ENVIRONMENTAL, SOCIAL AND DEVELOPMENT ... 2013 final.pdfOverview 1. INTRODUCTION We hereby present you the fourth edition of the annual Environmental, Social and Development Perfomance

ENVIRONMENTAL, SOCIAL AND DEVELOPMENT PERFORMANCE REPORT 2013

Table of contents

TABLE OF CONTENTS

Abbreviations 6

1. Introduction 8

2. Overview 10 2.1 Structure IFHA 10 2.2 Investment policy 11 2.3 Portfolio companies 12

3. IFHA’s Development Matrix 14 3.1 Development objectives 14 3.2 Objectives per sector 14 3.2.1 Healthcare provision 14 3.2.2 Health insurance 15 3.2.3 Wholesale and distribution 15 3.2.4 Production and Manufacturing 16 3.3 Indicators (SMART) 16 3.4 Practice 16

4. IFHA’s portfolio companies: ESD impact 19 4.1 Ensure equitable access to products and services 19 4.2 Increase availability of health products and services 20

5. Conclusion 22

6. Annexes 25 Annex 1: Environmental, Social and Development Management System IFHA 1.1 IFHA’s Dvelopment philosophy 25 1.2 Environmental Social and Development policy 26 1.2.1 IFHA’s exclusion list 26 1.2.2 National laws on environment, health, safety and social issues 26 1.2.3 IFHA’s development matrix (KPMG) 26 Reviewed on: 1.2.3.1 Millennium Development Goals (MDGs) 27 1.2.3.2. IFC Performance Standards and IFC guidelines for specific sectors 27 Annex 2: Examples of ESD Impact within IFHA’s portfolio companies 29 1- Increase availability of products and services 29 2- Ensure equitable access to products and services 29 3- Increase affordability of products and services 29 4- Ensure quality of products and services 29 5- Stimulate (local) economy and equitable access to employment 30 6- Stimulate decent work 30 7- Reduce negative enironmental impact 31 8-Apply good governance and transparency 32 Annex 3: Data ESD audits subsidiaries IFHA Portfolio Companies 33 Annex 4: Data ESD audits per sector 36 Annex 5: Snapshot Portfolio Companies 44 Hygeia 44 Pyramid Pharma 45 Strategis 46 Hello Doctor 47 AAR 48 Sourcelink 49 ER Corporate 50 Kampala Hospital Limited 51 Eco Health Limited 52

4 ESD Performance Report 2013

5

A

bbreviations


ABBREVIATIONS

AfDB African Development Bank

AHSM African Health Systems Management Company (Manager)

ESD Environmental Social Development

ESDPR Environmental Social Development Progress Report

FAPA Fund for African Private Sector Assistance

GIIRS Global Impact Investing Ratings System

HMO Health Maintenance Organization

IFC International Finance Cooperation

IFHA Investment Fund for Health in Africa

IRIS Impact Reporting and Investment Standards

MDGs Millennium Development Goals

NGO Non-Governmental Organization

SIFA Social Investor Foundation for Africa

WHL Worldwide Healthcare Limited

WHO World Health Organization

WWCVL World Wide Commercial Ventures Limited

ESD audit at WWCVL Nigeria (October 2013)

A

bbreviations

7

Overview

1. INTRODUCTION

We hereby present you the fourth edition of the annual Environmental, Social and Development Perfomance

Report (ESDPR) of the Investment Fund for Health in Africa (IFHA). In 2013, three new investments were

completed being World Wide Commercial Ventures Limited (WWCVL, Nigeria), Worldwid Healthcare

Limited (WHL, Ghana) and Kampala Hospital Limited (Uganda). Eco Health Limited was incorporated to

merge WHL Ghana and WWCVL Nigeria for the purpose of an exit. In this report the ESD results are pre-

sented separately for each company.

In 2013, entry measurements by KPMG were carried out at our portfolio companies in Ghana

(WHL), Nigeria (WWCVL) and South Africa (Sourcelink and ER Corporate). The entry measurement for

Kampala Hospital Limited is scheduled for July 2014.

The main goal of this report is to make the annual ESD performance of our portfolio companies

transparent to our investors. Furthermore, we aim to give insight in how we measure the ESD performance

and how we attach this to the popular terminology surrounding ESD impact.

Introduction

AAR’s Beckmann Trust de-worming program (2013)

Overview

9

Introduction

Overview


2. OVERVIEW

Investing in African health systems is an opportunity to accelerate economic development and

growth, contribute to saving millions of lives and preventing life-long disabilities, and move coun-

tries closer to achieving objectives of national poverty reduction strategies and the Millennium

Development Goals (MDGs)1.

It is with this thought in mind that IFHA was established in 2007; a private equity capital fund dedi-

cated to investments in private healthcare companies in Africa.

IFHA’s first closing was in May 2008 in which €14.7

million was committed from anchor investors FMO,

Goldman Sachs and the Social Investor Foundation

for Africa (SIFA). In August 2010, the second clo-

sing was completed in which an additional amount

of €35.4 million was committed by FMO, Pfizer,

APB pension fund, the African Development Bank

(AfDB) and the International Finance Corporation

(IFC).

2.1 Structure IFHA

IFHA is managed by African Health Systems

Management Company (AHSM), “the Mana-

ger” consisting of an experienced management

team with several years of experience in the

private healthcare industry in Africa.

Historically, strong ties exist between “the Ma-

nager” and PharmAccess Foundation; a Dutch

Non-Profit Organization (NGO) specialized

in capacity building in private healthcare in

Sub-Saharan Africa. The corporate governance

structure is a solid structure including an Ad-

visory Committee, Investment Committee and

Supervisory Board. The IFHA team constitutes

of six professionals with substantial private

equity and finance experience, including one

1- Harmonization for Health in Africa (HHA-2011), Investing in Health in Africa; the case for strengthening Systems for Better Health outcomes. Accesible at: http://www.who.int/pmnch/media/membernews/2011/investing_health_ africa_eng.pdf

Overview

11

team member in South Africa.

Figure 1 presents IFHA’s corporate governance structure.

2.2 Investment Policy

IFHA is set up as a fund that invests in fast-growing

markets which show unique advantages over the

competition and uses several sectoral focus points

when investing in private healthcare in Africa:

* Health insurance and Health

Maintenance Organizations (HMOs)

* Healthcare provision

* Pharmaceutical wholesale and

distribution

* Manufacturing of pharmaceuticals and

medical supplies

* Other health related investments

Furthermore, IFHA maintains a number of

investment criteria when considering an investment:

- The size of investee companies in terms of

annual turnover should lie between EUR

1 to EUR 20 million, although investments in

larger companies may also be considered

- The minimum investment size is not smaller

than EUR 500,000 in a single investment

- The normal investment size ranges from

EUR 0,5 to EUR 7,5 million

- IFHA will focus on equity participations

with protections through board seats and

provisions, although it has the ability to invest

in other instruments

- Favorable assessment of management

capacities

ESD Performance Report 2013

Overview


- High growth rates in the domestic markets

and sufficient current market size

Figure: Geographical scope investments IFHA

2.3 Portfolio companies

In 2011 IFHA performed six investments:

- Hygeia

Hygeia is the largest HMO in Nigeria and offers both

health insurance and delivery of healthcare in Nige-

ria.

- Pyramid Pharma

Pyramid Pharma is a pharmaceutical wholesale and

distribution company based in Tanzania.

- Strategis

Strategis is a company which offers health insurance

in Tanzania.

- AAR

AAR is the largest private healthcare company in the

East African region and offers both health insurance

and delivery of healthcare in Kenya, Uganda and

Tanzania, and in Zambia from 1 May 2014.

- Hello Doctor

Hello Doctor is an innovative company which uses

medicine services to improve the access to healthcare

services and is based in South Africa.

- Sourcelink

Sourcelink is a South African based manufacutring

company which produces medical supplies.

In 2012 IFHA performed the following investment:

- ER Corporate

ER Corporate is a specialized medical administration

and training company and is part of the ER Group.

ER Corporate manage 18 Emergency and other spe-

cialist practices across South Africa.

In 2013 IFHA performed the following investments:

- Kampala Hospital Limited

Kampala Hospital Limited (KHL) is an urban hospi-

tal in Uganda with significant growth potential.

- Eco Health Limited (WWCVL and WHL):

Eco Health Limited and its wholly-owned group

companies WWCVL Nigeria and WHL Ghana are

engaged in the wholesale and retail distribution of

healthcare related products.

Overview

13

IFHA’s D

evelopment M

atrix

14ESD Performance Report 2013

3. IFHA’s DEVELOPMENT MATRIX

3.1. Development objectives

In collaboration with KPMG, IFHA has redesigned

the initial development objectives to a comprehen-

sive list of eight objectives which directly relate to

the MDGs which can be found in the figure below.

The first two development objectives 1- Increase

availability of products and services; and 2- Ensure

equitable access to products and service, are IFHA’s

main strategic indicators.

3.2 Objectives per sector

Because of the fact that IFHA’s portfolio compa-

nies are active in several sectors, namely healthcare

provision, health insurance, production and manu-

facturing, and wholesale and distribution, specific

objectives are applicable per sector on which will be

elaborated in the next sections.

3.2.1 Healthcare provision

The healthcare sector includes investments in hospi-

tals and clinics. Currently three of IFHA’s portfolio

companies can be labled under the healthcare provi-

sion sector, namely AAR Healthcare in East Africa,

Lagoon Hospitals of Hygeia in Nigeria and Kampala

Hospital Limited in Uganda.

For IFHA, the main development objectives for the

healtcare provision sector are (see next page):

This chapter gives an overview of the development and validation of IFHA’s Development Matrix.

Furthermore, it gives an insight in how IFHA measures the Social and Environmental Impact of its

portfolio companies.

Development objective

1- Increase availability of products and services.

2- Ensure equitable access to products and services.

3- Increase affordability of products and services.

4- Ensure quality of products and services.

5- Stimulate (local) economy and equit able access to employment.

6- Stimulate decent work.

7- Reduce environment impact.

8- Apply good governance and transparency.

IFHA’s D

evelopment M

atrix

15

- To ensure the quality of products and services

Examples:

* Number of pharmaceuticals which have expired

* Total value of pharmaceuticals dispensed

* Has the company a quality system in place?

- To ensurance equitable access to products and

services

Examples:

* Total number of patients

* Total number of clinic visits a year

* Total number of healthcare workers

* The bed occupancy rate (BOR)

3.2.2 Health insurance/HMO

IFHA has invested in three companies which are

providing health insurance: AAR Insurance in East

Africa, Hygeia HMO part of Hygeia in Nigeria and

Strategis in Tanzania. One main development objec-

tive that IFHA maintains is:

- To increase the affordability of products and

services

Examples:

* Lowest cost insurance package provided

* Services covered in the lowest cost package

* Services covered in the lowest package provided

3.2.3 Wholesale and distribution

Pyramid Pharma in Tanzania, WWCVL in Nigeria

and WHL in Ghana are IFHA’s portfolio companies

which are active in the wholesale and distribution sec-

tor. For IFHA, the two main development objectives of

this sector are:

- To increase the availability of products and services

Examples:

* Total number of drugs delivered which are

related to specific conditions/diseases

* Total number of medical equitment delivered

* Total number of companies supplied through distribu-

tion channel

* Total number of distribution warehouses


Examples:

* Number of times not being able to deliver an order

* Number of times of late delivery

* Inventory and stock control system in place


IFHA’s D

evelopment M

atrix


3.2.4 Production and manufacturing

In 2011, IFHA’s investment in Sourcelink Healthcare

in South Africa was completed. Sourcelink is a com-

pany which manufactures disposable medical sup-

plies. The two main objectives that IFHA maintains

for this manufacturing company are:

- To reduce the environmental impact

Examples:

* Procedures for waste disposal in place

* Total amount of hazardous waste generated

* Total amount of non-hazardous waste generated


Examples:

* The appropriate infrastructure in the company is in

place to ensure the proper maintanance of products

3.3 Indicators (SMART)

In collaboration with KPMG, IFHA has created

SMART indicators which measure the development

objectives. SMART means that the indicators have

to be Specific, Measurable, Attainable, Relevant and

Time-bound.

3.4 Practice

As mentioned before in chapter 3, IFHA’s develop-

ment matrix is reviewed based on the several tools

used to measure the Environmental and Social

impact, namely the MDGs and the IFC Performance

Standards and Guidelines. Based on the outcome of

this review, IFHA created eight development objec-

tives, described in this chapter, which can be linked

to specific indicators and the healthcare sectors

IFHA invests in.

