Dr Betty Gikonyo is the co-founder and CEO of The Karen Hospital, a Nairobi-based private hospital. A respected pediatric cardiologist and surgeon, Gikonyo and her husband Dan established the 102-bed specialty hospital in 2006. Recent expansion includes opening a nursing school and five satellite centres in different parts of Kenya.

Gikonyo and her husband first had the idea of setting up a private hospital in the 1980s but their dream almost didn’t come true due to lack of funding. Financial institutions turned them down because neither of them had a background in business. It wasn’t until years later that a local bank and equipment supplier agreed to offer them credit.

As CEO, Gikonyo has steered the expansion of The Karen Hospital. Speaking to How we made it in Africa, the charismatic entrepreneur shares her advice to other business owners on how to succeed against all odds.

1. Expand your boundaries

When starting a business every entrepreneur has ideas about the number of customers they will attract and how much profit they will make. Gikonyo warns that these projections hardly ever materialise, necessitating that entrepreneurs may need to find ways to increase their income without deviating from their core business.

“You have to think on your feet [and] find ways to keep the business going. You should not limit yourself,” she suggests.

The Karen Hospital was meant to focus on cardiology. However, when it began operations seven years ago, Gikonyo realised that many patients could not afford to pay for treatment.

“As a doctor you are trained in many other things. As you treat the cardiac patients, you can treat other patients as well and bring in doctors who have other specialisations. We decided to expand within the provision of medical care. We did not move away from our core business, we simply looked at other opportunities that exist.”

2. Do not fear debt

Gikonyo notes that most people think debt is a bad thing and therefore limit how far their businesses can go because they do not actively seek capital. She explains that every business and “even governments run on debt”.

“Being in debt is part and parcel of being in business. I believe the bigger your risk appetite, the greater the returns. I am a risk taker. I am a person who can go to the bank and ask for KSh. 100m (US$1.15m) and I am able to convince the bank that I will repay and even show the steps I will take.”

Business owners have to be clear on how they will repay loans, she says. They should also build a relationship with a financier who will stand by them during difficult times when they may have to delay payments or seek additional credit to keep the business afloat.

3. Use professionals, not “cousins”

You are looking to hire a business development manager and the first person that comes to mind is your cousin George. He did take some accounting classes after all. Give him a phone call, right? No, says Gikonyo.

“Be professional in the way you do things. If it is a contractor you want to hire, go through the tendering system. Don’t just ask your brother or cousin who has no experience to do the job. You also can’t become the Jack of all trades. Yes, the vision is yours and you are the general, but you are not the foot soldier fighting on the ground. You need to set up departments and hire professionals who can be held accountable.”

4. Don’t let your profession limit you

Most people tend to confine themselves to their profession, but Gikonyo says entrepreneurs should keep their options open.

“Don’t let your good training be the very thing that limits you in what you can be and what you can do,” she says. “The fact that you veered into medicine or engineering does not mean it is the only thing you could do. You needed to do one thing and graduate in one thing. It should only give you the foundation to be able to do many other things.”

However, do ask questions, undertake research and enroll for short courses to increase knowledge in any new fields.

5. Have a clear marketing strategy

Gikonyo notes that regardless of how good a business service or product is, without marketing they are unlikely to attract customers.

“That is one thing we did not do very well during the early stages. We were very much concerned with setting up and making sure that things were running right. We learned along the way and now we have a very good marketing strategy.”

6. Don’t take short cuts

Whether it’s purchasing office computers, company cars or multi-million dollar hospital machines, Gikonyo advises business owners to look for the best quality to get value for their money.

“You should purchase tested and well-known brands, especially when you are spending huge amounts of money. Another thing that people miss on equipment is a service contract. You should also build relationships with suppliers so that you can get good deals and extended payment periods.”

She also suggests having auditable systems in place.

7. Be persistent

Gikonyo says most entrepreneurs miss out on success because they lack “staying power”.

She tells how for 10 years, she and her husband knocked on the door of every financier in the country hoping to get funding to establish their hospital. The couple didn’t give up and eventually found willing investors. She urges entrepreneurs to hold on in the toughest of times.

“You must have the spirit of persistence. You must believe that one day your dream will become possible no matter how long it takes.”