emrging trends in healthcare

Acknowledgement

India’s competitive advantage lies in the lower production and research cost, its large pool of low cost technical and scientifically trained personnel, and large number of compliance certified manufacturers and serviceproviders, which make us different from others. ASSOCHAM feels that technology incubation is no longer confined to a few institutions; it is a responsibility that wehave to share, if we wish to see a better and a healthy future ahead. There is an immense need to develop skilled manpower in the area of healthcare and modern as well as traditional medicines. I am glad that thisSummit on Emerging trends in Healthcare will bring forth the journey from research desk to the bedside of patient, as we will look at healthcare at the frontline to identify some common challenges that may help explain the complex nature of healthcare and the scale of the “change” challenge.

I wish to thank KPMG for unanimously contributing towards this Knowledge Paper, which gives a rich and comprehensive insight of the trend in healthcare. I would also take the opportunity to thank QCI for supporting this event. The case studies contributed providing the best of their services and support towards improving the healthcare scenario of India, I wish them great success ahead. Last but not the least, I wish to extend a token of appreciation for the Healthcare/ BioPharma team for their effort and interaction with the Healthcare/Bio Pharma industry at different levels.

(D.S. Rawat) Secretary General ASSOCHAM



Acknowledge ent

India’scompetitive advantagelies in the lowerproductionandresearchcost, itslargepool of low costtechnicalandscientificallytrainedpersonnel,andlargenumberofcompliancec rtifiedmanufacturersandserviceproviders,whichmakeusdifferent fr m others.ASSOCHAMfeelsthat technologyincubation is nolongerconfined to a fewinstitutions;it is arespo sibility that we have to share, if we wish to see a betterand a healthyfutureahead.There is animmenseneed todevelopskilledmanpowerintheareaofhealthcareand modernaswellastraditionalmedicines. I am gladthatthisSummitonEmrgingtrends in Healthcarewillbringforththejourneyfromresearchdesk to th bedsideofpatient,as wewilllookatheathcareatthefrontline to identifysomecommonchallengesthatmayhelpexplainthe complexnature of healthcareandthescaleofthe“change”challenge.

I wish to thankKPMGforunanimouslycontributingtowardsthisKnowledgePaper,whichgives a rich andcomprehensiveinsightofthe tren inhe lthcare. I wouldalsotaketheopportunity tothankQCI fo supportingthisevent.Thecasestudies

c ntributedbythedynamicstakeholdersshow theirvibranteffortsand c mmitmenttowardsproviding the bestof theirsrvices a d supporttowardsimprovingthehealthcarescenario

ofIndia, I wish th m greatsuccessahead.Lastbutnottheleast,I wish to extend a tokenofappreciation for theHealthcare/Bio harma t am fortheireffortandinteractionwiththeHealthcare/Bio P armaindustryat differentlevels.

(D.S.Rawat)SecretaryGeneralASSOCHAM


Contents

Introduction 1

Changing disease patterns: Implication for healthcare infrastructure 6

Emerging Trends in Healthcare Delivery 10

Building Functional Efficiencies 21

Conclusion 25

CaseStudies

1. Acuity Information Systems Pvt. Ltd. (AcuVena) 29

2. Arogya Parivar (Novartis) 32

3. Chronic Care Foundation 34

4. Fresenius Medical Care India 36

5. Shantha Biotechnics 38

6. VLCC40


IntroductionThe Healthcare sector, in India, is at an inflection point and is poised for rapid growth in the medium term. However, Indian healthcare expenditure is still amongst the lowest globally and there are significant challenges to be addressed both in terms of accessibility of healthcare service and quality of patient care. While this represents significant opportunity for the private sector, the Government can also play an important role in facilitating this evolution.

Current State of Healthcare in India

Current Size of the Healthcare Industry

TheIndianHealthcaresectorcurrentlyrepresentsaUSD40Billionindustry1.Abreak-upofthesectorasof 2009 is

provided:

HealthcareIndustryBreak-up

Insurance&MedicalEquipment15%

Diagnostics10%

Hospital50%

Pharma25%

Source: IDFC Securities Hospital Sector November 2010

India’shealthcarespendissignificantlylowwhencomparedtotheglobal,developedandothersimilaremergingecon

omies.Tofurtherillustratethispoint,wehaveexaminedtheIndianhealthcarespendonvarious parameters.

TheIndianhealthcarespendislessthanhalfthe globalaverageinpercentagetermswhencomparedon a“percent

of GDP” basis.

1Source: IBEF

1

15.70%

9.70%

8.40% 8.40%

4.30% 4.10%


81.70%

73.80%

55.30%58.40% 59.60%

54.50%

44.70% 45.50%41.60% 40.40%

26.20%

18.30%

China Brazil India USA UK Global

Spendingasa%ofGDP

18.00%

14.00%

12.00%

10.00%

8.00%

6.00%

4.00%

2.00%

0.00%


Source: WHO World Health Statistics 2010

Thehealthcarespend,whencomparedonthebasisofpublic-

privatecontribution,alsodepict

saskewedpicture.Asisnotedfromthecomparisonbelow,PrivateSectorcontributiontothehealthcaresectorat~75p

ercentisamongstthehighestintheworldinpercentageterms.Publicspending,ontheotherhand,isamongst the

lowest in the world and is ~23 percentage points lower than the global average.

Comparisonof HealthcareSpend

90.00%

80.00%

70.00%

60.00%

50.00%

40.00%

30.00%

20.00%

10.00%

0.00%

PublicSectorspending PrivateSectorSpending


Finally,thehealthcarespendexaminedo

napercapitabasis,bothintermsofUSD(ataverageexchangerateconversion)andintermsofPurchasingPowerPari

ty(PPP),isamongstthelowestglobally.Further,whencomparedtotheglobalaverage,thepercapitaIndianhealthcar

espendis~95percentloweronanaverage exchange rate basis and ~87 percent lower on a PPP basis.


2

7,285

3,867

606802

108 40


7,285

2,992

837 863

233 109



PerCapitaSpending(US$)

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

-


PerCapitaSpending(PPP)

8,000

7,000

6,000

5,000

4,000

3,000

2,000

1,000

-


India’shealthcarespendingis,however,growinga

tahealthyCAGRof~14percentfrom5.5percentoftheGDPin2009to 8 percentin2012.2

Growth in the Healthcare Industry

Asstatedearlier,theIndianHealthcareIndustryiscurrentlyestimatedatUSD40Billion.Theindustryisexpectedtogro

wto~USD79Billionby2012and~USD280Billionby20203.TheaverageCAGRforthenext 10 years, therefore, has

been estimated at ~ 21 percent.

2IBEF November 2010

3IBEF_November 2010

3

CAGR21%

280

79

40

HealthcareIndustry

300

250

200

150

100

50

0

2010 2012E 2020P

Source: IBEF

Drivers of growth for the Healthcare Sector

A

combinationofdemographicandeconomicfactorsisexpectedtobringaboutincreasedhealthcarecoverageinIndia

whichisexpectedtodrive the growth of the sector

Demographic factors:

IncreaseinPopulation:Expectedincreaseinpopulationfromabout1.1billionin2009-

2010to1.4billionby20264

Shiftindemographics:60percentofthepopulationintheyoungeragebracketandanexpectedincreaseofgeriatricpopulationfromcurrent96milliontoaround168millionby2026.Thisrepresentsa huge patient base and creates a market for

preventive, curative and geriatric care opportunities5

Riseindisposableincome:HouseholdsintheaboveINR200,000perannumbracketcanbenefitfromanincreaseindisposableincomefro

m14percentin2009-2010Eto26percentin2014-2015Pmaking healthcare more affordable6

Increaseinincidenceoflifestyle-

relateddiseases:Thereislikelytobeamarkedincreaseintheincidenceoflifestyle-

relateddiseases,suchascardiovascular,oncologyanddiabetes,whencomparedtothecommunicableandinf

ectiousdiseases

RisingLiteracy:Growinggeneralawareness,patientpreferencesandbetterutilisationofinstitutionalised

care as a result of increase in literacy rates7

Economic factors:

Taxbenefits:Lowerdirecttaxes,higherdepreciationonmedicalequipment,incometaxexemptionfor 5 years

to hospitals in rural areas, etc. are being provided by the Government to the sector8

MedicalTourism:Indiaemergingasamajormedicaltouristdestinationwithmedicaltourismmarketexpected

to reach USD 2 billion by 20129

4Crisil Research Hospitals Annual Review November 2010

5KPMG Analysis

6Crisil Research Hospitals Annual Review November 2010

7NFHS Survey

8KPMG Analysis

9IDFC Securities Hospital Sector November 2010

Insurancecoverag

e:Increaseinhealthinsurancecoveragewithanumberofprivateplayersandforeignplayersenteringthemarket

tocatertoincreaseddemand.Thesectorisexpectedtoseeandincreaseinthepenetrationfromthecurrent10per

cent-

1

5percenttoalmost50percentataCAGRof24percent.Ataninstitutionallevel,insurancepenetrationislikelytoc

ontinuetoincreasefrom5percentto15percentto20percent.Intertiarycarethisisalmostashighas40percent-

55percentwith the inclusion of employer paid coverage.10

Emerging Trends in Healthcare: Challenges and Interventions

WhiletheIndianHealthcaresectorispoisedforgrowthinthenextdecade,itisstillplaguedbyvariousissues and

challenges:

1 Dual Disease Burden:

UrbanIndiaisnowonthethresholdofbecomingthediseasecapitaloftheworldandfacinganincreasedincide

nceofLifestylerelateddiseasessuchascardiovasculardiseases,diabetes,cancer,COPDetc.Atthesameti

me,theUrbanPoorandRuralIndiaarestrugglingwithCommunicableDiseasessuchastuberculosis,typhoi

d,dysenteryetc.RuralIndiaisalsoseeingahigheroccurrenceofNon-CommunicableLife-

stylerelateddiseases.ThisrepresentsaseriouschallengethattheIndianHealthcare system would need

to address

2 LackofInfrastructureandManpowe

r:Accessibilitytohealthcareservicesisextremelylimitedtomanyruralareasofthecountry.Inaddition,existinghe

althcareinfrastructureisunplannedandisirregularlydistributed.Further,thereisaseverelackoftraineddoctors

andnursestoservicetheneeds of the large Indian populous.

