Blended-Finance Bankability Director

The mandate

The programme combines referral hospitals, diagnostic hubs and distributed clinics under public service and availability payments, but its financing concept layers grants, concessional loans and commercial debt without explicit risk allocation. Forecasts assume utilisation and government payment while leaving workforce, equipment uptime and referral behaviour disconnected. The defined problem is to create an investable structure that protects health outcomes and affordability rather than using subsidy to mask an unbankable operating model.

The deliverables are a service-and-cash model, risk allocation matrix, capital-stack design, payment mechanism, downside and affordability cases, investor information package and phased financing roadmap. The work must connect patient pathways, capacity, staffing, diagnostics, maintenance, public payment verification, construction, equipment replacement, currency, political risk, insurance and performance measures across facility types.

Four milestones span six months: week five accepts demand, service and cost evidence; week twelve approves risk allocation and payment options; week nineteen concludes structured testing with development and commercial capital providers; and week twenty-six delivers the preferred capital stack, term-sheet requirements, affordability, fallback and investment decision dossier. Billing follows acceptance of each milestone.

Acceptance requires health operators to reproduce capacity and cost, public counterparts to validate payment mechanics, counsel to confirm client interpretations, and funders to state attributable conditions rather than generic interest. The structure must show who bears demand, construction, equipment, workforce, payment, currency and performance risk and remain solvent under delayed public payment and slower referral growth.

The client provides service plans, demand studies, public agreements, capital and operating costs, construction schedules, health outcome targets, grant terms, counsel input and provider access. The consultant does not arrange capital, negotiate binding terms, deliver medical advice, approve public commitments, value land, select contractors or lenders, provide legal or tax opinions or sign financing.

Why this is external work

Clinical planners optimise access, government teams optimise affordability, development partners optimise additionality and commercial lenders optimise debt service. Current models add their instruments without reconciling the underlying service risk. Independent blended-finance expertise can expose where subsidy is genuinely catalytic, require investable payment evidence and prevent a complex capital stack from obscuring an unsustainable health operating model.

What you will own

• Build patient, referral, capacity, workforce, equipment, maintenance, service and public-payment drivers by facility type.
• Map construction, demand, availability, performance, payment, currency, political, clinical-operating and replacement risks to accountable parties.
• Design grant, guarantee, concessional, commercial, sponsor and contingency layers with triggers, conditions and loss order.
• Test payment mechanisms for verification, affordability, gaming, service continuity and unintended exclusion of difficult patients.
• Model downside for delay, lower utilisation, workforce gap, equipment failure, slow public payment and currency movement.
• Conduct capital-provider roundtables that distinguish mandate fit, diligence need, approval dependency and conditional appetite.
• Deliver the bankability pack, capital stack, risk matrix, roadmap, fallback and unresolved public decisions.

Candidate qualifications

• Has structured blended finance for hospitals, diagnostics, clinics or comparable essential-service infrastructure in emerging markets.
• Understands grants, guarantees, concessional capital, commercial debt, public payments, political risk and currency together.
• Can model healthcare capacity and operating cash without treating utilisation as demand automatically served.
• Has designed performance payments that protect outcomes without encouraging exclusion or unverified activity.
• Has tested funder appetite independently of arrangement fees and exposed subsidy that merely conceals weak operations.
• Produces investable evidence usable by health operators, governments, development institutions and commercial credit committees.

Non-negotiables

• Can maintain the Nairobi hybrid cadence and complete both county observations and all capital-provider roundtables.
• Will disclose relationships with funders, government bodies, health operators, insurers, advisers and contractors.
• Brings healthcare blended-finance structuring; grant strategy or commercial project finance alone is insufficient.
• Will not arrange capital, accept success fees or make legal, public-policy or clinical determinations.

1. 49 words maximum. Which healthcare operating assumption most often makes a blended-finance structure falsely bankable?
2. 49 words maximum. How would you prove that a grant is catalytic rather than masking recurring deficit?
3. 49 words maximum. What performance payment could unintentionally exclude the hardest-to-serve patients?