Progression through philanthropy

International Hospital Kampala uses a self-sufficient and sustainable business model to bring medical expertise and high-quality care to the people of Uganda.

International Hospital Kampala isn’t any ordinary private healthcare facility. As part of the International Medical Group (IMG) – which includes a health sciences university, medical insurance company, charitable foundation, construction division and outpatient clinics – it is the central hub of a complete package designed to address the local community’s health issues. Behind it all is IMG founder Dr Ian Clarke and his vision for developing Uganda’s medical sector.

“I want to develop medical expertise and healthcare quality so that Uganda can stand on its own two feet and be leading in the region as far as healthcare is concerned,” he says.

There is an interesting story behind Clarke’s philanthropic aspiration. Before moving to Uganda almost 25 years ago, he worked as a general practitioner (GP) in Northern Ireland, UK. That was until news of Uganda’s HIV endemic in the mid-80s shook up his priorities. “I was really keen to get involved medically and felt that I’d be a lot more useful working in Uganda than in the UK,” he explains.

“So that’s why I went to work with the Church Mission Society in rural Uganda for six years. After that I didn’t see much point in going back to the UK where there wasn’t much HIV or tropical disease, in which I was experienced.”

However it was a realisation he made while working at the mission that primarily persuaded him to stick around. “In terms of sustainability, I’d realised that the problem with the mission hospital and aid side is that it requires donor support,” Clarke says. “So I wanted to create something that was self-standing. At the IMG we train nurses, clinical officers and technicians at the university and generate a lot of cash from medical insurance or fees. It’s a socially responsible entity that seeks to be self-sustaining in terms of commercial viability.”

Gaining ground

Clarke’s first foray into Uganda’s private healthcare sector was a clinic he started around 15 years ago. Under his sole governance this grew into a 30-bed hospital and, with the employment of many more staff, IMG eventually built and transferred to its own 200-bed-capacity hospital six years ago. This was Uganda’s first hospital to have ISO certification, in terms of both management and environmental sensitivity.

Having its own in-house construction division for building and refurbishment enables IMG to sustain and expand itself independently. Already it has built 10 clinics in Uganda and one in South Sudan, and Clarke says “there’s always new developments and construction going on”. Recently IMG Construction expanded the company’s community clinic in Lira to have a theatre block and new laboratory. This clinic forms part of IMG’s charitable International Medical Foundation (IMF) division and aims to provide vital free healthcare to a region ravaged by 20 years of conflict between the Lord’s Resistance Army (LRA) and the Ugandan Government Forces.

More than increasing capacity, however, IMG wants to expand its capabilities. “At the moment we’re good at primary care and secondary care,” Clarke says. He explains that primary care comprises the kind received at a general practice, while secondary includes treatment for people involved in road accidents, requiring emergency appendectomy or giving birth. “We also provide a certain level of tertiary care, including intensive care and minimally invasive surgery,” he adds.
“We are aiming to improve on our level of tertiary care so that we can become the regional health centre for people coming from outside Uganda as well. We would also be like to be very affordable, offering very good hospital facilities at prices adapted for the region.”

On a mission

The hospital hopes to achieve these goals with support from a couple of new partnerships it has forged. One is a management contract with Indian group Fortis Hospitals, which owns 76 hospitals including ones in Singapore, Australia and Canada. “They’ve sent over a general manager for our hospital and the idea is that, because we’re self-taught and self-grown, we can draw on their expertise to improve and perfect our hospital systems,” Clarke says.

“Uganda is not known for quality of medical care so to reach a quality that’s nationally recognised we still have work to do. We have an interest in developing local capacity – we want to train nurses so that they can improve the quality of care they give. Hopefully tapping into Fortis’s expertise will allow us to fill gaps here in Uganda.”

A number of IMG nurses and clinical officers are trained at the hospital’s university facility. Clarke hopes that IMG’s link with Fortis will enable it to train doctors in the future. “Our strategic plan for the university is to develop a medical school,” he says. “We haven’t quite got there yet but hope we will soon.”

Minority shareholders in the medical group have brought in the cash required to buy a 40-slice CT scanner for the hospital, which Clarke claims will be the biggest in Uganda. “We’re also going to upgrade our intensive care facilities with more monitoring and other equipment; upgrade our theatre for keyhole surgery; and expand and upgrade our maternity service with a prenatal intensive care unit,” he says.

Making a difference

For Clarke it’s not just about boosting standards at his own medical facilities, but improving healthcare across the country. “My aim with this private sector development is really to demonstrate that you can be sustainable while offering value for money and good standards of care,” he says.

“Because what I see in the public sector is that they fail to deliver healthcare. There’s a lot of disease and need here. But when it comes to the implementation, even the delivery of basic services, the public sector fails.

“I would like to see a different way of financing healthcare, whereby you have more public-private partnerships through which the private sector, which is more efficient in delivering healthcare and more focused on results, joins forces with the public sector to make a greater impact on the health sector,” he continues.

Clarke says IMG strives to provide its customers with the best possible value for money. “If you’re coming in for normal secondary care, such as having a baby, it’s very affordable for Uganda’s growing middle-class population,” he says. Having a baby delivered at the hospital costs around $200 and a year’s health insurance, including access to free drugs, ambulances and care up to a value of $30,000, is also $200.

Offering expensive procedures to everyone in poverty-stricken Uganda, Clarke says, is unfortunately impossible. “We have a population of 32 million here and at the bottom of the pyramid, no matter what price something is, it’s not affordable and you have to be subsidised,” he explains.

“We’re trying to be in the economic middle, where we can reach up – because if we can get some of that business it’s good commercially – and reach down as well, through our social programmes such as that at Lira.”

It seems incredible what Clarke has achieved so far and there’s far more on the horizon – yet in his eyes, all it takes is passion. “My perspective is that you can be an individual – you don’t have to be a big organisation or government – to make an impact,” he says. “And it’s possible to earn a living by doing something sustainable, which results in real benefits for a country such as this.”