Theprivatesectorhasevolvedamulti-

prongedapproachtoincreaseaccessibilityandpenetration.IthastackledtheissueofLifestylerelateddiseaseswitht

hedevelopmentofhigh-endtertiarycarefacilities.AlsonewdeliverymodelssuchasDay-

carecentres,singlespecialtyhospitals,end-of-

lifecarecentres,etc.areonthehorizontoservicelargersectionsofthepopulationandaddressspecificneeds.

ThePublicSectoriskeentocontinuetoencourageprivateinvestmentinthehealthcaresecto

r11

andisnowdevelopingPublic–PrivatePartnershipsi.e.PPPmodelstoimproveavailabilityofhealthcareservices

and provide healthcare financing.

BothsectorshavealsoundertakeninitiativestoimprovefunctionalefficienciesintheformofAccreditations,Clinicalr

esearch,outsourcingofnon-coreareas,increasedpenetrationofhealthcareinsurance and third party payers.

These issues and initiatives have been further discussed in the ensuing sections.

10KPMG Analysis

11National Health Policy, 2002

Changing disease patterns:Implication for healthcare infrastructureChangesinthelifestyleofthepeopleareresultinginadualdisease burden.Thisemanatesfromthecomplexityofcommunicableandnon- communicablediseasesintheruralandurbanregionsofthecountry. Theoccurrenceofthesediseasepatternshasimpactedthehealthcare infrastructurerequirementsandhasresultedininfrastructural challenges for the government and the private players.

Changing Disease Trends

Indiaratespoorlyoneventhebasichealthcareindicatorswhenbenchmarkedagainstnotonlythedevelopedeconom

ies,butalsotheotherBRICnations.Thisisevidenceofthefactthatasignificantportion of the Indian population is

unable to access healthcare services. This is a consequence of:

Lack of healthcare infrastructure

Lack of trained and qualified manpower

Indicator Year India

Developed Economies Emerging Economies

US UK Japan Brazil Russia China

Life expectancy at birth (years) 2008 64 78 80 83 73 68 74

Infant Mortality Rate

(probabilityof dying by age 1 per

1000 livebirths) 2008 52 7 5 3 18 9 18

Maternal Mortality Rate

(per100000 births) 2000-09 254 13 7 3 77 24 34

Source: WHO, World Health Statistics, 2010

These issues have been examined and discussed in the sections below.

Changing Disease Pattern: The Dual disease burden

India’surbanpopulationhaswitnessedanincreaseof4.5timesover1951-2001comparedt

oa3timesincreaseinthetotalpopulationoverthesameperiod12

.Withincreasingurbanizationandtheproblemsassociatedwithmodern-daylivinginurbansettings,thediseaseprofilesareshiftingfrominfectioustolifestyle-

related.13

Itisestimatedthatby2012,50%ofthespendingoninpatientbedswouldbeforlifestyle-related diseases14

.



14Strategic Healthcare Solutions Private Limited, Article “Healthcare: Destination India”, 2007

6


Indiafacesthefollowingchallengesindiseasecontrol:

TacklingmaternalandinfantmortalityaswellascommunicablediseasessuchasTuberculosis,vector-

bornediseasesofmalaria,kala-azarandfilaria,water-bornediseasessuchascholera,diarrhoeal diseases,

leptospirosis, and thevaccine-preventablemeaslesandtetanus

Tacklingrisingoccurrenceofnon-

communicablediseases(NCDs)includingcancers,diabetes,cardiovascular diseases, chronic obstructive

pulmonary diseases and injuries

Developingsystemstocopewiththecategoryofthenewandre-emerginginfectiousdiseaseslikeHIV, avian

influenza, SARS, and H1N1 influenza15

Burden of Non Communicable DiseasesDisease Number of Cases Deaths 2005* Projected

Numberof Cases

2015**

Projected

Deaths2015

**Cardiovascular 3,80,41,090 20,89,50

8

6,40,71,981 34,20,752

Diabetes 3,10,39,932 N/A 4,58,09,149 N/A

COPD 1,70,20,000 N/A 2,22,10,000 N/A

Cancer 20,16,700 5,38,858 24,96,133 6,66,563*CVD/diabetes data from 2005; COPD from2006;cancerfrom2004.** Projected data for CVD/diabetes is for2015;COPDis2016;canceris2014.

Source:WorldHealthOrganisation,WorldHealthStatistics2010

ThefourleadingchronicdiseasesinIndia,asmeasured by their prevalence, are cardiovascular

diseases(CVDs), diabetes mellitus (diabetes), chronic obstructive pulmonary disease (COPD) and cancer.

All fourof these diseases are projected to continue to increase in prevalence in the near future given

thedemographic trends and lifestyle changes in India16

.

Healthcare infrastructure deficiencies

ThepenetrationofhealthcareinfrastructureinIndiaismuchlowerthanthatofdevelopedcountriesandeven lower

than the global average.

Current Infrastructure

The healthcare infrastructure in India is inadequatecomparedwiththeglobalstandards.Itlagsbehindtheglobal average in terms of healthcare infrastructure and manpower. India has an average 0.6 doctors

per1000populationagainsttheglobalaverageof1.2317

which suggests an evident manpower gap.

Indicators Year India USA UK Brazil ChinaHospitalBedDensity(per10000population)

2000-2009 12 31 39 24 30

DoctorDensity(per10000population) 2000-2009 6 27 21 17 14

15AR, Government of India Ministry of Health and Family Welfare, September 2010

16WorldHealthOrganisation,WorldHealthStatistics2010

17CII, Technopak report


7


Indicators Year India USA UK Brazil China

Birthsattendedbyskilledhealthpersonnel(percent) 2000-2009 47 99 NA 97 98

Noofdoctors 2009 6,43,520 7,93,648 1,26,126 3,20,013 18,62,630

No.ofNurses 2009 13,72,059 29,27,000 37,200 5,49,423 12259240

No.ofDentists 2009 55,344 4,63,663 25,914 2,17,217 1,36,520

Avg.no.ofdoctorsperbed 2009 0.6 0.81 0.53 0.69 0.46

Avg.no.ofnursesperbed 2009 1.27 3 0.16 1.18 3.02

No.ofdoctorsper1000p 2009 0.6 2.7 2.1 1.7 1.4

No.ofnursesper1000p 2009 1.3 9.8 0.6 2.9 1

Source:www.oecd.org,www.whoindia.org

In2009,thenumberofbedsavailableper1000peopleinIndiawasonly1.27,whichislessthanhalftheglobalaverageo

f2.6.Thereare369,351government beds in urban areas and a mere 143,069 beds inrural areas18

.

2008 2018 2028

Additional

BedsRequired

1.1 million 3.1 million 2 million

Bed/

1000population

ratio

0.7to1.7 4 5

Source: CII Technopak

Atsixdoctorsper10,000people,thenumberofqualifieddoctorsinthecountryisnotsufficientforthegrowingrequirementsofIndianhealthcare.Moreover,rural“doctorstopopulation”ratioislowerby6timesas compared to urban

areas19

.

Parameter Current Annual Production Tofillthegap

Physicians 30,558 9,93,500

Nurses 1,14,218 2,510,250

Source: CII Technopak

18Source:NationalHealthProfile2009

19Source: CII Technopak

8

9


AsofFY10,Indiahadapproximately300medicalcolleges,290collegesforBachelorofDentalSurgeryand140colleg

esforMasterofDentalSurgeryadmitting34,595,23,520and2,644studentsannuallyrespectively.Indianeedstoope

n600medicalcolleges(100seatspercollege)and1500nursingcolleges(60 seats per college) in order to meet

theglobalaverageofdoctorsandnurses.

Moreover, the medical personnel are concentrated in urban areas. Around 74 percent of the graduatedoctors in India work in urban settlements which account for only approximately one-fourth of thepopulation. The countrywide distribution of these institutes is also skewed. 61 percent of the medicalcolleges are in the 6 states of Maharashtra,Karnataka, Kerala, Tamil Nadu, Andhra Pradesh andPuducherry, while only 11 percent are in Bihar, Jharkhand,OrissaandWestBengalandthenorth-easternstates

20.

20Source:TaskForceonMedicalEducationfortheNationalRuralHealthMissionandTheNationalMedical Journal

of India Vol. 23, No. 3, 2010

10


E erging Trends i HealthcareDeliv ryIn the last decade, private participation in thehealthcare sector hasris n significantlyon the back of i creased interest by investorsandrising Private Equityand MergersandAcquisitions(M&A) activity.Futher,thesectorhasalso evolved through increased investment inR&D and the introduction of specialiseddeliverymodels.

Investment Trends

Driven byincreas d domesticdemand forhigh- nd investment servicesas well as medical tourism, the

healthcare sector hasattracted huge investmentslately. The healthcare sector islikelyto see anincreasein

investment from USD34.2bn in 2006 to USD 78bn in 2012E (CAGR of 15percent), with ~80percent of

investments from private players.2

The investmentsto thisscale are expected to increase the bed ratio

from 0.9 bedsper 1000peopleto 1.85 bedsper 1000people.22

Moreover, large scale investmentsin infrastructure are

requirdevelopedcountries.d to make healthcare facilities on par with

Source: Centrum Healthcare Sector October2010

Foreign DirectInvestment(FDI)

TheFDIinflowsinthehospitalsectrhavenotbeensignificantlyhighdespitegovern entincentivesto

attractFDIinvestments(including100percentFDIinmosthealth-relatedservices).Therearec rrently

limitednumberof“100percentforeign-ownedh althcare”playersintheIndianmarket.However,this

scenarioisexpectedtochangegiventheattractivenessofthesector.Manyforeignplayersaremakin

gaforayintothemarketthroughjointventureswithlocalhealthcareunits.Forexample,Singapore'sPacificHealthcar

emadeitsfirstforayintotheIndianmarket,openinganinternationalmedicalcentre,whichisa

21Source: Centrum HealthcareSector October2010

22Source: Centrum HealthcareSector October2010

m o


jointventurewithIndia'sVitaeHealthcare,intheIndiancityofHyderabad.Singapore-basedParkwayGroupHealthcarePTELtdhadenteredtheIndianhealthcaremarketin2003throughajointventurewiththeApollogrouptobuildtheApolloGleneagleshospital,a325-bedmulti-

specialityhospitala

tacostofUSD29million23

andislookingatajointventureforanothertertiarycarehospitalinMumbai.Many

internationaldiagnosticcareplayershaveentereare

looking keenlyat sectoral entry points.

