Wednesday, 26 May 2021

It’s a big day for diplomacy as Cairo rolls out the welcome mat for Blinken + IMF gives Egypt high marks, unlocking USD 1.6 bn in funding

TL;DR

WHAT WE’RE TRACKING TODAY

Good morning, friends. We’re almost at the weekend, and diplomacy dominates the press, the airwaves, and our issue today. We have the updates on Palestine, GERD, and Qatar, but first:

THE BIG STORY HERE AT HOME- Egypt looks set to unlock the USD 1.6 bn third and final tranche of its USD 5.2 bn IMF standby loan after reaching a staff-level agreement with the fund. We have chapter and verse in this morning’s news well, below.

US Secretary of State Antony Blinken is due in town today, according to state-run news agency MENA. Blinken is set to meet with Foreign Minister Sameh Shoukry, MENA confirms, but we expect a sit-down with President Abdel Fattah El Sisi will also be on his agenda. Blinken was most recently in Jerusalem and Ramallah (we have more on his visit in Around the World, below) and will head to Jordan after Cairo to round off his peacebuilding trip.

THE BIG STORIES ABROAD THIS MORNING- No single story dominates international headlines, but the US’ renewed calls for an investigation into whether covid-19 could have leaked from a Wuhan lab, as well as coverage of memorials and marches marking a year since the death of George Floyd at the hands of police officers made the front pages. Other news of note:

  • Amazon is being sued for violating Washington’s competition laws by restricting sellers from listing products cheaper on other platforms.
  • European airlines are rerouting to avoid Belarus’ airspace following outrage at the forced landing of a plane in Minsk and the arrest of an opposition journalist on board.

ALSO HAPPENING TODAY-

Budget week rolls on in parliament: The House will continue committee-level discussions of allocations in the state’s FY2021-2022 budget for institutions including the Higher Education Ministry and its agencies, the National Railways Authority, the National Tunnels Authority, the General Authority for Planning Transportation Projects, the National Transport Institute, and the New Urban Communities Authority. The House CIT Committee signed off yesterday on the spending plan for the National Telecommunications Regulatory Authority, according to Youm7.

There’s more coming on Thursday: The House Healthcare Committee is due to discuss the budgets for the General Authority for Healthcare; the Universal Healthcare Ins. Authority; the Health Ins. Organization; and the General Authority for Healthcare, Accreditation, and Regulation, according to parliament’s schedule.

The EU is hosting a webinar at 10 am today to discuss the outcomes of its Inclusive Economic Growth Program in Egypt, which aimed to support SMEs and promote inclusive growth, according to a press release (pdf). The EU-funded program backed businesses in sustainable tourism and heritage sites, among others. The webinar will feature Deputy Head of the EU Delegation to Egypt Tobais Krause as well as Assistant to the Minister of International Cooperation and Supervisor of the European Cooperation Sector Sherihan Bekheit. You can register for the webinar here.

*** CATCH UP QUICK with the top stories from yesterday’s edition of EnterprisePM:

  • Part two of our exclusive with EFG Hermes Group CEO Karim Awad: EFG Hermes’ Awad talks about foreign institutional investors coming back and what’s next for the debt market in Egypt.
  • Economic recovery needs the private sector: Private sector involvement is needed for Egypt’s post-covid recovery, says European Commission.
  • IDH gets IFC facility: IDH landed a USD 45 mn debt financing package from the IFC after listing on the EGX.

CIRCLE YOUR CALENDAR-

Foreign Minister Sameh Shoukry is due to hold meetings in Athens next month with counterparts from Greece, Cyprus, and France, Cypriot Foreign Minister Nikos Christodoulides said in a statement picked up by Cyprus Mail. The EU could be looking to participate in the East Mediterranean Gas Forum and will send in a request soon, Christodoulides suggested.

Check out our full calendar on the web for a comprehensive listing of upcoming news events, national holidays and news triggers.

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*** It’s Hardhat day — your weekly briefing of all things infrastructure in Egypt: Enterprise’s industry vertical focuses each Wednesday on infrastructure, covering everything from energy, water, transportation, urban development, as well as social infrastructure such as health and education.

In today’s issue: We look at private sector healthcare investments in Egypt. Even before the outbreak of the pandemic, the Egyptian healthcare market has had solid fundamentals that make it primed to absorb investments and expansions in services. But while there has been increased appetite, there are key issues holding back more private sector investments.

