City Hospital Projects, Turkey
In the mid-2000s, the Turkish government launched a programme to transform its public healthcare system to ensure universal coverage for the public and improve access to high-quality healthcare across the country. Beginning in 2009, the Ministry of Health undertook an ambitious programme to upgrade its healthcare infrastructure, aiming to develop a series of new hospitals in key urban areas with a combined 42,000 new beds through public-private partnerships.
In line with its mission to deliver inclusive sustainable development, Meridiam, a developer and long-term asset manager of sustainable infrastructure, engaged with the Turkish government to develop four hospital projects in key secondary cities where improved access to high-quality and specialized healthcare was particularly needed given the growing urban populations.
Today, Meridiam operates four hospitals with a combined total of 4,400 beds, equating to more than 10% of Turkey’s planned new bed capacity under the programme and representing an investment of more than €1.5 billion.
The four hospitals integrate global environmental, social and governance (ESG) standards and were structured to maximize affordability and thus value-for-money for the government. Strong partnerships – with central and local authorities, contracting partners, service providers and local communities – ensure that stakeholders remain engaged in the projects’ delivery and long-term planning.
As key contributors to their urban communities, the hospitals were designed for resilience, from utilization of advanced seismic isolation technology to withstand earthquakes, to robust crisis management procedures and well-trained staff (both medical and non-medical) to ensure an adaptive and rapid response to public health emergencies, as evidenced by the hospitals’ contribution to the country’s fight against COVID-19.
How the GFC-6 Qualities are present in the Meridiam City Hospital Projects:
The hospitals provide the public with affordable and efficient access to a full range of high-quality healthcare in a single location. Due to the nature of the projects, accessibility for vulnerable groups was a crucial focus in the design phase, and fully implemented during construction and operation.
Seismic isolation technology installed ensured resilience against the recent Elazig earthquake, enabling full continuity of service and no damage to the facility. These hospitals were the first PPPs in Turkey to feature comprehensive ESG, SDG and climate-change monitoring and reporting. The hospitals were also LEED certified gold thanks to design elements like lighting automation, heating/cooling system automation and rooftop solar energy collectors.
A stakeholder engagement plan was activated for continuous development. Community outreach and programmes were established in each city, setting the hospitals as focal points for community life. This plan incudes implementing and undertaking periodic satisfaction surveys and regular stakeholder meetings. An independent study measuring the impact of the hospitals on their communities was also conducted as were community initiatives that engage and support youth, and women and focus on environmental sustainability. Additionally, the developers designed and implemented a public training plan that supports IT literacy for community, preventative healthcare, hygiene for women and children.
Economic and institutional effectiveness
Affordability is a key public concern, so Meridiam worked closely with the Ministry of Health on a robust payment and funding solution: revenues are designed to maximize local currency costs and resources. Affordable, long-term financing was also provided, bringing together DFIs and international commercial banks and enabling significant cost savings compared to previous financing alternatives.
All projects are contractually structured to ensure extraordinary maintenance across the life cycle and concession period. Global trends will be monitored to support relevant government entities in searching for and implementing best practice for primary and critical healthcare planning, and how the facilities can suit the master planning. There will also be continuous assessment and monitoring of digitalization of the facilities enabling the client to provide innovative, integrated healthcare services, e.g. telemedicine, video-surgery.
Critical mass potential
Developed a replicable framework for the programme by:
- Updating and refining the healthcare PPP legislation to meet international financing requirements
- Helping to draft standardized project documentation (setting a programme-wide precedent)
- Establishing a balanced contractual risk allocation between public and private sector
- Building capacity at the Ministry of Health