In preparation for the actual ESD audit in which

the consultants will visit IFHA’s portfolio compa-

nies to measure the ESD performance, IFHA sends

out a development matrix questionnaire. This is an

Excell sheet in which categories are combined with

questions relating to one of the eight development

objectives which in turn are linked to indicators.

Page one of the development matrix questionnaire

is visible in the figure on the next page. The red part

on the left represents the ESD category in which the

questions fall.

Besides answering the general questions in the co-

ver sheet and general questions section, each port-

folio company is asked to fill in the sheet which is

applicable to their branch.

IFHA’s D

evelopment M

atrix

17

When the actual audit takes place, the questionnaire

serves as a guidance tool after which the questions in

the audit are streamlined. At the end of each audit the

consultants give a so-called “Close-out presentation”

in which they share their findings with the portfolio

company and where they share their suggestions for

improvement. Eventhough IFHA’s ESD audits are not

intended as an obligatory instrument to which the

portfolio company has to comply; the first (entry) sta-

ge of measurement creates a sense of ESD awareness

which will hopefully stimulate the portfolio company

to improve their ESD impact not only on a topdown,

but also at a grassroots level. Once the mid-term audit

results are in, IFHA will compare these with the entry

level outcomes in order to find out whether the port-

folio companies have taken the improvement suggesti-

ons for better use and if ESD improvement has set in.

Figure : First page of IFHA’s development matrix questionnaire


ESD audit at WWCVL Nigeria (October 2013)

IFHA’s D

evelopment M

atrix


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IFHA’s D

evelopment M

atrix

4. IFHA’s PORTFOLIO COMPANIES: ESD IMPACT

This chapter gives an overview of the ESD impact at IFHA’s portfolio companies and connects them to IFHA’s

two main strategic objectives; “To increase availability of products and services” and “To ensure equitable ac-

cess to products and services”. As IFHA’s development objectives are connected to each other, the data pre-

sented below can also be linked to IFHA’s other development objectives. The data is obtained via ESD impact

measurements at IFHA’s portfolio companies and its subsidiaries. In 2011 Pyramid Pharma and AAR Heal-

thcare Tanzania were audited, in 2012 the other AAR subsidiaries and Hygeia; and in 2013 Sourcelink, ER

Corporate, WWCVL Nigeria and WHL Ghana. For a more detailed overview of the outcomes see Annex 2.

4.1 Ensure equitable access to products and services

Introduction

IFHA’s investments in health insurance, telemedicine,

and pharmaceutical distribution result in more equit-

able access to health.

Increasing the total number of customers having a

health insurance, in addition to implementing low-

income schemes and offering products and services

both in urban and rurals areas improve access to

health. This has a direct impact on the reduction of

diseases (MDG 6), improved health (MDG 3, MDG

4, MDG 5), and hence a more and stable predicta-

ble income (MDG 1). Some examples of improved

access to health products and services are set out in

this chapter. For specific examples of the progress

of IFHA’s portfolio companies in 2013 in relation to

IFHA’s development objectives, see Annex 3.

Insured customers

The number of people with health insurance has in-

creased during the lifetime of IFHA’s investments.

Enrollment data in 2007 and 2008 include customers of Hygeia. 2009 include Hygeia and Strategis. 2010 , 2011 and 2012 and 2013 include customers of Hygeia, Strategis and AAR.

Note: the number of people with managed healthcare insurance in 2013 is less than in 2012 due to a reduction of 10,000 enrolles in a donor funded pogram of the Health Insurance Fund implemented by the Hygeia Community Health Care (HCHC) programme.


Number of people insured2006 2007 2008 2009 2010 2011 2012 2013

High income 105,646 149,322 175,547 222,247 305,901 301,600 319,318 340,183 Middle income 43,250 63,149 65,849 66,324 135,734 161,485 173,393 141,193 Low income 6,483 29,529 52,225 63,388 96,843 137,338 139,961 144,800

Total 155,379 242,000 293,621 351,958 538,478 600,423 632,671 626,175

IFHA’s Portfolio C

ompanies: ESD

Impact


General trend: Rural and urban insured.Enrollment data in 2007 and 2008 include customers of Hygeia. 2009 include Hygeia and Strategis. 2010, 2011, 2012 and 2013 include Hy-geia, Strategis and AAR.

Out-patient visits

In 2013, a total number of approximately 800,000

out-patient visits took place at clinics of Hygeia and

AAR. This is a growth of about 125,000 compared

to 2012 without the addition of an extra portfolio

company (which contributed to the strong growth

between 2009-2010).

Increased focus on solvency and capital requirements

have led to higher pricing and less growth in insured.

In 2013, IFHA’s portfolio companies Hygeia, Strategis

and AAR insured approximately 626.000 customers.

When more people are insured, their health will im-

prove which will give them the opportunity to work

and to provide for a more stable and predictable

income. The table below shows a substantial increase

in the number of people insured in IFHA’s lifetime.

Insured high/middle/low income levelEnrollment data in 2007 and 2008 include customers of Hygeia. 2009 include Hygeia and Strategis. 2010 , 2011, 2012 and 2013 include Hygeia, Strategis and AAR.

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

2007 2008 2009 2010 2011 2012 2013

Insured: high, middle, low income level

High income Middle income Low income

IFHA’s insurance companies follow the natural evo-

lution from high income to middle and low-income

customer, as illustrated in the graph.

Closely related to the natural evolution of the in-

surance customer base from high to middle and

low-income customers (see graph), is the evolution

of urban to rural based customers.The number of

customers based in urban areas increased from over

106,000 customers by the end of 2006 to roughly

500,000 customers by the end of 2013. The number

of customers based in rural areas increased from

roughly 49,000 to 120,000 in the same period.

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

2007 2008 2009 2010 2011 2012 2013

Rural and urban insured

Urban Rural

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

2007 2008 2009 2010 2011 2012 2013

Out-patient visits

Outpatient visits

Number of out-patient visitsNumber of visits in 2007, 2008 and 2009 include Hygeia. 2010, 2011, 2012 and 2013 include Hygeia and AAR.

21

4.2 Increase availabilty of health products and

services

Introduction

With IFHA’s investment in health insurance and

wholesale and distribution, the availability of pro-

ducts and services increases. Adding services to exis-

ting insurance packages, and extending the product

portfolio as well as sustaining the delivery of phar-

maceuticals (MDG 8), are examples of increasing the

availability of healthcare. This has a direct impact on

the reduction of diseases (MDG 6), improved health

(MDG 3, MDG 4, MDG 5), and hence a more and

stable predictable income (MDG 1).

In the table above is visible how the number of

people insured are divided amongst several sectoral

groups (Corporate and Governmental Organisations,

Civil servants and Community program).

The group which falls under the Community pro-

gram- sector has dencreased the past year due to

a reduction of enrollees in a pogram of the Health

Insurance Fund implemented by the Hygeia Com-

munity Health Care (HCHC) programme.

Number of people insured.Enrollment data in 2007 and 2008 include customers of Hygeia. 2009 include Hygeia and Strategis. 2010, 2011, 2012 and 2013 include Hy-geia, Strategis and AAR.

-

500

1,000

1,500

2,000

2,500

3,000

2007 2008 2009 2010 2011 2012 2013

Division male/female

Female Male

Employee division male/female. Data in 2007 include employees of Hygeia. 2008 include Hygeia and Pyramid Pharma. 2009 include Hygeia, Pyramid Pharma and Strateg-is. 2010 include Hygeia, Strategis, Pyramid Pharma, Hello Doctor and AAR. 2011 include employees of Hygeia, Strategis, Pyramid Pharma, Hello Doctor, AAR and Sourcelink. 2012 include Hygeia, Pyramid Pharma, Strategis, Hello Doctor, AAR, Sourcelink and ER Corporate. In 2013, data of Kampala Hospital and Eco Health Limited is added.

Employees

Another indicator which shows that IFHA’s invest-

ments are having an impact on the availability of

health products and services is the number of people

that are employed. After all, a company that is in-

creasing its operations needs to expand its capacity

in order to meet the growing need for products and

services. The graph on this page shows the employ-

ee-trend over the last years. It is important to note

that women represent more than half of all employ-

ees within the companies in IFHA’s portfolio. Provi-

ding equal opportunities for men and women is well

presented here (see graph below). The total work-

force in 2013 increased with 900, primarily because

of IFHA’s three new portfolio companies in 2013.

-

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

2006 2007 2008 2009 2010 2011 2012 2013

Number of people insured

Corporate and governmental organizations Civil servants Community program


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onclusion


5. CONCLUSION

This fourth edition of the ESD performance re-

port described the performance of IFHA’s portfolio

companies in 2013. The development and validation

of IFHA’s development matrix was outlined and an

explanation has been given on how IFHA uses the

matrix in order to measure the ESD impact of its

portfolio companies.

Entry level ESD measurements have taken place in

2013 at all of IFHA’s portfolio companies, except for

Kampala Hospital Limited which is scheduled for

July 2014. All these measurements have created ESD

awareness and monitoring of the ESD results is pre-

cisely monitored by IFHA’s Environmental & Social

Manager.

Moreover, an important achievement during 2013 is

that Pyramid Pharma Tanzania has received an ISO

9001:2008 Quality Standard Certification, which is

an international quality accreditiation.

Furthermore, AAR’s membership of the UN Global

Compact allowed it to take part in the putting toge-

ther of the Code of Ethics for Business in Kenya. In

March 2012, AAR became the signatory of this Code

as well as supporter for the ‘Rights of the Child in

Business’ which was launched in Nairobi in October

2012. Besides this, in 2013 AAR’s CEO has signed the

United Nations Global Compact Water Mandate.

Achievements of AAR’s Beckmann Trust in 2013 are

as followed:

- 35,000 children have been de-wormed

- 170 schools are on board for the “Trees for Health”

project and 4,468 trees were planted

AAR’s Beckmann Trust Trees for Health project (2013)

23

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onclusion

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nnexes


6. ANNEXES: TABLE OF CONTENTS

Annex 1: Environmental, Social and Development Management System IFHA 25 1.1 IFHA’s Dvelopment philosophy 25 1.2 Environmental Social and Development framework 26 1.2.1 IFHA’s exclusion list 26 1.2.2 National laws on environment, health, safety and social issues 26 1.2.3 IFHA’s development matrix (KPMG) 26 Reviewed on: 1.2.3.1 Millennium Development Goals (MDGs) 27 1.2.3.2. IFC Performance Standards and IFC guidelines for specific sectors 27 Annex 2: Examples of ESD Impact within IFHA’s portfolio companies 29 1- Increase availability of products and services 29 2- Ensure equitable access to products and services 29 3- Increase affordability of products and services 29 4- Ensure quality of products and services 29 5- Stimulate (local) economy and equitable access to employment 30 6- Stimulate decent work 30 7- Reduce negative enironmental impact 31 8-Apply good governance and transparency 32

Annex 3: Data ESD audits subsidiaries IFHA Portfolio Companies 33

Annex 4: Data ESD audits per sector 36

Annex 5: Snapshot Portfolio Companies 44

Hygeia 44 Pyramid Pharma 45 Strategis 46 Hello Doctor 47 AAR 48 Sourcelink 49 ER Corporate 50 Kampala Hospital Limited 51 Eco Health Limited 52


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nnexes


The African healthcare market offers attractive investment opportunities, not only in terms of finan-

cial returns, but also in terms of social returns. Private sector development is essential in order to

achieve a better healthcare system in Africa and hence a better quality of life. In recent years, leading

international institutions such as the World Bank and IFC have stressed this fact and have put incre-

ased focus on stimulating private sector initiatives.

1.1 IFHA’s development philosophy

By providing private equity, IFHA breaches the vici-

ous circle through stimulating the supply side of the

healthcare market. The delivery of adequate health

services in Africa is prevented by the existence of a

vicious circle that consists of (1) a low demand for

good quality healthcare and (2) a low supply of good

quality healthcare:

1- Low (paying) demand for healthcare

The quality of services is key for the demand for

healthcare. Without good quality of healthcare the

willingness to pay for it is low, especially in the case

of Africa where people have few resources. The same

applies for health insurance: with limited resources,

people are not willing to prepay for services which

they might (not) use and are of low quality.

2- Low supply of quality healthcare

Due to little income from pre-paid health insurance

and few paying customers, revenues for healthcare

providers are limited and uncertain.

Due to the interconnectivity of the circle, higher

quality of the supply side, higher efficiency, and so

on, people are more willing to pay for healthcare and

demand will be higher.

