This story was produced in partnership with the International Consortium of Investigative Journalists.
Jacob Njagi’s newborn son could barely breathe when he arrived in an ambulance at the emergency ward of an Avenue Group hospital in Nairobi, Kenya, in the early hours of the morning. It was June 2022—Covid-19 cases were surging—and Njagi and his family had spent hours searching for an available bed. When they finally pulled up to the hospital in Parklands—a leafy neighborhood that felt a million miles away from the poverty around their home on the edge of the city—Njagi was exhausted. His infant, Jason, was in peril, his lungs clogged.
But Njagi said administrators at the hospital—which is backed by the International Finance Corp. (IFC), a member of the World Bank Group that works to relieve poverty—demanded a deposit. “We had to beg them to at least give us oxygen, because the oxygen in the ambulance was almost out,” Njagi recently told the International Consortium of Investigative Journalists (ICIJ).
Josephine and Jacob Njagi with their two children at their home in Wang’uru, an agricultural center northeast of Nairobi, Kenya, in March 2025Micah Reddy
Admission, he learned, required a deposit of 100,000 Kenyan shillings (about $850 at the time), more than a month’s income from the wholesale foods business he’d built. Njagi scrambled for funds, begging his sister for assistance. Her friends helped scrape together enough to cover a deposit for the baby, he said.
Nearly a week later, Jason was well enough to go home, but he had spent three days on a ventilator in the neonatal intensive care unit and needed further treatment, the doctors warned. Njagi, who is 34, was concerned that he could never pay the bill—already more than 400,000 shillings (about $3,600)—so he asked for his son to be discharged. Jason’s care had come at an almost unbearable cost: the financial stability Njagi had built for his family.
In Kenya, where only about a quarter of the population was insured in 2023, health care is scarce and often ruinously expensive. But the IFC-backed hospital that treated Njagi’s son was supposed to be different.
One of five institutions that make up the World Bank Group, the IFC’s mission is to fight poverty in developing nations by investing in the private sector, a task supported with funds from its more than 180 member countries. Its investment in Avenue Group, the company that runs the hospital where Njagi’s son was treated, was intended to advance the World Bank Group’s health care strategy, which includes helping families in the developing world avoid “poverty due to illness.”
Instead, IFC-backed, for-profit hospitals like those run by Avenue Group have destabilized the finances of families across East Africa, a yearlong investigation by ICIJ has found. Avenue Group’s operator, the Evercare Group, said that its hospitals and clinics provide “access to quality care for many poor and lower-income Kenyans” and that it does not make emergency care contingent on a patient’s ability to pay upfront.Since 2009, the IFC has partnered with at least four private equity firms that have invested its money in for-profit hospitals in Kenya and Uganda. While the IFC has made public promises to improve health care for everyone, its financing for private hospitals in East Africa has instead deepened inequality. It has also contributed to the tens of millions of dollars in management fees and financial performance bonuses paid to private equity firms for their work managing investments in hospitals on behalf of the IFC and others.
In over 70 interviews, former and current doctors, nurses, and executives from IFC-backed facilities in Kenya and Uganda and from the private equity firms managing them described how pressures to improve returns for investors contributed to increased treatment costs and reduced accessibility. This saddled some patients with crushing debt and diverted resources originally intended to help the poor toward making medical facilities more profitable. These accounts are supported by court records, internal corporate communications and documents, and patient records reviewed by ICIJ.
To collect unpaid bills, some of the hospitals unlawfully detained patients up to months at a time, ICIJ found. Some of these incidents were widely reported in the media and were the subject of high-profile court cases and government inquiries. But the IFC failed to prevent problematic practices from continuing at hospitals it helped finance. And the organization has continued backing private hospitals even as it has remained unclear whether the investments increase accessibility or affordability for the poor in any meaningful way.
The model was “profit before life. It was profit before health care. It was profit first,” according to one former executive who requested anonymity to discuss his experience leading a hospital in East Africa managed by an IFC-backed company. Care at some of the hospitals was so expensive that their own doctors and nurses could not afford it, ICIJ learned. In interviews about more than a dozen patients at these hospitals, their relatives and friends described how they solicited money for medical care from churches, mosques, workplaces, and even their home villages, effectively draining wealth from entire communities.
