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Medical Credit Fund Progress Report 2012-2013


PROGRESS REPORT MEDICA L C RE D IT F UN D

Preface Medical Credit Fund provides loans to private healthcare providers, enabling them to improve the quality of their services, develop their business potential and service more patients. After a successful pilot program in 2010, we rolled out operations in Tanzania, Kenya and Ghana, adding Nigeria to the program in 2012. By the end of June 2013, we had disbursed just under USD 2.5 million in loans to 322 health care facilities. Medical Credit Fund (MCF) is the first fund dedicated to providing loans for small and medium health enterprises. After winning the G20 SME Finance Challenge Award for our innovative financing model, we attracted funding from international investors and closed our first round of investments in 2012. Through the layered capital structure, public funds leverage large amounts of international and local private capital. As such we are able to increase our development impact significantly. Participating investors are the Overseas Private Investment Corporation (OPIC), Bill & Melinda Gates Foundation, Soros Economic Development Fund, Calvert Foundation, Deutsche Bank Americas Foundation and Dutch private investors. Clinics in the private sector in sub-Saharan Africa service 50% of the population, yet have a hard time securing loans. MCF and our technical partners help clinics to draw up a business plan, enroll them in a quality improvement program and bring them into contact with local banks. Demand for loans and technical assistance among these facilities continues to grow. Impressive loan repayment rates have alerted banks to the Medical Credit Fund’s business proposition, and we have been able to expand our network of partner banks as a result. Clinics are benefitting from the chance to upgrade their facility. A year into their loan, they report a 15% average increase in patient visits. November 2012 marked the start of the African Health Markets for Equity (AHME) consortium, a USD 60 million investment led by Marie Stopes international and funded by the Bill & Melinda Gates Foundation and the UK’s Department For International Development. This five-year partnership aims to increase the scale and scope of franchised health care for the poor in Nigeria, Ghana and Kenya. Our role in this initiative will be to facilitate loan provision, business support and quality improvement for hundreds of new clients. These developments build confidence in the future of our program. With our partners and investors, we continue to work towards building a financially sound private healthcare sector that complements the public sector and provides improved quality services for people in Africa. Monique Dolfing-Vogelenzang Managing Director August 2013

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PROGRESS REPORT MEDICA L C RE D IT F UN D

Our vision and mission Our vision is to make good quality basic health care more accessible in Africa. Our mission is to contribute to building a better healthcare system by enabling primary healthcare providers to fully explore and develop their potential as key players in the delivery of quality health care. Medical Credit Fund assists healthcare clinics in procuring loans from local banks, under the condition that they enter a comprehensive technical assistance program for quality improvement and business planning. We strive to strengthen the business cases of private primary healthcare providers by: • improving the quality of their clinical and medical services by facilitating access to investment capital; • providing business advice and top quality technical assistance.

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'This is a good example of how we can achieve maximum results in developing countries despite a shrinking government budget.' Lilianne Ploumen, Dutch Minister for Foreign Trade and Development Cooperation, speaking in April 2013 on how to leverage declining aid budgets with private funds.


PROGRESS REPORT MEDICA L C RE D IT F UN D

Health care in Africa African governments and major donor organizations are recognizing that, when it comes to health care, the private sector has an important role in complementing the public system. Sustained economic and population growth is leading to an increased demand for affordable and good quality healthcare services. However, the necessary investments in the private sector are falling short.

Underfunded SMEs The vast majority of private healthcare providers in Africa are small and medium enterprises (SMEs). This segment includes smaller hospitals, diagnostic centers, health centers, dispensaries, maternity homes and nurse-driven clinics. These primary healthcare facilities represent the most underfunded segment of the healthcare sector. Two-thirds of these SMEs need additional capital below the USD 250,000 mark to improve their facility and attract more patients. However, many of them lack a credit history, adequate bookkeeping and accounting systems, financial performance records and sufficient assets to securitize

The MCF operates mainly in segments 3-5 of the healthcare market, where most health SMEs are active.

TERTIARY (TEACHING) HOSPITAL providing all specialized services, including complex curative interventions. Full range of (para)medicals and specialists.

1 2

formal bank loans. Also, most SME owners are medical professionals with little to no background in business management. These circumstances make it difficult for them to enter into loan agreements with banks. While many banks would like to become involved in the healthcare sector, they also have strict internal and regulatory guidelines to adhere to.

