Investment Opportunity in Emerging Market Healthcare
CARE9 partners with Development Finance Institutions (DFIs), multilateral development banks, and institutional investors to deliver attractive risk-adjusted returns while scaling healthcare infrastructure across Africa and South Asia. Our healthcare investment thesis combines strong fundamentals with significant social impact and currency diversification benefits.
Investment Highlights
Financial Returns Profile
Target IRR & Returns
- 12-15% IRR on equity investments (mid-market range)
- 6-9% IRR on debt instruments (senior tranches)
- 8-11% IRR on mezzanine structures
- 15-20%+ potential for higher-risk equity co-investments
- 4-7 year payback period on most project structures
Capital Requirements by Investment Type
- Healthcare facility development: $30-150M per project
- Pharmaceutical manufacturing: $25-80M capex
- Diagnostic network expansion: $10-40M per regional network
- HIMS deployment at scale: $5-20M for national rollout
- Syndication opportunities: Participate in $50M+ consortium deals
Proven Financial Metrics
Revenue Generation
- $2-5M annual EBITDA per 250-bed specialty hospital
- 40-50% EBITDA margins in pharmaceutical manufacturing
- $500K-2M annual revenue per diagnostic center
- $1-3M annual SaaS revenue per major HIMS deployment
- Double-digit annual growth rates across all business units
Cash Flow Characteristics
- Diversified revenue streams (facility fees, pharmaceutical sales, diagnostics)
- Recurring revenue from long-term government contracts
- Operating leverage from shared services model
- Strong free cash flow generation by Year 3-5
Risk Management & Mitigation
Sovereign & Currency Risk
Sovereign Risk Mitigation
- Long-term PPP agreements with government guarantees
- Availability payment mechanisms reducing revenue risk
- Multi-country portfolio diversification (Ghana, Nigeria, Zimbabwe, Kenya, Rwanda)
- DFI co-financing reducing single-lender exposure
Currency Risk Management
- Natural hedges through local currency revenues
- Debt denominated in hard currencies (USD, EUR)
- Foreign exchange derivative facilities
- Government cost-escalation clauses indexed to inflation
Operational Risk Mitigation
Proven Execution Track Record
- CARE9 management team with 20+ years healthcare infrastructure experience
- Established vendor relationships and supply chain networks
- Pre-qualified contractor and equipment supplier networks
- Comprehensive project management and controls framework
Performance Guarantees
- Liquidated damages for construction delays
- Service level agreements (SLAs) with >95% uptime targets
- Performance bonds from major contractors
- Key person insurance and succession planning
Market & Demand Risk
Healthcare Demand Drivers
- Africa’s healthcare spending growing at 8-10% annually
- Population growth and urbanization driving facility demand
- Government mandate for local pharmaceutical manufacturing
- Rising prevalence of chronic diseases (oncology, diabetes, cardiovascular)
- Digital health adoption accelerating HIMS demand
Demand Protection Mechanisms
- Government take-or-pay contracts
- Minimum volume guarantees in procurement agreements
- Multiple revenue streams reducing single-source dependency
- Essential medicines and services focused (recession-resistant)
Investment Structure Models
Model 1: Senior Debt (6-9% IRR)
Typical Structure
- Loan amount: $20-80M
- Term: 7-15 years
- Security: First charge on project assets
- Tenor: Match project cash flow generation profile
- Currency: USD with local currency options
Suitable for
- Risk-averse institutional investors
- Insurance companies and pension funds
- IFC, AfDB, DEG, Proparco
- Export credit agencies (EXIM India, UKEF)
Expected Returns
- Consistent coupon payments
- Principal repayment from operational cash flows
- Currency appreciation upside
Model 2: Mezzanine Finance (8-11% IRR)
Typical Structure
- Investment amount: $5-20M
- Equity-linked coupon (2-4% base + upside participation)
- Senior to equity, junior to debt
- Conversion rights at predetermined valuation
- 7-10 year tenure
Suitable for
- Blended finance investors
- Impact investors seeking moderate returns
- Development finance specialists
- Institutional investors with ESG mandates
Expected Returns
- Higher coupon than senior debt
- Potential equity upside upon exit
- Senior waterfall priority
- Lower volatility than pure equity
Model 3: Equity Co-Investment (15-20%+ IRR)
Typical Structure
- Equity stake: 15-35% alongside CARE9 (35-50%)
- Board representation (optional)
- Exit window: 5-10 years post-operational stability
- Dividend policy: Reinvest for growth initially, then 30-40% payout ratio
- Secondary market liquidity options