Indiaandothersincludingmedicaleducationplayers

Source: Indiastat

*FDIforHospitalsandDiagnostic Centres, Medicaland Surgical Appliances, Drugsand Pharmaceuticals

M&ADeals

Pharma,biotechandhealthcaresectorhasseensignificanttractionoverthelastfouryearswithdealvaluesrangingfr

omUSD1.5billionin2007toUSD6.2billionin2010.Healthcareservicesaccountedfor14percentofthetotalM&Adeal

valuein2009.Pharma,biotechandhealthcaresectorsawinboundM&Adealsto thetune of 52 percent of

thetotalM&A deal value in 2010.24

Nu ber Value (USD billin)2007 NA 1.5

2008 NA 5.5

2009 23 1.5

2010 57 6.2

Source: Grant hornton DealTracker

PrivateEquityInvestment

TherehasbeenanincreaseinthePEandVCactivity(bothdomesticandglobal)overthepastcoupleof

years. These investments have been made across the healthcare delivery chain. However, these

investments are mostly made intertiary care hospitals inmetros/tier IIcities, chains ofhospitals,

diagnosticlabs, etc.


23Source: IDFCSecuritiesHospital SectorNovember2010

24Source: Grant Thornton DealTracker, 2010

11


Theprivateequityinvestmentsnearlydoubledinvaluein2010forthepharma,healthcareandbiotechsector. A

number of PE investors invested in hospitals and healthcare services.

Number Value (USD billion)

2009 15 148.5

2010 23 320.4

Source:GrantThorntonDealTracker,2010

Developments in Research

Healthcareresearchisacorefocuswithinthehealthcaresector.IntheUnionbudget2010/11,theexpenditurebudgetoftheMinistryofHealthandFamilyWelfareforhealthresearchincreasedby25percentY-o-YcorrespondingtoUSD110millioninabsoluteterms

.25

NotableresearcheffortsinthelastfewyearsincludeWellquest’sresearchcentreinHyderabadandBioconIndia’s

andBristol-MyersSquibb’s joint R&D centre at Biocon's SEZ in Bangalore26

.

Moreover,risingR&DcostsanddecliningR&Dproductivity,hasledtooutsourcingbeing a

keystrategyforimprovingprofitabilityforglobalinnovatorcompanies.Thishasbee

nakeydriverforthegrowthofContractResearchandManufacturing Services (CRAMS) in India.

Contract Research in India

ContractResearchi

safastemergingbusinessopportunityforIndiancompanies,particularlyformidsizedcompanies.

ThemarketsizeofcontractresearchinIndiain2009wasUSD0.9billioncomparedwithUSD0.6billionin2008

,agrowthof50%.PlayersintheIndianCROmarketintheyear2005were20andincreasedto100in the year 2008.

These are expected to be in the range of 150-200 in the year 2012.

Hospitalchainsareventuringintocontractresearchtoreducetheiroperationalandclinicalcosts.FortisHealthcareha

sbecomethelatestentrantincontractresearchwithitsFortisClinicalResearchServices.ApolloHospitals’sitemana

gementorganization—ApolloSpectraResearchFoundation—

hasbeenmanagingclinicaltrialsforsomeyearsnowandtheMaxgroup,ownerofMaxchainofhospitals,ha

sacontract research organization called Neeman Medical International.

About60percentoftheglobalclinicaltrialsmarketisoutsourcedtodevelopingcountrieslikeIndia.IndiangenericpharmacompanieslikeDaiichiSankyo,DrReddy’salongwiththeglobalplayerssuchasPfizerand Merck are involved

in the outsourcing in the Indian market27

.

25Economic Intelligence Unit Healthcare November 2010

26Cygnus, Industry Insight - CRAMS 2010

27Cygnus, Industry Insight - CRAMS 2010


12


Emerging Trends in Clinical Research

Clinicalresearchinmanyspecialitieshasledtoimproveddiseasemanagementandpatientcare,reducedALOS,bett

erBTR(BedTurnOverRates)makinghealthcaredeliverymoresustainable.Thisalsosignificantly improves the

DALY (Disease Adjusted Life Years).

ResearchinbetterdiagnosticcarehasbeeninbothlaboratorymedicinemovingtohighergenerationELISA’s,NAT(N

ucleicAcidTesting),movingtomoleculardiagnostics,immunologyandantigentesting,evolvingdiseasemarkersan

dsoon.Ontheradiologyfronttootherehavebeensubstantialimprovementsfromtraditionalmethodstocomputerisat

ion,PACS(PictureArchivedComputerisedSystem),betterradiation dose control and so on.28

Stem Cell Research

Stemcelltherapyinvolvestherebuildingorreplacingofcellsdamagedduetogeneticanddegenerativedisordersincl

udingage-

relatedfunctionaldisorders,autoimmunediseases,cardiovasculardisorders,Parkinson’sandAlzheimer’sdiseas

es,differentcancersetc.Scientistsareworkingtocreatestemcelltherapies that might help tackle a variety of

disorders,andwillhelpintheregenerationof a neworgan.

InIndia,theDepartmentofBiotechnologyhasallocatedmorethanUSD66Millionoverthelastfiveyearstowardsbasicandappliedresearchinstemcelltechnology.Thefocusistounderstandthefundamentalsofstemcellsfunctionandconductclinicaltrialstogaugetheeffectivenessofthetherapy.NationalCentrefor Biological Sciences (NCBS) in

Bangalore is involved in this29

.

A

varietyofinstitutessuchasAIIMS,L.V.PrasadEyeInstitute,CentreforStemCellResearchatCMCVelloreandNatio

nalCentreforCellSciences(NCCS)atPuneUniversityarefocusedonapplicationsforspecifically three areas:

Regeneration of damaged muscles due to heart attack, stroke or cornea damage.this confirms to the high

incidence rate of heart attack, blindness and stroke in India.

Thetaskoftheseinstitutesistolocatepromisingsourcesofstemcells,applystemcelltherapytocurepatients and

verify if the procedure is stable enough for wider application.

Theprivateeffortshavebeen a greathelpinthiscontext.DrSatishPatkiet-

alandDrNareshTrehanhavedemonstratedsuccessfulmodelsforstemcellresearchinIndiawithtestsonendometri

umandbonemarrowcellsrespectively.Reliancelifescienceshavebeengiventhenodforventuringintostemcellrese

arch in India

StoringthestemcellscanbeofgreatbenefittothehealthcarefraternityCompanieslikeRelianceLifeSciences,LifecellhaveandStemadehavecreatedfacilitytostorestemcellsfromumbilicalcordandmilkteeth.Stem-cellbankingthereforeisemergingasahotdestinationforinvestments.ItsmarketinIndiaistoutedtobeaboutUSD22Million,andisgrowingatover40perc

entperyear30

.

28Source: Cygnus, Industry Insight - CRAMS 2010

29Source:DepartmentofBiotechnology,AnnualReport2010

30Source: DNA, “Stem-cell bankers seek to tap India” September 2010


13


Drug Eluting Stents

Deathsduetocardiacailmentswillincreaseby100percentinIndiaby201531

.Drugelutingstents(DES)are increasingly being used in the treatment of coronary artery diseases.

OneofthemajorbenefitsofDESisthattheprocedureisminimallyinvasiveandtheperformanceisequalorbetterthanb

aremetalstents(BMS).Eventhoughpolymersareimportantinkeepingthedrugintact,polymerfreeDESarelikelyto

minimizeDES-relatedcomplications.AninterestingfacetofresearchisbeingundertakenatSurat-

basedEnvisionScientific.Thejudiciousapplicationofnanoparticleswillincreasethecellabsorptionandthusreducet

hecomplicationsofthedrugandpolymersNanocarrierdeliverycanbeusedfordifferentmedicalapplications.Comp

anieslikeEnvisionscientific,B-

Braun,areaddressingthesekeyissueswithlandmarkresearches.Thelatestresearchinthisfieldisdrugelutingballo

on (balloons without stents) which will travel the artery and act at the wound site.32

Hospitals and Research

InIndia,manycorporatehospitalsandmajorpublichospitalsareactivelyinvolvedinconductingclinicaltrials of

various drugs.

PrivatecorporatehospitalssuchasApolloCare,NarayanaHrudayalaya,UshaCardiacInstitute,ShankarNetralaya,Indraprastha,BreachCandy,andBayerdiagnostics as well as public hospitals such as All IndiaInstituteofMedicalSciences,NizamInstituteofMedicalSciencesandmanyoftheMedicalcollegesandteaching

hospitals are actively involvedinvariousstagesofclinicaltrials33

.

Manyofthemhavestate-of-the-

artinfrastructurefacilitiesforconductingclinicaltrialsandtreatingpatients.Thesehavenotonlyhelpedinimprovingp

atientoutcomesbutalsohelpedintacklingincreasedvolume of patients suffering from debilitating diseases.

Developments in Private Healthcare

Evolving Delivery Models

Day care Centres

Need:Theconceptofout-patientsurgeriesisgrowingworldwideasin-

patientfacilitiescanbeexpensiveandinconvenientinsomecases

.AlargenumberofsurgeriescannowbeperformedwithoutthepatienthavingtobeadmittedatallwiththehelpofDayca

reSurgeryCentres.Thisdeliverymodelisadvantageousforbothhealthcareprovidersandconsumers.Itisestimated

thatby2020,75percentofallsurgicaloperationswillbecarriedoutinambulatorysurgerycentres/

unit

s34

.Todayoveraquarterofthesurgeriesarecontributedbyophthalmicprocedures.Thecostadvantageofdaysurger

yisbestachievedin free-standing centres or free-functioningunitswithinhospitals.

31Source: Express Pharma Online, “Lupin launches Ivabrad”, 2008

32Source: KPMG Analysis

33Source: Cygnus, Industry Insight - CRAMS 2010

34Source: indianhealthcare.in


14


InIndia,theconceptofstand-alonedaycaresurgerycentresiscurrentlyinitsinfancy.Manyofthemajorhospitalshaveaseparatedaycaresurgerycentrewhichcaterstothemanagementofambulatory(alsocommonlyreferredtoas“sa

medaysurgery”)procedures.InIndia,about20percentofallsurgicalprocedures are performed on outpatients35

.

Studiesrevealthattreatmentinthesecentreswouldcostabout47percentlessthaninhospitals36

..This

model can be economically efficient for the Indian healthcare which is scarce in resources37

.

