How UMC Victoria Hospital is Shaping Uganda’s Healthcare Future: A Conversation with Dr. Chirag Kotecha

How have you improved your services at the hospital? What specialties do you offer?

At Victoria Hospital, over the last three years, we have expanded our radiology department by installing state-of-the-art MRI and CT machines. In terms of diagnostics, this has been a significant improvement. Prior to that, we outsourced our MRI and CT services, which required transporting patients by ambulance to other facilities. Now, we can provide these services in-house.

Additionally, we have opened a new optical department and ophthalmology services, allowing patients to have eye checkups. We already had a dentistry department, but we realized that many patients were looking for a one-stop solution. For instance, while waiting for their ECG and heart services, they could also address their optical needs. Even though optical services are not emergencies, patients appreciate the convenience.

We are also at an advanced stage of setting up an IVF unit for fertility services. Our equipment has arrived, and we are in the process of installing it in our state-of-the-art lab. IVF services are in high demand, both in our region and globally, so we are committed to meeting that need.

Moreover, we have been accredited as one of the private healthcare facilities for HIV/AIDS treatment services. Our two buildings are strategically organized: the main facility focuses on inpatient critical care treatments, while the building across the road is dedicated to elective services like optical care, physiotherapy, and dentistry. By separating these two functions, we ensure that patients requiring chronic day-to-day services, such as optical or dental care, have a separate, more focused environment.

We are also opening two or three additional clinics in other towns. Previously, we were constrained by capital, but now our senior management is well-trained, and our operations are more automated. Expanding into new locations allows us to broaden our outreach and strengthen our brand presence, so people become more aware of our services.

How have you addressed the challenge of attracting more specialized talent to Uganda in the past few years?

We have recruited intensivists and orthopedic specialists. Additionally, we have brought in doctors from Cuba. Most recently, one of our highly reputed doctors in the region came from Sudan due to the ongoing issues there. Sudan, being a large country with a significant population, has produced many well-trained doctors who have dealt with a wide range of pathologies. As a result, they bring a lot of experience. While the language barrier can sometimes be a challenge, some of them speak English. We have found that these doctors provide excellent patient care and have strong medical ethics, which has been very helpful.

We have also invested heavily in training. We regularly hold online seminars and continuing medical education (CME) sessions, with doctors from India either physically coming in or joining us online to conduct seminars and training. This has significantly improved the skills of our local team. While we do bring in foreign talent, we recognize the importance of training our local personnel, including doctors and nurses born and trained in Uganda.

However, our biggest challenge remains the high turnover among nursing staff. The pool of nurses is relatively small, and many are quick to move from one facility to another for a slight increase in pay, sometimes as little as $50 to $100. In Uganda, this is a significant salary difference, equivalent to around 200,000 to 400,000 Ugandan shillings. This lack of loyalty is a problem, but it reflects the realities of a growing economy and nation.

How successful have you been in reducing the number of Ugandans seeking advanced medical care abroad?

It is improving, especially with non-communicable diseases. Previously, patients would travel to places like India or Dubai for heart and blood pressure issues. Now, people are becoming more educated about the benefits of receiving these treatments locally. If an emergency arises, it is better to have access to a doctor who knows their medical history. This awareness was not there before, but with the advent of social media and an online presence, people are learning more.

While we do not always encourage using “Google Doctor,” patients are becoming more aware of the importance of having primary care physicians close by. In the past, people used to travel abroad for procedures like hip or knee replacements. Some still do, especially those who can afford it. The top tier often opts for overseas treatment, but we are seeing a growing middle class that prefers local services due to cost. Travel expenses have tripled in the last three years, so when you consider that, more patients are choosing to receive care here.

We have also seen success with patients from South Sudan, who used to go to Kenya or India for treatment. Through our outreach services and partnerships in South Sudan, we are attracting many patients to our facility. Additionally, Uganda Airlines has started operating again in the last three to four years, and we are advertising in their in-flight magazines. This partnership makes it easier for patients to come in for treatment.

Overall, it’s a small but steady improvement. While the top tier may still prefer to go abroad, the growing middle class is increasingly accessing healthcare services locally.

future plans to How has your medical tourism from Congo, South Sudan, and other regions evolved? What are your attract more international patients?

We are one of the only United Nations accredited facilities in Uganda, and we have partnerships with the UN, including Monusco, the peacekeeping services. These are more governmental and parastatal services that we collaborate with, largely due to our reputation and quality of service. A lot of our growth comes from word of mouth, especially from patients returning to South Sudan who recommend our services.

We haven’t made much progress with patients from Congo or Rwanda. Right now, our main focus is on South Sudan and within Uganda itself. We are expanding our network and planning to open clinics in other cities, starting with Entebbe, which is the gateway to Uganda and where the airport and UN bases are located. We used to have a clinic there before COVID, but we closed it down. Now, we are considering setting up a small 15-bed hospital or clinic offering general care, daycare, and inpatient services.

