Comar Health will be controlled by the Amen Group, a diversified conglomerate (agribusiness, tourism, distribution, IT, healthcare, financial services) controlled by the Ben Yedder family. The single largest shareholder in Comar Health will be COMAR, the second largest insurance company in Tunisia, and the largest among privately owned insurance companies. COMAR underwrites non-life insurance for corporate and individuals (including automobile, transport, health, fire, multi-risk, and agriculture), with life insurance handled by a wholly owned subsidiary. The Group enjoys a strong reputation in the region with skilled professionals managing the Group’s businesses.

IFC has been strengthening its relationship with the Amen Group since the early 1990’s with joint shareholding in Maghreb Leasing Algeria, the second largest leasing company in Algeria.

The total project cost is expected at approximately $53.2 million. The proposed investment will be a common equity stake representing 15-20% of the equity value of the existing and future hospital facilities, or, up to approximately $7.8 million equivalent.

8.21 million (USD)

Product Line	IFC Investment (million USD)
Risk Management
Guarantee
Loan
Equity	8.21

* These investment figures are indicative

Physical infrastructure investments will apply to one existing and three greenfield facilities. Comar Health currently encompasses two existing facilities located in Tunis, the capital. The private hospital will also be constructed in Tunis, whereas the two new clinics will be constructed in Gafsa, a town in southwestern Tunisia, and Beja, a town in northwestern Tunisia.

This Project is unique in that it supports private provision of services to publicly funded patients, thereby broadening access to private healthcare to all, including lower socioeconomic segments of the population. More specifically, benefits of the Project include:

• increased access to healthcare services in underserved markets;
• increased access to high quality private healthcare services (complementary to public healthcare sector), provided at affordable prices due to economies of scale from the expansion of the multi-site network;
• creation of 600-650 direct jobs; and
• a demonstration effect supporting private health care, serving as a showcase to other potential investors in the sector

IFC is expected to have a dual role: (i) provision of risk capital; and (ii) sharing of global knowledge and experience. IFC would provide equity financing, which is still difficult to obtain in Tunisia for a healthcare project like this one. In addition, IFC is expected to play an important role in advising the Sponsor on Project structuring and implementation issues. The Sponsor has already agreed to de-lever the financial structure of the Project through the provision of additional equity. These adjustments should improve the risk profile of the Project. Finally, IFC plans to leverage its broad experience in private healthcare both in the region and across the world to further assist the Sponsor in the area of hospital management.

IFC’s appraisal included a review of technical, environmental, health and safety, labor, community and social information provided by COMAR including independently designed and monitored quality management system; life and fire safety programs at existing facilities and plans for new clinics and a hospital; human resource policy and procedures; and copies of recent wastewater treatment tests.

While all Performance Standards are applicable to this investment, IFC’s environmental and social due diligence indicates that the investment will have impacts which must be managed in a manner consistent with the following Performance Standards:

• PS1: Social and Environmental Assessment and Management Systems;
• PS 2: Labor and Working Conditions;
• PS 3: Pollution Prevention and Abatement;
• PS 4: Community Health, Safety and Security; and
• PS 5: Land Acquisition and Involuntary Resettlement.

Based on the discussions with the client and visits to the Sponsor’s existing facilities in Tunis as well as the site for the new clinic in Beja, this project will have limited adverse environmental and social impacts. In addition, impacts will be few in number, site-specific, reversible, and easily addressed through agreed mitigation measures. For these reasons, this is a Category B project according to IFC’s Environmental and Social Review Procedure.