Potential Benefits:

The range of services provided and the cost arethe prime benefits of the day care services.

I

nahospitalwiththedaycareservicesthesurgerydepartmentprovidesservicesforeyesurgery,includingremovalofc

ataracts,eyemusclesurgery,Arthroscopicsurgeries,Generalsurgery,Cosmeticsurgeryandremovalofforeignbo

dies,providingthepatientwithplethoraofservicesinasmalltimeframe.

Anaveragecorporatehospitalontheotherhandtake

saminimumof18monthsinthemakingandaminimumofthreetofiveyearstobreakeven.Companyexecutivespointo

utthateveninahospitalsetuparound75percentofrevenueisfinallymadefromthesurgeries.Thisfactfurthersupport

sthegrowthofday care centres.

CapexandEBIDT

A:DuetothedependencyonthespecialityandlevelofcarethataDayCareCentrewouldcatertoitisdifficulttopendow

nanindustryaverageontheCapexbutafairindicatorwouldbeINR

3.5 –4.5Million/bedforaninternationalstandarddaycarecentre.EBIDTAmarginsforDayCarecentresrange

between 25 percent and 30 percentwith a pay back of ~3–4 years38

.

Case Studies39

:

NOVA DAY CARE CENTRE

ThepromotersandtheUS-basedprivateinvestmentfirm,plantosetuparound100day-

caresurgerycentresinthenextthreetofouryearswithaninvestmentofoverINR800crore.Thecompanyexecutives'c

laimthatthepatientscouldsaveabout15-

20percentinsurgerycostsatNova'sdaycarecentrescomparedtothecorporatehospitalsrates.

"Thelow-

costmodelandthehighefficiencyratesof450surgeriespermonthpercentrewouldmakei

tabefittingmodelforIndia,whichhasabedtopopulationratioof0.7perthousandpersonscomparedtotheworldavera

geof3.3.Overnightroomcostsandrelatedoverheadcostsareeliminatedandthemodelenables surgeons to attend

to more patients in less time.

Itessentiallyaspirestofocusonminimallyinvasivesurgeries,whichusethetechnologicaladvancesinmostoptimum

manner.ThedaycaresurgerymodelhasamarketpotentialofINR42,000croreinthecountry.

(SureshSoni,chairmanandco-

founder,NovatoldFE.)Inthefirstphase,thegroupplanstobuild25centresin10majorcitiesinthenexttwoyears.They

35Source:indianhealthcare.in

36Source:indianhealthcare.in – “Daycare Surgery 4 Centres”, 2010

37Source: Article by Express Healthcare


39Source: Company Websites


15

“Theseventoeightmonthsbreakevenofthismodelisanattractivepropositionforthehealthcareverticals compared to 2-3 years which a hospital takes.” (Girish Rao, CEO-NOVA)40

MedicalCentres,aspecialiseddaycaresurgerycentre chain,andMaxHealthcareInstituteLimited(MHC)recentlyannouncedaJointVenture(JV)toexpandthereachofdaycaresurgeryintheNationalCapitalRegion.MHCwillholda31percentstakeintheJVentity.Thisstrategicallianceisdesignedtohelpbothcompaniesboostthereachandefficiencyoftheirservices.NovaissettoexpanditsreachacrosstheNCRregionwithtwodaycarecentresscheduledtoopeninthenextfewmonthswithplanstoreachatotal of six centres in the near future.

PallativeCareSetting


End of life care centres

Need:Inmedicine,end-of-

lifecarereferstomedicalcarenotonlyofpatientsinthefinalhoursordaysoftheirlives,butmorebroadly,medicalcareof

allthosewithaterminalillnessorterminalconditionthathasbecome advanced, progressive and incurable.

Therefore end of life care centres have three objectives

To reduce the agony and burdenofprolongeddyingprocess

To develop mental peace at the time of death

ToestablishethicalprinciplessupportingdeathintheIndianhospitals

PotentialBenefits

:Byincreasingtheproportionofcommunityandhomecare,palliativecarecanreducecostsassociatedwithhospitalst

aysandemergencyadmissionsmuchpalliativecarecanbeandisgivenat home.

InIndia,over138organisationsprovidehospiceandpalliativecareservicesin16statesorunionterritories.Theseservicesareusuallyconcentratedinlargecitiesandregionalcancercentres,withtheexception of Kerala, where

services are more widespread41

.

Palliativecare structure inIndia

Regionalcarecentres&f

ree-standinghospi

ces

OutreachClinicsGovernmen

t&Private Hospitals

DayandHomeCareServices

Single Speciality Hospitals

Nee

d:Singlespecialityhospitalsareasmallbutrapidlygrowinggenreamongtoday’shospitalsinIndia.Thegrowingnumb

erofspecialitycentresandhospitalssignalsamovetowardsmaturityofthehealthcareindustry with an increasing


complexityof business and consumer affordability.

40Source: Financial Express February 5, 2010

41Source:DepartmentofSocialPolicy&SocialWork, University of York, York, United Kingdom

16


Specialityhospitalformatsrangefromlow-riskspecialityincludingeyecare,dermatology,motherandchildtohigh-

endspecialityincludingcardiology, cancer and transplant medicine.

Themid-levelspecialitiesareofferedinamultispecialityhospitalformat.Thelow-

riskspecialitymodelsrequirelowcapitalexpenditureandhavecomparativelylowoperatingcostsasin-

patientstayisrarelyrequiredfordayprocedures.Thisreducestheneedforsupportinfrastructureandofferseasyrepli

cation.Consumers expect convenience and are not willing totravel too far for such speciality services.

Potential Benefits:

There are several advantages to Single Speciality Hospitals

Cost efficiency due to higher volumes

Providehigherqualitycareduetogreaterspecialization

Easily attract human resource

Economiesofscaleandscope

Ease of operation

Increase consumer satisfaction

Competitivepricingandincreasedchoiceforconsumer

CapexandEBIDTA:CapitalExpenditureisestimatedatINR4toMillion/beddependingonthespecialty.TypicalEBIDTAmarginsrangefrom30percentto34percentalthoughsomespecialit

ieshavehighermargins. Pay Back period is estimated at 2–3 years which may vary with the speciality42

.

Case Studies:43

Arvind eye care

3,950bedsatfivehospitals.

Examines more than two million patients annually.

Arvindsurgeonperformsanaverageof2,000ormoresurgeriesperyear,measuredagainsttheIndiannational average of 250.

Bydevelopingacorecompetencyexpandingaccessinafocusedareaofcareorganizationsindevelopingcountriescanmarshalneededresources.

Bein

gaspecialtycaresystemhasmadeiteasierfororganizationssuchasArvindtostandardizemanagementandclini

calprocesses,trainaspecializedparaprofessionalworkforce,pursuelower-costtechnology, and build

volume with focused community outreach and education

Mohan’s diabetic care

61beddedin-patientdiabetescareunitSpecialistconsultationsinthefieldsofcardiology,neurology,nephrology, urology, dermatology, ophthalmology, psychology, orthopaedics and paediatrics

Staff have been trained and prepared for emergency care

Wide range of surgical services for the diabetes patients with three well equipped operation theatres.

Surgeries related to diabetic foot complications, general and eye surgeries (cataract and


43Source: Company Websites

17


Ayurvedic and Wellness Care

Ayurvedictreatmentsare5,000yearsoldinIndiawiththebulkoftheayurvedictreatmentmarketconcentratedinSout

hIndia,mostlyinKerala44

.PEfirmsarealsoinvestinginthisspacewhilemergerswith ayurveda pharmacies are also taking place.

Ayurvedicmarket(whichi

sapartoftheBeautyandRejuvenationmarket)isestimatedatINR40Billionin200945

.Indiaisapopulardestinationforayurvedictherapiesleadingtoalargenumberofforeigntouristsvisitinglocalspasandayurvedictreatmentcentres.InboundmedicaltourisminIndiaisthereforegrowingat a 12 percent CAGR.

TheStategovernmentofKeralaalsohastakencertaininitiativestoencourageAyurvedicspasandresortsas a

touristdestination.Spa'sinKeralareceive government approval when they are set up.

Ayurvedacentreswhichareapproved/

certifiedbytheStateDepartmentofTourismareeligibleforclaiming10percentstateinvestmentsubsidyorelectrictari

ffconcessionandconsideredduringpublicityand promotional activities through print and electronic media by

the Department

Keralagovernmenthasevencollaboratedwithlargeprivateplayersinordertodevelopresortspas.Inordertoattractto

uristsintoIndia,theGovernmenthasintroducedvariousschemesandtoimplementthemithasalsotiedupwithleadin

gwellnesscentres.TourismministrylaunchedapromotionalschemeofferingonenightfreestayataspacentreinIndi

aifatouristbooksthreenightsatacertainwellnesscentres46

Hospitals are also setting up wellness centres to cater to the requirements of the medical tourists

ApolloHospitalshasanentitycalledApolloWellnessPluswhichhasfitnessandayurvedictreatmentcentres

ManipalHospitalsprovidesayurvedictreatment,fitnesssolutionsthroughManipalCureandCare47

Case Studies48

:

Kerala Ayurveda Ltd.

Ramesh Vangal owned KAL was founded in 1945

It is listed on Bombay Stock Exchange

Ithas30wellnesscentreswhicharemostlyconcentratedinthesouthbutitalsohasitspresenceinthe north

It owns Kerala Ayurvedegram that is present in Bangalore

IthasenteredintoanExpressionofInterestwithCoimbatorebasedAryaVaidyaPharmacytobecomethe largest Ayurveda Utility

Ananda Spa

IthasdestinationspasinTehri-Garhwal,UttaranchalwhichprovidesTreatmentbasedonayurvedicscience via herbal scrubs, wraps and packs

44Source: Research on India, Wellness Services Market Report, 2010

45Source: Research on India, Wellness Services Market Report, 2010

46Source: Kerala Tourism; India PR Wire “Bharat Hotels”; “Kerala government to develop resort”;

May2009;AlishaTravels47

Source: Research on India, Wellness Services Market Report, 201048

Source: Company Websites

18


VCC Ayurveda and Panchakarma Clinic

It is located in central Kerala

ItprovidesKeralaMassagetherapy,relax-detoxtherapy,rejuvenationtherapy,anti-ageingtherapyand also has weight loss programs

Kare

Kerala Ayurvedic Research and Rejuvenation is located on the outskirts of Pune

Its services include ayurvedic massage therapy,anti-ageingayurvedictherapy

Developments in Public Healthcare

Initiatives by the Government

Totacklethechallengesmentioned,theGovernmenthastakenvariousinitiativestoimprovethePublicHealthcaresy

steminIndia.TheGovernmentlaunchedtheNationalRuralHealthMission(NRHM)in2005whichaimstoprovidequa

lityhealthcareforallandincreasetheexpenditureonhealthcarefrom0.9percent of GDP to 2-3 per cent of GDP

by 2012.