The IFC did not answer detailed questions from ICIJ about allegations of patient mistreatment or aggressive efforts to collect payments at the hospitals it funds. It said the IFC “advocates for improved financial protection for citizens,” adding that its client hospitals try to help low-income patients, but people still struggle because many countries’ public health care systems aren’t sufficiently funded. The organization also said that it expects the hospitals to inform the IFC and other relevant authorities of credible allegations of wrongdoing and that when necessary, the hospitals should strengthen internal controls.“We can and must do better in our oversight and supervision,” the IFC said in its statement, adding that, going forward, it “will not work with new clients who do not commit to—and follow—our standards, and ethical principles and practices for patient care.” Bloomberg News and the anti-poverty organization Oxfam have both also recently reported on the high cost of care and problematic practices at IFC-financed hospitals.
Evercare, Avenue Group’s operator, also said, “It is not our policy to detain patients for non-payment.” It noted the “robust financial counseling programs” and “flexible payment solutions” it provides to patients and said it has introduced care protocols that include an express prohibition on detentions.
But the concerns shared with ICIJ about the IFC’s investments cannot be reduced to individual acts of wrongdoing; they go to the very core of the organization’s approach to investing in health care—one based on trust in private equity firms and for-profit corporations to protect the most vulnerable. Since 1999, the IFC has put more than $9 billion into backing private health care companies in countries such as Kenya and Uganda, kicking off a surge in financing from taxpayer-funded development institutions into private hospitals across the developing world. It has set the bar for other players investing in international development, promising that its health care investments will work toward “emphasizing robust health systems and ensuring accessible, affordable quality services for all.”
The IFC has delivered on part of that promise: Its financing has helped underwrite the construction or acquisition of hospitals and outpatient clinics in Africa, Asia, Latin America, and the Middle East. And it has, among other things, helped providers secure loans to buy equipment and set up operating theaters that enable hospitals to offer lifesaving care.
For some, however, those services have come at an almost unbearable cost. Njagi is grateful to the IFC-backed Avenue Group hospital that saved his son, but the bill put him in a financial spiral, he said. His family was homeless at one point and has at times lived with relatives, he said, adding that the strain nearly ended his marriage.
Before his encounter with Avenue Group, Njagi’s finances were stable and he was “able to provide,” he said.But now, he works as a day laborer in the rice fields near his home, which is a single room with a communal toilet.Financially, he said, “I have nothing left.”
Jacob Njagi at his home in Wang'uru Micah Reddy
Founded in 1956 and headquartered in Washington, DC, the International Finance Corp. is tasked with promoting private enterprise in the developing world and helping to create global prosperity. But in its first four decades, it largely stayed away from health care, an area that many at its parent organization, the World Bank Group, believed was better left to governments.
In the 1990s, however, as a wave of enthusiasm for the privatization of government services swept the Western world, the World Bank Group reevaluated the private sector’s role in providing health care. In 1997, it released a comprehensive health strategy that pledged to use its vast resources and influence to improve health outcomes for the poor and protect them from “the impoverishing effects of illness.” Responding to the call, the IFC began pouring money into the health care sector, and by 2001, it had approved dozens of projects.
Still, some at the IFC weren’t sure that financing private hospitals would advance its anti-poverty mandate. They worried about how patients would afford the care at these new facilities: Private hospitals “are less open to poor people unless there are some financial mechanisms,” such as universal health coverage, to pay the costs of their care, Guy Ellena, the IFC’s then-director of health and education, told a 2002 meeting of its board.
By 2007, however, such concerns had faded. In a report titled “The Business of Health in Africa,” the IFC described how investors could, through strategies like increasing patient volume, profit from hospitals tending to the continent’s poor.
Seeking to set an example for other investors, the IFC announced plans to launch the Africa Health Fund—a $100 million investment vehicle for “helping low-income Africans gain access to affordable, high-quality health services.”
To manage the undertaking, the IFC and several co-investors selected Aureos Capital, a private equity firm focused on small-scale investments in the developing world. In a 2008 fund proposal obtained by ICIJ, Aureos told prospective shareholders that it saw “no conflict in the goals of improving Africans’ livelihoods through better healthcare provision, and generating 15-20% gross annual returns to investors.”Aureos would collect an industry-standard 2.5 percent management fee, according to an appointment letter from the IFC. And the firm would earn millions more if it met the fund’s goal of serving the “bottom of the pyramid”—people earning less than $3,000 per year. Additional rewards would kick in if the investments reached those making under $1,000. (Nearly 40 percent of Kenyans live on less than 8,006 Kenyan shillings a month, equivalent to about $730 a year, according to the most recent government survey.)
