Canada and Vietnam have much to celebrate internationally – Canada’s natural resource management, for example, has prompted world recognized innovation in mining and processing for mined material, Canada is a leader in banking innovation and it is also recognized worldwide for its expertise in healthcare. Canada, however, is more widely known for being understated when promoting achievements. Vietnam, in direct contrast, has emerged in recent years as the engine in ASEAN (Association of South East Asian Nations) and has fast become a go to investment market from other Asian and western markets. Canada has been tacitly interested in Vietnam – until recently. Much has been noted in Canada about the emerging opportunity in Vietnam and the hyper-growth that is being realized there as a result of investments in certain sectors – now including healthcare.
The government of Vietnam recognized early that outreach and collaboration with western economies is the life-blood for growth and economic stability. One initiative in recent years that capitalized on the special relationship shared between Canada and Vietnam is the establishment of the Canada Vietnam Business Council, an initiative of the government of Vietnam. Vietnam’s government and business community realized, too, that Canada is a country that should have stronger and longer term economic relations with Vietnam. This was demonstrated when Canada’s Governor General, the Rt. Hon. David Johnston visited Vietnam in 2012 and recently Canada’s Minister of Foreign Affairs, Hon. John Baird visited the nation to promote more trade between the two countries. This past February, Canada’s Prime Minister, Stephen Harper, celebrated “Tet” among Canada’s largest Vietnamese-Canadian community in the Greater Toronto Area, officially signalling the importance of the relationship between Canada and Vietnam.
From a more tangible perspective, healthcare in Vietnam is one of the more important public policy issues facing the country. At a 2010 meeting in Toronto, Canada between His Excellency Le Sy Vuong Ha, Ambassador to Vietnam and members of the Canada Vietnam Business Council the topic of healthcare was the focal point.
Specifically, the Ambassador recognized that Vietnam and Canada have a special relationship. He pointed out that Vietnam’s understanding of Canadian healthcare and, particularly, its knowledge of the structure of Canada’s healthcare system – publicly funded and privately delivered – place Vietnam uniquely in a position to exploit opportunities to promote private sector investment in healthcare in their country. Canada’s healthcare system, by virtue of its funding mechanism(s) make it one of the most unique systems in the world. That noted, however, Canada – specifically trade organizations and government, must do a better job to promote its healthcare system to and in emerging markets like Vietnam and by extension ASEAN, but that is a topic for another day.
Today, the Vietnamese economy continues to strengthen and Vietnamese citizens in urban areas reap the economic benefits of this growth – specifically Hanoi and HCM City. Social and lifestyle issues continue to improve as the Doi Moi (the renovation policies) unfold. However, for some Vietnamese there remains a disparity in health equity and, as such, health quality and access to health services available in Vietnam have not kept pace. “There is tremendous stress on the public system in Vietnam and alternative, private sector based opportunities have to be unlocked. There is, however, one immutable benefit of the Doi Moi – a segment of the population of Vietnam are becoming wealthier. As such, the opportunity to access quality healthcare for those with means in the country is terribly limited so most Vietnamese with economic means, seek personal healthcare outside Vietnam”, said Marc Kealey, a principal at Triple Eye Corporation of Canada – a health infrastructure company.
Ambassador Ha cited numbers as high as six billion dollars ($6 billion) a year that is spent outside of Vietnam by its citizens seeking healthcare services in countries like Singapore, Malaysia, Japan, Australia and China. Those countries reap the benefit of Vietnam’s developing healthcare system, while Vietnam struggles through its renovation policies. Ambassador Ha, through myriad meetings with the Canada Vietnam Business Council and Triple Eye Corporation, expressed the desire and rationale of his government to repatriate that capital, encourage direct foreign investment in healthcare in Vietnam and encourage more private sector investment in healthcare services.
One such company that has risen to the challenge to invest in healthcare opportunities in Vietnam is Canada’s International Infrastructure Inc (better know as Triple Eye), one of the founding members of the Canada Vietnam Business Council (CVBC). Senior partners in the company took up Ambassador Ha’s challenge and travelled to Vietnam in 2010 to answer the call on health care investment opportunities. On the first visit, with other members of the CVBC, Triple Eye participated in an historic signing of a cooperation agreement on developing healthcare opportunities there.
With considerable experience in developing and designing emergency medical services, Triple Eye executives have worked in Latin America, Eastern Europe and other Asian countries. On the visit in 2010, members of Triple Eye – Marc Kealey and Danny Leung met with the Chair of the Dai An Joint Stock Company (JSC), Madame Phuong Truong Tu ,whose organization operates one of Vietnam’s largest economic free trade zones – one is located in Hai Duong province, east of Vietnam’s capital city, Hanoi. At meetings in Hai Duong, Madame Phuong made it apparent that her vision matched the vision of Ambassador Ha’s with respect to the necessity of repatriating Vietnamese healthcare dollars in Vietnam. She also offered ideas to improve and provide quality care services for Vietnamese citizens who might otherwise seek their care in foreign jurisdictions – her idea was to look to countries like Canada, Japan, Taiwan and other such places. After an initial qualification process in Vietnam, Triple Eye presented its bona fides and outlined how working together for a protracted period of time (25 years) rather than, say, a five year payback would encourage public policy decision makers in Vietnam to endorse the model of greater participation with Canada in healthcare investment. Triple Eye and Dai An immediately began to negotiate.
