ADB lends Türkiye €620 million for nine disaster-resilient hospitals

The Asian Development Bank has approved a €620 million loan to help Türkiye's Ministry of Health build disaster-resilient public hospitals in earthquake-affected and high-risk provinces, the bank said on 28 October.

The government will add €182 million of its own money, the bank said, and the loan is worth about $700 million. By 2033 the hospitals are expected to serve nearly 300,000 inpatients a year. The project covers nine secondary and tertiary hospitals, including two research and training hospitals and a specialised mental health facility. The bank recalled that the 2023 earthquakes severely damaged 136 hospitals and about 15 per cent of primary health care facilities.

The board paper behind the loan, the Report and Recommendation of the President dated October 2026, sets out how the money will be spent and controlled. It is a sector loan: of the nine indicative subprojects, three have been confirmed and the rest will be chosen during implementation under agreed selection criteria. Eight are climate- and disaster-resilient hospitals; the ninth is a detoxification and mental health hospital, and the advance actions include advertising the Balıkesir Detoxification and Mental Health Facility.

Where the €802 million goes

The report puts the total cost at €802.13 million, of which the government contributes €182.13 million. The base cost of €623.94 million splits into €434.41 million for the eight hospitals, €185.29 million for hospital service delivery, research and training, and specialised mental health services, and €4.25 million for operational readiness, monitoring and supervision. Contingencies add €93.46 million and financial charges during implementation €84.73 million. The total includes €103.99 million of taxes and duties, of which the bank will finance €93.29 million.

The bank pays for civil works and part of the contingencies; the government pays for equipment and furniture (€64.22 million), part of the contingencies and the financing charges. The regular loan from ordinary capital resources runs for 25 years with a six-year grace period, a commitment charge of 0.15 per cent a year and an average maturity of 15.75 years. The bank counts €496.00 million of its financing as climate finance, €347.20 million for mitigation and €148.80 million for adaptation.

Fiduciary risks rated moderate

The report rates financial management risk before mitigation as moderate, mainly because the ministry and its project management support unit have no prior experience of the bank's financial management and disbursement rules, the unit lacks capacity for the extra workload, and there is no project financial management manual yet. The fixes are online courses for the unit's finance staff, a briefing at inception, a manual and dedicated financial management staff.

Procurement risk is also rated moderate, reflecting the unit's expertise, the type of works and the readiness of contracts and designs. Procurement follows the bank's Procurement Policy of 2017 and its Procurement Directive for borrowers of 2026. The report plans nine works contracts by nationally advertised open competitive bidding, worth $608.48 million, and nine supervision contracts by quality- and cost-based selection, worth $18.26 million and shared equally by the bank and the government. There is no retroactive financing. On integrity, the report states: "No significant integrity risks were identified." The bank says it explained its Anticorruption Policy to the government and the ministry and will run regular awareness activities for ministry staff.

Oversight and timetable

The report's risk table lists three main risks: inconsistent application of seismic and climate standards, hospitals completed but not fully functional for lack of staff, equipment or systems, and fiscal pressures diverting counterpart funding. Against the last, the bank will include loan assurances requiring the government to budget adequately for counterpart resources, recurrent costs and the operation and maintenance of project assets.

An oversight committee made up of a deputy health minister and senior ministry officials supervises the project; the ministry is the executing agency and a 10-person project management support unit implements it. Implementation runs from January 2027 to December 2033, with the loan due to close on 30 June 2034. Every hospital must meet the national quality standards of the Türkiye Health Care Quality and Accreditation Institute, run at least one disaster drill with a documented after-action review and set up confidential grievance and patient feedback channels. At least one core non-clinical service in each hospital will be procured from the private sector.

The project page lists the loan, project 59413-001, as $700 million from ordinary capital resources. For the state of Türkiye's institutions more widely, see our country governance briefing; the project's climate finance share sits beside the rules for the pilot period of Türkiye's emissions trading system, issued on 1 October.