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ECONOMY

IMF gives initial approval for final tranche of USD 5.2 bn standby loan

Egypt expects to unlock the third and final USD 1.6 bn tranche of its USD 5.2 bn IMF standby loan after reaching a staff-level agreement with the fund, the IMF said in a statement. An IMF delegation was (virtually) in town over the past two weeks for the second review of the 12-month program and its annual Article IV consultations, which the IMF usually holds with its member states once a year as a way to keep track of local economies. The disbursal of the third tranche is contingent on the approval of the IMF’s executive board, which is expected within the next few weeks, according to the statement. Reuters also has the story.

Refresher on the facility: The IMF had signed off last June on the one-year package to support Egypt’s economic recovery through covid-19, as key economic sectors — including the vital tourism industry — were negatively impacted by the pandemic. The funding was also made available to support healthcare, shore up the country’s social safety net, advance structural reforms, boost private sector growth and job creation, and help the government narrow its budget deficit.

Overall, the review appears to be quite positive, with the fund noting that “all structural benchmarks were met” under the agreement. “Over the past 12 months, the authorities’ strong performance and commitment helped achieve the program’s objectives of maintaining macroeconomic stability during the pandemic while protecting necessary social and health spending and implementing key structural reforms,” the statement read.

The economy showed “resilience” over the past several months thanks to the government’s “strong implementation” of its policy program. Egypt’s GDP is expected to close the current fiscal year with 2.8% growth before accelerating to 5.2% in FY2021-2022, the fund says. The fund had bumped up its outlook for Egypt’s growth from 2% following the completion of its first review of the program in January. Fiscal policy for the upcoming fiscal year “appropriately targets a gradual consolidation to balance needed support for the economic recovery while safeguarding fiscal sustainability,” the fund says, giving a nod to the government’s plan to ramp up its investments in priority sectors such as healthcare, education, and infrastructure. The government’s sustainable development plan for FY2021-2022 outlines healthcare, transport and railway infrastructure, and education as its top priority areas.

Reserves + the banking sector are still a bright spot: The IMF team found that the primary balance and international reserves have exceeded the program’s targets, which was also the case when it reached a staff level agreement for its first review in November. Foreign reserves have been steadily rising since June, coming in at USD 40.3 bn at the end of April, bringing us closer to our February 2020 peak of USD 45.5 bn. The fund also gave a nod to the Central Bank of Egypt’s “readiness to act as necessary to support economic recovery amid muted inflation.” The country’s banking system is “liquid, profitable, and well-capitalized,” the fund says.

There are still covid-19 risks, but we have the right policies in place: Economic performance could be undermined by lingering risks related to the pandemic, resulting in a bit of uncertainty to the outlook. But the fund is optimistic that short-term recovery has appropriate policy support, while the government’s structural reform program — the second phase of which Prime Minister Moustafa Madbouly and Planning Minister Hala El Said announced last month — will “unleash Egypt’s enormous growth potential in the medium term.”

Next steps: The fund wants to see “specific policy measures” to support the targets of our Economic Reform Program 2.0, suggesting that the government outline clear steps to boost private sector involvement in the economy and help encourage exports by removing trade barriers.

INVESTMENT WATCH

Saudi’s RSGT has over USD 1.5 bn to invest in ports, and Egypt is on the short list

Could Egypt be in line for a slice of investments from a Saudi port operator? Red Sea Gateway Terminal (RSGT) — in which Saudi Arabia’s Public Investment Fund and Cosco Shipping Ports together hold a 40% stake — is planning to invest in three or more ports in Africa and the Middle East over the next five years, CEO Jens Floe tells Bloomberg. Each investment is expected to total up to USD 500 mn.

While Floe did not specify the countries RSGT is eyeing, he said that part of the port operator’s “strategy will be geared toward supporting the kingdom’s food security plan,” noting that many of Saudi’s policy strategies mesh well with the company’s own plans. “We have a focus on ports in Sudan and Egypt. They weren’t picked for that reason, but they happen to be significant countries for Saudi Arabia’s food security strategy,” he said.

DEBT WATCH

Third tranche of JPMorgan railway loan coming soon + NBE seeks USD 1 bn syndicated loan for debt refinance

Egypt could get the third USD 335 mn tranche of a JPMorgan loan to finance the construction of two monorail lines within four months, according to a report in Al Mal’s print edition this morning that cites unnamed sources. The Transport Ministry is reportedly in talks with the lender to move ahead with the necessary steps to unlock the next installment as part of a wider lending agreement, but the total value of the loan is still unclear. Egypt had received the first USD 332 mn tranche in October, and reportedly took receipt of a second tranche, the newspaper says, without disclosing its size.

