East Africa: Turning a gap in the market into a growing healthcare chain

Staff at an Africa Healthcare Network dialysis centre.

Staff at an Africa Healthcare Network dialysis centre.

How Nikhil Pereira-Kamath, founder of Africa Healthcare Network, built a chain of 30 dialysis centres to treat people with kidney disease.

In 2012, Nikhil Pereira-Kamath was working in private equity in Boston, when he was contacted by a Rwandan businessman to set up a dialysis centre, providing treatment for people with kidney disease, in Burundi. The businessman came across similar centres that Pereira-Kamath’s family established in India as part of an NGO project. Intrigued by the idea, Pereira-Kamath refocused the NGO to Africa to help build the facility with his Rwandan counterpart in Bujumbura. He worked on the project remotely in the evenings, while still holding his private equity job in the US. After establishing the first dialysis centre in Burundi, during his travels to the East African country, Pereira-Kamath discovered the centre was financially mismanaged and ultimately decided to part ways with Rwandan counterpart.

However, the experience confirmed to him there was a huge gap in the market, with few dialysis centres in the region despite a fast-growing number of people with kidney disease.

In 2015, Pereira-Kamath relocated to Rwanda to set up his own business, Africa Healthcare Network, which is now one of the largest dialysis chains across sub-Saharan Africa.

Setting up the business

But there were many issues along the way. Pereira-Kamath said that enlisting the right support was crucial – from finding a co-founder with extensive nephrology experience, to recruiting local talent and lastly establishing an experienced board of directors.

Forming a good working relationship with the Rwandan government was also important for quick approval and accreditation to get the first dialysis centre up and running. While this centre was a standalone dialysis unit, going forward the business formed partnerships with hospitals, so that patients would be able to receive a range of services in one setting.

Nikhil Pereira-Kamath, founder and executive chairman of Africa Healthcare Network.

Nikhil Pereira-Kamath, founder and executive chairman of Africa Healthcare Network.

The company charges a per-treatment fee to patients. Those suffering from kidney failure typically require dialysis of up to three treatments per week and will usually need dialysis for the remainder of their life until they receive a kidney transplant. Revenue is also generated through other treatments provided, such as medications and other related procedures.

Most patients are covered by national insurance schemes. These insurance schemes, coupled with private insurers, reimburse Africa Healthcare Network’s facilities across East Africa either directly to its centres or indirectly through its hospital partners.

Africa Healthcare Network has strived to reduce its two biggest overhead costs – dialysis equipment and human capital – in order to keep dialysis affordable for patients, costing between US$80-$105 depending on the country.

“As we are the largest purchaser of dialysis equipment we have been able to ink direct purchase agreements with the global manufacturers at the best pricing in the continent,” says Pereira-Kamath.

“From the human capital side, we have focused on continuing to invest in training our nurses and clinicians so that they are able to better manage patients receiving dialysis, reduce wastage, improve critical care of patients … and ultimately increase efficiency within our units.”

Most recently, the company hired Matthew Williams, a seasoned dialysis executive, to take the roll of CEO as Pereira-Kamath transitions to executive chairman of Africa Healthcare Network.

Expanding to other countries

Initially self-funded, Africa Healthcare Network received investment from Polaris Partners in the US and Flint Atlantic Capital Partners in Nigeria to grow past its first centre in Rwanda. With kidney disease being expensive to treat, the company selected markets that could support the business. More recently Africa Healthcare Network received investment from Asia Africa Investment & Consulting and the United States International Development Finance Corporation as it began to scale rapidly.

In 2017, Africa Healthcare Network expanded to Tanzania, and a year later to Kenya, using Rwanda as a blueprint for the business model. In most instances, it has employed a revenue share model with its partner hospitals.

“We selected countries which could support the treatment of kidney disease either through a strong private insurance market, strong public insurance or a national health insurance scheme, or a large enough cash patient population who can afford out of pocket expenditure,” he says.

Since its inception, the company has seen considerable growth, starting with one centre in 2015 to 30 at the moment. It aims to operate in over 100 centres by 2025 – currently expanding into Ghana, while also planning growth across eastern and southern Africa.

“As insurance penetration increases, patient awareness improves, and clinicians are better informed to detect the disease, patients receiving dialysis is expected to increase nearly 25% year over year with an expected 25,000 patients on dialysis within the next five years in the countries in which we operate,” says Pereira-Kamath.

With few competitors in the market, he expects Africa Healthcare Network will soon be the largest renal care provider in sub-Saharan Africa. Entering new markets has become easier with time, says Pereira-Kamath, after facing numerous stumbling blocks in the early days of inception.

“In the early days, when we entered a different country, it was like starting from scratch. The doors were often closed but we managed to find another entrance and relationship-building at all levels of government has been key for that,” he says.

“Now entering a new market has become much easier – we have a replicable playbook and a team capable of scaling rapidly. But it took seven years of lessons to get here.”