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Ankara Etlik Hospital PPP Project



Project number:


Business sector:

Municipal and environmental infrastructure

Notice type:


Environmental category:


Approval date:

17 Dec 2014



PSD disclosed:

03 May 2013

Translated version of this PSD: Turkish

Project Description

The EBRD is considering a hospital infrastructure PPP project involving the design, construction, equipping, financing, and maintenance of an integrated health campus in Etlik, Turkey, pursuant to a 27.5 years concession awarded by Turkey’s Ministry of Health. Under this PPP structure, the Concessionaire will supply and maintain the hospital facilities, while the provision of medical care and services will remain the responsibility of the Ministry of Health. Total Project Costs are estimated at ca. EUR 1.1 billion.

EBRD will assist in increasing private sector participation in the hospital infrastructure sector in Turkey. The Project is expected to be one of the first hospital infrastructure PPPs in Turkey to involve an international sponsor, and as such it will be a flagship project setting standards for future PPP projects in the country. In response to the need for large capacity investments in healthcare systems, governments are seeking to tap private sector resources and know-how to construct and manage infrastructure related facilities more rapidly and more efficiently, while medical service provision remains under the responsibility of the state.

Transition Impact

The transition impact of the Project will be derived from three main sources:

1. Demonstration effect of new ways of financing, procuring and operating hospital infrastructure: The Project is expected to be the one of the first PPP transactions in hospital infrastructure in Turkey and is set to appeal to the international market. The Project is structured on a design-build-finance-lease-transfer (DBFLT) basis with strong demonstration effects for the rest of Turkey and other countries in the region, by promoting the use of concession contracting, and demonstrating good practice in international PPP standards. 

2. Demonstration effect of better value all-in cost service than a public sector alternative: The Project is expected to deliver better value from an all-in cost service perspective when compared to the public sector alternative, providing a high value for money to the Ministry of Health. Following a review of the tender documentation and the template PPP contract, the Turkish Hospital PPP programme is seen as effective in procuring hospital infrastructure services. 

3. New Business Standards: The project is expected to achieve  high standards of business conduct by construction modern hospital infrastructure based on international standards, implementing performance based compensation scheme and monitoring quality.

The Client

The client is Ankara Etlik Hastane Sağlık Hizmetleri İşletme Yatırım A.S., a special purpose company that will supply and maintain hospital facilities under the PPP scheme, while the provision of medical care will remain the responsibility of the Ministry of Health. The client is 51 per cent owned by Astaldi an Italian construction company and experienced hospital operator, and 49 per cent owned by Türkerler, a Turkish construction company.

EBRD Finance

EBRD A loan of up to EUR 100 million and a B loan, the size of which remains to be determined. The EBRD financing will be in parallel with facilities from export credit agencies, other international financing institutions and commercial banks.

Project Cost

Total project cost is expected to amount to EUR 1.1 billion.

Environmental Impact

The project could result in potentially significant environmental and social impacts and issues which cannot be readily identified or assessed. Hence the project was categorised A in accordance with 2008 EBRD Environmental and Social Policy (ESP). A formalised and participatory Environmental and Social Impact Assessment (ESIA) process was carried out by independent consultants for the project in accordance with EBRD Performance Requirements (PRs). The Turkish Ministry of Environment and Forestry concluded that the proposed project does not require an EIA under the scope of the Turkish EIA Regulation (Official Gazette Date/Number 17.07.2008/26939).

The ESIA package (Non-Technical Summary, ESIA, Environmental & Social Management Plan, Stakeholder Engagement Plan and Environmental & Social Action Plan) were disclosed to the public on 24 May 2013 in accordance with EBRD Public Information Policy. The SEP ensures that project stakeholders are appropriately engaged both during the ESIA process and project implementation. Independent consultants reviewed the ESIA and supporting studies and confirmed that the project with the ESAP is structured to be in compliance with EBRD's PRs. The ESAP addresses the following key issues:

  • traffic impacts during the construction and operation of the hospital;
  • noise, dust and vibration associated with the construction;
  • sub-contractor management during the construction and operation of the hospital;
  • environmental, health and safety management systems during the construction and operation;
  • issues associated with the closure of the existing smaller hospitals;
  • waste management during the hospital operation, in particular medical/hazardous/radio-active wastes;
  • hygiene management during the hospital operation;
  • hazardous materials management during the hospital operation;
  • life and fire safety of the hospital building; and
  • grievance mechanisms for the workers, patients and the public.
The project aims to introduce advanced medical equipment and systems to reduce patients’ waiting time and improve the level of services. It is also expected to support the modernization of medical services for the population in the Anatolian Region by replacing the existing outdated hospitals and equipment.

There is an Environmental and Social Impact Assessment available for this project.

Technical Cooperation


Company Contact

Serhat İnanç Ankara Etlik Hastane Sağlık Hizmetleri İşletme Yatırım Anonim Şirketi
Turan Güneş Bulvarı Galip erdem Cad. No:11
0312 492 03 06
PSD updated: 6 November 2014

Business opportunities

For business opportunities or procurement, contact the client company.

For state-sector projects, visit EBRD Procurement: Tel: +44 20 7338 6794

General enquiries

EBRD project enquiries not related to procurement:
Tel: +44 20 7338 7168

Public Information Policy (PIP)

The PIP sets out how the EBRD discloses information and consults with its stakeholders so as to promote better awareness and understanding of its strategies, policies and operations. Please visit the Public Information Policy page below to find out how to request a Public Sector Board Report.
Text of the PIP

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