The funding is being used to construct two monorail lines — one a 54-km line from the new administrative capital to Cairo Stadium Station (expected to be completed in 2022), and the other linking Gameat El Dewal Station to Sixth of October through a 42-km line (scheduled for completion in 2023). A consortium led by Bombardier, Orascom Construction, and Arab Contractors signed a 30-year contract for the construction and maintenance of the lines in 2019, with Orascom and Bombardier breaking ground on the new capital-Nasr City line last May.

State-owned National Bank of Egypt (NBE) is close to raising a three-year USD 1 bn syndicated loan package from a group of banks that will be “partly used to refinance existing debt,” Bloomberg reported, citing unnamed sources with knowledge of the matter. “[The transaction] was conducted within the bank’s normal course of business and timed to take advantage of the preferential market and interest rate conditions currently prevailing,” said the NBE’s head of financial institutions Hesham Elsafty.

Bloomberg quotes unnamed sources who said the bank wants to narrow the margin on its new facility by 40 basis points to 230 bps, but did not name the banks involved in the transaction, provide a timeline on when NBE would get its hands on the funding, or specify the number of tranches into which the facility would be divided.

LEGISLATION WATCH

Customs Act regs are up for discussion again

The business community has one week to give feedback on the latest version of the Customs Act’s executive regulations (pdf), after the Finance Ministry incorporated suggested amendments and requests from the latest round of public consultations last month, Al Masry Al Youm reports. Under the proposed regulations, importers would be allowed to pay customs in chunks over six-12 months, depending on how established their business is. The regs would also allow goods to move out of Egypt without submitting waybills on the spot.

What's changed? The new draft cuts inspection fees for larger containers to EGP 800 from EGP 1k for exports, and to EGP 200 from EGP 400 for imports. Otherwise, the regulations don't appear to have undergone significant reworking since they were initially issued in March. The latest draft shows the majority of the amendments applied to the language and technical terms used in the regulations, in addition to updating the terms of the regulations to account for the digitization of customs processes.

This isn’t their first rodeo: The Customs Act has been met with pushback from exporters, shipping agencies, and customs brokers since it came into effect in November. The Finance Ministry eventually capitulated to some of their grievances, including on ins. requirements.

STARTUP WATCH

Sawari Ventures to make new North Africa investments this year

Cairo-based venture capital firm Sawari Ventures plans to make new investments in Tunisia or Morocco this year, a source at Sawari told Enterprise, without specifying an amount or an exact date. The source spoke on condition of anonymity. Sawari has earmarked some EGP 250 mn from its EGP 1 bn investment platform for new startups, the source said, some of which will presumably go towards the planned investments in Tunisia / Morocco. The Sawari-managed platform is made up of its Egypt-focused tech fund, which invests in parallel with a seperate Netherlands-based fund under the same platform.

The platform has so far made investments worth EGP 400 mn in a total of 15 Egyptian and foreign companies, and has earmarked EGP 350 mn for follow-on investments. The companies cover the fields of mass transportation, fintech, as well as micro businesses, the source said, including eight local startups. Locally, Sawari has invested in online fashion marketplace Brantu, e-commerce platform ExpandCart, microelectronics company Si-Ware Systems, and AI startup Elves, among others.

Sawari closed last April its Egypt-focused tech fund, raising USD 28 mn (EGP 440 mn) from an array of local and regional investors. The Netherlands-based fund earlier separately raised commitments of USD 42 mn from the European Investment Bank, the UK’s CDC, the French Development Agency’s private sector financing arm Proparco, the Dutch Good Growth Fund and Sango Capital, brining the platform’s combined commitments to USD 70 mn (EGP 1.1 bn).

OTHER STARTUP NEWS- Egyptian logistics startup Bosta plans to raise mns of USD in a new funding round to close in mid-2022, with 25 new investors expressing interest, CEO and co-founder Mohamed Ezzat said, according to Al Arabiya. By the end of 2022, the company aims to have reached a cumulative total of 15 mn parcel deliveries in Egypt compared to 1.7 mn in 2020, and plans to increase its local customer base to 20k from the current 3k. On average the company currently delivers 12k parcels per day, Ezzat said.

