R-2024-111E

1. Executive Summary

This Review analyzes case studies of successful health-focused impact investments to inform the future direction of the Impact Investment Initiative for Global Health (Triple I for GH). Through examination of Medical Credit Fund, Adjuvant Capital, and Cross Border Impact Ventures (and its collaborator, Grand Challenges Canada), it identifies key success factors: transparent impact measurement, government-financial institution collaboration, and formal evaluation frameworks. The paper concludes with recommendations for Triple I's future activities, including clarifying its unique value proposition, sharing impact measurement methodologies, and facilitating connections between healthcare companies and impact investors.

2. Introduction

At the 2023 G7 Hiroshima Summit, the “Impact Investment Initiative for Global Health” (Triple I for GH) was endorsed to raise awareness and share best practices in impact investing for global health. The initiative was officially launched during the High-Level Meetings of the United Nations General Assembly in September 2023[1]. As of November 2024, the Japanese government serves as the secretariat, with 96 organizations participating as partners.

The primary goal of Triple I for GH is to improve access to healthcare for people in low- and middle-income countries (LMICs), address global health challenges, and contribute to a more sustainable world. Simultaneously, it aims to demonstrate how these efforts can enhance corporate value on a global scale. The Japanese government played a key role in launching this initiative by raising awareness of impact investing, fostering dialogue among stakeholders, collecting success stories, and developing evaluation methodologies.

Triple I for GH focuses on three core objectives:

1. Raising awareness of impact investment in global health by presenting best practices;
2. Promoting transparency in impact investment through expertise in measurement, verification, and disclosure; and
3. Expanding investment opportunities by facilitating networking, knowledge exchange, and thematic investment identification.

The initiative’s target areas are diverse, including infectious and non-communicable diseases, digital health technologies, health insurance and logistics, and strengthening foundational healthcare systems.

3. Purpose of this Review

This Review highlights case studies at the intersection of global health and impact investing. Building on the goals and framework of Triple I for GH, it analyzes collected case studies in detail and proposes insights on how they can be utilized to enhance Triple I's activities.

Specifically, this Review focuses on:

• How success stories balance sustainable health improvements with the creation of economic value;
• The practical application of Impact Measurement and Management (IMM) methodologies to visualize investment outcomes; and
• How governments and development finance institutions promote investments and strengthen health ecosystems.

Through this Review, we aim to reaffirm the importance of Triple I for GH and outline the future of impact investing in global health. By doing so, we strive to broaden investment opportunities that will contribute to sustainable solutions for global health challenges.

4. Impact Measurement and Management (IMM)

The Global Impact Investing Network's IRIS+ system provides the industry standard framework for Impact Measurement and Management (IMM)[2]. IMM is a four-step iterative process to optimize investment impact[3]:

1. Goal Setting
2. Strategy Development
3. Metrics Selection and target setting
4. Measure, track, use the data, and report

This standardized approach enables investors to systematically measure and enhance their impact while maintaining financial performance.

5. Global Impact Investment Case Studies

Case studies of successful impact investments demonstrate the powerful potential to achieve measurable health outcomes while generating sustainable financial returns. In addition to case studies collected by Triple I, this Review provides additional real-world examples from the perspective of investors, to deliver compelling evidence that strategic investments in global health can simultaneously deliver social impact and maintain financial viability, setting important precedents for future investment frameworks.

a. Stichting Medical Credit Fund - Healthcare impact investor in Europe

Founded in 2009, Medical Credit fund is a non-profit foundation established by PharmAccess Group under Dutch law, dedicated to increasing access to financing for small and medium-sized African companies in the health sector (health SMEs) to improve healthcare access for low-income patients in sub-Saharan Africa[4]. MCF gained significant momentum in 2010 after winning the G20 SME Finance Challenge, securing a $1 million United States Agency for International Development grant for first-loss funding. This led to a substantial $10.6 million in debt financing from impact investors in 2012 to support African healthcare development. Through loans to healthcare entrepreneurs, quality standards, and health insurance facilitation, MCF has provided nearly 10,000 loans worth over €180 million to more than 2,000 healthcare providers. In 2017, British International Investment invested $10 million USD[5].

MCF seeks to achieve impact in three dimensions[6]:

1. Financial: Demonstrating that the private health sector is bankable and can provide a reasonable return to investors. As trust in the sector increases, local markets begin financing health SMEs, and financing becomes more affordable;
2. Developmental: A stronger and more efficient healthcare value chain will deliver better services to patients; and
3. Social: Better healthcare services will be available to more people, including those in urban slums and rural areas who are currently underserved. 

In 2022, MCF demonstrated substantial impact across multiple dimensions. Financially, they disbursed 6,505 loans totaling $138.5M USD, with a strong 96% repayment rate and over half being digital loans. Their developmental impact reached 1,878 health SMEs, including 1,086 female entrepreneurs, while partnering with 17 financial institutions in six countries. Socially, supported facilities served 5 million patients annually—55% from low-income communities—with 85% of health SMEs showing quality improvements.

