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REIMAGINING HEALTHCARE
IN INDIA THROUGH
BLENDED FINANCE
February 2022
WHITE PAPER Reimagining Healthcare in
India thr ough Blended Finance
Publishing Agency
978-81-953811-8-0
NITI Aayog and SAMRIDH HEALTHCARE BLENDED FINANCE FACILITY
Year of Publication
ISBN
2022
Prepared by:
Technical Suppor t Unit, SAMRIDH Healthcare Blended Finance Facility
Under P artnerships for Affordable Healthcar e Access and Longevity (PAHAL) Pr oject
USAID/India Cooperative Agreement Number: AID-386-A-15-00014
Implemented b y IPE Global Limited
Reimagining Healthcare in India thr ough Blended Finance TABLE OF CONTENTS
i
FOREWORD - MISSION DIRECTOR, ATAL INNOVATION MISSION
MESSAGE – CEO, NITI AAYOG
MESSAGE – ADDITIONAL SECRETARY, NITI AAYOG
MESSAGE – MISSION DIRECTOR, USAID/INDIA
MESSAGE – FOUNDER & MANAGING DIRECTOR, IPE GLOBAL
ACKNOWLEDGEMENTS
LIST OF CONTRIBUTORS
ABBREVIATIONS
INTRODUCTION
3
4
5
6
7
8
9
10
1
4
4
4
5
5
5
6
8
8
8
9
12
12
13
15
18
18
21
23
25
27
30
33
BLENDED FINANCE - AN OVERVIEW
What is blended ﬁnance?
How does blended ﬁnance work?
Key characteristics of blended ﬁnance
How does blended ﬁnance achieve social goals?
Blended ﬁnance archetypes
Principles of blended ﬁnance
BLENDED FINANCE FRAMEWORK
IMPROVING HEALTHCARE IN INDIA WITH BLENDED FINANCE
CASE STUDIES
KEY CHALLENGES TO ACHIEVE BLENDED FINANCE AT SCALE
THE WAY FORWARD
What are the pre-requisites for initiating a blended ﬁnance transaction?
Checklist for mobilizing commercial capital from private investors in blended ﬁnance transactions
Participants in blended ﬁnance transactions
Current healthcare investment landscape in India and funding gaps
Investment opportunities within health subsectors
How can blended ﬁnance be pivotal for India’s healthcare industry?
Case study
I - Sustainable Access to Markets and Resources for Innovative Delivery of Healthcare (SAMRIDH)
Case study
II - SAMRIDH's portfolio level Social Success Note program
Case study
III - USAID's Portfolio Guarantee Program for Healthcare Enterprises in India
Case study
IV - Blackfrog Technologies Pvt. Ltd.
Case study
V - Skill India Impact Bond, India's First Skill Impact Bond with a Gender Lens
Reimagining Healthcare in India through Blended Finance
ii
iii
iv
v
vi
vii
viii
ix ii MESSAGE
In the year 2021, NITI Aayog had launched a report called- "Investment
opportunities in India's Healthcare sector", which talked about the range
of investment opportunities in various segments of India’s healthcare
sector, including medical devices and equipment, health insurance,
telemedicine, home healthcare and medical value travel. It is great to see
that many start-ups have started springing up in the above sectors. But
even though we see that the number of start-ups in the healthcare
domain is on the rise, the gestation period for these start-ups remains
high. The severity of the Covid crisis and the urgency to act is such that
innovative ﬁnancing models have become indispensable.
The blended ﬁnance model hits two birds with one stone- it uses
development ﬁnance and philanthropic funds to attract private capital
into deals, and the private investors receive ﬁnancial returns which are in
line with market expectations. In doing so, it not only helps reduce the
dependency of start-ups on government debt but also accelerates the
building of commercially viable social impact projects. Such ﬁnancing
models will help fast-track India's response to subsequent waves and
support the immediate deployment of high-impact healthcare solutions.
I will want to congratulate the Atal Innovation Mission (AIM), NITI Aayog,
for joining hands with SAMRIDH Health Blended Finance Facility,
supported by USAID India, to strengthen India's health systems with
blended ﬁnancing solutions. It is great to see that our start-ups are
innovating, and the overall ecosystem is evolving to support them with
innovative ﬁnancing models.
Amitabh Kant,
Chief Executive Ofﬁcer, NITI Aayog
iii iv Message fr om Veena Reddy , USAID/India Mission Director
White Paper: Reimagining Healthcare in India thr ough Blended Finance
As the COVID-19 pandemic began, the U.S. Agency for International Development
(USAID) and our partners sought to leverage the expertise and innovation of India’s dynamic
private sector to develop and scale responsive healthcare solutions. In 2020, USAID collaborated
with IPE Global and stakeholders from the Indian government, academia, and the private sector
to develop an innovative blended finance facility to combine public and philanthropic funds with
commercial capital to create and scale market-based health solutions. Thus, the Sustainable
Access to Markets and Resources for Innovative Delivery of Healthcare (SAMRIDH) initiative
was created. In a short span of time, SAMRIDH has helped to scale 19 novel innovations that are
expanding the reach of private healthcare, improving India’s healthcare infrastructure, and
strengthening the supply chain in order to reach vulnerable populations.
This informative and compelling white paper,ReimaginingHealthcare in India through
Blended Finance, developed in collaboration with NITIAayog’ s Atal Innovation Mission,
articulates the concept of blended financing and synthesizes the early learnings from the
SAMRIDH initiative.Reimagining Healthcareoffersapproaches to leverage innovative
financing mechanisms to improve healthcare services for India’s most vulnerable populations.
Notably , the white paper provides case studies to illustrate SAMRIDH’s technical application of
blended finance solutions to address healthcare challenges. We hope this document will serve as
a resource for interested development partners, government agencies, academia, civil society,
and the private sector, including the finance sector and entrepreneurs.
I commend NITI Aayog and Atal Innovation Mission for their partnership and leadership
in this important effort. Special thanks are also due to the staff of USAID’s Partnerships for
Affordable Healthcare Access and Longevity (PAHAL) project, implemented by IPE Global, for
their technical expertise in leading the SAMRIDH initiative and developing this white paper.
As articulated in the white paper, blended finance is an important tool to both incentivize
private sector participation in development outcomes and maximize our reach, investing in
projects that deliver both financial and social returns as we strive for broader sustainable
development outcomes. Through initiatives such as this, USAID is proud to collaborate with the
Government of India, the private sector, and civil society to strengthen the impact, reach,
affordability, and quality of health services in India.
Veena Reddy
Mission Director , USAID/India
v

IPE GLOBAL LIM ITED
Corporate & Regd. Office: IPE Global House, B - 84, Defence Colony, New Delhi - 110 024, India
Tel. +91 11 4075 5900 Fax +91 11 2433 9534 Email ipe@ipeglobal.com Website www.ipeglobal.com
CIN: U74140DL1998PLC097 579
Branch Offices: Bhopal I Bhubaneshwar I Lucknow I Jaipur I Patna
International Offices: Ethiopia I Kenya I United Kingdom I Bangladesh I Philippines
I Myanmar I Nepal
(An ISO 9001:2015 Company)

Ashwajit Singh
Founde r & Managing Director
IPE Global

Message

At the onset of the pandemic, health systems world over were unprepared to respond to
the scale and complexity of COVID-19. India was no excep�on. The already fragile health
system was overwhelmed with the rampant spread of the novel virus and the surge in cases.
The crisis highlighted the need to rapidly reform the sector through investment in market
solu�ons and innova�ons.
However, the resources and funds available from government and philanthropic sources, no
ma�er how generous, are just not enough for such a massive exercise . There is thus an
urgent need to ﬁnd innova�ve ways to speed up structural reforms and encourage
commercial investments for these eﬀorts.
SAMRIDH, supported by USAID and implemented by IPE Global, was thus born amidst the
ﬁrst wave of COVID-19 to unlock greater capital for scaling up of high impact health
solu�ons. Considering private investors are mostly hesitant to fund projects in this domain,
as they perceive them to be risky ventures, SAMRIDH leverages the dis�nct blended
ﬁnancing model that mobilizes grant funding to oﬀset barriers for commercial investments.
This approach to innova�ve ﬁnancing is rapidly proving to be a game changer by mee�ng
the unique capital needs of healthcare enterprises, helping them reach out to vulnerable
popula�ons across �er 2 and 3 ci�es in India with their high-impact innova�ve solu�ons.
IPE Global is proud to collaborate with Atal Innova�on Mission (AIM), NITI Aayog to further
accelerate India's response to the pandemic and future health emergencies. This White
Paper is a reinforceme nt of the importance of leveraging blended ﬁnance towards building a
resilient and sustainable healthcare system for India.

Ashwajit Singh
vi ACKNOWLEDGEMENTS
India has made great progress in improving the health of its citizens over the past few decades. But still, many
health inequities persist. The private sector, startups, and healthcare enterprises can play a critical role in bridging
this gap. Unfortunately, access to affordable capital, especially commercial capital, is a bottleneck to scaling up.
Often termed as the second valley of death, innovators are unable to access resources for scaling proven
high-impact solutions. Blended ﬁnance can offer a way out of this predicament.
In 2021, IPE Global partnered with NITI Aayog’s flagship program Atal Innovation Mission to support various
current and future initiatives of AIM program beneﬁciaries and promote innovation and entrepreneurship amongst
aspiring entrepreneurs.
This document emerged out of this partnership. An incredible amount of work went into its creation, and we are
especially thankful to NITI Aayog for their partnership in developing this white paper. It would not have been
possible without members' contributions from multiple organizations across teams.
