Inside RFH Healthcare: Dr. Maxwell Okoth on PET-CT Scans, Lutetium Therapy, and Cancer Care in Kenya

A strong advocate for capacity building, Dr. Okoth explains the institution’s investment in training healthcare professionals through its medical training college, which offers nursing diploma programs and addresses the shortage of healthcare workers in the country. RFH’s vertically in the country. RFH’s vertically integrated approach extends to health insurance solutions, such as Redleaf Insurance, to counter low health insurance penetration in Kenya and make affordable medical insurance accessible to the middle-income healthcare segment.

In this candid exchange, Dr. Okoth also reflects on RFH’s role in medical tourism in Kenya, expanding care to neighbouring countries, and tackling persistent challenges such as pharmaceutical import costs, healthcare inflation, and adverse selection in insurance schemes. The interview is a must-read for anyone interested in preventive healthcare programs, community health education, and the future of the Kenyan healthcare system.

Could you give us an overview of the inception of RFH Healthcare and its current status in the Kenyan market?

My name is Dr. Maxwell Okoth. I am a medical doctor by training, and the founder and group managing director of RFH Healthcare. RFH Healthcare is a group of healthcare facilities based in Nairobi, which has been in existence for the past 13 years, since 2012. From a very humble background, a medical intern with a very modest seed capital of roughly $3,000, we have grown over the years to a chain of 12 healthcare facilities, having one of the biggest oncology units in Nairobi today.

We have pioneered a number of innovations, and I am proud to say that we have brought in the fourth PET-CT scan, with the others owned by a government institution, the Aga Khan Foundation, and a competitor private facility. Secondly, we have the first lutetium therapy for prostate cancer diagnosis and treatment in sub-Saharan Africa, which is a ground-breaking innovation that we have been able to bring to this part of the continent.

We are determined to democratise healthcare in terms of access, affordability, and availability of healthcare services. Our branches are domiciled within the densely populated middle and lower-income populations, so we are mostly impact-oriented, quality assurance, and giving the same type of healthcare that people would get in premium healthcare facilities. We are bringing dignity to the common person by giving them access to healthcare services where they need it, when they need it, at a cost that does not bring adverse financial stress to them.

We have about 10 middle-level facilities, Level 4 facilities, which offer maternity, dental, surgical, and optical services. We also have imaging, such as x-ray, MRI, CT scans, and we are determined to expand this across the country and, eventually, have a branch network in other countries. We are keen on countries like the Congo, Uganda, Tanzania, and eventually other Western Africa countries.

We also run a medical training college – we are having our third graduation ceremony next month – which is aimed at producing well-trained, cultured, and nurtured healthcare personnel, because anybody who runs a hospital will tell you their biggest headache, after supplies, is human resource. We want to nurture the human resource that would want to work for us, so we started with health-affiliated courses: healthcare systems, nursing, medical billing and coding, and dental assistance. We are looking at starting a diploma in nursing, higher diplomas in critical care and oncology, and an upper higher diploma in renal services.

Our Level 5 facility, which is the RFH Specialist Hospital, offers a number of services: four theatres, an MRI and CT scan, seven ICU beds, a laparoscopic tower for minimal invasive surgery, endoscopy, HDU dialysis, neurosurgeries, orthopaedic surgeries, and gynaecological surgeries, and many other services.

What makes your hospital stand out in the Kenyan healthcare landscape?

We are part of pioneer healthcare facilities that have showed that healthcare can be affordable and still make profit. We are a for-profit business because we need to be sustainable and we need to pay the bills, but we need to put this at a price point that people can afford. We were among the first private hospitals to sign the contract category for comprehensive healthcare services within the Social Health Insurance Fund run by the government.

Initially, private hospitals shied away from this because they did not want to be comprehensive, so that they could co-charge, but we grew with that and people saw that it can actually work. Today, we have multiple facilities that I can confidently say have opened due to the fact that they have seen us grow over the years, and so we are a trailblazer. We are a mentor and an encourager to many other facilities.

Other than that, our competitive advantage is our price point and location. For the longest time, in Kenya, healthcare has been divided into two. We have the so-called big boys, the top five healthcare facilities, which are premium, high-end facilities. Then we had very many disenfranchised, small medical facilities running their own operations, and so there was no middle-sector brand that was taking care of the middle bracket. We have come and filled that gap. Competition has come in, after seeing our growth, but we still keep advancing.

