INNOVATIVE FINANCING FOR CATARACT SURGERY THE CASE FOR PILOTING A DEVELOPMENT IMPACT BOND
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1 INNOVATIVE FINANCING FOR CATARACT SURGERY THE CASE FOR PILOTING A DEVELOPMENT IMPACT BOND
2 The Need for Innovative Financing Outlook for traditional ODA and private philanthropy uncertain DAC funding has held up but global economy unclear and many national budgets remain under pressure Rising cost of raising funds Increasing need to show effectiveness Corporate sector increasingly seen as a major development player PRESENTATION HEADING 2
3 Impact Investors PRESENTATION HEADING 3
4 Why Impact Investing? Impact investing attractive to the wealthy Impact/mission investing is seen as the most promising trend by most philanthropists (52%) worldwide.* Taps into potentially large pool of new development funds of socially motivated investors Additionality: investment increases quantity/quality of social output cf. what would otherwise have occurred Emphasises outcomes over outputs e.g. not were the treated bed nets produced but did they reduce malaria? * PRESENTATION HEADING 4
5 The Impact Investment Market Debt most prominent, then equity Most investments in mature industries Health small but fastest- growing sector DIBs still very small and likely to remain so Source: J.P. Morgan and the Global Impact Investing Network pub/2014marketspotlight.pdf PRESENTATION HEADING 5
6 Development Impact Bonds: What Donor Implementer Social impact investors M&E Main risk carrier GRANT PAY-BY-RESULT FINANCING DEVELOPMENT IMPACT BOND 3 Reporting 4 Reporting 5 Reimbursement 3 Evaluation 1 Financing 4 Reimbursement 2 Evaluation 1 Financing 2 1 Implementation Implementation 2 Implementation
7 Development Impact Bonds: Why Bring new money and new actors into unconventional areas Payment depends on achieved quantified outcomes Cataract surgery particularly suited to DIBs well established procedures highly cost effective easily verified results PRESENTATION HEADING 7
8 Eye Health in Cameroon Significant burden of eye disease in Cameroon >1.5 million people need eye care services 3 ophthalmologists per million (WHO: at least 4) Backlog of 46,000 cataract surgeries (WHO) with no additional action, 74,000 at risk of blindness from cataracts by 2020 Most cataract sufferers live outside of cities Limited cataract treatment capacity (particularly in rural areas); high cost; weak primary and secondary health infrastructure Cataract patient, Cameroon PRESENTATION HEADING 8
9 The Cameroon Eye Hospital Mission: To preserve, improve and restore vision for the people of Cameroon and adjacent nations of Central Africa, with no prejudice towards social status, disability, religion & gender. SUSTAINABLE SOCIAL BUSINESS MODEL Offtake Free Discounted Full Pay $ $ $ Cross-Subsidizes At start-up: 1,000 surgeries per year At scale: >6,000 surgeries per year SUB-SPECIALTY EYE-CARE FOCUS Oculo-plastic & Orbital Pediatric & Strabismus Cornea & external eye Sub-specialties Retina & Posterior segment Cataract & Refractive Glaucoma & Neuroophthalmology Initial focus on cataract services in first 2 years, scaling to other sub-specialties overtime REGIONAL TRAINING INSTITUTE At start-up: 4 surgeons and 19 ophthalmic paramedics At scale: 7 surgeons and 35 mid-level ophthalmological support staff in training per year
10 The Cataract Bond: How it will work A US Foundation US Foundation 90% The Fred Hollows Foundation and Sightsavers 10% PRESENTATION HEADING 10
11 Some early lessons Clearly show how a DIB can make a contribution The right partners, technical expertise and advice is essential. Robust, independent monitoring and evaluation of outcomes critical: investors depend on outcomes being verified. The outcome funder is the linchpin of the deal Don t go down the DIB track unless your organization is prepared to take risks and try something different PRESENTATION HEADING 11
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