‭Table of Contents‬

‭What‬‭is‬‭Blended‬‭Finance?‬‭........................................................................‬‭2‬
‭ evolutionizing Menstrual Health and Hygiene through Impact Bond in‬
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‭Delhi‬‭.........................................................................................................‬‭3‬
‭ nsuring Access to Healthcare: Innovative Insurance Programs for daily‬
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‭wage‬‭labours‬‭or‬‭Migrant‬‭workers‬‭using‬‭concessional‬‭finance‬‭.................‬‭6‬
‭Ensuring‬‭Optimal‬‭Nutrition‬‭through‬‭Social‬‭Impact‬‭Bond‬‭for‬‭Children‬‭...‬‭9‬
‭ evolutionizing Eye Care with the Social Impact Guarantee or Cataract‬
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‭Surgery‬‭Bond‬‭..........................................................................................‬‭13‬
‭What is Blended Finance?‬

‭ n innovative approach that combines development finance, philanthropy, and private capital to‬
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‭finance projects with significant social impact, especially in the healthcare sector. By blending‬
‭concessional funds with private investments, this model mitigates investment risks, enhances‬
‭project viability, and fosters sustainable development outcomes. Blended finance holds immense‬
‭potential in fostering more resilient, equitable, and sustainable healthcare systems.‬

‭Critical Attributes of Blended Finance:‬

‭●‬ L
‭ everage:‬‭Use of development finance and philanthropic‬‭funds to attract private capital‬
‭into deals‬

‭●‬ ‭Impact:‬‭Investments that promote social, environmental,‬‭and economic progress.‬

‭●‬ R
‭ eturns:‬‭Private investors can expect financial returns‬‭in line with market expectations,‬
‭based on both real and perceived risks.‬

‭SWOT Analysis of Using Blended Finance in Healthcare‬

‭ he United Nations has highlighted a funding gap of‬‭$3.9 trillion‬‭for achieving the Sustainable‬
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‭Development Goals (SDGs) by 2030. Current public, private, and philanthropic funding levels‬
‭only cover $1.4 trillion, leaving a $2.5 trillion gap. Blended finance is a crucial tool to bridge this‬
‭gap by combining resources from public, private, and philanthropic sectors.‬
‭Revolutionizing Menstrual Health and Hygiene through Impact Bond in Delhi‬

‭❖‬ ‭Gaps:‬‭Each year,‬‭23 million girls‬‭drop out of school‬‭due to a lack of proper menstrual‬
h‭ ygiene management facilities, including the availability of sanitary pads and information‬
‭about menstruation. This affects their confidence and ability to attend school or work in‬
‭appropriate conditions. According to a recent study in Delhi,‬‭40% of girls‬‭missed school‬
‭during menstruation, linked to factors like menstrual product type, privacy issues,‬
‭restrictions, maternal education, and information sources.‬

‭ dditionally, 65% reported menstrual challenges affecting their school activities, causing‬
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‭missed tests and classes due to pain, anxiety, embarrassment, leakage fear, and uniform‬
‭stains. Figures from the National Family Health Survey (NFHS) report published in May,‬
‭about half of all‬‭women aged 15-24‬‭in India still‬‭use cloth for menstrual protection,‬
‭which can lead to multiple infections if reused. This is attributed to a lack of awareness‬
‭and the existence of a taboo surrounding menstruation. Menstrual-related issues among‬
‭adolescent girls in India are a significant concern, affecting physical, mental, social, and‬
‭psychological dimensions. These disorders impact daily lives and require comprehensive‬
‭attention and intervention strategies. Inadequate menstrual hygiene directly or indirectly‬
‭affects the achievement of Sustainable Development Goals (SDGs) 3, 4, 5, and 6, which‬
‭are crucial for the overall development of young adolescents and the nation.‬

‭❖‬ ‭How to Structure the Program:‬‭The program will be‬‭structured as an impact bond. In‬
t‭his model, a social investor provides upfront capital, and another acts as an outcome‬
‭funder. The outcome funder repays the initial investment based on pre-agreed milestones,‬
‭with a percentage of returns on investment.‬

‭ e can work as an intermediary with on-ground implementation partners and directly‬