The Kenya Parliment building and nearby Uhuru Park, one of the recreational areas of Kenya’s capital, NairobiSteffen Trumpf/picture-alliance/dpa/AP
For its first investment, Aureos selected a company that looked like a perfect fit for the fund’s objectives: a private hospital in Nairobi founded by Sam Thenya, a charismatic young doctor who used his profits to subsidize charitable work.
Thenya founded Nairobi Women’s Hospital in 2001, driven by his anger after administrators at his previous job insisted that a sexual assault survivor pay for emergency care out of pocket. The hospital tended to Nairobi’s middle class and poor while offering free care to survivors of sexual and domestic violence.
“I told the [Nairobi Women’s Hospital] board that we had to provide free services even though we were struggling financially,” Thenya said in a 2014 interview. When the board told him that the work was unaffordable, he refused to listen: “I told them, ‘Over my dead body!’”
Thenya’s story was compelling for the IFC’s fund manager Aureos, and by early 2010, it had acquired over 20 percent of Nairobi Women’s for $2.7 million; two Aureos staff members joined the company’s board of directors.
Finding other investments that fulfilled the IFC’s ambitious goals was a slow task. More than a year later, Aureos invested in two more private health care providers. One was Avenue Group, which ran the hospital that would one day treat Jacob Njagi’s infant son.Soon, the Africa Health Fund attracted partners from around the world, including the development finance institutions of France, Norway, and South Africa. But there were already concerns that the money was failing to reach those it was intended to serve.
In 2012, an independent advisory firm hired by the IFC and its partners to evaluate their health initiative in Africa noted that private investments focused on helping the underserved “may not be viable on a commercial scale.”
That didn’t seem to deter Abraaj Capital, a Dubai, United Arab Emirates–based private equity firm focused on emerging economies. The firm acquired Aureos later that year, taking over management of the IFC-backed Africa Health Fund.
The fund’s portfolio of companies epitomized the kind of “impact investing” that Abraaj’s founder, Arif Naqvi, had championed in settings like the billionaire-studded World Economic Forum in Davos, Switzerland: businesses that promised to make large profits while improving lives in the developing world.
With the Aureos deal, Abraaj gained control of around $7.5 billion worth of investments in a variety of industries worldwide. That same year, an industry publication ranked Abraaj the largest private equity firm specializing in emerging markets. Abraaj had previously invested in hospitals and other health care businesses in the Middle East and Asia, and it quickly increased the Africa Health Fund’s stake in Nairobi Women’s.
With the fund as a backer, the chain had rapidly expanded its operations, opening new hospitals and clinics. Avenue Group had also grown quickly, doubling its clinics and adding a hospital. Bolstered by this apparent success, Abraaj began approaching investors about a new fund: a billion-dollar “ecosystem” of health businesses serving developing countries.
The IFC decided to invest $150 million in the project. The organization’s involvement signaled to other potential backers that their money would be well spent, a portfolio manager at the pension fund of the United Church of Christ, a socially liberal Protestant denomination, said duringa 2017 forum co-hosted by Abraaj. For those interested in social change, he said, the power of the IFC’s imprimatur “literally cannot be overstated.”
Altogether,investorspiled $850 million into the new fund, allowing Abraajto make major acquisitions in India, Pakistan, and elsewhere.The fund also dramatically increased its presence in Kenya: It took controlling stakes in Nairobi Women’s and two other hospitals and acquired Avenue Group.
In a disclosure, the IFC said the new fund would contribute to its anti-poverty mission by targeting “improvement in access, quality and affordability of healthcare for low-income and middle-income populations in Africa” and elsewhere.
During meetings at a public hospital in Kenya, however, Khawar Mann, head of Abraaj’s health investments, provided a less optimistic analysis to a medical student who questioned how the fund would help the poor.
“We can’t go to that part of the population,” Mann replied, according to a description of the encounter in the New York Times.“The business is just not sustainable.”