HIMS is used for data capturing/analysis. Laboratory, radiology and pharmacy services available.

REFERRAL HOSPITAL providing a broad spectrum of medical procedures except specialized treatment. Includes complicated abdominal services.

3

DISTRICT HOSPITAL or faith-based/private hospital with similar services. Providing 24 hrs service, maternal health, HIV and TB treatment, minor and some major surgery.

4

PRIMARY HEALTH CENTER consisting of medical doctor, nurse and lab technician offering minor surgery and chronic disease management.

pe

MC

F p rog ra m

Investment climate Potential investors and banks tend to be deterred by the investment climate in sub-Saharan Africa, which suffers from low trust levels, weak institutions and high transaction costs. The private health sector is especially unattractive for investors: it is highly fragmented, it suffers from a lack of information and clinical standards, and financial and medical benchmarks are scarce. Also, revenue streams are erratic due to the high percentage of out-ofpocket payments. If investors do decide to invest in private health, they levy high surcharges and mark-ups to cover all these unknown risks, making cost of capital virtually unaffordable for most providers. This leaves the private health sector in a vicious circle of low trust, low demand, low willingness to prepay, few investments and low quality supply. MCF aims to build trust and break this vicious circle by reducing uncertainty and risk, and by setting clinical standards in order to make quality improvement measurable.

Sco

Sub-Saharan Africa accounts for 44% of the world’s communicable diseases, but less than 1% of global health expenditure is spent on the continent. At the same time, non-communicable diseases such as diabetes, cancer, high blood pressure and heart disease are on the rise. The World Health Organization predicts that death rates from chronic diseases will be four times as high as those from infectious diseases, maternal and perinatal conditions and nutritional deficiencies within the next ten years. As such, expanding the capacity of Africa’s primary health systems is of great importance. While health is generally considered a public good, public resources in most African countries are limited. Therefore, 50% of the people turn to the private sector instead.

A closer look at the healthcare sector in Africa

5

BASIC HEALTH CENTER staffed by clinical officer offering general health and maternal health care.

5

6

HEALTH SHOP/NURSE-DRIVEN CLINIC giving advice on basic health care issues.


PROGRESS REPORT MEDICA L C RE D IT F UN D

‘Since we have improved our quality, customers have gained trust in our facility and we have seen a 40% increase of patients.’ Pharis Yikobera, Arafa Dispensary, Dar es Salaam

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PROGRESS REPORT MEDICA L C RE D IT F UN D

Our approach Many health SMEs in sub-Saharan Africa lack access to capital, as the investment risks are often considered too high. MCF prepares health SMEs for securing loans from the local capital market, provides technical assistance and helps banks to see the potential of this emerging asset class. Our approach is based on an intricate pattern of cooperation between clinics, technical assistance (TA) partners, banks and MCF. Ultimately, our aim is to build capacity and increase bankability and scalability of the sector, thereby enhancing access to affordable private quality healthcare for low-income people.

Technical assistance MCF’s local TA partners recruit health SMEs for the loan program and produce expert opinions, which outline staff and patient numbers, long-term investment plans and how the clinic intends to use the loan. They monitor business and quality performance through-out the tenure of the loan. Quality advisors provide quality training and help SMEs to compose their highest priorities for quality improvement. This is based on a clinical due diligence

using the SafeCare methodology, an international quality assessment system designed especially for resource-limited settings. As a result, banks can compare healthcare facilities, evaluate progress according to fixed standards and measure investment results. Business advisors provide business training, perform financial due diligences and facilitate the interaction between the clinics and the banks where necessary. They work with health SMEs to compose annual statements, propose efficiencies in management and operations, scan the market for growth opportunities and, finally, support them in producing a convincing business plan. Ultimately, the TA partner assesses the clinic’s general performance, identifies its most urgent needs and improvement priorities, formalizes the relationship

COUNTRY

BANKING PARTNERS

TECHNICAL ASSISTANCE PARTNERS

Tanzania

• BancABC • National Microfinance Bank (NMB)

• Association of Private Health Facilities in Tanzania (APHFTA)

Kenya

• KREP Bank

• Kisumu Medical and Educational Trust (KMET) • Population Services International (PSI/Kenya) • Marie Stopes International, Kenya (MSK)

Ghana

• Merchant Bank Ghana (phasing out) • uniBank (from 2013) • HFC Bank (from 2013)

• PharmAccess • Marie Stopes International, Ghana (MSG)

Nigeria

• First City Monument Bank (FCMB)

• Hygeia Foundation, Society for Family Health (SFH) • Marie Stopes International, Nigeria (MSN)

the technical assistance (TA) program

the loan program

grants

loans

between the clinic and a local bank, and calculates whether the clinic will be able to repay the loan within a given time frame. Once the clinic is ready, the TA partner assists in submitting a loan application to the bank.