We would like to thank our advisors, Dr. Chintan Vaishnav, Mission Director, AIM; Dr. Rakesh Sarwal, Additional
Secretary, NITI Aayog, Mr. Ashwajit Singh, Managing Director, IPE Global; Mr. Himanshu Sikka, Health Practice
Lead, IPE Global), for extending their valuable insights and guidance, which has been instrumental in creating this
white paper.
We thank Ms. Sangita Patel, Director, Health Ofﬁce, USAID, Dr. Amit Shah, Deputy Director, Health Ofﬁce, USAID,
Ms. Cynthia Gire, Senior Advisor Innovations, USAID, Mr. Gautam Chakraborty, Development Assistance Specialist
(Health Finance), USAID and other USAID India team members for their continuous support and encouragement.
We acknowledge the invaluable support from SAMRIDH partners — Indian Institute of Technology (IIT-D), the
Principal Scientiﬁc Advisor to the Government of India, the National Health Authority, Rockefeller Foundation,
IndusInd Bank, Axis Bank, Caspian, and NATHEALTH on this blended ﬁnance journey.
The case studies used in the document would not have been possible without contributions from IndusInd Bank,
Caspian Debt, Blackfrog Technologies, National Skill Development Corporation, and British Asian Trust.
We want to acknowledge the contributions of SAMRIDH’s Advisory Committee Members. Lastly, we would like to
acknowledge the contributions provided by the entire SAMRIDH’s Technical Support Unit at IPE Global. We want
to extend special thanks to Dr. Ashish Mendhi, Project Director, PAHAL; Ms. Vinaina Suri, Sr. Communications
Manager; Ms. Ritika Pandey, Associate Director; Ms. Aanchal Jain, Manager Financial Advisory;
Mr. Sudheer Nadipally, MLE Expert and Dr. Sandeep Goyal, Public Health Expert.
vii
Reimagining Healthcare in India through Blended Finance LIST OF CONTRIBUTORS
No Name Designation Organization
1 Archita Adlakha Assistant Manager IPE Global Ltd.
2 Archish Gupta Associate Director IPE Global Ltd.
3 Manjunath Shankar Head Technical Team IPE Global Ltd.
4 Neeta Rao Senior Health Lead USAID
1 Pramit Dash Program Director Atal Innovation Mission
NITI Aayog
2 Rohan Kar Consultant Atal Innovation Mission
3 Hafsa Ahmad Consultant NITI- H&FW Vertical
2 Rakesh Sarwal Additional Secretary NITI Aayog
4 Anisha Bhasin Young Professional Atal Innovation Mission
1 Chintan Vaishnav Mission Director Atal Innovation Mission
List of Advisors
3 Ashwajit Singh Managing Director IPE Global Ltd.
4 Himanshu Sikka Chief Health Practice IPE Global Ltd.
viii
Reimagining Healthcare in India through Blended Finance
List of Authors AB
BAT
BRICS
CAGR
CHW
CIFF
CSO
CSR
DFC
ESG
FA
FCRA
FDA
FDCO
FDI
FI
GDP
GOI
HNI
IIT
M&E
MHA
MoHFW
NBFC
NGO
NHA
P4P
PAHAL
PAT
PCMC
PE
PM-JAY
PSA
SAMRIDH
SDG
SIB
SSN
TVET
UN
USAID
USG
VC
ABBREVIATIONS
Ayushman Bharat
British Asian Trust
Brazil, Russia, India, China, and South Africa
Compound Annual Growth Rate
Community Health Worker
Children's Investment Fund Foundation
Civil Society Organization
Corporate Social Responsibility
Development Finance Corporation
Environmental, Social and Corporate Governance
Financial Assistance
Foreign Contribution Regulation Act
Food and Drug Administration
Foreign, Commonwealth & Development Ofﬁce
Foreign Direct Investment
Financial Institutions
Gross Domestic Product
Government of India
High-Net-worth Individuals
Indian Institute of Technology
Monitoring and Evaluation
Ministry of Home Affairs
Ministry of Health and Family Welfare
Non-Banking Financial Company
Non-Governmental Organization
National Health Authority
Pay-for-Performance
Partnerships for Affordable Healthcare Access and Longevity
Proﬁt After Tax
Pimpri Chinchwad Municipal Corporation
Private Equity
Pradhan Mantri Jan Arogya Yojana
Principal Scientiﬁc Advisor
Sustainable Access to Markets and Resources for Innovative Delivery of Healthcare
Sustainable Development Goals
Social Impact Bond
Social Success Note
Technical and Vocational Education and Training
United Nations
Unites States Agency for International Development
United States Government
Venture Capital
ix
Reimagining Healthcare in India through Blended Finance INTRODUCTION 1
Citing $2.5 Trillion Annual Financing Gap during SDG Business Forum Event, Deputy Secretary-General Says Poverty Falling Too Slowly
2
The State of Blended Finance 2021, Convergence
3
Opportunity2030 The Standard Chartered SDG Investment Map
4
India unlikely to meet sustainable development goals on health by 2030: CAG, Business Standard
INTRODUCTION
Source: SDG 2030 Agenda
Global economies are taking giant strides towards a world where poverty is eradicated, economies are transformed,
and sustainable development beneﬁts everyone with minimal environmental degradation. But the resources needed
to achieve this are immense. As per the latest estimates by the United Nations, nearly USD 3.9 trillion is needed to
achieve the Sustainable Development Goals (SDGs) by 2030, more than double the current funding of $1.4 trillion
dedicated towards SDGs from domestic and international sources
1
.
It is therefore imperative for private investment to augment efforts of the development ﬁnance institutions and
philanthropic funders to achieve the SDGs. One of the key challenges of the SDG era is to channel more private
investment and resources to the countries and sectors that need it the most.
According to the State of the Blended ﬁnance Report, the SDG ﬁnancing gap which stood at USD 2.5 trillion before
the onset of pandemic, went up by an additional USD 1.7 trillion
2
due to pandemic-related ﬁnancing needs. The
devastation caused by the pandemic also exposed the gaps and shortcomings of the healthcare sector and
ampliﬁed the need for new-age health solutions and innovations and increased healthcare capacity and
infrastructure.
Standard Chartered SDG Investment Map estimates a need for investments worth USD 2.64 trillion to achieve the
SDGs in India, offering the private sector an opportunity to invest USD 1.12 trillion+ by 2030
3
. While the health
ministry plans to boost India's public health expenditure to 2.5% of its Gross Domestic Product (GDP by 2025, data
from recent years shows this has remained within a narrow band of 1.02-1.28% of GDP
4
so far.
Reimagining Healthcare in India through Blended Finance
1 Given the vast inequalities in healthcare distribution, glaring lack of trained healthcare personnel and
infrastructure and low government spending on healthcare, India has immense potential for innovative, sustainable,
and scalable healthcare technology to improve the lives of its citizens. Yet in a country with 1.38 billion people, many
now equipped with internet connections and smartphones, it is still difﬁcult to ﬁnd more than a handful of examples
of digital technology being widely used to signiﬁcantly impact healthcare outcomes. Even though there are about
4,308 start-ups ofﬁcially registered in the health-tech
5
domain, they are unable to scale up due to multiple challenges
like regulatory roadblocks, access to appropriate capital and markets, lack of incentives to adopt innovative
practices, market inefﬁciencies, and high barriers to entry, to name just a few.

India's unique accessibility, affordability, and quality challenges can be addressed by innovative healthcare solutions.
Given the size of the sector, a quick rate of adoption and the resultant scale will have an immense impact. But for
this to happen, conventional modes of healthcare funding will need to be aided by innovative funding methods. A
tri-sector collaboration between public, private, and philanthropic capital is thus a distinct option which could help
unlock the funding challenges.
Blended ﬁnance, the strategic use of public and philanthropic resources to mobilize private capital to achieve
development outcomes, can be an essential tool to address healthcare challenges. Blended ﬁnance can drive
signiﬁcant new capital flows into high-impact sectors like healthcare, while effectively leveraging private sector
expertise to identify and execute developmental investment strategies. The vital themes shaping healthcare delivery
in the future include empowered and informed customers, flexible and adaptive operating models, non-traditional
resources and partnerships, a growth and innovation mindset and a laser sharp focus on accountability, integrity,
and sustainability.
This white paper briefly introduces the principles of blended ﬁnance, explains how it can play a role within the Indian
healthcare sector, and concludes with a series of case studies that demonstrate the green shoots of new models for
ﬁnancing health impact.
5
Tracxn Healthtech India report 2020
Reimagining Healthcare in India through Blended Finance
2 BLENDED FINANCE - AN OVERVIEW What is blended ﬁnance?
How does blended ﬁnance work?
Source: Convergence, Blended Finance
Blended ﬁnance is an approach towards ﬁnancing where catalytic funding (e.g., grants and concessional capital)
from public and philanthropic sources is utiliz ed to mobilize additional private sector investment to realize social
goals and outcomes.
Blended ﬁnance is the strategic use of concessional capital and private capital in projects where the perceived risks
are too high for private players to participate alone. By combining concessional and commercial capital, blended
ﬁnance can achieve acceptable risk/return proﬁles for diff erent types of ﬁnancing partners, including private capital.
Blended ﬁnance is a structuring approach that allows enterprises to invest alongside each other while achieving their
different objectives: ﬁnancial return, environmental/social impact, or a blend of both. Blended ﬁnance is therefore not
a single instrument but rather a ﬁnancial structure in which different investors with diff erent inv estment priorities
can participate.
Blended ﬁnance is expected to achieve additionality, both ﬁnancial and developmental. The deﬁnition requires that
blended ﬁnance mobilizes additional ﬁnance (ﬁnancial additionality) which is used for sustainable development
(development additionality). In other words, blended ﬁnance is a ﬁnancial mechanism to deliver additional
development impact by mobilizing commercial capital that would otherwise not be available if left to mark et forces.