Moving on to the oncology unit, cancer care is depriving facilities today. People are selling properties, their homes, and everything they have in order to fundraise. I know that everyone within this continent has someone they know who has succumbed to, or is currently battling, cancer, and so we come in. It is a very capital-intensive project, but we have pushed it to bring hope to the middle- and lower-income families. That they can still get the same services that people fly out to get in India, London, and America. We bring them back home and treat them with dignity.

What would you say are the current trends and challenges in the Kenyan healthcare industry?

Healthcare in Kenya has been very stable for the past 10 years, and has grown in leaps and bounds – hundred billions of dollars per year – and it has been very robust over time. We have seen a lot of investment coming into the health sector, with NHIF growing over time. Currently, there has been a transition from NHIF to SHIF, Social Health Insurance Fund, which is the government’s project to bring universal healthcare.

There have been a lot of challenges in the past one year, in terms of the transition – hospitals being paid, registration of new members – and that has brought a bit of instability within the health sector. Other than that, one thing Kenya prides itself on is the fact that we have the personnel and the expertise that most of the countries around us do not have, and so it becomes like the medical tourism hub for East and Central Africa. We see people coming from Congo to give birth in Kenya. We see people coming from Ethiopia for x-rays and laboratory tests, and so Kenya is the epicentre for healthcare service in East and Central Africa.

Is there room for growth? Enormous room for growth. There was a time Kenyans would go to India for just a basic total hip and knee replacement. Today, those are normal, common procedures which are done locally, and at a cost that probably is less than what they would spend when they travel. There has been a notion that healthcare is cheaper out there, but I still think we can make it cheaper here. People also heal closer to their relatives. People do not have to travel thousands of miles to get care. We can get care at home, because only when you are closer to your relatives do you even heal faster.

The challenges, I still believe, are surmountable. We are giving it time so that the industry settles and we hope the government will be able to fast-track this. Other than that, the investment that has gone into the health sector today is something that is commendable, and I still believe there is so much room for growth in this industry.

What role does insurance play in the Kenyan health sector, with healthcare being expensive?

Well, healthcare is expensive. That is a fact. There is a cost to it, and somebody must pay for it at the end of the day. There is very low insurance penetration in Kenya. It is about 5%, subject to confirmation, with a gap for 95%. The government has started the process by giving the Social Health Insurance Fund, and today, they say they have registered 20 million Kenyans. That is about 40% of Kenyans, give or take, with the aim being to have all Kenyans registered within the SHIF platform.

The key thing for sustainability of an insurance is the premium collection vis-a-vis the claims management. And so, what is your premium to claim ratio? The problem that usually happens is the adverse selection, so that you find that the people who pay for insurance are the people who actually know they will need it, and that makes insurance very difficult to be sustainable over time. The other thing is the moral hazard, the fact that the healthcare practitioner wants to maximize profit and the insurance wants to minimize claims, and so they are not in sync.

My policy and belief is that the insurance provider and the healthcare provider need to speak the same language if they are going to coexist together. They need to be aligned, and for that reason, as a facility, as an institution, we have a sister company that we started some time back called Redleaf Africa, which is Redleaf Insurance Brokers Limited. We have an affordable in-house package that members can buy for as low as $300, to have a very good insurance cover. Today, we have about 6,000 families under that platform. We are expanding it so that it is not only getting service within our network, but we can also on-board other facilities and see how we can manage that.

The cost of healthcare is mostly on human resource, pharmaceuticals, and non-pharmaceutical distributorship. How are we able to cut these costs? We need to see that the cost of pharmaceuticals and non-pharmaceuticals are reduced. The reason why costs are high is mostly because Africa is a commodity trading continent. We import and do not manufacture, and so our taxation regimes also need to be looked at so that this cost can come down. It is only when we reduce these costs that the cost of healthcare will come down.

The other thing is human resource. India is cheap because they train a lot of healthcare practitioners, and so, due to competition, also the remuneration kind of comes down because of the demand and supply rule. If the supply is too high vis-a-vis the demand, then of course the equilibrium goes down.