AccordingtoUnionBudget2010-11,theplanallocationforMinistryofHealthandFamilyWelfarehasincreased from

USD 4.2 billion in 2009-10 to USD 4.8 billion in 2010-11.

Moreover,inordertomeetrevisedcostofconstruction,inMarch2010thegovernmentallocatedanadditionalUSD1.2

3billionforsixupcomingAIIMS-likeinstitutesandup-gradationof13existingGovernment Medical Colleges49

.

TheUnionCabinetonOctober20,2010approvedtheproposaloftheMinistryofHealthandFamilyWelfaretodeclare

NationalInstituteofMentalHealthandNeuroSciences(NIMHANS),BangaloreasanInstituteofNationalImportanc

eonthelinesofAllIndiaInstituteofMedicalSciences,NewDelhi,PostGraduateInstituteofMedicalEducationandRe

search,ChandigarhandJawaharlalInstituteofPostgraduate Medical Educationand Research, Puducherry.

Private-Public Partnerships

TheIndianGovernmentisfocusedondevelopingthePPPmodeltocoverthedemand-

supplygapprevalentinthehealthcaresector.Privatesectorexpertisecoupledwithefficienciesinoperationandmain

tenancewouldleadtoimprovedhealthcareservicesdeliverytothemasses.Thismodelcanactasacatalystinthecrea

tionofnewcapacityandimprovementofefficiencyintheexistinginfrastructureestablished.TheGovernmentalsoem

bracedPPPmodeltocounterepidemicslikeH1N1swineflu,HIV,etc. However, it is evident that this model be far

more beneficial.

ThecriticalsuccessfactorsforPPPare:

Political Commitment and introduction of requisite regulations

49Source: Firstcall Research, Apollo Hospitals Enterprise Limited Company Research Report, Q2, 2011

19


Policy and legal framework for operating PPP models

Strong control mechanisms for efficient oversight including dispute resolution procedures

Risk apportionment through careful design of the contract

Incentivize the private sector with an ‘acceptable rate of return’

Few successful PPP projects are mentioned below50

:

Karnataka Karuna Trust; Yashaswini Scheme

Tamil Nadu Mobile health services

Andhra Pradesh Aarogyasri

Andhra Pradesh Diagnostic Services for 4 Medical Colleges

West Bengal Mobile health services

Madhya Pradesh Community outreach program

Rajasthan Contracting in publichospitals

Gujarat Chiranjeevi Project

50Source: Technopak Report “A Peek into the Future of Healthcare: Trends for 2010”

20

21


Building Functional EfficienciesWhileinfrastructureimprovement,capacityadditionanddevelopment ofmanpowerarecriticalfortheIndianhealthcaresector,itisalso necessarythattheexistingfacilitiesareoperatedinanefficient manner.Thiscanbeensuredthroughvariousmeanssuchas Accreditation,adoptionofCostAccountingProceduresandfinally increased penetration of Healthcare Insurance.

Accreditation

Accreditationisoneofseveralmodelsofexternalevaluationusedbyhealthcareentitiesthroughouttheworldtoregula

te,improveandpromotehealthcareservices.Domestically,accreditationissoughtfromtheNationalAccreditationB

oardforHospitalsandHealthcareProviders(NABH),anentityunderthecontrol of the Quality Council of India.

JCIaninternationalaccreditationarmoftheUSjointcommissionalsoprovidesaccreditation.FewhospitalsinIndialik

eMoolchandHospital;Fortishospitalsetc.havealreadybeenaccreditedbythisbody51

.

Trends of Accreditation

Todate,only17IndianhospitalsareJCI-accreditedandallarelargecorporateentities,includinghospitalsintheApollo,Fortis,andWockhardtHospitalsyste

ms52

.

AsofMarch2007,over700IndianhospitalshadappliedforNABHaccreditation.TheNABHisinvolvedintheaccreditationofbloodbanks,diagnosticcentres,nursinghomes,dentalclinics,andAyurvediccentresinadditiontoprivatehos

pitals,nursinghomes.AsofJanuary1,2008,only12medicalfacilitieshavebeenaccreditedbyNABH53

.

Advantages of Accreditation Patientsbenefitintermsofhighqualityofcareandpatientsafety.Theyareservicedbycredentialmedicalstaffan

dtheirrightsarerespectedandprotected.

Accreditationresultsinhelpingcontinuouslyimprovetheoverallservicesofthehospitalinordertoprovidehighqu

alitycarewithleastpossiblerisks.Accreditationprovidesanobjectivesystemofempanelmentbyinsuranceand

otherthirdparties.Itprovidesaccesstoreliableandcertifiedinformationonfacilities,infrastructureandlevelofcar

ewitheducationongoodpracticestoimprovebusiness operations.

51Source: http://www.jointcommissioninternational.org

52Source: http://www.jointcommissioninternational.org

53Source: Gluck: An article from the Saint Louis University Journal Of Health Law & Policy


Healthcare Insurance

Indian health financing faces a number of challenges including:

Increase in health care costs

High financial burden on poor effecting their incomes

Need for long term and nursing care for senior citizens because of increasing nuclear family system

Increasing burden of new diseases and health risks

Limitedgovernmentfundingleadingtonegligenceofpreventiveaswellasprimarycareandpublichealth

functions

Healthinsuranceisestablishedinmanycountries,however,stillremainslargelyuntappedinIndia.Lessthan15perce

ntofIndia’s1.1billionpeoplearecoveredthroughhealthinsurance54

.Itmostlycoversgovernmentemployees,shareofpublicfinancingintotalhealthcareisjustabout1percentofGDP.Over80percentofhealthfinancingisprivatefinanci

ng,muchofwhichisout-of-pocketpaymentsandnotbyany pre-payment schemes.55

HealthcareFinancing

Social1

%

OutofPocket80%

Other17%

State12

%

Local2%

Centre2%

Insurance3%

Source: Centrum Healthcare Sector October 2010, KPMG analysis

However,healthcareinsuranceisslowlypickinguppaceinIndia.Accordingtothe2010statisticsreleasedbytheIRD

A(InsuranceRegulatoryDevelopmentAuthority),thetotalhealthinsurancepremiumswrittenbynon-

lifecompaniesandstandalonehealthinsurancecompaniesgrewby25.2percentinFY2010overFY 2009.

54Source: www.indianhealthcare.in

55Source: Emerging Health Insurance in India – Anoverview,ByJ.Anita,ActuariesofIndia,GlobalConference

of Actuaries

22

CAGR19%


HealthcareInsurancePenetration

9.00%

8.00%

7.00%

6.00%

5.00%

4.00%

3.00%

2.00%

1.00%

0.00%

2008 2013

Source: Centrum Healthcare Sector October 2010

Government insurance Schemes

GovernmentinitiativesliketheRashtriyaSwasthyaBimaYojna(RSBY),ComprehensiveHealthInsuranceScheme(RSBY-CHIS),Kerala;ApkaSwasthyaBimaTrust(ASBT),Delhi;NiramyaHealthInsuranceScheme, Ludhiyana

are now actively drivingthe health insurance market in India56

.

RSBYmayalsobeextendedtoNationalRuralEmploymentGuaranteeAct(NREGA)workerswhoworkedunder the

scheme for 15 days in a year.

Theinitiativescanhelpaddresstheneedsofthepeoplebelowpovertylineaswellastheothervulnerablesections of the society.

Emerging role of TPA’s:

TheTPA’s(ThirdPartyAdministrators)haveaddedtothechangingscenarioofhealthinsuranceinIndia.Theirroleisg

raduallychangingfromgreenfieldventurestoanestablishedsystem.Theirwidespreadnetworkwithhospitalsandot

herhealthcareprovidershavecertainlystrengthenedthehealthinsurancestructure in India.

Major TPA’s No of hospitals added to the network

I Care Health Management and Services 2040

E Meditek Services 867

HealthIndiaServices 786

Total coverage by all the TPA’s in India 10974

Source: IRDA Annual Report 2010

56Source: Towers Watson – New Planned Launches Article 2010

23


Tobringinuniformityandsmoothfunctioningoftheprocess,theIRDA(Insuranceregulatoryanddevelopmentauthor

ity)hasdirectedtheTPA’stoformulatestandardguidelinesandformatsforbettercommunication and transparency

in the system.

Potential benefits:

Visibility of health insurance in the hospitals and amongst the patients could improve

Credibilityofthehealthinsurancepracticeswillhelpimprovedrivingmorenoofpeopleintothesystem.

A formal structure will be created reducing theambiguityinthehealthinsurancedelivery

24


ConclusionHealthcareisataninfluxofparadigmshiftsintermsofchanging diseasepatterns,increasingdualdiseaseburdenforbothruraland urbanIndia.Onthesupplysidetherehasbeenunevendistributionof healthcareinfrastructureandresourcesposingvariouschallengesto thesector.Amulti-prongedapproachfromkeystakeholdersis necessarytoaddresstheissue.Boththepublicandprivatesector needtoworkintandemtomakehealthcareavailable,accessibleand affordable. India would need various solutions towards this end.

Way Forward

Public Sector and Government Interventions – Now and Ahead:

Improving the Reach and better Quality:

Thegovernmentplanstoundertakebuildin

g6superspecialitytertiarycarehospitalswithresearchandeducationcentresacrossthecountry.Thesewouldcatertotheweakersectionsmakinghighendclinicalcareavailabletothemasses.

Encouragingcurrentinitiativesonpubicprivatepartnerships,forboththecareproviderandeducationsectors, should continue.

ThegovernmentshouldcontinueflagshipprogrammessuchassuchasRashtriyaSwasthaBimaYojana (RSBY) and State level Insurance schemeslike the Arogyashri, Chiranjeevi etc.

