Watch the recording here.

 

At a pivotal moment for global health financing, the Bay Area Global Health Alliance convened a members-only virtual deep dive with the U.S. International Development Finance Corporation (DFC) to help organizations better understand DFC’s mandate and assess whether their work aligns with the agency’s strategic priorities and financing tools. The DFC’s Nafisa Jiwani, Associate Vice President of Health Initiatives, and Monisha Ashok, Director of Health Investments, provided a clear overview of DFC’s investment criteria and strategic focus — along with practical guidance to help members evaluate potential fit and identify next steps for engagement.

“The goal of the session is to provide clarity around three areas: the DFC’s eligibility criteria and investment parameters, examples of DFC’s investments, and concrete next steps to learn more or apply for investment,” explained moderator Krista Donaldson, Director of Innovation to Impact at Stanford Mussallem Center for Biodesign and Alliance board member.

With Congress reauthorizing DFC at a $205 billion investment cap in December 2025, the conversation with Jiwani and Ashok provided timely clarity on what the expanded cap may mean for digital health startups, established technology and pharmaceutical companies, and health systems implementers that are looking to drive innovation and scale health impact across priority markets.

When summarizing the eligibility and priorities, Ashok shared, “At a high level, is it in the private sector?… Is it a commercially viable project?…Is this advancing American foreign policy and national security priorities?…And is there support from the host country’s government?”

“Every transaction, no matter what, will go through a rigorous review of how it makes America more prosperous, safer, or stronger,” Jiwani emphasized. “Really understanding the [U.S. Department of State’s America First Global Health] strategy is very helpful as you’re thinking about the types of transactions that this administration is interested in.”

 

Key Takeaways

• Ensure the project is commercially viable. DFC prioritizes projects that are financially sound and capable of generating returns.
• Align with U.S. foreign policy and national security strategies. Understanding the U.S. Department of State’s America First Global Health Strategy will be helpful in thinking about what the administration is interested in.
• Demonstrate strong local impact and government partnerships. Projects are evaluated for positive impact in the host country, including government support and alignment with local health priorities.
• Leverage DFC’s diverse range of financial tools. The agency combines debt, equity, political risk insurance, project development financing, and fund investments to meet different needs. 
• Engage early and utilize DFC’s open application process. Success often depends on early engagement and understanding DFC’s priorities. Get guidance on strategic alignment to improve your chances of success.

 

DFC’s Mandate, Mission, and Financial Tools

The DFC is focused on increasing private sector investment across multiple markets. With its recent reauthorization, DFC has expanded beyond traditional emerging markets to support broader foreign policy and national security priorities.

“On [Capitol] hill, you’ll hear about the DFC being one of the sharpest foreign policy tools that we have,” Jiwani said. “Our goal is to increase private capital not just in emerging markets, but in several different markets that we haven’t been able to work in before.”

Jiwani clarified how DFC operates more like a bank, noting how they do not provide grants or concessional loans. “We offer longer tenors and competitive interest rates because we have an interest in working with the private sector entity and the region or country where we’re investing,” she shared.

DFC relies on a set of financial tools to support its investments, with debt financing and political risk insurance forming the backbone of its operations. Equity, while newer, is becoming an important tool for the agency, alongside investment funds and limited project development support. 

“We now have a $5 billion evolving equity fund, and we can take up to a 40% stake in a company,” Jiwani shared, highlighting how the recent reauthorization strengthened DFC’s financial tools and expanded its capacity to invest, including in equity and new markets, from a $60 billion to $205 billion cap. 

She also highlighted the agency’s evolving geographic focus, with reauthorization allowing the DFC to invest in high income countries. “We will still focus on emerging markets for health — sub-Saharan Africa, the Indo-Pacific, and the Western Hemisphere — but there are opportunities to invest in high-income countries when there’s a clear foreign policy imperative,” Jiwani explained, noting that the DFC’s Office of External Affairs will provide formal guidance on where the agency can and cannot operate by sector.

Ashok noted that DFC rarely does smaller investments under $5M, as transaction costs are similar to larger deals, with the agency’s average ticket size around $25M and a current focus on larger, strategically important projects.

