Expanding quality healthcare across the Indian Ocean: the acquisition of Madagascar’s CTB network by C-Care
A rare opportunity in a small but coveted healthcare market
C-Care is a leading healthcare group in the Indian Ocean, and the undisputed leader in Mauritius with a market share of close to 50%. As a subsidiary of CIEL, one of the largest Mauritian conglomerates, the group operates across hospitals, specialized clinics, medical laboratories, and imaging centers. True to CIEL’s tradition of long-term and structured growth, C-Care has defined a clear regional expansion strategy across the Indian Ocean and East Africa, with the ambition of becoming one of the reference healthcare groups in Africa. In this context, Enexus acted as the exclusive M&A advisor on a highly strategic regional healthcare mergers-and-acquisitions transaction.
Madagascar was a natural market for this expansion. Despite pressing healthcare needs, the private sector remains small and fragmented, with few structured operators. Yet the market is increasingly sought after, with several regional and international investors on the lookout for acquisitions. In such a context — few targets, many suitors — identifying and securing the right partner was a significant challenge.
CIEL Group mandated Enexus to support its entry into Madagascar through an acquisition strategy. Following an extensive screening of the market, Enexus identified CTB, a network of medical biology laboratories founded and developed by Mr. Philippe Poncelet. Despite competition from other strategic buyers, C-Care and Enexus demonstrated that their offer combined financial strength with the best continuity for CTB’s long-term vision.
Bridging two worlds: a complex acquisition process
Finding the right target was only the first step. Making it work proved to be the real challenge. C-Care, a listed and structured company nearly 350 times larger than CTB, had to engage with a small and relatively unstructured laboratory network, with limited resources and little exposure to international M&A standards. This asymmetry created significant hurdles: quality and availability of information, preparedness for due diligence, and unfamiliarity with key transactional concepts such as, for instance, asset and liability guarantees.
To overcome these challenges, Enexus’ role had to extend beyond traditional buy-side advisory. We guided CTB towards suitable advisors and provided hands-on support: assisting in preparing information packages for due diligence, explaining the mechanics of a professional M&A process, analyzing competing offers, and ensuring that the seller could engage constructively — all while avoiding conflicts of interest.
Success required a combination of in-depth knowledge of the Malagasy business environment, the ability to create trust between buyer and seller, and strong involvement from both C-Care and Enexus to fill the information gap. Thanks to close cooperation, pragmatic flexibility, and committed work from all parties, the transaction moved from first non-binding offer to completion in under six months – a testament to disciplined deal execution from start to finish.
A milestone for Madagascar’s healthcare sector
Following the acquisition, CTB was rebranded as C-Lab Madagascar, marking C-Care’s first step in the country. Beyond reinforcing local laboratory services, C-Lab now facilitates access to Mauritius for patients seeking advanced diagnostics, treatment, and surgery, creating new healthcare pathways for Malagasy patients.
Though modest in size, this transaction is strategically significant: it provides a platform for C-Care to expand into other healthcare segments in Madagascar and strengthens its role as one of the few structured, multi-country healthcare groups in Africa. By combining regional experience, strong governance, and the capacity to invest in quality care, C-Care is positioned to play a decisive role in developing healthcare services in Madagascar and across the continent.
