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Save the Date: 8th German-African Healthcare Forum 2021

The 8th German-African Healthcare Forum will take place on October 27 discussing “Partnerships for Resilient Healthcare Systems in Africa”. The forum is organized by German-African Business Association (Afrika-Verein) and German Health Alliance (GHA) and will be as a side conference to the World Health Summit which will be held from 24th to 26th October 2021 in Berlin.

Due to COVID-19 situation this year the forum will take place online given access to hundreds of companies from all over the world.

The panel discussions comprising of ministers, representatives from international organisations, private sector, NGOs and academia will have a closer look at the healthcare sectors with examples from some African countries. The main focus of the discussion will be on the following topics:

– financing and investing in healthcare and scaling up local value chains in Africa
– digital and innovative healthcare solutions 
– partnerships in strengthening health systems

Global cooperation and public-private partnerships also play a big role and will be discussed during the upcoming forum.

Visit the website of German-African Business Association to register and learn more.

The source and photo credits: healthafrica.de

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Maharashtra Government Approves PPP Model to Build Medical Colleges and Hospitals across the State

The Maharashtra state cabinet decided to set up new medical colleges and super-specialty hospitals across the state under a public-private partnership basis to expand the health infrastructure in rural and semi-rural areas.

The Chief Minister’s Office reported the conditions enabling the project which is State Industries Department’s scheme of incentives, model concession agreement of NITI Aayog for healthcare infrastructure projects and support of International Finance Corporation.

"The state will encourage greenfield projects, where we will provide land and private parties can set up medical colleges and super-specialty hospitals. This will be specially beneficial to rural areas."

Amit Deshmukh, Maharashtra medical education minister

In the next three years, additional 1,000 seats in post-graduate programs and various specialist doctors courses will be created. These seats include 350 in the proposed government medical colleges and 650 in the existing medical colleges.

It is also expected increasing number of patients in outpatient departments by 10 million and inpatient department by 1 million for every year.

Sources: The Times of India, news18.com

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FAST-Infra and SI Label: Promoting Common Standards on Sustainable Infrastructure

A sustainable infrastructure investment gap estimated about $3 trillion a year over the next 10 years, especially in developing countries where infrastructure deficits are easily observable.

The public and private sectors had taken immediate action to reach zero net carbon emissions in new hospital projects by 2030, with all buildings retrofitted to zero net carbon by 2050.

The first IFC initiative Green Building Certification System called EDGE, that PPPHealth4All offers as a service, empowers to scale up resource-efficient hospitals and other social infrastructure in a fast, easy and affordable way. 

It is now clear that if the current generation doesn’t accelerate in developing sustainable infrastructure, the global population won’t be able to meet decarbonization goals in line with the Sustainable Development Goals and Paris Agreement commitments.

Recognizing the need, the Global Infrastructure Facility (GIF) together with the Climate Policy Initiative (CPI), HSBC, the International Finance Corporation (IFC) and the Organisation for Economic Co-operation and Development (OECD) came up with initiative called FAST-Infra—the ‘Finance to Accelerate the Sustainable Transition-Infrastructure initiative. First claimed and developed in 2020 by One Planet Lab, “FAST-Infra is a public-private initiative bringing more than 50 organizations together to push for collective action to mobilize private finance and de-risk investments in sustainable infrastructure in developing countries.”

The next step was to create a consistent, globally applicable labeling system for sustainable infrastructure. The working group with Macquarie Green Investment Group developed a key component of FAST-Infra – The Sustainable Infrastructure Label (SI Label). It is meant as a tool to guide project planning, prioritization, and design. One of the goal of the label certification is to motivate public authorities to design more projects with sustainability criteria at their core —encouraging developers to maintain high environmental, social, and resiliency standards at all stages of the infrastructure lifecycle.

The public consultation and invitation to submit an Expression of Interest to develop data reporting platform closed on August 31, 2021. The respondents to this EoI will be reviewed and successful expressions will be selected for further engagement ahead of an Invitation to Bid stage.