 

DFC’s Health Investment Strategy and Priorities

“The opportunity for regionalization [of manufacturing and supply chains] is huge. I think this portfolio in particular will still be a priority for this administration.” — Nafisa Jiwani, Associate Vice President of Health Initiatives, U.S. DFC

DFC’s health portfolio focuses on three core areas. First, healthcare services and delivery, which includes infrastructure such as hospitals, clinics, and labs. Second, manufacturing and supply chains, covering medical devices, vaccines, therapeutics, diagnostics, and the inputs required across regions — a priority amplified by recent global supply chain challenges. Third, the intersection of health and technology, including digital health systems, electronic health records, insurance platforms, and biosecurity or surveillance systems. 

“The opportunity for regionalization [of manufacturing and supply chains] is huge. I think this portfolio in particular will still be a priority for this administration,” Jiwani said. She noted that investment allocation across these areas will be guided by the administration’s foreign policy priorities and the percentage they want to allocate for equity. 

“In terms of guardrails, there’s a lot more space for us to explore with debt, and our exposure limits are fairly high,” Jiwani explained. “The challenging piece is really finding the types of transactions that are bankable.” While DFC has the capacity and flexibility to provide sizable loans, it still prioritizes projects that are financially sound and likely to succeed, ensuring that each investment is commercially viable and capable of generating returns.

 

Examples Highlighting DFC’s Investment Approach

While DFC has the capacity and flexibility to provide sizable loans, it still prioritizes projects that are financially sound and likely to succeed, ensuring that each investment is commercially viable and capable of generating returns.

Institute Pasteur de Dakar (IPD): Vaccine Manufacturing in Senegal | Project Development Financing

DFC supported vaccine manufacturing at Institute Pasteur de Dakar through a stepwise financing model: a $3M project development financing in 2021 to prepare for broader investment, followed by a $15M loan in 2023 to complete construction of a vaccine manufacturing facility and begin operations to produce both outbreak and routine vaccines. “This is an example where collaboration and patient capital was really required because it was such a new, and quite an ambitious, endeavor,” Ashok highlighted. The facility aims to produce 200 million doses annually and partnered with other development finance institutes and U.S. agencies like Department of Health and Human Services (HHS) and the Biomedical Advanced Research and Development Authority (BARDA) for tech transfer and workforce development.

Kasha: Digital Health Platform | Equity Investment

Kasha is a digital health platform that delivers health and household products to last-mile populations in East and South Africa. The DFC initially made a $1M equity investment in 2021, followed by a $3M follow-on in their Series B in 2023–2024. Kasha now generates over $50M in revenue, has expanded its product offerings, and is exploring partnerships with U.S. pharmaceutical companies. “This is an example of an equity investment from the early days of deploying our equity tool,” Ashok explained. “It’s a smaller and earlier-stage investment than what we typically do today, because now we’re focusing on larger projects aligned with strategic foreign policy and national security priorities.” Ashok also shared that DFC rarely pursues investments under $5 million and prioritizes larger, strategically aligned projects, averaging about $25 million.

Quadra Health Fund: Health Services and Manufacturing in India | Fund Investment

Quadra is a private equity fund focused on healthcare services, manufacturing, and technology, primarily in India but also across South and Southeast Asia. “This one gives us an ability to invest in areas where it’s harder for us to do direct investment…If there’s something very specific, then it’s helpful for us to partner with funds that have those capabilities to invest on our behalf,” Ashok explained, highlighting DFC’s $75 million follow-on investment in Quadra’s third fund. Moving forward, DFC plans to focus on more specialized funds aligned with U.S. strategic interests, taking an active role as either a general or limited partner and exploring co-investment opportunities.

Good Life: Pharmacy Chain in Rwanda | Political Risk Insurance

DFC’s political risk insurance safeguards investments against unpredictable public sector challenges, such as government instability, regulatory changes, or sudden contract cancellations. “This tool helps make assets, whether debt or equity, more attractive for investors, especially in fragile markets,” Ashok shared. DFC provided a $15 million political risk insurance policy to support Good Life Pharmacies’ expansion into rural areas, helping ensure the financial viability of new clinics. This coverage was deployed alongside a follow-on debt investment, illustrating how DFC combines its financial tools to mitigate risk and attract private capital for strategic health projects in emerging markets.

 

DFC Application Process & Timeline

DFC’s application process for health investments is designed to be open, thorough, and highly selective.  Ashok explained that they look at the commercial viability of the project, whether it is advancing American foreign policy and national security priorities, and why this is strategic for the DFC. She emphasized that all applicants must have a solid business plan, financial track record, and realistic projections. 

