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<strong>Impact</strong> Investments:<br />

An emerging asset class<br />

Global Research<br />

29 November 2010<br />

Complementing government service provision<br />

Access to water has recently been deemed a basic human right by the United<br />

Nations 65 , and in many countries, access to water is provided by governments. The<br />

same is true in the BoP markets we analyze, though in many cases the businesses are<br />

successful because of the lack of government provision (particularly in rural areas).<br />

For example, according to Water Health, consumption at their water purification<br />

plants in Ghana is about 3–4x that of a typical site in India, mainly because of the<br />

lack of alternative sources for water in Ghana. In India, by contrast, many<br />

communities still have access to water through the Rural Water Supply Programme 66 ,<br />

even though this water is not what Water Health would consider safe for drinking.<br />

Not only will this variation in government provision across regions affect the success<br />

of businesses as they start up in different geographies, but it can also be a factor that<br />

changes over time, affecting the competitive landscape and long-term prospects of a<br />

business operating in this sector.<br />

Case studies<br />

LifeSpring Maternity Hospital<br />

(India)<br />

R-Jolad (Nigeria)<br />

Health: Maternal care in urban areas<br />

Case studies: Maternal care in India and Nigeria<br />

Within the health sector, there are many potential businesses we could use for a case<br />

study, from pharmaceutical providers to specialist surgical hospitals. We have chosen<br />

a maternity hospital chain in India – LifeSpring Maternity Hospital. We complement<br />

the analysis of LifeSpring’s business with an analysis of R-Jolad, a hospital based in<br />

Lagos, Nigeria that also delivers antenatal care (although its services are broader).<br />

These two hospitals are both designed to operate as high volume, low cost businesses<br />

and target high occupancy, utilization and turnover rates in order to ensure<br />

profitability. LifeSpring, founded in 2005 and currently operating as a for-profit<br />

chain of six 20-bed hospitals, broke even after only 18 months operating as a private<br />

company 67 . R-Jolad delivers high single figure net margins 68 , having grown from a<br />

single-physician clinic in 1982 to a 150 bed, 250 out-patients per day hospital.<br />

Sizing summary: $0.4–$2.5bn of potential invested capital; $0.1–$1.4bn potential<br />

profit opportunity<br />

Given the case studies we reference, there is potential for $0.4–$2.5bn of invested<br />

capital to fund hospitals that, like LifeSpring, specialize in maternal health services.<br />

Sizing the entire market for healthcare provision is too broad a task for this research<br />

piece. Instead, we have identified the capital that could fund maternal health<br />

provision, particularly the attendance of births by a skilled professional when<br />

otherwise a professional would not have been present. This of course is only one<br />

segment of healthcare services that could be provided by impact investment, and<br />

given that maternal health has been estimated to account for only 2% of total<br />

healthcare expenditures on average in the developing world 69 we can estimate that<br />

the total health market for impact investment could be as large as $18–$123bn.<br />

65 General Assembly declares access to clean water and sanitation is a human right, UN News<br />

Centre, July 28, 2010.<br />

66 http://www.india.gov.in/sectors/rural/rural_water.php<br />

67 LifeSpring Hospitals, Gita Johar, Columbia CaseWorks, April 26, 2010.<br />

68 The Business of Health in Africa, Annex I, IFC, Dec 2007.<br />

69 Estimate provided by Marty Makinen, Results for Development Institute<br />

53

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