Men walk at dawn in the Mathare slum in Nairobi, Kenya.Tony Karumba/AFP/Getty
By the third quarter of 2017, Abraaj had collected $37.6 million in management fees from the new health care fund—enough to cover the cost of a routine birth for over 77,000 women at an Avenue Group hospital.
Meanwhile, administrators at IFC-backed hospitals required uninsured patients—more than 75 percent of the population in Kenya and nearly everyone in Uganda lacks insurance—to pay large upfront deposits for admission, occasionally causing delays in critical care, according to interviews with current and former hospital staff and patients’ families. (Evercare denied making emergency care contingent on a patient’s ability to pay upfront.)
Once admitted, patients without the ability to pay their bills could be stuck indefinitely. Even transfer to a cheaper facility could depend on a patient’s financial resources: One man interviewed by ICIJ was hit by a car in late2024 and lay in Avenue Group’s Parklands hospital in Nairobi for a week with two broken legs and a broken jaw while family and friends solicited donations for his treatment. His family asked for a transfer after a doctor estimated it would cost 700,000 Kenyan shillings ($5,400 at the time) to fix one leg, according to a supporter and medical bills reviewed by ICIJ. Management agreed to move him, a friend said, but only after the family paid the bill for his ICU care and other services, which by then had risen to more than 1.3 million Kenyan shillings ($10,263). When he eventually went to a public hospital, treatment costs were a fraction of what Avenue Group charged. Hospital administrators, including at Avenue Group, sometimes asked patients in arrears to turn over the deed to their land or their car as collateral, according to doctors, nurses, staff, and patients interviewed by ICIJ, as well as a legal agreement and internal documents from Avenue Group.
Those without assets to turn over sometimes faced a bleaker scenario: remaining in the hospital while they—or their friends and family—collected funds. Public and private hospitals throughout the region were notorious for the practice of holding patients until they settled their bill, sometimes known as “discharge-in.” This most often happened to uninsured people who had come in for a serious emergency.
The problem was particularly acute at Nairobi Women’s. The hospital, which had received its first IFC-backed investments by early 2010, had been under scrutiny by the news media and local authorities for holding patients and even bodies over unpaid bills since at least 2014, the year a man reportedly sued the hospital for allegedly refusing to transfer his ailing wife to another facility because of an outstanding bill.Thenya, the hospital group’s founder and current CEO, freely admitted to the practice. In a 2016 interview, he told the Kenyan newspaper Business Daily that his “biggest problem” was “politicians calling for release of patients who have not paid their bills.”
As the years went by, examples of abuses at Nairobi Women’s piled up: Patient “detentions” were noted in court cases and chronicled in newspaper articles and two television exposés in 2017 and 2019 that found 16 people being held at the company’s hospitals. One woman had been there for nearly 230 days.
“We just became sick like any other person can get sick,” one of the patients told a reporter in 2017, as Abraaj piled up its management fees. “And now we’ve been detained in here like prisoners.”
In an interview with a television reporter about the detentions, Thenya said, “‘Cheap’ does not exist in health care.” Nairobi Women’s was owed over 430 million Kenyan shillings ($4.2 million) in outstanding bills, the report noted, but did not explain why.
Following a news report, a Kenyan parliamentary committee ordered an investigation into the monthslong detention of the body of a young woman whose kidneys had failed after she received treatment at one of Nairobi Women’s hospitals. Before she died, her family had requested a transfer to a cheaper public facility. But Nairobi Women’s moved her instead to a different branch, where she died several weeks later, the committee found, adding that the family consent form the hospital shared with the committee “appeared to be a forgery.” The administrators’ actions, the committee noted, seemed to have been “motivated by the need to keep the patient in the hospital’s custody to ensure payment of the bill already incurred”—nearly 2.6 million Kenyan shillings (about $25,000).
