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UPDATE: The Cameroon Cataract Bond
exceeds expectations

24 MAY 2021

The Cameroon Cataract Bond was launched in 2018 as a new way of funding health care. This innovative cataract project brings together public and private investors, health donors, and eye care delivery experts in Cameroon, and is funded through a Development Impact Bond (DIB). Despite the unprecedented disruption from the COVID-19 pandemic, it has exceeded its third year targets during 2020.

 
COVER PHOTO: Magrabi ICO Cameroon Eye Institute

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 What is the Cameroon Cataract Bond?

The Cameroon Cataract Bond is a pay-for-performance loan, also known as a development impact bond or DIB. It supports the Magrabi ICO Cameroon Eye Institute (MICEI) to provide as many as 18,000 high-quality cataract surgeries in Cameroon over five years. 

MICEI provides surgeries to low-income patients for free or at a subsidized rate, in addition to its full-paying customers (those who can afford to). The DIB aims to help the hospital become self-sufficient in five years, with plans to develop it into a regional center of excellence to help build capacity in the region. 

The primary donor and founder of the hospital, Dr. Akef el-Maghraby, internationally renowned ophthalmologist and Chairman of the Magrabi Hospital Group says: 
“We know that in Cameroon we need to carry out about 48,000 surgeries each year to treat new cases of cataracts as well as addressing the current backlog of people who need cataract surgery. I am very proud that despite the devastating impacts of COVID-19 we have managed to achieve such good results at the end of our third year. I want to thank all of the members of the Coalition and the staff at MICEI for their contributions.”
 


What impact has the Cameroon Cataract Bond created?

In 2020, the Cataract Bond supported the hospital to complete almost 1200 cataract surgeries, bringing the three-year total to 6374 surgeries, ahead of the 5600-surgery target. 

The quality of surgeries has continued to improve and again exceeded World Health Organization standards , with 81% having a good outcome the day after surgery, up from 67% in year one. MICEI exceeded its target of at least 50% of surgeries achieving a good outcome the day after surgery. 

As a result of these two outcomes being achieved, full outcome payments will be made for year three targets and investors will earn the maximum interest in year three.

Peter Laugharn, president and CEO of the Conrad N. Hilton Foundation, the main financial contributor to the outcome funding pool says: 
“The Coalition continues to be encouraged by the progress made under the Bond as part of our commitment to improving eye care capacity in Cameroon. This innovative financing mechanism is designed to support the sustainability of MICEI, and we believe that this work is driving us toward that outcome."
 
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Photo: Magrabi ICO Cameroon Eye Institute
 


How did the Cameroon Cataract Bond overcome the impact of COVID?

Cameroon has recorded almost 75,000 COVID cases with 1,152 deaths due to COVID, and it  had a massive impact on the hospital’s operations. But despite the extreme disruption, MICEI managed to continue serving patients with only a two-week interruption to operations when COVID initially hit.

As soon as the first cases of the virus surfaced, MICEI formed a taskforce and created a detailed risk register and new safety protocols, in order to allow the main hospital to continue its operations, performing surgeries as needed.

The most significant impact of COVID was the hospital’s ability to hold outreach camps, which were forced to stop for seven months because of government restrictions on gathering sizes. 

Outreach restarted at the end of 2020 at a smaller scale and with a full set of COVID hygiene measures in place, but a second wave of COVID infections meant camps were again suspended in March 2021. This impacted the hospital’s overall volume of surgeries, as well as its ability to reach patients from lower socioeconomic areas. 

Algene Sajery, Vice President of the Office of External Affairs and Head of Global Gender Equity Initiatives at U.S. International Development Finance Corporation (DFC), an investor in the Cataract Bond says: 
“DFC is proud of the progress that the Bond and MICEI have made in providing healthcare and advancing development in Cameroon. In addition to supporting innovation in both healthcare and development, DFC’s investment, made possible through our Portfolio for Impact and Innovation (PI2) initiative, is continuing to support market penetration of development impact bonds worldwide. The Cameroon Cataract Bond project demonstrates the power of innovative public-private financing mechanisms to foster strong and resilient health systems in the developing world.” 
 


How will the Cameroon Cataract Bond continue to have an impact?

The hospital is working to resume outreach services and continue its primary focus of reaching patients from disadvantaged backgrounds once it is safe to do so. Financially, the hospital is performing well and is on track to become financially sustainable within five-years. 

Bond Coalition Members are currently considering the extent to which the project’s year five targets will be impacted by the ongoing COVID disruptions, particularly around volume of surgeries and equity. This may see changes to the bond structure or an extension to the performance period depending on the length and severity of COVID’s continuing effects.

The Coalition is working with researchers at the Brookings Institution, Oxford University’s Government Outcomes (GO) Lab and Ecorys to share lessons and best practice on how impact bonds can deal with shocks including events like COVID.
 

 
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