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‭engage with the communities and target beneficiaries, including community members and‬
‭schoolgirls. As a results-based financing mechanism, we aim to increase projects' focus‬
‭on outcomes rather than activities and inputs or outputs. We also require the‬
‭implementation of a robust evaluation methodology, which has the potential to generate‬
‭rigorously measured outcome-based evidence and contribute to learning about what‬
‭works. Impact bonds allow outcome funders to externalize financial and execution risks‬
‭associated with innovative programs to social investors, thereby only paying for‬
‭successful and efficient initiatives. For social investors, impact bonds generate‬
‭meaningful social impact alongside attractive financial returns and allow them to‬
‭diversify their investment risk by investing in a financial product that is uncorrelated with‬
 t‭raditional asset classes. Impact bonds increase the accountability of service providers by‬
‭introducing rigorous impact evaluation frameworks, creating incentives to enhance‬
‭projects' performance, and providing greater flexibility in delivery.‬

‭ ome important measures to assess menstrual health and hygiene (MHH) programs‬
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‭include the number of women and girls who have better mobility during their‬
‭menstruation, the level of knowledge communities have about menstruation and MHH,‬
‭the percentage of women and girls who have access to their MHH needs, the percentage‬
‭of schools that have MHH-friendly facilities, and the percentage of vouchers that are‬
‭redeemed for reusable sanitary pads. Blended finance for a Menstrual Health and‬
‭Hygiene (MHH) Impact Bond in India can yield numerous social benefits, such as‬
‭improved menstrual health education, access to affordable menstrual products, reduced‬
‭school absenteeism, empowerment of women and girls, healthier communities,‬
‭employment opportunities, inclusive solutions, and long-term behavioral change. These‬
‭initiatives contribute to advancing gender equality, promoting human rights, and‬
‭achieving sustainable development goals related to health, education, and gender‬
‭empowerment.‬

‭❖‬ ‭How can blended finance make a difference:‬‭Blended‬‭finance presents a powerful tool‬
f‭ or advancing Menstrual Health and Hygiene (MHH) initiatives, offering tailored‬
‭solutions and innovative financing modalities. With flexibility in funding structures, such‬
‭as revolving funds or challenge funds, it addresses specific barriers hindering MHH‬
‭projects while ensuring sustainable access to menstrual hygiene products for underserved‬
‭populations. Additionally, by attracting diverse investors and optimizing financial returns,‬
‭blended finance enhances the risk-return profiles of MHH investments, appealing to those‬
‭seeking economic and social returns. Furthermore, it catalyzes market development for‬
‭MHH products and services, stimulating private sector participation and innovation in‬
‭underserved markets. Impact bonds incentivize private sector engagement in developing‬
‭innovative MHH products like biodegradable sanitary pads, promoting sustainability and‬
‭environmental stewardship.‬

‭ oreover, blended finance prioritizes data-driven decision-making, promoting‬

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‭accountability and transparency through rigorous monitoring, evaluation, and impact‬
‭assessment. By analyzing MHH outcomes, stakeholders can optimize resource allocation‬
‭and drive continuous improvement in programming. Lastly, blended finance fosters‬
‭cross-sector collaboration and partnerships, leveraging collective expertise and resources‬
‭to address complex MHH challenges and maximize the impact of investments in‬
‭menstrual health services.‬
‭❖‬ ‭Why not use traditional finance:‬‭The limitations of traditional finance methods‬
c‭ ompound the challenges of Menstrual Health and Hygiene (MHH) programs. Private‬
‭investors often shy away from MHH projects due to the high costs, uncertain returns, and‬
‭lengthy timelines. Moreover, the absence of comprehensive metrics to measure the social‬
‭impact of MHH interventions within private financing means that non-financial benefits‬
‭may be overlooked. This lack of funding accessibility can leave marginalized‬
‭communities underserved, exacerbating disparities in MHH service access. Additionally,‬
‭collaboration among stakeholders is crucial for addressing these challenges effectively.‬
‭However, government funding constraints, bureaucratic processes, political instability,‬
‭and a lack of innovation can hinder the efficiency of traditional finance approaches.‬
‭Furthermore, private investors' focus on profitability may lead to insufficient investment‬
‭in MHH initiatives if societal benefits are not adequately considered. Thus, a‬
‭comprehensive and collaborative approach is necessary to overcome the multifaceted‬
‭obstacles of MHH programs.‬

‭❖‬ ‭Scale up potential:‬‭India's large population, increasing‬‭awareness, government‬

c‭ ommitment, private sector engagement, community participation, technological‬
‭innovation, and partnership opportunities collectively contribute to the significant‬
‭scale-up potential of Menstrual Health and Hygiene (MHH) initiatives in the country.‬
‭With a growing demand for affordable MHH products and facilities, supportive policy‬
‭environments, and community-driven approaches, ample opportunities exist to expand‬
‭MHH interventions across diverse regions and population segments. Leveraging these‬
‭factors and fostering collaboration among stakeholders can accelerate progress towards‬
‭achieving equitable access to menstrual health services and promoting gender equality in‬
‭India.‬