Hence, because of the absence of good quality

healthcare, investments are perceived risky and do

not take place. This involves that the quality of care

(supply) remains low and there is a vicious circle of

low quality and low demand (see figure below). The

impact IFHA strives to bring about starts with the

injection of money into Africa’s private heathcare

Annex 1Environmental, Social and Development Management System

Figure: Vicous circle of healthcare quality

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nnexes


sector. This induces market movements enlarging the

development impact. For example, before the year of

inception of IFHA (2007), health insurance for low-

income groups within Africa was mainly provided

by public funds of governments and NGOs. Capital

investment in private insurance companies, such as

a Health Maintenance Organization (HMO) leads to

increased risk pooling and subsequent lower reli-

ance on out-of-pocket payments by individuals. This

results in more stable cash flows for health providers

and a risk reduction for private investors implicating

a lower cost of capital. Through lower perceived risk

more private investments can be attracted. Hence,

IFHA’s capital injection creates additional funds in

the system that have a social impact.

1.2 Environmental, Social and

Development (ESD) Framework

IFHA’s ESD Framework is embedded in its invest-

ment policy, in which reference is made to specific

guidelines with respect to environmental, social and

development impact of investee companies.

The ESD policy includes (1) IFHA’s exclusion list, (2)

Standards as set down in applicable national laws on

environment, health, safety and social issues and (3)

IFHA’s development matrix.

1.2.1 IFHA’s exclusion list

IFHA developed a list which defines the types of

activities of investee companies that IFHA does not

invest in or finance, e.g. production and trade in

wapons, the tobacco industry, or radiactive materials.

1.2.2 National laws on environment, health,

and safety

IFHA makes sure that the activities of IFHA’s

investee companies align with the national laws on

environment, health and safety.

1.2.3 IFHA’s development matrix

IFHA ensures that all activities undertaken by the

portfolio companies are consistent with IFHA’s ESD

policy, through periodic review and analysis of the

portfolio companies. This is done via IFHA’s deve-

lopment matrix which is an important component of

the ESD Framework. With the development matrix,

besides the social impact brought about by capital

investment in private companies, other impact areas

can be identified. These areas are captured and mea-

sured along predefined indicators in IFHA’s develop-

ment matrix in order to make the contribution to the

MDGs measurable.

IFHA has collaborated with KPMG in order to deve-

lop and review the development matrix which is in

the first place based on the (1) MDGs and is designed

to make IFHA’s contribution to the MDGs measura-

ble. Besides the fact that IFHA’s development matrix

A

nnexes


is based on the MDGs, IFHA’s E&S Manager (in

collaboration with KPMG) has reviewed the com-

pleteness of the development matrix against specific

globally recognized standards which are the IFC

Performance Standards and Guidelines for specific

sectors.

1.2.3.1 Millennium Development Goals

The MDGs were established in September 2000 when

world leaders came together at the United Nations

Headquarters in New York to adopt the United Nati-

ons Millennium Declaration. In this Declaration they

committed their nations at a new global partnership

to reduce extreme poverty and setting out a series

of time-bound targets (with a deadline of 2015).

The eight goals in the Declaration are known as the

MDGs.1 Because of the fact that IFHA aims to con-

tribute to the global partnership to reduce extreme

poverty and make it visible; IFHA monitors indica-

tors that are based on the MDGs. These indicators

include the increase in labor productivity, increase in

local knowhow, and the increase in access to health-

care (i.e. increase in number of hospitals / clinics; or

increased affordability of services) since better health

will allow people to work. Three of the eight MDGs

relate directly to the sectors in which IFHA invests.

These are the following: MDG 4 ‘Reduce child mor-

tality’, MDG 5 ‘Improve maternal health’ and MDG

6 ‘Combat HIV/Aids, malaria and other diseases’. By 1 Source: http://www.un.org/millenniumgoals/bkgd.shtml, April 2012

investing in health, IFHA has a direct impact on these

MDGs. In addition, IFHA’s investments, targeting the

African population, affect MDG 1 ‘Eradicate extreme

poverty and hunger’ as well as MDG 3 ‘Promote gen-

der equality and empower women’. Measuring along-

side the MDGs will enable IFHA to show development

impact such as increased access to quality healthcare

in Sub-Saharan Africa. IFHA’s indicators measure

development impact within the areas: affordability,

accessibility, availability and quality of healthcare, as

well as improvement of the working conditions of the

companies’ employees. Below is set down how deve-

lopment impact for each MGD is realized.

1.2.3.2 IFC Performance Standards and

Guidelines for specific sectors

The International Finance Corporation (IFC) applies

its Performance Standards to manage social

and environmental risks and impacts and to enhance

development opportunities in its private sector

financing in its member countries eligible for finan-

cing. 2 These Performance Standards define the roles

and responsibilities for managing projects and requi-

rements for IFC support. They also include require-

ments to disclose information.

In addition to these Performance Standards, IFC

developed guidance notes which provide guidance

2 Source: International Finance Corporation’s Performance Standards on Social & Environmental Sustainability, 30 April 2006.

A

nnexes


for meeting the Performance Standards in specific

sectors. IFHA linked IFC’s Performance Standards

to the indicators of the development matrix in order

to get a better overview and understanding of the

environmental and social status (and improvement)

of the investee companies.

MDG 4: Reduce child mortality.Reached by increasing the number of children with insurance, inclusion of treatments in insurance packages and improved accessebility, availability and affordabilty of services.

MDG 5: Improve maternal health.Reached by increasing the number of mothers/women with insurance, inclusion of treatments in insurance packages and improved accessibility, availability and affordability of services.

MDG 6: Combat HIV/AIDS, malaria and other diseases.Reached by the inclusion of these treatments in insurance packages, proved healthcare and better available and af-fordable services.

MDG 7: Ensure environmental sustainability.An environmental and sustainable (work) environment is created by increased and professional attention to workking conditions and compliance with international standards on environmental and social issues, sucha s the IFC Perfor-mance Standards.

MDG 8: Develop a global partnership for development.Providing access to affordable and qualified drugs and creating a reliable healthcare network contributes to the development of a global partnership for development.

MDG 1: Eradicate extreme hunger and poverty. This is realized by reducing the out of pocket expenses paid by people when healthcare is needed, and hence providing them with a more stable income and better health. As well, by increased job opportunities and training, local knowhow will increase.

MDG 3: Promote gender equality and empower women.Reached by a better health for women (including maternal health insurance packages), training on the job and incre-ased job opportunities.

Overview Millenium Development Goals:

A

nnexes


Annex 2: Examples of the ESD impact within IFHA’s portfolio companiesIn this Annex examples are given of the ESD im-

pact within IFHA’s portfolio companies and the ac-

complishments of IFHA’s portfolio companies with

regard to (inter)national awards, certificates and

accreditations that were obtained in 2013. These

examples are linked to the development objectives.

1- Increase availability of health products and

services

In April 2013, Pyramid Pharma Tanzania has re-

ceived an ISO:2008 Quality Standard Certification,

which is an international quality accreditiation. This,

among other things, resulted in a turnover growth

and entails an expansion of Pyramid Pharma’s distri-

bution activities and thereby increasing the availabi-

lity of health products in the region.

2- Ensure equitable access to products and services

The main goal of Hello Doctor is to connect doctors

to patients via telemedicine services and hereby to

ensure equitable acces to healthcare products and

services. The services that Hello Doctor provides are

especially interesting for people with a lower income

as contact with the doctor

will occur via telephone or

email and thereby re-

ducing the doctor’s fee.

Patients living in remote areas can have easy access

to the service as they do not have to travel to see a

doctor, but can contact the doctor from their home.

IFHA has exitted in Hello Doctor in 2013.

3- Increase affordability of products and services

IFHA’s portfolio company in Nigeria ‘Hygeia’ in colla-

boration with PharmAccess and the Health Insurance

Fund, provides equitable access to affordable and

qualtiy healthcare services to selected low-income

communities in the region via the Hygeia Commu-

nity Health Care (HCHC) programme.

4- Ensure quality of products and services

Besides ensuring quality of products and services on

a business profit-making level, IFHA’s portfolio com-

panies are also contributing to the quality of health-

care not directly aimed at direct financial returns. An

example is the Hygeia Foundation which depends on

external funding and which main aim is to improve

skills and abilities in the Nigerian healthcare sector.1

Moreover, in 2012 Sourcelink received an ISO 13485

Quality Standard Certification and in 2013, Pyramid

Pharma Tanzania received an ISO 9001:2008 certifi-

cation which shows a high-standard of their products

which is internatiolly recognised.

A

nnexes


In April 2011 Hygeia’s Lagoon hospitals became the

first hospitals in Sub-Saharan Africa to earn accre-

ditation from the Joint Commission International

(JCI). JCI is the worldwide leader in improving the

quality of healthcare.

5- Stimulate (local) economy and equitable access

to employment

As at 31 December 2013, the direct total employ-

ment of our portfolio companies is 2,384 employees

of which 1,249 female employees. This shows that

women have equitable access to employment and the

new jobs are stimulating the local economy.

6 Stimulate decent work

In 2012 Pyramid Pharma has improved in several

ways regarding the stimulation of decent work.

First of all the company hired a HR manager which

resulted in the fact that all employees received an

official employment contract. A system has been set

up in which all employees who did not have a bank-

account were offered one. Pyramid Pharma now pays

out salaries via banktransfers, a much safer payment

way and a clear indicator in the stimulation to decent

work. All Pyramid Pharma warehouse-workers

received a formal tenue with strong closed shoes.

The new clothes and shoes are a contribution to their

safety on the workfloor.

Hygeia Foundation - Statistics

- Active in 24 States in Nigeria

- Almost 12,000 people placed on HIV/Aids

treatment

- The only indigenous NGO implementing a free

comprehensive Anti-Retroviral Treatment

programme across all the States of Nigeria

- Integrating HIV/AIDS medical intervention with a

peer support system

A

nnexes


7 Reduce environmental impact

The most obvious example in which one of IFHA’s

portfolio companies creates environmental aware-

ness and reducess negative environmental impact is

the AAR Beckmann Trust (named after the founder

of the company). The Trust is leveraging on AAR’s

expertise in health delivery, and combining it with

the Beckmann family’s commitment towards health

around the world. The Trust creates programmes

that provide hands-on opportunities for East African

communities to improve their environment, and en-

gage in income-generating and sustainable activities

to obtain access to health.

AAR - Trees for Health

One programme in the AAR Beckmann Trust is

called “Trees for Health” . The programme enables

schools to grow trees and provide a self-sustaining

source of firewood.

The programme aims at:

- Re-forestation

- Encouraging schools to grow their own firewood

- Generated/ saved funds used for basic preventive

health needs of the school children

- Directly involving children in the tree planting

process and hence creating environmental

awareness.

By the end of 2013, AAR has 170 schools on board of

the program and 4,468 trees were planted.

A

nnexes


8 Apply good governance and transparancy

All of IFHA’s portfolio companies have a supervi-

sory board which monitors the operations. IFHA

has a minimum of one boardseat in each portfolio

company and can therefore have an influence on the

operational process and make sure good governance

and transparancy are well executed.


