Healthcare PPP’s

For the Ministry of Health of Jamaica, appointed by the Planning Institute of Jamaica as part of a consortium with Sanigest and Korea University Medical Centre to lead the transaction advisory team comprising specialists in all aspects (health economists, health planners, technical and facilities planners and designers, clinicians, financial modellers and project financiers, legal advisers, commercial and PPP advisers, environmental and social) on a PPP project to establish Centers of Excellence in Nephrology and Oncology. The scope covers the entire PPP transaction from conceptual masterplan through to feasibility, business case, full tender documents, procurement and negotiation support. Phase 1 completed, comprising conceptualisation, demand and supply analysis for kidney and cancer treatments, sizing and master planning of facilities and medical equipment, capital and operational costing, technical feasibility, environmental and social assessment, legal analysis and term sheet recommendation, business case, affordability and fiscal impact analysis, financial modelling, value for money analysis, cost benefit analysis, PPP transaction structuring and facilitation of approval.

For IFC Advisory, part of the World Bank Group, appointed as technical consultant for establishing a rehabilitation centre using the PPP modality.  The scope covers the entire PPP transaction from feasibility and business case to generating the full tender schedules, and procurement and negotiation support. CR is leading a team along with designers Atelier 7 from Poland and Korea University Medical Centre, coordinating with legal firm Kalikova & Associates. Project Business Case (comprising demand and supply analysis for rehabilitation treatments, recommending capacity, developing treatment plans and undertaking activity-based costing to establish expected tariffs, sizing and planning of facilities and medical equipment, capital and operational cost derivation, environmental and social assessment, assisting with term sheet development, affordability and fiscal impact analysis, financial modelling, value for money analysis, cost benefit analysis, PPP transaction structuring and facilitation of approval. Phase 2 (procurement) commenced in February 2020.

For InterHealth Canada, a leading international healthcare group bidding for Diagnostic and Treatment Centers in the UK under the Public Private Partnership scheme which aimed to provide clinical and surgical services on a complete BOT project-financed basis. CR was lead advisor and chief negotiator and successfully led the transaction structuring and negotiation of commercial contracts and project financing for on two such deals (PPP Orthopedic Hospital at Runcorn and the PPP Orthopedic Facility at Kidderminster). The work was comprehensive and involved managing teams of technical advisers, clinicians, equipment planners, HR specialists, economists, financial modellers, project finance specialists, costing using activity-based costing methods, pricing, proposal submission, negotiation, insurance providers, and others. CR closed the deals, securing the required debt and mezzanine financing for the project.

For InterHealth Canada, a hospital operator which is a leader in the integrated healthcare PPP model, provided strategic commercial and transactional advice on the Zywiec Integrated PPP Hospital project at the city of Zywiec in Poland.

For KHIDI (Korea Health Industry Development Institute), a government organization established by the Korea Ministry of Health and Welfare that is responsible for promoting growth of the Korean healthcare industry, CR conducted research and completed a study entitled “Healthcare PPP Entry Strategy for Selected Markets”.  The purpose of this study was to provide meaningful data and analyses so that Korean health systems, engineering, procurement and construction contractors (EPCs), facility managers, and financial service institutions are able to assess the opportunities in various countries. It also provides them with insights into the attractions, key risks and benefits of participating in such opportunities in these markets.

For EBRD, acted as strategy consultant and undertook pre-feasibility studies on the structuring of three hospital projects in Romania (Bucharest Sector 1, Brasov and Constanta) as Public Private Partnerships (PPPs). Project involved supply and demand analysis, technical feasibility evaluation (land suitability and facility and equipment planning), costing, financial modelling, recommending the PPP transaction structure and roadmap, and evaluating fiscal impact.

Conducted a comprehensive 1-week capacity building workshop for the Asian Development Bank in Manila on public private partnerships (PPPs) in the social sector. This covered healthcareeducation and elderly care. Attendees were officers of ADB both from headquarters and resident missions covering many of the ADB countries of operation.

Acting as strategy consultant to the World Bank IFC Advisory, undertook a pre-feasibility study on three healthcare services for their potential to structure as Public Private Partnerships (PPPs) in Kyrgyzstan (rehabilitation, diagnostics – imaging and laboratory – and polyclinics). Worked in coordination with the IFC team and legal advisors. Undertook research, analysis, demand derivation and sizing and formulated conclusions which were presented to the Ministry of Health.

Appointed by KfW (the German Development Bank) in April 2018, reporting to World Bank IFC, provided post-contract support to the Ministry of Health of Kyrgyzstan on the haemodialysis PPP project operated by Fresenius, the first healthcare PPP in Central Asia. This covered overseeing the construction phase through to commissioning, contract administration and variation negotiation support, as well as environmental and social evaluation and monitoring. Further mandate secured in February 2020 as adviser and team leader, working with GITEC, to support MoH in monitoring the same project and developing the PPP unit. Mandate encompasses PPP Unit design, formation and capacity building, developing dialysis standards and undertaking environmental assessments.

Appointed by Asian Development Bank as PPP Specialist and Team Leader to advise the Ministry of Health of Kazakhstan on structuring a PPP program for its primary healthcare sector across Kazakh regions (oblasts), working along with Grata Law firm and Rebel Group. Project involved establishing a “Program PPP” structure for fast-track implementation of PPPs in primary healthcare and for introducing reforms legislated by the Order of the Minister of Health issued in July 2018 on restructuring of primary healthcare pursuant to the reform program “Densaluk” issued as a Presidential Decree. Developed template suite of procurement documents, draft contract documents and financial models for such PPPs covering three modalities (new build, refurbishment and management contracts), along with comprehensive guidance documents.

For IFC Advisory, part of the World Bank Group, appointed as technical, commercial and strategy consultant to assist in establishing a roadmap for healthcare PPPs in Uzbekistan, working with the IFC team.  Identified potential healthcare projects suitable for the PPP modality in radiography & diagnostic imaging, oncology, rehabilitation, laboratory diagnostics as well as full service general hospitals.

For City of Brasov in Romania, undertook a pre-feasibility study on establishing a Regional Emergency Hospital covering three districts. Developed demand and supply analysis and opined on capacity. Undertook facility and equipment planning, evaluated capital and operating costs and derived fiscal impact on the City of the PPP contract.   Recommended the PPP structure and roadmap for EBRD to launch the project through the various procurement stages. Project was approved and moved into the project preparation phase.

For ADB, appointed as healthcare strategic consultant to assist in assessing the viability of undertaking diagnostic imaging, laboratory diagnostics and dialysis services as integrated healthcare PPPs pilot projects in Dhaka, Bangladesh. Undertook options evaluation, derived demand and established capacity and equipment sizing, developed fiscal impact and made recommendations for both rapid implementation and roll out into other locations in Dhaka and country-wide.

Appointed by EBRD on behalf of the Ministry of Health of North Macedonia to undertake a pre-feasibility study on re-locating the specialist hospital in Skopje (St Naum) to another part of the city (Aerodrom) and to rationalise health service delivery in Skopje by establishing a general hospital on the same site. Undertook demand and supply analysis, facility and equipment planning, capital and operational costing, evaluating potential availability payment and service payment levels, the latter based on potential admission data and tariffs adopted by the Health Insurance Fund. Recommended optional PPP structures (both FM PPP and Integrated PPP) and roadmap for preparation and implementation.