Few people, even in Egypt, have heard of Hend El Sherbini. But she built a publicly held lab company with $1.9 Egyptian pounds ($115 million) in revenue that operates in four countries in Africa. With a market cap of $670 million, Integrated Diagnostics Holdings (IDHC) trades on the London Stock Exchange.
In an interview in Cairo, El Sherbini described how she built her company from one lab founded by her mother to a company with 414 branches in Egypt, Sudan, Jordan and Nigeria. It served more than 7 million patients in 2018, and saw revenue increase 27% over 2017.
Her key advice for other women entrepreneurs: “Don’t listen to what people are saying, because they’re probably jealous. You have to have a lot of self-confidence, especially here in Egypt and the Middle East. You’re not a second-rate citizen. Trust your gut.”
In an interview with Oxford Business Group, El Sherbini succinctly outlined the demand in emerging markets for health care services.
“The biggest factor is the population, which is driving demand for everything from diagnostics to pharmaceuticals to hospital care. Health care in Egypt remains highly fragmented and localized, which has a negative impact on service quality. This, however, also creates opportunities for consolidation, economies of scale and, consequently, improved services. For instance, when we were conducting research on the diagnostics market, we found that there were more than 5000 labs with at least one doctor in the country. While this looks like a reasonably adequate number when you consider the country’s total population, after further examination we realized that demand actually far exceeded supply because most of these labs are very small, with limited and outdated offerings. This is further complicated in a heavily congested place like Cairo, because patients often have to go to more than one lab to complete all of their tests, spending a significant amount of time in traffic. Through consolidation, and by putting all the necessary tests under one roof, efficiencies can be achieved and the lives of ordinary Egyptians can be greatly improved.”
We talked about how her parents influenced her career, her perfectionism (obviously a great quality in a pathologist) and clothes. She favors dresses, because they look tidier.
How did you build the company?
I’m a clinical pathologist. I did my Master’s at Cairo University, and then I went to the States. I started in New York – Cornell Medical College in New York City.
I went because I wanted to do research, and get my PhD.
And I was also doing my MPH (Master of Public Health) in ’98.
I came back here at the end of 2000. I started working at the university and a lab in 2001, which was actually built by my mother, who was a pathologist.
And I began with Al Mokhtabar (her company) in 2004. We started increasing our branches and our network and the way we were doing the different units (that were doing tests).
I was trying to increase the business in terms of quality and quantity.
IDH was formed in 2012 by a merger of Al Mokhtabar, Sherbini’s company, and Al Borg Laboratories, controlled by the private equity giant Abraaj Group [Editor’s note: Abraaj later collapsed]. Why did you agree to the merger?
I thought it would be a good match. They were not pathologists, and they were not really interested in running the business. They were in private equity, and they wanted to exit.
I thought this was going to help us. It was, first, going to raise the quality. This was going to give us a very big platform. The lab business relies on economy of scale; so the larger you are, the more you can negotiate with your suppliers. You can get better machines, so you get better service from your suppliers. You can actually decrease the cost of the work while increasing the quality.
Your mother was a doctor, as well?
My mother was a doctor. My father was a surgeon. My grandparents were doctors as well. We’re a family of doctors.
Did you always want to be one?
In school, I wasn’t really focusing on medicine. I didn’t have to be a doctor. It just came… my father encouraged me to go into medicine, and he was right. You learn a lot. I have just finished my MBA, and medicine is very different than anything you learn. There are always two sides to everything—except in medicine. I was amazed by anatomy.
Everything has to be designed in a specific way for the body to work.
The way it’s designed, the physiology, it’s amazing.
Public health must have been an interest too, because you got the MPH.
I was working in the CDC. If you learn pathology, you’re more able to see the picture in the right way. If you’re just a physician, you think everything pertains to that case. But if you’re a pathologist, looking at many patients and the data context, you’re better able to understand. You’re not going to get twisted. For example, when they were looking at lung cancer patients, they thought drinking contributed to lung cancer. When in fact, they were wrong. So, you can get really bad conclusions. My research helped me a lot to understand the different diseases.
Did your mother want you to come back here and work with her?
If I wanted to stay in the States, she wouldn’t have minded. She’s very open-minded. However, my father wanted me to come back. I’m an only child. But he’s dead now. And I wanted to come back. I always knew I wanted to come back because I didn’t want to live all my life abroad.
I love Egypt. All of my friends and family are here. I’m not saying I wasn’t happy in the States – I was happy working. I like the way that people are very committed to their work. And I was very lucky – I was working with very elite scientists. Research can be done easily. And when I came back here to Egypt, it was very difficult. People don’t seem to be interested.
How did you turn the single lab into a company, starting in 2004?
You need finances, HR, all the things… I wanted to open more branches. I was focused on doing a good job, and more patients in Egypt needed this service. And quality is expensive. So it’s all in a circle… you need more of one thing to invest in another. All of the blocks need to be there.
Male CEOs often say they were driven by success… they say that they want to win.
You can define success as getting what you want, but I do not think of success in that definition. I think if you can give a good medical service to all patients, then that is success. The constant progression of quality is more definition of success.
Was there a moment around 2004 when you decided, “This is really what I want to do”? What was the seminal moment?
It just came to me… I thought we needed to grow. My mom is a physician. She’s more focused on the work; she’s not really a manager. However, she is a visionary. She was always encouraging, and we complemented each other.
What was the hardest moment during those early years?