A

nnexes


Annex 3: Data ESD audits subsidiaries IFHA Portfolio Companies

Subs

idar

ies I

FHA

Port

folio

co

mpa

nies

whi

ch h

ave

been

m

easu

red

sepe

rate

ly >

>>

AAR

HC

Tanz

ania

(2

013)

Pyra

mid

Ph

arm

a (2

013)

Hyge

ia H

MO

(2

013)

Hyge

ia

Hosp

itals

(201

3)

AAR

HC

Keny

a (2

013)

AAR

HC

Ugan

da

(201

3)

AAR

Insu

ranc

e Ta

nzan

ia

(201

3)

AAR

Insu

ranc

e Ug

anda

(201

3)

AAR

Insu

ranc

e Ke

nya

(201

3)

Sour

celin

k He

alth

care

(2

013)

ER C

orpo

rate

Ad

min

istra

tion

(201

3)

Kam

pala

Ho

spita

l (20

13)

WW

CVL

Nig

eria

(201

3)W

HL G

hana

(2

013)

Obj

ectiv

e: S

timul

ate

(loca

l) ec

onom

y an

d eq

uita

ble

acce

ss to

em

ploy

men

t

Fina

ncia

l yea

r is

from

1 A

pril

- 31

Mar

ch

Fina

ncia

l yea

r is

from

1 A

pril

- 31

Mar

ch

Tota

l rev

enue

TZS

6,35

7,92

4,04

6TZ

S 22

,706

,048

,672

NGN

8,

350,

360,

188

NGN

3,

217,

770,

975

KES

884,

569,

072

UGX

12,4

76,4

89,8

11TZ

S 36

,248

,218

,000

UGX

22,5

74,3

09,2

21KE

S 2,

619,

874,

265

ZAR

839,

030

ZAR

18,5

23,7

71UG

X 3,

668,

555,

000

NGN

20

,682

,080

,356

CEDI

8,5

00,0

00

Subs

idie

s and

free

goo

ds re

ceiv

ed0

N/A

00

00

00

00

00

00

New

inve

stm

ents

(inc

ludi

ng p

rivat

e in

vest

men

ts a

nd d

onor

/ pub

lic

fund

ing)

.0

00

0AA

R HC

Ho

ldin

gs:

USD

353,

000

IFHA

&

Swed

fund

: US

D 35

3,00

00

0IF

HA: Z

AR

3,10

4,31

2IF

HA: Z

AR

5,00

5,00

0

IFHA

: USD

3.8

m

(not

all

avai

labl

e ye

t)

Chai

nrai

Fam

ily:

NGN

3,5

00,0

00

(wor

king

capi

tal

loan

)

0

Inve

stm

ents

rece

ived

in p

revi

ous

year

s tha

t con

tinue

d to

be

rece

ived

in

the

repo

rtin

g ye

ar (i

nclu

ding

pr

ivat

e in

vest

men

ts a

nd d

onor

/ pu

blic

fund

ing)

.

00

00

00

00

IFHA

: EUR

8,

434,

853

00

00

0

Tota

l cos

t of p

urch

ases

from

su

pplie

rs th

at p

rodu

ce th

eir g

oods

/ se

rvic

es in

you

r cou

ntry

:N

/ATZ

S 2,

080,

665,

557

NGN

6,

903,

196,

826

0N

ot a

vaila

ble

UGX

16,3

55,7

00TZ

S 31

,911

,595

,609

UGX

16,9

01,6

83,6

29KE

S 2,

153,

884,

419

ZAR

2,87

7,00

6ZA

R 6,

592,

686

UGX

2,00

0,00

0 pe

r mon

thN

GN 1

44,9

37,5

05CE

DI 1

00,0

00

Tota

l cos

t of p

urch

ases

from

su

pplie

rs w

hich

pro

duce

thei

r go

ods o

r ser

vice

s in

othe

r Afr

ican

co

untr

ies:

N/A

00

Not

ava

ilabl

eUG

X 10

4,38

5,70

0TZ

S 1,

026,

029,

329

UGX

272,

589,

838

KES

5,21

6,78

9N

/A0

UGX

6,00

0,00

0 pe

r mon

thN

GN 8

60,3

55,3

280

Tota

l cos

t of p

urch

ases

from

su

pplie

rs w

hich

pro

duce

thei

r go

ods o

r ser

vice

s in

coun

trie

s tha

t ar

e no

t in

Afric

a:

N/A

TZS

12,6

26,0

31,2

650

Unkn

own

KES

262,

692,

879

UGX

2,53

8,36

7,80

6TZ

S 78

0,13

1,06

10

KES

11,3

94,8

16ZA

R 46

,234

0UG

X 12

3,80

0,00

0N

GN

17,4

76,2

15,6

42CE

DI 6

,000

,000

Com

pany

's fa

cilit

ies t

hat w

ere

built

/exp

ande

d/im

prov

ed w

hich

al

so h

ave

a pu

blic

ben

efit.

If ye

s, p

leas

e ex

plai

n.

Sinz

a Cl

inic

st

arte

d it'

s op

erat

ion

May

20

13. L

ocat

ed

at S

inza

M

aduk

ani

whe

re it

's ac

cess

ible

to

both

priv

ate

and

heal

th

insu

red

mem

bers

from

di

ffer

ent

insu

ranc

e co

mpa

nies

NO

NO

Yes,

new

ge

nera

l ou

tpat

ient

pr

efab

ricat

ed

build

ing

in

Apap

a

YES,

1.

Emba

kasi

and

M

ount

ain

Mal

l Clin

ics

open

ed in

N

ov

2013

&De

c 20

13 2

. Ki

sum

u Cl

inic

ex

pand

ed (3

co

nsul

tatio

n ro

oms)

3.

Eldo

ret C

linic

ex

pand

ed to

(2

co

nsul

tatio

n ro

oms)

NO

NO

NO

Yes,

AAR

In

sura

nce

Nye

ri &

N

aiva

sha

bran

ches

w

ere

reno

vate

d

NO

NO

YES:

im

prov

emen

t of

the

road

lead

ing

to th

e Ho

spita

l fr

om K

aboj

ja

Juni

or S

choo

l

YES:

new

Enu

gu

depo

t - S

ep

2012

. WH

expa

nsio

ns in

Ab

a &

Oni

tsha

Non

e, e

xcep

t for

a

cold

room

All t

axes

(inc

ome,

corp

orat

e, V

AT,

etc)

and

levi

es m

ade

to th

e go

vern

men

t:Un

know

nTZ

S 75

0,00

0,00

0N

GN 2

6,59

4,91

5Un

know

nKE

S 44

,396

,103

UGX

350,

920,

568

TZS

733,

309,

000

UGX

19,6

47,2

02KE

S 11

9,77

8,46

8ZA

R 35

7,17

7ZA

R 1,

769,

276

UGX

48,7

11,0

00N

GN 1

10,0

00,0

00CE

DI 1

,200

,000

Num

ber o

f em

ploy

ees o

n pa

yrol

l:Pe

rman

ent s

taff

149

5817

859

321

915

072

5012

41

6615

434

337

Tem

pora

rily

staf

f43

422

011

785

143

823

2N

A77

7N

umbe

r of n

atio

nal e

mpl

oyee

s on

payr

oll:

149

5519

059

333

614

671

4820

64

6615

431

840

Num

ber o

f nat

iona

l hig

hly

skill

ed

empl

oyee

s on

payr

oll

122

4113

844

829

414

966

4812

44

313

211

635

Tota

l hou

rs o

f tra

inin

g:N

ot re

cord

ed39

0896

Not

reco

rded

3071

160

618

Not

reco

rded

Not

reco

rded

120

994

Not

reco

rded

560

584

A

nnexes


Subs

idar

ies I

FHA

Port

folio

co

mpa

nies

whi

ch h

ave

been

m

easu

red

sepe

rate

ly >

>>

AAR

HC

Tanz

ania

(2

013)

Pyra

mid

Ph

arm

a (2

013)

Hyge

ia H

MO

(2

013)

Hyge

ia

Hosp

itals

(201

3)

AAR

HC

Keny

a (2

013)

AAR

HC

Ugan

da

(201

3)

AAR

Insu

ranc

e Ta

nzan

ia

(201

3)

AAR

Insu

ranc

e Ug

anda

(201

3)

AAR

Insu

ranc

e Ke

nya

(201

3)

Sour

celin

k He

alth

care

(2

013)

ER C

orpo

rate

Ad

min

istra

tion

(201

3)

Kam

pala

Ho

spita

l (20

13)

WW

CVL

Nig

eria

(201

3)W

HL G

hana

(2

013)

Obj

ectiv

e: A

pply

goo

d go

vern

ance

and

tr

ansp

aren

cyAn

ti-co

rrupt

ion

proc

edur

es in

pl

ace:

YES

YES

NONO

YES

YES

YES

NOYE

SYE

SNO

NOYE

SYE

S

Tota

l num

ber o

f em

ploy

ees

that

ha

ve b

een

train

ed in

com

pany

's

anti-

corru

ptio

n pr

oced

ures

:0

50

00

035

40

00

011

35

Tota

l num

ber o

f new

cas

es o

f co

rrupt

ion:

00

Not r

ecor

ded

Not r

ecor

ded

Not r

ecor

ded

00

0No

t rep

orte

d0

00

00

Proc

edur

es in

pla

ce fo

r co

mpl

aint

s of

(grie

vanc

e pr

oced

ure)

:YE

SYE

SYE

SYE

SYE

SYE

SYE

S YE

SYE

SYE

SYE

SNO

, but

fe

edba

ck fo

rms

for c

lient

sYE

SIn

form

al

proc

edur

e

Num

ber o

f com

plai

nts:

Clie

nts

0;

Empl

oyee

s 3

Clie

nts

12;

Empl

oyee

s 0

Clie

nts

42;

Empl

oyee

s no

t re

cord

ed

Clie

nts

35;

Empl

oyee

s:

not r

ecor

ded

Clie

nts

330;

Em

ploy

ees

not r

ecor

ded

0Ci

ents

41;

Em

ploy

ees

4Cl

ient

s 7;

Empl

oyee

s 0

Not

regi

ster

ed0

Clie

nts:

0,

Empl

oyee

s: 0

Not r

egis

tere

dCl

ient

s: 3

0,

Empl

oyee

s: 0

Clie

nts:

6,

Empl

oyee

s: n

ot

reco

rded

Does

the

com

pany

repo

rt in

form

atio

n pu

blic

ly:

YES

NONO

NO

NO

Fi

nanc

ial n

o,

non-

finan

cial

ye

sFi

nanc

ial y

esNO

Fi

nanc

ial y

esNO

NONO

NONO

Num

ber o

f loc

al m

embe

rs (f

rom

th

e sa

me

coun

try) r

epre

sent

ed o

n th

e Bo

ard

at th

e en

d of

the

prev

ious

yea

r:

22

44

21

31

42

311

10

Writ

ten

Hum

an R

esou

rce

polic

y in

clud

ing

the

follo

win

g is

sues

:If

not,

plea

se s

peci

fy w

hy.

Abol

ition

of c

hild

and

forc

ed la

bor

YES

YES

NONO

NO*

NO*

YES

NO*

NO*

YES

NONO

NO**

YES

Free

dom

of A

ssoc

iatio

nYE

SYE

SNO

NONO

*NO

*YE

SNO

*NO

*YE

SNO

NONO

**YE

SEl

imin

atio

n of

disc

rimin

atio

nYE

SYE

SYE

SYE

SYE

SYE

SYE

SYE

SYE

SYE

SYE

SNO

NO**

YES

Gend

er e

quity

YES

YES

YES

YES

YES

NOYE

SYE

SYE

SYE

SYE

SNO

NO**

YES

Qua

lity

syst

em in

pla

ce:

YES

YES

YES

YES

YES

YES

NONO

NOYE

SYE

SNO

YES

SOP

in p

lace

If ye

s, p

leas

e sp

ecify

whi

ch

syst

em a

nd w

heth

er it

is

certi

fied/

accr

edite

d or

not

and

st

ate

how

ofte

n pe

rform

ance

is

mon

itore

d.

Bi-a

nnua

l Re

gion

al

Inte

rnal

Aud

it,

bi-a

nnua

l Ex

tern

al

Labo

rato

ry

Qua

lity

Asse

ssm

ent

Sche

me,

qu

arte

rly D

rug

Form

ular

y Re

view

ISO

: ann

ual

mon

itorin

g by

ext

erna

l pa

rty

In-h

ouse

qua

lity

mon

ityor

ing

syst

em: y

early

re

view

Join

t Co

mm

issi

on

Inte

rnat

iona

l:tri

enni

al s

urve

y du

e th

is y

ear

lab

serv

ices

m

onito

ring

(inte

rnal

and

ex

tern

al),

Stan

dard

Tr

eatm

ent

Guid

elin

es,

Stan

dard

O

pera

ting

Proc

edur

es

regi

onal

aud

it fo

rmul

ary

revi

ew (b

i-an

nual

) &

Drug

Fo

rmul

ary

revi

ew

(qua

rterly

)

ISO

134

85,

annu

al

mon

itorin

g

Shar

epoi

nt,

ongo

ing

mon

itorin

g

NAFD

AC:

mon

itorin

g tw

ice

a ye

ar,

ISO

900

1 (a

ccre

dita

tion

is fo

rese

en in

fu

ture

)

Pfize

r and

GSK

in

tern

al a

udits

ta

ke p

lace

bi-

annu

ally

Corp

orat

e gi

ving

sN/

A

USD

21,0

00

to V

illag

e of

Ho

pe.

