Youthful Doctor Fixing Kenya’s Health Sector One Hospital at A Time

“If you want something so bad the universe conspires to give it to you,”  says Dr.Maxwel Okoth.

While working as an intern at a public hospital located in Central Kenya Dr. Maxwell Okoth came face-to-face with challenges besetting the country’s chronically underfunded health system and decided to do something to ameliorate the forbidding situation.

This altruistic act inadvertently catapulted him into becoming the youngest social health entrepreneur to own a world-class referral hospital with a 100-bed capacity in Africa’s third-biggest economy in dollar terms.

“We would be in a delivery room with an expectant mother and the facility would intermittently suffer power outages while other times basic medical kits to perform an operation would lack and as a consequence patients would be shortchanged in service delivery,” says Dr.Okoth, a 2010 medical graduate of the University of Nairobi (UON), the country’s premier institution of learning.

He was 25 years old then.

It was while he was doing the rounds in the theater that Dr. Okoth met his epiphany, leading him to become a problem solver rather than a whiner. “While working as an intern I saw a gap in the area of access and provision of affordable health care and that’s when this dream started. There was a huge health need in the country that needed to be fixed especially in maternal and child health care, “says Dr. Okoth.

Kenya has a little more than 8,600 registered medical doctors – in a country that has more than 56 million people as of Jan 14 2023  – and as of 2020, the country had 12,792 registered medical doctors, resulting in a ratio of 26 physicians per 100,000.

Retrospectively, within a year of graduating from medical school Dr. Okoth’s destiny steered towards entrepreneurship.

And this should not have been surprising.

A sneak peeks into his past while at the university presciently shows the medic had a contagious urge for running a personal business. “While at the university I was involved in Kenya’s first e-commerce platform known as mkopa.co.ke which I shut down when I got into my fifth year at the med school for I found it difficult to run a business and the same time concentrate on my education,” says Dr. Okoth.

Convinced that a lacuna existed in the local medical ecosystem that needed to be filled, Dr. Okoth began scouring for a location to set up his inchoate idea, settling for Ruai, a dusty peri-urban dormitory town disproportionally populated by the lower cadres of society located in the furthest eastern part of Nairobi, because “there were only a few professionally run facilities there” he says.

He began with an outpatient facility at the Ruai shopping center in one of those ubiquitous buildings dotting Africa’s land mass whose architecture is simply functional using a loan of Ksh 300, 000 (USD$ 3000) from his mother’s retirement benefits.

Verifiably, the 26- year -old medic was now moonlighting as an entrepreneur.

On 11th Sep 2011, the rubber met the road and he opened the doors of what he eponymously named Ruai Family Health Center (RFHC). It turns out Pamela, the mother to Dr. Okoth had been laid off from work at a local lender, courtesy of cost-cutting measures the bank was executing, that came with severance pay for those affected. Robert her husband had preceded her into retirement. 

In retrospect, Dr. Okoth did not expect to get a loan from his mother, who had proved to be a stern disciplinarian to her five children, with the fledgling entrepreneur being the eldest. She had a special liking for the term frugality

“ Growing up mum would give you anything you wanted in terms of books, shoes, and school fees but not money. She brought us up with tough love. Imagine if I topped in class and I walked into the house to inform her of my achievement, she would only say ‘ that’s good’ and the matter would end there,” says Dr. Okoth whose formative years were spent in Homa Bay County.

To date, Dr. Okoth still wonders what mellowed her mothers’ heart in handing him the wherewithal to kick-start his project.

“I do not know what made her weigh in on my project. But like I keep saying if you want something so bad the universe conspires to give it to you,” he says.

In Dr. Okoth’s telling, the mother has had a seminal effect on him.

 “ I recall one day when I was tempted to steal a thousand shillings (US$ 9) from my mums’ handbag for the purpose of going to the movies with my peers. When my mother discovered what I had tried to do, she whipped me thoroughly. And from that day I vowed never to involve myself with any form of impropriety,” says Dr. Okoth who began the clinic facility with basic equipment. He then hired a clinical officer and a lab technician while still attached to a District Hospital. And only when he got a chance to sneak in the evenings would he go to check how his inchoate business was evolving.

Sadly, the clinic was barely sustaining itself and at some point he gave up his rented house in Kiambu, opting to sleep in the clinic.

