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Extension of Hospital PPP Framework in Turkey



Project number:


Business sector:

Municipal and environmental infrastructure

Notice type:


Environmental category:


Approval date:

22 Jun 2016



PSD disclosed:

17 May 2016

Sub-projects signed under this framework

Translated version of this PSD: Turkish

Project Description

In September 2014, the EBRD approved a EUR 600 million framework to help Turkey's Ministry of Health prepare and deliver, in line with best international practice, a large scale hospital facilities management PPP programme covering up to 60 facilities across Turkey and worth EUR 12 billion.

To date, the Bank has signed three sub-projects under the framework (Adana Hospital PPP, Ankara Etlik Hospital PPP and Konya Hospital PPP), providing financing of EUR 313.1 million and mobilising additional EUR 311 million in B loans. Once the other projects - mandated and under preparation - are signed during 2016, the framework is expected to be nearly fully utilised. The Bank is considering to extend the framework by an additional EUR 350 million which will encourage the participation of untapped investor classes in the programme, thereby enabling the diversification of funding sources and providing depth to a maturing PPP programme. Under the extension, EBRD investments may take form of standard loans, anchor investments in project bonds, unfunded credit facilities and equity.

Project Objectives

The primary purpose of the extension will be to enable the diversification of the funding sources by  promoting the participation of untapped investor classes in the PPP healthcare sector, alongside the conventional commercial bank project financing covered under the original framework. The untapped investor classes include institutional investors (e.g., pension funds, insurance companies, infrastructure funds and other financial investors), international strategic investors and Islamic financing sources.

The extension will also promote the introduction of non-conventional financing solutions, most notably, the expansion of equity and debt capital market financing.

The EBRD will continue to assist in increasing private sector participation in the hospital infrastructure sector in Turkey. 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 extension will build on the transition impact of the original framework in the underlying subproject either through (i) the promotion of the use of PPP contracting in accordance with international standards; or (ii) the achievement of value-for-money versus the traditional public sector procurement alternative. In addition, under the extension the Bank will demonstrate new ways of financing by promoting the participation of untapped investor classes in the programme.

Client Information

The extension will be available for the private sector concessionaires established with the sole purpose of running the respective sub-projects. The shareholders of the concessionaires will be major companies with significant experience in building, operating and running infrastructure projects as well as a strong understanding of the Turkish market.

EBRD Finance Summary

EUR 350,000,000.00

Total Project Cost

EUR 7,600,000,000.00

Environmental and Social Summary

The programme's extension itself is not categorised. Each hospital PPP sub-project under the extension however is categorised, and subsequently goes through an environmental and social due diligence process managed by the EBRD's Environmental and Sustainability Department. It is expected that the implementation of this extension is likely to result in benefits in terms of enhanced medical care quality and accessibility. To date three sub-projects under the framework (Adana Hospital PPP, Ankara Etlik Hospital PPP and Konya PPP Hospital projects) have been signed.

The Bank's environmental and social due dilligence and monitoring of the existing portfolio has identified a number of issues that are likely to be common amongst the up-coming sub-projects, namely the environmental approval and environmental and social assessment process; information disclosure and public consultation requirements; and various site specific risks and issues, including (i) traffic (for both the construction and operation stages); (ii) organisational health and safety issues and temporary accommodation for construction workers; (iii) community health & safety; (iv) life and fire safety of the buildings; (v) contractor management; (vi) employee grievance mechanism for both the construction and operation stages; and (vii) stakeholder engagement. Experience from existing projects will be used during project appraisal. An Environmental and Social Action Plan will be developed for each sub-project to ensure that respective issues can be addressed by mitigation measures as well as each sub-projects meets the Bank's requirements, including EBRD's performance requirements and the IFC Environmental, Health and Safety Guidelines for Health Care Facilities. The Bank will monitor each subproject's environmental and social performance by reviewing an annual report as well as site visit.

Technical Cooperation

The sub-projects under the extension indirectly benefit from two existing Technical Cooperation projects with the Ministry of Health as the beneficiary under the original framework, namely:

(1) Value-for-money analysis: detailed elaboration of a methodology as a component of project preparation to demonstrate in a rigorous manner that a given PPP project provides value versus a traditional public procurement approach.

(2) Contract monitoring: design and training of a new hospital PPP monitoring function organised as a dedicated unit within the ministry.

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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