Bosta plans to expand to as many as seven countries in the coming five years, Ezzat told Reuters, with a UAE and Saudi Arabia expansion slated for 2021. The company plans to expand further into Kuwait and other African countries within five years. Bosta has raised some USD 9.2 mn including a USD seven-figure investment in a series A round in February 2020 and another USD 6.7 mn investment led by Jordan-based VC fund Silicon Badia to complete the series earlier this month.

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GERD

What’s going on down south?

Has Ethiopia already started the second filling of GERD? Sudan apparently has evidence to suggest that Ethiopia began the second filling of the Grand Ethiopian Renaissance Dam’s (GERD) reservoir at the beginning of May, Reuters reports, citing an unnamed Sudanese official. Khartoum has gathered data on river flows, which “show changes in the level of the Blue Nile River that indicate water is being pooled,” Bloomberg reports, also citing an unnamed Sudanese official.

Ethiopia says it’s fake news: Sudan’s claims are “not true” and are “deliberately misleading statements targeted to confuse everyone,” Ethiopian Irrigation Minister Seleshi Bekele told the business information service. Addis Ababa has previously said it plans to begin the second filling of the dam during its upcoming rainy season, which is expected around July or August, and has recently maintained it will move ahead with the filling with or without an agreement with Sudan and Egypt on the filling and operation of the dam.

What’s certain is that Ethiopia has pushed ahead with the construction needed for the second filling, Sudanese political analyst Essam Dakeen told Ala Mas’ouleety’s Ahmed Moussa. Addis Ababa appears to have begun pooling some amount of rainwater, but it is uncertain whether this means it has actually started the second filling of GERD’s reservoir. In all cases, Ethiopia has proven that it will act unilaterally for its own interests without heeding requests from Egypt, Sudan, and the international community to reach an agreement first, Dakeen said (watch, runtime: 6:35).

So, what now? For starters, let’s not jump straight to war, pundit Emad Eldin Adib tells Kelma Akhira’s Lamees El Hadidi. It is highly unlikely that President Abdel Fattah El Sisi would opt for this scenario unless all other options have been exhausted, which is not the case yet (watch, runtime: 4:53). Political commentator Mostafa El Fekky said much the same to Yahduth fi Misr’s Sherif Amer, suggesting that GERD affects too many other countries in the region for the international community to sit back until an open conflict unfolds (watch, runtime: 3:42). Foreign Minister Sameh Shoukry recently said Egypt was “confident” it would be able to mitigate the effects of the GERD filling through water conservation efforts, and that escalations would only take place if the filling material damages Egypt’s water supply.

DIPLOMACY

Cairo and Qatar are now friends IRL

Qatari FM’s first meeting in Cairo makes our friendly relations official: Enhancing bilateral relations and boosting cooperation and investment between Egypt and Qatar were key talking points during a meeting yesterday between Foreign Minister Sameh Shoukry and Qatari FM Mohammed bin Abdulrahman Al Thani, who met for the first time in Cairo since the recent lifting of Egypt and the GCC’s 2017 blockade on Qatar, according to a Foreign Ministry statement. The FMs also discussed ways to consolidate joint Arab action in the face of regional challenges — given Qatar's presidency of the Arab League — while touching on other regional issues, including the Grand Ethiopian Renaissance Dam (GERD) impasse.

Could El Sisi make a reciprocal visit soon? In a separate meeting with the Qatari FM yesterday, President Abdel Fattah El Sisi received an official invitation to Doha from Qatari Emir Tamim bin Hamad Al Thani. If it goes through, it would be his first to Qatar since assuming the presidency. The two agreed to enhance bilateral consultation and coordination, and to coordinate further visits of government officials from both countries.

More than just a formality: “This latest visit confirms that there is indeed more than a simple signing of letters,” Carnegie Endowment’s H.A. Hellyer told the Associated Press. The rapid development of bilateral relations “certainly impacts the existing geopolitical arrangements of the region” and could set the tone for a realignment of regional allegiances, Hellyer said. An Egyptian-Qatari committee tasked with follow-up on the implementation of the reconciliatory Al-Ula accord will continue to meet to discuss outstanding issues, the foreign ministry statement said.

Al Thani arrived in Cairo on Monday for a two-day visit after stops in Sudan and Libya, as Egypt continues to mend fences with Qatar after the two countries decided to restore ties earlier this year, following 3.5 years of suspended diplomatic relations.

