Financing Cataract Solutions for the Developing World: Introducing the World’s First Development Impact Bond in the Eye Health Sector

By Olivia Iloetonma and Barbara Kong

Winesi March has never seen his 18-month old grandson – he has only ever heard him cry. Prior to going blind from cataracts, Winesi was the breadwinner: his maize farm fed his family and kept his children in school. But as his cataracts developed, he had to rely on his wife and children for tasks as simple as bathing. He stopped growing his maize. He could no longer see the path to his farm.

Winesi’s blindness and its impact on his household is part of a widespread and growing problem across developing countries. Four out of five blind people are needlessly blind, most of them live in developing countries, and the reason for their blindness is more often than not due to cataracts.


A broken financing model

Cataracts, the partial occlusion of the eye lens, affect both men and women, especially above 50. Untreated cataracts lead to blindness for millions of people in developing countries due to high cost of quality care and low cataract surgery capacity. Funding for eye health services makes up just a sliver of local and international health funding—in Cameroon, it is only a fraction of the 2% GDP spending on health. In Central Africa alone, our estimates show that 75,000 people suffer from cataract blindness and another 3 million are at risk, but there are only 122 active ophthalmologists in the region. Cataract surgery should be a relatively straightforward and cost-effective procedure, but public health systems are underfunded and service providers are constrained by scarce, competitive, and expensive financing.

The bottom line is, the financing model for eye health in developing countries is broken. And as a result, those who can least afford to are losing their sight.

Opening the eye health space to private investors

Innovators have found a way to ease this quintessential development problem. The Aravind Eye Hospital in India has pioneered and revolutionized an innovative and cost-effective approach to tackling cataracts in the developing world—a social enterprise model that delivers high-quality cataract surgeries for $40 each, half the cost of an annual Amazon Prime membership. Aravind hospitals gross over $10 million annually through 300,000 cataract surgeries, half of which are free or subsidized. This model proves that it is possible to provide sustainable, affordable quality cataract surgery at high volumes, with fees from those who can pay subsidizing treatment costs for those who cannot.

So what if we could replicate this model in Central Africa? Unfortunately hospitals looking to do so face a financing wall. A sub-specialty eye hospital in Cameroon that could perform 6,000 surgeries per year and build local capacity would cost about $13 million to build, equip, and staff before serving a single patient. The drip-drop of public finance is not going to cut it. Private investors find the prospect too risky. From the hospital’s point of view, a debt investment would compromise financial sustainability and ability to scale while keeping costs low.

What we need is an entirely new financing model that brings private funders into the eye care space by sharing the risk across public and private partners. A third-party promise to pay for performance could be the key making this possible.

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Nigeria Needs Urgent Steps to Deal with its Unemployment Crisis

First published in Business Day.

By Nneka Eze

Nigeria is facing a youth unemployment crisis. This problem affects the daily lives and long-term futures of 5 to 12 million youth who are currently unable to find work to sustain their households – that’s nearly a quarter of Nigeria’s entire population.

These youth are entering the labour market unprepared with inadequate skills that the market requires, and limited access to the tools they need to create their own jobs. The majority of these youth are from rural areas but beyond geographic disparities, female youth are particularly disadvantaged when it comes to employment and economic opportunities given social norms where females are expected to shoulder domestic responsibilities.


Photo Credit: Flickr, World Bank Photo Collection

Addressing youth unemployment should be a national priority. Here we look beyond macroeconomic indicators that reflect jobless GDP growth and propose six solutions that center on the small and medium enterprise (SME) sector, which we believe can drive inclusive growth and raise living standards.

1. Support small and medium enterprises and protect informal workers. Simply put, there are not enough jobs – particularly formal-sector jobs – in Nigeria. Nearly 85 percent of those employed work in the informal sector, which includes small and medium businesses ranging from petty trading and personal services to informal construction, transport, money lending, manufacturing, and repairs. SMEs have potential to drive economic transformation in Nigeria and around the world, but their job creation potential is grossly unrealized. Given the primacy of Nigeria’s informal sector, job creation should emphasize entrepreneurship to provide opportunities for youth. For this to happen, the government should support SMEs with the resources they need to overcome infrastructural, trade policy, and legislation challenges. The growth of the informal sector itself is partially due to government failure – including lack of infrastructure and lack of access to finance – but it’s the government that now needs to step in to provide cushions to protect workers against income shocks and variability, and to sustain long-term employment.

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The Delicate Balance Between Increasing Economic Opportunities in Northern Nigeria While also Addressing Security

First published in Business Day.

