dear life to practices that are centuries old may be inimical to cultural progression.
To hark back to old dress styles in the name of tradition, when newer and current methods are clearly vastly superior is foolhardy. Or to perpetuate practices that come from a time when women were regarded as inferior and akin to children or property, is also demeaning and outrightly dangerous. These traditions may suit certain vested interests, but are ultimately out of their time and should be discarded forthwith.

How Has China’s Economy Performed under the COVID-19 Shock? -Liberty Street Economics

Posted on by
Reply

China’s official GDP growth figures so far for 2020 have been broadly in line with alternative indicators; that growth presently is staging a strong rebound and providing a boost to the global economy, but faces headwinds.
— Read on libertystreeteconomics.newyorkfed.org/2020/10/how-has-chinas-economy-performed-under-the-covid-19-shock.html