The board of Nairobi Women’s, which at the time included at least one representative from Abraaj, had met to discuss the case, the hospital group’s chief operating officer told the committee, adding that the board was empowered to forgive debts after 12 months. But it was only after the committee began its investigation that the hospital agreed to release the woman’s body and waive the bill. The committee took no further action, and detentions at Nairobi Women’s hospitals continued: Two years later, in 2019, the Kenya Ministry of Health reportedly found 15 bodies and 12 discharged patients being held there. Even rulings from Kenya’s High Court, which heard at least three civil suits by patients detained unlawfully at Nairobi Women’s, did little to stop the practice. In 2016, a judge ordered the company to pay a million Kenyan shillings ($9,600) to a woman it had held for more than three months over an outstanding bill of 173,000 Kenyan shillings ($1,700). Two years later, the court ordered Nairobi Women’s to release a man it had held for months after a traffic accident. And in 2021, it awarded damages to a young mom, Emmah Njeri, whom Nairobi Women’s had held for more than five months in 2018 over unpaid bills exceeding 2.7 million Kenyan shillings (about $27,000).
When Njeri finally went home, her 9-month-old son no longer recognized her, she told ICIJ: “The bond has never been as before.”
In a statement to ICIJ, Thenya wrote that the practice of “delayed discharges” was never meant to be punitive. Rather, they were merely “a reflection of systemic challenges in healthcare financing.”
The board, he wrote, had been aware that Nairobi Women’s was holding patients over unpaid bills, and—after the first High Court ruling—the company took steps to end the practice. Still, the hospital “continues to face difficulties” with uninsured patients, “which sometimes complicates discharge logistics,” Thenya added. “Nevertheless, we remain committed to patient dignity and legal compliance.”It’s unclear what the IFC knew about the detentions at Nairobi Women’s and other hospitals, and it has not been named in any of the publicly available court documents involving former patients reviewed by ICIJ. But representatives from multiple IFC-backed private equity funds—not just Abraaj—knew of detentions, according to interviews with five people familiar with the situation.
By the end of 2017, investors had begun raising questions about Abraaj and its global health fund. According to allegations in court filings by the US Securities and Exchange Commission, hundreds of millions of dollars earmarked for health care investments had been flowing into the firm’s other accounts “to cover cash shortfalls.” The following year, Abraaj returned part of the IFC-backed fund’s capital under pressure from its investors, who soon began a search for a new firm to take over its assets.
It had been a decade since the IFC had begun its private health care push into Africa, but a report by the World Bank’s independent evaluation group found there was still “limited evidence” that the IFC’s health care investments had benefited the poor.
Meanwhile, staff at Avenue Group hospitals were increasingly concerned about their employer’s direction since their purchase by Abraaj. Dissatisfaction with wages and conditions led nurses and other staff to unionize. A petition reportedly signed by more than 100 employees decried Avenue Group’s focus on profit over patient care: “Priorities have changed from provision of high-quality health care for a reasonable price to one in which staff have been encouraged to over test, over prescribe and generally overcharge our valuable patients to increase profits.”
In April 2019, Abraaj’s founder, Arif Naqvi, was arrested in the United Kingdom on fraud charges, including the alleged misappropriation of approximately $100 million of the health fund’s assets. Shortly after, TPG, one of the world’s largest private equity funds, took over Abraaj’s health portfolio, including its IFC-backed investments in Kenya, renamed it the Evercare Health Fund, and wrapped it into its own impact investment portfolio, the Rise Fund. (Naqvi is currently awaiting extradition to the United States to stand trial. Naqvi has denied wrongdoing and could not be reached for comment.)
On its new website, in an echo of the Abraaj fund’s founding logic, Evercare stated that its mission was “to build a legacy of accessible, high quality, safe private healthcare for low and middle-income patients in emerging markets.” But by the end of 2020, the reference to low- and middle-income patients had disappeared. In a statement to ICIJ, the company said it “continues to focus on access to high quality care for patients across the socio-economic spectrum, particularly in underserved markets.”
A mural promotes awareness of coronavirus in the Kibera neighborhood of Nairobi.Donwilson Odhiambo/SOPA Images/Getty
That same year, local media reported on leaked messages from a WhatsApp group made up of Nairobi Women’s employees. The messages, from before TPG took over, showed the CEO of Nairobi Women’s at the time, Felix Wanjala, pushing doctors to meet daily admissions targets and apparently urging them to extend patients’ hospital stays. Progress updates posted to the group included a category for “discharge-ins.”
In an email to the hospital group’s board after the leak, Wanjala denied accusations that he was trying to raise revenue unfairly. But he wrote that, under TPG, the need to boost returns was only growing more urgent: Profits were the “number one issue that every one of our directors keep an eye on,” he wrote, adding, “we rarely discuss patient care in our meetings—[it’s] a side issue.” TPG, he said, “wants EBITDA X3 in three years,” using an abbreviation for a common measure of profitability.