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ENTERPRISE+: LAST NIGHT’S TALK SHOWS

It was diplomacy as far as our eyes could see and our ears could hear on the airwaves last night, mirroring a news cycle in the print press that was almost entirely focused on diplomacy. The key topics:

Blinken in the region + Biden and El Sisi’s call: Kelma Akhira’s Lamees El Hadidi took note of US Secretary of State’s regional peacebuilding tour (watch, runtime: 3:33), while Ala Mas’ouleety’s Ahmed Moussa hosted pundit Abdel Moneim Said for his two cents on President Abdel Fattah El Sisi’s most recent phone call with US President Joe Biden earlier this week (watch, runtime: 10:27). The Palestine-Israel crisis is now part of the considerations in the US’ strategy on Iran, as Washington and Tehran work on a revived nuclear agreement, pundit Emad Eldin Adib told Lamees. Tehran maintained its distance from the latest conflict in Palestine, despite historically supporting Hamas as part of Iran’s proxy war with Israel, suggesting the country did not want to risk upsetting the US as it seeks to bring it back into the 2015 nuclear agreement (watch, runtime: 22:52).

Warming up with Qatar: Al Hayah Al Youm (watch, runtime: 8:23) and Masaa DMC’s Ramy Radwan (watch, runtime: 1:19) each reported on Qatari Foreign Minister Mohammed bin Abdulrahman Al Thani’s sit-down with El Sisi and Foreign Minister Sameh Shoukry yesterday. Lamees also took note of the importance of the visit in accelerating a return to Egypt and Qatar’s friendlier relationship before tensions began in 2013 (watch, runtime: 2:09). We have the full story in this morning’s news well, above.

EGYPT IN THE NEWS

Leading the conversation on Egypt in the foreign press: Four members of Egypt’s security services are going on trial in Italy this October over their alleged role in the disappearance and killing of Giulio Regeni, after a judge decided yesterday there is “sufficient evidence” to formally accuse them of the crime. Covering the story: Reuters | BBC | NYT.

Also making headlines:

  • GERD: Experts believe that the Grand Ethiopian Renaissance Dam (GERD) poses risks to Egypt’s water security, despite tighter water-saving measures promising to avert the second filling’s impact. (Al Monitor)
  • Tourism: UK tour operator TUI has halted its holiday packages to eight countries on the UK’s restricted travel “amber list,” including Egypt, until 27 June. (The Sun)
  • Fish fossils: Ancient marine fish newly discovered in the Eastern desert were found to have been able to survive in tropical climates during a period of extreme global warming 56 mn years ago. (University of Michigan)
  • Egypt-US arms sales: Egypt’s significant shift away from US weapons toward Russia and France points to a possible weakening of the historically close relationship that could impact the US’ regional interests. (Defense News)

ALSO ON OUR RADAR

A few things we’re keeping an eye on this morning:

  • The Supply Ministry is reportedly looking to bring down its wheat imports by 300-500k tonnes this year as local wheat production looks set to increase by as much as 500 mn tonnes to end this season on 15 June at 3.6 mn tonnes.
  • Elaraby Group inaugurated yesterday its newest cooking appliances factory in Qalyub, with an estimated annual production capacity of 500k units.

COVID WATCH

Airport employees are getting vaxed

Vaccine rollout to airport workers officially began yesterday with the Egyptian Airports Company lining up doses for its employees through the Health Ministry, according to MENA. National flag carrier EgyptAir had also started inoculating its staff members a few days earlier, starting with “frontline” employees who are most frequently exposed to passengers. The move comes as part of a wider push to vaccinate tourism workers. The Health Ministry has said it plans to have vaccinated all workers in the sector before the summer season begins.

The Health Ministry reported 1,140 new covid-19 infections yesterday, on par with 1,149 the day before. Egypt has now disclosed a total of 256,124 confirmed cases of covid-19. The ministry also reported 49 new deaths, bringing the country’s total death toll to 14,807.

The World Health Organization is suffering a funding shortfall of over 70% that threatens to leave the organization “in real imminent danger of being unable to sustain core functions for urgent priorities,” Reuters reports, citing a statement by Executive Director of WHO Health Emergencies Program Mike Ryan to health ministers yesterday. The WHO is seeking nearly USD 2 bn to fund its covid-19 response plan.

Could WHO funding shortages affect Covax? The WHO’s Covax scheme — designed to provide vaccines to low- and middle-income countries — has already been running behind schedule, delivering less than half of the 170 mn vaccines previously envisioned. This is largely due to an export ban by Oxford / AstraZeneca vaccine manufacturer the Serum Institute of India, which looks set to last till late this year as the country struggles to contain a spike in its local covid infections.