Those are the things we need to look at to bring down the cost of healthcare, and that is why, as a facility, we have this vertical integration whereby we have a medical training college, a pharmaceutical distributorship, and medical insurance agencies, so as to see how we can have a network that works together to accommodate some of these costs.

Please, tell us more about the cancer unit.

The cancer treatment project is worth about $25 million, and we have done it ourselves. We had a fundraising of $10 million. We got $7.5 million and an underfunding of about $2.5 million, so it is a project that has pushed me to the limit. We have been able to reach this point with the support of stakeholders who have seen us through to deliver it.

Essentially, we are putting together a one-stop shop comprehensive cancer centre, and this is based on research and benchmarks that I did in Ankara University Hospital and Acibadem in Turkey. I have travelled to Sheba and multiple other areas just to see how it is done. Cancer is not necessarily a death sentence. People need to be cautious and aware of their health. People need to go for annual check-ups and need to be aware of the danger signs to look out for, so that the diagnosis is done early.

But even if diagnosis is not done early, there are still other modalities that are targeted, and that is what Africa has been losing. We have had patients being injected with chemotherapy, and more often than not, in as much as chemotherapy is a modality of treatment, some of them end up making it worse, instead of better. We are looking at having diagnostics which are targeted treatments, and so that is why we have invested in a PET-CT scan that is able to let us know the precise location of the cancer, the type of growth, and the stage of growth.

Even if treatment is done, how are you progressing? For that, we have an ultramodern Elekta Harmony machine, which is one of the best modern radiotherapy machines, that is very precise and can target the cancer cells, kill them, and burn them with precision. Previously, this investment was not there, and these are not small investments.

We also have brachytherapy, which is a very targeted treatment for ovarian, throat, and oesophageal cancers. You have a channel that introduces the radioactive source material into the targeted cancerous cells, so you do not have the cancer treatment burning all the other good cells. More often than not, people use treatments that have a systemic effect in their body, and you find that somebody gets worse through treatment, instead of better.

We have the SPECT-CT and we are targeting iodine therapy for things like thyroid cancers, so that we are able to target and treat them very well. As well as lutetium therapy, which has not been available. Prostate cancer is ravaging most of our fathers and grandfathers on the continent. How can we treat them? Even with advanced prostate cancers, you have lutetium therapy that can treat stage 3 and 4 cancers, so we are giving hope to those people who had lost hope.

For the longest time, cancer diagnosis in Africa has been a death sentence, but the problem with this death sentence is that it sucks every single energy and resource you have in your body before it finishes you. That is what we want to convert. That people can have a hope that even when they are spending on their treatment, they are looking at favourable outcomes, and not spending on treatment and eventually going to die, because that has been the case.

We currently lose a substantial number of people. Today, they say about 76,000 Kenyans are diagnosed with cancer. Chances are 80% of these people will die at the end of the day, so it is like when you get diagnosed, it is as good as a death sentence. I do not think that should be the case, and so that is why we chose this particular sector to be our investment, and separate us and differentiate us from other healthcare service providers.

Do you have preventive healthcare programs that you use to engage the public, to encourage routine check-ups that are necessary to prevent some of these diseases?

We have wellness programs that are designed as packages that are rolled out during days like International Women’s Day, Mother’s Day, Father’s Day, etc. These packages tell people, that for a discounted cost, they can have a screening. These wellness packages check your blood pressure, sugar, and tumour markers for monitoring cancer. We make them affordable so that people are able to catch the diseases early, because that is where the difference is with the rest of the world.

We also have health talks that we use to inform people on how to keep healthy, things they need to discontinue. Also, through our Kenya Healthcare Federation, we are lobbying on some regulations, on some of the chemicals which are being allowed in the country, because cancer is mostly about the exposure environment, such as smoking and what we consume. As long as the cells get beaten every day by very toxic chemicals, then that is when they mutate to become cancerous.

There are a lot of things that are at the public level, which need to be at the policy level, but as an institution, it is for us to let you aware that you need to watch out for a couple of things: take care, eat healthy, and exercise.

Looking at your master plan, vis-a-vis medical tourism and your expansion to other countries, what would you like to achieve in the medium term?

