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

Meet Audrey Mwala, Member of PPPHealth4All Advisory Board

PPPHealth4All is honored to introduce a member of the PPPHealth4All Advisory Board – Mrs Audrey Mwala, Acting CEO of Malawi PPP Commission, Co-President of AP3Network, Founder of Sycamore Consult Limited.

„It is a great honor for me to join the PPPHealth4All Advisory Board to play a role of making health not a privilege but a basic service available for all. The vision of PPPHealth4All Advisory Board personally speaks to my heart and ignites my zeal and  eager to one day step into a world in which everyone can live a long and healthy life. Coming from Africa where over one million babies prematurely die within 4 weeks of birth and 25% die before 5 years it is my sincere desire to see a world where everyone has access to health infrastructure and service enabling them to live long and healthy lives.”

I am very excited to be in the team that is 
championing this agenda to end preventable deaths
of babies, reduce global mortality and end pandemics
to attain Agenda 2030 and SDG.3
 
 
 

Meet Engr Chidi Izuwah, Member of PPPHealth4All Advisory Board

PPPHealth4All is honored to introduce a member of the PPPHealth4All Advisory Board- Engr Chidi Izuwah, DG /CEO The Presidency Infrastructure Concession Regulatory Commission of Nigeria; Co-President of Africa Public Private Partnership Network; Member of Steering Committee, WAPPP; Co-founder Defeat Autism in Nigeria Advocacy Group.

„ …I wish PPPHealth4All all the best in its quest to promote better healthcare and greater wellbeing of citizens all over the world and in Nigeria in particular through the promotion of innovative, affordable and sustainable PPP health models. PPPHealth4All can help mobilize international support to:

  • close African healthcare infrastructure gap exposed by current Covid-19 pandemic;
  • assist African governments in adoption of PPP models  to finance healthcare infrastructure with engagement of  MDBs;
  •  strengthen the participation of African  banks in health PPPs through innovative financing structures.

I look forward to selflessly playing my part as a member of the advisory board to ensure that the health infrastructure and current outcomes in Africa get the urgent intervention required via various innovative PPP models to address communicable and non communicable disease burden in Africa.”

"My dream is to see a better and healthy Africa via 
the impact of innovative healthcare PPPs."

 

Meet Mark Moseley, Member of PPPHealth4All Advisory Board

We are happy and proud to introduce a next member of the PPPHealth4All Advisory Board- Mark Moseley, Principal of Moseley Infrastructure Advisory Services, and prominent PPP expert with considerable experience of working with MDBs.
“….I am excited to join the PPPHealth4All Advisory Board, as I believe that Public-Private Partnerships can be an effective tool, in both advanced countries and emerging markets, for helping to deliver healthcare on a universal basis. As we face the challenge of dealing with COVID-19, and possible future pandemics, the need for global access to quality healthcare has never been more apparent. PPPs can be part of the solution, but only if both the public and private partners can work closely together in a truly collaborative manner. This means ensuring that governments have the tools necessary to plan for and manage these complex and highly-impactful transactions, and ensuring that the private partners have contractual frameworks that will allow them to deliver and maintain innovative healthcare facilities and services for the public in an efficient and effective manner. These are key parts of the PPPHealth4All mission, and that is why I am happy to support this initiative.” 

Meet Dr Rosemary Kumwenda, Member of PPPHealth4All Advisory Board

We are happy and proud to introduce a member of the PPPHealth4All Advisory Board- Dr Rosemary Kumwenda.
“….I am happy to join PPPHealth4All because I am a firm believer that the SDGs are universal and indivisible contracts between states and their people. Global public health plays a big role in supporting states and communities to reach their greatest potential using SDGs, as their social, economic and environmental determinants leverage for sustainable development. I play my part in sharing knowledge with stakeholders to increase their and my growth potential in the health sector and beyond through multi-stakeholder partnerships. PPPHealth4All provides this great opportunity to access international expertise and resources for people-centered inclusive rights based public-private partnerships for global health”.