The main barriers for private investors addressed b y blended ﬁnance are:
i. High perceived risk on an investment opportunity
ii. Poor returns for the given risk r elative to comparable investments
Mobilizing
PRIVATE
CAPITAL
DEVEL OPMEN T
FUNDING
BLENDED
FINANCE
STRUC TURES
(Public and philanthropic
funders) Concessional
Market-rate
BLENDED FIN ANCE - AN O VERVIEW
Reimagining Healthcare in India thr ough Blended Finance
4 How does blended ﬁnance achieve social goals?
Blended ﬁnance archetypes
Blended Finance can be characterized by three main features:
Use of development ﬁnance and philanthropic funds to attract private capital into deals
Financial returns for private investors in line with market expectations, based on
real and perceived risks
Reduces dependency on government debt and sovereign guarantees
Builds a pipeline of commercially viable social impact projects
Reduces the risk premium through co-ﬁnancing and co-investment
Investments that drive social, environmental and economic progress
Blended ﬁnance is a valuable tool for Bilateral and Multilateral agencies, Philanthropic Organizations, and Corporate
Social Responsibility (CSR) foundations to complement traditional grant-making and invest their monies in the form
of loan/equity/guarantee in projects that deliver ﬁnancial and social returns. It has enabled large foundations such
as the Bill and Melinda Gates Foundation, Rockefeller Foundation, Michael and Susan Dell Foundation, Open Society,
Children’s Investment Fund Foundation, bilateral and multilateral agencies like USAID, UKAID and others to bridge the
risk appetite gap and subsidize ﬁnancial risk through grants or forms of low-cost returnable capital to direct
commercial capital into development initiatives.
Blended ﬁnance also has a crowding-in effect wherein, when new models are workable and successful, other
commercial players also start providing funding in the space independently using similar models. Over a period, this
leads to an increase in the total capital deployed in the target areas.
Blended ﬁnance should not be seen as an investment approach, or an instrument, or an end solution.
As per Convergence
6
, there are four common blended ﬁnance structures:
I. Public or philanthropic funders provide funds at below-market terms within the capital
structure to lower the overall cost of capital, or provide an additional layer of protection
to private investors (referred to as concessional capital).
II. Public or philanthropic funders provide credit enhancement through guarantees or
insurance on below-market terms to private investors (referred to as risk
guarantees/insurance).
III. The transaction is associated with a grant-funded technical assistance facility that
can be utilized pre- or post-investment to strengthen commercial viability and
developmental impact (referred to as technical assistance funds).
LEVERAGE
IMPACT
RETURNS
6
Blended Finance Archetypes, Convergence
Commercial Debt / Equity
Concessional Capital
Debt /
Equity
Guarantee/
Insurance
Debt /
Equity
TA
Facility
KEY CHARACTERISTICS OF BLENDED FINANCE
IV. Transaction design or preparation is grant-funded (including project preparation or
design-stage grants) (referred to as design-stage grants).
Debt /
Equity
Prep /
Design
Grant
Reimagining Healthcare in India through Blended Finance
5 Source: Re-imagining Traditional Finance for India's COVID Recovery
Principles of blended ﬁnance
The blended ﬁnance principles outline the practical steps and elements that can facilitate the design and
implementation of blended ﬁnance programs. These principles aim to enhance the growth and expand the quality of
ﬁnance that can be mobilized and invested in the sustainable development of economies globally.
With the changing landscape of developmental and sustainable ﬁnancing, numerous innovative instruments are
deployed across the nations, developing new approaches and practices. The ﬁve underlying principles below reflect
the new developments and best practice examples for blended ﬁnance and act as a guiding framework to
successfully mobilize private capital to maximize the impact for sustainable development.
Principle 1
All blended ﬁnance
activities should be
tied to a development goal
Principle 4
Focus on effective
partnering for
blended ﬁnance
Principle 5
Monitor blended
ﬁnance for transparency
and results
Principle 2
Blended ﬁnance should
increase the mobilization
of commercial ﬁnance
Principle 3
Tailor blended ﬁnance
to local context
Reimagining Healthcare in India through Blended Finance
6 BLENDED FINANCE FRAMEWORK What are the pre-requisites for initiating a blended ﬁnance transaction?
S. No.Parameters Indicative questions to ask for conducting the evaluation
1 Sustainability
Does the healthcare enterprise have an operational history with sustainable growth, say, increase
in Net Sales/ PAT margins / Net Worth?
2 Unit Level Viability Positive unit economics (more revenue per unit sold or service /per cost incurred for the unit/service)
3
Existing Capital
StructureDoes healthcare enterprises’ capital structure allow them to take commercial capital on their books?
4
Commercial
Viability
Is the healthcare enterprise in the early-mid revenue/post-revenue stage? And;
Has the healthcare enterprise demonstrated the ability to generate revenue from the proposed solution?
5
Management
Capability
Does the leadership team of the healthcare enterprise have a deﬁned vision and goals for
the next 3-5 years?
6
Competitive
Positioning
Does the healthcare enterprises’ solution have a competitive edge over existing solutions in the
market in terms of pricing/ features/ location, etc.?
7
Market
Opportunity
Is there a proof of market demand for the proposed solution? Or
Does the healthcare enterprise have orders in hand to scale up the proposed solution?
8
Business
Model
Is the healthcare enterprise dependent on non-commercial funds (such as grants,
CSR funds, philanthropic capital) to provide services to its customers?
Checklist for mobilizing commercial capital from private investors in
blended ﬁnance transactions
The need for capital support should ideally be looked at the entity level instead of the transaction level
The support through blended ﬁnance should result in scale-up and expansion of business
The blended ﬁnance structure should enable the entity to progress from early to mid-revenue or launch the
commercial journey with debt capital
There should be a lender or risk investor participation in the structure or should be attractive to the impact
investors to participate
The blended ﬁnance solution should demonstrate leverage of at least 3x on the donor funds
The solution created should catalyze pathway to unlock more commercial capital subsequently
The blended ﬁnance solution should be looked at from the lens of accelerating it into a borrowing program for
a private placement or platform listing on a social stock exchange in future
The entity should score high on the following aspects for the blended ﬁnance solution involving commercial
capital (debt) to be viable
Some of the pre-requisites for initiating a blended ﬁnance transaction that involves commercial investors should
include:
BLENDED FINANCE FRAMEWORK
Reimagining Healthcare in India through Blended Finance
8 Participants in blended ﬁnance transactions
Participant Objective
Role in
blended ﬁnance
Financial instruments
Donor Country
Governments
Historically, various institutions have been identiﬁed to participate in numerous blended ﬁnance transactions.
However, their objectives for participating in a blended ﬁnance transaction vary.
Below is a list of different participants, with their respective objectives, roles, and preferred instruments:
High development impact
Eligibility concessional return
Provider of concessional
ﬁnance for de-risking
Enabler of blended ﬁnance
ecosystem Investors
- Grants
- Loans
- Equity (in some cases)
- Guarantees
Partner Country
Governments
High development impact
Concessional return
Recipient of ODA,
policymaker, regulator,
investor
- Grants
- Loans
- Equity (in some cases)
- Guarantees
National
Development Banks
High development impact
Financial sustainability
Concessional returns in
targeted development areas
Investor/guarantor, provider
of local currency ﬁnance,
manager of concessional
ﬁnance for blending
- Loans
- Equity
- Guarantees
- Grants (as trustee)
National Investment
Funds (SWF, Public
Pension Funds) Commercial returns
Development impact
Project developer, arranger
of blended ﬁnance
solutions, investor
- Loans
- Equity
Project Developers
Project development
Commercial returns
Preparation of bankable
projects, arranger for
project development phase
- Grants
- Equity
Commercial Banks Commercial returns
Investor and arranger
(in some cases)
- Loans (short- to
medium-term)
- Equity (limited)
Institutional
InvestorsCommercial returns
Investor
- Loans (short- to long term)
- Equity
Multilateral
Development
Banks and
Development
Finance Institutions
Development impact
Financial sustainability
Commercial returns (for
private sector operations)
Concessional returns (for
public sector operations)
Arranger,
anchor/co-investor,
guarantor, M&E, policy
advice, trustee/manager of
concessional funds for
blending
- Loans (mainly senior,
some mezzanine)
- Equity (limited)
- Guarantees
- Grants and other conces-
sional instruments (as
trustee)
Reimagining Healthcare in India through Blended Finance
9 Participant Objective
Role in
blended ﬁnance
Financial instruments
Retail Investors Commercial returns Investor
- Debt
- Equity
Impact Investor
Eligibility concessional returns
High development impact
Investor
- Debt
- Equity
Philanthropy Development impact
Concessional returns
Incubation, piloting,
provider of concessional
Finance for de-risking
- Grants
- Patient/Catalytic capital
(Equity, Debt)
Civil society
(NGOs, Trade
Unions, etc.)
Development impact
Transparency Equity
Compliance with human rights
and ESG standards
M&E, capacity building,
piloting innovative ﬁnance
Grants
Research Centers
and Academia Transparency learning Capacity building, policy
advice, knowledge
Grants
Reimagining Healthcare in India through Blended Finance
10 IMPROVING HEALTHCARE IN INDIA
WITH BLENDED FINANCE 7
Investment Opportunities in India’s Healthcare Sector NITI AAYOG
8
India’s economy needs big dose of health spending
9
National Health Policy 2017 MoHFW
10
Financing and Funding Indian Healthcare: Navigating the Turbulent Tide NATHEALTH PwC
11
Blended Finance for a post COVID-19 world, Observer Research Foundation, July 2020
12
Funding Indian healthcare Catalysing the next wave of growth NATHEALTH PwC
Current healthcare investment landscape in India and funding gaps
Although India’s healthcare sector has grown rapidly over the last ﬁve years (Compound Annual Growth Rate of
22%)
7
, COVID-19 has brought to the forefront persistent challenges such as a weak health system, lack of quality
infrastructure, and lack of quality service delivery to vulnerable populations.