Between supply shortages and underfunding, it’s looking increasingly unlikely that WHO boss Tedros Ghebreyesus’ goal of getting 30% of the world’s population vaccinated by the end of the year will be met.

PLANET FINANCE

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Abu Dhabi is offering incentives to kickstart its dormant IPO pipeline: ADX officials have reached out to companies with offers of flexible freefloat requirements and promises to slash or waive listing fees, unnamed sources said, in a bid to tempt companies to list after nearly four years with no new IPOs, according to Bloomberg. The ADX hasn’t seen a single listing since the sale of Abu Dhabi National Oil Company in 2017, and bourse officials said they hoped the new incentives could encourage at least 10 new listings this year.

Turkey’s central bank management gets its third shakeup this year: Turkish President Recep Tayyip Erdogan has appointed a new deputy governor, Semih Tumen, to replace Oguzhan Ozbas, Bloomberg reports, citing a presidential decree in the Official Gazette. The decision comes two months after the president dismissed the bank’s third governor in almost two years, sending the country’s currency tumbling, while inflation remains at a near two year high in the double digit realm.

Down

EGX30

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Buy 15.62

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8.25% deposit

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The EGX30 fell 2.13% yesterday on turnover of EGP 1.24 bn (2.5% below the 90-day average). Local investors were net buyers. The index is down 2.89% YTD.

In the green: MM Group (+0.7%).

In the red: Sodic (-6.2%), ElSewedy Electric (-4.1%) and Ezz Steel (-4.1%).

It’s green as far as the eye can see this morning for shares in Asia, and major European indexes look set to join Wall Street later this morning by opening in positive territory.

AROUND THE WORLD

US Secretary of State Antony Blinken pledged a combined USD 112.5 mn in aid to Palestine in a statement to the press alongside Palestinian President Mahmoud Abbas in Ramallah yesterday, on the first day of his four-city tour to the Middle East dedicated to solidifying the Egypt-brokered Gaza-Israel ceasefire. The US will provide USD 5.5 mn in immediate aid to Gaza, with an additional USD 75 mn earmarked for economic and development funds to Palestine in 2021, and USD 32 mn allocated to the UN’s Palestine refugee agency. With these new contributions, the US is now in the process of providing USD 360 mn in assistance to Palestine, Blinken said.

The US will also reopen its consulate in Jerusalem, which had served as the country’s main diplomatic channel for Palestinians, reversing a Trump-era closure of the office.

Blinken also warned both sides against disturbing the peace: The US will “oppose any unilateral provocative actions that risk sparking more violence,” including settlement activity, annexation of territory, home demolitions or other incitements to violence, Blinken said, reiterating the US’ support for a two state solution.

Blinken also earlier met with Israeli PM Benjamin Netenyahu in Jerusalem, vowing that the US would work, “to ensure that Hamas does not benefit from the reconstruction assistance” (watch, runtime: 58:37). Blinken also committed to the US replenishing Israel’s Iron Dome anti-missile defense system, Bloomberg reports. Reuters also had the story.

The Secretary of State’s next stops will bring him to Cairo, then to Amman in the coming days.

hardhat

What’s driving private sector investment in healthcare? The private sector’s FY2018-2019 investment in healthcare reached EGP 9.3 bn, accounting for 42% of total investment in the sector during the fiscal year, according to government figures. And more investments are expected in the next 10 years, as evidenced by the boom in healthcare M&A activity in 2020 and 1Q2021. Egypt is a market that is primed to absorb healthcare services, with its large population and prevalence of chronic diseases such as high blood pressure, diabetes and (formerly) Hep C. But beyond the covid-19 pandemic and the fundamentals (which have always existed), what’s been driving this expansion in private sector healthcare?

The rollout of the Universal Healthcare Plan and the construction of new cities are behind the heightened appetite. Having more people covered by ins. and new areas that need healthcare services translates into heightened demand, which bodes well with investors’ ROI expectations, industry players we’ve spoken with tell us. But a fundamental issue remains: Some governorates are still underserved when it comes to healthcare services, due to a lack of talent outside cities with university medical faculties, and private investors being unable to hit ROI targets beyond urban centers like Cairo and Alexandria.

Investment in the sector has been increasing since 2015: Total implemented investments in the private healthcare sector increased 1.5x between 2015-16 and between 2018-19 in nominal terms, totaling EGP 9.3 bn in private and EGP 9.8 bn in public investments in 2018-2019, according to a joint February report (pdf) by Dcode Economic and Financial Consulting and The American University in Cairo.