People can open centres, but what is the impact of these centres? First, as a facility, what impact have we had within the community we operate in? Starting from a facility with three employees, today we have created jobs to over 1,000 Kenyans who have a livelihood. They have dignity to provide. We have provided indirect jobs to over 3,000 people. Of course, we pay our taxes, and of course we have that impact to the government. We treat about 260,000 lives every year, and growing every so often. We hope this will probably double when this cancer project kicks off fully.

I am looking at setting up a one-stop centre of excellence, a centre of reference. We have talked of Apollo in India, Acibadem in Turkey, and Erasmus Medical Centre in Amsterdam. Can we have that centre in Africa that is started and run by Africans? We are the solution to our problems. We understand what happens, and we can have a home-grown facility, franchise, label, or brand that would give hope to quality healthcare standards, to international standards.

Of course, we cannot do this alone. We will do this by collaboration and partnerships, like we are currently doing. We have networks in India, Turkey, Netherlands, and Israel, and we are looking at multiple countries that would partner with us, Egypt and such. We bring knowledge transfer, exchange programs, and bring top-notch healthcare services to Africa and many other African countries.

Please share with us some of the awards and recognitions you have received since starting the hospital.

In 2019, I was recognised with the Young Entrepreneur of the Year, under 35. I was also feated for Top 40 Under 40, Kenya, by the Business Daily, which is an annual award. Last year, I got Top 40 Under 40, Africa, and our facility, as a hospital, was recognised by the Stanford Seed Transformation Program as the fastest growing enterprise within their network. I was also recognised as the 50 Most Influential Men in 2024, while the Kenya Medical Association, which is the umbrella body for doctors, awarded me the entrepreneurship award in 2024, as well. Furthermore, I have been the recipient of the presidential award of the Moran of the Order of the Burning Spear, which was in 2024, as well.

What investments have you made to get you to be a well-decorated entrepreneur?

I have invested in multiple educational exploits over time that have given me insight, exposure, and opened my mind through networking with various entrepreneurs. Other than doing a medical degree, that is Bachelor of Medicine and Surgery, I have completed the Senior Executive Program for Africa from the Harvard Business School. I have also completed the Stanford Seed Transformation Program, which is a seed transformation program for growing businesses in Africa and other networks. There is Stanford Seed India, and many other networks. I have also done the Global CEO Program, which is offered by Strathmore Business School, Lagos Business School, and Yale School of Management. Lastly, I have also done Managing Healthcare Business from Strathmore Business School, as well.

What is your philosophy in life? What do you want to achieve that keeps you going and striving for this professional growth?

Number one, I say do good and ashame the devil. Do not return bad for bad and just keep doing good to the world, as it always pays back. I want to leave an impact and to leave a legacy that my children will look back and say, “My father did something for the world.” That is what keeps me moving. People will look for wealth, but that is temporary. There is a stage of life when you want to relentlessly acquire, but then what is the next step? I always say you can only wear one shirt, one shoe, and drive one car, but you can touch many lives with one single move of your life and people will always remember you.

They might not appreciate it there and then, but eventually, they will look back and say, “Somebody passed here and left an impact.” For me, it is the impact. Setting up business in Africa is not the easiest thing. The challenges and the problems in this continent can drain you and finish you any day, but you need to keep pushing. It is a hostile environment, but I always applaud the African businessmen who have succeeded within this environment, because it is not easy. There could be support, but not that much, and so we do not do it because we enjoy it. We do it because it has to be done by someone at the end of the day. The African entrepreneurs are the people who have sacrificed their sleep and their happiness to be able to deliver it. They could be doing it for the profits, but at the end of the day, the fact that they have an impact that they do somewhere is what stands out.

For me, what pushes me every day is, why do I want to start a college? I want to give a child hope, who could not go to the university. Why do we want to expand with more hospitals? It is because there is a place somebody cannot get something. When you have a brand, you protect that brand, and people will trust the brand because they know, “If anything goes wrong, I have a brand to attack. I have a brand to go for.”

For us, that is what keeps pushing us. That we are able to scale this to more levels, for everybody who comes and tell us, “I came and I was sorted,” “I came and I was attended to,” “I came and you touched my life,” “I came and you gave me hope.” That we can have multiple of these stories. All the children who have been born here will say, “I was born at this particular institution, and this institution was a gateway to me starting life.” That becomes the impact story that we keep talking about.