India's healthcare spending is 3.6% of GDP, including out-of-pocket and public expenditure. The combined total
government expenditure of both central and state is 1.29% of GDP. India spends the least among BRICS
countries: Brazil spends the most (9.2%), followed by South Africa (8.1%), Russia (5.3%), China (5%)
8
.
The National Health Policy has mandated states to increase health spending on primary care by at least 10%
every year to reach the target of spending 2.5% GDP
9
. In addition, the government has liberalized FDI norms to
allow up to 100% investment in almost all sectors (hospital construction, medical devices, insurance, and in
greenﬁeld projects related to healthcare, biotechnology, pharmaceutical) except for brownﬁeld sectors like
healthcare, biotechnology, and pharmaceutical where it is up to 74%
7
. Despite this, 66% of the FDI inflows in the
past two decades were in drugs and medicines, followed by hospitals & diagnostic centers and medical &
surgical appliances
7
. Since 2010, more than 110 private equity (PE) and venture capital (VC) investors have
invested in the healthcare delivery space, with a transaction value of USD 1,275 Million (2016)
10
. Four major
hospitals and diagnostics chains recently had successful initial public offerings to raise capital. But the
investments and capital raised have been from established market players with a strong focus on proﬁtability and
growth and not necessarily on accessibility and affordability.
To address this, the Government of India has launched the flagship initiative Ayushman Bharat (AB) Pradhan
Mantri Jan Arogya Yojana (PM-JAY) the world's largest non-contributory Government-sponsored health insurance
scheme that enables increased access to in-patient healthcare for poor and vulnerable families in secondary and
tertiary facilities. Ayushman Bharat will cover 500 million poor people, increasing demand for secondary and
tertiary care by one crore hospitalizations per year. It is estimated that 300,000 new beds will be required, which
can be met by utilizing spare capacity, increased efﬁciency through technology and large additional resources
mobilized for the sector. Innovations, both technological and ﬁnancial, are expected to play a vital role in bridging
this gap.
Before COVID-19, it was estimated that over $500 billion of private capital must be mobilized annually to meet all
of India's sustainable development goals by 2030
11
. To address access, affordability, and quality healthcare, it is
estimated that under a business-as-usual scenario USD 256 billion would be needed by 2034 to achieve
sustainable development goals related to health. But with the adoption of new technologies and a focus on
prevention and wellness, the funding requirement is estimated at USD 156 billion
12
. This implies that government
and philanthropic funding will need to be applied even more judiciously. The potential solution is blended ﬁnance,
i.e., using a combination of public or philanthropic (grant) and commercial (equity or debt) capital to create new
funding structures towards achieving developmental impact in healthcare
IMPROVING HEALTHCARE IN INDIA WITH BLENDED FINANCE
Reimagining Healthcare in India through Blended Finance
12 Investment Opportunities within Health Subsectors
India's healthcare industry comprises hospitals, medical devices and equipment, health insurance, clinical trials,
telemedicine, and medical tourism. Major Segments on the supply side of India's healthcare sector are shown below.
Source: Healthcare. India Brand Equity Foundation
COVID-19 will likely catalyze long-term changes in attitudes towards personal health and hygiene, health
insurance, ﬁtness and nutrition, and health monitoring and medical check-ups. In addition to the curative
segments above, the preventive healthcare market in India is segmented into healthy consumption, ﬁtness and
wellness, infection prevention care, health monitoring, and wellbeing assurance segments. The primary care
industry is currently valued at $13 bn
13
. The preventive healthcare market in India was valued at $49 bn in 2019
and is expected to reach $194 by 2025, expanding at a CAGR of ~27.30% during the 2020-2025 period
14
. The
pandemic has also accelerated the adoption of digital technologies, including telemedicine. The major areas
where funding is required include:
The hospital sector in India accounts for 80% of the total healthcare market. It was valued at USD 61.79 Billion in
FY17 and is expected to reach USD 132 Billion by 2023, growing at a CAGR of 16%-17%
15
. It is noteworthy that
around 65% of hospital beds in India cater to almost 50% of the population concentrated in Uttar Pradesh,
Maharashtra, Karnataka, Tamil Nadu, Telangana, West Bengal, and Kerala. The other 50% of the country's
population living in the remaining 21 States and 8 Union Territories has access to only 35% of hospital beds. This
indicates a need to grow hospitals beds by at least 30% to ensure equitable access to healthcare for citizens in all
parts of the country.
Hospitals
Pharmaceutical
Diagnostics
Medical Equipment
and Supplies
Medical Insurance
Telemedicine
Government (healthcare centres, district hospitals, general
hospitals)
Private (nursing homes, mid-tier & top-tier private hospitals)
Includes manufacturing, extraction, processing, puriﬁcation &
packaging of chemical materials for use as medications for humans
or animals
Comprises businesses & laboratories that offer analytical or
diagnostic services, including body fluid analysis.
Includes establishment primarily manufacturing medical equipment
& supplies, e.g. surgical, dental, orthopedic, ophthalmologic,
laboratory instruments, etc.
Includes health insurance & medical reimbursement facility,
covering an individual's hospitalization expenses
incurred due to sickness
Has enormous potential in meeting the challenges of healthcare
delivery to rural & remote areas besides several other applications in
education, training & management in the health sector
13
Invest India healthcare industry overview 2022
14
Preventive Healthcare Market in India 2020
15
Invest India healthcare industry overview 2022
Reimagining Healthcare in India through Blended Finance
13 16
Healthcare. India Brand Equity Foundation. Retrieved December 15, 2020
17
Invest India pharmaceuticals sector overview 2022
18
Invest India healthcare industry overview 2022
19
Telemedicine market size in India 2010-2025. Statista Research Department. Retrieved January 7, 20201
Health insurance contributes 20% to the non-life insurance business, making it the 2
nd
largest portfolio. PM-JAY,
launched by the Government of India as part of the Ayushman Bharat initiative, could increase the penetration of
health insurance in India from 34% to 50%
16
. This would, in turn, increase the demand for in-patient services.India's pharmaceutical sector is the third largest by volume globally. The cost of production in the country's
pharmaceutical sector is around 33% lower than that of the United States and is being continually brought down
further
17
. India has the opportunity to boost domestic manufacturing, supported by recent Government schemes
with performance-linked incentives, as part of the Aatmanirbhar Bharat (Self-Reliant India) initiative. Medical devices are considered a sunrise sector of the Indian economy with relatively lower barriers to entry
compared to other industries. The size of the Indian medical devices market is estimated at USD 11 billion, and
expected to grow to USD 50 billion by 2025
18
. India's trade in medical devices has increased though India remains
a net importer. Many start-ups in the medical devices space need growth funding to scale up.
The COVID-19 pandemic provided an impetus for the expansion of the home healthcare market in India. With
social distancing as the new norm, telemedicine solutions are fast emerging as a convenient alternative. The
market size for telemedicine in India (USD 830 million, as of 2019) is projected to increase to USD 5.5 billion by
2025, growing at a CAGR of 31% during 2020-25
19
.
A low presence of doctors in semi-urban, rural, and remote areas has resulted in limited access to healthcare
facilities for many people. Telemedicine and e-Health are considered potential solutions for addressing this lack
of access, due to the extensive smartphone penetration in India and improving mobile connectivity.
All these areas require signiﬁcant investment from private and philanthropic sources. Blended ﬁnance can help
leverage the private sector to ﬁll this health funding gap across various sub-segments of the healthcare ecosystem.
The private sector has the potential to play a pivotal role in reducing out-of-pocket costs for private services and
making them more affordable and accessible. There is a need for market-based solutions or commercially viable
solutions that are scalable and sustainable which can be purchased by government, employers or individuals
according to their purchasing power and social good. Blended ﬁnancing can facilitate these market-driven high-impact
solutions by creating viable business models which can penetrate to the most vulnerable through appropriate risk
mitigation where philanthropic grant can be utilized to subsidize commercial capital.
Reimagining Healthcare in India through Blended Finance
14 Source: Country Archetypes, Figure 7, Greater than the sum of the parts, Blended Finance Roadmap
for Global Health, USAID, CII Investing for Impact
Countries in the build phase, with less-developed health systems and low investor attractiveness, may deploy
simpler blended ﬁnance instruments like technical assistance grants and guarantees to mobilize additional capital
and resources to move closer to the desired health goals. In comparison, countries in the transition phase with more
established health systems and greater participation from private sector investors could explore more intricate
instruments like impact bonds, debt-buydowns, and impact funds. A holistic approach with the right set of enablers
and strategic partners is required to channel the resources corresponding to each country's healthcare priorities.

India lies somewhere between the strengthen and transition space for investment attractiveness as speciﬁc regions.
Subsectors in healthcare systems within the country don't align with the overall prototype. Investment Opportunity
Areas such as improving primary healthcare services in rural areas have great potential for high development
impact, but such models' commercial viability remains unproven. Business models in these 'white spaces' currently
face signiﬁcant commercial hurdles and need to develop further before attracting large-scale commercial private
investments. Blended ﬁnance can play a critical role in these white spaces and mature areas by incentivizing them to
serve vulnerable populations.
