Botswana: Doctor-turned-entrepreneur seizes healthcare opportunities

by MMC
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Matlhogonolo Mongwa-Mouwane, founder of the Kalafhi Medical Center

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 decor or extras until income permitted. This strategy paid off. Today, Kalafhi has four clinics, three pharmacies, a physiotherapy center and a beauty clinic. Jeanette Clark speaks with Mongwa-Mouwane about the company’s growth and expansion plans, which include a day hospital, high-tech mobile 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 Diploma in Medicine, Bachelor of Surgery (MBBS). Matlhogonolo Mongwa-Mouwane was one of these first students. She wanted to become 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.

After graduating in 2014, Mongwa-Mouwane interned in two public hospitals until the end of 2015.

She was then thrown into the deep end when in 2016 she had to find her feet running a rural clinic in Phitshane Molopo, as the most senior member of staff. “Imagine you’re starting your career and you’re thrust into this position where you’re running an entire clinic,” she recalls. “That’s where I learned most of my leadership skills.”

In 2017, she returned to the capital, Gaborone, where she was employed at the still-open clinic and did locum placements at Bokamoso Private Hospital. All the while, she was planning a future where she could go into private practice on her own.

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

“It actually doesn’t cost much (to open a private practice),” says Mongwa-Mouwane. “We’re always so afraid to start because we’re looking at the big picture or where we want to end up (that) we don’t allow ourselves… to start with the bare minimum.”

She used her own savings to purchase necessary basic equipment, such as desks, beds, blood pressure and vital sign machines. “I was the only employee,” she says.

Offer something new

From day one, Kalafhi Medical Center offered something the city’s residents sorely needed: extended hours. Many patients, even those who could afford private medical care, frequently found themselves visiting the hospital after hours because their daily obligations prevented them from seeing a doctor during the day.

Kalafhi was open from 8 a.m. to midnight every day. It was a difficult time for Mongwa-Mouwane who was working solo. “I was expecting my child at that time. It was quite hectic, but it had to be done because I couldn’t afford to employ anyone else yet.

Mongwa-Mouwane kept her costs low: she had no other employees, paid reasonable rent, and didn’t splurge on decor or extras in the beginning. “Today the business has the look and aesthetic I envisioned, but in the beginning it wasn’t a priority.”

All profits were reinvested in the business, funding equipment that expanded the center’s primary and preventive health care offerings.

A boost to financing

After several months of building her patient database, Mongwa-Mouwane secured a BWP80,000 (US$5,800) grant from the Botswana Youth Development Fund, a government-backed initiative for startups and expanding businesses.

She believes she received this funding because she had already proven that her business was viable and had potential. “It’s very difficult for people to believe in a project if you haven’t launched it yet.”

A branch of Kalafhi Medical Center in Tlokweng.

Develop one location at a time

Kalafhi has added a new clinic or center every year since opening, gradually building its network. In 2018, the company only had 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 in 2020 it added a third, also in the capital. The third clinic was Kalafhi Medical Center’s first executive clinic, accessible by appointment only; the previous two operated without an appointment. “The executive clinic was aimed more at companies where we did medical exams and provided services to busy executives,” says Mongwa-Mouwane.

The third clinic opened in 2020, as the world shut down due to the Covid-19 pandemic. ” It was very difficult ; it took a while for (business at the) clinic to pick up,” she recalls.

Kalafhi stayed afloat by offering house calls to people too scared to visit health care and to patients who have been unable to find care due to an overwhelmed medical system.

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

In 2022, another clinic and pharmacy were opened on the outskirts of Gaborone. It was a big year for Kalafhi as she also added a physical therapy practice and an aesthetic clinic, the latter offering Botox injections, chemical peels and micro-needling facials.

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

Next year, Kalafhi is expected to open its first day hospital in Gaborone, with a capacity of 26 beds. This hospital will focus on outpatient procedures and treatments, using the most modern medical equipment. Currently, the company is in talks with a US-based organization on integrating robotic-assisted surgery. Specialty areas will include general medicine, internal medicine, pediatrics, obstetrics and gynecology, urology, neurology, oncology, etc.

One of the challenges Kalafhi faces is the constant struggle with registrations and licensing, notes Mongwa-Mouwane. The country’s medical regulatory framework is not fully equipped to support a health care network like the one it is building. Every time the company opens a new clinic or pharmacy, Kalafhi’s team must start the process from scratch.

Looking to the future: from mobile clinics to medical tourism

Mongwa-Mouwane is an advocate of ambitious growth and continually seeks customer feedback to identify areas where Kalafhi can intervene.

“We truly believe that anything that doesn’t grow dies,” she says. Recently, team members traveled to the United States 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 transform it into a smart hospital. (We want to be) intentional in using technology,” says Mongwa-Mouwane. Subsequently, the network will adopt a hub-and-spoke model. Primary health care centers will serve as referral points to the hospital. This structure will not only allow Kalafhi to improve its services to its current clients, but also to expand its reach.

In the medium term, the company plans to expand its presence in rural areas, using mobile clinics equipped with technology such as portable diagnostic devices. This will allow patients to connect with consulting doctors who could be based anywhere in the world. “These things are real and happening in other countries…and could really improve accessibility to health care,” Mongwa-Mouwane says.

In the long term, Kalafhi aims to position itself as a must-visit destination for medical tourists. Mongwa-Mouwane believes his market extends beyond just residents of the country and could potentially cater to visitors from the Southern African Development Community (SADC) region who travel to Botswana for certain procedures medical.


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