Suitable for
- Growth-focused institutional investors
- Impact capital funds
- Strategic healthcare investors
- Patient capital with long-term horizons
Expected Returns
- Dividend income from Years 4+
- Capital appreciation through operations and multiple expansion
- Stake sale to strategic buyers or secondary funds
- Potential platform IRR of 20-25% over full life
Model 4: Blended Finance Structure
Typical Capital Stack (100M Project)
- DFI Debt (50-60%): $50-60M at 4-6%
- Commercial Debt (20-25%): $20-25M at 8-10%
- Mezzanine (5-10%): $5-10M at 9-11%
- Sponsor Equity (15-20%): $15-20M targeting 20-25% IRR
- Government contribution: Land, licensing, policy
Advantages
- De-risked through layered capital structure
- Blended cost of capital: 7-8%
- Risk-appropriate returns at each level
- Demonstrates strong sponsor commitment
- Attracts diverse investor base
Sector-Specific Investment Opportunities
1. Specialty Hospital Development (Oncology, Cardiology)
Investment Thesis
- $100-150M Indo-African Oncology Institutes
- 250-350 bed facilities with advanced imaging (PET-CT, advanced surgery)
- Medical travel mitigation (30-40% reduction in patient outflows)
- Government partnerships providing demand certainty
- Strong pricing power in specialized oncology care
Financial Profile
- 18-24 month construction period
- 2-3 year ramp to 80% occupancy
- $4-6M annual EBITDA per 250-bed facility
- 35-40% EBITDA margins at full capacity
- 12-15% IRR on blended capital
DFI Appeal
- Aligns with health outcome SDGs (SDG 3)
- Job creation (500-800 direct jobs)
- Technology transfer and local capacity building
- Government co-investment demonstrates demand
2. Pharmaceutical Manufacturing & CDMO
Investment Thesis
- $40-80M capex for GMP manufacturing facilities
- Import substitution potential: $150-200M annually
- Technology transfer from international partners
- Export readiness and regional market access
- Job creation: 800-1,200 skilled manufacturing jobs
Financial Profile
- 24-36 month setup and validation
- 3-5 year market ramp to full capacity
- $15-25M annual EBITDA at capacity
- 40-50% EBITDA margins in pharmaceuticals
- 13-16% IRR on equity capital
DFI Appeal
- Import substitution supports national priorities
- Skills development and technology transfer
- Backward linkage with API sourcing
- Regional export market potential
- Strong currency dividend (local production)
3. Diagnostic Network Expansion
Investment Thesis
- $30-50M regional diagnostic networks (5-10 centers)
- Hub-and-spoke model with advanced imaging and molecular labs
- Tele-radiology and pathology expertise access
- Integration with hospital network referral systems
- Essential service with stable demand
Financial Profile
- 12-18 month deployment period
- Immediate revenue from operations
- $2-3M annual EBITDA per center (at scale)
- 35-45% EBITDA margins
- 11-14% IRR on blended capital
DFI Appeal
- Rapid deployment and cash flow generation
- High social impact (early disease detection)
- Complements government facility strategy
- Relatively lower capex per facility
- Clear exit opportunities through clinic networks
4. HIMS Deployment & Digital Health
Investment Thesis
- $10-30M for national HIMS rollout (50-100 facilities)
- SaaS-based recurring revenue model
- Government standardization mandates
- Digital health adoption accelerating post-COVID
- Data infrastructure creating additional revenue streams
Financial Profile
- 18-30 month deployment period
- Subscription revenue: $50-150K per facility annually
- $3-5M annual recurring revenue at scale
- 70-80% EBITDA margins in SaaS operations
- 14-18% IRR on lower capex base
DFI Appeal
- Rapid growth with SaaS economics
- Lower capex than facility development
- Scalable across multiple countries
- Tech transfer and digital health acceleration
- Strong ESG outcomes (health data democratization)
ESG & Impact Metrics
Environmental (E)
Climate Resilience
- Green building standards (LEED/WELL certification targets)
- Renewable energy integration (10-30% solar potential)
- Water efficiency and waste management systems
- Medical waste handling protocols
- Carbon footprint tracking and reduction targets
Environmental Benefits
- Reduced energy consumption vs traditional facilities
- Water recycling and rainwater harvesting
- Proper pharmaceutical waste disposal (vs unsafe burning)
- Reduced medical travel (carbon emission reduction)
- Local supply chain development (logistics efficiency)
Social (S)
Healthcare Access & Equity
- Population coverage increase: +100K-500K per project
- Reduced wait times for specialty care
- Affordability programs (15-25% subsidized capacity)
- Rural-urban access equity improvements
- Targeted services for underserved populations
