Elazig Integrated Healthcare Campus/ First “Green and Social Bond” for an infrastructure project in Turkey

Elazıg Integrated Health Campus Project has been proposed by the Ministry of Health as part of the Public-Private Partnership projects to serve Elazıg and surrounding Provinces. Project aims to provide efficient access to a full range of high-quality healthcare in a single location to a population of about 600,000 people, with 1,850 among doctors, nurseries, technicians, and administrative personnel.


Health Care

Direct Impact SDGs:

Elazig Integrated Health Campus Project is consists of the design, construction, financing and maintenance of an integrated health campus with 1038 beds, serving the 4th healthcare region of Turkey. The concession contract with the Ministry of Health of the Turkish Republic is comprised of a three-year construction phase followed by 25 years of operation. Hospital also has the following;

  • 6 blocks
  • 2 helipads
  • 131 intensive care units
  • 304 polyclinics
  • 39 surgery rooms
  • 1871 carpark capacity

The Elazig Integrated Health Campus Project will be realized by the Ministry of Health on an area of 356.000 sqm in the Central district of Elazig with the Public Private Partnership model and will serve Elazig and surrounding cities.

Elazığ City Hospital has increased easiness to the access to health services and quality. Based on surveys conducted among patient and patient relatives, favorability and satisfaction level of the hospital by community is more than 80%.

The hospital provided new services to the city as well. For instance, Medical Genetics Language and Speech Therapist and Polyclinic-Robotic Walking services introduced to the city for the first time with the establishment of the city hospital.  The hospital’s new health centres also attract people who prefer city hospitals. These centres serve not only the residents of Elazığ, but also those living in nearby cities.  Four secondary emergency services in the emergency department of the city hospital brought much relief to the problem of the city’s emergency services. Also, the average waiting times for services such as X-ray, MRI, blood tests and imaging services in the provinces, and waiting times for outpatient clinic appointments have been shortened with the Hospital.

One established indicator of the project is its effect on employment. Job opportunities from the Elazig Hospital project began with its construction and continued at the operation. At its peak, 5,000 people were working at the site and about 1500 by SPV and total Ministry of Health, about 4100 during operation. About 40% of the current employees are women, which is a high proportion for Eastern Turkey and about 90% local employment has been provided.

As noted above, as well as its positive impacts for providing good health in parallel with (SDG 3) Good Health and Well-being and Partnership for the Goals (SDG17), its impacts seen at the crisis situations.

One test of a hospital, especially in an emerging economy, is its ability to manage a health crisis. For the Elazig Integrated Health Center, there were two crises in rapid succession in 2020: an earthquake and a pandemic. Together, Elazığ IHC demonstrated the important ongoing role that a well-equipped, well-managed hospital can play in a community – not just helping recover from a crisis, but preventing it from escalating, with well managed and a large-scale partnership between the public and private sectors, and a local focus on quality and preventative care.

The earthquake took place on January 25, 2020. It was a 6.8 magnitude shock in eastern Anatolia, with an epicenter just 30 miles from the hospital. Many buildings collapsed, trapping dozens of people under the rubble. More than 40 people were killed, and about 1,600 were dead. Elazig Hospital had been built to withstand earthquakes, and became critical for treating many of the injured people.

Two months later, the Covid-19 pandemic reached Turkey, and the hospital system was tested again. This time, Elazig Hospital became an ongoing coordination point for response and community prevention.

In terms of SDG3,

Elazig Integrated Health Campus (IHC) is Meridiam’s third public private partnership in the country’s health sector. The Project provides efficient access to a full range of high-quality healthcare in a single location to a population of about 600,000 people, with 1,850 among doctors, nurseries, technicians, administrative personnel and other staffs employed in the campus with bed capacity of 1038 that is consist of 888-bed main hospital, a 300-bed Women/Maternity and Pediatrics Hospital, 60-unit mouth and dental health centre and all of the necessary support buildings and facilities.

The Elazig IHC is one of around 20 major hospital developments planned through a major programme of expansion and modernisation of health facilities that developed by the Ministry of Health  in Turkey.

Elazig IHC contributes to achieve universal health coverage and access to quality essential health-care services for all and strengthening the country’s capacity in managing national and global health risks.

The health campus contributes to achieving universal health coverage and access to health services by:

  • Adding 1038 hospital beds to the country’s total. This represents 0.45% of the country’s total.
  • Welcoming close to average 1,800,462 patients annually (hospitalizations including visits), with an average bed occupancy of 62% (pre-COVID pandemic)
  • Serving not only Elazığ city, but also eastern Anatolia region and the smaller nearby cities Diyarbakır, Malatya, Muş, Tunceli and Şanlıurfa
  • Introducing digital or virtual health services, reinforcing the innovative aspect of the health center by strongly using IoT technologies compared to the other hospitals in the country.

In terms of SDG17,

  • For more than 30 years, Turkey has been utilising the public private partnership (PPP) model which brings financial and technical capacities of private and public sectors together through joint initiatives. In Turkey, the PPP model is mostly employed in transport and healthcare sectors. Elazığ IHC is a part of the Turkish Healthcare PPP program developed by MoH that encourages the development of modern health facilities and the provision of world class healthcare services, as 5th PPP project of its kind in the sector & in the country overall.
  • For the Elazig Integrated Health Campus Hospital PPP Program, the design, construction and operations are managed by a 28-year concession held by ELZ Saglik Yatirim A.S (SPV). The consortium consists of Meridiam, Rönesans Holding, and S.A.M. Yapi Sanayi ve Ticaret Ltd. as shareholders.
  • SPV issued bonds to obtain funding from international lenders while undertaking the design, construction, operation and maintenance of Elazığ IHC and operates the hospital since 2018 successfully in terms of 18 services, in good cooperation with Administration.
  • Construction and operation of Elazig’s Integrated Health Centre have followed Meridiam’s environmental, social and corporate governance (ESG) requirements, in line with performance standards of MIGA, EBRD and the World Bank. Setting the framework for this, a comprehensive Environmental and Social Action Plan and Stakeholder Engagement Plan have been implemented.
  • The Elazig IHC stands apart from other PPPs, due to its being the first developed project through an innovative financing structure featuring a ‘green and social’ project bond in Turkey. The project bond has been certified as Green and Social by second party approver, Vigeo.
  • Equipped with world-class cutting-edge isolators, the Elazığ City Hospital is able to seamlessly carry out all its operations, even during and after the most severe earthquake scenarios.


The health sector is an important element of Meridiam’s strategy of investing to make a positive difference to people’s lives. Through proactive public-private partnerships, investment in hospitals and other health facilities is bringing benefits of local economic and social development, as well as raising standards and boosting the efficiency of healthcare. Serving not only as a landmark in the transformation of Turkey’s healthcare sector, as Turkey’s first project bond, Elazig is also expected to catalyze Turkey’s nascent capital markets sector for infrastructure funding.