Two days later, Nairobi Women’s announced that Wanjala would step aside from his post. Instead, a three-person committee from TPG’s Evercare would lead the hospital group and report to the board.
The Kenya Medical Practitioners and Dentists Council subsequently admonished the company’s management for overruling doctors’ decisions to medically discharge patients. But, the council noted, it had seen no evidence of overcharging for services. In response to questions from ICIJ, Evercare wrote that after the leak, the board of Nairobi Women’s hired an outside firm to recommend ways to improve patient care and established better reporting and monitoring of admissions and discharges.
Speaking to ICIJ, Wanjala said that the WhatsApp messages were taken out of context and that there was no evidence that patients had been overcharged. Additionally, he said that during his time as CEO, Nairobi Women’s never received specific profit targets from investors and his email was in regards only to initial conversations he had had with TPG.
For some executives at Evercare and Avenue Group, the scandal confirmed long-held suspicions about Nairobi Women’s. For years, fund managers had viewed it as the most successful of the IFC-backed hospital businesses in Kenya, an example for others to emulate, according to four former executives at Avenue Group and Evercare.
But few investors questioned how the business achieved its results. The focus on “financials and nothing else” had stopped investors from seeing what was happening right in front of their eyes, a former Avenue Group executive said. When a hospital is overly focused on generating substantial returns, that means “there’s a patient who’s suffering. There’s a patient who’s losing in terms of either losing quality of life [or] quality of care.”
In 2023, Evercare sold Nairobi Women’s back to its founder, ending IFC’s involvement with the chain. But Nairobi Women’s never fully recovered from the WhatsApp leak about patient discharges. Its Rongai branch closed in October 2024, and employees across the company quit as it fell months behind on paychecks.In a Facebook post addressing the situation, Thenya, Nairobi Women’s founder, attributed the shortfall to delayed payments from government-run health insurance plans. Nairobi Women’s performance is improving, he told ICIJ.
A health care worker administers a vaccine to a Nairobi resident during a mass vaccination drive countrywide.John Ochieng/SOPA Images/Getty
In the summer of 2020, after the WhatsApp leak and as Covid-19 spread, the IFC launched an initiative to promote ethical principles in the private health sector.
A guide to the initiative provided examples of unethical practices, including “incarcerating patients for non-payment,” in what appeared to be the first public acknowledgement by an IFC-affiliated organization of the widespread practice of holding patients with unpaid bills.
The IFC encouraged private health care investors and providers to commit to a set of 10 ethical principles, including one calling on hospitals to deal “humanely” with patients unable to pay their bills. But there was no built-in enforcement: Organizations that pledged their commitment to these standards would not be held accountable to them.
For instance, one of the ethics initiative’s founding signatories, Hospital Holdings Investment, managed a Ugandan hospital that in 2021 drew national condemnation after it reportedly refused to release the body of a doctor who had died of Covid-19. In 2019, the IFC had provided $27 million in financing to the business—including a $22 million equity investment that made it one of the company’s largest shareholders—pledging to “ensure that the Company adheres to high environmental, safety and social standards.” A 2018 proposal for the venture told potential investors that they could expect a “minimum” 25 percent return over a five-year period, according to documents reviewed by ICIJ.
In a statement to ICIJ, the Investment Fund for Health in Africa, the private equity fund managing Hospital Holdings, wrote that the case of the detained doctor’s body occurred at the height of the pandemic, when health care providers globally were strained, and that it has since strengthened care and “has policies in place to avoid detention of patients or corpses over unpaid medical bills.” It also said ICIJ’s email asking about the Investment Fund for Health in Africa’s operations contained “multiple statements which are incorrect and taken out of context,” but did not provide examples.
Evercare signed on to the ethics pledge in September 2021. But at some hospitals in its portfolio, pressure from management to increase revenue in ways that might run afoul of that pledge was still present, according to people familiar with the situation and documents reviewed by ICIJ. In a meeting with representatives from TPG in early 2021, Avenue Group’s chief operating officer accused the medical group’s then-CEO of instructing doctors “to contravene medical policy and ethics by referring patients for admission to treatment who do not fit that medical criteria,” according to a witness statement submitted to the Kenyan High Court in relation to a labor dispute.