Build
Health status
Minimal public health
expenditure, insufﬁcient
access to health facilities, and
poor health outcomes
StrengthenTransition
Investment
attractiveness
Approach to
blended ﬁnance
Moderate public health
expenditure, better health
infrastructure but low access,
improving health outcomes
Higher public health
expenditure with variable
access and better health
outcomes
Underdeveloped ﬁnancial
sector, lack of
investor interest
Financial markets still
developing, but private
healthcare players have
better access to capital
More established ﬁnancial
sector, as well as moderately,
developed private sector and
investor interest
Development agencies can
focus more on building
capacity and pipeline
for blended ﬁnance
Amenable to deploying
simpler instruments but likely
not ready for complex
blended ﬁnance tools
Development agencies can
deploy complex blended
ﬁnance tools, gradually
helping countries transition
to self-reliance
How can blended ﬁnance be pivotal for India’s healthcare industry?
Every nation has different healthcare priorities, and it is crucial to identify them before shortlisting the right mix of
blended ﬁnance instruments to support the overall health developmental goals. Two indicators can determine the
blended ﬁnance prototypes: one, to measure the country's health system status (build, strengthen & transition), and the
other to gauge investment attractiveness given the country's ﬁscal and economic situation (see matrix).
Reimagining Healthcare in India through Blended Finance
15 Source: Figure 14, SDG Investor Map Report for India 2020, UNDP India
Blended ﬁnancing is an emerging sector globally, and still in its infancy in India. The following case studies
demonstrate how blended ﬁnancing can work in India to solve critical health system gaps. This is followed by
the key challenges that need to be addressed for enabling blended ﬁnance in India.
SubsectorAffordable Healthcare Delivery
Affordable Medical
Equipment and Supplies*
Affordable
Pharmaceuticals
USD 13 bnUSD 11 bnUSD 5.5 bnUSD 62 bnUSD 13 bn
Primary care
in rural areas
Primary care market
is valued at The hospital industry is
estimated to be worth
Telemedicine market is
expected to worth
Estimated market size of medical
devices industry in India is
Models have
demonstrated
proﬁtability and
attracted private equity
investments
Promising models
have attracted
venture capital,
but have not yet
established
proﬁtability
A number of
existing players
are adopting these
models, but models
have not yet been
proven as proﬁtable
Emerging
Technology-
enabled,asset-light
scalable satellite
centres/small care
units that offer
secondary and
tertiary care
Technology-
enabled,asset-light
scalable specialist
care centre
Scalable mobile-
based software
solutions and
mobile workforce
models that allow
for remote/at-
home medical
consultation and
symptom-
management for
chronic diseases
Low-cost
manufacturing and
distribution of
consumables and
equipment for
hospitals and care
centres
Manufacturing of APIs
for affordable drugs for
high-burden disease
categories, such as
Cardiovascular diseases,
Diabetes and
Tuberculosis and drugs
included under the
National List of Essential
Medicines (NLEM)
EmergingMatureMature
Models have
demonstrated
proﬁtability and
attracted private equity
investments
Models not
yet commercially
viable
White space: strong
scale potential but
not successful
business models
Primary and
preventive care
centres in rural
areas
Low-cost hospital
satellite centres/
care units in
non-metros Tech-enabled
remote care
services (such as
Telemedicine)
Affordable medical
equipment
and consumables
Active Pharmaceutical
Ingredients
manufacturing
India’s bulk drugs market
(APIs and intermediaries) is worth
Opportunity
Areas
Investors identiﬁed
area as fundamentally
marketable?
Scale Potential
Proven in-market
as evidenced by
investors interest?
Opportunity type
Emerging
business model(s)
Reimagining Healthcare in India through Blended Finance
16 CASE STUDIES There is both a challenge and a promise to strengthen India’s Healthcare Systems, which underlines the need for
tri-sector collaboration between public, private, and philanthropic resources to support innovative healthcare models
with capital access.
Case study I - Sustainable Access to Markets and Resources for Innovative Delivery of
Healthcare (SAMRIDH)
Background: India’s existing healthcare ecosystem is coping with the following challenges:
SAMRIDH Healthcare Blended Finance Facility
20
an initiative under the United States Agency for International
Development (USAID) and IPE Global’s flagship project Partnerships for Affordable Healthcare Access and Longevity
(PAHAL), aims to catalyze innovative ﬁnancing mechanisms to improve healthcare services for India’s most
vulnerable populations. SAMRIDH is supported by USAID in technical collaboration with the Principal Scientiﬁc
Advisor to the Government of India, Atal Innovation Mission, NITI Aayog, National Health Authority, Indian Institute of
Technology (IIT-D), The Rockefeller Foundation, IndusInd Bank, Axis Bank, Caspian Impact Investments and
NATHEALTH. This initiative is implemented by a Technical Support Unit managed by IPE Global.
Through this initiative, SAMRIDH combines commercial capital with public and philanthropic funds to mitigate
barriers to private investment in healthcare. The approach aims to drive greater resources towards market-based
health solutions to improve access to affordable and quality healthcare services for India's most vulnerable.
SAMRIDH has mobilized a capital pool of over USD 250 million as of January 2022 to offer both grant and debt
ﬁnancing provision to healthcare enterprises, enabling them to augment their capacity for production and
supply of high-impact health solutions for COVID-19. This is complemented by strong technical assistance and
capacity building component to help enterprises raise commercial investments through blended ﬁnancing solutions
for long-term sustainability and expansion.
Limited access to appropriate capital
Less incentives to adopt innovative practices
Lack of market intelligence and network
IMPROVING HEALTHCARE
SERVICES FOR VULNERABLE
COMMUNITIES THROUGH
HIGH IMPACT HEALTH
SOLUTIONS
GROWTH FINANCING
STRENGTHENING BUSINESS
MODELS FOR SCALE
SAMRIDH PIPELINE
Business advisory to reﬁne
business models, make
process and product
improvements, enhance
market access and design
effective marketing strategies
Structuring blended
ﬁnncing instruments,
combining grant and debt
capital
• Concessional capital
• Returnable Grants
• Cash Collaterals
• Market Validation
• Assistance Grants
• Portal/ First Loss Guarantee
• Portfolio Umbrella Guarantee
• Social Success Notes
Broker partnerships with
banks and debt funds to
provide debt ﬁnancing
Available Debt Pool: USD
200 Million
Screening,
evaluation and
selection of
solutionsusing
SAMRIDH blended
ﬁnance framework
Solving complex
Healthcare
Challenges
Mobilize grant support as
catalytic funding with an aim
to get leverage of 5-10x
Grant Pool: ~ USD 25 Million
Tested and
market-ready
health solutions
Targeting
vulnerable
communities in
Tier 2 and 3 cities,
rural and tribal
regions
20
SAMRIDH Healthcare Blended Finance Facility
CASE STUDIES
Reimagining Healthcare in India through Blended Finance
18 Focus areas aligned to current national healthcare priorities
Key objectives
How can SAMRIDH support national healthcare priorities?
Vaccine supply and delivery systems
Healthcare infrastructure
Diagnostic products and services
Medical devices
Training and capacity building of health workers
Information, Education, and Communication for behavior change
Oxygen supply
Bridge supply-side gaps in healthcare facilities to respond to health emergencies in the immediate,
medium, and long term
Accelerate scale-up and adoption of innovative and market-based health solutions
Mobilize resources to support high impact health solutions and build sustainable healthcare systems
Promote local and comprehensive solutions at the community and facility level for vulnerable population
Approach
Identify high impact healthcare solutions
Facilitate access to affordable capital for healthcare enterprises through its partner ﬁnancial institutions
Offer innovative and customized blended ﬁnancing instruments to ensure long-term sustainability
Monitor and evaluate for impact at scale
Provide technical assistance to maximize the impact and make necessary connections with other
enterprises within the larger healthcare ecosystem
Deployment Ready Innovations Pipeline: Access to curated investment deals with high-impact
health solutions that have the potential to improve healthcare services for vulnerable communities.
Global Exposure for Make-in-India solutions: Leverage the global network of SAMRIDH's key
stakeholders to showcase and enable market access beyond India for high impact health solutions
Blended Financing structures: Proof of concept for combining commercial capital with philanthropic
funding to scale healthcare solutions
Health System strengthening: Targeted solutions to improve comprehensive healthcare services for
the vulnerable 40% of the population
Reimagining Healthcare in India through Blended Finance
19 The SAMRIDH Healthcare Blended Finance Facility is taking the below-mentioned measures to overcome some of
the challenges associated with adopting blended ﬁnance to achieve scale.
It is collaborating with government stakeholders and agencies like NITI Aayog, National Health Authority, Principal
Scientiﬁc Advisor to the Government of India, IIT Delhi to advocate the regulatory changes required to scale up the
adoption of the blended ﬁnance solutions across the healthcare ecosystem.
To mitigate the challenges concerning mobilization of private capital and fostering strategic partnerships to
implement multi-stakeholder models, the SAMRIDH facility is leveraging philanthropic capital to partner with
ﬁnancial institutions, including Banks and NBFCs. Through this experience, important learning have emerged that
acknowledge gaps in donors' expectations versus private funders. The win-win solution is to create social success
notes or partial risk guarantees, which provide capital to for-proﬁt enterprises with a social impact mindset. These
structures will provide a much-needed impact on philanthropic capital and commercial returns to private capital.
In addition, SAMRIDH assesses the commercial viability and technical robustness of the solutions to impact the
most vulnerable populations and provides technical assistance to social enterprises. To foster learning and promote
transparency on the blended ﬁnance activities, SAMRIDH has created a robust monitoring evaluation and learning
system. This includes detailed documentation of the structure of the transaction, stakeholders involved, outcomes
and impact achieved, and the amount of leverage realized. This will help propagate the advantages of mobilizing
blended ﬁnance transactions, provide a guided road map for structuring potential future transactions, and increase
the scalability of these concepts. SAMRIDH is also forging partnerships with institutions like the Association of
Impact Investors and Academic Institutions to create and promote the circulation of templatized models for blended
ﬁnance structures using different sources of capital for easy adoption and scale-up.