Private sector healthcare in 2020 and 2021 — an M&A story: Our internal tracker tells us 19 healthcare transactions were completed in 2020, with the sector being the most active after banking and finance, which came in at 32 transactions. Major M&A included Al-Ahly Capital acquiring El Nada Hospital, Ezdehar Egypt Mid-Cap Fund getting a minority stake in Al Tayseer Healthcare Group, and in turn Al Tayseer upping its stake in Mansoura Medical Center, PE outfit Alta Semper increasing its stake in Macro Holding to 80%, and several more. Companies are also competing for Abu Dhabi Commercial Bank’s 51.4% stake in Alexandria Medical Services. A mega-merger between Cleopatra Hospital Group (CHG) and Alameda Healthcare was also in the works, but recently faltered.

The private sector’s expanded role in healthcare is also evident when we look at its market share in the last 10 years. As of 2019, just over a quarter of Egypt’s hospital beds could be found in private sector healthcare facilities, equivalent to almost 36k beds, according to the Dcode report. Moreover, private sector hospitals increased by 20%, from 942 to over 1.1k between 2009 and 2019, increasing their market share from 58.8% to 63.4%. Private beds increased from 21k in 2009 to just under 36k in 2020 — an almost 70% growth rate.

Why is this happening? Two reasons: Ins. coverage and new cities. The high penetration of the ins. market, including the rollout of the universal healthcare plan, means that an investor’s potential market in the sector will increase, Hassan Fikry, corporate strategy and investor relations director at ‎CHG explains. This ensures healthcare service demand — and return. Also, a lot of organized investment has been injected into infrastructure and the creation of new cities, which will need medical services, says Neeraj Mishra, group CEO of Alameda Healthcare, creating potential for more healthcare investment.

But Egypt’s healthcare sector has a lot of catching up to do: There were 1.4 beds per 1k people, and only 0.8 physicians for every 1k people as of 2017, according to Dcode. This is half the global average. Worldwide, the average number of beds per 1k people stands at 2.9 and the number of physicians per 1k people stands at 1.6, the report notes. Only 4.9% of our GDP is spent on healthcare, with the average life expectancy hovering at 63. In all categories, Egypt ranks lower than KSA, Tunisia and Jordan in the Arab world.

Why such low KPIs? The sector was late to institutionalize: Historically, the sector in Egypt was dominated by doctors who built hospitals based on their own specialization, Fikry says, adding that the demand-supply gap was exacerbated by the fact that the sector was not investment-driven, but rather doctor- or family-run. This also fueled the rise of specialized rather than general, hospitals. An increasing number of beds were only available to certain types of patients, resulting in a growing number of private beds not being used.

This ultimately culminated in an uneven geographic distribution of services: Over 12.7k private sector hospital beds can be found in Cairo and Alexandria alone. Giza governorate boasts another 3.9k beds, according to CAPMAS. This means that almost 50% of private sector hospital beds are concentrated in just three governorates. The remaining 19.4k beds are scattered across the remaining 24 governorates. This would be equivalent to an average of just over 800 private beds per governorate — in theory, though practically the distribution is fragmented. South Sinai, for instance, only has 18 available private sector beds, according to CAPMAS.

Why hasn’t the private sector gone to these high demand governorates? A lack of talent and profitability: Access to doctors and nurses in governorates can be tricky, especially if the city does not have a medical faculty, Fikry says. To move talent from governorates with medical faculties to others will require having to pay higher salaries, Mishra, adds. Moreover, average income levels in other governorates are lower than in Cairo and Alexandria, so hospitals cannot charge the same fees they would elsewhere. They have to run hospitals at a price point that is affordable in the city they are in, Mishra says.


Your top infrastructure stories for the week:

  • Atmospheric water generator: Mariout Hills will establish a USD 3.4 bn atmospheric water generator in New Alamein city, through which it will extract moisture from humid air to produce 50k liters of drinking water per day, Chairman Ahmed Hassan said.
  • Not a developer? No land for you: New city authorities are no longer permitted to sell land earmarked for construction to individuals after the Housing Ministry issued a decree limiting sales to real estate developers.
  • Mixed feelings on road infrastructure: The government’s road building campaign isn’t sitting well with some who have had their homes expropriated to make way for new roads, according to Reuters.

CALENDAR

20-28 May (Thursday-Friday): Gouna International Squash Open 2021.

24-26 May (Monday-Wednesday): British Egyptian Business Association virtual healthcare week.

