Healthcare, Education and Agribusiness in Uganda: An Interview with Dr Ian Clarke

Interview with Dr Ian Clarke, Owner and CEO of International Medical Group and Clarke Group

What is your assessment of the healthcare sector in Uganda? What are the latest trends?

I am a medical doctor and I have been involved in the healthcare sector now for over 30 years. During that period of time, I have seen the demographics of Uganda really change. When I first came here, there was 12 or 15 million people and now there is 41 million. You can see that there is plenty of need. There is plenty of pathology. There is a lot to do. We have an open country in terms of investment. The government really encourages foreign direct investment. It is free and you can bring in money and take money out. There are quite a few investors now in the healthcare sector. But, at the same time, you have to be cognizant that a lot of those 41 million people are poor. If you find a way to get down to the bottom of the pyramid, then you have a lot of people to deal with. If you stay only at the top, then it may be a lot more competitive. Many people in Uganda go out to India and out of the country if they can afford it. Building up the services at the top end is also good. I have heard investors tell me about any sector in Uganda that it is a very friendly country to invest in. We may not be top of the league in terms of ease of investment, but it is not a difficult country to work in.

You have been in this business for a long time. What does the Group bring that is different? What is the competitive advantage of the Group?

I set up International Medical Group about 20 years ago and grew it organically. I grew three parts of the Group: the hospital with curative services, secondary, and tertiary care; 17 primary care clinics; and a medical insurance or HMO company with about 65,000 members. The advantage there is holistic. You can bring your clients through the insurance and other insurances. You have a good network of primary care which you can repeat where you see there is a need in a town or area and you can set up another center. There is still room for improvement and growth in bringing more higher level services as far as the International Hospital is concerned. I sold the majority about five years ago and stay on the Chair as a minority shareholder.

Since you sold, you have been diversifying yourself to other sectors. Where are you present now?

The first hospital I started here was a charitable hospital. It is a success that for more than 25 years it has been going strong. It employs 400 people and is run by young Ugandans.

I have always been conscious of the developmental impact. I have been here a long time. The very first hospital I started was a mission hospital. I then went into the private sector to develop that side. The sectors which are really important for a country are health, education, and in this country, agribusiness because about 75% of our people live in rural areas. I had already been doing education in the healthcare sector through our International Health Sciences University that I have expanded now into a business because you need appropriate education establishments that are training your young people fit for purpose. We have many graduates, but sometimes those young graduates come out and they are still not appropriately qualified for the needs of business. I have diversified the University into business and IT. In IT, it is interesting because we have taken IT graduates and given them relatively short courses, sometimes a coding course that brings their coding standards up to a level that would be needed to offer their services, and then the development of applications, websites, etc. We are currently doing that bridge where you take someone who has the academic abilities and then train him for another six to nine months and he really becomes useful in an international market or even to develop his own business. I find that quite interesting. Sometimes, our qualifications here are a bit too academic. Even if you take farm management, which is the other sector I am involved with, how do you get someone who is really going to be able to come to your farm and manage it? We also have a primary school in Kampala which can be scaled. Kampala has about 4 million people. You have to have your schools strategically positioned simply because of traffic. Our model is “inquire, discover, learn”. We want to move away from the old way of rote, didactic teaching. Our maximum class size is 28, where many other schools will go up to 40 or 50. We found through doing this first school that it is financially viable and you can really make an impact in terms of that child and that child’s outlook, education, and preparing them for the 21st century. For me, the education impact is very significant that you do things that are appropriate for Africa and Uganda but are also financially viable. Education has really tremendous potential and one can scale it as well, especially with schools. The other sector I am involved in quite hands on is agribusiness. Uganda is the pearl of Africa. Everything grows here. We wanted to know if we could really make an agribusiness work. So, I put my money where my mouth is, bought a big piece of land, and I have developed it over the last four years into a commercial farm with a big emphasis on coffee. Uganda grows Robusta coffee. There is a big output, but they could get a lot more income if the coffee that was being exported was of higher quality. Coffee that is exported is often grown by small holders with poor agronomic practices, poor harvesting practices, poor post harvesting handling, etc. The coffee that comes out tends to be used for instant coffees and at a low price point. I developed a specialty Robusta coffee, not because it is really any different but because I am using good rootstock and doing the proper agronomy. I am getting nice yields and good coffee which I drink myself. I want to not only export my coffee directly to the roasters or some of the big exporters who give me a premium, but also to get down the food chain and have out growers who see my farm as a demonstration farm. We buy the small washers for them and buy their coffee back. We can expand and have good developmental potential. The coffee is quite exciting.

