Page 29 - U4SSC Compendium of practices on innovative financing for smart sustainable cities projects

specializing in cardiology, neurology, orthopedics, oncology, maternity, pediatrics, and physical
medicine and rehabilitation).
• Improved access to health services: The city hospital serves Elaziğ and a wide regional area of
neighbouring cities, with a total population of approximately 3.4 million people. Construction
of the hospital has allowed for a five-fold increase in the number of qualified beds in the region,
from 211 to 1 038.
• New job opportunities and a commitment to gender equality: The construction of Elaziğ Fethi
Sekin City Hospital has created 5 000 new jobs during construction and 4 500 during operation,
with 35–40 per cent of them for women. All the project documents include gender-equality and
non-discrimination clauses for women.

• Use of smart technology: The hospital uses ICT systems such as medical services, e-Government,
e-Bill, e-Procurement and electronic healthcare data with the Hospital Information Management
System (HIMS). In addition, their help desk system uses information technology to monitor the
effectiveness of hospital operation services, penalties and satisfaction surveys. Also, the hospital
building uses smart systems in lighting and heating and cooling, and fire and life safety system
managed by a Building Information Management System (BIMS).

• Strong commitment to sustainability and resilience: Commitments to sustainability and
resilience are reflected clearly in contractual provisions among project stakeholders, with risks
on affordability, accessibility and equitability assessed during the feasibility study. The city
hospital services are easily accessible to all, including the most vulnerable and disadvantaged.
The city hospital uses trigeneration units to reduce GHG emissions and the project has a zero-
waste certificate from the Ministry of the Environment.

Financial information

The investment cost covered the construction and operation of the hospital. The project was
financed with the first green and social bond for an infrastructure project in Turkey in the amount
of USD 400 million. Green bonds are used to provide financing for environmental projects, while
social bonds raise funds for projects that address or mitigate a specific social issue and seek to
achieve positive social outcomes. The project’s bond is a landmark transaction for Turkey and
has been certified as “Green and Social” by ESG services specialist Vigeo-Eiris and the credit
enhancement has resulted in a Moody rating of Baa2. The project’s leverage is 80 per cent, which
was raised through green and social project bonds privately placed with major financial institutions,
meaning a debt-to-equity ratio of 80:20. Investor’s shares are as follows: Meridiam - 68 per cent;
Ronesans - 26 per cent; and SAM Yapı - 6 per cent.

Project bonds are repaid through availability payments, which come from quarterly instalments
(within the first seven business days of the quarter) by the Ministry of Health. The bonds are paid
back by direct repayment over 15 and 18 years.

• A1A bond - maturity: 2034

Compendium of practices on innovative financing for SSC projects | January 2023 17