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Botswana: Doctor-turned-entrepreneur seizes healthcare opportunities

When Matlhogonolo Mongwa-Mouwane founded Kalafhi Medical Center in Botswana in 2018, she kept costs to a minimum. She was the only employee and refrained from spending on décor or any extras until revenue permitted. This strategy paid off. Today, Kalafhi boasts four clinics, three pharmacies, a physiotherapy centre, and an aesthetic clinic. Jeanette Clark and Samuel Kwame Boadu speaks to Mongwa-Mouwane about the company’s growth and her expansion plans, which include a day hospital, mobile high-tech clinics in rural areas, and tapping into the medical tourism market.

In 2009, the University of Botswana opened its doors to the first cohort of medical students for its five-year Bachelor of Medicine, Bachelor of Surgery (MBBS) degree. Matlhogonolo Mongwa-Mouwane was one of those first students. She had wanted to be a doctor since she was a young girl growing up in the northeast of the country, always telling her friends and teachers about her dream.

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After graduating in 2014, Mongwa-Mouwane completed her internship at two public hospitals until the end of 2015.

She was then thrown in the deep end, when in 2016, she had to find her feet in managing a rural clinic in Phitshane Molopo, as the most senior member of staff. “Imagine just starting out in your career and you are thrust into this position where you are managing a whole clinic,” she recalls. “This is where I learnt most of my leadership skills.”

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In 2017 she moved back to the capital city, Gaborone, where she was an employee of the Always Open Clinic and doing locum stints at Bokamoso Private Hospital. All the while she was planning a future where she could move into private practice on her own.

Then in 2018, she took the leap and opened Kalafhi Medical Center at the Village Centre in Gaborone.

“It doesn’t actually cost a lot of money [to open a private practice],” says Mongwa-Mouwane. “We are always so afraid to start because we envision the bigger picture or where we want to end up being [that] we don’t allow ourselves … to start with the bare minimum.”

She used her own savings to buy the basic equipment needed like desks, beds, blood pressure and vital signs machines. “I was the only employee,” she says.

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Offering something new

From day one, Kalafhi Medical Center offered something that the people of the city were in dire need of: extended operating hours. Many patients, even those who could afford private medical care, frequently found themselves visiting hospitals after hours as their workday commitments prevented daytime doctor consultations.

Kalafhi was open from 8 am to midnight, every day. It was a tough time for Mongwa-Mouwane who was working solo. “I was expecting my child at the time. It was quite hectic, but it had to be done as I could not yet afford to employ anyone else.”

Mongwa-Mouwane kept costs low: she had no other employees, paid a reasonable rate for rent, and didn’t splurge on décor or extras in the beginning. “Today the company has the look and aesthetic that I envisioned, but as I started, that was not a priority.”

All profit was reinvested into the business, funding equipment that expanded the centre’s primary and preventative healthcare offerings.

A funding boost

After several months of building her patient database, Mongwa-Mouwane secured a grant of BWP 80,000 (US$5,800) from Botswana’s Youth Development Fund, a government-backed initiative for startups and expanding businesses.

She believes she received the funding because she had already proven her business was viable with potential. “It is very difficult for people to believe in a project if you haven’t started.”

A Kalafhi Medical Center branch in Tlokweng.

Growing one location at a time

Kalafhi has added a new clinic or facility each year since it first opened, gradually building its network. In 2018, the company had only the original clinic, which offered limited services and outsourced anything it couldn’t provide.

The following year, the company opened a second clinic in Gaborone, and by 2020, it added a third, also in the capital. The third clinic was Kalafhi Medical Center’s first appointment-only executive clinic; the previous two operated on a walk-in basis. “The executive clinic was meant to cater more to corporations where we were doing medical exams and providing services to busy executives,” explains Mongwa-Mouwane.

The third clinic opened its doors just as the world was shutting down due to the Covid-19 pandemic in 2020. “It was very difficult; it took some time for [business at the] clinic to pick up,” she recalls.

Kalafhi stayed afloat by offering home visits to individuals too scared to visit healthcare facilities and to patients who couldn’t find care because of the overwhelmed medical system.

Then, in 2021, as things began to slowly normalise, the company decided to in-source some services and opened its first pharmacy at one of its clinics. Later that year, a second pharmacy was established.

Moving into 2022, another clinic and pharmacy were opened on the outskirts of Gaborone. This was a big year for Kalafhi as it also added a physiotherapy practice and an aesthetic clinic, with the latter offering Botox injections, chemical peels, and micro-needling facials.

Kalafhi currently employs 51 staff members, supplemented by part-time doctors who provide locum services as needed. The company has a client database of 40,000.

Next year, Kalafhi is set to open its first day hospital in Gaborone, with a 26-bed capacity. This hospital will focus on outpatient procedures and treatments, making use of the most up-to-date medical equipment. Currently, the company is in talks with a US-based organisation about integrating robotics-assisted surgery. Areas of specialty will encompass general practice, internal medicine, paediatrics, obstetrics and gynaecology, urology, neurology, oncology, and more.

One of the challenges Kalafhi faces is the constant struggle with registrations and licences, notes Mongwa-Mouwane. The country’s medical regulatory framework isn’t fully equipped to support a healthcare network like the one she’s building. Every time the company opens a new clinic or pharmacy, the Kalafhi team has to start the process from scratch.

Looking ahead: from mobile clinics to medical tourism

Mongwa-Mouwane is a proponent of ambitious growth and continually seeks feedback from clients to pinpoint areas where Kalafhi can intervene.

“We really believe that anything that doesn’t grow dies,” she says. Recently, team members journeyed to the US for a benchmarking exercise, visiting renowned hospitals such as Mass General and Mayo Clinic, to understand how technology and AI are shaping the delivery of medical services.

“Our immediate plan is to start the day hospital and set it up as a smart hospital. [We want to be] intentional about using technology,” says Mongwa-Mouwane. Subsequently, the network will adopt a hub-and-spoke model. The primary healthcare centres will serve as referral points to the hospital. This structure will not only allow Kalafhi to enhance its services to current clients but also broaden its reach.

In the medium term, the company plans to extend its reach into rural areas, using mobile clinics equipped with technology, such as wearable diagnostic devices. This will allow patients to connect with consulting doctors who might be based anywhere in the world. “These things are real and happening in other countries… and could really address the accessibility of healthcare,” says Mongwa-Mouwane.

In the long run, Kalafhi aims to position itself as a go-to for medical tourists. Mongwa-Mouwane believes that its market extends beyond just the country’s residents and could potentially cater to visitors from the Southern African Development Community (SADC) region who travel to Botswana for certain medical procedures.

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