Call for Members of PPPHealth4All Advisory Board

PPPHealth4All sees as a priority to set up an Advisory Board that will act as an external consultation body to the initiative, to steer the PPPHealth4All initiative in the right direction and to make sure that the voices of key stakeholders groups are heard and taken into account. The Board will provide a leadership, strategic governance and advice and will ensure a high level of accountability, transparency and competence. The members of the Advisory Board will work in close cooperation with the PPPHealth4All team and will support them to achieve the objectives of the project. Advisory Board does not have any legal authority.

The AB is composed of at least 4 and up to 7 members. The AB members will be selected for a 1- year term, considering their geographical origin (at least 50% from developing countries), field of experience (50% from independent NGOs and 50% from industry) and gender (at least 50% female).

Responsibilities assigned to the Advisory Board include the following:

  • Strategic advice and validation of approaches, “wise counsel”;
  • Exploration of new services to the PPPHealth4All membership and ecosystem;
  • Co-definition of the key performance indicators to be used for assessing the performance and results of PPPHealth4All;
  • Validation and improvement of the business models designed for the rollout of PPPHealth4All activities;
  • Funding Leadership.

We invite our partners, members and stakeholders to nominate prominent individuals that could bring value to PPPHelath4All initiative. The deadline for nominations is 20 June 2020.

More information

EIB supports Irish community nursing PPPs

Photo by Laurin Grether

The EIB project for the Ministry of Health of Ireland will finance the design, construction, equipping and maintenance of up to nine Community Nursing Units (CNUs) across different regions of Ireland using a Private-Public Partnership (PPP) framework. These units will replace the existing ones that are no longer compliant with the HIQA (Supervision Authority for Acute and Community Services) regulations.

The aim is to improve access to high quality elderly and long term care throughout Ireland. The new CNUs are based on a person-centred approach giving to the residents the opportunity to lead their own lives in an environment reproducing the comforts of home, according with their cognitive and physical abilities. The main purpose is to normalise care and promote the person’s autonomy in everyday tasks, while providing care and assistance.

It is expected that the project will bring wider benefits to the community as social and healthcare are elements of social cohesion and economic development. The EIB will verify that the project respects the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), as ratified by the host country and included in national legislate framework. The Bank will encourage the Promoter to take into account the circular economy principles during the development and future operation of the project.

Procurement

The promoter has to ensure that contracts for the implementation of the project have been tendered in accordance with the relevant applicable EU procurement legislation, Directive 2014/24/EU, where applicable, as well as Directive 89/665/EEC as interpreted by the Court of Justice of the EU, with publication of tender notices in the EU Official Journal, as and where required. A prior information notice has been published by the Promoter, reference 2019/S 152-373937.

Status: Approved – 23/04/2020

More information

Call for applications to participate in a pilot project on stakeholder consultations

Photo by Bill Hamway

PPP initiatives address different players, directly and indirectly, and at different timescales, from immediate to longer term. In order to be successful, the PPP must have an agreed stakeholder engagement and communication strategy which includes an appropriate approval process. PPPHealth4All is working on development of a digtial tool for stakeholder consultations tailored to PPP healthcare projects. It is planned to implement several pilots to test the module of stakeholder consultations with beneficiaries and market participants. For this purpose, interested state or local authorities are invited to apply for the pilot. Requirements for the pilot project:

1. The PPP project in the healthcare sector is at the initial stage of preparation (preferably at the stage of preparation of pre-feasibility study).

2. The public partner will ensure the access to the Internet, video-confereing tools and will assign an a staff emember with good command of English.

3. The public partner is prepared to sign the Memorandum of Cooperation on Pilot Project.

Interested public organisations are invited to submit their applications to info@ppphealth4all.de. PPPHealth4All will provide the following services (free of charge): methodology on stakeholder consultations and mapping of stakeholders for a particular project; identifying issues of concern from the perspective of each group of stakeholders; visualization of stakeholders and market participants networks protocols and findings in final report.

