Flow of Investment Capital
Private investors and grant makers include private donor organizations, social impact investment funds, private individuals and corporations. Public investors and grant makers are mostly development banks and governmental donor agencies.
The hybrid status of the MCF makes it a Public-Private Partnership (PPP) in its own right. In the MCF approach public and private donors can contribute to finance healthcare assets (including working capital and skills) for the lower-end of the healthcare market by mitigating credit risks for investors and supporting the program costs. As a result the risk of financing these assets is reduced, which subsequently will trigger and leverage both international and local private investments. This way the total amount of capital is multiplied and the lower-end of the market becomes financeable and scalable.
During 2011-2018 the MCF aims to facilitate 3500 loans and provide technical assistance on business planning and quality improvement to around 2500 health care providers in Africa. All of these providers will be assessed and graded according to SafeCare, and together they are estimated to have around 45 million patient visits while participating in the program.
Impact will be achieved in three key performance areas, allowing the Fund to develop a triple bottom line return proposition to its investors and contributors;
- Financial: local financial markets will finance the local private health sector due to its improved financial basis and records of reliability. Financial risks have become known, trust is increased, financing becomes more affordable and investors can expect a reasonable financial return.
- Medical:enhanced clinical performance, quality assurance and SafeCare certification thereof will gain higher trust among patients and thus contribute to better service delivery leading to higher utilisation.
- Social:by focusing on the lower end of the market and improving the quality of healthcare, the Fund will contribute to African countries' ambitions to realize the Millennium Development Goals, particularly MDGs 4, 5 and 6 dealing with child health, maternal health and HIV/AIDS.
MCF Loan Products
Health SMEs participating in the MCF Program have access to sequential loan provision. Most SMEs, especially those with no formal credit history, will be offered a small loan only. This product is commonly known as the entry loan. During the tenure of the small loan, all technical assistance is provided so that by the end, the SME is ready to submit a request for a medium loan. After completion of the medium loan, the SME may qualify for a mature loan.
In case a Health SME is more experienced in dealing with investors it may entry at the level of a medium loan. Yet, before a loan will be granted, the SME shall have completed business and clinical due diligence. In exceptional cases a Health SME may apply for a special loan product, which is denominated in US dollars or dollar equivalents.
The interest rates follow local market rates. MCF rates are affordable nonetheless because the borrowing client's repayment capacity is taken into account, and repayment terms are more lenient. MCF and its banking partners are resolute as regards prompt loan repayment and payment of interest.
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The Medical Credit Fund works in partnership with African banks to handle loan provision to Health SMEs. Local healthcare organizations select, recruit, train, support and guide these Health SMEs to become eligible for lending from the banks.
The MCF Program consists of two lines of activities. The Finance Program pioneers access to investment capital whereas the Technical Assistance Program strengthens Health SMEs in the areas of both business and quality. The MCF enters into partnership with larger healthcare organizations as Technical Assistance (TA) partners to scout and select eligible Health SMEs to join the MCF Program and work with them to steadily increase business and quality performance. This reduces investment risk and drives good loan repayment whilst offering better services to patients.
The banks participating in the MCF Program provide loans to Health SMEs after they have been analyzed by the TA Partners and deemed bankable. Loan provision is an incremental process: Health SMEs that have never borrowed from a bank before start with a small loan after which they can access consecutive larger loans, until they will have become a preferred client of the bank.
Technical Assistance Program
The provision of TA covers two main areas: business and clinical performance. As regards business the Health SME will undergo training and financial due diligence. Then the TA partner will assist in producing a business plan that will determine the SME's capacity to borrow and results in the submission of a loan application to the bank.
In the area of clinical performance the Health SME undergoes quality training and a clinical due diligence which points out performance areas to be addressed. This is captured in a quality upgrade plan which serves as input for the business plan. During the tenure of loans, business and clinical performance is monitored by the TA partner.
Clinical due diligence is based on the SafeCare methodology. This assessment system allows for measuring performance in resource-poor settings and acknowledges step-wise improvements through certification based on international standards. As a result of this the healthcare facilities can be compared, progress can be evaluated according to standards and the results of the investments can be measured.
The technical assistance process is based on an intricate pattern of cooperation between several organizations: banking partners, TA partners, the MCF and PharmAccess International for the application of the SafeCare methodology. To ensure efficient service delivery, the respective tasks and responsibilities of all MCF Program partners are detailed in a standardized flowchart.
Activities are sequenced and milestones are formulated to move from one Program phase to another. All steps are recorded and documented in the MCF's database for monitoring and reporting purposes. The database contains valuable information on business and clinical performance which serves for further policy and product development.
The SafeCare quality label is a joint initiative from the Joint Commission International (JCI), the Council for Health Service Accreditation of Southern Africa (Cohsasa) and PharmAccess International. It allows healthcare facilities to measure and improve the quality, safety and efficiency of their services.