MCF stands out for its proactive reporting of achievements through annual reports and other publications. They ensure their goal setting and strategy development are aligned to achieve impact and financial returns. Additionally, in this organization’s case, the efforts of the financial institutions behind it also seem to play a crucial role^[7].

b. Adjuvant Capital

Adjuvant Capital[8] (AC) focuses on the public health of low- and middle-income countries while pursuing

• Neglected, high-burden, and emerging infectious diseases, including antimicrobial resistance and pandemic threats
• Maternal, newborn, and child health challenges
• Reproductive and sexual health
• Nutrition

By annually declaring their alignment with the Operating Principles for Impact Management (the Impact Principles)^[9], AC publicly demonstrates its commitment to integrating impact throughout the investment lifecycle and promotes the importance of transparency, discipline and credibility for impact management practice in the capital market. Furthermore, it engages the services of BlueMark[10], a third-party provider of independent impact verification services to report on the alignment of AC’s impact management system with the Impact Principles[11].

BlueMark provides independent verification and intelligence for sustainable and impact investing by evaluating organizations against industry standards. Its services include analyzing, benchmarking, and verifying impact measurement and management systems for investors and companies. It aims to advance best practices and ensure the impact investing industry scales with integrity.

AC is proactive in its IMM by ensuring its impact goals and strategies are aligned to ensure meaningful improvements in public health in LMICs while ensuring first-rate financial returns. It ensures its impact is measured through engaging independent impact verification services and commits itself to standardized principles for impact management.

c. Cross Border Impact Ventures

Cross-Border Impact Ventures (CBIV) is a women-led investment firm focused on advancing the health of women, children, and adolescents, addressing gender health inequalities[12]. It invests in companies commercializing medical devices, diagnostics, therapeutics, and digital health innovations targeting global markets, with a particular emphasis on LMICs and growth strategies in North America and Europe. The firm’s portfolio spans the four key sectors of sexual and reproductive health, maternal and child health, general health (including chronic diseases), and health software infrastructure.

CBIV collaborates with Grand Challenges Canada (GCC), a women-led non-profit supported by the Government of Canada and other partners, to fund innovators in LMICs, conflict-affected regions, and Indigenous communities in Canada. GCC focuses on advancing global health with particular emphasis on maternal and child health, early childhood development, mental health, safe abortion, sexual and reproductive health, sanitation, and gender equality[13]. According to its 2022-2023 annual report, GCC achieved a 227% leverage rate[14] with supported innovations demonstrating sustained growth and impact beyond the initial funding period[15].

Furthermore, in 2021, CBIV announced the launch of its Women's and Children's Health Technology Fund, which invests in transformative health technology companies with the potential of meeting the needs of women, children and adolescents throughout global markets[16].

Cross-Border develop investment strategies that complement their impact goals to achieve tangible improvements for the health of women, children and adolescents while ensuring financial returns on their investments.

d. Summary of Case Studies

A comparison of these case studies shows that each venture capital or fund operates with the backing of financial institutions, government agencies, and organizations like the Gates Foundation, which actively promote impact investing. Importantly, each case demonstrates its commitment to serving underserved populations. Furthermore, all organizations declare their impact investment policies, conduct impact measurement, and publish results in reports. Some, such as Adjuvant Capital, also receive certification for their policies from external organizations like BlueMark.

5. Proposals for Triple I

Based on the examples presented, this Review proposes the following regarding Triple I's activities:

(1) Clarifying Triple I’s Position

As demonstrated in the presented examples, many countries and organizations have already begun initiatives related to global health from the perspective of impact investing, focusing on investment and evaluation. These organizations often disclose their investment policies and the impacts achieved by their investments. In this context, it is essential to consider the unique value of Triple I's efforts. One potential value lies in making organizational initiatives public, thereby promoting information exchange among organizations and fostering an environment for mutual improvement.

(2) Collection and Disclosure of IMM Methods

Organizations engaged in impact investing evaluate impact and manage investments using unique methodologies tailored to their objectives. While many of these organizations publish reports, the methodologies behind their impact evaluations are not always fully disclosed. This Review suggests that Triple I could contribute by collecting and sharing case studies and IMM methodologies that serve as references for organizations new to impact investing. However, considering the diversity in global health—such as differences in target diseases and products/services—it may be difficult to evaluate everything using a single indicator. Therefore, the focus should remain on presenting a variety of IMM case studies rather than pursuing uniformity.

(3) Providing Opportunities to Receive Impact Investments in Global Health

While it is possible to learn about initiatives related to global health, companies working on global health often have limited opportunities to actually receive investments from these impact investors. There should be efforts to create opportunities that make it easier for companies engaged in global health to access these investments. For example, a website could be developed to list organizations investing in specific global health themes, allowing companies seeking investments to approach these organizations directly.

