A Digital Artifact Presentation proposing a Financial Solution to Healthcare development crisis in the Central Africa Republic. This part of Final Project Submitted in the Finance For Development Course -MOOC run by the World Bank Group via EDX.

1. DIAMOND IN THE DIRT:
LEVERAGING HEALTHCARE INFRASTRUCTURE INVESTMENT
OPPORTUNITIES TO FACILITATE DEVELOPMENT IN CENTRAL
AFRICA REPUBLIC (CAR)
By
Enaifoghe Nathan Ohiomokhare

2. "...I'm a diamond in the dirt yet to be
found...." - Curtis Jackson III - aka
50CENT (Multi-Award winning American
Hipop Artist).

3. AIM: To mobilize private funding by convincing Nigeria's business community under
Nigeria Association Of Chambers Of Commerce, Industry, Mines And Agriculture
(NACCIMA) to invest in Central African Republic by leveraging on favourable investment
climate aided by the Multilateral Development Banks (MDBs) and supported by the CAR
government.
OBJECTIVE: Create an Innovative-Healthcare-Financing-Mechanism (IHFM) by
creating a special purpose vehicle (spv) / Investment-Fund through which Nigerian
businesses can "crowd funds" towards development of Healthcare infrastructure
including renewable energy and water.

4. COUNTRY OVERVIEW
The Central African Republic (CAR), a landlocked country in Central Africa is embarking
on a long path to recovery. Its history has been marked by political instability and in
2013, a major security and humanitarian crisis erupted, unraveling the country’s social
fabric and displacing over 25% of its population. 2

5. SocioPolitical Landscape;
Faustin-Archange Touadera, a former
prime minister and maths professor,
was declared the winner of a
presidential election in February 2016
seen as crucial to turning the page on
years of sectarian violence.
Recent presidential and legislative elections have brought three years of political
transition and turmoil to an end. On March 2, 2016 for the first time in its history, the
Central African Republic has a democratically-elected President and Parliament.
Previous sectarian tensions between Muslims and Christians uprooted nearly 1.2
million people. After 3 years, 384,000 people remain displaced within the country and
more than 467,000 people are still refugees in Cameroon, Chad and the Democratic
Republic of Congo. More than half of the country's population (about 2.3 million people)
are in urgent need of humanitarian assistance. At the national level, only 55% of health
facilities are functional; only 25% of health facilities have an energy source, while only
2% have a potable water source.2
As at 2011, there was only 1 doctor for
every 15,000 people and 1 health
facility for every 8,000 people. The
instability and violence in CAR over the
last two years substantially
deteriorated the health system and
health needs remain acute for much of
the population.3

6. Economy:
Economic recovery has been very modest. After the collapse of 2013, when real GDP
fell by 36%, the economy picked up only 1% in 2014, and 4.8% in 2015.
In 2015, tax revenue was still only half the level of 2012, as commercial activity
recovered very slowly. The contributions of export duties on diamond, timber and gold
in the revenues are low. 2
CAR is rich in natural resources, including diamonds, timber, uranium, and potential oil
and gas deposits. A rise in import and export activities coupled with Diamond exports
and forest concessions, a revival of the agricultural and mining sectors could boost real
GDP growth to an estimated 5.7% in 2016.4
Porter taking cassava to market in
the CAR - Image
copyright GETTY IMAGES

7. WAY FORWARD
INITIATIVES ND ROUND ORK LREADY N LACEA G W A I P :
Several initiatives by International Financial institutions and the CAR government are
already in place which make private investment in the country attractive, viz;
1) The WorldBanks Group now adopts a "cascade aproach" to development financing
which first prioritizes private investors over other sources of finance. A new $2.5 billion
Private Sector Window (PSW), introduced together with the International Finance
Corporation (IFC) and Multilateral Investment Guarantee Agency (MIGA), will help
mobilize private capital and scale up private sector development in the poorest
countries, particularly in fragile situations such as the CAR.5
2) The International Financial Corporation's (IFC) Fragile and Conflict-Affected States in
Africa (FCS-CASA) Program is a regional initiative designed to bring private sector
development to Africa’s fragile states by increasing IFC's portfolio in these challenging
markets. CASA funds IFC advisory projects in FCS directly, provides market intelligence
and advice, and helps governments strengthen their business environments. CASA is
currently active the Central African Republic.6
3) In May 2015 the WorldBank Group approved a total of US$12 million in new financing
to specifically rebuild the health system and strengthen the delivery of health services
in war-torn Central African Republic (CAR). The project is expected to reach over 1
million direct beneficiaries by 2019. Additionally , more interventions will be funded by a
US$11.2 million dollar grant from the World Bank's Health Results Innovation Trust
Fund (HRITF), which supports results-based financing approaches to accelerate
progress in maternal, child and adolescent health.
7

