Kenya Healthcare Sector: Overview of Columbia Africa Healthcare Limited

Interview with Dr. Sumit Prasad, General Manager of Columbia Africa Healthcare Limited

What is your assessment of quality and service in the healthcare sector in Kenya compared to other countries in the region?

Healthcare in Kenya is one of the more advanced sectors in the east African region. People from other countries in East Africa such as Somalia, Tanzania, Uganda and Rwanda, prefer to come to Kenyan hospitals to seek medical and health related solutions. However, most Kenyans’ first preference would be to travel outside of Kenya for their healthcare needs to countries such as the UK, South Africa, the Middle East or India. The first reason for that is the availability of information. They feel that people abroad know about more services that are not available in Kenya. Other factors are cost and quality. There is more than enough good human capital in Kenya. There are skilled people who have trained in the best parts of the world and are delivering services here. The bigger challenge is the cost, and this is where things need to be investigated more. The same services and treatments can be procured in India or Thailand at a much more reasonable cost, or in the developed world, such as the UK or South Africa, at a marginally higher cost. Healthcare is expected to expand greatly in the next five to ten years. There is a lot of investment now, especially from large companies who are exploring the possibilities around entering the healthcare field in Kenya. There are good educational capabilities that are being offered in our medical colleges and nursing colleges and the human capital is growing. Quality is available, but there are pockets of good quality, centers of excellence, large hospitals practicing like any other part of the globe. But there are also other pockets practicing medicine which is not evidenced based, resulting in very uncontrolled scenarios. There is sincere effort from all quarters to achieve the right level of quality to be a benchmark across the board.

Columbia Africa is part of an international healthcare group which operates modern hospitals across Asia. What is the history of the group and its main areas of expertise? Why did you decide to come to Kenya?

We are using a home-grown system, which means monitoring everything from the time the patient walks in to the various services, such as registration, consulting doctors, or performing tests, and then coming back to the patient and closing the bill so they can walk out of the clinic.

Columbia Pacific Management is a Seattle based investment group which is the promoter for both Columbia Asia and Columbia Africa. Daniel Baty, who is the main principal, previously managed old age homes and long term care facilities, then ventured into healthcare in the mid 90’s in Malaysia. We typically have been in emerging economies and areas where there is growth happening. We started in Malaysia, then expanded to Vietnam, India, Indonesia and China. The idea was to bring to the developing world the quality and service of healthcare which is available in the developed world at an affordable cost. In the last 20 years, we have built about 27 hospitals and two clinics across each of these areas. Columbia Africa was established last year. This new venture aims to come into Africa with the same level of quality expertise. We do not just manage the properties, we build the properties and run them. They are all our own properties. It is a very standardized and controlled environment under which we can provide care to people. Africa is a large continent with a large population. Kenya is the preferred destination considering the environment of human capital and government policies. Everything is in the right place to invest. This economy is growing. There is a large and growing middle class with disposable income. There is a demand for quality healthcare. That is where we need to be and that is why we are here.

What makes your company different from the competition in service and quality?

The definition of “quality” and “service” is very ambiguous. One of the things we strive to deliver is good service and high quality. Quality is in our DNA. There is much to be desired of high quality and the maintenance of that standard. Starting from the moment you walk into a clinic, the maintenance and the appearance are all a part of a good quality healthcare system that needs to be maintained. The second part is the medical quality. We not only believe in getting good doctors, we also believe in maintaining the education level. We keep training them to enhance their skills so they can continue to deliver results. In terms of service, we have the right mix of hospitality in healthcare in our companies and they understand turnaround time and monitoring. We are using a great deal of technology to ensure this happens. There is not just a paper-based record where you do not know what is going wrong and then try to run analytics. We are using a home-grown system, which means monitoring everything from the time the patient walks in to the various services, such as registration, consulting doctors, or performing tests, and then coming back to the patient and closing the bill so they can walk out of the clinic. We want to minimize the time this takes. In most of the larger hospitals, a consultation alone might take anywhere from three to four hours. Our benchmark is that the patient should be out of the clinic within an hour. We are still young in this market, but we are very hopeful. We have achieved this in five countries already.

Do you have any specialties?