Atthebaseofthepyramid - Toimproveavailabilityofmedicalstaffinruralandfar-

flungandinaccessibleareas,doctors,specialistsandpara-

medicalsaregivenmonetarybenefitssuchas25percenthiketothosepostedindifficultareasand50percenthikef

orthoseinareasthatarealmostunreachable by road.

AtruncatedmedicalcoursedesignedbytheCentralGovernmentfromtheChinese“barefootdoctorsmodel”thatis

assumedtoproduce145,000ruraldoctorseveryyearwhichwouldcovermostprimarylevelneeds57

.Theexistinghealthsub-centres,thefirstpointofcareforvillagers,arenowbeingmanned by Auxiliary Nurse Midwives (ANM).

ThroughNHSRC,theNRHM(NationalRuralHealthMission)isencouragingalmost200hospitalstogofor a sustainedQualityAccreditationprogram andthisissoughttoextendto400hospitals.

TheCGHS(CentralGovernmentHealthServices)hasmadeitmandatoryforallhealthcareinstitutionsanddiagnosticcentresprovidingcaretohaveeitherNABH / NABLcertification.

Healthcare Education58

:

Tomeetthedemandformorehumanresources,especiallythedoctorsandnursesthegovernmenthasreducedt

helandrequirementsfrom25acresformedicalcollegesto10acresinurbanareas.TheINC norm of 4 acres for

nursing colleges has also been relaxed.

57Source: FICCI Report, 2010

58Source: Government Regulation issued by MedicalCouncilofIndia&IndianNursingCouncil

25


PrivatemedicalcollegesareallowedtoconducttheirownCETandthereservationcriteriaforgovernmentseatsa

ndmanagementquotahavebeenrelaxedwithauniformpre-decidedfee.OnlytheNRIreservationismaintainedat15percent.

PrivatemedicalcollegesarenowallowedtoregisterunderSection25Act,unlikeearlierwheretheyhad to be under the Charitable Trust banner.

Tax Benefit Interventions59

:

AllnewhospitalsbeingsetupinTierIIandTierIIItownsofIndiaaregive

nafiveyeartaxholidaybythegovernment.TheUnionBudget2009–

2010hasstayedtheorderandthiswindowisopenfromApril1,2008toMarch31,2013,duringwhichthehospitalm

ustcommenceoperations.Hundredpercenttaxdeductiontoprivateinvestorsonthecostofbuildinginfrastructur

eforminimum100bedhospitals anywhere in India.

Forthediagnosticandmedicalequipmentandconsumablesegment.Uniformconcessionaldutyof5percent.

CVD of 4 percent with exemption from

specialadditionaldutyonmedicalequipment;retainingfullexemptiononassistivedevicesandmedicalrehabilit

ationaids.Weighteddeductionsonpaymentsmade to national labs have been increasedfrom 125 percent

to 175 percent.

Import Duty Concessions60

:

Reduction in Import duty on equipment from 25 percent to 5 percent

Customs Duty reduced from 16 percent to 8 percent for medical and veterinary furniture

Custom’sdutyon24medicalequipmentlikeX-ray,tele-therapystimulatorequipment,goniometeretc.have been reduced to 5 percent

Depreciationonmedicalequipmentraisedfrom25percentto40percent

Medical Device Interventions:

ThegovernmentannouncedaUSD69millioninOctober2009topromotedomesticdevicemanufacture to enable price control of critical equipment including stents, catheters, heart valves etc,

Centralgovernmenttosetupthefirstspecialiseddevicecentre‘NationalCentreforMedicalDevices’in Gujarat

to promote indigenous R&D efforts61

Medical Devices Regulation Bill has been tabled and is under consideration62

EnablingITdrivenhealthcaretoimprovethereachandcosts.Tele-

medicine,asabranchofdiagnosisandtreatment,shouldbeencouragedandwidelyimplementedtohelpensureavailabilityandaccessibility of care to all areas in spite of infrastructural inefficiencies

Public Sector – Action Items: Specialbenefits,ViabilityGapFunding,andsubsidiesoncostofcareforPPPinitiativeswouldmakeitmore

attractive for the private sector to participate

Awarenessdrives,IECforHealthInsuranceschemescoveringboththeruralandurbanpoortobeinitiated through collaborative approach like NGO participation etc.

Incentivize corporate sector to take up healthcare initiatives for CSR activities

Thecurrentcompulsoryruralstintformedicalprofessionalstobecontinued.Butneedstobeaugmentedwithbetterfacilitiesandsupportsystems

59Source: Income Tax Act, 1961 read with Income Tax Rules, 1962 & Customs Act, 1962 read

withCustoms Tariff Act, 197560

Source: The Customs Act, 1962 read with The Customs Tariff Act, 197561

Source: FICCI Report, 201062

Source: FICCI Report, 2010

26


Givinganinfrastructurestatustotheindustryandalsoencouragesubsidiesonpower,waterandotherutilities to reduce overall cost of care

Providingincentivestotheindustrytosetupinfrastructuresinruralareas.Thiswouldleadt

oamultipleeffectofimprovingtheoveralleconomicandsocialstatusalsomakingitattractiveandsustainablefor

medicalprofessionalstowork

Makingitmandatoryforalldiagnosticservicestohavearegistrationprocesswhichlaysdownsomeminimumstandardscriteria.Thiswillhelpintheprovision of better qualitydiagnostic services.

Providingacommondiscussionplatformforallqualitycouncilswhichenforce,assessandmaintainqualitystandardsinHospitalsandHealthcareInstitutions(includingeducation).

Private Sector Interventions – Action Items: PrivatesectorshouldworkintandemwiththegovernmentonPPPinitiativestoeducatethelaterfordevelopingmo

resustainabledeliverymodels

Provide Hub and Spoke models for both treatmentanddiagnosticcaredelivery

TakeontheresponsibilityofMedicalEducationwhichincludesmedicalprofessionals,nursing,andparamedicalstaff

Toformacommonhealthcareforum/platformtocorroboratealleffortswhichrequirepolicydecisionchanges which would giving more lobbying power

EncourageandextendCSRinterventionsincrossfunctionalformatsforcapacitybuildingofthepublicsectorpers

onnel.Thiscanbedonethroughexchangeprograms,CME’s,shortstaycertificationsinareaslikehospitaladmini

stration,qualitycontrols,specialisednursingcarelikeintensivecare,operationtheatre,highenddiagnosticstec

hniquesandreportingforlaboratorymedicineandradiologyCT / MRI scans, interventional radiology etc.

Encourage provision locum medical staff forshort durations or on specific programs

Work with the government to encourage better penetration and utilisation of health insurance schemes

Withintheirownsetups–encourageaccreditation,makeitmandatoryforcredentialingofMedicalProfessionals while recruiting/ appointing to help ensure quality standards.

27

S TCA ES UDIES


28


AcuityInformationSystemsPvt.Ltd.

AIIMS, New Delhi deploys acuVena™ - Blood Bank Software

AllIndiaInstituteofMedicalScience

s,AIIMS,isconsideredasoneofthemostprestigiousmedicalcollegesinIndiaandisgloballyrecognizedforproviding

bestinclassmedicalcaretoalargenumberofpatients.Itwasestablishedasaninstituteofnationalimportancebyanac

toftheIndianparliamentwiththeobjectiveofdevelopingastrongcurriculumandteachingguidelinesforundergradua

teandpost-

graduateeducationinallbranchesofmedicineinIndia.TheDepartmentofTransfusionMedicineatAIIMSis

runninga full timeBlood

BankintheInstituteandalsoorganizingteaching,researchactivities.TheBloodBankfunctionsroundthe

clockandisaRegional BloodTransfusionCentreforsouthDelhi.

AIIMSdecidedtogoinforanend-to-

endcomputerizationofthebloodbankservicesfrommanagementofdonorstomanufacturingofcomponentsaswell

asadetailedtraceabilitytoensuretheconceptofhaemo-

vigilancefromthestandpointofadonorandtherecipient.AIIMSbegantoreviewsomeofthebest-of-

breedbloodbanksoftwareproductsavailableandarrivedatasolutionfromanIndiancompanybythename–

acuis™.ThenameoftheirbloodbanksoftwareproductwasacuVena™.TheteambehindacuVena™hadconcentrat

edonthecomplexitiesoftheworkflowsofindependentandhospitalbasedbloodbanks.Theirsolutionhadbeensucce

ssfullyrunningatmanyofIndia’sleadingbloodbanksforthepastfiveyears.acuVena™hadbeenshowcasedatindust

ryconferencesinIndiaandtheUSAandhadevolvedbestpracticesfromtheindustryovertheyears.Beinganenterpris

eclass,web-basedsoftware;itseemed to fit in line with the vision of the blood bank at AIIMS.

acuVena™presentsitselfasaprocess-driven,feature-

richbloo

dbanksoftwarethathasbeenbuiltonaServiceOrientedArchitecture.Thekeytoitssuccesshasbeentheinputsgiven

bythecoreR&DteamconsistingofdomainexpertswhoarestalwartsoftheIndianbloodbankindustry.acuVena™ha

smappedkeystakeholderslikedonors,blooddriveorganizersandcare-providersinitsdesignfromtheground-

up.Thisinsuresthatthesestakeholderscanactivelyinterac

twiththesystemratherthanthesystembeingrunessentiallybytechniciansanddataentryoperators.Thesoftwareca

nbebroadlyclassifiedintothefollowing subsystems:

Donor Centricity

Oneofthekeystakeholdersinthesystemisth

edonor.Thesystemhelpsmarkdonorsaseligibleanddefersthosewhoarenoteligible.Theentiredonorworkflowhas

beentracedontoacuVena™process


29


map.Donorquestionnairesarecompletelycustomizable.Donorscanhavetheoptionofself-

registrationeitherviatheweboraninteractivetouchscree

nmodule.Itrecordshistoryofpreviousdonationsandrestrictsdonorsfromdonatingbeforetheireligibleperiod.acu

Vena™hastheaddedadvantageofnotlosingtrackofdonorswhoaretemporarilyunfitfordonationbyremindingthe

mtocomebackwheneligible.