By Nneka Eze

Whether due to dominance of the media or current economic power, the “average” Nigerian is not thinking about the huge economic potential or the breadbasket (agricultural production zones) of Nigeria when they think of Northern Nigeria. On their minds is likely the religious extremism that has been on the rise in the recent past and contributed to the development of one of the region’s bloodiest militant groups in the region – Boko Haram. While it is true that Boko Haram has wreaked havoc on the North, it’s also true that the militant group is one of several difficulties that Northerners have faced for decades. As the current administration continues on its mission to crush Boko Haram and end its season of tyranny, solutions must sought that also address socioeconomic and geographic issues in the North to prevent the resurgence of such groups that thrive in times of desperation and exclusion.

People displaced by Boko Haram in the city of Yola. (Photo Credit: Flickr, European Commission DG ECHO)

People displaced by Boko Haram in the city of Yola. (Photo Credit: Flickr, European Commission DG ECHO)

It is undisputable that the economic landscape in Northern Nigeria has been severely affected by Boko Haram. The activities of this Islamist militant group have led to mass migration of Nigerian citizens to areas not affected by the violence. This has in turn resulted in children abandoning school, adults losing jobs, disruption of trade and an overall drop in foreign direct investment (FDI) flows, affecting livelihoods.Boko Haram’s emergence four years ago is estimated to have led to a 21% drop in FDI between 2011 and 2012.The negative effects have largely been dictated by geography and have been felt most acutely among the country’s Northern states. Three states in particular – Borno, Adamawa and Yobe – have borne the brunt of the insurgency leading to a state of emergency being declared in 2013 and running till November 2014.

An estimated 3,000 people were killed in 2015 as a result of the insurgency and a further 3 million internally displaced to date. Boko Haram and ISIL are jointly responsible for 51% of all claimed global fatalities in the previous year (2014) – with the total figure of those killed through terrorism in 2014 coming to 32,658 with 7,512 in Nigeria alone (23% of all deaths caused by terrorism in that year.) The region’s problems however began long before the emergence of Boko Haram.

Despite occupying the majority of the country’s landmass, Northern Nigeria has consistently ranked lower than the country average on human development indicators. The Northern part of Nigeria consists of 19 states, which geographically occupy 719,435 square kilometers or 79% of Nigeria’s landmass and constitute 53.6% of Nigeria’s population. Long-standing under investment by government and insecurity in the region has resulted in significant slow-down of both educational and commercial activities. Similarly, the Northern states face the highest maternal and infant mortality rates in the country, the lowest school enrolment rates for children, the highest youth unemployment rates, highest levels of poverty and highest inter-ethic and inter-religious conflict, notably the Boko Haram terrorism. Continue reading

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If Human Rights Arguments Won’t Get the Nigerian Gender Equality Bill to Pass, Perhaps Economics Will

First published in Business Day.

By Nneka Eze and Tania Beard

It came as a surprise to many a few weeks ago when a gender equality bill was voted down by the Nigerian Senate (which comprises 7 women and 102 men). The bill, which sought to guarantee equal rights in education, marriage and inheritance, was rejected for not being ‘part of our culture and tradition’ and ‘unNigerian’. The components outlined in the bill are fundamental human rights enshrined in the Universal Declaration of Human Rights – articles 2, 7 and 8 and embedded in the Nigerian constitution. The need for further outlining the rights of women and gender equality should be a pressing issue for Nigeria. Approximately 30% of women experienced physical or sexual violence in 2013. Furthermore, child labour and child abuse were highest among women (61.8% and 75.7% respectively of all children forced into labour or abused).

Photo Credit: Flickr, UN Women

Photo Credit: Flickr, UN Women

This bill comes at a critical low point in our country’s economy. There is a major economic crisis compounded by rock bottom oil prices (petroleum exports account for 90% of Nigeria’s export revenue). The Naira has plummeted by 118% against the dollar in the past 12 months. We are facing consumer price inflation driven by foreign exchange restrictions and high and fluctuating parallel market foreign exchange rate. Beyond the oil-dollar situation, over 70% of Africa’s largest population live in poverty. Youth unemployment is at an all-time high of at least 50%. It is at this critical standpoint that Nigeria voted against a bill – a move that threatens to leave half its population – 80 million people out of vital sectors of the society and economy.

If gender equality as a human right is indeed considered ‘unNigerian’, the economic argument for gender equality may be more effective as a first step in the broader rights based struggle. Continue reading

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Featuring HUGinsure: The World’s First Social Impact Insurance Firm

Oxford Said Business School’s Skoll Centre for Social Entrepreneurship recently featured HUGinsure as one of Africa’s new innovative finance vehicles pushing the boundaries of traditional finance for greater development impact.

InnovativeVehiclesHUGinsure, a joint venture between D. Capital Partners and Hollard Insurance South Africa, is the world’s first social impact insurance firm. HUGinsure creates bespoke insurance products for social investments, ensuring timely availability of capital for social impact projects that would otherwise go unfunded. By harnessing risk management and mitigation principles, HUGinsure increases funders’ ability to fund projects where risk is unknown or exceptionally high. At the same time, social enterprises can insure themselves against shocks, such as delayed government payments.