Hosp

ital

incl

udin

g an

or

phan

gae

for H

IV

infe

cted

ch

ildre

n

All c

orpo

rate

gi

ving

is

cond

ucte

d th

roug

h th

e Hy

geia

fo

unda

tion

All c

orpo

rate

gi

ving

is

cond

ucte

d th

roug

h th

e Hy

geia

fo

unda

tion

174

hour

s,

Free

med

ical

ca

mps

, de

wor

mon

g sc

hool

ch

ildre

n

Clea

ning

at a

ba

bies

' hom

e,

heal

th

prom

otio

n ac

tiviti

es in

th

e co

mm

unity

, pa

rtici

patio

n in

cha

rity

mar

atho

n

Mw

anan

yam

ala

Hosp

ital:

dona

tion

of

mos

quito

ne

ts&

beds

heet

s. If

tar

Day:

25

staf

f pa

rtici

pate

d in

ser

ving

fo

od. E

nviro

nm

enta

l Day

: 10

sta

ff pa

rtici

pate

d in

cl

eani

ng&

don

ated

cl

eani

ng

equi

pmen

ts.

Mal

aria

day

: do

natio

n of

m

osqu

ito

nets

180

hour

s m

onth

ly

Ever

y em

ploy

ee is

ob

ligat

ed to

sp

end

at

leas

t 5 h

rs in

ch

arita

ble

activ

ities

. Co

ordi

nate

d th

roug

h Be

ckm

ann

Fund

N/A

None

KHL

offe

rs th

e ch

ange

for

med

ical

st

uden

ts to

co

me

to th

e ho

spita

l fro

m

Lago

s in

ord

er

to b

e ex

pose

d to

the

MRI

sy

stem

and

le

arn

from

it

(this

is d

one

for

free)

. No

estim

antio

n of

ho

urs

used

by

empl

oyee

s is

av

aila

ble.

NGN

2,38

0,00

0 NA

FDAC

, PSN

, AC

PN

Conf

eren

ces

and

NGN

3,50

0,00

0 do

natio

n to

TCF

fo

r Eye

care

Pr

ojec

ts

None

** P

lan

in p

lace

to im

plem

ent

* By

nat

ure

of A

AR b

usin

ess

we

do n

ot h

ave

such

cas

es. F

urth

er A

AR is

mem

ber o

f the

UN

Glob

al C

ompa

ct th

at u

phol

ds th

ese

prin

cipl

es

A

nnexes


Subs

idar

ies I

FHA

Port

folio

co

mpa

nies

whi

ch h

ave

been

m

easu

red

sepe

rate

ly >

>>

AAR

HC

Tanz

ania

(2

013)

Pyra

mid

Ph

arm

a (2

013)

Hyge

ia H

MO

(2

013)

Hyge

ia

Hosp

itals

(201

3)

AAR

HC

Keny

a (2

013)

AAR

HC

Ugan

da

(201

3)

AAR

Insu

ranc

e Ta

nzan

ia

(201

3)

AAR

Insu

ranc

e Ug

anda

(201

3)

AAR

Insu

ranc

e Ke

nya

(201

3)

Sour

celin

k He

alth

care

(2

013)

ER C

orpo

rate

Ad

min

istra

tion

(201

3)

Kam

pala

Ho

spita

l (20

13)

WW

CVL

Nig

eria

(201

3)W

HL G

hana

(2

013)

Obj

ectiv

e: R

educ

e en

viro

nmen

tal i

mpa

ctPr

oced

ures

in p

lace

rela

ted

to th

e fo

llow

ing

aspe

cts:

Was

te m

anag

emen

tYE

SYE

SNO

YES

YES

YES

NOYE

SNO

YES

NONO

YES

YES

Ener

gy u

seNO

NOYE

SYE

SNO

NONO

NONO

NONO

NOYE

SYE

SW

ater

man

agem

ent

NONO

YES

YES

NONO

NONO

YES

NONO

NOYE

SYE

SOc

cupa

tiona

l Hea

lth a

nd S

afet

yYE

SYE

SYE

SYE

SYE

SNO

YES

YES

YES

YES

YES

NOYE

SYE

S

Envi

ronm

enta

l, he

alth

and

saf

ety

licen

ses

requ

ired

for t

he

com

pany

's o

pera

tion:

YES,

med

ical

w

aste

in

cine

ratio

n ce

rtific

ates

, an

nual

pr

actic

ing

certi

ficat

es

for m

edic

al

wor

kers

, fire

ce

rtific

ates

Tanz

ania

Fo

od a

nd

Drug

Au

thor

ity,

Priv

ate

Heal

th

Labo

rato

ry

Boar

d

N/A

Lice

nse

for a

ll fa

cilit

ies

from

He

alth

Fac

ility

M

onito

ring

and

Accr

edita

tion

Agen

cy

Natio

nal

Envi

ronm

ent

al

Man

agem

ent

Aut

horit

y au

dits

don

e

Ope

ratin

g lic

ence

s fo

r cl

inic

s,

Prac

ticin

g lic

ence

s fo

r m

edic

al

pers

onne

l

Heal

th a

nd

safe

ty

licen

ce

thro

ugh

OSH

A

Med

ical

w

aste

in

cine

ratio

n ce

rtific

ates

, an

nual

pr

actic

ing

certi

ficat

es

for m

edic

al

wor

kers

Occ

upat

iona

l he

alth

and

sa

fety

No

neNo

ne

Lice

nse

to

pose

ss a

nd u

se

radi

atio

n.

Ope

ratio

nal

licen

se o

f He

alth

Uni

t Pr

emis

es

N/A

Phar

mac

y lic

ense

, fire

sa

fety

and

fu

mig

atio

n lic

ense

, fo

od

and

drug

au

thor

ity

licen

se

Are

all r

equi

red

licen

ses

in p

lace

?YE

SYE

SNO

YES

YES

YES

NOYE

SYE

SN/

AN/

AYE

SN/

AYE

SNu

mbe

r of n

ew li

tigat

ion

char

ges

rela

ted

to e

nviro

nmen

tal i

ssue

s in

th

e la

st 1

2 m

onth

s:0

00

00

0N/

A0

00

N/A

00

0

Num

ber o

f (in

ter)n

atio

nal

envi

ronm

enta

l cer

tific

atio

n(s)

/ ac

cred

itatio

n(s)

:If

any

accr

edita

tion

is a

vaila

ble

plea

se s

peci

fy w

hich

.

00

N/A

2 - F

ire

certi

ficat

e of

fa

cilit

ies

and

Radi

atio

n Pr

otec

tion

certi

ficat

e

NEM

A ce

rtific

atio

n fro

m th

e au

dits

0N/

A0

00

N/A

00

N/A

Tota

l ene

rgy

cons

umpt

ion

Elec

trici

ty:

4,24

8,64

8 KW

H Di

esel

: 46

80 li

ters

Non-

rene

wab

le

sour

ces

(Tan

esco

): 2,

9321

,016

Elec

trici

ty: N

GN

9,31

2,50

9 /

Dies

el N

GN:

24,6

72,5

00

No d

ata

avai

labl

e

Rene

wab

le:

KES

608,

335,

No

n-re

new

able

: KE

S 1,

693,

307

Non

rene

wab

le

sour

ces:

Di

esel

260

0 lit

ers

Elec

trici

ty

KWH:

60,

000

- Die

sel

21,6

00

Elec

trici

ty:

KWH

26,1

81

Elec

trici

ty:

KES

1,32

1,32

4

Non-

rene

wab

le:

ZAR

26,5

70

No d

ata

avai

labl

egr

id (h

ydro

) KW

H: 2

96,8

37

Dies

el: 2

91,2

44

litre

s, G

asol

ine

40,5

89 li

ters

No d

ata

avai

labl

e

Plea

se s

tate

whi

ch lo

catio

ns a

re

incl

uded

in th

is m

easu

rem

ent.

Heal

th

Cent

res,

Ad

min

istra

tion

offi

ces,

Am

bula

nces

(re

scue

)

Offi

ce a

nd

war

ehou

se

214

Broa

d St

reet

, Ele

phan

t Ho

use,

Lag

osN/

AAl

l 13

clin

ics

Heal

th

cent

res,

Ad

min

istra

tion

offi

ces,

am

bula

nces

Chat

o &

Ar

usha

, M

ikoc

heni

, Ha

ider

y Co

mpl

ex,

Soph

ia P

laza

Lt

d.

Head

offi

ce,

Sale

s of

fice

Amou

nt

incl

udes

El

ectri

city

&W

ater

at t

he

bran

ches

.For

th

e He

ad

Offi

ce,

Elec

trici

ty

cost

is

incl

uded

in

the

Rent

Onl

y 1

loca

tion

N/A

Kam

pala

Ho

spita

l

War

ehou

se,

Lago

s an

d Em

ma

Plaz

a,

Lago

s

Prem

ises

in

Accr

a (K

umas

si

not i

nclu

ded)

Tota

l wat

er w

ithdr

awal

(lite

rs):

No d

ata

avai

labl

e

TZS

3,15

8,00

0 (li

ters

un

know

n)

Unkn

own

No d

ata

avai

labl

e1,

908,

000

N/A

1200

02,

254,

000

No d

ata

avai

labl

e12

2,55

0Un

know

n6,

562,

000

600,

000

liter

s76

2

Plea

se s

tate

whi

ch lo

catio

ns a

re

incl

uded

in th

is m

easu

rem

ent.

N/A

War

ehou

se21

4 Br

oad

Stre

et, E

leph

ant

Hous

e, L

agos

N/A

All 1

3 cl

inic

sN/

AM

ikoc

heni

, Ar

usha

, M

wan

za

Head

offi

ce,

Sale

s of

fice

N/A

Onl

y 1

loca

tion

N/A

N/A

War

ehou

se,

Lago

s

Prem

ises

in

Accr

a (K

umas

si

not i

nclu

ded)

A

nnexes


Annex 4: ESD audits per sector

Sect

or: H

ealth

care

pro

visi

onAA

R HC

Ken

ya (2

013)

Lago

on H

ospi

tals

Hyge

ia N

iger

ia

(201

3)AA

R HC

Uga

nda

(201

3)AA

R HC

Tan

zani

a (2

013)

Kam

pala

Hos

pita

l (20

13)

Obj

ectiv

e: In

crea

se a

vaila

bilit

y of

pr

oduc

ts a

nd se

rvic

esTo

tal n

umbe

r of h

ealth

care

faci

litie

sFo

r eac

h fa

cilit

y, li

st th

e ty

pe a

nd lo

catio

n (a

ddre

ss).

13 u

rban

faci

litie

s5

urba

n fa

cilit

ies

7 ur

ban

faci

litie

s 5

urba

n fa

cilit

ies

1 ur

ban

faci

lity

Will

iam

son

Hous

e -

Nairo

biHo

spita

l - A

papa

, Lag

osAc

acia

Hea

lth c

entre

- Ka

mpa

laCh

ato

Heal

th C

entr

e, C

hato

Str

. Dar

es S

alaa

mKa

mpa

la H

ospi

tal,

plot

6 C

Mak

indu

Cl

ose,

Kol

olo

Sarit

Cen

tre C

linic

- Na

irobi

Hosp

ital-

Ikej

a, L

agos

City

cen

tre h

ealth

cen

tre -

Kam

pala

City

Cen

tre

Clin

ic (H

ealth

Cen

tre)

, Mak

taba

Sq

uare

Str

. Dar

es S

alaa

mCi

ty C

entre

Ciln

ic -

Nairo

biCl

inic

- Vi

ctor

ia Is

land

, Lag

osBu

golo

bi H

ealth

cen

tre -

Kam

pala

Arus

ha H

ealth

Cen

tre,

Phi

llips

Roa

d, A

rush

a

Mom

basa

Clin

ic -

Mom

basa

Spec

ialis

t clin

ic -

Vict

oria

Isla

nd, L

agos

Bwey

oger

ere

Heal

th c

entre

- Bw

egog

erer

eSi

nza

Heal

th C

entr

e, S

inza

Mad

ukan

i, Da

r es

Sala

amEl

dore

t Clin

ic -

Eldo

ret

Clin

ic -

Ikej

a, L

agos

Gulu

Hea

lth c

entre

- Gu

lu

Kisu

mu

Clin

ic -

Kisu

mu

Ntin

da H

ealth

cen

tre -

Kam

pala

Naku

ru C

linic

- Na

kuru

Kaba

laga

la H

ealth

cen

tre -

Kam

pala

Kare

n Cl

inic

-

Na

irobi

Thik

a Ro

ad C

linic

- Na

irobi

Park

land

s Cl

inic

- Na

irobi

Adam

s Cl

inic

- Na

irobi

Emba

kasi

Clin

ic,

Nairo

biM

ount

ain

Mal

l, Na

irobi

Tota

l num

ber o

f mob

ile c

linic

s ow

ned

by th

e co

mpa

ny:

