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ECA Financing for Healthcare Projects: A Viable Option That Requires Careful Planning

Healthcare infrastructure projects in emerging markets often face the same challenge: the need is clear, the technical solution can be defined, but financing remains difficult. Export Credit Agencies can play an important role in closing this gap. ECAs are public institutions, or institutions acting on behalf of governments, that support national exports by providing loans, guarantees, insurance or other forms of official export-credit support. In a typical buyer-credit structure, a commercial bank finances the foreign buyer while the ECA covers part of the political and commercial repayment risk. This can make long-term financing available where conventional lending would otherwise be difficult or too expensive. Examples include SACE in Italy, UKEF in the United Kingdom, Bpifrance Assurance Export in France, Euler Hermes in Germany, US EXIM , NEXI and JBIC in Japan, and K-SURE and KEXIM in South Korea. The OECD maintains the official list of Export Credit Agencies involve...
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Rebuilding Syria’s Healthcare System: How to Turn Healthcare Needs into Bankable Infrastructure Projects

The first investment in Syria’s healthcare reconstruction may not be a new hospital. It may be the evidence required to decide which hospitals—and which other services—the country actually needs. Syria has entered a new phase in the reconstruction of its healthcare system. After more than a decade of conflict, economic deterioration, displacement and chronic underinvestment, the scale of healthcare needs remains enormous. In 2026, the WHO Health Sector estimates that 12.8 million people remain in need of health assistance , while 8.2 million are targeted by the humanitarian health response. The challenge, however, is no longer only to respond to emergency needs. The challenge is to move from emergency response to structured healthcare system reconstruction . This requires more than rehabilitating damaged hospitals or announcing new healthcare facilities. Before deciding what to build, where to build it and how to finance it, Syria needs a comprehensive understanding of what ...
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Why Healthcare Projects Need Identification and Pre-Feasibility Before Full Feasibility

The most valuable early-stage decision may be to reshape or stop a project before major resources are committed. A hospital project can respond to a genuine healthcare need and still be the wrong investment. The problem may not be an inadequate design or an unsuitable financing structure. It may be more fundamental: the project may have defined the solution before it properly understood the need. The wrong starting question Healthcare infrastructure projects often begin with a physical answer: a 200-bed hospital, a specialist centre, an extension to an existing facility or a new diagnostic unit. Political urgency, visible capacity shortages and stakeholder expectations can create pressure to move quickly toward design, tendering and financing. Yet “What should we build?” is not the first question. The first question is “What health-service problem must be solved?” This distinction matters because infrastructure is only one possible response to a healthcare need. A shortage of accessibl...
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Sources of Finance in Healthcare

In the period from the 13th to the 16th of July 2015, the Third International Conference on Financing for Development, organized by the UN, was held in Addis Ababa, Ethiopia. 174 United Nations member states sent delegations; 28 heads of State, vice presidents and heads of government attended. Governments were joined by the heads of the United Nations, the International Monetary Fund (IMF), the World Bank and the World Trade Organization (WTO), prominent business and civil society leaders, and other stakeholders. As an outcome, heads of states and governments adopted the Addis Ababa Action Agenda known also as AAAA . The text of the document was endorsed by the General Assembly in its resolution 69/313 of 27 July 2015.  The Action Agenda establishes a strong foundation to support the implementation of the 2030 Agenda for Sustainable Development. It provides a new global framework for financing sustainable development by aligning all financing flows and policies with economic, s...
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PPP in Healthcare, The lndian experience

PPP Ground in India  India has a long culture of PPP. Many projects have been realized using this model. The total number of PPP Projects reaching the financial closure since 1990 is 1031 projects with total investment value of 252,897 million US dollar. The currently active projects, under construction or under operation, is 989 with total active investment of 238,571 million US dollar. PPP in Healthcare, The Indian experience The majority of the projects are the traditional PPP projects in Energy and transportation fields as well as ports and airport construction and rehabilitation. (1) To prepare the ground for PPP, India created in 2006 a specific unit for PPP projects which is the The PPP Cell, that acts as the Secretariat for Public Private Partnership Appraisal Committee (PPPAC), Empowered Committee (EC), and Empowered Institution (EI) for the projects proposed for financial support through Viability Gap Fund (VGF). The PPP Cell is responsible for policy level matte...
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Inkosi Albert Luthuli Central Hospital, a success case of PPP in Healthcare

PPP projects in healthcare are still subject of public debates between skeptics of the effects of “privatizing” the healthcare sector, especially after the failure of some projects in countries like Australia, Japan and Italy (1), from one side and the defenders of this model to face the constraints of public resources and to use the experience of the private sector in this field from the other.  Actually, there is no country in the world where healthcare is financed entirely by the government. While the provision of health is widely recognized as the responsibility of government, private capital and expertise are increasingly viewed as welcome sources to induce efficiency and innovation. (1)  The aim of this article is to present a successful case of PPP hospital project, Iknosi Albert Luthuli Central Hospital (IALCH) in South Africa. It will analyze the contract and the role of the private partner and will discuss the keys of success.  This successful case shows tha...
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COVID-19 Lessons learned

The actual pandemic shows the weaknesses of the healthcare sector on global basis. The healthcare sector wouldn't resist alone under the crisis and we would have seen a much higher number of deaths in all countries. Therefore other complementary measures and policies had to be taken in order to support it. The unavoidable result was to reach the lock down in the majority of the countries. From Ethical point of view, I agree with the adopted policies, of isolation, self-isolation, lock down etc.  and I believe that they are the only ways since there are no available alternatives.  I find, however, this kind of measures very basic and simple. Social distancing is same measure used in the middle ages to reduce number of victims in pandemic times.   This kind of measure was taken in times when countries didn't have national health systems and advance medical technologies as we have nowadays.  Our hyper-connected world and the advanced technologies accelerate the...
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