26 May (Wednesday): Final day for Africa-based startups to apply for the French government-sponsored AFD Digital Challenge (pdf).

27-29 May (Thursday-Saturday): Informa Markets’ Nextmove real estate exhibition, Cairo International Convention Center, Nasr City.

30 May (Sunday): Al Mal GTM is organizing the Portfolio Egypt conference under the theme ‘Growth under the weight of the pandemic.’

31 May (Monday): Egypt is hosting Trescon Global’s World AI Show with the support of ITIDA.

7 June (Monday): British Egyptian Business Association hosts an event featuring Oil Minister Tarek El Molla.

14 June (Monday): Egypt's Green Economy Forum.

17 June (Thursday): The CBE’s Monetary Policy Committee will meet to review interest rates.

17-20 June (Thursday-Sunday): The International Exhibition of Materials and Technologies for Finishing and Construction (Turnkey Expo), Cairo International Conference Center.

22-27 June (Tuesday-Sunday): The CIB PSA World Tour Finals for 2020-2021 will take place in Cairo.

24 June (Thursday): End of the 2020-2021 academic year (public schools).

26-29 June (Saturday-Tuesday): The Big 5 Construct Egypt, Cairo International Convention Center, Cairo, Egypt.

30 June (Wednesday): The IMF will complete a second review of targets set under the USD 5.2 bn standby loan approved in June 2020 (proposed date).

30 June (Wednesday): 30 June Revolution Day.

30 June- 15 July: National Book Fair.

July + August: Thanaweya Amma exams take place.

1 July: (Thursday): National holiday in observance of 30 June Revolution.

1 July (Thursday): Large taxpayers that have not yet signed on to the e-invoicing platform will suffer a host of penalties, including removal from large taxpayer classification, losing access to government services and business, and losing subsidies.

1 July (Thursday): Businesses importing goods at seaports will need to file shipping documents and cargo data digitally to the Advance Cargo Information (ACI) system.

15 June (Saturday): EGX-listed will have to complete filing their financial disclosures for the period ended 31 March.

19 July (Monday): Arafat Day (national holiday).

20-23 July (Tuesday-Friday): Eid Al Adha (national holiday).

23 July (Friday): Revolution Day (national holiday).

5 August (Thursday): The CBE’s Monetary Policy Committee will meet to review interest rates.

9 August (Monday): Islamic New Year.

12 August (Thursday): National holiday in observance of the Islamic New Year.

12-15 September (Sunday-Wednesday): Sahara Expo: the 33rd International Agricultural Exhibition for Africa and the Middle East.

16 September (Thursday): The CBE’s Monetary Policy Committee will meet to review interest rates.

30 September-2 October (Thursday-Saturday): Egypt Projects 2021 expo, Egypt International Exhibition Center, Cairo, Egypt.

30 September-8 October (Thursday-Friday): The Cairo International Fair, Cairo International Conference Center, Cairo, Egypt.

1 October (Friday): Expo 2020 Dubai opens.

6 October (Wednesday): Armed Forces Day.

7 October (Thursday): National holiday in observance of Armed Forces Day.

12-14 October (Tuesday-Thursday): Mediterranean Offshore Conference, Alexandria, Egypt.

18 October (Monday): Prophet’s Birthday.

21 October (Thursday): National holiday in observance of the Prophet’s Birthday.

28 October (Thursday): The CBE’s Monetary Policy Committee will meet to review interest rates.

1-3 November (Monday-Wednesday): Egypt Energy exhibition on power and renewable energy, Egypt International Exhibition Center, Cairo, Egypt.

1-12 November (Monday-Friday): 2021 United Nations Climate Change Conference (COP26), Glasgow, United Kingdom.

29 November-2 December (Monday-Thursday): Egypt Defense Expo.

13-17 December: United Nations Convention against Corruption, Sharm El Sheikh, Egypt.

16 December (Thursday): The CBE’s Monetary Policy Committee will meet to review interest rates.

14-16 February 2022 (Monday-Wednesday): Egypt Petroleum Show, Egypt International Exhibition Center, New Cairo, Egypt.

1H2022: The World Economic Forum annual meeting, location TBD.

May 2022: Investment in Logistics Conference, Cairo, Egypt.

27 June-3 July 2022 (Monday-Sunday): World University Squash Championships, New Giza.

**Note to readers: Some national holidays may appear twice above. Since 2020, Egypt has observed most mid-week holidays on Thursdays regardless of the day on which they fall and may also move those days to Sundays. We distinguish below between the actual holiday and its observance.

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