“I was paying both my employees including rent and buying clinic supplies from my pocket and as an intern, I was just paid Ksh 48,000 (US$436.64),” says Dr. Okoth who in April 2012 was transferred to Nyeri Provincial Hospital, which is 150 km NorthEast of Nairobi as a medical officer, a move that arguably worsened his business prospects.

Meanwhile in December 2012 while traveling to Nairobi to carry out a routine check at the clinic, he was involved in a grisly road accident that left his car written –off leading an insurance company to pay him Ksh 600000 (US$5,463) as compensation.

He agonized about buying another vehicle as a replacement but instead opted to approach a medical equipment provider.

After making a down payment of Ksh600, 000, the hospital was provided with X-ray and ultrasound machines as well as theater equipment.

“I do not know how they accepted my down payment but even in my shaky financial status they gave me equipment worth about Sh4 million (US$ 36,427),” he said, of the Dec 2012 transaction.

“I was then required to fork out Ksh 232, 000 (US$ 2112) monthly as loan repayment and I had no idea where I was going to get the money from. I only had faith that things would work out in my favor,” he says.

With new equipment installed, Dr. Okoth hoped to divert patients that visited public hospitals within the Ruai neighborhood into his medical boutique.

“I remember the theater was in some small room but it could save a life when the occasion called for it,” he says.

Unfortunately, the business failed to pick up as he had anticipated and he was forced to take another loan from a bank to make the first payment to the medical equipment suppliers.

When he eventually got an opportunity to spend time at the clinic he was surprised that within 12 hrs the books indicated Ksh 26, 000 ($ 237) had streamed in.

“ When I was in Nyeri the team I had employed was telling me no patients were showing up and when the going was good they were only able to record Ksh 2000 daily which was a rare occurrence. So I was routinely forced to pay them from my pocket. It’s then that I realized they had been stealing from me and I parted ways with them,” says Dr. Okoth.

He then hired a clinical officer whom he had supervised during his internship at the Nyeri Provincial Hospital to supervise the medical facility.

Then in Dec 2013, the country experienced a doctors’ strike and Dr. Okoth got time to camp at the clinic it was at this point that he realized the people he had employed were actually stealing from him.

They would under-report the clients they had served and many times he would go back to his pocket to get the clinic running to a point where he was about to give up. But on the first day, he camped there he saw 20 patients as opposed to the average six patients the clinic used to attend to daily. So I fired all of them,” he says.

 “ This was like a re-birth for  Ruai Family Hospital. It’s always dark before dawn,” he says.

RFH Health Care Hospital

In June 2014, a month before his internship in Nyeri ended he received a financial boost from a Government run Youth Development Enterprise Fund (YDEF) which loaned him Ksh 1.8 million (US $ 16374.06).

From his experience, Dr. Okoth says people interested in starting a business should not be afraid of taking bank loans if they possess a vision.

 “Don’t be scared of risks because the biggest risks have the biggest rewards,” he says.

A month later the clinic relocated to a bigger space within Ruai for verifiably the space he was operating from had become too small for the business.

“I spoke with the landlord of this premises and he was very kind to us. I also convinced my girlfriend to sell her car. We used the cash to clear our debts and also partition the new building,” he says.

Now the Ruai Family Hospital was occupying all three floors of an imposing building in Ruai Town and was the biggest private health facility in the town.

“It was a journey and we were now making ends meet,” says Dr. Okoth.

The hospital now had 40 beds, and 12 permanent employees and could afford to hire top doctors on a need basis.

“On average, we served 60 patients daily and we were now listed with all major insurance companies in Kenya including the government-run National Health Insurance Fund (NHIF),” he says.

In 2017 Dr. Okoth bought land within the same Ruai locale and began putting up a landmark building which in 2019 saw the emergence of the celebrated 100- bed RFH Specialist Hospital, the name change indicative of the ambition imbued in the D.N.A of the 36-year-old doctor who currently owns four hospitals, all fixated on serving what he calls the “lower mass market”

“I want RFH to be the next disrupter in healthcare. I see the brand becoming a Pan African Group. And the biggest challenge in Africa is getting access to health care and mostly not because of location but because of the cost and value of health care and that is the disruption we are working towards. I see a continental brand, ” says Dr. Okoth.

It turns out that after 12 years of running the hospital Dr. Okoth this January 8  announced he would be exiting the CEO perch. 

“I will therefore be handing over the day-to-day operations of this institution to a team of very able management,” he said.