Following a competitive tender, an agreement has been signed between ADN PPP Sağlık Yatırım A.Ş (“the Project Company”). and the Ministry of Health according to which the Project Company will be responsible for the detailed design, construction, equipping, financing and maintenance of the Project during the 28-year project period, while the provision of medical services will be under the responsibility of the Ministry of Health. The project sponsors are a consortium comprised of Ronesans Holding A.S, Ronesans Saglik Yatirim A.S., Meridiam Eastern Europe S.a.r.l, TTT Saglik Hizmetleri Egitim Insaat Sanayi Ticaret A.S., Sam Yapi Sanayi ve Ticaret Ltd. Sti., and Sila Danışmanlık Saglik Bilisim İnşaat Ticaret A.S.

Established in 1993, Rönesans Holding is an Ankara-based diversified conglomerate with activities in construction, real estate, energy and healthcare PPP projects. Operating in 10 countries with more than 30,000 employees, the Holding is composed of 4 business units: (i) Construction: Ronesans’ primary business unit specializes in design and construction of shopping centers, offices, hotels, mixed-use facilities, heavy industry plants, infrastructure facilities and civil engineering.; (ii) Real Estate: including development, investment, and management of commercial real estate with a portfolio of 36 assets in Turkey and Russia and a focus on shopping malls, offices and mixed use projects; (iii) Energy: through its subsidiaries, Ronesans is involved in hydro and gas fired power generation in Turkey; and (iv) Other businesses: which include a mixed-use Istanbul Seaport project and development of healthcare projects under the PPP model in Turkey.

Meridiam Infrastructure: Founded in 2006, Meridiam Infrastructure is a 25 year infrastructure fund designed for investment in PPP infrastructure projects within OECD, with a focus on transportation, health, education, public accommodation and environmental sectors. Meridiam will inject equity in the Project through a recently-created investment vehicle, Meridiam Eastern Europe S.a.r.l a subsidiary of the Meridiam Infrastructure Eastern Europe (SCA) SICAR fund, which was established in December 2011 for investments in Eastern Europe countries.

Sila Consulting was established in 2004 and has more than 250 employees both in Turkey and oversees. It is specifically experienced in delivering medical and related support services to public and private hospitals. Sila is generally responsible for the project development and realization, medical equipment procurement, clinical operations advisory and training.

Şam Engineering was founded in 1991 in Ankara. This company is experienced in construction and design, in addition to medical equipment procurement and servicing.

The proposed IFC investment entails an IFC A Loan of EUR 35 million from its own accounts, EUR 26.25 million from IFC acting in its capacity as implementing entity for the Managed Co-Lending Portfolio Program, and mobilization from commercial and development finance institutions to participate in the EUR 467 million financing of the Project.

48.66 million (USD)

Product Line	IFC Investment (million USD)
Risk Management	2.50
Guarantee
Loan	46.16
Equity

* These investment figures are indicative

The Project is located at the south of Turkey residing in Yuregir District in Adana Province.

- The proposed financing will improve infrastructure for public health services in Adana, a second tier city in Turkey, and adress the need for improved bed capacity and to develop underserved specialized areas.
- Successful financing and implementation of this flagship project under the program is expected to lead the way for the rest of the projects in the program, most of which focused on second tier cities.
- The project is also expected to provide better health outcomes through implementation of modern clinical and diagnostic services, better patient flow (with services consolidated in one campus) and reduced waiting lines.
- Additionally, the proposed project will have a demonstation effect in the region and for other sectors (i.e. education), where PPP models are being investigated as an alternative to improve social infrastructure, and are expected to follow the example of the Turkish healthcare PPP Program.

Through the proposed project, IFC will:
- Provide long-term financing and mobilization of additional financing from commercial and development finance institutions
- Share knowhow in PPP financing and healthcare PPPs (through PPP advisory)
- Contribute to the negotiations to achieve improved bankability of projects
- Improve the visibility and attractiveness of the other health PPP projects

Indicator	Metrics	Comments	Calendar Year 2022	Calendar Year 2023	Calendar Year 2024
Patients Served (#)	Actual Inpatients (#)		Not Available	Not Available	Not Available
Patients Served (#)	Actual Outpatients (#)		Not Available	Not Available	Not Available
Organizational capacity and Management Programs(%)	Organizational capacity and Management Programs(%)		Not Available	Not Available	Not Available
Human Resources Policies and Procedures(%)	Human Resources Policies and Procedures(%)		Not Available	Not Available	Not Available
Occupational Health and Safety(%)	Occupational Health and Safety(%)		Not Available	Not Available	Not Available

Based on a review of available project information, key project related environmental health and safety (EHS) aspects were identified as life and fire safety risk and adequacy of emergency preparedness and response for the campus; seismic risk consideration in building design; construction related EHS impacts and adequacy of the environmental and social management system; implementation of good hospital management practices; workers’ health and safety, including training and housekeeping; disinfection, sterilization, and hygiene; hospital solid waste and effluent treatment and disposal; hazardous materials management; opportunities for energy conservation and efficiency as well as waste minimization and community health, safety and security.



The core health services will be provided by the MoH and support services will be outsourced based on detailed specifications provided by the MoH. Construction, maintenance and facilities management of the Adana IHC will be undertaken by the project company. Thus, the overall environmental, health, safety and social management systems to identify, assess, and manage key E&S risks and impacts during the construction and operation in compliance with IFC Performance Standards may be split between the public and private partners.



The risks and impacts associated with the construction and operation of medical facilities are site specific, largely reversible and readily addressed through known mitigation measures, this investment is categorized as B.

Please refer to the related Environmental and Social Review Summary (ESRS) document for this project.

Please refer to the Environmental and Social Action Plan (ESAP) tab in the related Environmental and Social Review Summary (ESRS) document for this project.