The facility demonstrates the efﬁcacy of structuring customized and innovative blended ﬁnancing structures to offer
a win-win solution for all the different stakeholders involved in any transaction. These blended ﬁnance transactions
are ﬁlling a crucial bottleneck in tackling new frontiers to support business models focusing on social impact with
the help of philanthropic donors and commercial investors, which otherwise may not have been possible.
Impact (May’21 to Jan'22)
Over USD 11 Mn+ committed from grant pool in 25+ high impact healthcare solutions, reaching
28+ states across India.
Through the blended ﬁnancing solutions, SAMRIDH so far has achieved leverage of 10.7x on
development funding mobilized from corporates, philanthropies, and development agencies.
Reached over 1200+ Healthcare facilities; 15000+ Medical staff, CHWs, Nurses and covered 30 million
population through its partners.
Key learnings
Reimagining Healthcare in India through Blended Finance
20 A Social Success Note (SSN) is a blended ﬁnance instrument based on the principle of pay-for-success, which helps
for-proﬁt social enterprises access affordable debt to scale their operations and impact while delivering
mission-aligned targets and outcomes.
A Portfolio Level Social Success Note is an altered version of a traditional SSN wherein multiple social enterprises
with a proven business model are covered under an umbrella of low-cost loans offered by the same ﬁnancial
institution. Each of the social enterprises which form part of the portfolio have to achieve quantiﬁable and
measurable impact indicators basis which the quantum of outcome payments are linked. If the social enterprises
within the portfolio achieve the predetermined impact indicators and outcomes, the outcome payer (donor/
philanthropic funder) offers the risk investor (ﬁnancial institution) an added incentive depending on the outcomes
which have been achieved. This approach ensures a competitive risk-adjusted return for the risk investor, thereby
making the instrument attractive for private sector players. The outcome payer may also choose to provide an
incentive to the social enterprises through ﬁnancial institutions to reduce the operational hassle of transferring funds
directly. This program offers a standardized blended ﬁnance instrument that can further promote greater adoption
and scale-up opportunities for social enterprises and reduce the process and time involved in processing SSNs at an
entity level.
Aligns incentives of various
stakeholders to provide enterprises with
mission-aligned affordable capital to
help them scale up and become
ﬁnancially sustainable
Beneﬁcial for social enterprises since
they struggle to raise high-cost
commercial capital owing to lower
margins in serving underserved
segments
The outcome payer gets access to a
larger pool of social enterprises across
segments and geographies and could
deﬁne such limits under the program to
ensure targeted impact-oriented
interventions
The pooled structure can be easily replicated and scaled up with multiple ﬁnancial institutions, thereby making
commercial capital affordable for high-impact social enterprises through an incentive structure
Case study II - SAMRIDH's Portfolio Level Social Success Note Program
The advantages of utilizing a portfolio level social success note program include:
SAMRIDH's Portfolio Level Social Success Note Program
Investment Manager: Caspian Debt, IPE Global
Launch Year: 2021 | Size: USD 5 Mn | Sector: Healthcare | Region: India (Asia)
Outcome Funder: United States Agency for International Development (USAID) through SAMIRIDH (IPE Global)
Market Opportunity: Small and niche enterprises aiming to provide affordable healthcare solutions to the
vulnerable population in India often struggle to run businesses commercially. Given the early business stage
of the enterprises, lending to this segment becomes highly risky for commercial investors.
4a1
4b
Investor
Social Enterprise
Outcome payment
Outcome payment
Monitoring and
Beneﬁciaries
Evaluation (M&E)
Outcome payer
Repayment
Provides goods
and services
Loan
2
3
Reimagining Healthcare in India through Blended Finance
21 Model: Caspian Debt (acting as risk investor), after thorough due diligence, will provide loans to the healthcare
enterprises in the pool, using which the enterprise will work to achieve pre-agreed social impact outcomes. Based on
the achievement of these outcomes, they will receive an outcome payment (from SAMRIDH) via Caspian Debt
equivalent to 5% p.a. of the interest payment, thereby reducing the overall interest cost for the enterprises.
The rationale for blended ﬁnance: This facility creates a joint intervention for commercial investors and philanthropic
funders to provide high-impact healthcare enterprises with the necessary resources to raise commercial capital and
scale in a sustainable manner so that they can continue delivering on their mission.
Impact: Through this pooled project, multiple healthcare entities will mobilize commercial capital for scaling up and
expanding their business. The outcome funder will be able to derive a higher impact on its funds spreading across a
portfolio of healthcare enterprises. The program's intent will be to support solutions focusing on providing healthcare
solutions and facilities to the under-served- in rural/semi-rural areas, urban poor, or tier 2&3 cities.
Reimagining Healthcare in India through Blended Finance
22 Guarantees are legally binding agreements under which a third party ("guarantor") agrees to pay in the event of
non-payment or loss of value. The public or philanthropic sector deploys guarantees to create investment
opportunities with acceptable risk-return proﬁles for the private sector by de-risking the investments and improving
the risk-return proﬁles relative to the market norms.
Guarantees act as a risk underwriting measure. They help to ensure that investors receive a minimum level of
returns or limit an investor's losses if an investment underperforms expectations. Guarantees may be full (i.e., cover
the full value of scheduled repayments) or partial (i.e., cover a portion of the full value). A partial credit guarantee can
attract private investors by improving the business enterprise/project’s creditworthiness by limiting the downside
risk and reducing the required return for other investors.
The availability of a guarantee can signiﬁcantly improve the business enterprise/ project’s ﬁnancial viability by
off-setting the high up-front transaction costs, thereby reducing the uncertainty over whether the project will become
operational.
Making social impact/ developmental projects commercially viable by shifting the risk-returns ratio and/or reducing
the cost of capital
Enables developmental/ philanthropic funders to support larger projects than individual instruments and programs
Guarantees do not require an immediate outlay of capital, and only require funds when they are called for, which
enables the same pool of capital to support multiple projects
Allows diversiﬁcation of risk across the portfolio of borrowers and provides participation from multiple stakeholders
to make high-impact investments in healthcare enterprises
This structure also allows for higher leverage on grant capital compared to transaction-level support
Case study III - USAID's Portfolio Guarantee Program for Healthcare Enterprises in India
Beneﬁts of Guarantees (Full or Partial Risk) include:
Repayment Unidentiﬁed
Borrower
Unidentiﬁed
Borrower
Unidentiﬁed
Borrower
All
borrowers
within
identiﬁed
sector
Repayment
Repayment
Loan
Loan
Loan
USAID 50% Loan
Portfolio Guarantee
Identiﬁed
Lender
Reimagining Healthcare in India through Blended Finance
23 USAID's Portfolio Guarantee Program for Healthcare Enterprises in India
Investment Manager: IndusInd Bank
Developmental Funder: United States Agency for International Development (USAID)
Launch Year: 2018 | Sector: Healthcare | Region: India (Asia)
Portfolio Size: USD 50 Mn | Guarantee Size: USD 25 Mn (50% Pari-passu risk on principal only)
Market Opportunity: Early-stage and growth-stage healthcare enterprises often experience difﬁculties raising
commercial capital due to long tenors, capital-intensive business models with dynamic market regulations. In addition,
commercial banks may be unwilling to lend further due to a lack of adequate collateral due to long working capital cycles
leading to cashflow mismatch and high perceived risk. There is a signiﬁcant need for medium- to long-term ﬁnancing for
healthcare enterprises in India, which can be an attractive opportunity for commercial investors and lenders.
Model: The guarantee from USAID covers 50% Pari-passu risk on principal only on the qualifying loans extended by the
bank to the healthcare entities by paying a utilization fee to the USAID every year on the outstanding loan book. The
guarantee is not a ﬁrst loss guarantee but a pro-rata risk-sharing guarantee of losses after collection efforts pursuant to
the claim. In case of recovery, the bank shall reimburse USAID on a pro-rata basis the Recovered Funds after deducting
any expenses incurred in the collection efforts.
Impact: The partial risk guarantees act as a powerful catalyst to encourage ﬁnancial institutions to lend into new
markets, making credit available to under-served borrowers. The guarantee also entices the lender to offer favorable
terms to the healthcare enterprises, which enables them to optimize proﬁts, expand reach, and become sustainable in
the long run.
Rationale for blended ﬁnance: USAID, by acting as a guarantor, is strengthening the bank's ability to lend to healthcare
enterprises catering to customers, including the vulnerable population, thereby improving access to affordable and
quality healthcare services within India.
Reimagining Healthcare in India through Blended Finance
24 Case study IV - Blackfrog Technologies Pvt. Ltd.
NBFC
BFF
Blackfrog
Loan Availed
Bank
Guarantee
For manufacturing of
medical device
Principle +
Interest
repayment
BFF
Blackfrog
For manufacturing of
medical device
Repayment
of grant
Returnable
grant
Emvólio
NBFC
BFF
Blackfrog
Loan Availed
For manufacturing of
medical device
Interest
component
reimbursed
Principle +
Interest
repayment
Interest Subvention: In interest subvention, based on the social impact that is
achieved by the business enterprise, the interest component on loan gets paid
fully or partially by a developmental funder or a donor to promote the
achievement of social goals. Generally, interest subvention is provided by the
government to facilitate affordable capital to the entrepreneurs, thus
encouraging business activities in priority or focus sectors. However, parallels
can be drawn to the development sector and developmental capital can be
utilized to accelerate achievement to sustainable development goals.
Interest subvention instrument acts as a great incentive for the business
enterprises to expand their portfolio of products/services while creating social
impact and not compromising on their commercial viability. The subvention also
encourages the enterprise to service the loan better and provides comfort to the
lender(s) thereby reducing credit/default risk on the borrower due to improved
margins.