I like to have things ran in a proper way – I am a perfectionist. You have to really be able to do this on a daily basis.
What was the hardest problem you’ve had to solve?
People who do not like change. Doctors kept telling me, “You cannot do that.” People in Egypt like things the way they are. They are afraid of change. It’s not like it is in the States. The work ethic in Egypt is different than the West. People in the states take pride in their work. In Egypt, employees need to see someone to follow. The system is not there automatically – the employees need direction.
Does it have to do with a lack of trust in the system, a question about whether you will be rewarded if you do the right thing?
Maybe, or maybe it is the whole environment – the changes that have went on in the country over time. They need to feel pride in what they’re doing. They need to feel important, different. Teamwork is important – and no one owns the company entirely. Everyone has a contribution to make.
How many people do you have working here?
Right now it’s around 4,000.
What are the systems you put in place to build trust and rewards them if they do well?
They need to know what metrics they’re being measured on. They also need to know what they have to accomplish – the KPIs. HR is always working on forming trust that they’re part of a team… We also have benefits – it’s not all about work. It’s like a family, even with 4,000.
You said benefits… like healthcare? Retirement?
We have health, profit share, bonuses, social activities, and dinner meetings. Also their lab space is being improved.
How unusual is your company compared to others in Egypt?
I’m not familiar with companies outside of healthcare, but there are not many companies like IDH. Doctors run most of the health care companies, and they don’t have management backgrounds. It’s more of a practice rather than a business. Health care is a bit particular – the patient has to be the center of your focus, and everything else comes after that.
When Abraaj approached you about a merger, was it always understood that it was going to be a public exit?
No, it wasn’t. We had an agreement that it was going to be either IPO (public offering) or an international business adding value through technology.
When the merger happened, was it obvious that you were going to lead the company?
They were happy actually, because they didn’t want to run it.
Why did you decide on the IPO?
Nobody was really interested in Egypt at this time. (The revolution). We did the merger in 2012, a year after the Revolution. International investors were not interested. And even an IPO was difficult at that time.
How did the IPO go?
It went well, very well. I was happy that people were appreciating the story.
What percentage of the employees are women?
Is that the norm in Egypt? Higher or lower?
In Egypt, it’s about the average… I think. It should be around 50%, but some women do not want to work after they get married. There is no support for them. I think we should encourage women more and help them.
Did you ever feel it was harder because you were a woman?
Sometimes, yes. Men do not like to take orders from women… at least at the beginning, but then it fades.
So there were times when you would tell someone to do something and they just wouldn’t do it?
No, but they felt insulted that a woman was telling them what they do… that men are better than women. They try to test you at the beginning, but once you respond well, they respect you. I’m a very low-profile person. I’m an only child. I’m a bit of an introvert, and I don’t really like that kind of testing …
As a woman, it’s a hostile environment. So, do you ignore it?
If you’re like a man in business, then they call you aggressive. It’s not like this in Egypt alone. It’s like this all the time. Maybe it is different in the States. In Egypt, they wouldn’t come and tell you. They say it to someone else. But I don’t really care – they can say whatever they want.
What advice would you give to someone who would want to build a business?
You need to be passionate. If you’re not, you’ll lose focus. I was always passionate about learning, my work, and being a successful person. At the same time, perseverance is important.
What was your worst failure?
I was disappointed when, at one point, I got back to the States, because I wasn’t able to do the research I had been doing. But then I found something else that I was interested in. That’s another thing: you have to keep on looking. If you keep on looking, you will find it. People always look at very narrow things. It’s wide open; you can do a lot of things. And really, as Americans say, the sky is the limit. I believe in that. Also, I like to have things done in the proper way…especially in my field. Quality is very important.
Where did you get that sense of self-confidence?
My mother is a doctor and she is very successful. My grandmother is also a doctor. We’re a family of strong women. You were never weak.
Have you sacrificed something to be where you are?
Intentionally, no. But I took a lot of time – in education, business, etc. But I wasn’t doing it out of sacrifice. I was doing it because I wanted to.
What else do you want me to know?
I just finished my MBA – and I’m really proud of that. I knew very little on finance, accounting, etc. I wanted to know it well as they (partners) knew it. I enjoyed it. It was a good decision. It was a challenge – an executive program. You travel every month for five days. And because I’m a bit older than the average (in my 40s). And you sit in a class from 9AM-7PM – that’s a bit difficult for me now.
What are your plans for the company?
We have a good base for the company in terms of patient outcomes. We are trying to increase our platform (test we’re doing), formula into other services, etc. It will benefit other medical services in Egypt. We are getting into radiology. The medical service in Egypt is not properly run, and we’re trying to fix that.
Which is the fastest growing market – Egypt, Jordan, or Sudan?
Egypt. It’s a really fast-growing market of 90 million people.
(Interview transcribed by Garrett Ziegler, @gmichaelziegler) An earlier version of this story was published on Forbes.com.
This story and others on Times of E are made possible by a sponsorship from the Ewing Marion Kauffman Foundation. The Ewing Marion Kauffman Foundation is a private, nonpartisan foundation that provides access to opportunities that help people achieve financial stability, upward mobility, and economic prosperity – regardless of race, gender, or geography. The Kansas City, Mo.-based foundation uses its grantmaking, research, programs, and initiatives to support the start and growth of new businesses, a more prepared workforce, and stronger communities. For more information, visit www.kauffman.org and connect with www.twitter.com/kauffmanfdn and www.facebook.com/kauffmanfdn.