‭❖‬ ‭Social benefits of it:‬‭Improving menstrual health‬‭and hygiene through an Impact Bond‬
h‭ olds transformative social benefits for society. By mitigating health risks associated with‬
‭poor menstrual hygiene practices, the initiative directly contributes to the overall‬
‭well-being of women and girls. This, in turn, translates into fewer missed days at school‬
‭or work, fostering improved educational and economic outcomes for women.‬
‭Empowering women with better menstrual hygiene promotes gender equality and social‬
‭inclusion for a healthier society.‬
‭ nsuring Access to Healthcare: Innovative Insurance Programs for daily‬
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‭wage labours or Migrant workers using concessional finance‬

‭❖‬ ‭Gaps:‬‭The economic impact of healthcare costs in India‬‭is profound, perpetuating a cycle‬
o‭ f poverty and affecting millions. In 2011-12, out-of-pocket health expenses pushed 55‬
‭million Indians below the poverty line, with 38 million individuals were impoverished by‬
‭spending on medicines alone. Private hospitals, accounting for over half of‬
‭hospitalizations, impose a considerable financial burden, with average medical expenses‬
‭per hospitalization seven times higher than those in government hospitals which causes‬
‭catastrophic healthcare costs for‬‭over 17% of households‬‭,‬‭particularly impacting‬
‭marginalized communities. We must make comprehensive reforms to our healthcare‬
‭system.‬

‭How Medical Expenses Are Funded‬

I‭ mproving insurance coverage and policy comprehensiveness is vital to ease financial‬

‭burdens and ensure equitable access to healthcare. Access to health care can be improved‬
 s‭ ignificantly if the system can protect the poor households from significant OOP‬
‭expenses. This particularly affects the marginalized daily wagers whose mean monthly‬
‭income from labor work has fallen to Rs.3,500 from Rs.9,500, representing a ‭6‬ 2%‬
‭decrease.‬‭The most recent report from the National‬‭Crime Records Bureau (NCRB)‬
‭highlights that daily wage workers represent the‬‭largest‬‭proportion of individuals who die‬
‭by suicide in the country.‬

‭ aily wagers in India face numerous healthcare challenges, primarily stemming from‬
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‭their precarious economic circumstances and lack of access to comprehensive healthcare‬
‭services. Some of the typical healthcare problems they encounter include limited access‬
‭to healthcare, vulnerability to illnesses, financial strain from medical expenses, and‬
‭mental health issues. Implementing health insurance programs tailored to the needs of‬
‭daily wagers can address these challenges effectively. By providing comprehensive‬
‭coverage for medical expenses, including hospitalization, outpatient care, and preventive‬
‭services, health insurance can improve access to healthcare, offer financial protection,‬
‭promote preventive care, and enhance mental health support. Overall, implementing‬
‭health insurance programs for daily wagers can promote their health, provide economic‬
‭security, and improve their quality of life.‬

‭❖‬ ‭How to Structure The Program:‬‭To design an insurance‬‭product for daily wage workers‬
i‭n India using blended finance, we would focus on comprehensive coverage,‬
‭affordability, flexible payment options, a simple enrollment process, community‬
‭engagement, risk pooling, partnerships, incentives for healthcare utilization, and‬
‭continuous improvement. By integrating these elements, we can create a sustainable and‬
‭inclusive healthcare financing solution that meets the needs of daily wage workers while‬
‭leveraging blended finance to mobilize capital and maximize social impact.‬
‭We can structure the program by leveraging concessional finance alongside private‬
‭capital. Concessional finance, including grants, subsidized loans, or other forms of‬
‭low-cost capital, can mitigate the risk associated with providing insurance coverage to‬
‭low-income populations. Concessional finance makes the investment more attractive and‬
‭viable by reducing the financial burden on private investors. This approach helps address‬
‭the affordability challenge and encourages private sector participation in financing the‬
‭insurance scheme.‬

‭ urthermore, blending concessional finance with private capital allows for pooling‬
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‭resources from multiple sources, thereby diversifying the funding base and spreading the‬
‭risk. This can ensure the insurance product's sustainability and scalability over the long‬
‭term. Additionally, by involving private investors, we can tap into their expertise in risk‬
‭management, product design, and distribution channels, enhancing the overall‬
‭effectiveness and efficiency of the insurance scheme. Using concessional finance aligns‬
 f‭ inancial incentives, mitigates risks, and leverages the strengths of both public and private‬
‭sector stakeholders to achieve the dual objectives of financial inclusion and social impact.‬

