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Paper short abstract

This paper examines the role of Development Finance Institutions (DFI) in the financialisation of healthcare in the Global South and presents case studies of health debt and related harms experienced by patients at private hospitals financed by these institutions.

Paper long abstract

In the name of Universal Health Coverage (UHC), Development Finance Institutions (DFIs) invest in private for-profit healthcare in the Global South. Limited information is available about how and what they finance and whether UHC objectives are achieved. This paper presents findings from the first known systematic mapping of healthcare investments by four European DFIs together with the World Bank’s International Finance Corporation (2010 to 2022), together with primary research on patient healthcare seeking experiences in sample hospitals, and desk-based research on the affordability and accessibility of all identified funded hospitals.

The paper evidences the role played by five DFIs in the financialisation of healthcare in low- and middle-income countries by investing hundreds of millions of dollars in expensive private hospitals via a complex web of financial intermediaries, mostly private equity funds. Purposefully selected patient case studies reveal that at least some of the revenue generated by investee hospitals is derived from alleged exploitative and extractive practices, in addition to high fees, leading to catastrophic health expenditure and other related harms, such as patient detentions. Cases include low-income government-insured patients denied the cashless healthcare they were entitled to. The data gives insight into coping mechanisms including emergency sales of land, and loans from extended family and friends and/or commercial and financialised lending facilities.

Significant transparency, governance and accountability shortfalls are evidenced, many of which appear inherent to the commercial and financialised character of the DFI investee intermediaries and healthcare companies. The paper stresses the urgency of further independent research and investigations.