Learn more about the initiative here.

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PPPHealth4All Persona – Lisbeth Erlands, Vice President, Europe and MENA at Danish Investment Fund

We are honored to welcome our PPPHealth4All Persona – Lisbeth Erlands, Vice President, Europe and MENA at Danish Investment Fund (IFU), who has more than 25 years of experience in impact investments dealing with complex commercial transactions – business development, due diligence, deal structuring and contract negotiations.
 
Dear Lisbeth, could you please introduce IFU to our readers? What set you apart from other financiers?
 
IFU is the Danish Development Finance Institution with a clear mandate to create impact through our investments focusing on creating green, just and inclusive societies. The impact mandate is combined with a commercial approach to the investments, and consequently we also need to develop businesses that are financially sustainable and will provide a return to the investors. IFU is owned by the Danish state but is also acting as fund manager for several public private funds. This includes the Danish SDG Investment Fund that invests with the purpose of supporting the Sustainable Development Goals.

“IFU has vast experience from more than 1,300 investments in over 100 countries in Africa, Asia, Latin America and Europe. Total capital under management is EUR 1.7 billion.”

 
IFU is an impact investor focusing on developing countries whose investment strategy is led by a holistic, sustainable approach. How do you measure the impact?
The impact of the investments is measured across a range of indicators like direct employment, local taxes, energy produced, number of clients served with microfinance and the carbon footprint. The results are primarily based on annual reporting from our investees supplemented by model calculations on a few indicators. The impacts are published annually in IFU’s Sustainability and Impact Report and are used to take stock of our achievements, evaluate our performance and as the basis for a dialogue on how to improve, for example by reducing our carbon footprint going forward.
 
In our 2020 report, IFU has for the first time calculated the total climate footprint of its investments in order to monitor the development and contribute to reducing the total CO2 emissions in the portfolio. For this we were recently rewarded in Denmark, see here.
 
IFU publishes an annual Sustainability & Impact Report, which describe about our strategy, processes and results. The report is available on IFU’s website.
 
How IFU integrates sustainability and impact into the investment process?
As an impact investor sustainability and impact issues are integrated in the investment process from the first screening and until the investment is divested. First of all, a potential investment must fall within our country and sector focus. Moreover, it must fit the purpose of our impact criteria creating green, just and inclusive societies. This includes compliance with the EU taxonomy for green investments, for example. Finally, the activity must not be included on IFU’s exclusion list.
 
All investments are categorizes based on their identified environmental and social risk. The higher the risk the more comprehensive assessments will be made during due diligence.

“In general, IFU requires direct investments to comply with national regulation and to follow relevant international standards and principles.”

To ensure that the investees meet their environmental and social obligations, IFU and the investees agree on an action plan describing gaps and measures, which must be implemented within a certain timeframe.
 
The impact potential is also assessed in relation to the SDGs, and specific impact areas are identified. During the process this materializes into an impact creation plan that is implemented as part of IFU’s active ownership throughout the ownership period.
 
What are IFU’s priorities in Europe and MENA region?
Denmark and the EU have a strong commitment to the Eastern neighborhood with a special focus on Ukraine and Georgia and these two countries are also core focus countries for IFU. In terms of sector priorities, we pursue the same impact agenda as in any other regions and countries.
 
Healthcare is a relatively new sector for IFU, but it is already one of the primary focus areas. You’ve invested in Egypt, Morocco, India, Africa. Why have you chosen these countries and these projects?
As a key driver for our selection of healthcare projects we require that the investment will improve the access to quality healthcare for lower and middle-income patients at affordable prices. To achieve that goal, private healthcare must be integrated in the national healthcare ecosystem as a supplement to the public healthcare system in the given country e. g. by a regulatory framework for the private and/or public health insurance system.
 