Months later and several trips back and forth to Vietnam and Canada (for both parties), agreement was reached on a site for a hospital to be built at the Dai An Industrial Zone along Hwy 5 in Hai Duong province – east of Hanoi. The intention to build the hospital, a first between Canada and Vietnam was announced in media after a visit by a large delegation to Canada from Vietnam in June of 2012 and shortly after that Triple Eye spent considerable time in the summer and fall of 2012 in Hai Duong to prepare pre-feasibility on the proposed hospital site.
The Hospital project
Recommended and located on several hectares of serviced land in Hai Duong, the proposed site for what has become known as “Madame Phuong’s hospital project” is strategic for the provision of private sector health services for ex-patriates living in that area of Vietnam and for those in Vietnam with means and for employees and their families who are employed at plants located at the Dai An Industrial zone.
The prefeasibility study, conducted by a team of health specialists led by Marc Kealey of Triple Eye in 2012 determined if the land for siting the hospital was suitable for building a hospital and other practical issues – like sizing – environment and ease of access for patients and their families to the proposed site. Preliminary economic issues were discussed too, including costing and planning. It was determined after considerable study the project is viable and that the overall cost for a 200 bed hospital in Hai Duong would be $265 million dollars.
The meeting with the Minister of Health in Vietnam bore particular fruit for the proposed hospital project and credibility for the relationship between Dai An JSC and Triple Eye. Of note was the discussion between the country’s Minister of Health and Marc Kealey of Triple Eye where Minister Tien gave endorsement and support for private sector investment in healthcare in her country. The Minister endorsed the agreement between Triple Eye and Dai An JSC and gave an impassioned plea that private healthcare investment was needed for the country because health care policies have not kept pace with the expansive growth in the economy.
The Minister made it clear in her remarks that the government encourages private sector investment in healthcare and her aspirations for such an investment meshed perfectly with that of Ambassador Ha’s about repatriating capital from Vietnamese seeking healthcare in foreign jurisdictions.
Kick-starting health care policy aspirations for any developing nation accrues to the government , she noted, and in the case of Canadian investment in healthcare, like the proposed project to be built by the Dai An Vietnam Canada International Hospital Corporation, there is, seemingly active interest and immediate results for Vietnam. The Minister offered her unqualified support.
The business case for a private hospital
A private hospital corporation developed by agreement between a Vietnamese Corporation like Dai An JSC and Canadian company Triple Eye Corporation could be of significant benefit to Vietnam says Marc Kealey, principal of Triple Eye Corporation. “It behooves us as Canadians to try and find alternatives within our own system to help Vietnam realize her potential in a global world where health dollars should stay close to home” he says. He noted that options for healthcare are being considered in Vietnam by other countries like Malaysia, China, France and the United States and they are being closely examined to see how they can work. The benefit of a Canadian proposal is that the policy framework for private sector hospital projects or PPPs has worked in Canada and may be adopted in Vietnam.
“Private sector investment in healthcare is the way to go in country’s like Vietnam as the country matures – state run systems without adequate capitalization are never good. And as economies grow, so too, does choice for those with means who live there”, says Kealey. “There is a lot of talk from foreign companies who claim to have all the answers, we aim to have all the pieces in place, make a full contribution and realize the potential we set out to provide with our partner in Vietnam.”
The agreement between Triple Eye Corporation and Dai An JSC has prompted the establishment of a corporation in Vietnam called the “Dai An Vietnam Canada International Hospital Corporation”, which, is now in the throes of achieving its investment certificate. It is anticipated that the certificate will be granted when all the paperwork has been signed off. There have been hurdles and some bureaucracy from both Canada and Vietnam that have slowed things a bit, but the path is clear that a certificate will be granted and the project will begin.
For its part, Triple Eye Corporation of Canada is actively interviewing Canadian companies with who it will partner for the engineering, design, construction and staffing of the 200 bed hospital slated for completion in late 2015.
In the meantime, Triple Eye continues to lecture and promote the project widely across Canada. In recent months it has sought and garnered Canadian medical staff and a recognized Canadian university to work alongside in education and staffing for Vietnamese workers. There continue to be many emails and letters from interested Vietnamese health workers to Triple Eye about employment opportunities and Triple Eye is actively promoting the project to funding partners for financing the project – interest is high.
One of the greatest challenges facing Triple Eye in Canada comes from funding sources who inquire as to how to mitigate risk in Vietnam. This fear, Triple Eye believes comes largely from of lack of practical knowledge of the current Vietnam. “I personally believe that Canadians have to visit Vietnam if they are interested in that market and see for themselves the potential that exists there” says Kealey, “once Canadian business people and those available to deploy finance for large projects like our hospital corporation, well see how the economy is shifting and they will see the enormous opportunity that also exists there. Once that’s realized, the appetite for investment will increase and the fears for risks will be minimized. We have the right partner in Dai An JSC, the right economic environment, the right policy directives set from the highest levels of government in Vietnam and the Canadian Embassy in Hanoi is extremely helpful. Our job is to demonstrate the viability of the project to deploy funding from the finance sector and risk management organizations in Canada to see what we see in Vietnam”, said Kealey.
Time is of the essence for projects of this magnitude and Triple Eye and its partner Dai An JSC is striving to have all its papers in order by the end of summer 2013 to begin construction as soon as possible and have this, the first such hospital, ready for patients in 2015.