Loan program MCF has a risk-sharing agreement with local banks in every country of operations. Once a clinic has submitted its business case and MCF has approved it, the clinic sends the loan application to our local partner bank. Health SMEs that are new to the MCF program usually start with a sixmonth tenure entry loan of no more than USD 5,000. If a clinic already has an established track record with a bank, if it is too large to benefit from a loan of that size, or if it has successfully repaid the entry loan, clinics can apply for a medium or mature loan. These loans can be as high as USD 50,000 to 100,000 respectively, and have a tenure of 24-36 months. Medium and mature loans have additional requirements, such as a SafeCare entry assessment, a first quality assessment, a two-day business and a one-day quality training, the development of a quality upgrade plan as well as a business plan. These loans are co-financed by the local bank, thus leveraging the MCF capital.

SafeCare Sub-Saharan Africa has a shortage of institutions and standards that can ensure objective measurement and rating of the level of quality of basic healthcare facilities. As a result, quality levels are not transparent, benchmarking is not possible and patients face uncertainty with regard to the quality

local TA partner

SafeCare entry assessment

local bank

quality Improvement plan

business plan

monitoring of quality improvement

loan amount quality dependent

clinic

9 quality improvement

more patients, receiving better health care

MCF

local bank

repayments and possibly a next loan


PROGRESS REPORT MEDICA L C RE D IT F UN D

of services at different facilities. Building institutions and creating standards that help patients to make informed decisions about health care will address these issues. In addition, such systemic changes can stimulate providers to improve the quality of care, motivate performance-based financing mechanisms by (inter-)national donors and investors, and enable local and national healthcare authorities to monitor and regulate healthcare providers. For the above reasons, PharmAccess, JCI and COHSASA established the SafeCare Initiative. SafeCare acts as the custodian of internationally recognized, unique sets of standards that are realistic for resource-

limited settings while not compromising on quality levels. SafeCare standards focus on ‘bottom of the pyramid’ public and private healthcare facilities such as dispensaries and health centers. These facilities constitute the main healthcare delivery channel for lowincome settings and often struggle with patient safety and quality demands. The methodology consists of measurable steps towards quality improvement. While full accreditation may remain a bridge too far for most clinics, SafeCare creates an improvement path that offers healthcare providers positive incentives to move steadily upwards in quality.

Certificate definition

Regular Independent Assessment

6. Excellent quality systems in place: healthcare provider has a proven track record of continuous quality

Accreditation

SafeCare V

SafeCare IV

SafeCare III

SafeCare II

SafeCare I

Entry Level

improvement, is in substantial compliance with the SafeCare standards, and meets the decision rules for accreditation by independent organization COHSASA. 5. Demonstrates long-term commitment to continuous quality improvement, ready for accreditation program and self-sufficiency of continuous quality improvement. Very limited technical assistance required. 4. Strong quality systems in place, but high-risk areas still in need of attention. Limited technical assistance required. 3. Medium quality strength, acceptable but vulnerable to changing environment. Focus on self-evaluation of quality improvement processes using quality indica-

processes and quality systems and the availability of financial means to ensure availability of proper

leadership commitment and a strong desire to provide

3

4

5

6

safe health care, recognizes that significant improvements are needed to reach levels of consistent, efficient, safe quality care for each patient. It has

Poor

Janet Oguto and Sammy Said

Martin Otieno

Wesley Ngetich

Team Leader KMET, Nairobi, Kenya

Business Manager KREP, Nakuru branch, Kenya

“For a long time, there was a disconnect between the public and private sector. It was difficult to get banks aboard and it took us a year to arrange the first loan. Now, banks are starting to see doctors as business people with good cash flow as well as social enterprises. Working with MCF has been an eye-opener. Many facilities can’t obtain loans because they don’t do banking. Our business advisors train them in skills like bookkeeping. Our quality assessment team helps clinics fill gaps in their services. As the entry loan is only for six months, we prefer clinics to use it for improvements that will increase cash flow, like better and more drugs or maybe computer software.”