We are a healthcare centered diagnostic and medical center. Our family medicine and pediatrics are the backbone of the clinic. They are supported by various other specialties such as opthal, surgery, orthopedic and cardiac. We use technology a great deal. We use telemedicine to provide patients consults from specialists at other hospitals in our network. For example, if a patient needs a neurosurgeon, the family medicine specialist can talk to the neurosurgeon through a telemedicine application and consult with them right there, and then provide service. Patients often do not have confidence in and do not feel comfortable with the doctor’s opinions they are receiving. Now, they can come here without traveling outside of Kenya, and get a second opinion from across the globe. We are using telemedicine and teleradiology quite a lot. We also have radiology and lab work. We have a CT scanner, X-Ray and ultrasound. We do the majority of the tests for our outpatient clinics in our own labs. We also have dental services and a small procedure room. These are all supported by the pharmacy. If a patient is looking for surgery for an appendix or gallbladder, we cannot do that. But 80-90% of hospital visits are for ailments which do not require admission and we can take care of those cases.

What is your vision for the future of the healthcare sector in Kenya in the next 5 years? What achievements will happen?

In Kenya, as in any developed country, all the services are growing. Most of the hospitals have advanced healthcare facilities available. They now have CAT labs. They are also improving PET scan capabilities, as well as radiation therapy and nuclear medicine for cancer treatment, which was previously lacking. For a population this size, the government is investing enough in all these areas. In the next five years, there will be a number of large hospitals opening here and infrastructure will become a big topic. Once that happens, the next stage is the human capital. There are many Kenyans practicing abroad who want to come back and practice here. They would get the right infrastructure backed up with the right human capital, which is important for a practitioner to be able to deliver the right quality of care. There is a lot of investment happening in education. The quality of education in nursing and paramedics is approaching a world class standard. All the pieces of the puzzle are there, they just need to be put together. There is a higher penetration of medical insurance in this country. The government is changing their own medical insurance plans and NHIF. Everything is coming together, it just takes time. It is not something that will happen overnight. Kenya will be a very strong regional hub, if not a global hub, for the healthcare scenarios in the future.

Columbia Africa is a very new company. What do you hope to achieve in the next 2 to 3 years?

This is our first venture in Africa. We started with Nairobi as our headquarters. We would not be here for just one clinic. With every country we have entered, we have grown. Hopefully, the same will be true in Kenya. This is a very early stage for us, and we need to stabilize this place, then continue to expand further from there.

Are there plans to expand to any other Africans countries?

It is too early to predict because there was a limited bandwidth available here in Kenya. Conducting a project, along with the launch of an operation, doing market studies and evaluating other markets is not very easy. Our first focus was this clinic. This first year has been a good learning experience to understand the space and what kind of human capital is here. We have built up a good team here. Going forward, we will determine the next area to move into.

What do you do so that people get to know Columbia Africa?

We have not used a very aggressive media plan. Our doctors have their own patient base and they are getting a lot of references from word of mouth and a large number of walk-in patients. We make sure our services and prices are good, and provide quality results. Going forward, we also plan to use activity based marketing which gives the patient a “look, touch, feel” environment to bring them in.

Why should people come to Columbia Africa?

Firstly, and most importantly, we are all about good doctors. Secondly, we are backed by high quality and authentic reporting of imaging and lab services. You walk in quickly and walk out quickly. You do not need to keep coming back to us because of a lack of good care.

How easy is it to setup a business in Kenya? Why should people consider Kenya as an investment destination?

When we first started, there were 100 people a day allowed. The minimum requirement is quite small. You could start a company with just two residents with the Kenyan Revenue Authority’s PIN registration. The environment is adequate, the taxations are very transparent and the process is very simple. The entire Revenue Authority is available online. Once the company is established, few licenses are required. There are more required in healthcare, but the licensing process in Kenya is easy. There is often the topic of corruption in Kenya, though I have not encountered much. If you are trying to bypass the laws, you will encounter corruption just as anywhere else in the world. But if you follow the laws it is not very troublesome. Once you invest, repatriation is a very easy way to take your money back. Establishing a company is not difficult and once it is established there is good human capital here. The infrastructure is very good. Traffic is a challenge, but it is the same with any large city in the world. There is a large population with a disposable income to spend. Kenya is the right place to be.