EIC-健康投资作为Covid-19的回应：需要更多的冒险和创新（英文）-2020.5-21页_518kb

DFI Health Investments as a Covid-19 Response Summary

Core Content

This document explores the role of Development Finance Institutions (DFIs) in responding to the health challenges posed by the Covid-19 pandemic. It emphasizes the need for DFIs to take on more risk and focus on high social return investments, particularly in the health sector. The authors argue that while DFIs have historically concentrated their health investments in infrastructure and pharmaceuticals, especially in upper-middle and lower-middle income countries, there are opportunities to diversify and innovate.

Main Points

• Need for Risk-Taking and Innovation: DFIs should consider adjusting their objectives, business models, and tools to take on more risk and focus on high social return investments, including health, in response to the pandemic.

• Current Investment Pattern: DFI health investments are low, with most directed towards infrastructure and pharmaceuticals in upper-middle and lower-middle income countries, particularly Turkey and India.

• Innovation and Market Development: Examples like pooled investment vehicles, volume guarantees, and Development Impact Bonds (DIBs) show DFIs can act as catalysts for market development in health supply chains, enabling both public and private investments to scale.

• Equity and Access: While DFIs have the potential to address equity issues, there is a need for more transparent reporting on who benefits from these investments and how they impact vulnerable populations.

Key Findings

From 2013 to 2018, DFIs invested nearly $5.6 billion in the health sector, with the majority (96%) going to five major DFIs: IFC, US DFC, MIGA, EIB, and CDC Group.

• Geographic Distribution: Over 90% of DFI health investments went to upper-middle and lower-middle income countries, with Turkey and India receiving the largest shares.
• Turkey's PPP Hospitals: The Elazig hospital project, supported by IFC and MIGA, demonstrates how DFIs can use innovative financing to support large-scale health infrastructure, improving access and ratings.
• India's Diverse Investments: DFI investments in India were more varied, covering different types of health services, while those in Turkey were more focused on infrastructure.
• Impact on Low-Income Countries: Only $16 million was invested in low-income countries, and only $102 million explicitly targeted poor or low-income clients.

Innovative Examples

1. Volume Guarantees: MedAccess

• CDC Group seeded MedAccess with $200 million to provide volume guarantees to medical suppliers.
• These guarantees reduced commercial risk and enabled suppliers to scale production of affordable medical products, such as mosquito nets and diagnostic tests.
• The guarantees also supported the expansion of contraceptive implants at significantly lower prices.

2. Pooled Investment Vehicles: Global Health Investment Fund (GHIF)

• GHIF is a $108 million fund supporting late-stage innovations for neglected diseases.
• IFC provided $10 million in equity, while BMGF and SIDA offered partial guarantees.
• Investee companies are required to provide affordable access to developing countries, and the fund has the potential to save 140,000 lives by 2025.

3. Development Impact Bonds (DIBs): Cameroon Cataract Bond (CCB)

• The CCB is the first DIB with a DFI as the main investor.
• It includes a financial sustainability target and an equity target to ensure affordability for the poorest.
• US DFC and Netri Foundation provided initial investments, and the bond is expected to increase treatment capacity in Cameroon by up to 50%.

4. Health Insurance: MicroEnsure and Intellicare

• IFC invested in MicroEnsure to expand insurance coverage for low-income populations.
• MicroEnsure uses innovative models to subsidize insurance premiums for its clients.
• IFC also supported Fullerton Health's acquisition of Intellicare, helping to expand health insurance access to 900,000 more Filipinos.

Key Insights for Future DFI Investment

• Scaling Investment: DFIs can use volume guarantees and pooled investments to attract private capital and scale health interventions.
• Risk and Return Balance: DFIs can balance financial and social returns by adopting innovative financing tools, such as guarantees and DIBs.
• Collaboration and Flexibility: DFIs with limited capital can collaborate with other investors, including donors and philanthropists, to remain flexible and effective.
• Equity and Access: DFIs can and should integrate equity concerns into their health investments to ensure that vulnerable populations benefit from these initiatives.
• Transparency: Improved reporting on who is impacted by DFI health investments is essential to understand their true development impact.

Conclusion

This note highlights the importance of rethinking DFI investment strategies in the context of the pandemic. By embracing innovative financing mechanisms, DFIs can not only support the development of resilient health systems but also enhance access to essential health services for the most vulnerable populations. The examples provided demonstrate the potential of DFIs to act as catalysts for market development and to align financial returns with high social returns.