‭❖‬ ‭Why Use Blended Finance:‬‭Blended finance, particularly‬‭through concessional finance‬

t‭ools, presents a compelling approach for funding initiatives like insurance for daily‬
‭wagers. Concessional finance allows for blending grant or low-interest capital with‬
‭private investment, thereby reducing the financial risk associated with such projects. By‬
‭leveraging concessional finance, we can attract private investors who may be hesitant to‬
‭engage in higher-risk ventures, thereby expanding the pool of available capital.‬
‭Additionally, concessional finance offers flexibility in structuring repayment terms,‬
‭making it more accessible to vulnerable populations and ensuring affordability for‬
‭beneficiaries. Furthermore, using concessional finance can incentivize innovation and the‬
‭development of sustainable business models, leading to long-term impact and scalability.‬
‭Overall, leveraging concessional finance within a blended finance framework effectively‬
‭addresses the financial challenges of initiatives like insurance for daily wagers, ultimately‬
‭improving access to essential services for underserved communities.‬

‭❖‬ ‭Why not use traditional Finance:‬‭Relying solely on‬‭traditional finance or government‬
g‭ rants for this initiative might present challenges. Traditional finance channels often‬
‭entail strict collateral prerequisites and high interest rates, potentially excluding‬
‭low-income individuals and daily wage workers, who form the primary beneficiaries.‬
‭Similarly, depending solely on government grants may not offer a sustainable, enduring‬
‭solution, given potential budget limitations and competing funding priorities. An‬
‭integrated strategy incorporating diverse financing mechanisms, including blended‬
‭finance, could more effectively cater to the financial requirements of vulnerable‬
‭populations, ensuring the initiative's long-term viability and scalability.‬

‭❖‬ ‭Scale-up Potential:‬‭The scale-up potential of initiatives‬‭like insurance for daily wagers,‬
f‭ inanced through blended finance, is significant. By successfully implementing and‬
‭demonstrating the effectiveness of such initiatives, we can attract additional investment‬
‭from various stakeholders, including governments, philanthropic organizations, and‬
‭impact investors. As the initiative proves its viability and impact, it can serve as a model‬
‭for replication in other regions or sectors facing similar challenges. Moreover, scaling up‬
‭can be facilitated through partnerships with local governments, community organizations,‬
‭and private sector entities, leveraging their resources, expertise, and networks to reach a‬
‭larger audience. Additionally, advancements in technology and data analytics can‬
‭enhance the efficiency and reach of the initiative, allowing for broader coverage and‬
‭more tailored services. Overall, the scale-up potential is considerable, driven by the‬
 d‭ emonstrated success of the initiative, strategic partnerships, and innovations in‬
‭implementation.‬

‭❖‬ ‭Social Benefits of the Program:‬‭The potential for‬‭initiatives like insurance for daily‬
‭ age earners, financed through blended finance, to grow is significant. By successfully‬
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‭implementing and demonstrating the effectiveness of such initiatives, we can attract‬
‭additional investment from various stakeholders, including governments, philanthropic‬
‭organizations, and impact investors. If the initiative proves its viability and impact, it can‬
‭serve as a model for replication in other regions or sectors facing similar challenges.‬
‭Furthermore, scaling up can be facilitated through partnerships with local governments,‬
‭community organizations, and private sector entities, leveraging their resources,‬
‭expertise, and networks to reach a larger audience. In addition, advancements in‬
‭technology and data analytics can improve the efficiency and reach of the initiative,‬
‭allowing for broader coverage and more tailored services. Overall, the growth potential is‬
‭considerable, driven by the demonstrated success of the initiative, strategic partnerships,‬
‭and innovations in implementation.‬

‭Ensuring Optimal Nutrition through Social Impact Bond for Children‬

‭❖‬ ‭Gaps:‬‭Over‬‭33 lakh children‬‭in India suffer from malnutrition,‬‭with more than half‬
f‭ alling into the severely malnourished category. Since 2015, there has been no significant‬
‭improvement in the percentage of children under five‬‭who are stunted‬‭(Short for Age) as‬
‭defined by the World Health Organization standards. Despite numerous programs and‬
‭initiatives, India's efforts to reduce child malnutrition have not yielded the desired results‬
‭over the past five years.‬

