Turkey paid Turkish lira (TRY) 70.8bn ($1.7bn) to city hospital project contractors from January to July, according to health ministry data .

The ministry’s overall expenditures were TRY 594bn in the same period, meaning 12% of its budget was channelled to the contractors, which turn into hospital operators when they complete their public private partnership (PPP) projects.

Enough to pay for 78 state hospitals

For TRY 71bn, the government could build 78 state hospitals each providing 100 beds, Ankara Medical Chamber (@ankaratabipoda) noted on August 13. The hospitals could be built taking into account city and town demographics, urban structure and transportation infrastructure, it added.

To ensure “custom” for the giant city hospitals, built on the outskirts of cities, more accessible state hospitals are shut down to force patients into the new “market”.

Meanwhile, the difficulties posed by a lack of sufficient family health centres, which provide primary care services, continue, the chamber also said, adding that the construction of a four-unit centre costs TRY 10mn on average.

105bn lira is just the start

For 2025, the health ministry budgeted TRY 105bn, about 10% of its overall expenditures, for city hospital contractors. The actual expenditure will surpass the budgeted figure. It always does.

Also this year, the government budgeted a combined sum of TRY 202bn for PPP contractors. That’s equivalent to 1.4% of its forecast combined expenditures set at TRY 14 trillion and 10% of its budget deficit target of TRY 1.9 trillion.

In the 2024 budget, TRY 162bn was allocated for PPP contractors.

Each year, the actual figures in these areas also surpass the budgeted figures – with no exception.

Pay, pay, pay

Turkey’s government has provided $156bn in income guarantees to public-private-partnership (PPP) projects, including $81.2bn for city hospitals (to be paid between 2021 and 2045), $35bn for Akkuyu nuclear plant (2021-2035) being built by Russian contractors, $32bn for highways and bridges (2021-2042) as well as $7bn for airports (2021-2042), according to calculations made by Ugur Emek of Baskent University.

The $81.2bn sum will certainly be paid to city hospital operators as rent.

Some guarantees could possibly be unrealised if concerned projects earn money. However, among the completed projects, a self-financing project is yet to emerge.

Under PPP schemes, Turkey has built or is to build 20 airports and 25 city hospitals in addition to 102 power plants, 46 highways, 20 marinas and one railway, along with hotels, ports, mines and other kinds of infrastructural facilities.

More where that came from

Lately, Turkey’s “orthodox” economy management team led by ex-Merrill Lynch banker Mehmet Simsek has been announcing billions of dollars’ worth of loan deals to finance more infrastructure projects.

Earlier this month, Allianz Trade said in a report, entitled “3.5% to 2035: Bridging the Global Infrastructure Gap”, that Turkey needs to spend $121bn in non-energy infrastructure investments by 2035.

Turks will have to work a little harder. Their government and its foreign stakeholders have struck a consensus when it comes to channelling hundreds of billions of dollars to the contractors.