6. Conclusion

There is no doubt about the importance of promoting global health and the role of impact investment in achieving this goal. Triple I, led by the Japanese government, represents a significant initiative to accelerate this movement.

In this Review, we have collected successful examples of impact investments in global health, aligned with the objectives of Triple I, and derived insights from these cases. These efforts highlight the critical importance of close collaboration between governments, financial institutions, and foundations worldwide. They also underscore the necessity of transparent evaluation and effective management of impact investments as key elements of success.

It is our hope that the insights presented here will serve as a valuable resource for Triple I’s ongoing activities.

[1] Triple-I for Global Health, "About," accessed March 13, 2025, https://tripleiforgh.org/about.html.
[2] Global Impact Investing Network, "IRIS: Impact Reporting & Investment Standards," accessed December 24, 2024, https://s3.amazonaws.com/giin-web-assets/iris/assets/files/IRIS_2-Pager.pdf.
[3] Global Impact Investing Network, "Introduction to IRIS+," IRIS+, accessed December 24, 2024, https://iris.thegiin.org/introduction/.
[4] Medical Credit Fund, accessed December 24, 2024, https://www.medicalcreditfund.org/.
[5] British International Investment, "Stichting Medical Credit Fund," accessed December 24, 2024, https://www.bii.co.uk/en/our-impact/direct-header/stichting-medical-credit-fund/.
[6] Medical Credit Fund, "MCF I Annual Report 2022," July 2023, https://www.medicalcreditfund.org/wp-content/uploads/sites/4/2023/07/MCF-I-Annual-Report-2022.pdf.
^[7] ibid.
[8] Adjuvant Capital, accessed December 24, 2024, https://adjuvantcapital.com/.
^[9] The Operating Principles for Impact Management, accessed December 24, 2024 https://www.impactprinciples.org/.
[10] BlueMark, December 24, 2024, https://bluemark.co/.
[11] ‘Adjuvant Capital, "Impact Measurement," accessed December 24, 2024, https://adjuvantcapital.com/impact-measurement/.
[12] Cross-Border Impact Ventures, accessed December 24 2024, https://www.crossborder.ventures/portfolio/.
[13] These seven areas have been identified by GCC as having the greatest potential for impact using innovation.
[14] For every $1 that GCC has deployed from Global Affairs Canada, GCC has leveraged $2.27 from other partners.
[15]  Grand Challenges Canada, "Annual Report 2022-23," January 2024, https://www.grandchallenges.ca/wp-content/uploads/2024/01/GCC-Annual-report-2022-23-FINAL.pdf.
[16] CrossBorder, "Toronto Venture Firm Backing Women's and Children's Health Technologies Taps J&J, Gates-Backed Group in Quest to Raise US$100-Million Fund," accessed March 13, 2025, https://www.crossborder.ventures/toronto-venture-firm-backing-women-and-childrens-health-technologies-taps-jj-gates-backed-group-in-quest-to-raise-us100-million-fund-2/.

References:

Adjuvant Capital. "Impact Measurement." Accessed December 24, 2024. https://adjuvantcapital.com/impact-measurement/.
BlueMark. Accessed March 13, 2025. https://bluemark.co/.
British International Investment. "Stichting Medical Credit Fund." Accessed March 13, 2025. https://www.bii.co.uk/en/our-impact/direct-header/stichting-medical-credit-fund/.
CrossBorder. "Toronto Venture Firm Backing Women's and Children's Health Technologies Taps J&J, Gates-Backed Group in Quest to Raise US$100-Million Fund." Accessed March 13, 2025.
https://www.crossborder.ventures/toronto-venture-firm-backing-women-and-childrens-health-technologies-taps-jj-gates-backed-group-in-quest-to-raise-us100-million-fund-2/.
CrossBorder. "Portfolio." Accessed March 13, 2025. https://www.crossborder.ventures/portfolio/.
Global Impact Investing Network. "Introduction to IRIS+." IRIS+. Accessed December 24, 2024. https://iris.thegiin.org/introduction/.
Global Impact Investing Network. "IRIS: Impact Reporting & Investment Standards." Accessed March 24, 2024. https://s3.amazonaws.com/giin-web-assets/iris/assets/files/IRIS_2-Pager.pdf.
Grand Challenges Canada. "Annual Report 2022-23." January 2024. https://www.grandchallenges.ca/wp-content/uploads/2024/01/GCC-Annual-report-2022-23-FINAL.pdf.
Medical Credit Fund. "MCF I Annual Report 2022." July 2023. https://www.medicalcreditfund.org/wp-content/uploads/sites/4/2023/07/MCF-I-Annual-Report-2022.pdf.
Medical Credit Fund. Accessed December 24, 2024. https://www.medicalcreditfund.org/.
Triple-I for Global Health. "About." Accessed December 24, 2024. https://tripleiforgh.org/about.html.