‭ rgent attention is needed to address the challenges of weak implementation of‬

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‭government schemes, insufficient investment in health and other critical sectors, as well‬
‭as issues related to unsafe water, and inadequate sanitation and hygiene. Despite decades‬
‭of investment aimed at addressing this issue, India's‬‭child malnutrition rates‬‭remain‬
‭among the most alarming globally. India ranks 94th out of 107 countries according to‬
‭global hunger index.‬
‭ hild and maternal malnutrition stand as a significant challenge, contributing to 15% of‬
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‭India's overall disease burden. Research indicates that investing $1 (equivalent to Rs‬
‭75.08) in nutritional interventions in India could yield public economic returns ranging‬
‭from $3‬‭4.1 to $38.6, surpassing the global average‬‭by threefold‬‭. Studies indicate that‬
‭India faces substantial economic losses due to child malnutrition, amounting to up to 4%‬
‭of its gross domestic product (GDP) and up to 8% of its productivity.‬

‭ espite improvements in child safety in India, malnutrition remains a significant‬

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‭contributor to child mortality,‬‭accounting for 68%‬‭of such deaths. Addressing both‬
‭undernutrition and overnutrition can play a crucial role in reducing this alarming statistic.‬

I‭ t's also concerning that 52% of pregnant women and 67% of children under five are‬
‭anaemic, according to NFHS-5 data. Addressing malnutrition comprehensively is‬
‭essential to ensure the health and well-being of both current and future generations.‬
‭Research indicates that as much as‬‭half of global‬‭cases of undernutriti‬‭on can be linked to‬
‭inadequate WASH facilities and poor environmental conditions (WHO, 2008).‬‭In the‬
‭Union budget for 2021-22, while total allocations saw a 14.5% increase, there was a‬
‭concerning‬‭18.5% decrease‬‭in the allocation towards‬‭child nutrition compared to the‬
‭previous fiscal year (2020-21).‬
‭❖‬ ‭How to Structure the Program:‬‭A Social Impact Bond (SIB) program for child‬
n‭ utrition in India requires financial structure that aligns the interests of investors, service‬
‭providers, and the government while ensuring measurable impact. This structure would‬
‭involve defining specific outcome metrics related to child nutrition, such as reductions in‬
‭child stunting rates or improvements in dietary diversity. These metrics serve as the basis‬
‭for determining investor returns, with payments made by the government or another‬
‭outcome payer contingent upon achieving predefined targets.‬

‭ e must assess the total upfront capital costs and ongoing operational expenses to ensure‬
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‭sufficient funds for the program. We will structure the investor financing to cover these‬
‭costs, with returns tied to success in achieving outcome targets. We will establish a clear‬
‭payment schedule to manage risks and give investors’ confidence in the program's‬
‭progress. To ensure proper financial management and governance, an Impact Investment‬
‭Fund or a Special Purpose Vehicle (SPV) would be established to act as an intermediary‬
‭entity. This body would be responsible for receiving investor funds, disbursing payments‬
‭to service providers, and overseeing the overall financial flow of the SIB program.‬
‭Moreover, securing a commitment from the government or another outcome payer to‬
‭fund the program based on the achieved outcomes is crucial.‬

‭ inancial guarantees or insurance mechanisms may be explored to mitigate risks to‬

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‭encourage investors to participate in the program and provide them with additional‬
‭confidence. It is crucial to offer investors competitive interest rates or rates of return‬
‭while ensuring the program's financial sustainability. The program should have an exit‬
‭strategy for investors and mechanisms to continue successful interventions beyond the‬
‭SIB period. This will provide the sustained impact and long-term benefits of children's‬
‭nutrition in India. By designing a robust financial structure in this manner, the SIB‬
‭program can effectively mobilize private capital, align incentives, and deliver tangible‬
‭improvements in child nutrition outcomes.‬