Are you looking for investors in one of these sectors?

In education it could well facilitate investment. We have done the proof of concept successfully with one school. That could be scaled to six schools around Kampala. At the University as well, we could scale up on the business training and IT. For me, it is about development. That is where you can make an impact and be financially viable. I am still highly involved in the health side, but sometimes the healthcare sector has a contradiction where the need is there, but someone has to pay for it and who will do that? So, you find the healthcare clumped in the cities and the upper end of the pyramid, yet the need is out there in the rural areas.

Are you looking for international help or technological improvements? Are you looking for partners in any of these fields?

I would love to see linkage between the young people that we train here in IT skills. There are plenty of companies that can use those skills in Ireland and Britain. Often, they look to the east for coders, but why not look south? I was in Ireland recently and there was a young man who was running an innovation center there and he told me one of the most expensive things for them is finding good, competent IT people. We can upgrade with our post graduate training that is appropriate for someone who needs a coder with that skill in Ireland. There are so many websites where people can farm out their work. In terms of growing coffee, the closer I get to the roasters the better prices I get. This year, I will produce 40 tons from my initial coffee but I will be producing up to 5 or 10 times that amount of green bean coffee of good quality. I am looking for markets for somebody to take a container or significant quantities and get myself established for good quality Robusta for which I can get a premium. In investment, there are people who want to invest in a significant coffee farm and I am open to that. There are those who also see the potential of the out grower schemes. That is tremendous because that will bring increased income and good livelihoods to the farmers. There are companies who, when they see something like a successful agribusiness, they are interested in expanding it and investing in it. I am open to that, though we do not necessarily go out looking for it.

How do you drive your efforts for CSR?

For me, I would not want to be involved in something that was socially negative. I would not want to be producing something like tobacco. For example, I am not very interested in property development because I do not see it as adding much. The sectors that I have been involved in I feel help develop the country. I came here in the aid sector and the first hospital I built was a faith based, highly subsidized hospital. It is still running and doing a good job after 25 years. However, I realized that you cannot go out begging for money all the time. So, I moved over to the private sector, basically with the idea that there was not much hospital development then and if I was to provide a service for middle income Ugandans for which they paid, then I could develop a hospital, which I did. Subsequent of that, you can see that there is a need for education, better trained nurses, etc., and we started on that. You can then see the need in business and education. In education, there needs to be a transformation in Africa. It is sad when you set an interview for a position for a young person and they are desperate to get a job, but they have not been trained in the right way. They have a piece of paper qualification but they are not able to solve problems, move forward, think clearly. To move people from that passive education into active is my goal. My passion for Africa and Uganda comes from the fact that I believe in the people. If you give the people the opportunity and the appropriate training, they are world class. Some Ugandan doctors are the best I have ever met. Yet, someone would criticize a nurse who has not had the same opportunity and motivation. Farmers also need that bit of training to improve their harvest. We have many issues. We have the third highest reproductive rate in the world. We have gone from less than 16 million when I came here to 41 million today in 30 years. That is a huge challenge to actually support these people, give them a good education and healthcare service, etc. It is impossible for a government to do. What worries me is that sometimes we are just creating more poverty. We need to take what we have and use it in a financially stable way. It is not about CSR where you make all your money on one side and do a bit of good on the other. We need to do good work in healthcare, education, and agribusiness, while also having a business.

Do you have a success story you are proud of?

I could point to many bits of work I have done and say they were success stories. The first hospital I started here was a charitable hospital. It is a success that for more than 25 years it has been going strong. It employs 400 people and is run by young Ugandans. It offers this tremendous service to the community at a very cheap price because it has partners in Ireland and Australia who support it. They can offer services for about 20% of the real cost. That is financially sustainable because of the partnership with the Irish and the Australians. This 200-bed hospital offers good services and is involved in the community. One of the things that motivates me is seeing young people who have grown and watching them as they grow further. There is one young lady, only 32, and she worked for me for nine years and she rose to be head of procurement. I have a business in South Sudan and I was not really pushing it at the time. I asked if she wanted to partner in the business and she said yes and went for it and it is very successful. When you give people the opportunity and empower them, then they move forward. I have seen that so much and that really gives me a lot of motivation. It is not necessarily the bricks and mortar, but it is how you have really worked with people.

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