Returnable Grants: Returnable Grants are an innovative ﬁnancial instrument
that aims to leverage the best of grant capital structured in the form of a loan.
Through this mechanism, the borrower receives a zero-interest loan with only a
moral obligation to repay. Once returned, the grant capital forms part of a
revolving fund that can then be re-disbursed, thereby creating enormous
leverage on the initial grant capital.
This type of ﬁnancing appeals to developmental funders and philanthropic
donors as they can regularly receive the reflows and deploy the funds across
other programs or priorities.
Partial Risk Guarantee: With this instrument, the guarantor agrees to pay part
of the entire value of the loan to the lender as a risk-mitigation measure in the
event of non-payment or loss of value. The partial risk guarantee aids in
shifting the risk-return proﬁle of the investment and reduces the cost of
capital, making the investments commercially viable. A partial credit
guarantee can attract private investors by improving an investment's
creditworthiness by limiting the downside losses reducing the required return
for that level of risk for other investors. It can also signiﬁcantly improve an
investment's ﬁnancial viability by offsetting high up-front transaction costs,
reducing the uncertainty of a project becoming operational.
Reimagining Healthcare in India through Blended Finance
25
Emvólio
Emvólio Blackfrog Technologies Pvt. Ltd.
Investment Manager: IIT-Delhi, Caspian Debt & IPE Global
Developmental Funder: USAID and Rockefeller Foundation
Launch Year: 2021 | Sector: Healthcare
Total Investment Size: USD 200,000 | Interest Subvention: 10% p.a. for 18 months | Returnable Grant: USD 71,000
Partial Risk Guarantee: USD 114,000
Market Opportunity: Blackfrog Technologies is a health-tech company specializing in the last mile delivery of medical
supplies and biologicals. Their groundbreaking invention, EMVÓLIO, a portable, active cooling, battery-powered device
facilitates safe last-mile delivery of COVID-19 vaccines across the country. The enterprise needed to raise funds to
increase its manufacturing capacity and expand its presence to other geographies.
Model: Through the blended ﬁnance structure, Blackfrog was able to avail a loan from Caspian Debt, a leading NBFC.
However, given the risk proﬁle of the enterprise, there was a requirement for additional collateral to avail the loan and
initial support to service the loan at market rates until entity achieves commercial sustainability. Given the future demand
for the EMVÓLIO product and the order pipeline, the enterprise was a good ﬁt to avail a blended investment for business
expansion and long-term sustainability. Further, Blackfrog was provided with scale-up advisory support through technical
assistance facility of USAID to enable access to international markets such as Africa.
Rationale for blended ﬁnance: Given the nascent stage of the enterprise, Blackfrog was experiencing a cashflow crunch
triggered by long working capital cycles, high up-front costs, and limited manufacturing capacity. Combining returnable
grants with a commercial loan from NBFC allowed the enterprise to scale up faster and achieve ﬁnancial sustainability
without relying heavily on the equity funds.
Impact: The blended approach enabled the enterprise to avail commercial lending at favorable terms to ﬁnance its
expansion which further enabled greater economies of scale and improved cash flows.
Reimagining Healthcare in India through Blended Finance
26 Case study V - Skill India Impact Bond, India's First Skill Impact Bond with a Gender Lens
Social Impact Bond (SIB): An innovative blended ﬁnancing instrument that blends public, private, and philanthropic capital
through performance-based contracts dedicated to creating social impact. In a SIB, a risk investor provides the initial
capital to the social enterprise (implementation partner) to scale its work. An outcome funder(s) repays the risk investor if
and when the project's target outcomes are achieved, and the on-ground impact has been generated.
Social Impact Bonds can also be categorized as Pay-for-Performance instruments. They enable desired outcomes to be
achieved, triggering success payments to implementers and repayment of principal to investors via outcome sponsors.
Social Impact Bonds invite participation from the private investors to cover the upfront capital to kickstart the project. The
funds are then repaid by outcome funder(s) i.e., government, philanthropic organizations, donors, only if the pre-deﬁned
impact outcomes are achieved and veriﬁed by an independent third party. This approach brings in the discipline for
outcome funders to derive high level of impact with every dollar spent. In addition, social impact bonds promote
entrepreneurship and private sector dynamism towards developmental challenges and create investable opportunities for
public, private and philanthropic investors.
Social Impact Bonds are built on the premise of aligning the interest of the social enterprise, investor, and outcome funder,
thus advancing social and developmental objectives. In the healthcare sector, these instruments propel the implementation
partner/agency to achieve required targets, enhance the quality of care, prioritize initiatives/activities in the focus areas and
promote efﬁciency in the health system.
This blended ﬁnance instrument enables the means for mobilizing private capital, fostering collaboration between various
stakeholders, promoting innovation, increasing accountability, and driving performance for better social returns.
Skill India Impact Bond - India's First Skill Impact Bond with a Gender Lens
Risk Investors: National Skill Development Corporation and Michael & Susan Dell Foundation
Outcome Funders: British Asian Trust, The Children's Investment Fund Foundation, HSBC India, JSW Foundation
and Dubai Cares
Implementation Partners: Apollo Medskills Ltd, Gram Tarang Employability Training Services, Learnet Skills,
Magic Bus Foundation, and PanIIT Alumni Foundation
Performance Manager: Dalberg Advisors | Outcome Evaluator: Oxford Policy Management
Technical Partners: FCDO (UK Government) and USAID through its flagship innovative ﬁnancing platform – PAHAL
Launch Year: 2021 | Sector: Skilling & Education Region: India (Asia)
Investment Size: USD 16 Mn over 4 years
Market Opportunity: There is a signiﬁcant skilling gap within the country's youth which has been widened due to the
effects of the COVID-19 pandemic. There lies a bundle of opportunities for the skilling ecosystem with joint efforts by the
public and private sectors to drive changes among the beneﬁciaries with respect to changes in their income level, health
status, consumption pattern, employment opportunities, decision making, etc.
Reimagining Healthcare in India through Blended Finance
27 Model: The Skill India Impact Bond aims to support 50,000 youth in India over four years, of which 60 percent will be
women and girls. The youth will be imparted skills through training and provided access to wage employment in
COVID-19 recovery sectors such as healthcare, retail, logistics, etc. Under SAMRIDH the focus will be on skills for the
healthcare sector and allied sectors/services that contribute to health outcomes.
Rationale for blended ﬁnance: Through this collaborative pay-for-success model, the SIB will inch closer to bridging the
skilling gap in urban and rural India and address the employability crisis due to pandemic. The SIB model aims to
approach mainstream gender factors in business investments to yield higher economic, social, environmental, and return
on investment outcomes, mitigate risks.
Impact: The above collaboration intends to build the capacity of India's Skilling and Technical and Vocational Education
and Training (TVET) by promoting strategic collaborations to assist learning outcomes. Further, with support from USAID,
PAHAL (under IPE Global) aims to explore the linkages between the skilling program and its impact on the health status,
well-being, needs, economic status, etc. among the skilled individuals.
For more information, please visit https://nsdcindia.org/sib
Reimagining Healthcare in India through Blended Finance
28 KEY CHALLENGES TO ACHIEVE
BLENDED FINANCE AT SCALE Measurable and clear health outcomes (e.g., whether the patients are successfully treated, vulnerable populations
are vaccinated, preventive care services are available and accessible to people)
Strong funding interest from the investment community, risk capital providers, and outcome funders, as well as a
large and diverse pipeline of service providers from the private and public sector
A developing ecosystem of intermediaries active in blended ﬁnance who can bring in all participants in the
structures
Scaling up through existing templates of blended ﬁnance structures which can establish pricing of outcome
Some key challenges hampering the adoption of blended ﬁnance at scale include:
The blended ﬁnance market in India has been growing, inviting the participation of public, private, and philanthropic
capital, which can play a crucial role in unlocking the additional ﬁnancing required to achieve the SDGs. Blended
ﬁnance offers India a unique opportunity to promote strategic partnerships with the private sector to mobilize capital
towards developmental initiatives. Though the world has seen new blended ﬁnance projects in the last few years, the
health sector comprises a small proportion of the blended ﬁnance portfolio globally and has room for expansion.
The healthcare sector is well suited to fund the extraordinary efforts because of the following reasons:
Lack of a private sector mobilization strategy and action plan: Blended ﬁnance is one tool in the development
toolbox centered on increasing the quantum of ﬁnancing to SDG projects. Donors are the main source of the
catalytic funding that create the market-equivalent investments that mobilize private investment, but they have not
prioritized and budgeted private sector mobilization as a necessity to signiﬁcantly narrow the SDG ﬁnancing gap.
Further, the idea of providing ﬁnancial returns to risk investors has not been adopted widely by the development
sector community.
Low levels of coordinated participation from the government: Representation from governments is crucial to
scaling blended ﬁnance. The current government system is based on input-based budgeting, while blended ﬁnance
structures such as SIBs require a shift to outcome-based funding. The tendering process involved in creating
structures such as SIBs creates delays in structuring blended ﬁnance transactions.
High transaction costs and long timelines in structuring blended ﬁnance solution: Though the design and
evaluation costs for structures such as DIBs and SIBs are decreasing over the years, these are still high. A blended
ﬁnance solution's design and contracting time is typically higher than traditional grants or pure commercial
investment. However, with structures like portfolio level guarantees or social success notes, the time to execute
transactions is coming down due to the portfolio-level approach, which provides both higher impact and scale. The
blended ﬁnance intermediaries executing these structures in short timelines and with lower transaction costs should
act as a harbinger of blended ﬁnance and collaborate and strategize with other structuring agencies to minimize the
lead time to increase the adoption of blended ﬁnance.