‭❖‬ ‭How can blended finance make a difference:‬‭Blended‬‭finance would benefit a child‬
n‭ utrition initiative because it allows for mobilizing private sector capital alongside public‬
‭and philanthropic funds. This increases the overall pool of resources available, enabling a‬
‭greater scale and impact. Additionally, blended finance encourages innovation, efficiency,‬
‭and risk-sharing among stakeholders. Private sector involvement brings expertise and‬
‭management capabilities, improving the delivery of nutrition interventions. Moreover,‬
‭blended finance models are scalable and sustainable, fostering long-term impact and‬
‭incentivizing the development of innovative solutions to address child malnutrition.‬
‭❖‬ ‭Why not use traditional finance:‬‭For several reasons, using traditional finance alone for‬
a‭ child nutrition program may not suffice. Traditional finance sources like government‬
‭grants or loans may have limited availability or may need to be more sufficient to meet‬
‭the scale of the program's needs. Additionally, relying solely on public funding may‬
‭strain government budgets and limit the flexibility to address other pressing social issues.‬
‭Moreover, traditional finance often needs more bureaucratic processes and longer‬
‭approval timelines, delaying program implementation.‬
‭Furthermore, traditional finance may need more innovative and flexible structures to‬
‭attract private sector participation and optimize resource allocation. By incorporating‬
‭blended finance, the program can leverage private sector capital, expertise, and‬
‭efficiency, supplementing traditional finance to achieve a more significant impact.‬
‭Blended finance offers a more diversified funding approach, reducing reliance on any‬
‭single funding source and enhancing the program's financial sustainability and resilience‬‭.‬

‭❖‬ ‭How to scale up the initiative:‬‭To scale up the child‬‭nutrition program nationwide, we'll‬
c‭ ollaborate closely with governments at all levels, integrating our efforts with existing‬
‭nutrition policies and programs. Local communities will play a pivotal role, actively‬
‭participating in program planning and implementation to ensure relevance and‬
‭effectiveness. Public-private partnerships will be fostered to harness private sector‬
‭resources and expertise, driving innovation and sustainability. Capacity-building‬
‭initiatives will empower healthcare workers and volunteers, ensuring high-quality service‬
‭delivery nationwide. Behavior change communication campaigns will promote healthy‬
‭nutrition practices, utilizing diverse channels to reach communities effectively.‬
‭A robust monitoring and evaluation framework will track progress and inform continuous‬
‭improvement. Advocacy efforts will focus on shaping supportive policies and‬
‭regulations, while successful interventions will be replicated and adapted to suit local‬
‭contexts nationwide. Through these concerted efforts, we'll extend the reach and impact‬
‭of the child nutrition program, improving the health and well-being of children‬
‭throughout India.‬

‭❖‬ ‭Social Benefits of the Program:‬‭The child nutrition‬‭program offers numerous social‬
b‭ enefits. It improves overall health outcomes, reducing the prevalence of diseases and‬
‭enhancing children's physical and cognitive development. By addressing malnutrition, the‬
‭program helps prevent premature deaths and improves children's chances of survival,‬
‭thereby reducing mortality rates. Proper nutrition positively impacts children's cognitive‬
‭abilities and school performance, empowering them with the skills needed for success.‬
‭Additionally, by breaking the cycle of poverty, the program contributes to‬
 s‭ ocio-economic advancement. Investing in child nutrition fosters community‬
‭development, social cohesion, and resilience.‬
‭Moreover, it reduces healthcare costs by preventing malnutrition-related illnesses.‬
‭Long-term benefits include higher productivity, increased earning potential, and‬
‭economic growth. Overall, the child nutrition program generates significant social‬
‭benefits, improving the well-being of children and communities alike.‬

‭ evolutionizing Eye Care with the Social Impact Guarantee or Cataract‬

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‭Surgery Bond‬

‭❖‬ ‭Gaps:‬ ‭In India, the prevalence of blindness and vision‬‭impairments is staggering, with‬
a‭ pproximately‬‭4.95 million‬‭individuals classified‬‭as blind and an additional 70 million‬
‭coping with varying degrees of visual impairment. Among this population, a notable‬
‭proportion includes 0.24 million blind children, highlighting the significant impact on the‬
‭younger generation. The economic ramifications of such widespread visual impairments‬
‭are substantial, with an estimated loss of productivity amounting to a staggering‬‭INR 646‬
‭billion‬‭(Int$ 29.4 billion). This economic toll primarily‬‭arises from the reduction in‬
‭productivity associated with avoidable blindness.‬

‭ he root causes of this economic burden are multifaceted. Avoidable blindness decreases‬
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‭the likelihood of individuals entering the‬‭workforce‬‭by 30%‬‭and diminishes the‬
‭productivity of those who remain employed by 20%. These statistics underscore the‬
‭critical link between visual health and economic prosperity, emphasizing the need for‬
‭comprehensive interventions to address the underlying factors contributing to vision loss.‬

