FINAL REPORT ASSESSMENT OF HEALTH RELATED INVESTMENT AND FINANCING OPPORTUNITIES IN SENEGAL Financing Growth Work Order 2014-03 Contract No. AID-EEM-E-00-08-00002 Order No. AID-OAA-BC-14-00030 March 2015 This document was prepared by Banyan Global under Financing Growth: Assessment of Health Related Investment and Financing Opportunities in Senegal. ASSESSMENT OF HEALTHCARE RELATED INVESTMENT AND FINANCING OPPORTUNITIES IN SENEGAL FINAL REPORT MARCH 2015 Contract No.: AID-EEM-E-00-08-00002 Order No: AID-OAA-BC-14-0030 Work Order No. 2014-03 Submitted to: Lawrence Camp, COR Director USAID, Millennium Challenge Corporation DISCLAIMER The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development (USAID) or the United States Government. PROJECT OVERVIEW Financing Growth: Assessment of Healthcare Related Name Investment and Financing Opportunities in Senegal Contract Number AID-EEM-E-00-08-00002 Order Number AID-OAA-BC-14-0030 Work Order Number 2014-03 Start Date January 21, 2015 End Date February 28, 2015 Geographic Coverage Senegal Quarterly Progress Report #1, October - December 2014 CONTENTS Acronyms.........................................................................................................................................i 1. Introduction ........................................................................................................................... 2 2. Project Tasks and Activities ................................................................................................. 3 2.1 Task I: Collect Secondary Data on the Private Health Sector in Senegal ..................................................3 2.2 Task II: Identify Information Gaps to be Filled in Through Local Research...............................................3 2.3 Task III: Develop a Framework Spreadsheet Model to Assess Opportunities .........................................5 2.4 Task IV: Develop Market Projections..................................................................................................................6 2.5 Task V: Identify Financial Institutions...................................................................................................................7 3. Key Findings ........................................................................................................................... 8 3.1 Characteristics of Health Private Sector in Senegal.........................................................................................8 3.2 Health Market Characteristics..............................................................................................................................9 3.3 Facility Owners.........................................................................................................................................................9 3.4 Facilities.....................................................................................................................................................................10 3.5 Business Management and Financing..................................................................................................................10 3.6 Four Market Segments..........................................................................................................................................10 3.7 Market Segementation ..........................................................................................................................................11 3.8 Financial Needs and Willingness to Borrow....................................................................................................11 3.8.1 Assumptions and Analysis...........................................................................................................................11 3.8.2 Summary of the Market Opportunity......................................................................................................13 3.9 Additional Information and Observations........................................................................................................13 4. Constraints and Limitations ............................................................................................... 15 5. Recommendations and Steps Forward.............................................................................. 16 Annex A: Summary of the Secondary Data Review ................................................................ 17 Annex B: Framework Spreadsheet ........................................................................................... 21 Annex C: Private Sector Survey................................................................................................ 22 Annex D: List of Private Health Facilities Interviewed ........................................................... 29 Annex E: Profiles of Key Private Healthcare Facilities............................................................ 30 Annex F: Health Lending Opportunities in Senegal: Summary of the Projections.............. 33 Annex G: Model Calculations for Senegal ................................................................................ 37 Annex H: List of Financial Institutions Interested in Health Lending.................................... 38 Annex I: Exit Debriefing with USAID Senegal ......................................................................... 39 Quarterly Progress Report #1, October - December 2014 ACRONYMS ADEMAS Agence de Développement du Marketing Social CFA Communauté Financière d’Afrique DCA Development Credit Authority DHS Demographic Health Survey E3 Bureau for Economic Growth, Education, and Environment (USAID) EIF European Investment Fund FI Financial Intermediaries GOS Government of Senegal HLT Health Lending Toolkit IFC International Finance Corporation IMP Institution de Prévoyance Maladie MFI Micro Finance Institutions MOH Ministry of Health MOHSA Ministry of Health and Social Action MPEP Office of Microenterprise and Private Enterprise Promotion (USAID) ONMS Ordre National des Médecins du Sénégal PPP Public Private Partnership SHOPS Strengthening Health Outcomes through the Private Sector Project USAID U.S. Agency for International Development Work Order 2014 – 03: Assessment of Healthcare Related Investment and Financing Opportunities in Senegal i 1. INTRODUCTION The USAID-funded Assessment of Health Related Investment and Financing Opportunities in Senegal under the Financing Growth project conducted a rapid review of current and projected healthcare lending opportunities in Senegal. The assessment was undertaken to analyze the current market demand for financing from the health sector and develop a presentation of the data that could facilitate a go/no- go decision by financial intermediaries exploring whether to pursue lending to this sector. The E3 bureau, in conjunction with the Global Health Bureau through the SHOPS project, had developed a Health Lending Toolkit (HTL), which is designed to support financial institutions in: Phase One – determining whether healthcare lending (primarily private clinics and pharmacies) is a profitable lending market for them; and if so, Phase Two – Developing a healthcare lending program and products with which to pursue the opportunity identified. The premise of the HLT is that obtaining a real commitment from a financial intermediary to enter into a specialized lending area - such as healthcare - is contingent upon that institution having made an evidenced-based decision about the market opportunity. Financial intermediaries (FIs) may seek technical assistance or partial guarantees from USAID, but too often the guarantee remains under- utilized. This is partially a result of FI’s lack of understanding about the opportunities in the health sector due to limited pre-assessment and analysis of the sector. As such, a key element of the Healthcare Toolkit is to work with FIs to obtain the market data they need to make a go/no-go decision based on the lending opportunities in their catchment area. Once that decision is made, the FI needs to make the institutional investments needed to enter into this targeted area. The USAID Senegal Mission expressed interest in hosting a beta test of the HLT in Senegal, of which the current project constitutes phase one. Phase two will be undertaken based on interest from local financial institutions. The project team for the assessment included Mr. Piotr Korynski, Senior Associate at Banyan Global, who traveled to Senegal from February 9-19, 2015. Mr. Korynski was supported by a Senegalese health systems expert, Mr. Daouda Mbengue. Work Order 2014 – 03: Assessment of Healthcare Related Investment and Financing Opportunities in Senegal 2 2. PROJECT TASKS AND ACTIVITIES This project involved the review of secondary data, a rapid assessment of current and potential healthcare lending opportunities in Senegal, and a presentation of the data in a format which could facilitate a go/no-go decision by a financial intermediary. 2.1 TASK I: COLLECT SECONDARY DATA ON THE PRIVATE HEALTH SECTOR IN SENEGAL The project reviewed the secondary data on the private health sector in Senegal to ascertain the amount and type of information that is already available. As expected, some information is available through the Demographic Health Survey (DHS) data base, which in Senegal is updated annually, and specific reports and assessments that focused on the private sector healthcare market. A short summary of the secondary