The End of the Beginning

A good friend of mine, Dr. Nick Wooding, often tells me that we often over-estimate what we might achieve in just 2 years but under-estimate what we can achieve in 5.

About 3 years ago I sat with another good friend, Dr. Ian Clarke, and we talked about the 5 year plan that we had developed for his organisation in Uganda, International Medical Group. I’ve known Ian since 1979 when he was my landlord in a student house in Belfast. In the mid-eighties I was at the church meeting in Bangor when the congregation prayed blessings on him and his family as they made their way out to Uganda to start a hospital in the bush (which became Kiwoko Hospital), in the middle of the Luwero Triangle which was only just beginning to recover from the Amin madness.

Ian and me at his Birthday in January 2008

Now some 23 years later we were sat in a hotel in Kampala and having discussed the IMG 5 year plan, I was telling him of my mad idea that I wanted to come out to Uganda and work with him to make it happen. With the gracious acceptance by Pamela and our children, I started my full-time role as MD of the group, soon to be the CEO, in May 2009.

An essential element of that 5 year plan was to bring on board equity investors who could provide the capital and expertise that would help us to achieve our shared vision. I don’t really know what I thought I was coming to, somewhere in the back of my mind I thought that this would be a great way to give something back and to make a difference in the lives of those that had less than we were used to in the UK; how wrong, or at least naive, was that, International Development and Public Health is much more complex, certainly less black and white (no apology) than that.

In the early part of 2009 we were made an offer by a leading private equity firm operating in East Africa, which had a special interest in Healthcare. The offer was just far too low and came with too many conditions, so we rejected it and then continued to manage IMG for the next two and a half years, not being able to fully move forward with our capital expansion plans and every day needing to consider careful management of cash-flow (a bit like most businesses in the UK today). Managing a business in the developing world is, in my experience, no different from managing one in the UK; it is always about MONEY and PEOPLE.

International Medical Group employs more than 750 staff, constitutes probably the best private hospital in Uganda (IHK), 10 primary care health centres (IMC) (GP surgeries) and provides pre-paid health plans (IAA) for 41,000 members. We serve more than 250,000 patient visits each year. We have an NGO, IMF, that provides essential basic healthcare to the poor, with a special focus on community based reproductive health services. We also have a health sciences university, IHSU, which today had its 2nd graduation ceremony and is training more than 850 students of nursing, health management and public health.

Justice Julia Sebutinde awarding degrees to the Masters of Public Health students at IHSU. That's Nick to in the right background.

In its first 10 years Dr. Ian and the team had continued to grow and extend the services of IMG from whatever surpluses they could make from the revenue being generated. This had worked very well in the early years but now we had reached a stage of our corporate development when we needed a much more significant injection of capital.

It seems that for most of 2011 I’ve been working on the 5 year Business Plan, re-working the financials, the cost-benefits and selling our potential. Early in 2011 we had 2 serious equity investment offers, both of which were definitely of interest, but we had to chose just one and after a very intense 6 months of due diligence, it is just so great to have finally closed and to have executed a deal. We now have new private equity investors, with a capital investment that will enable us to start moving forward with our development plans. Just as importantly, these new shareholders will also bring essential corporate and medical experience and a link into the largest healthcare group in India. Now we can we start the next phase of the 5 year plan. So we have definitely reached the “end of the beginning”.

On a personal note, I need to now spend the next week being a student at IHSU and do my last 4 exams and start my thesis for my MPH, that too has taken more than 2 years.

About Kevin Duffy

Interim Management and Consulting - Global Healthcare Development. Kevin has over ten years of senior management experience in the delivery of healthcare services in Africa and South Asia. His current focus is on the strategic development of policy, guidance, and tools to help healthcare organisations achieve sustainable impact – balancing the need to become financially sustainable, with the mission of ensuring equitable access to affordable healthcare services.
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