00

00

0

MRI

01

00

1Ne

onat

al in

cuba

tor

07

00

4X

ray

mac

hine

s2

20

01

CT sc

anne

rs0

10

01

ECGs

107

24

1Ul

traso

und

54

11

2Ne

bulis

ers

185

64

2EE

G 0

00

00

TB d

iagn

osis

mac

hine

s13

00

00

Phar

mac

ies

133

77

1La

bora

torie

s13

37

71

Num

ber o

f hea

lthca

re fa

cilit

ies

whi

ch o

ffer

serv

ices

for e

ach

of th

e fo

llow

ing

cond

ition

s/ca

re

area

s M

edic

alHy

perte

nsio

n13

57

81

Hype

rlipi

dem

ia13

57

81

Diab

etes

135

78

1As

thm

a13

57

81

Card

iac

cond

ition

s13

57

41

Surg

ical

Card

iac

01

00

0Ca

rdio

thor

acic

01

00

0Ne

urol

ogic

al0

10

01

Num

ber o

f pat

ient

s tre

ated

for e

ach

of th

e fo

llow

ing

cond

ition

s/ca

re a

reas

:M

edic

alHy

perte

nsio

n16

4637

5839

6260

0un

know

nHy

perli

pide

mia

261

7129

1no

t rec

orde

dun

know

nDi

abet

es63

120

0383

0no

t rec

orde

dun

know

nAs

thm

a12

3035

264

1no

t rec

orde

dun

know

nCa

rdia

c co

nditi

ons

5026

9457

36Su

rgic

alCa

rdia

c0

2593

0N

/A0

Card

ioth

orac

ic0

280

N/A

0Ne

urol

ogic

al22

10

N/A

0

Fac

tory

Clin

ics (

Waz

o, C

oca

Cola

, Po

lyce

m/R

affia

, Sou

ther

n Su

n -D

ar e

s Sal

aam

, Ta

nga

Clin

ic-T

anga

)-(D

ispe

nsar

ies)

A

nnexes


Sect

or: H

ealth

care

pro

visi

onAA

R HC

Ken

ya (2

013)

Lago

on H

ospi

tals

Hyge

ia N

iger

ia

(201

3)AA

R HC

Uga

nda

(201

3)AA

R HC

Tan

zani

a (2

013)

Kam

pala

Hos

pita

l (20

13)

Num

ber o

f pat

ient

s tre

ated

for e

ach

of th

e fo

llow

ing

cond

ition

s/ca

re a

reas

:M

alar

ia11

6666

7017

9030

00No

t rec

orde

dDi

arrh

eal d

iseas

e (e

.g. C

hole

ra)

3458

173

299

480

Not r

ecor

ded

Mal

nutri

tion

50

2No

t rec

orde

dNo

t rec

orde

dHI

V/AI

DS13

112

012

11N/

ANo

t rec

orde

dTB

9558

24N/

ANo

t rec

orde

dM

ater

nal c

are

545

8504

2483

1140

Not r

ecor

ded

Num

ber o

f hea

lthca

re fa

cilit

ies

whi

ch o

ffer

serv

ices

for e

ach

of th

e fo

llow

ing

cond

ition

s/ca

re

area

:M

alar

ia13

57

91

Diar

rhea

l dise

ase

(e.g

. Cho

lera

)13

57

91

Mal

nutri

tion

135

74

1HI

V/AI

DS13

57

01

TB13

57

01

Mat

erna

l car

e13

57

41

Obj

ectiv

e: In

crea

se a

ffor

dabi

lity

of

prod

ucts

and

serv

ices

Num

ber o

f hea

lthca

re fa

cilit

ies

whi

ch o

ffer

serv

ices

for e

ach

of th

e fo

llow

ing

care

are

as:

Child

car

e re

late

d to

the

5 m

ain

caus

es o

f dea

th13

57

41

Mea

sles i

mm

uniza

tion

134

71

1Ot

her i

mm

uniza

tions

KE

PI: 1

3He

patit

is B

:4 ,

OPV

:4, D

PT:4

7He

patit

is B

Vac

cine

: 40

Surg

ery

01

00

0Tr

aum

a0

50

00

Num

ber o

f pat

ient

s tre

ated

for e

ach

of th

e fo

llow

ing

care

are

as:

Child

car

e re

late

d to

the

5 m

ain

caus

es o

f dea

th95

931

14No

t rec

orde

dNo

t rec

orde

dNo

t rec

orde

dM

easle

s im

mun

izatio

n11

3349

0No

t rec

orde

dNo

t rec

orde

dNo

t rec

orde

d

Othe

r im

mun

izatio

nsTe

tanu

s:10

36He

ptat

itis

B - 2

681,

OPV

- 39

43, D

PT -

2836

Hepa

titis

B:2

516,

Yel

low

feve

r:468

, Rot

a vi

rus:

490,

Pne

umoc

occa

l:118

8No

t rec

orde

dNo

t rec

orde

d

Pedi

atric

Not r

ecor

ded

Not r

ecor

ded

Surg

ery

059

030

00

Trau

ma

028

360

00

Do y

ou o

ffer s

ervi

ces

for t

he fo

llow

ing

cond

ition

s fo

r fre

e? If

yes

, ple

ase

spec

ify w

hich

ser

vice

s.

Mal

aria

NONO

NONO

NODi

arrh

eal d

iseas

(e.g

Cho

lera

)NO

NONO

NONO

Mal

nutri

tion

NONO

NONO

NO

HIV/

Aids

NOYE

SYE

SNO

(giv

en fo

r fre

e un

der N

atio

nal A

ids

Cont

rol P

rogr

amm

e)NO

TBNO

NONO

NO (

give

n fo

r fre

e un

der N

atio

nal T

B Co

ntro

l Pro

gram

me)

NO

Mat

erna

l Car

eNO

NONO

NONO

Child

car

e re

late

d to

the

5 m

ain

caus

es o

f dea

thNO

NONO

YES

NO

Mea

sles i

mm

uniza

tion

YES

- und

er K

EPI

imm

unia

tion

NOYE

SYE

SYE

S

A

nnexes


Sect

or: H

ealth

care

pro

visi

onAA

R HC

Ken

ya (2

013)

Lago

on H

ospi

tals

Hyge

ia N

iger

ia

(201

3)AA

R HC

Uga

nda

(201

3)AA

R HC

Tan

zani

a (2

013)

Kam

pala

Hos

pita

l (20

13)

Low

est p

riced

ser

vice

s of

fere

d:GP

con

sulta

tion

KES

700

- # 1

,267

pa

tient

s tre

ated

Mar

k up

= -3

0%, m

anag

ed c

are

patie

nts

pay

30%

less

than

priv

atel

y in

sure

d.

Chec

king

Blo

od P

ress

ure

(200

0 TZ

S)

List

pha

rmac

eutic

als

(and

thei

r cor

resp

ondi

ng

cond

ition

s) w

hich

hav

e ex

perie

nced

sho

rtage

s in

th

e pr

evio

us y

ear:

Phar

mac

eutic

al (c

ondi

tion)

- Fr

eque

ncy

- Rea

son

for s

horta

ge

Phar

mac

eutic

al (c

ondi

tion)

- Fr

eque

ncy

- Re

ason

for s

horta

ge

Phar

mac

eutic

al (c

ondi

tion)

- Fr

eque

ncy

- Re

ason

for s

horta

ge

Phar

mac

eutic

al (c

ondi

tion)

- Fr

eque

ncy

- Rea

son

for s

horta

ge

Tote

rodi

ne 2

mg

- 6 -

com

pany

had

pr

oble

ms

at m

anuf

actu

ring

plan

tCo

arte

m (M

alar

ia) -

1 -

Shor

tage

of t

he

AMFM

Pro

ject

-sub

sidi

sed

drug

sNi

lTa

b. P

iogl

itazo

ne -

regu

latio

n fro

m N

DANo

rmal

sal

ine

nasa

l - 5

- log

istic

s pr

oble

m w

ith im

porta

tion

of d

rug

ARVs

(HIV

-AID

S) -

1 - I

ncon

sist

ence

in th

e lo

gist

ics

and

supp

ly d

epar

tmen

t at J

MS

Inj.

Phen

ytoi

n - o

ut o

f sto

ck fr

om

supp

liers

Mid

azol

am in

ject

ions

- 4

- log

istic

s pr

oble

m w

ith im

porta

tion

of d

rug

Bact

ocla

v 37

5mg

Tabl

ets

(Infe

ctio

ns) -

1 -

Out

of s

tock

with

our

pre

-qua

lifie

d su

pplie

r

I.V. M

anni

tol -

out

of s

tock

from

su

pplie

rs

Feno

fibra

te -

3 - c

ompa

ny s

topp

ed

prod

ucin

g be

caus

e of

redu

ced

dem

and

in N

iger

ia

Inj.

Fent

anyl

- ou

t of s

tock

from

su

pplie

rs

Amio

daro

ne in

ject

ion

- 3 -

logi

stic

s pr

oble

m w

ith im

porta

tion

of d

rugs

Salb

utam

ol in

hale

r - 2

- Su

pplie

r out

of

stoc

k

Obj

ectiv

e: E

nsur

e qu

ality

of p

rodu

cts

and

serv

ices

Drug

- am

ount

- ty

pe o

f uni

t - to

tal

valu

eDr

ug -

amou

nt -

type

of u

nit -

tota

l val

ueDr

ug -

amou

nt -

type

of u

nit -

tota

l val

ueDr

ug -

amou

nt -

type

of u

nit -

to

tal v

alue

List

pha

rmac

eutic

als

(and

thei

r cor

resp

ondi

ng

cond

ition

s) w

hich

hav

e ex

pire

d in

the

prev

ious

ye

ar:

Adre

nalin

e - 2

3 -1

MG/

ML

inje

ctio

n -

NGN

276

PRIO

RIX

0.5M

L (M

MR)

VAC

CINE

- 56

- VI

AL -

UGX

1,25

9,34

4Is

opha

ne B

i-pha

sic

Inj 1

0IU/

ml-w

osul

in -

1 -

am

p - T

ZS 1

5400

Zyce

l 100

mgs

- 40

- ta

bs -

UGX

6,40

0

Antis

nake

ven

om -

3 -in

ject

ion

- N

32,5

00VA

XIGR

IP S

H AD

ULT

1ML

(INFL

UENZ

A)-1

0-VI

AL-U

GX 3

58,9

00Tr

amad

ol 1

00m

g In

j-urg

endo

l - 2

- am

p -

TZS

5600

Am

ino

Acid

s - 3

- bo

ttles

- UG

X 10

5,00

0Ch

loph

enira

min

e ta

bs -

140

- tab

lets

- N3

0LI

PICA

RD 2

00M

G-22

4-Ca

psul

es-U

GX

192,

000

Emes

et 4

mg/

2ml -

5 -

amp

- TZS

125

00Do

pam

ine

- 3 -

Inje

ctio

n - U

GX

45,0

00Hu

mal

og in

sulin

e - 4

- 10

iu/m

l -

N32,

500

CIM

ETID

INE

400

MG

TABL

ETS-

666-

Tabl

ets-

UGX

64,4

36Vi

tam

in B

com

plex

Inj.

im/iv

10m

ls-e

styp

lex

- 24

- am

p - T

ZS 3

00,0

00Ni

fedi

pine

Dro

ps -

90 -

UGX

8,00

0

Teta

nu im

mun

oglo

bulin

- 2

- 250

iu

inje

ctio

ns -

N3,8

50PI

ONO

RM 3

0MG

TABL

ETS-

718-

Tabl

ets-

UGX

219,

968

Chlo

rhex

idin

e Tu

lle G

ras-

bact

igra

s - 6

9 -

each

- TZ

S 10

0,05

0

List

the

tota

l val

ue o

f pha

rmac

eutic

als

disp

ense

d in

the

prev

ious

yea

r:Ge

neric

dru

gs: N

GN 1

41,1

57,5

79Ge

neric

dru

gs: U

GS 2

,134

,153

,476

Gene

ric d

rugs

: UGX

80,

000,

000

Bran

ded

drug

s: N

GN 7

,429

,346

Bran

ded

drug

s: U

GS: 5

24,9

55,7

30Br

ande

d dr

ugs:

UGX

25,

000,

000

List

the

med

ical

sup

plie

s w

hich

hav

e ex

perie

nced

sh

orta

ges

mor

e th

an o

nce:

Med

ical

sup

ply

Freq

uenc

yRe

ason

fo

r sh

orta

ge

Elas

topl

ast

3O

ut o

f st

ock

None

Tong

ue D

epre

ssor

s - 2

- no

sup

plie

r had

it

in s

tock

None

Phen

ytoi

n in

j - 2

- ou

t of s

tock

fro

m s

uppl

iers

Prim

apor

e m

ediu

m2

Out

of

stoc

kUl

tra s

ound

gel

- 2

- no

supp

lier h

ad it

in

stoc

kCe

ll Pa

ck -

3 - o

ut o

f sto

ck fr

om

supp

liers

Need

les

25G

4O

ut o

f st

ock

Typh

oid

Strip

s - 2

- O

ut o

f sto

ck w

ith o

ur

pre-

qual

ified

sup

plie

rM

anni

tol I

V - 1

- ou

t of s

tock

from

su

pplie

rs

Sutu

res

reve

rse

cut

5O

ut o

f st

ock

Plas

tic c

onta

iner

s3

Out

of

stoc

k

Hexa

niou

s so

lutio

n2

Out

of

stoc

kBa

ctrig

ras

3

Num

ber o

f tot

al h

ealth

faci

litie

s th

at a

re

certi

fied/

accr

edite

d an

d w

ith w

hich

bo

dy/o

rgan

izatio

n:0

2 - J

CI0

00

Typh

im m

ultid

ose

- vac

ine

- 19

- via

l - K

ES

8,22

9

Cym

alta

30m

g - A

nxie

ty -

6 - K

ES 9

86

Cycl

ogyl

eye

dro

ps -

1 - t

ube

- KES

410

Tam

oxife

n - C

a br

east

- 15

- ta

blet

- KE

S 65

0

1,01

2,52

0,23

1 TZ

S (F

or b

oth

Gene

ric &

Br

ande

d)Br

ande

d dr

ugs:

KES

85,

133,

968

Co-m

icar

dis

- 1 -

out o

f sto

ck

Esos

ip 4

0mg

- 2 -

out o

f sto

ck

Gene

ric d

rugs

: KES

127

,251

,292

Dexa

-G -

4 - o

ut o

f sto

ck

Duof

ilm s

olut

ion

- 6 -

out o

f sto

ck

Glyf

orm

in 5

00/8

50m

g - 3

- ou

t of s

tock

Alda

cton

e 25

- 2

- out

of s

tock

Zolid

plu

s - 3

- ou

t of s

tock

Epan

utin

- 1

- out

of s

tock

Phar

mac

eutic

al (c

ondi

tion)

- Fr

eque

ncy

- Re

ason

for s

horta

ge

Drug

- am

ount

- ty

pe o

f uni

t - to

tal v

alue

Piog

lit 3

0mg

- Dia

btes

- 30

- ta

blet

- KE

S 85

0.00

Hum

alog

Car

t - D

iabt

es -

25 -

cartr

idge

- KE

S 19

,605

A

nnexes


Sect

or: H

ealth

care

pro

visi

onAA

R HC

Ken

ya (2

013)

Lago

on H

ospi

tals

Hyge

ia N

iger

ia

(201

3)AA

R HC

Uga

nda

(201

3)AA

R HC

Tan

zani

a (2

013)

Kam

pala

Hos

pita

l (20

13)

Obj

ectiv

e: E

nsur

e eq

uita

ble

acce

ss

to p

rodu

cts a

nd se

rvic

esTo

tal n

umbe

r of p

atie

nts:

67,6

7914

,506

215,

000

Not r

ecor

ded

14,4

85To

tal n

umbe

r of v

isits

a y

ear:

250,

444

49,0

3121

5,00

011

3,99

614

,011

Tota

l num

ber o

f hos

pita

l adm

issi

ons:

230,

958

2,43

90

Not r

ecor

ded

474

Num

ber o

f hea

lthca

re w

orke

rs:

395

7011

580

29To

tal n

umbe

r of G

Ps:

140

5728

136

Tota

l num

ber o

f nur

ses:

6514

547

2587

Tota

l num

ber o

f spe

cial

ists

:44

2423

1955

Bed

occu

panc

y ra

te (B

OR)

:N/

A76

.00%

Not r

ecor

ded

Not r

ecor

ded

20

Obj

ectiv

e: R

educ

e en

viro

nmen

tal

impa

ctPr

oced

ures

for w

aste

dis

posa

l in

plac

eYE

SYE

SYE

SYE

SNO

Tota

l am

ount

of h

azar

dous

was

te g

ener

ated

(in

tonn

es):

15.5

56No

t rec

orde

d8,

416

6 to

nnes

Not r

ecor

ded

Tota

l am

ount

of n

on-h

azar

dous

was

te g

ener

ated

(in

tonn

es):

7.34

9No

t rec

orde

d11

,3No

reco

rded

Not r

ecor

ded

Obj

ectiv

e: S

timul

ate

dece

nt w

ork

Heal

th a

nd s

afet

y pr

oced

ures

in p

lace

:YE

SYE

SYE

SYE

SNO

Prot

ectio

n eq

uipm

ent f

or e

mpl

oyee

s ag

ains

t ha

zard

ous

subs

tanc

es a

nd d

isea

ses

avai

labl

e at

he

alth

care

faci

litie

s:YE

SYE

SYE

SYE

SYE

S

Num

ber o

f wor

k re

late

d in

jurie

s:0

00

0No

t reg

iste

red

Num

ber o

f fat

aliti

es:

00

00

Not r

egis

tere

dTo

tal h

ours

wor

ked:

141,

520

926,

592

309,

000

199,

760

360,

976

Num

ber o

f pe

ople

pro

vide

d w

ith b

asic

med

ical

tra

inin

g:15

127

915

014

60

A

nnexes


Sect

or: H

ealth

Insu

ranc

e

Obj

ectiv

e: In

crea

se a

vaila

bilit

y of

pro

duct

s and

serv

ices

Tota

l num

ber o

f pro

vide

rs:

Num

ber o

f hea

lth in

sura

nce

brok

ers/

sal

es

repr

esen

tativ

es:

Plea

se li

st in

sura

nce

pack

ages

pro

vide

d by

th

e co

mpa

ny, i

nclu

ding

pric

e an

d to

tal

num

ber o

f mem

bers

:

Insu

ranc

e pa

ckag

e

Pric

e pe

r ye

ar (a

nd

curre

ncy)

# m

embe

rs

urb

an

Insu

ranc

e pa

ckag

e P

rice

per y

ear

(and

cur

renc

y)

#

mem

bers

ur

ban

Insu

ranc

e pa

ckag

ePr

ice

per y

ear

(and

cur

renc

y)

# m

embe

rs

urba

n

Insu

ranc

e pa

ckag

ePr

ice

per y

ear (

and

curre

ncy)

# m

embe

rs

urba

n

HYES

SENT

IAL

Plus

26

,450

.00

4

5,47

3 C

orpo

rate

4

00,0

00.0

0

7,71

2.00

Go

ldUS

D 55

1 - 2

968

2,9

31

Gold

KES

790

57

6,0

56

HYPR

IORI

TY P

lus

28

,750

.00

1

7,27

2 B

ronz

e

5

50,0

00.0

0 2

6,69

5.00

Si

lver

USD

471-

234

0

9

,991

Si

lver

KE

S 71

881

28,

462

HYCL

ASSI

C Pl

us

39,8

00.0

0

32,

375

Silv

er

1

,250

,000

.00

1,

072.

00

Bron

zeUS

D 31

8- 1

578

29,6

96

Bron

zeKE

S 3

1147

21,

196

HYPR

ESTI

GE P

lus

143

,750

.00

3,4

98.0

0 G

old

2

,200

,000

.00

698.

00

HMO

USD

300-

771

9

17

Cove

r Me

KES

1048

2

3,0

72

GCUS

D 32

5

45

,477

Gr

oupc

are

IPCu

stom

ised

3

,368

In

patie

ntUS

D 16

5-81

9

293

Re

scue

US

D 25

0

9 Af

ya M

aish

aUS

D 89

2

19

Out

patie

ntUS

D 17

5 N

A

Obj

ectiv

e: E

nsur

e eq

uita

ble

acce

ss to

pro

duct

s and

serv

ices

Num

ber o

f fem

ales

mem

bers

and

de

pend

ents

:53

,273

16,9

7834

,220

35,4

56

Num

ber o

f chi

ld d

epen

dent

s:33

,887

12,9

4311

,271

16,7

89

Hyge

ia H

MO

(201

3)AA

R In

sura

nce

Keny

a (2

013)

Ow

n pr

ovid

ers:

15,

pre

ferre

d pr

ovid

ers:

404

6057

6

AAR

Insu

ranc

e Ta

nzan

ia (2

013)

AAR

Insu

ranc

e Ug

anda

(201

3)

Ow

n pr

ovid

ers:

3 P

reffe

red

prov

ider

s: 5

Ow

n pr

ovid

ers

9, p

reffe

red

prov

ider

s 17

8

923

Ow

n pr

ovid

ers:

8, p

reffe

red

prov

ider

s 25

1

A

nnexes


Sect

or: H

ealth

Insu

ranc

e

Obj

ectiv

e: In

crea

se

affo

rdab

ility

of p

rodu

cts a

nd

serv

ices

Low

est c

ost i

nsur

ance

pac

kage

pro

vide

d.Pl

ease

spe

cify

pric

e (a

nd c

urre

ncy)

and

to

tal m

embe

rs:

HYGE

IA

ESSE

NTIA

L NG

N 26

450

- 454

73

mem

bers

Corp

orat

e Ca

rd

UGX

400,

000

- 7,

712

mem

bers

Bron

ze T

ZS

3946

80-

2072

070

-28

696

mem

bers

Cove

r me:

KES

10

,482

- 32

247:

307

2 m

embe

rs

Serv

ices

cov

ered

in th

e lo

wes

t cos

t in

sura

nce

pack

age:

Med

ical

Hype

rtens

ion

YES

YES

YES

NOHy

perli

pide

mia

YES

YES

YES

NODi

abet

esYE

SYE

SYE

SYE

SAs

thm

aYE

SYE

SYE

SNO

Card

iac

cond

ition

sYE

SYE

SYE

SNO

Surg

ical

Card

iac

NO

YES

YES

NOCa

rdio

thor

acic

NOYE

SYE

SNO

Neur

olog

ical

NOYE

SYE

SNO

Pedi

atric

Surg

ery

YES

YES

YES

NOTr

aum

aYE

SYE

SYE

SYE

SDi

seas

es o

f pov

erty

Mal

aria

YES

YES

YES

YES

Mal

nutri

tion

YES

YES

YES

NOHI

V/Ai

dsYE

SYE

SYE

SYE

STB

YES

YES

YES

YES

Mat

erna

l car

eYE

SYE

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347

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nya

(201

3)

A

nnexes


Sector: Wholesale & DistributionObjective: Increase availability of products and servicesTotal number of drugs delivered related to the following conditions/diseases

Medical: Urban Rural Medical: Urban Rural Medical: Urban Rural

Hypertension 7466 8782 Hypertension N/A Hypertension 1575080 N/AHyperlipidemia 1271 521 Hyperlipidemia N/A N/A Hyperlipidemia 94704 N/ADiabetes 12732 10428 Diabetes 166,290 N/A Diabetes 268545 N/AAsthma 2163 603 Asthma N/A N/A Asthma 6868 N/ACardiac conditions 4024 938 Cardic

conditionsN/A N/A Cardiac

conditions246914 N/A

Malaria 36634 560550 Malaria 1143021 N/A Malaria 33750 N/ADiarrhoeal disease (e.g. Cholera)

N/A N/A Diarrhoeal disease (e.g. Cholera)

N/A N/A Diarrhoeal disease (e.g. Cholera)

254550 N/A

Malnutrition N/A N/A Malnutrition N/A N/A Malnutrition Unknown N/AHIV/AIDS HIV/AIDS

35 N/A

HIV/AIDS

None

N/A

TBC N/A N/A TBC 0 0 TBC None N/AMaternal care 154837 1670 Maternal care N/A N/A Maternal care 678870 N/AChild care Multivit

amin and mineral

2 Child care 14,306 N/A Child care Unknown N/A

Total number of medical equipment delivered (e.g. Xray, MRI, CT, ECG)

Urban Rural Urban Rural Urban Rural

0 0 0 0 0 0Total number of companies supplied through distribution channel

Urban Rural Urban Rural Urban Rural

96 0 750 0

Total number of warehouses 3 10 1 0

Objective: Ensure quality of products and services

Urban Rural Urban Rural Urban Rural Number of times not being able to deliver an order 10 20 0 0Number of times of late delivery 10 18 59 0.25% 0.50%Average time to deliver orders for rural/urban areas 2 days 5 days 48 hrs in Lagos within 24 hours within 48 hours