Lack of transparency on blended ﬁnance activity limits its scalability: Concessional capital providers do not
publicly disclose ﬁnancial terms or ex-post development outcomes, limiting the evidence base for blended ﬁnance
as a development tool, while private investors do not disclose data on ﬁnancial performance due to conﬁdentiality
concerns. Together, this hinders blended ﬁnance from scaling.
Reimagining Healthcare in India through Blended Finance
KEY CHALLENGES TO ACHIEVE BLENDED FINANCE AT SCALE
30 Regulatory Constraints in mobilizing grant capital such as CSR funds: The government of India mandated in 2013
that 2% of corporate proﬁts be directed to the development sector, boosting the spending pool for CSR activities by
an estimated $7 billion. While the initiative started slowly, some CSR initiatives, impact investors, and donors are
now actively exploring creative channels to best combine the CSR mandate with the ﬁnancial innovation in the
market. However, legal obstacles and regulatory constraints still exist for the use of CSR in blended ﬁnance
structures, and it requires clear guidance from regulators to make the best use of CSR funds.
The ecosystem for blended ﬁnance is underdeveloped: There is a lack of ﬁnancial intermediation in the blended
ﬁnance market and addressing the SDG investment gap more generally. Donors and investors are looking to channel
large amounts of capital towards market opportunities aligned with the SDGs. Yet the projects are often small, and
few intermediaries in the market are equipped to manage these ﬁnancial flows. Even when blended ﬁnance can
successfully aggregate cross-border investment pools, few intermediaries can channel these flows effectively.
Focused mandate restricts flexibility: Each party involved in a blended ﬁnance transaction has its focused mandate
restricting the flexibility of ﬁnance required for blended ﬁnancing structures. For instance, philanthropic institutions
are guided by developmental impact in line with their speciﬁc mandates determining outcomes, geographies, target
beneﬁciaries, thematic areas. In contrast, commercial institutions engage in blended ﬁnance with commercial
motives, seeking a commercial return according to their regulatory requirements.
Lack of openness from NGOs & CSO for availing commercial capital: Non-Governmental Organizations
(NGOs)/Civil Society Organizations (CSOs) that have higher penetration to the most vulnerable sections of the
society and thereby can help achieve larger impact, are not open to commercial investments. These organizations
mostly focus on raising grants to provide services to end beneﬁciaries without charging them. This restricts their
ability to get on to a common term with the commercial institutions, which require sustainable models. Further,
focusing on the speciﬁc needs of vulnerable populations necessitates more localized support, which limits the scale
of these NGOs/CSOs.
Lack of templatized models: Templatized models have not been created due to the inherent complexity in the laws
while structuring fund flows using different sources of capital. The blended ﬁnance intermediaries need to develop
right partnerships with institutions likes association of impact investors and academic institutions which can help
create such models, assess their impact and cost-effectiveness.
Reimagining Healthcare in India through Blended Finance
31 THE WAY FORWARD There is no one-size-ﬁts-all solution to initiating or scaling blended ﬁnance. Each enterprise’s journey is unique.
Supporting innovative businesses and projects utilizing concessional capital at an early stage, thereby attracting
private capital in the medium-long term ﬁnancing, can be truly transformational and enable success stories of
sustainable business models. Blended ﬁnance can be a positive tool for creating investment opportunities and
promoting tri-sector collaboration between public, private, and philanthropic organizations towards scaling impact
for development. Globally, blended ﬁnance is entering the mainstream, wherein traditional policymakers and
grant-making agencies are adjusting their perspectives and exploring opportunities that can be leveraged to
revolutionize the development ﬁnance sector. Added participation and involvement by the private sector magniﬁes
the blended ﬁnance market, leading to improved scale in investing approaches and solutions. Although an enormous
funding gap still exists towards fulﬁlling the gap in SDG ﬁnancing, there is growing momentum for blended ﬁnance,
and positive signals are being received from the capital markets for greater adoption.
Some of the recommendations and key takeaways to promote the adoption and inclusion of blended ﬁnance
investments include:
Support domestic ﬁnancial ecosystems and market development: Blended ﬁnance should be used strategically to
develop sustainable domestic market systems and build the capacity of local capital market actors by:
Going beyond bespoke structures: To scale blended ﬁnance instruments further, the stakeholders involved need to
go beyond bespoke structures towards larger risk-sharing arrangements and syndicate funding to High-Net-worth
Individuals (HNIs) and family ofﬁces. In addition, creating awareness about this new asset class with a lower
risk-adjusted return and some capital loss protection as a sweetener can allow philanthropic capital recycling while
funding for measurable impact.
Advocacy for enabling regulations to mobilize CSR capital and relaxations in FCRA Act, 2010: To unlock private
capital, enabling regulations like provision to use Corporate Social Responsibility (CSR) funds as risk capital or
outcome funding could potentially scale up the use of blended ﬁnance structures. Further, The Ministry of Home
Affairs ("MHA") has recently tightened FCRA regulations to prevent any misuse of funds. MHA may consider
introducing suitable modiﬁcations to enable blended ﬁnance transactions more generally, subject to additional
spending reporting requirements to ensure it is not misused.
Fastrack creation of marketplaces such as Social Stock Exchange: Creating new marketplaces like the proposed
Social Stock Exchange, which could potentially list impact bonds, social bonds, debt swaps, and not just equity
instruments of social enterprises, could help in narrowing down the funding gap.
supporting local capacity-building to improve the enabling environment
greater mobilization of local investors
strengthening the role of national development banks in deploying blended ﬁnance
creating bigger pools of philanthropic funds and getting the government to allocate more capital for outcome
funding or guarantees that can leverage 5 to 10 times as much risk capital
investor education and knowledge exchange
Reimagining Healthcare in India through Blended Finance
THE WAY FORWARD
33 Design blended ﬁnance solutions to reach the "last-mile": Blended ﬁnance actors should design innovative
structures that target the hardest to reach and most underserved areas by:
Improve impact management and measurement and promote transparency: Lack of transparency of blended
ﬁnance operations severely hinders the further growth and improvement of the blended ﬁnance market. Blended
ﬁnance actors should focus on:
focusing on risk mitigation tools
engaging local stakeholders to identify project opportunities in line with local needs
targeting the "missing middle" enterprises
employing digital ﬁnancial solutions
improving impact management and measurement practices
increasing the transparency of existing investments
promoting collaboration and the sharing of knowledge, best practices and lessons learned.
Bring blended ﬁnance to large scale through systemic and transformational approaches: Supporting
transformation towards more sustainable and resilient economies post-COVID-19 requires blended ﬁnance to move
towards more systemic approaches by:
incorporating blended ﬁnance into coordinated multilateral crisis responses, national recovery, and sustainable
development plans
adopting a portfolio approach (through vehicles, platforms) for scalable solutions
ensuring the accessibility and affordability of products and services developed with the support of blended ﬁnance
investments.
Reimagining Healthcare in India through Blended Finance
34 ADDITIONAL READINGS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.Convergence Blended Finance
https://www.convergence.ﬁnance/blended-ﬁnance
Telemedicine market size in India 2010-2025. Statista Research Department. Retrieved January 7, 2021
https://www.statista.com/statistics/605179/indiatelemedicine-market/
Investment Opportunities in India's Healthcare Sector
https://www.niti.gov.in/sites/default/ﬁles/202103/InvestmentOpportunities_HealthcareSector_0.pdf
Leveraging the private sector to ﬁll the global health funding gap
https://www.devex.com/news/leveraging-the-private-sector-to-ﬁll-the-global-health-funding-gap-94795
Asha Impact's primer on Blended Finance
https://ashaimpact.com/Admin/CMS/PDF/Asha%20Impact_Blended%20Finance%20Primer.pdf
IIC publication on "Re-Imagining Traditional Finance for India's COVID Recovery
https://iiic.in/research-publications/#
USAID publication on "Greater than the Sum of its Parts: Blended Finance Roadmap for Global Health"
https://www.usaid.gov/sites/default/ﬁles/documents/1864/Blended-Finance-Roadmap-508.pdf
OECD DAC - BLENDED FINANCE PRINCIPLE 4 GUIDANCE
https://www.oecd.org/dac/ﬁnancing-sustainable-development/blended-ﬁnance
principles/documents/Principle_4_Guidance_Note_and_Background.pdf
Brookings’s report - The Promise of Impact Investing in India
https://www.brookings.edu/wp-content/uploads/2019/07/the-promise-of-impact-investing-in-india.pdf
OECD Publication - Mobilizing institutional investors for ﬁnancing sustainable development in
developing countries
https://www.oecd.org/dac/ﬁnancing-sustainable-development/Mobilising-institutional-investors-for-ﬁnanci
ng-sustainable-development-ﬁnal.pdf
International Development Finance Club report, Blended Finance: A Brief Overview
https://www.idfc.org/wp-content/uploads/2019/10/blended-ﬁnance-a-brief-overview-october-2019_ﬁnal.pdf
Press Release: Skill India Impact Bond
https://www.investindia.gov.in/siru/indias-ﬁrst-skill-impact-bond-gender-lens#:~:text=The%20announced%20
Skill%20India%20Impact,logistics%2C%20to%20name%20a%20few.
Reimagining Healthcare in India through Blended Finance
35 For more details visit
www.aim.go v.in
www.usaid.gov
www.samridhhealth.org
Disclaimer: This report is made possible by the generous support of the American People thr ough
the United States Agency for International Development (USAID), under the terms of cooperative
Agreement No.AID-386-A-15-00014. The contents are the sole responsibility of IPE Global Limited
and do not necessarily r eflect the views of USAID or the United St ates Government

AIM, NITI IPE white paper on Blended Financing