“The MCF program is very important for the private health sector in Kenya. Clinics are upgrading their quality and we are attracting many new clients in the health sector. The fact that MCF offers a guarantee on the entry loan lowers the threshold for us. KMET provides us with interesting potential clients and we take care of the financial side, looking into their account books and monitoring the loan. In the future, we plan to increase the payment period from three to five years so that clinics can access bigger loans. Also, it would be good if MCF would broaden its portfolio to include specialists and pharmacists.”

Directors GodsWill clinic, Nyanza, Kenya

“We used our first loan to give the clinic a general facelift and created partitioning such as the reception walls. After paying it off, we received a larger loan to procure extensive equipment for the laboratory. KMET provides us with technical support such as trainings and advice on payment issues. We are located in a slum area and our patients sometimes have difficulty paying their medical bills. KMET helped us develop phased payment schemes. The best improvement to our clinic has been the addition of a lab. Before, we had to refer patients to other clinics. Now, we can perform the tests ourselves and other facilities are even referring patients to us.”

tuate. Focus on the securing of quality systems and processes especially in high-risk areas. 1. Very modest quality, with continued need for peri-

2

Clinic

assistance. Healthcare quality is still likely to fluc-

odic technical support. Focus on implementation of

1

Bank

tors, guidelines and standard operating procedures. 2. Modest quality strength, requiring medium technical

infrastructure and assets. 0. Poor quality, however the organization has shown

0

TA Partner

Excellent

fluctuating quality healthcare provision due to the unavailability of services at times.

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PROGRESS REPORT MEDICA L C RE D IT F UN D

‘With the MCF loan, we bought a professional washing machine, set up an IT network and improved our system of care.’ Dr. Beatrice Bonyo, Director of Milimani Maternity Hospital, Kisumu, Kenya

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PROGRESS REPORT MEDICA L C RE D IT F UN D

How clinics invested their loans

Achievements First generation participants in the MCF program have seen their business increase and their quality performance improve. They are attracting more patients, providing better services and are in better financial shape than before.

6%

7%

6%

Renovations Medical equipment Accounts & other

3%

expenses Medical Stock / Inventory

MCF is building a strong network of banking and technical assistance partners. High repayment rates within the MCF portfolios are leading to growing trust in the healthcare sector. By the end of June 2013, MCF had disbursed 322 loans, 264 of which were entry loans, 57 were medium loans and one was a mature loan. Entry loans are guaranteed by the MCF and are a strong indicator of the bankability and reliability of the health SMEs. We have developed standardized flowcharts, procedures and protocols in order to guide and streamline operations. A robust back-office capacity handles the constant flow of information and performance data to produce accurate monitoring and reporting on all loans provided to clinics by our local partner banks.

Pfizer’s Global Health Fellows is an international corporate volunteer program that places Pfizer employees in short-term assignments with international development organizations. In 2012, three Pfizer fellows analyzed the medicine supply chain in Tanzania. Their goal was to investigate the feasibility of a loan product for pharmacies, combined with quality standards, a quality monitoring program and technical assistance. Many pharmacies deal with supply chain issues such as illegal, fake or expired medicines. In 2013, two new fellows started researching the possibility for such a loan product in Kenya, aiming to connect the loan with an improvement in the reliability of supply lines. November 2012 saw the launch of the African Health Markets for Equity (AHME) consortium, a five-year partnership

INDICATOR

2011

2012

Q1 2013

Q2 2013

Healthcare Providers in Program

96

279

336

430

Expert Opinions and Business Plans

109

355

474

558

Trained Professionals

274

508

540

788

Loans disbursed (cumulative)

84

227

271

322

Value of loans disbursed in USD (cumulative)

604,046

1,660,753

1,987,683

2,488,541

SafeCare First Assessments

70

206

256

316

Healthcare Providers improved 1 level or more

0

14

25

26

Medium Loans approved by Banks

12

48

55

68

Fixed assets ICT

49%

29%

led by Marie Stopes International and funded by the Bill & Melinda Gates Foundation and the UK’s Department For International Development (DFID). AHME strives to improve health outcomes by enhancing the quality of care in the private sector in Ghana, Nigeria and Kenya. As part of this program, the healthcare providers in the partners’ franchise networks have access to MCF loans as well as support in business and quality improvement.