Inventory and stock control system in place, which ensures expiry dates are monitored

YES

Total value of items which has at least one unit at stock at the end of the previous year

unknown

Appropriate infrastructure to ensure the cold chain is maintained and in placeNumber or inventory losses due to failures within the cold train

0 0

Objective: Stimulate (local) economy and equitable access to employmentOrigin of drugs purchased Same country: 617608

In Africa: ? In Africa: 17Outside Africa: 1049468

Number of distribution accidents 0 1 0Number of fatalities 0 Unknown 0Total hours worked 127,224 609,168 Unknown

Objective: Reduce environmental impact

Policy for pharmaceuticals disposal in place YES YES YES

Outside Africa: 472

YESYES

YES

0

Same country: 0

Outside Africa:balanceIn Africa: 2

TZS 2,415,675,802 NGN 4,306,856,485

YES YES

Same country: 5

Pyramid Pharma (2013)

500 (Incl. centers throughout country)

WWCVL Nigeria (2013) WHL Ghana (2013)

Unknown

Mylan products sold, but ordered through government

Nr of units Nr of units Nr of units

A

nnexes


Sector: ProductionObjective: Increase availability of products and servicesMedical supplies and respective quantitites approved Type Amount

Masks 948,000Total R&D expenditures 0R&D expenditures invested in the diseases of poverty 0

Objective: Increase affordability of products and servicesPricing policies in place to ensure affordability of pharmaceuticals addressing the diseases of poverty

N/A

Patents in place for pharmaceuticals addressing the diseases of poverty

N/A

Pricing policy in place to ensure affordability of basic medical supplies

N/A

Objective: Ensure quality of products and servicesTotal number of pharmaceuticals developed N/ANumber of pharmaceuticals developed which were tested according to an (inter)nationally recognized quality standard

N/A

Total number of medical supplies developed 0Number of medical supplies developed and tested according to (inter)nationally recognized quality standards

0

Inventory and stock control systems in place, which ensures expiry dates are monitored

Inputs

YES N/ATotal value of input inventory at year end ZAR 1,057,233Total value of input losses due to expired dates NoneTotal value of produced pharmaceuticals which has at least one unit at stock at the end of the previous year

N/A

Objective: Reduce environmental impactProcedures for hazardous waste disposal in place N/ATotal amount of hazardous waste generated (in tonnes) N/ATotal amount of non-hazardous waste generated (in tonnes)

0

Total waste water generated 0

Objective: Stimulate (local) economy and equitable access to employmentImported equivalent products protected by the government in company's portfolio

NO

Local raw materials used in production process NOExisting partnerships with multi-nationals NO

Objective: Stimulate decent workOccupational Health & Safety procedures in place addressing the following topics:Maximum number of hours an employee can be working with a machine

YES

Restricted access to company's area YESSafe handling of hazardous substances YESProtection equipment for employees against hazardous substances available

YES

Number of work related injuries Own employees

0Number of fatalities Own

employees0

Total hours worked Own employees

11,310

Contractors

0

Contractors

0Contractors

0

Sourcelink Healthcare (2013)

Produced pharmaceuticals

A

nnexes


HYGEIA

Snapshot

How it began: Hygeia began operating in 1986, as

what has now become its flagship hospital, Lagoon

Hospital Apapa in Lagos, currently one of the four

hospitals in Nigeria offering both MRI and CT scans.

Since then the company has expanded its business to

include two further hospitals in the Ikeja and Vic-

toria Island districts of Lagos as well as two subsi-

diaries operating in the health insurance market:

Hygeia HMO and Hygeia Community Health Plan.

Hygeia HMO is a health maintenance organization

providing managed care to an enrollee base of over

300,000 individuals through a network of more than

1,200 providers across Nigeria. Hygeia Community

Health Plan is a donor-funded initiative that aims to

improve access to quality healthcare to low income

groups in Nigeria. Through the Hygeia Nigeria Li-

mited Foundation, the company also builds capacity

for medical personnel in and beyond its provider

network.

Sector: Healthcare provision, HMO

Geographic focus: Nigeria

Based in: Lagos, Nigeria

Year of investment: 2007

Business mission: Through its four companies,

Hygeia delivers primary and secondary healthcare

to the Nigerian population and strives to be the

first choice for healthcare solutions of internatio-

nal standards in Nigeria.

Annex 5: Snapshot Portfolio Companies

A

nnexes


Pyramid Pharma

Snapshot

How it began: Pyramid Pharma was established in

2001 as a wholesaler and retailer of quality pharma-

ceutical products and represented 13 regional and

international pharmaceutical companies in Tanzania.

It was acquired by GM Pharmacy Ltd in 2004. Pyra-

mid Pharma was the first pharmaceutical wholesaler

with a regional presence. The company has shown

significant growth and is positioned to become the

premier distributor of branded and generic drugs

in the country, as well as medical and laboratory

equipment. The company is handling importation,

distribution, marketing and distribution of drugs to

government and NGOs. Many of the supplies have

reached areas in parts of Tanzania where basic health

care did not exist or was severely interrupted. The

company has excellent relations in the private sector,

government, and development agencies. The com-

pany currently owns four branches: Ruvuma, Rukwa,

Mwanza and Mbeya.

Sector: Pharmaceutical import- and distribution

Geographic focus: Tanzania

Based in: Dar es Salaam, Tanzania


Business mission: to provide good quality affordable

pharmaceuticals and medical and laboratory equipment

and supplies in Tanzania.

A

nnexes


Strategis

Snapshot

How it began: Strategis Insurance Tanzania started

operations in 2002, as joint venture between Strate-

gis International, Heritage All Insurance Company

and Mac Group. It was registered as the first private

health insurance company in Tanzania in March

2003. Strategis offers medical insurance services. The

company utilizes various service suppliers (both local

and international). Since the start of its operations

the company has seen considerable growth in recent

years. Strategis has currently over 75,000 members

compared to 58,000 members in 2009 and 27,000 in

2008.

Sector: Health insurance

Geographic focus: Tanzania

Based in: Dar es Salaam, Tanzania


Business mission: to be the undisputed brand leader

in the Tanzanian health insurance arena by providing

access to quality healthcare and wellness solutions

through flexible, innovative and realistically priced

health plans.

A

nnexes


Hello Doctor

Snapshot

How it began: the founders of Hello Doctor ex-

perienced that across Africa there is a challenge to

provide equitable access to high quality healthcare at

low cost. Utilizing technology could help overcome

the overspending on health in the developed world

and under provisioning in the poor world. In South

Africa there is both a world class private healthcare

sector and lack of capacity and funding in the public

healthcare sector. Therefore the opportunity existed

to create a technical platform to enable the delivery

of medical resources not just in South Africa but also

throughout Africa.

Sector: Telemedicine1, healthcare delivery

Geographic focus: South Africa with potential to

collaborate throughout Africa with local HMOs

Based in: Johannesburg, South Africa


Year of exit: 2013

1 Telemedicine is the use of Information and Communication Technology (ICT) to provide and support healthcare activities, when distance separates the patients.

Business mission: Tele-health as a model of healthcare

delivery is expected to alleviate problems such as acces-

sibility, affordability and quality of healthcare particu-

larly in the developing world. The business is based on

four value pillars: 1) Trust; 2) Convenience; 3) Choice;

and 4) Affordability.

A

nnexes


AAR

Snapshot

How it began: AAR started operating in 1984 with

evacuation of medical and accident causalities,

both by road and air as its primary business. As its

membership increased, so did the need of its clients,

creating more opportunities to comprehensively

provide healthcare packages for its clients. AAR cur-

rently is the largest private healthcare company with

a footprint in the East African region. AAR operates

23 health centers located in Kenya, Uganda, and

Tanzania, providing preventive and curative primary

healthcare, rescue and evacuation and local and

international medical insurance to clients of various

income brackets. AAR has membership of around

135,000 people and is the preferred provider for both

the public and private sector in East Africa.

Sector: Healthcare, health insurance

Geographic focus: East Africa

Based in: Nairobi, Kenya


Business mission: AAR strives to continue to run

a sustainable and socially responsible business,

with its core values Timeliness, Caring Attitude,

Quality, Integrity and Team-ness being incorpora-

ted as the pillars in every decision and action the

company makes.

A

nnexes


Sourcelink

Snapshot

How it began: In 2011, IFHA finalized its investment

in Sourcelink South Africa. The core of the South

African business is the manufacturing and distribu-

tion of disposable masks, gowns, pillowslips and bed

linen. Today the factory in South Africa is establis-

hed and is in the process of manufacturing disposa-

ble products and distributing them within regional

African markets.

Sector: Production and manufacturing

Geographic focus: South Africa

Based in: Johannesburg, South Africa


Business mission: In Africa there is very little manu-

facturing of medical products. Besides the products

manufactured by Sourcelink South Africa, almost all

disposable masks, gowns and linen used in Africa are

imported. In many cases inferior quality products

are being imported from places like China. Kim-

berly Clark and 3M, large US listed multinationals

and manufacturers of such products, have seen their

market share reduced in many African countries due

to the unaffordable cost of their products. There is thus

a great need for affordable, but high quality disposable

infection control products in Africa.

A

nnexes


ER Corporate

Snapshot

How it began: In July 2012, IFHA finalized its invest-

ment in ER Corporate. ER Coporate (Pty) Ltd is a spe-

cialized medical administration and training company

and is part of the ER Group. ER Corporate manage 18

emergency and other specialist practices across South

Africa.

Sector: Medical administration and training

Geopraphic focus: South Africa

Based in: Bryanston, South Africa


Business mission: Training in the South African medical

landscape is essential for the development of the heal-

thcare system. Through a broad bouquet of emergency

medical courses for doctors, nurses, paramedics and

the public, the training centre completes the circle of

services for the busy medical practitioner at any level.

In partnership with IFHA, the ER Training and Deve-

lopment Centre plans to extend its services first across

South Africa and then onwards into Africa. The training

centre offers consistent quality and service to all

students on the courses and the high standards and

professionalism will ensure an excellent training

experience. The ER Training and Development

Centre has its main facility in Bryanston, Johan-

nesburg and will be rolling out further centres in

the coming months. Remote training is one of the

key differentiators of the ER training and Develop-

ment Centre. The training centre team will take the

training courses to the clients in the same profes-

sional manner as if the course was done on site at

our main facilities.

A

nnexes


Kampala Hospital Limited

Snapshot

How it began: In November 2013, IFHA finalized its

investment in Kampala Hospital Limited (KHL) which is

an urban hospital in Uganda with significant growth po-

tential. The total bed capacity is 109 of which 27 beds are

currently in use, with another ~30 beds almost ready for

use with limited investments. KHL is centrally located in

Kampala, the capital city of Uganda, at Kololo Hill. KHL

has a network of experienced, highly regarded and locally

well networked specialist consultants from a wide range

of specialties. Its service mix includes basic high volume

services including maternity care, malaria-related care and

simple theatre interventions. KHL will be positioned as

one of Kampala’s top mid-tier private hospitals.

Sector: Healthcare provision

Geopraphic focus: Uganda

Based in: Kampala, Uganda


Business mission: To establish a center of excel-

lence equipped with diagnostic facilities to enable

a quick diagnosis, irrespective of the complexity of

the disease process.

A

nnexes


Eco Health Limited

Snapshot

How it began:

In March 2013, IFHA finalized its investment in Eco Health

Limited. Eco Health Limited was incorporated to merge

World Wide Commercial Ventures Limited (WWCVL,

Nigeria) and Worldwide Healthcare Limited (WHL, Gha-

na) for the purpose of an exit. Eco Health Limited and its

wholly-owned group companies are engaged in the who-

lesale and retail distribution of healthcare related products

(ethical and generic pharmaceutical products, vaccines,

medical equipment, reagents and supplies, over the counter

products and veterinary medicine. The current operation

in Anglophone West Africa is the largest private healthcare

distribution business in this region.

Sector: Wholesale and distribution of healthcare

products

Geopraphic focus: Nigeria/Ghana

Based in: Mauritius


Business mission: To provide quality healthcare

products and services across Africa ensuring af-

fordability, availability, visibility and accessibility

within arm’s reach of the consumer .

Documents

ENVIRONMENTAL, SOCIAL AND DEVELOPMENT ... 2013 final.pdfOverview 1. INTRODUCTION We hereby present you the fourth edition of the annual Environmental, Social and Development Perfomance