Bag Lifecycle

acuVena™maintainsthedetailedhistoryofabagrightfromthetimethestoresofficerreceivesit,tillit

isfinallyissuedtotheintendedrecipient.Thesystemacceptsdonorsofwholebloodaswellasaphaeresis.Itallowsco

mponentpreparationdependingonthetypeofbagchosen.acuVena™enablestypingofbloodforRedCell,Leuco

cyteandPlateletAntigen.Onecanviewthetransfusioncentre'sstockaccordingtostocklocation,bloodgrouporcom

ponent.Everystageofthebloodbagfromcollection,componentpreparation,storage,stockmovement,cross-

match,issue,returnanddiscardaretraceablewithinthesystem.Thesystemhasanoptionofautomatic as well as

manual discard of blood components.

Transfusion Care

Thesystemallowsbothinternalandexternalbloodrequests.Incaseoftertiarycarecenters,thebloodbanksalsoserv

eexternalrequestsfromneighboringhospitalsandnursinghomes.Thesystemsupportsbulkissuestostoragecente

rs,emergencyissues,cross-match,issue,returnandbillingofbloodcomponents in

stock.acuVena™enablesadversetransfusionreactionreporting from the point of care.

Blood Drive (Camp) Management

acuVena™hasacomprehensiveblooddrive(bloodcamp)organizationmodulethathelpsbloodbanksorganize

resources (personnel, vehicles, consumables and assets) for blood drives (camps).

DonorLoyalty

:acuVena™storesinformationaboutdonorswhoareeligibleaswellasthos

ewhomaynotbeeligibletodonatetoday.Thiseligibilityisautomaticallycalcu

latedbyanintelligentquestionnairesystemthatcalculatesthenumberofday

sadonormaybedeferredduetoapre-

existingcondition.Sincesuc

hasystemisrulebased,itallowsthebloodcentertochangetheeligibilitydays

dependingontherulessetforthbythegoverningregulatory

authority.Storingdataofineligibledonorsnotonlyhelpsthebloodcentercallthembackwhentheyarenext eligible, it

also enables the blood center from pro-activelyknowingthestatusofthedonorifhe/shere-

visitsbeforetheyarenexteligibletodonate.Inaddition,thishelpsthebloodcenterconvert(motivate)replacementblo

oddonorsintovoluntaryblooddonorsbycallingthemwhentheyarenexteligibletodonate blood.

FasterTATs(Turn-Around-

Times)

:Sincethestocklevelsareinstantlyaccessiblewithinandoutsidethesystem

,thebloodbankstaffareabletoattendtobloodrequestsinanefficientmanner

.Thesystemallowsbloodreservationinadvance.Thesystemhasin-

builtemailandsmsalertsforadversetransfusionreaction,lowstocklevels

and expiring units of blood.

30


ProcessDriven:Havingbeenbuiltwithinputsfromdomainexpert

softhebloodtransfusionindustry,thesoftwarehascoveredthevariousstagesofbl

oodbankinginacomprehensivemanner.Itcoversredcellantigen,plateletantigen

andHLAtyping.Ittakesintoaccountinformedconsentofdonorsdependingonthet

ypeofcollection(wholebloodoraphaeresis),exhaustiveinformationrelatedtoblo

odcollection,donorreactionsaswellasvariousstagesofthecomponentmanufact

uringprocessdependingonthekindofbagused.Theseprocessdrivenstagescanb

etracedperbloodunitandtechnicianscanalsogenerateworklistscorrespondingt

othesestagesthattheychoosetodoinbatches.

EnhancedTrace-

ability:acuVena™coversallthestage

sofdonormanagementandcomponentpreparation.Thebloodbankpersonnelusi

ngacuVena™cantracebackanybloodunittothedonormedicalhistoryortothedat

eofpurchaseofthebloodbagfromthevendor.Theintelligentlabelingsystemalsod

isplaysthetestresultsoftheTransfusionTransmittableInfectiousmarkerscarried

outonthebloodunitforenhancedsafety.Anyadversetransfusionreactioncanbed

ocumentedinthesystemandisonceagaintraceabletothedonorand bloodbag.

GreaterCompliance:Thesystemgeneratesmos

toftheessentialreportsrequiredtobesubmittedtotheauthorities.Man

ybloodbankseitherdedicatepersonnelforthisactivityorspendalotofti

mecollatingthisdataagainasmostoftheprocessesandconsumableso

fthebloodbankarenotfedintothebloodbankmoduleoftheHIS.acuVen

a’sprocessdrivenapproachnotonlycapturestheessentialinformatio

n,itgeneratesmost

o

fthereportsrequiredbytheauthoritieswhoseekthisinformation.Thes

ereportscanbegeneratedinadditiontothemanualregistersbeingmai

ntainedbythebloodbank.

FocusonPointofCare:Deployin

gabestofbreedbloodbanksoftwarelikeacuVena™ensuresthatseniorofficial

sconcentrateonusingthedataeffectivelytoachievetheirqualityinitiativesrat

herthancreatingthereports.Byfreeinguptheirtimefromreportgeneratingac

tivity,italsoenablesthecare-

providersi

nabloodbankfocusmoretransfusioncareandresearchrelatedactivities.


31


NovartisIndiaLimited

Thematic AreasHealthcare

Location of Arogya Parivar sitesUttar Pradesh, Uttaranchal, Bihar, Rajasthan, Gujarat, Maharashtra, Chhattisgarh, Andhra Pradesh, TamilNadu, Karnataka

Case Study:Arogya Parivar – Improving healthcare access for India’s rural poor

Mission:Toimprovehealthcareaccessfortheunderservedmillionslocatedatthe‘bottom-of-the-pyramid’using a social business approach.

Objective:To create health awareness among people and toimprove healthcare infrastructure for themarginalized rural poor.

Reaching out to rural IndiaAccordingtotheWorldHealthOrganisation,65%ofIndia'spopulationdoesnothaveaccesstoqualityhealthcare.Th

esenot-so-

privilegedpeoplearedisfranchisedoftheirrighttohealthwithwomenandchildrenbeingamongtheworstsufferersint

he600,000 + villages spread across the country. Low

diseas

eawareness,poorhealthcareinfrastructure,lowincome(50%liveonlessthanadollaraday),lackofanadequatedistr

ibutionsystemexacerbatestheissue.Fordailywageearners,goodhealthisoftennotapriority.

Novartisfirmlybelievesthatpharmaceuticalcompaniescanplayanimpactfulroleincreatinghealthcareawarenessa

mongthepoorandalsoinupgradingtheknowledgeofhealthcareproviders.Towardsthisend, Novartis set up

Arogya Parivar, a rural healthcare initiative, as a pilot in two states in 1997.

ArogyaParivarisbasedonthefourpillarsofawareness,adaptability,availabilityandaffordability.Theseprinciplesw

orkinanintegratedwaytoensurelong-termimpact,andmakecomprehensivehealthcareavailable in rural areas.

Themedicinesincludeanti-TBdrugs,antibiotics,anti-infectives,anti-diabetics,brandedgenerics,over-the-

countercuresforcoughs,colds,allergies,diarrheaandcalciumdeficiencies.Productsalsoincludenon-

steroidalanti-inflammatoryagents,anti-fungalandanti-

anxietytreatments.Itcombinessocialentrepreneurshipwithcorporatesocialresponsibilitytospecificallyaddressth

ehealthneedsofruralIndiawhileprovidingopportunitiestoexpandbusiness in an innovative and responsible

way.

Itemploy

sacombinationoftechniquesusedbypharmaceuticalandconsumergoodscompaniesanditsfundamentalinnovati

onrestsonapplyingamarketingmixbasedonthe“4As”–Awareness,Acceptability,Affordability and Availability –

adapted to low-income markets.

Awareness

:ArogyaParivarconductshealtheducationprogrammesatthegrassrootslevelwiththehelpofHealthEducatorsrecr

uitedfromamongthevillagersthemselves.Educatorsshareinformationonpreventive health measures and

educate the community on the need for and importance of good health.

Adaptability:Thetherapeuticareaportfolioiscustomisedasperthelocaldiseaseburden.Allcommunicationincludingthatonproductpacks is adapted to local conditions.


32


Availability:Stronglinkswithdoctorsensurelast-mileavailabilityandgofarbeyondtraditionalpharmapracticeswhichfocusondoctordetailing.Theextendedsupplychainreachesouttothelocalpharmacyinthe village.

Affordability:Innovativesolutions,strongbrandingandlocalresourcesmakea difference.Sincevillagersoftenperceivemedicalcareasbeingexpensiveandinaccessible,medicinesaremadeavailablein small packs at affordable prices.

ArogyaParivarisorganizedaroundalightcentralmarketingandplanningteamresponsibleforcreatingmaterialsusedinthefield:leaflets,posters,trainingmanuals,minimoviesforawareness,includingtranslationinlocallanguages.Itgoesbeyondsimplepromotiontothedoctortocreatingawarenessamong the rural population and finally reaching out to every patient for drug compliance.

Fieldoperationsarestructuredintoindependentcells,eachcoveringaradiusofapproximately35kmor20miles.Eachcellismanagedbyasupervisor,assistedbyafewhealtheducatorswhosemainroleistoraisediseaseawarenessamongthepeopleincludingpreventionandtreatment,referpatientstodoctors,brief physicians about the program and meet patients to ensure patient completes prescribed treatment.

The patient at the centreAll activities are centred on the patient by involving various stakeholders.

1. Complement doctor detailing with FMCG marketing approach resulting in a new way to market

2. IntroducenewpacksizessopricepointremainssameasalsoproductssuchasORS(oralrehydration salts)

aimed at the rural market.

3. Distribution system uses foot soldiers so that itreaches critical economic mass for direct deliveries.

4. Collaborativeeffortwithlocalsocialdevelopmentagenciesforcommunityparticipationandwiderreach.

5. Follow

sapatientcentricapproachthataddressesthecommunityonhealthissues,educatesandmotivatespeoplefor

theiroverallwell-

being,usesdoctorreferralcardstohelptrackpatientsandengageswiththepatienttoensurecompliance.

Reaping resultsArogyaParivarhasenhancedaccesstomedicinesforcloseto50millionpeoplein10Indianstatescovering30,000+vi

llageswith11healthprograms:tuberculosis,skinandgynaecologicalinfections,diabetes,micro-

nutrientsduringpregnancyandchildhood,intestinalworms,acidreflux,coughandcoldand allergies. People

covered is expected touch100 million (25% of people at stake) by 2011.

