Public Investment Banks

Another opportunity for significant positive change lies with public investment banks. If banks such as the European Investment Bank (EIB) or the Council of Europe Development Bank (CEB) shift their approach from traditional ‘hard’ infrastructure investments to support ‘soft’ investments, this could have a positive impact on health and wellbeing. Public Investment banks, such as the EIB, the CEB, the national promotional investment banks and others make investments in the health sector. These investments, however, tend to finance expensive ‘hard’ infrastructures, such as hospitals, and innovation coming from medical research, technology and equipment, health informatics and medical training. Large investments will now also go to crisis preparedness following bio-medical models. While important, these investments usually have less impact on the reduction of health inequalities. Investments into more psycho-social approaches of health, wellbeing and resilience are going to be scarcer.


However, public investment banks are changing. Thanks to their experiences with the benefits of ‘green investments’ in the climate and infrastructure sectors, public investment banks are increasingly exploring the benefits of similar socially-conscious investments in the health and social sectors. For example, in Ireland, 14 new primary care centres are to be built following agreement of a €70 million 25-year loan from the European Investment Bank.


European Investment Bank financing of Primary Care Centres, Ireland

14 new Primary Care Centres are to be built across Ireland following agreement of a new €70 million 25-year loan from the European Investment Bank in 2018. This represents the EIB’s first support for healthcare investment in Ireland and the first dedicated backing for primary health care anywhere in Europe. The new public-private partnership (PPP)-based scheme will support the shift from hospital-based healthcare to community-based care closer to patients. The new Primary Care Centres are to be built in Sligo, Roscommon, Mayo, Galway, Limerick City, Waterford City, Tipperary, Wexford Town, Kildare and Dublin. They will provide basic health services, including GP surgeries, occupational therapy, social work and dietary advice. In some locations, additional services will also be provided, including mental health, dentistry, addiction services and a local ambulance base.


Financing from the EIB represents 49.5% of the total investment cost of the new facilities. The project will be co-funded by commercial lenders. This is the second healthcare project to be backed by EFSI.


One or several local and regional authority/ies could group together the investment needs in a variety of different sectors over which they have responsibility (either to provide or fund, or both) and request a loan directly. The EIB loan to the Irish National Development Finance Agency to build 14 primary care centres across the Ireland is a good example of how Irish authorities grouped together what could have been different investment projects. Another example is the EIB Framework loan to the town of Orebro in Sweden, who requested a €180 million via a 25-year-longloan to invest in 40 small to medium size schemes in education, childcare, and municipal housing.


Local and regional authorities are not the only bodies able to bundle projects together. With the right push for providers and enterprises requiring loans, banks can also bundle different projects together or see potential for such development access support from the European Investment Bank. One example of this is Belgian bank Belfius’ smart and sustainable cities programme where Belfius and the EIB invest together in over 100 different projects from a wide range of sectors: environmental, health, retirement care, and digital. Another option is for the service providers themselves to group their investment needs together and create a special purpose vehicle able to request financing from an investor.


Whilst there are some potential examples, this avenue remains largely unexplored; partly explained by the lack of support and capacity-building to such bundling by local and regional authorities. Some authorities are currently exploring how they could fund such developments, through for instance the Technical Assistance budget of the European Social Fund.

Case Study