‭ midst these challenges lies a glimmer of hope. Studies have shown that cataract surgery‬
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‭can yield significant economic and social benefits. For instance, a survey conducted by‬
‭the‬‭Aravind Eye Care System‬‭found that 85% of men‬‭and 58% of women who had lost‬
‭their jobs due to blindness regained employment following cataract surgery. The‬
‭economic impact of this intervention cannot be overstated, with each individual who‬
‭regained functional vision through cataract surgery generating economic productivity‬
‭equivalent to 1,500% of the surgery cost during the first year post-surgery.‬
 ‭ pproximately 771 million people worldwide suffer from avoidable vision loss,‬
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‭accounting for up to 90% of all cases. Shockingly, a PricewaterhouseCoopers report‬
‭revealed that an annual investment of just‬‭USD 2.20‬‭per person‬‭between 2011 and 2020‬
‭in low- and middle-income countries could have completely eradicated this preventable‬
‭blindness.‬

‭ oor vision challenges individuals, especially those from low-income backgrounds,‬

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‭affecting their education and social lives. Limited access to vision care services‬
‭exacerbates academic struggles, hindering students' ability to learn and participate fully‬
‭in classroom activities. By investing in comprehensive vision care services and‬
‭promoting initiatives that improve access to treatment, nations can unlock significant‬
‭economic potential while simultaneously enhancing the well-being and quality of life for‬
‭millions of individuals worldwide.‬

‭❖‬ ‭How to Structure the Program:‬‭To structure the Social‬‭Impact Guarantee for providing‬
e‭ yeglasses to poor people in India, Investors will provide funding upfront to cover the‬
‭cost of procuring eyeglasses, conducting vision screenings, and operational expenses.‬

‭ he implementing partner will use the funds to purchase eyeglasses, organize vision‬
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‭screening camps, and cover logistics costs. As beneficiaries receive eyeglasses, the‬
‭implementing partner tracks the program's impact, including improvements in vision and‬
‭any challenges faced. A portion of the funds is held in reserve to guarantee the program's‬
‭social impact. If predefined impact metrics are not met, the implementing partner may be‬
‭required to repay a portion of the investment to investors. If the impact metrics are‬
‭achieved, the funds are disbursed to the implementing partner, who can use them to‬
‭expand the program or sustain its operations. Regular monitoring and evaluation are‬
‭conducted throughout the process to assess the program's effectiveness and make any‬
‭necessary adjustments.‬

‭ y structuring the initiative this way, we ensure that investors have a mechanism to‬
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‭ensure their capital generates social impact. At the same time, beneficiaries receive‬
‭much-needed eyeglasses to improve their quality of life.‬

‭●‬ C
‭ ataract Surgery Bond:‬‭In India, a total of‬‭83.4 lakh‬‭successful cataract surgeries were‬
‭performed last year. However, a significant number of economically disadvantaged‬
‭individuals have been unable to undergo this procedure due to various challenges,‬
‭including financial constraints, lack of health insurance, limited awareness and‬
‭accessibility, shortage of healthcare providers, cultural and social stigma, infrastructure‬
‭and equipment limitations, and long waiting lists. The average cost of cataract surgery in‬
 I‭ ndia is‬‭15000 INR‬‭. To address this issue, a cataract bond can provide financial assistance‬
‭for the surgery.‬

‭ he proposed strategy for financing cataract surgeries in India involves the establishment‬
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‭of a particular purpose vehicle (SPV) called the "Indian Cataract Bond Initiative (ICBI)"‬
‭to issue a cataract bond. The funding for this bond will be raised through various sources,‬
‭including concessional finance, philanthropic contributions, and private capital. The bond‬
‭terms, including the principal amount, maturity date, interest rate, and repayment‬
‭structure, will be determined after carefully considering the various options available.‬
‭The proceeds from the bond will be allocated towards financing cataract surgeries for‬
‭low-income individuals, with accredited healthcare providers receiving the funds to cover‬
‭surgical procedures, medical supplies, and post-operative care.‬

‭ his initiative will also allocate a certain percentage of the proceeds towards training‬
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‭programs for ophthalmic surgeons and healthcare staff to enhance surgical capacity and‬
‭quality. Additionally, risk-sharing mechanisms will be implemented to mitigate any‬
‭potential risks associated with the bond. Regular audits and impact assessments will be‬
‭conducted to ensure compliance with bond covenants and alignment with project‬
‭objectives. By adopting this financial structure, the cataract bond initiative aims to‬
‭mobilize private capital, strengthen healthcare infrastructure, and improve access to‬
‭quality eye care services for underserved populations in India. This will contribute to the‬
‭government's efforts to achieve universal health coverage and reduce the burden of‬
‭preventable blindness.‬