The witness also claimed that staff repeatedly raised concerns through an employer-provided whistleblower platform. Avenue Group’s board, Evercare, and TPG ignored them and even took disciplinary actions against “those who oppose unethical or illegal instructions,” the person wrote in the statement.
Evercare told ICIJ that it had conducted an extensive investigation in response to the allegations and found “no evidence or indications of misconduct.”
In early 2024, managers at Avenue Group’s hospital in Parklands told medical officers that they would be evaluated in part on their ability to “increase revenue.” Targets included meeting an average “ticket price” per patient, performing lab work on 78 percent of patients, and sending 85 percent of patients to radiology, according to a document reviewed by ICIJ.
In its statement, Evercare said doctors “are not evaluated based on revenue generation or commercial targets but solely on quality patient care, clinical safety, and adherence to internationally accepted evidence-based medicine guidelines.”
Today, Avenue Group’s hospitals display signs telling patients that they are free to leave against medical advice but that they also have an obligation to settle debts. Discharge and financial consent policies, last updated in September 2024, do not mention detention or how staff should handle patients who cannot pay their bills. Former and current Avenue Group staff interviewed by ICIJ continue to question its direction. While there was wide agreement that health care resources had benefited from the investments by the IFC, almost all believed patients had been ill-served by the fundamental misalignment between the goals of private equity and the goals of health care providers. The hospitals provide high-quality care, one former executive told ICIJ. But, he added, if receiving treatment means “you’re in debt for the rest of your life, what’s the point?”
In recent years, despite court cases and news coverage, IFC-backed hospitals have continued to put patients in financial distress. (A new national health insurance program introduced last year in Kenya has aimed to make health care more accessible.) ICIJ found dozens of posts on social media and the fundraising site GoFundMe, published from 2020 to 2025, pleading for friends, family, and community members to contribute money toward bills at Avenue Group and other IFC-backed hospitals. ICIJ spoke with 12 people who since 2020 have received treatment at Avenue Group hospitals for themselves or family members, only to come under severe financial strain.Among them was Siamah Shabaan, who in March 2024 fell ill while pregnant and was taken to a public hospital in Kisumu. But doctors at government facilities nationwide were on strike, so she was moved to an Avenue Group hospital. The hospital admitted her without a deposit, but her baby died shortly after birth. The family soon took out a private loan to pay part of the baby’s bill.
Siamah Shabaan (left) with her mother at their home in MuhoroniMicah Reddy
Shabaan needed only a few days to recover from her illness, she said, but she remained in the hospital for almost two weeks as her mother begged the village chief and local imam to each send the hospital letters explaining that the family had no money. She hand-delivered them to the hospital to ask for leniency.
Not long after, Shabaan returned to her home in Muhoroni, where she lives with her mother in a shack with a tin roof and no electricity. When Shabaan was discharged, there were two bills: around $1,200 for her and around $600 for her baby, far more than she could pay. Even before Shabaan was treated at an Avenue Group hospital, she and her family had nearly nothing. Now, they have less, Shabaan said. The hospital regularly calls her mother, urging her to make payments toward the debt. The family says they have been told to pay any amount, even as little as 1,000 Kenyan shillings ($7.68). But her mother has no job and the family can’t afford to.
Shabaan is not bitter about the situation—she is thankful to the hospital for saving her life.She hopes to someday have the resources to pay the bills. She’s just not sure how that will ever happen.
Siamah Shabaan at her home in Muhoroni Micah Reddy
In the meantime, the creditors that Shabaan’s mother turned to when her daughter was hospitalized have threatened to have her arrested, Shabaan said during a visit with an ICIJ reporter. The women were sitting on a pair of old wooden chairs, the only decorations in their nearly empty home. The chairs had belonged to her grandfather, Shabaan said. Just a few days before, the creditors had come to take them.
The family had to plead with them not to, she said. But she doesn’t know how much longer they will wait.
*Contributors: Denise Ajiri, Jelena Cosic, Miguel Fiandor Gutiérrez, Karrie Kehoe, Delphine Reuter, *David Rowell, Annys Shin, Kathleen Cahill, Davi Sherman (ICIJ)**, Hannah Levintova (Mother Jones), and Frederic Musisi (Daily Monitor)
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