Bangladesh to pilot a Dialysis PPP Project involving 150 hemodialysis stations across up to three different hospital sites in the capital Dhaka

Photo by Pujohn Das

To address the growing chronic kidney related illness in Bangladesh, GOB intends to pilot a Dialysis PPP Project involving approximately 150 hemodialysis stations across up to three different hospital sites in the capital city, Dhaka (“the Pilot Dialysis Project” or the “Pilot”).  The Government of Bangladesh (“GOB”), through the Directorate General Health Services (“DGHS”) and the Health Services Division (“HSD”) of the Ministry of Health and Family Welfare (“MOHFW”), is receiving Technical Assistance from the Asia Pacific Project Preparation Facility (“AP3F”).

The TA is intended to support in capacity augmentation at DGHS and HSD, creation of a PPP cell and for the establishment of a sustainable model in Bangladesh to identify, prepare, and implement healthcare PPP projects with private sector investments and participations (the “Programme”).  GOB considers the delivery of high-quality clinical services such as dialysis, pathology/labs and imaging as immediate priority areas for potential private sector interventions.

The Office of Public Private Partnership (“OPPP”) at Asian Development Bank (“ADB”) is assisting GOB in implementing the Programme.  The first of such consultant procurement phases and this Terms of Reference (“TOR”) relates to preparation/implementation of a new hemodialysis project under PPP modality and restructuring of an existing dialysis PPP project.

Read more: ADB Tender TOR Dialysis Bangladesh

PPPHealth4All is the finalist of InfraChallenge organised by the Global Infrastructure Hub

The Global Infrastructure Hub (GI Hub), established by the G20 in 2014, has organized an  inaugural international innovation competition InfraChallenge” designed to disrupt the infrastructure industry through new digitally-driven solutions. The applicants from around the world and across sectors pitched their big ideas. The competition called for digital innovations that can be applied to solve social infrastructure issues and build momentum towards better infrastructure.

A shortlist of 20 finalists was selected in March 2020 and we are pleased to inform that PPPHealth4All is one of the finalists. The finalists are from all over the world:  the UK (5 projects),  Australia (4 projects), Spain (2 projects), Columbia, Germany, Mexico, the USA, Indonesia, India and Sierra Leone (1 project per country).

PPPHealth4All is honored to be selected along with the projects of the Inter-American Development Bank, National Agency for Infrastructure of Columbia, UNSW Sydney (the University of New South Wales), one of Australia's leading research and teaching universities, and many other established companies and startups. PPPHealth4All is the only project in the healthcare sector in this cohort.

The PPPHealth4All will be provided with access to industry leaders and the competition partner MIT Solve during an eight-week tailored mentoring program.

More about InfraChallenge:

InfraChallenge 2020 is an inaugural innovation competition organised by the Global Infrastructure Hub (GI Hub) that invited applicants to pitch transformational ideas, tackling the big infrastructure issues.  The contest focuses on digital solutions for a current or future economic or social infrastructure issue.

More about GHI

The Global Infrastructure Hub is an independent organisation, established by the G20 in 2014 to connect the global infrastructure community and share insights to facilitate delivery of G20 members’ economic, social and environmental outcomes through more and better infrastructure. GI Hub was endorsed by the G20 at the summit with an initial four year mandate. The mandate outlined by the G20 was to establish a global pipeline of projects advocating transparency and advocating a uniform regulatory and governance structure, while also promoting innovation by exposing data gaps, and benching marking best practice in the infrastructure industry GI Hub has published these mandates by developing a series of reports which have been developed into online interactive tools.

More about InfraChallenge Partner MIT Solve

MIT Solve is an initiative of the Massachusetts Institute of Technology (MIT) with a mission to solve world challenges. Solve is a marketplace for social impact innovation. Through open innovation Challenges, Solve finds incredible tech-based social entrepreneurs all around the world. Solve then brings together MIT’s innovation ecosystem and a community of Members to fund and support these entrepreneurs to help them drive lasting, transformational impact. MIT Solve advances lasting solutions from tech entrepreneurs to address the world’s most pressing problems. Solve is a marketplace for social impact innovation.