Investments So far in our program, clinics have spent the loans primarily on the improvement of infrastructure, such as tiling, roof repairs, and the renovation of the laboratory, the consultation room or the reception area. Many clinics also use the loan to purchase new or additional equipment. Popular items include microscopes, hematology analyzers and delivery beds. Accounts & other expenses, in the graph above, refers to activities

such as producing annual accounts, developing guidelines, protocols and standard operating procedures. Fixed assets concerns investments in, for example, generators, air conditioners and refrigerators.

Capacity building Business and quality trainings are contributing to the building of capacity among health SMEs. In addition to these ongoing activities, the MCF organized a symposium for its banking partners, ‘Financing Needs of the Private Healthcare Sector’, as well as a business training for the local PSI netwerk in collaboration with one of our TA partners, PSI Kenya. At the 1st East Africa Healthcare Federation Scientific Conference in February 2013, MCF, SafeCare and our banking and TA partners facilitated a session on financing quality improvements for private healthcare providers as well as a networking round table on ‘Strengthening Private Providers’ Businesses’.

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PROGRESS REPORT MEDICA L C RE D IT F UN D

LOANS

5

Clinics and results

Number of banks

132

322

2,488,541

95,4%

1,302,273

Total number of disbursed loans

Total disbursed loan amount in USD

Loan repayment performance

Current outstanding amount in USD

PATIENTS & CARE

269,607

17,190

Number of patient visits per month

3

85

HIV tests performed per month

1. Malaria 2. Hypertension 3. Skin infections

54

17

16,180

21,172

Top 3 diseases treated

1

Family planning visits per month

Immunizations per month

CLINICS

Kenya

40 32

430

190

415

874

294

2114

= 3697

13

Total number of clinics in program

138

Ghana

Doctors

Nurses

Midwives

Supporting staff

Total number of health care staff at clinics

83

15

CAPACITY BUILDING

2

Nigeria

430

51

4

Total number of health facilities in the MCF program

29 Number of local technical assistance advisors

316

Quality assessment

218

Quality training

208

Business training

160

162

Quality improvement plan

Business plan finished

17

Tanzania QUALITY INVESTMENTS SafeCare certificates

Category 3: District Hospital Category 4: Primary Health Center

Top 3 quality improvement areas

Top 3 priority areas

316

Category 5: Basic Health Center Category 6: Health Shop

1. Renovations 2. Medical equipment 3. Accounts and other expenses

1. Infection control 2. Basic infrastructure and equipment 3. Staffing and skills

Total number of SafeCare assessments

V

0

IV

0

III

1 1

II I level

24

clinics

Data until 30 June 2013


PROGRESS REPORT MEDICA L C RE D IT F UN D

‘SafeCare gives clinics the opportunity for all-round improvement. The combination of quality and business advice is MCF’s unique and major selling point.’ George Ogbonnaya, Vice President of First City Management Bank, Lagos, Nigeria

TA partner

Judith Njau Senior Quality Officer APHFTA, Dar es Salaam, Tanzania

“As a TA partner, we provide business trainings and help smaller healthcare facilities become bankable. These facilities face challenges in obtaining a loan for different reasons. Often, they don’t own the building in which they operate. MCF has arranged that medical equipment such as a microscope or an ultrasound machine can be used as collateral. Another issue is record keeping – many facilities cannot produce a financial statement, so we train them to be able to show their revenue streams. During the SafeCare entry assessment, we identify the gaps in their financial situation and draft a quality upgrading plan.“

Bank

Mwajuma Shaban Mbaga Relationship Officer ABC Bank, Dar es Salaam, Tanzania

“Partnering with MCF and APHFTA was an opportunity for our bank to move into a new sector safely. ABC was not yet investing in the health sector because we lacked the expertise. Now, we receive expert opinions and business proposals from APHFTA, informing us about our prospective clients. Thanks to the loans and the trainings, the facilities in our loan portfolio are improving their services. Before, some of these clinics didn’t meet the necessary criteria to be allowed to treat patients with insurance. Now, their quality is improving and the repayments are going well.”