What criteria the healthcare project or partner needs to meet to be considered by IFU to invest?
As a general rule, we partner up with companies and partners that have a proven track record in the business and a clear responsible investor and impact focus.
 
Are you interested in PPP projects? Under which conditions would you consider them?
The short answer is, we can invest in PPP projects. As for any project partnership to succeed, a successful PPP project will require that there has to be a common goal and a clear alignment of interests and expectations in the investor group. Also, there has to be a lead strategic (typically private) investor who is main responsible for driving the investment.
 
Interview by Natalia Domanska.
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PPPHealth4All Persona – Julien Beaujolin, CEO and Founder, ECMP

We are pleased to welcome our next PPPHealth4All Persona –  Julien Beaujolin, the CEO and founder of ECMP, a healthcare operating firm providing solutions to bridge the healthcare delivery infrastructure gap in South East Asia. Since inception 5 years ago, he focused on partnership with public and private hospital to deliver cardiac Cath-labs, diagnostic imaging and soon oncology services across Indonesia. Julien has an exceptional drive and interest to improve healthcare delivery systems. He believes they should improve the well-being of the communities they serve by making services available, accessible, affordable, and of good quality. Before founding ECMP, Julien was managing director of a South-East Asian medical equipment distributor and started his career in asset management in Switzerland.
 
Main lesson from healthcare PPPs in South-East Asia
If there’s any lesson from this pandemic, it’s that we need much more robust and equitable health systems.
 
Improving the quality of care by making it affordable and accessible is a paradox our world faces. However, the challenge of funding healthcare and bringing high-quality healthcare at affordable prices could not be more acute than in emerging economies, particularly in Asia, home to more than 50% of the global population.
 
The Government will need to expand primary and secondary healthcare capacity and partner with private operators and investors for tertiary services. Private capital will contribute even more significantly to the expansion of care required to achieve universal healthcare coverage (UHC). It is essential to increase the efficiency of healthcare, meet the capital needs for new and upgraded infrastructure, and reduce the strain on public resources.
 
By working with Governments, private capital will contribute to more significant health systems goals. More involvement through public-private partnerships will significantly augment public sector efforts and strengthen the Government’s service delivery.
 
Key aspects from our experience of building a healthcare delivery platform in Indonesia:
 
  • To ensure a levelled playing field, the Government must, i) have the capacity to manage and supervise long-term contracts, ii) ensure and enforce clinical quality and performance standards.
  • Foreign clinician exchange must be facilitated to enable easier access to training capacity and best practice exchange.
  • The low trust between the public and private sectors have to be accounted for and addressed.
  • Compared to other SEA countries, patience is critical in Indonesia; things take time. Partly due to cultural reasons and also to a daunting regional and national bureaucracy.
  • By offering turnkey managed care solutions to hospitals, we eliminate a potential source of red tape which can come with big-ticket medical equipment’s.
  • Long term, 5-10-year tax incentives for all health PPP would drive more capital towards this asset class.
Access to permanent capital
To improve healthcare delivery and access to care, numerous capital-intensive and fast- growing healthcare businesses need financing beyond the average fund life to reach scale and its full potential. This leads to a mismatch between fund and asset lifespan as most vehicles are closed-end funds.
 
Given an average fund life of 6-8 years and an investment period of 3-4 years, the average holding period for investments is 3-5 years. However, certain assets, such as healthcare infrastructure, particularly where greenfield development is involved, require a long lead time (7+ years) before they reach a point in their lifecycle to be efficiently monetized.
 
A permanent capital vehicle scales access to long-term capital by providing a structure attractive to a broad universe of investors. It unlocks private financing for businesses allowing them time to reach scale.
 
Permanent capital strategies are not new. We can argue it’s one of the oldest strategies around. For decades, assets in families have often been concentrated in permanent vehicles such as family businesses, land holdings, trusts, etc. However, in today’s investment practice, which focuses on year-long performance periods as a benchmark, less attention is given to permanent capital strategies.
 
