健康投资作为Covid-19的回应：需要更多的冒险和创新_21页_519kb

DFI Health Investments as a Covid-19 Response

Core Content

This document explores the potential for Development Finance Institutions (DFIs) to play a more dynamic and innovative role in health investment, especially in the context of the global response to the Covid-19 pandemic. It argues that DFIs should not only increase their investment volumes but also adjust their risk-return profiles to better align with high-impact health initiatives, which can have significant social returns while still being financially viable.

Main Points

• Need for Risk-Taking and Innovation: The current focus on scaling up DFI investment should include a discussion on whether their objectives and business models need to evolve to include higher-risk, high-social-impact investments in health.

• Current Investment Landscape: From 2013 to 2018, DFIs invested approximately $5.6 billion in health, with the majority ($4.9 billion) directed to upper-middle and lower-middle income countries, particularly Turkey and India.

• Concentration in Infrastructure: Most health investments are in infrastructure such as hospitals, clinics, and health centres. This reflects DFIs' preference for large-ticket, familiar return projects.

• Equity and Access Concerns: While some DFIs are addressing equity issues, the data shows that only 2% of health investments explicitly target low-income clients. Transparent reporting is needed to better understand the impact of these investments.

Key Insights

DFI Investment in Health is Low and Concentrated

• DFI health investments account for less than 3% of their total investments between 2013 and 2018.
• Over 96% of the $5.6 billion was concentrated in five DFIs: IFC, US DFC, MIGA, EIB, and CDC Group.
• The majority of investment was directed to upper-middle and lower-middle income countries, with Turkey and India receiving the largest shares.

Innovative Financing Mechanisms

• Volume Guarantees: MedAccess used volume guarantees to reduce commercial risk for suppliers and increase access to affordable medical products.
• Pooled Investment Vehicles: The Global Health Investment Fund (GHIF) is a pooled vehicle that diversifies risk and attracts both impact and commercial investors.
• Development Impact Bonds (DIBs): DIBs offer a performance-based model that can mobilise private investment and ensure sustainable health outcomes. The Cameroon Cataract Bond (CCB) is a notable example, where the service provider is incentivised to meet targets.
• Health Insurance: MicroEnsure and Intellicare demonstrate how DFIs can support access to health insurance, particularly for underserved populations.

Case Studies

Turkey's PPP Hospitals

• The government's Health Transformation Program (HTP) involved major DFIs in building and refurbishing hospitals.
• The Elazig hospital project was financed with a mix of debt and equity, supported by political risk insurance and revenue support facilities.
• The project's success was due to government support, strong contractual frameworks, and the recognition of multilateral mitigation products by ratings agencies.

MedAccess and Volume Guarantees

• CDC Group seeded MedAccess with $200 million to offer volume guarantees, which helped reduce commercial risk for suppliers.
• MedAccess partnered with BMGF and others to support the supply of mosquito nets and diagnostic testing at lower costs.

Global Health Investment Fund (GHIF)

• GHIF is a $108 million fund supporting late-stage innovations for neglected diseases.
• It is backed by IFC, BMGF, and SIDA, with the latter two assuming first loss risk up to 20%.
• Investee companies are required to provide affordable access to products in developing countries.

Medical Credit Facility (MCF)

• MCF is a debt fund focused on SMEs in the healthcare sector in sub-Saharan Africa.
• It uses a blended structure with USAID and DFIs providing first loss capital and debt financing.
• It has disbursed over 4,400 loans with a high repayment rate, indicating its effectiveness in supporting small-scale health enterprises.

Cameroon Cataract Bond (CCB)

• CCB is a DIB that aims to increase cataract treatment capacity in Cameroon.
• It includes a financial sustainability target and an equity target for the poorest patients.
• US DFC and Netri Foundation provided initial funding, and the hospital uses a cross-subsidisation model to ensure affordability.

Aga Khan Hospital, Karachi

• US DFC's $30 million loan supported the expansion of the hospital, which operates a cross-subsidisation model.
• This model helps ensure that vulnerable populations have access to essential health services, improving equity in healthcare access.

MicroEnsure and Intellicare

• IFC invested in MicroEnsure to expand health insurance coverage for low-income populations.
• IFC also supported Intellicare through a $40 million loan, enabling it to expand health insurance services in the Philippines.

Conclusion

• DFIs have the potential to move beyond traditional infrastructure investments and support a broader range of health interventions.
• Innovative financing tools such as volume guarantees, pooled investment vehicles, and DIBs can catalyse private investment and improve health outcomes.
• The shift in DFI capitalisation and accounting rules offers an opportunity to reorient investment strategies towards higher-risk, higher-impact health initiatives.
• Transparent reporting and a focus on equity and access are critical for evaluating the true impact of DFI health investments.