Clinic

Dr. Anthony Petro Managing Director Kinondoni B Dispensary, Dar es Salaam, Tanzania

“Before joining the MCF and SafeCare program in May 2011, we saw less than 20 patients a day. Now we treat between 50 and 70 patients a day. After paying off our USD 2,900 entry loan, we received a USD 30,000 medium loan. We installed a maternal and child health care unit as well as an antenatal clinic, started giving vaccinations, increased the number of rooms from 7 to 11 and bought a vehicle to bring waste safely to the place of incineration. We invested in training our staff and improving their contracts. Staff turnover has become lower and we were able to raise our consultation prices to match their new market value.”

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PROGRESS REPORT MEDICA L C RE D IT F UN D

Financial overview In December 2012, MCF announced its first closing of investments. Start-up donations from the Dutch Ministry of Foreign Affairs (through FMO) and Dutch private donors lowered MCF’s financing risks, thereby enabling new investments and leading to increased willingness of African banks to invest in the local private health sector.

680.981 95.169

Disbursed and outstanding loans in USD

1.300.000 1.200.000 1.100.000

Corporation (OPIC)

600.000

Mature Loan - Outstanding 469.169

500.000 400.000

Tanzania

Kenya

Ghana

10.258

0

118.149

100.000

57.747

200.000

40.924

300.000

18.286

Medium Loan - Outstanding

700.000

3.358 37.685

Entry Loan - Outstanding

800.000

Nigeria

Hybrid fund

INVESTORS AND CONTRIBUTORS • Overseas Private Investment

Mature Loan - Disbursed

193.062

Medium Loan - Disbursed

900.000

510.738 95.169

Entry Loan - Disbursed

540.975

Loans portfolio As per 30 June 2013, MCF had disbursed a total amount of USD 2,488,541 in loans. USD 955,986 went into entry loans, and USD 1,437,386 was used to disburse medium loans. Entry loans carry higher management fees and a higher risk profile, as these loans are issued to first-time, financially less experienced clients. As the clinic’s business administration and health care quality improve, the risk for later stage loans reduces. After successfully completing the entry loan stage, many clinics are starting to apply for the larger medium loans. These loans are more challenging for many clinics, as banks carry part of the repayment risk and credit controls are more stringent. Medium loans will have our focus in the near future.

203.663

Our participating investors are the Overseas Private Investment Corporation (OPIC), Bill & Melinda Gates Foundation, Soros Economic Development Fund, Calvert Foundation, Deutsche Bank Americas Foundation and Dutch private investors. In total, they provided USD 10.6 million in loans to improve health care in Africa. As such, MCF’s capital was leveraged to a total of USD 29 million. Since early 2013, we have noticed a change in the African healthcare financing landscape: banks are showing more interest in this market and our partner banks are experiencing a growing demand from healthcare providers for capital. In order to keep the loans affordable for the clinics we target, MCF interest rates remain at the low end of local market rates for small and medium sized enterprises.

715.481

1.000.000

• FMO on behalf of Ministry of Foreign Affairs of the Netherlands

• Calvert Foundation

• AIDS Fonds

• Soros Economic Development Fund

• De Grote Onderneming

• Health Insurance Fund/PharmAccess

• Bill & Melinda Gates Foundation

• IFC (G-20 SME Finance Challenge)

• Deutsche Bank Americas Foundation

Technical assistance is financed by grants from both public institutions and As a hybrid investment fund, the MCF private foundations such as De Grote has attracted both public and private Onderneming, Aids Fonds, FMO on behalf international capital; both in grants for of the Dutch Ministry of Foreign Affairs, technical assistance and first loss and in debt financing for the MCF loan program. USAID and several Dutch private donors. In addition, MCF was one of the winners The first loss grants serve as a cushion of the SME Finance Challenge, an initiative for the debt investors and absorb loan of the G20 and managed by IFC/SME losses and currency exchange rate risks. This was leveraged with the debt financing Finance Forum. from private investors and Development Finance Institutions (DFIs).