For ECMP to access a broader and deeper pool of capital and ease regulatory, compliance and structure concerns, we are working towards a listing Q1 2022.
 
SDGs and impact investors
As a healthcare operator, we seek to make a meaningful impact on society by improving access to affordable quality healthcare for underserved populations.
 
We believe that responsible investment and operations are critical to sustainable long-term value creation in Asia, and “doing well will only be possible by doing good” as they are not only compatible but mutually reinforcing.
 
Over our recent history, we have, for example, diagnosed and treated 21’000 at our 18 centres in partnerships with the public and private hospitals across Indonesia. Moreover, 95% of the patient are lower / middle income under UHC.
 

However, our experience and interactions with SDG funds were disappointing from an impact perspective. In our view, a majority of them are greenwashing. As with any other investors, the only metric analysed and considered were financial returns.

Financial performance is critical for the sustainability of any investment in the healthcare delivery space. However, patient capital is vital, especially with greenfield projects, as the road to profit and value creation is longer.
 
Value creation for hospital’s partnership
Collaboration and partnerships are essential in any business. In healthcare, they are critical as it’s impossible to succeed alone.
 
Value creation first comes from our team members who are dedicating themselves to provide the best environment of care for our patients and ensure the success of each of our hospital partnerships.
 
Secondly, value also comes from our third-party partners that support our center’s successful operation: consumables suppliers, equipment manufacturers, and technical services providers.
 
This ecosystem enables us to operate and deliver a qualitative and safe environment of care to our patients. Usually, if you provide the above, profit takes care of itself.
 
Healthcare delivery models
Across Asia, especially India, models that substantially lower the cost of healthcare without compromising clinical quality have emerged to satisfy significant unmet medical needs.
 
The principle behind those care models is to employ economies of scale and specialization to slash healthcare costs.
 
Several characteristics that drive access to care, improved quality, and efficiency have been identified:
 
 
These characteristics can help healthcare systems meet the needs of their populations more effectively and deliver significant improvement in the quality and affordability of care. The phenomenal future for healthcare delivery systems is that many models have been proven to make a difference. The challenge is to implement these strategies with capital and talent.
 
Executing investment in the healthcare delivery sector
In Asia, opportunities are about building businesses and driving young companies who need capital and expertise. As such, investors must get involved in operations and focus on adding value to be successful. In-depth industry expertise and experience are critical to achieving higher efficiency, promoting governance, and creating new business opportunities.
 
In Indonesia, ECMP has built a solid operational structure with healthcare expertise to support project management, technical maintenance, IT, sales & marketing, finance, human resources, and clinical services. Building our platform was a significant investment but key to creating value for our business.
 
With such oversight on operations, it reduces the risk for the company and our shareholders. In return, this level of transparency encourages good governance. Addressing risks and making a positive societal impact is good management practice and will deliver higher returns.
 
Ultimately, vision without execution is a hallucination.
 
Interview by Natalia Domanska
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Request for Qualifications for Kingston General Hospital Phase 2 Redevelopment

Infrastructure Ontario and Kingston Health Sciences Centre have announced request for qualifications for teams to design, build and finance the Kingston General Hospital Phase 2 Redevelopment project. Shortlisted teams will be invited to respond to request for proposals, which is expected to be released in late 2022.

Interested companies can download the RFQ at Merx and submit their responses until October 11, 2021.

The Kingston General Hospital will be located on the territory of the Kingston Health Sciences Centre’s site. The redevelopment will include the demolition of aging buildings and wings, the renovation of existing spaces, and the construction of a new 12-floor patient tower.

The project will be designed to meet the Canada Green Building Council’s Leadership in Energy and Environmental Design (LEED) Silver standards. The hospital will be consistent with the Ministry of Health’s high standards for patient and family-centered care, incorporating principles of senior-friendly design, accessibility and infection prevention and control.