Employment & Skills
- Direct job creation: 500-1,200 per facility
- Indirect jobs in supply chain and supporting services
- Technical training and fellowship programs
- Women-focused hiring (40%+ female workforce)
- Management development and capacity building
Community Impact
- Healthcare worker training: 5,000+ personnel by 2028
- Community outreach programs and mobile clinics
- Research and epidemiological data collection
- Patient education and health literacy programs
- Supply chain formalization and MSMEs support
Governance (G)
Corporate Governance
- Board composition with independent directors
- Audit committee oversight and risk management
- Transparent financial reporting and external audits
- Executive compensation linked to ESG metrics
- Stakeholder engagement mechanisms
Healthcare Governance
- Clinical governance and quality assurance committees
- Patient safety and quality improvement programs
- Data privacy and cybersecurity compliance
- Anti-corruption and ethical procurement standards
- WHO guidelines and international best practices adherence
Impact Accountability
- Third-party impact verification and reporting
- SDG alignment tracking (SDG 3 primary)
- Annual ESG reporting and impact measurement
- Stakeholder communication and transparency
- Continuous improvement initiatives
Investment Timeline & Milestone Roadmap
Phase 0: Investor Engagement (Months 1-3)
- Investment thesis presentation and Q&A
- Site visits and facility tours
- Management team meetings and due diligence
- Financial model review and assumptions validation
- Investment committee approval
Phase 1: Project Development (Months 4-12)
- Feasibility studies and technical assessments
- Government agreements and land allocation
- Environmental and social impact assessments
- Preliminary design and cost estimates
- Financing committee approvals
Phase 2: Financial Close (Months 13-18)
- Final project documentation and contracts
- Debt syndication (DFI and commercial banks)
- Equity funding rounds
- Government guarantees and long-term agreements
- Insurance and risk mitigation arrangements
Phase 3: Construction (Months 19-36)
- Design finalization and permitting
- Construction and equipment installation
- Regular investor updates and oversight
- Quarterly financial and progress reporting
- Contingency management and change orders
Phase 4: Operational Ramp (Months 37-60)
- Commissioning and soft opening
- Staff training and operations stabilization
- Revenue ramp towards full capacity
- Return of capital begins (via dividends)
- Performance monitoring against projections
Phase 5: Mature Operations (Years 5-10+)
- Stable cash flow generation and returns
- Potential exit opportunities
- Stake sale to strategic buyers or secondaries
- Dividend distributions from operations
- Potential platform expansion and follow-on investments
Historical Performance & Track Record
CARE9 Investment Portfolio Highlights
- 15+ successful healthcare infrastructure projects
- $300M+ in cumulative DFI financing arranged
- 95%+ on-time and on-budget project delivery
- Average 13-16% equity IRR realized on mature investments
- Strong sponsor equity capital deployed ($150M+)
Investor Base
- Multilateral DFIs: IFC, AfDB, DEG, Proparco
- Export credit agencies: EXIM India, UKEF
- Commercial banks: Standard Bank, Stanbic, Ecobank
- Impact investors and development partners
- Institutional investors and family offices
Investment Documentation & Diligence
Required Due Diligence
- Financial models (3 scenarios: base, upside, downside)
- Legal due diligence on all project agreements
- Environmental and social assessments
- Technical due diligence by independent consultants
- Regulatory and licensing verification
Investor Reporting
- Quarterly financial statements and KPI reports
- Annual audited financial statements
- Real-time project tracking dashboard
- Regulatory filing transparency
- Annual investor meetings and calls
Next Steps for Institutional Investors
- Schedule Investment Call: Discussion with CARE9 Investment Committee
- Investment Committee Presentation: Tailored thesis for your criteria
- Due Diligence Process: Financial, legal, technical, and ESG review
- Project Selection: Identify investment opportunities matching your ticket size
- Financial Close: Documentation, capital deployment, and governance setup
- Ongoing Partnership: Quarterly reporting, reinvestment opportunities, exits
Contact CARE9 Investor Relations: investors@care9.com
Available Investor Materials
- Detailed investment thesis papers
- 5-year financial model templates
- Sample DFI and syndication agreements
- Historical performance data and case studies
- ESG and impact measurement frameworks