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PROGRESS REPORT MEDICA L C RE D IT F UN D

Board and Team The MCF Team Monique Dolfing-Vogelenzang Managing Director Herman Abels Director Operations Bart Schaap Director Finance Nicole Spieker Program Director Quality, PharmAccess Tom Bouma Senior Financial Analyst Hanneke Peeters Senior Quality Manager, PharmAccess Anna Theuvenet Process Manager Marceline Obuya Program Manager East Africa Maxwell Akwasi Antwi Program Manager Ghana Uzodinma Kenneth Osisiogu Program Manager Nigeria Joost Zijlmans Finance Control Nada Coici Portfolio Analyst

Supervisory board Onno Schellekens Chairman | Managing Director PharmAccess Group Klaus Vink Vice-President | Solicitor, tax lawyer and senior partner at Vink & Partners Ton Coenen Executive Director Aids Fonds & SOAAIDS Nederland Frank Eijken Owner and manager of Eijken Management & Consultancy Ben Christiaanse CEO of National Microfinance Bank in Tanzania from 2006-2010, Christiaanse developed it into one of the largest financial institutes in the country

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The PharmAccess Group Medical Credit Fund is part of a group of non-profit organizations with a shared goal. The PharmAccess Group is working towards achieving inclusive health care for Africa. Many African governments struggle to meet the demand for health care of their populations. Population growth and the rise of non-communicable diseases are increasing the burden placed on their health systems even further. As public healthcare providers are often few and far between, overcrowded, understaffed and poorly stocked, many people pay out-of-pocket for health care at private clinics whose quality also leaves much to be desired. The fact that health insurance remains out of reach for most people means that, when they are injured or become ill, they can become trapped in a downward spiral of lost income paired with high and unexpected healthcare costs. Also, without solid institutions and proper standards, there is no way to ensure the quality of health care services. These shortcomings of the health system come at a price – for the individuals, but also for their communities and even their countries. After all, healthy populations are a major driver of economic growth.

Integrated approach The PharmAccess Group aims to improve access to quality health care for people in subSaharan Africa. Our integrated approach consists of complementary initiatives that aim to increase resources, efficiency and effectiveness within the healthcare system. By combining standards for quality improvement, loans for healthcare providers, health plans and in-depth impact research we simultaneously stimulate the demand for and supply of healthcare services. The expertise within the PharmAccess Group includes health plans and healthcare quality, financing and infrastructure. Our work also includes consultancy and HIV/AIDS corporate programs as well as healthcare innovations using mobile technology (mHealth). With the financial support of the Dutch Ministry of Foreign Affairs and other donors, we have been able to leverage our own investments, mobilizing additional resources from third party donors, local governments, investors, local banks, private clients and insurance premiums. As such, we are helping a growing number of people, from patients to medical professionals, gain access to the tools they need for social and economic development, thereby scaling up functioning health systems. Our approach has generated considerable international attention, including a G20 award that President Obama presented to us for our innovative healthcare financing model. This model helps to increase trust among patients, doctors, insurance companies, banks, government and international investors, thereby increasing their willingness to pay for or invest in health care in Africa. With a growing number of valued African and international partners, donors and investors from both the private and the public sector, we continue to work towards more inclusive health care in Africa.

Our partners, donors, investors and clients The PharmAccess Group works with: The Dutch and African governments, including the Tanzanian and the Nigerian Ministry of Health International (donor) organizations such as the World Bank/IFC, United States Agency for International Development (USAID), International Labour Organization (ILO), DfID, Clinton Foundation, Bill & Melinda Gates Foundation, Deutsche Bank Americas Foundation, Calvert Foundation, Overseas Private Investment Corporation (OPIC), Soros Economic Development Fund, CDC Foundation, Marie Stopes International, Society for Family Health and PSI. Multinational corporations such as Heineken and Shell. Strategic partners such as Kisumu Medical and Education Trust (KMET), Association of Private Health Facilities in Tanzania (APHFTA), Kenya’s National Hospital Insurance Fund (NHIF) and Tanzania’s National Social Security Fund (NSSF). Banking partners such as BancABC and National Microfinance Bank in Tanzania, KREP Bank in Kenya, uniBank and HFC Bank in Ghana and First City Monument Bank in Nigeria. Insurance companies such as Hygeia, AAR, Africa Medilink Ltd and MicroEnsure. Health accreditation organizations such as Council for Health Services Accreditation for Southern Africa (COHSASA) and Joint Commission International (JCI).

Photography by Karijn Kakebeeke Graphic design by Studio Saiid & Smale


Trinity Building C Pietersbergweg 17 1105 BM Amsterdam Phone: +31 (0) 20 566 7643 Fax: +31 (0) 20 566 9440 info@safe-care.org www.safe-care.org

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Medical Credit Fund Progress Report 2012-2013  

Medical Credit Fund Progress Report 2012-2013  

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