Projects are additionally assessed for positive impact to the host country, looking at if there is support from the country’s government, what kind of partnerships are in the country, and how the project fits with the broader health landscape. DFC will also assess eligibility based on whether they do business in the country of interest and whether or not the project falls within a prohibited sector.

DFC sources opportunities broadly, from conferences, roundtables, and interagency partners to incoming proposals from any company, anywhere, at any time. Once a project is identified, it goes through pre-screening, formal application, and comprehensive due diligence covering financials, legal, regulatory, environmental, social, and technical aspects. Approval occurs through multiple levels, including Vice President, CEO, and board review, followed by negotiation of financing terms, disbursement, and long-term monitoring that can last up to 25 years. 

Learn more about the Alliance’s financing and investing work, and find insights from our JPM 2024, 2025, and 2026 panels, featuring Jiwani, here.

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Speaker Bios

 

Nafisa Jiwani, Associate Vice President, Health Initiatives, U.S. International Development Finance Corporation (DFC)

Nafisa Jiwani is a seasoned global health leader with deep experience in development finance, health systems, and strategy. She has extensive expertise in translating complex development policies and regulatory frameworks into actionable, high-impact financial transactions such as vaccine manufacturing projects, regional productions hubs, and critical supply chain infrastructure-aligned with global health security and pandemic preparedness strategies. She is skilled in working with governments, development finance institutions, multilaterals and private sector partners to design blended finance solutions and public-private partnerships that accelerate access to health technologies while fostering local production capacity and long-term sustainability. Currently, Nafisa is the Associate Vice President and Head of Global Health initiatives at the U.S. International Development Finance Corporation, where she leads innovative health transactions and capital mobilization initiatives in emerging markets. Previously, Nafisa held senior leadership roles at the U.S. Department of Health and Human Services and the Centers for Disease Control and Prevention, advancing national priorities in value-based care, health innovation and public-private partnerships. Nafisa is passionate about creating scalable solutions that drive sustainability and resilience Worldwide. Ms. Jiwani’s career spans clinical and translational research, youth development, global health and development finance. She holds a Bachelor of Arts in Psychology from Southern Methodist University and a Master of Public Health in Management and Policy from Emory University’s Rollins Schools of Public Health.

 

Monisha Ashok, Director of Health Investments, U.S. International Development Finance Corporation (DFC)

Monisha Ashok is the Director of Health Investments at DFC, where she leads health strategy, policy, and investments across the agency. Previously, she was a Senior Advisor for Market Access & Innovative Finance at USAID’s Center for Innovation and Impact (CII) in the Global Health Bureau. At CII, she led blended finance initiatives to catalyze investment for global health. Prior to CII, Monisha was a Project Leader at the Boston Consulting Group (BCG) in Washington D.C., where she led strategy, organizational design, and operations for private and public sector clients. She has a deep passion for global health and previously worked with the World Bank on a national study on healthcare availability and quality in India. She holds an MPA in International Development (MPA/ID) from the Harvard Kennedy School and BAs in Economics and Public Health from the University of California, Berkeley. 

 

Krista Donaldson, Director of Innovation to Impact, Stanford Mussallem Center for Biodesign; Alliance Board Member

As Director of Innovation to Impact at Stanford Mussallem Center for Biodesign, Krista Donaldson’s work focuses on ensuring that design tools and processes are broadly applicable across global markets. She is also part of the team establishing the East Africa Biodesign Program, which kicked off in early 2023. Stanford’s Biodesign program advances health outcomes and equity through innovation education, translation, and policy. As the former CEO of Equalize Health (formerly D-Rev), Donaldson led the design and scaling of disruptive medical devices to address global health inequities. To date, nearly 1M people – mostly children and young people – have been treated by one of Equalize Health’s products in 70+ countries. Peter Singer of the Effective Altruism movement called Equalize Health “one of the world’s best charities” because of its cost effectiveness and exemplary end-to-end processes. Donaldson has been recognized as a World Economic Forum Technology Pioneer, TED speaker, and a GLG Social Impact Fellow. She was also named one of Fast Company’s “50 Designers Shaping the Future.” Prior to Equalize Health, she was an Economic Officer at the U.S. Department of State where she managed part of Iraq’s reconstruction portfolio. She also worked at KickStart International (Kenya), and the design firm IDEO (USA). Donaldson holds a master’s degree in Product Design and a Ph.D. in Mechanical Engineering from Stanford University.