8. MY PROPOSAL:
We propose to create a special purpose vehicle (SPV) known as the NACCIMA (Nigeria
Association of Chambers of Commerce Industry, Mines and Agriculture)
Tripple-Healthcare Investment FUND (3HIF) to take advantage of investment
opportunities in Healthcare in the CAR. Company's and Nigerian private investors
through NACCIMA will pool funds into the SPV . The Fund will Mobilize Nigerian Health
professionals to provide technical and professional expertise, Health-Infrastructure,
Medical equipment, Drugs and Consumables in development of the Health sector in
Central African Republic (CAR). The resulting WorldBank and Multilateral Development
Bank (MDB) guarantees, securities and instruments and CAR Government concessions
will pay for these services in the long term. The steps are;
.1) Create a SPV/fund known as "NACCIMA-TrippleHealthcae Investment Fund" (3HIF)
for healthcare at the three levels (Primary, Secondary and Tetiary) which member
companies will subscribe to. This is meant to generate a large pool of resource funds
subscribed by members and interested investors.
2).Apply to the WorldBank to seek support from the Multilateral development Banks
(MDB) in the form of a loan and guarantees from the IDA utilizing its $2.5 Billion
IFC-MIGA private sector window created within IDA.8
3) Appoint a multisectorial / Multidisciplinary / Interprofessional project management
consultative forum to design, develop and implement the project. This committee will
comprise all professionals needed to deliver the technical and financial aspects of the
proposed National project. All relevant institutions will be mobilized to design, establish
and implement the new CAR healthcare project as an important priority.
The objectivesof this proposed project are;
a) To upgrade or rebuild the entire national healthcare infrastructure (including
hospitals at primary, secondary and tertiary care levels).
b)To provide expertise in training, capacity development and on-site staffing in
healthcare services and emergency services.
c)To improve the quality of maternal and child health services and reproductive health
in targeted rural areas.
b) Provide emergency health services to populations affected by the recent
socio-political crisis.
c) Introduce results-based interventions to strengthen CAR’s health system over the
long-term.
d) Take steps aimed at transitioning the healthcare system from emergency relief
towards strengthening the health system over the medium- to long-term.
e) The provision of drugs, equipment, staffing and rehabilitation of health structures
affected by the crisis.

9. References;
1) (Central African Republic country profile) - http://www.bbc.
com/news/world-africa-13150040world-africa-13150040
2) Central African Republic Overview - http://www.worldbank.
org/en/country/centralafricanrepublic/overview - (October 10, 2016)
3). Central African Republic Overview - http://www.worldbank.
org/en/country/centralafricanrepublic/overview - (October 10, 2016)
4) Central African Republic | Enough. (http://www.enoughproject.org/conflicts/car)
5) http://ida.worldbank.org/about/how-does-ida-work
6). SUB-SAHARAN AFRICA PRIORITIES FRAGILE & CONFLICT-AFFECTED
STATES:FCS AFRICA PROGRAM -
http://www.ifc.
org/wps/wcm/connect/region__ext_content/ifc_external_corporate_site/
sub-saharan+africa/priorities/fragile+and+conflict+affected+states
7) May22,2015:http://www.worldbankorg/en/news/press-release /2015/05/22/
world-bank-helps-to-rebuild-health-care-delivery-system-in-central-african-republic
8). https://ida.worldbank.
org/sites/default/files/images/ifc-miga-private-sector-window-ida18.
IDA/SecM2016-0180; September 23, 2016;Further Details on the Proposed IFC-MIGA
Private Sector Window in IDA18.