Picture credit: Jom at German Wikimedia, CC BY-SA 2.0, via Wikimedia Commons

Development financing institutions (DFIs), which provide loans and make investments in development projects, are gaining increasing prominence in healthcare. In this post KCL undergraduate Nina Olshan highlights the often-opaque nature of this financing and makes the case for greater transparency and accountability by organisations working in this area.

Trawling the internet for investment data

In the era of the Sustainable Development Goals, DFIs are adopting major roles in the development finance (‘beyond aid’) landscape. Notable examples include multilateral organisations such as the World Bank’s IFC, and regional development banks like the EBRD, IADB and AfDB, alongside wealthy North American and European DFIs such as the USA’s OPIC, EU’s EIB, Germany’s DEG and Kfw, France’s Proparco and AFD and the UK’s CDC. These organisations have made direct commitments in healthcare provision estimated at in excess of USD 2.2 billion during the last 3 years (Hunter and Marriott, 2018).

During the past few months I have been conducting desk-based research to try to better map the landscape of DFI investment in healthcare. Information about the breadth of investment activity is in some cases easily available, usually through online sorting tools on DFI websites. Sometimes these tools are a bit counterintuitive, as they can be difficult to use! If the website lacks detailed information, often clear and comprehensive annual reports in at least two languages are available. It is sometimes possible to find funding amounts and linked goals, and in some cases even specific project reports giving a basic analysis and partner information.

There are also some strategies for finding some information about investments outside of direct DFI reporting. Mainly this involves combing through investment reports and trying to find the names of investors in online media. This is a far from satisfactory method of creating a picture of the development landscape in a broader sense.

(Non-)disclosure

It was striking how little consistency there is in DFI reporting for healthcare investments. This means that even with the most accessible data, the exact numbers on investments into a specific sector, like commercial healthcare are fairly difficult to find. Amongst the leading DFIs, there is substantial variation in terms of what types of data are available and to whom. I developed four broad categories to reflect this:

• High transparency (Project title, funded amount, project description, in depth analysis, impact report, links to multiple partners, if applicable, post-project analysis)
• Medium transparency (Project title, funded amount, project description and link to partner, region and more specific community information)
• Most basic level (Project title, funded amount, region)
• No information available (It is not uncommon for DFIs to publish no information on their investments, or to simply link to broad funds)

In general, multilateral and some European DFIs (including CDC, Proparco and DEG) have relatively good (medium-high) levels of disclosure for specific investments as they offer descriptive information and project details. However there are many European DFIs with very limited information on their investments. Italy for instance, has very limited information available about the specifics of its development investments. And it is difficult to find meaningful data for DFIs based in the USA and Canada.

There are other DFIs and investment actors whose activities in healthcare seem to be completely opaque. Many East Asian DFIs (for example, the Korean Development Bank and Chinese DFIs) have no English-language information available about specific investments. Similarly, sovereign wealth funds, with the notable exception of the Norwegian sovereign fund, are often opaque in disclosing information on their investments. While these funds do not necessarily have an explicit development agenda, they are nonetheless major actors in the development space, and have real influence and effect.

The need for transparency and accountability

Transparency is essential for keeping track of what work is being done and by whom, and for holding public organisations to account in development (Jenkins, 2018). Knowing where public funds are being spent is an important governance issue as it can be used to check for and campaign against the improper spending of public monies. It can also help detect the problematic use of tax havens by publicly-backed companies (Romero, 2014).

The lack of transparency amongst some DFIs is a particular concern when that spending enables the expansion of for-profit private healthcare. This basic level of knowledge is vital in a field like healthcare where there are a huge variety of actors working on issues that can completely change people’s lives. It is concerning to see private facilities being funded or subsidized by local governments and major DFIs, especially when those facilities are used mainly by a wealthy elite.

This work feeds into wider conversations that have been taking place on the issue of transparency for ‘beyond aid’ development financing (Tew and Caio, 2016) and accountability in the global governance architecture (Woods and Narlikar, 2008). Development financing is a tool. We need to know how that tool is being used, in healthcare and in other sectors, and we need to make sure that it is really being used to maximize, and not undermine, development.