PPP Solutions in Health Infrastructure – The Way Ahead 2 nd MENA Healthcare Infrastructure Investment & Finance Summit

PwC Today: The healthcare PPP revolution as told by numbers Spending on health as a % of GDP is growing in all mature and developing economies (includes OECD and BRIC nations, see graph below) In all cases, growth in health spending outpaces growth in GDP Governments are under pressure to consider new methods of financing and access private sector expertise and efficiency if they want to have any chance of sustaining required investment levels 2

PwC The classical infrastructure The service model Integrated model Integrated delivery Clinical delivery Infrastructure The evolution of PPP models PPPs can be structured around any or all of the following areas: Infrastructure – hospitals and clinical facilities Clinical services – delivery of medical care, including doctors, nurses, and know-how 3

PwC PPP is now a global initiative Majadahonda Hospital Treatment Centre - ISTC William Osler Turks & Caicos New Karolinska Solna UCLH Proton Beam Therapy Centre Yao City Inkosi Albert Luthuli McGill Belo Horizonte Primary Care Royal North Shore Hospital 4 Kuwait Hospital PPP

PwC Spotlight on the Middle East Demand drivers Chronic conditions as a proportion of total spending Global average: 46% GCC region: 21% Prevalence of diabetes Global average: 5% GCC region: 15.5% Prevalence of obesity GCC region: 20.6% Fifth highest rate in the world 5 Recent developments Saudi Arabia $6bn medical cities 117 new hospitals 750 primary healthcare centres Kuwait First hospital PPP in Kuwait 9 hospital expansion schemes Abu Dhabi $1.3bn Cleveland Clinic Mafraq Hospital Qatar Health insurance scheme

PwC Challenges of the PPP model in the Middle East 6 PPP Model Pricing optics Procurement timeline Appropriate risk allocation Stakeholder Management

PwC Building the way ahead 7 PPP Units Standards and guidance Common approach to risk allocation Government Building skills and capacity Tackling financing risks Building a refi market Funding Markets

PwC Key Contacts PwC Global Ian Wootton Partner, Global Health PPPs Leader, London +44 (0) PwC Middle East Charles Lloyd Partner, Capital Project and Infrastructure Leader, Abu Dhabi Simon Leary Partner, Health Industries Leader, Abu Dhabi Asim Iqbal Senior Manager, Capital Project and Infrastructure, Abu Dhabi +971 (0)

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