Source: Infrastructure Ontario, merx.com

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Ghana Launches the Construction of 111 Hospitals

The government of Ghana has secured US$100 million fund through the Ghana Investment Infrastructure Fund for the implementation of so-called ‘Agenda 111’ to build 111 hospitals across the country to bridge the health infrastructure deficit in the country.

The plan involves the construction of the new healthcare facilities including 101 district hospitals, two psychiatric hospitals, seven regional hospitals, and the redevelopment of an existing psychiatric hospital in the capital city of Accra.

Adjaye Associates firm, responsible for design, has recently revealed the design of the first hospital. All district hospitals will follow roughly the same design. However, each will be highly adaptable to meet the unique geographic conditions of each individual setting.

On 17th August 2021, Ghanaian president Nana Addo Dankwa Akufo-Addo was present at a sod-cutting ceremony at the site construction of the Atwima Kwanwoma District Hospital to kick off the official launch of Agenda 111 which will  “lead to Ghana becoming a Centre of Medical Excellence and a destination for medical tourism.”

“It is envisioned, under a public-private partnership, that the Ghana medical corps, a volunteer corps of medical specialists which will tap into the skills and resources of Ghanaians and non-Ghanaians locally and abroad, using IT and telemedicine to support the delivery of health care and training, will be established by 2023,” the president of Ghana stated.

Sources and picture: the official website of President of Ghana, Adjaye Associates

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Grupo Puentes was awarded to build the Roquetas de Mar Hospital in Spain

The Andalusian Health Service selected a spanish company Grupo Puentes and construction company Lirola to build the new High Resolution Hospital of Roquetas de Mar for 18 months execution period.

The new hospital will occupy about 16,300 m2 and will respond to the needs of more than 100,000 inhabitants. 

The hospital with a proposed bid for 29 million euros, will include heliport for a smooth arrival to the emergency, outpatient and radiology services, a surgical block and a multipurpose hospitalization area with a large central courtyard and distribution to serve both patients and visitors.

Press release: Europa Press, The Andalusian Health Service. Photo credits: Cadena Ser.

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Save the date – Dubai International PPP Conference on 10-11 October 2021

Dubai will host an international public-private partnership conference in October during Expo 2020 as part of the government strategy to build a productive ecosystem for public-private partnerships.

The highly anticipated event aims to foster a dialogue on partnership opportunities between the public and private sectors, and explore innovative approaches for partnerships with local and international investors.

The conference will bring together leading government entities including the Dubai Health Authority which will provide an overview of healthcare projects in the pipeline and highlight opportunities for the private sector.

The Dubai Health Authority, which is promoting the emirate’s mission to transform itself into a leading healthcare destination is pursuing public-private partnerships in the development of projects including hospitals, medical  and specialized care centers.

Awad Saghir Al Ketbi, director-general of DHA said: “The Dubai Health Authority is keen to cooperate with the private sector as a strategic partner, in order to continue developing the healthcare ecosystem and build an exceptional healthcare model that is resilient, sustainable and capable of meeting the needs of the emirate’s growing population, as well as serve Dubai’s ambitious plans to develop the world’s best healthcare ecosystem.”

Register to participate in the conference and learn more here.

Source: Khaleej Times. Image credits: Government of Dubai.

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Request for Qualifications for Clinical Support and Research Centre in Canada

Canadian healthcare provider Providence Health Care invites interested parties to submit Request for Qualifications for the new Clinical Support and Research Centre (CSRC) in Vancouver. Deadline for submission – September 20, 2021.

The CSRC will consist of a three-building fully integrated campus facility including wet lab, vivarium, innovation, incubation, medical and office spaces. Over 630,000 m2  campus is planned to be completed in the first quartal 2027 and will be situated directly to the new St. Paul’s Hospital. 

Locating such research center with outstanding researchers directly next to the new St. Paul’s Hospital will stimulate the integration between scientific discovery and clinical service delivery.

Image by the new St. Paul’s Hospital.