Rather than expanding regionally at the moment, we are focusing on becoming a forefront of healthcare within Uganda.

How has the integration of new technologies, like laparoscopic surgery, impacted the quality and accessibility of care at UMC Victoria Hospital?

In terms of healthcare, there is a global trend toward minimally invasive procedures, and it is growing in Uganda, not just at our facility. People do not want extended hospital stays, and neither do insurance companies, as that adds additional costs. Minimally invasive surgeries, such as laparoscopic surgery, involve small incisions and often allow patients to go home the same day or stay just one night in the hospital. Previously, patients would need to spend several days recovering in the hospital.

However, the integration of technology tends to drive up healthcare costs. In Uganda, with a population of about 49 to 50 million, less than 1% have private healthcare insurance. The rest either pay out of pocket or access government facilities. Even the premiums for insurance are low; one can obtain medical cover for as little as $200 to $300 per year.

When discussing technology-driven services like laparoscopic surgery, the pricing is significantly higher than that of traditional open surgeries. Insurance companies may not cover the costs of laparoscopic procedures as readily as they do for open surgeries, despite the high demand for these advanced services. The cost of admitting a patient and the hospital bed for one or two nights is minimal compared to the overall cost of the surgery. As a result, insurance companies may prefer to pay for more traditional surgeries rather than those driven by advanced technology, which presents a challenge.

Have there been any significant developments in healthcare infrastructure at UMC Victoria Hospital and in the healthcare system in Uganda since 2021?

In the last three years, there have been new facilities that have come up. Competition, which is always good, means that there is a demand for services. At our hospital, we have not had any significant structural developments, but we have been improving our efficiency by shifting departments.

I previously spoke about our two centers. We have two hospitals across from each other, where one focuses on inpatient, sick patients, and the other facility, which was closed down a few years ago and used as our COVID treatment center, has now been renovated for chronic care. We have moved our physiotherapy department, optical department, and pediatric services there. We are working on separating our departments to avoid mixing different age groups and categories of patients, focusing on improving patient care.

Are you using AI technology in your hospital? How has it impacted your operations, including chatbots and other applications?

We have used AI in terms of diagnostics, especially in the dermatology department for diagnosing skin conditions. We also utilize AI for information, particularly in translation services. We have reduced the need for a human translator by using chatbots to translate for patients, allowing for better communication. AI helps with reminders as well. However, we have not yet fully utilized AI’s potential. I have taken a few workshops and am looking to get my team into more workshops focused on AI. I believe there is a lot of room for improvement, and the quality of service delivery will change drastically, not only here but in other regions as well.

How do you see Victoria Hospital shaping the future of healthcare in Uganda? Also, what is your relationship with the government, and how has it supported private healthcare providers like Victoria Hospital?

We are one of the few United Nations-accredited facilities in Uganda, recognized as an HIV/AIDS treatment center. We have established major partnerships with government entities such as the Uganda Police Force, the military, and Uganda Prisons. Our facility is proactive in preventive healthcare, aiming to reduce the number of people seeking healthcare abroad.

As we expand our network, our biggest challenges remain human capital and financial resources. However, as we overcome these challenges, we can assist the government in improving healthcare delivery. Public healthcare will continue to be the primary focus, with organizations like USAID prioritizing maternal and child health and rural healthcare.

We are observing a trend of people migrating from rural areas to urban centers, and our network is targeting this demographic. While private healthcare currently represents a small percentage of the overall healthcare landscape, it is growing. With government support, particularly in terms of subsidies and timely payments, the quality of service delivery can improve significantly.

How has your life changed since we last spoke? Are you still traveling often? What is your current role in the company? Has it shifted to focus more on developing external clinics? Where are you concentrating your efforts now?

At the hospital, I am more involved at the strategic board level. I have also developed my skincare business, which was small when we last spoke. I now operate a network of five clinics: two in Uganda, one in South Sudan, and in Rwanda. My travel is primarily regional, and I also travel at least two to three times a year for training, whether to Turkey or the United Arab Emirates. This is for my personal growth in my profession. I wear two hats; I am either part of the business or engaged in clinical practice focused on aesthetics, cosmetics, and skincare dermatology. I see significant growth potential in this area.

What is the name of your skincare clinic business?

Refine Skin and body Clinic

What specialties do your clinics offer? Do you focus on skin, body, or all aspects of aesthetics?

I focus on general dermatology, but my main interest is in aesthetics. I use lasers, Botox, fillers, anti-aging treatments, and weight loss programs. I have personally lost about 35 kilograms over the last year or two. We emphasize three areas: helping clients look better, feel better, and perform better. To look better, we treat wrinkles, acne, and hair loss. For feeling better, we offer hormone replacement therapy and IV vitamin therapy.

I prefer to refer to those who come to us as clients rather than patients. This industry is rapidly growing, similar to trends in the West, Europe, and America. I started this business in 2013, but it was quiet while I focused on establishing the hospital I founded. I revived it post-COVID, and it is doing very well now.