‭❖‬ ‭How can blended finance make a difference:‬‭Blended‬‭finance is the optimal choice for‬
t‭his initiative because it combines various sources of funding to address the challenges of‬
‭providing eyeglasses to the impoverished in India. It effectively mitigates financial risk,‬
‭increases access to capital, and aligns the interests of investors with social objectives.‬
‭This approach encourages innovation, scalability, and sustainability while ensuring‬
‭accountability and transparency through robust monitoring and evaluation mechanisms.‬
‭Blended finance offers a flexible and dynamic solution to complex social issues,‬
‭maximizing impact and creating sustainable change.‬

‭❖‬ ‭Why not use traditional finance:‬‭Traditional finance‬‭and government grants may not‬
a‭ lign well with initiatives' complex financial needs and operational requirements to‬
‭provide vision care to underserved populations. Traditional financing mechanisms often‬
‭involve fixed interest rates, collateral conditions, and rigid repayment terms, which may‬
 n‭ ot be suitable for projects with uncertain or long-term outcomes, such as those focused‬
‭on improving eye health in disadvantaged communities. Similarly, while providing‬
‭essential funding, government grants can be subject to bureaucratic processes and may‬
‭need more flexibility to adapt to changing circumstances or scale up interventions‬
‭rapidly. Moreover, reliance solely on government funding may limit the ability to‬
‭leverage private sector expertise, technology, and resources that could enhance the‬
‭efficiency and effectiveness of vision care programs. Blended finance, however, allows‬
‭for the strategic combination of public and private capital, enabling innovative financial‬
‭structures tailored to the unique needs of vision care initiatives. By leveraging private‬
‭sector investment alongside government funding, blended finance mechanisms can‬
‭unlock additional resources, reduce financial risk, and incentivize private sector‬
‭participation in addressing vision disparities. This approach fosters collaboration between‬
‭diverse stakeholders, promotes sustainable financing models, and maximizes the impact‬
‭of vision care interventions, ultimately improving eye health outcomes for marginalized‬
‭populations.‬

‭❖‬ ‭How to scale up the initiative:‬‭Adopting a comprehensive‬‭approach is crucial to expand‬

i‭nitiatives aimed at providing vision care to underserved populations. This involves‬
‭building strong partnerships with government agencies, NGOs, and private sector‬
‭organizations to broaden the reach of eye care services, particularly in remote areas.‬
‭Leveraging innovative technologies such as telemedicine and portable diagnostic devices‬
‭can extend eye care delivery to marginalized communities. Additionally, investing in‬
‭training programs for healthcare professionals and community workers can enhance the‬
‭capacity to provide eye care services effectively. Establishing sustainable financing‬
‭models, such as fee-for-service arrangements and collaborations with health insurance‬
‭providers, ensures the continued availability of vision care services. Public awareness‬
‭campaigns and educational initiatives are vital in promoting eye health awareness and‬
‭reducing the stigma surrounding vision problems. Moreover, advocating for policy‬
‭reforms and regulatory changes can help prioritize vision care and strengthen healthcare‬
‭infrastructure to support scaling efforts.‬

‭❖‬ ‭Social Benefit of the Program:‬‭Implementing‬‭a program to address avoidable blindness‬

‭ ould yield numerous social benefits. Restoring vision enhances individuals' ability to‬
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‭engage in daily activities, improving their overall quality of life and well-being. Children‬
‭with restored image can participate fully in school, leading to better academic‬
p‭ erformance and increased opportunities for future success. Access to vision care‬
‭services empowers marginalized communities, including women and individuals with‬
‭disabilities, by providing them with equal opportunities for participation in society.‬
‭Restored vision enables individuals to engage in productive work, reducing reliance on‬
‭social welfare programs and lifting families out of poverty. Healthy vision fosters social‬
‭inclusion and cohesion within communities, promoting empathy and understanding‬
‭among individuals of diverse backgrounds. Addressing vision loss reduces the‬
‭psychological burden on individuals and families, improving mental health outcomes.‬
‭Restored vision enables individuals to contribute fully to the economy, leading to‬
‭increased productivity and economic growth at the community and national levels. By‬
‭preventing avoidable blindness, the program ensures the long-term sustainability of‬
‭healthcare systems and reduces the burden on healthcare resources. Overall, addressing‬
‭avoidable blindness would improve individual health outcomes and contribute to the‬
‭social and economic development of communities and nations.‬