Most recently, HUGinsure conducted credit and risk analysis and structured a financial guarantee for a South African NGO, Project Isizwe. Isizwe develops free Wi-Fi hotspots in public spaces in South Africa targeting low-income communities. Isizwe was awarded a grant to install Wi-Fi hotspots in Tshwane municipality but needed USD 1.3 million to kick start the project and lock in equipment discounts to save project costs. A HUGinsure guarantee unlocked the funds from a commercial bank, helping Isizwe successfully install the hotspots.

Read the HUGinsure case study>>

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Carlijn Nouwen on CNBC: Driving Africa’s Growth Through Financial Inclusion

The unbanked and underbanked represent a huge, untapped opportunity for the financial services sector across Africa. However, sub-Saharan Africa still has the largest portion of people excluded from formal financial services in the world.

On CNBC Invest Africa Dalberg Partner Carlijn Nouwen joined host Nozipho Mbanjwa, KPMG Senior Manager Adetorera Banjo, and Diamond Bank’s Head of Direct Banking Jude Anele to discuss how financial institutions can harness and meet the needs of the base of the pyramid. Carlijn shares common misconceptions that stop financial institutions from banking the unbanked and underbanked, and makes a case for why we need a deeper understanding of customers’ varying financial needs to build the right financial products.


Watch the video on CNBC>>

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Dalberg’s Ciku Kimeria Discusses Visa Openness on BBC

When Dalberg’s Ciku Kimeria planned her road trip through Côte d’Ivoire, Burkina Faso, Togo, and Benin earlier this year, she expected her home continent to embrace her with open arms. But this Kenyan woman—a seasoned traveller to 42 countries, 16 of them African—came up against a wall of visa regulations and incredulous officials who couldn’t believe she wanted to visit as a tourist and couchsurf.

The African Development Bank recently released a report on Africa Visa Openness, concluding that “North Americans have easier travel access to the continent than Africans themselves.” And Ciku’s personal story drives the point home.

Coinciding with the presentation of the EU’s new migration plan, BBC invited Ciku to discuss African visa openness in light of her own travel experiences. Have a listen (starting at 33:50) to hear Ciku’s story, her perspective on the history behind today’s African visa regulations, and which countries are being most progressive about opening up.


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Launch of the Senegal Women’s Investment Club – A Journey to the “Missing Middle” in Women-led Investment

This article was originally published on Business Fights Poverty.

By Tania Beard, Francine Ndong, and Salma Ait Hssayene

Women-led investment has slowly taken off in recent years in developed economies – initiatives such as 37 Angels in the U.S. and UAE-based WOMENA are prime examples. However, in the developing world – where the financing gap is the largest – women-led investment is still an anomaly. Africa has only a handful of women-led investment initiatives in the formal financial market: Kenya Women Investment CompanyWomen’s Investment Portfolio Holdings Limited in South Africa, Alitheia and Women Investors Fund (NWIF) in Nigeria – and still, only NWIF dedicates a significant portion of its assets to women investees.

01senegalwomanIn Francophone West Africa, what we have in abundance are ‘tontines’, or informal revolving savings and credit groups. Women from across the socio-economic spectrum participate, even if they hold a formal bank account; some estimate tontine membership as high as  80% of the adult female population in urban areas. Solidarity with other women, in addition to the rapid, flexible, and liquid cash management system offered by the tontine, are key motivating factors for membership. The amounts collected vary significantly, but can reach tens of thousands of dollars per month. However, no interest accrues and investments are informal, limited to small personal projects. In its current form, the tontine cannot significantly move financial markets.

Here we have a “missing middle” between the informal tontine and the formal women’s investment funds. How do we bridge this gap and support the evolution of tontines towards broader financial impact, while maintaining the powerful social aspects of tontines?

We have in front of us a prime opportunity: huge, untapped potential for women-led investment to drive financial markets and pioneer a shift away from African women as “recipients of financing” to “drivers of financial markets”.

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What’s Next for Women’s Empowerment? Maureen Gitata and 3 African Women Leaders Discuss

International Women’s Day celebrates the social, economic, cultural, and political achievements of women and girls. On NTV’s Victoria’s Lounge, Dalberg’s Maureen Gitata recently joined three African women leaders in a candid discussion about “the strong woman”.

Amidst increasingly prevalent rhetoric that women and girls are empowered enough, what do women and girls need for an equal footing at work, in politics, and at home? This discussion probes the messages we send to young girls, how new technology platforms have affected women’s empowerment, the balance between career and family, and how each woman tailors her strength to her own life.

Hear Maureen’s take as she navigates management consulting as a woman, and her thoughts on Dalberg’s commitment to gender diversity: Victoria’s Lounge: Does the ‘weaker’ sex really have the upper hand?

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