In2010,therewere250+Arogyacellscovering189districtsacross10statesinIndia,includingUttarPradesh,Uttaran

chal,Bihar,Rajasthan,Gujarat,Maharashtra,Chhattisgarh,AndhraPradesh,TamilNaduand Karnataka offering

improved healthcare access to almost 50 million people.

With11therapeuticapplicationstoaddresstherural/

localdiseaseburden,NovartisinIndiahascomeupwithspecialdrugsandpackagingtomeettheneedsofthisgrowing

market.Forinstance,thecompanyhasdevelopedaWHO-approvedORS+Zincanti-

diarrhealformulationinaffordablesachets,andananiseflavor.TheArogyaParivarconcepti

sawinningone,empoweringvillagers,providingemployment,improvingruralhealthcare,andstrengtheningtheNo

vartisbrandintheremotestofvillages.Whatmakesitextra special is that the model can be replicated inother

geographies facing similar healthcare challenges.

Arogya Parivar receives accoladesArogyaParivarhasreceivedinternalandexternalrecognition.ArogyaParivarwasawarded"BestLong-

termRuralMarketingInitiative"inIndiafor2006-

2008byRuralMarketingAssociationofIndia(RMAI),largestassociationofitskindinthecountry.MorerecentlyArogy

aParivarreceivedtheCMOAsiaawardin 2010 for the best rural brand.The initiative

alsoreceivedglobalrecognitionfromCorpEthicalin2010.


33


Chroni CareFoundation

An initi tivetowardspreventing chronicdiseases in India

Thesecondhalfofthetwentiethcenturywitnessedmaj rhealthtransitionsintheworld,propelledby

socio-economicandtechnologicalchangeswhichprofoundlyalteredwaysofliving.Amongthesehealth

transitions,themostgloballyp rvasivechangehasbeentherisingburdenofnon-communicablechronic

diseases(NCCDs).Ev nasinfectio sandnutritionaldeficienciesarerec dingasleadingcontributorsto

deathanddisability,cardiovasculardiseases(CVDs),cancers,diabete ,nephrologicailments,andother

chronicdiseasesarebecomingmajorcontributorstotheburdenofdisease.Indiatooillustratesthishealthtransition,

whichpositionsNCCDsasamajorpublichealthchallengeofgrowingmagnitudeinthetwenty-firstcentury.

TheWorldHealthReport2001hadindicatedthatNCCDsaccountforalmost60%ofdeathsand46%of

theglobalburdenofdiseases.Seventy-fivepercentofthetotaldeathsduetoNCDsoccuri developing

countries.Faci gadoubleburden,withaheavyloadofinfectiousdiseasesandanincreasingb rdendue

toNCDs,itis etimated that India accounts for17%of globalcardiovascular mortality, and thisis

projected torise to 50%in the future, therebyaccountingfor a majorproportion ofdisease and deaths.

With a visionto promote good healthby proactively

minimizingtheincidenceandeffectsofchronicdiseasesin

theIndia,ChronicCareFoundation(CCF)wasset pasa

notforprofit foundation, n 2006,toaddressissuesrelating

tochronicdiseases.CCFworkstopromotegoodhealthby

proactivelymini izingtheincidenceandeffectsofchronic

diseaseinsocietyandseekstoempowerthecommunitythroughpreven

tion,advocacy,educationandcollaboration

amongst stakeholders and the community leadingto

accessible,efficienthealthcaresystemthatimprovesthesafety

andqualityofcareofpatientswithchroniclifestylediseases.Thef

oundationiscommittedtowardsimproving

thecareandoutcomeofpatientswithnoncommunicablechronicdiseaseslikecardiovasculardiseases,diabetesan

d chronickidneydiseases.

The foundation’s activitiesrange from conducting studiesto identify the cause ofthee diseasesto

developingprogramsforpromotinghealthybehaviourandworkingwithmedicalpractitionersforbetter

deliver andoutcomes.Theorganizationhasundertakennicheresearchtitled“NCCDsinIndia–A

studyofthegaps,qualityandcostofcare”onnon-communicablechronicdiseasesonapan-India

basis-studyin17statesofIndia.Majorrecommendationsthate ergedfromtheresearchhighlightthat

community based activities incl ding education,communication, and interventions incommunities,

schools,andworkplacesareessentialtoprimarypreventionofNCCDs.Recommendationsalsoinclude

theneedtoimprovesecondaryandpreventionofNCCscree

ning;and accessible tertiarycare.sbymeansofimprovedheathcarefacilitiesand

Under the National Programme for Preventionof Non

Communicable Chronic Disease, CCF has launcheda

National Health Campaign titled ”Swasth Log,Swasth

Des

h”tospreadawarenessontheriskfactorsleadingtochronicdisease

swithspecificfocusontobaccoandalcohol

in17 tates ofIndiain collaboration with NGOs, private

sector partners and government bodies.It coversa

population of600,000 including schools (n=22), women


34


groups(N=32),villages(51)andurbanslums(17)in17statesofIndia.CCFhasorganizedseveral

capacitybuildingworkshopsforparnerNGOstoworkonhealthpromotionprogram eandcreateda

trained team of street theatre groupsand magiciansforcommunitylevel awareness generationactivities.

CCF also develops and disseminates communication material and

strategies to promote positive behaviour amongst individuals,

communitiesandsocietiesforpreventionofNCDsandhelptoprovid

easupportiveenvironmentforthepeopletosustainpositivebehaviour.We

have launched health campaigns, Health elas and developed

BCC/IEC materialspiloted inPunjab, Haryana, Delhiand UttarPradesh.

Chronic Care Foundation has also organized regional Round Table

ConferencesofSpecialistsonNonCommunicableChronicDiseasesin

four regions ofIndia withan aimto emerge with regional

recommendationsforinterventionsbydifferent stakeholders.

Withchanginglifestylepatterns,tobaccoisemergingasthe

leadingc useofdeathanddisabilityworldwide.Addressing

thedireconsequencesontobaccouseonhealth,CCFhas

conducted several awareness generation programmeson

tobaccoasariskfactorforchronicdiseaseincoordination

withitspartnerNGOsin chools,slums,generalcommunity

levelprogrammeinResidentWelfareAssociations.Oneof

the campains was organizedin Amritsarin Jan 2010

entitled“NashaMukhtP njab”–(Punjabdajosh–Punjab

diShaan). The campaign ws directedat the youthto

channelizethemintoeffectivechangeagentsofhealth.Ove

raperiodof5days,15streetplayswerestagedacrossthe

cityofAmritsar-includingmarketplaces,malls,schoolsandcolleges,sensitizingthelocalcommunityonthe illeffect

of addictions(tobacco, alcohol and drug)on health.

CCFinpartnershipwit AnchalCharitableTrustandPfizerIndiahaslaunchedapilotinitiativeonPublic

privatepeoplepartnershipfortobaccocontrolinPahariBastiandHauzKhasareaofSouthDelhi.Theprojectaimstode

velopaholisticapproachtowardsprevention,treatmentandcarefortobaccousers.

HealthCamps(inPahariBastislum) ndHealthTalks(inResidentWelfareAssociations,HauzKhas)

havebeenorganisedtoprovideinformationontobaccocessation,psychosocialcounselingandsupportavailablefor

quitting.CCFhassuccessfullyestablishedlinkageswithinstitutionslikeRMLHospitalandDentaldepartmentofAIIM

Sforcounselingandreferraloftobaccouserswillingtoquit.CCFhasalso

established linkages with indivi ual RWA,

federation ofRWA and private doctors inHauz

Khasarea forreferral of to acco users.


35


FreseniusMedicalCareIndia

Thematic Area

Critical Care – Affordable Quality Dialysis Treatment for HIV Patients

Case

StudyIntroduction

HIVinfectionorAID

sahealthcatastrophefirstreportedinIndiain1986inthestateofTamilNaduhasspreadacrossthevariousstatesofthe

country.India,ifseendemographically,maintainsastatusofsecondlargestcountryisunfortunatelyalsothirdlargest

countryintermsofPeoplelivingwithHIV/AIDS(PLHAs).

AsperNACOreportprevalencerateofHIV/AIDSinIndiais0.29percent(2008-

09)amountingthetotalpopulationofmorethan2.27millionpeople.Thesituationismoredauntingasnearly89%ofPL

HAscomefromotherwisehighlyproductiveagegroupof15-

49yearsmakingtheeconomicimpactgraver.Moreoverwit

hasocietylikeIndiawherestillmajorityoffamilybreadearneraremen,outoftotalinfectedpopulationapproximately6

0%happenstobemale.AlthoughwiththeconcentratedeffortofNACOandotherorganizations,scenarionowisfarbe

tterthanitusedtobeinyear2002withaprevalencerateof.45percent of country’s population.

TimeisnowtoextendthesupporttoHIV/

AIDSpatientsbeyondART,HAARTandPARTandalsofocusingavailabilityoftreatmenttothediseasesthatthispop

ulationisthusexposedto.ThecaseinfocusshowcasesgrowingnumberofHIV/

AIDSpatientsalsobecomingendstagerenaldisease(ESRD)patients,therebytheirgrowingdemandofdialysistreat

mentandinsufficientsupplyofqualitydialysistreatmentandhowaninitiativebyFreseniusMedicalCarealongwithTA

NKERfoundationhasmadeanimpact.

Requirement of Dialysis Treatment for Positive Patients

Asperstudiesalmost17percentofPLHAssufferfromChronicKidneyDisease(CKD)sometimeortheotherandalmo

st0.5to1%ofthemendupsufferingfromESRDtakingthefiguretoaround3,000(estimated)patients.Withmaximumh

ospitalsandtreatmentfacilitiesrefusingdialysistoHIV/

AIDSpatientsthedemandandsupplygapisveryhighandresultinginhighermortality.

Initiative by FMC India and TANKER Foundation

Astheysayproblemsarethebiggestopportunities,th

eissuesfacedbypatientsweretriggerforthejointinitiativeofFMCIndiaandTANKERfoundation.Majorissuewastha

tHIV/

AIDSinfectedpatientswerebeingdeniedDialysistreatmentinprivatehospitalsandthegovernmentfacilitiestoower

enotfullyequippedforthetreatmentdelivery.Realizingthedemandsupplydisparityandwithavisionofprovidingaffor

dablequalitydialysistothismuchneededsegment,FMCIndiaandoneofitscloseassociates,dedicatedtowardsprov

idingrenalcareandlowcostqualitydialysis,TANKERFoundationjoinedhandsand started a dedicated facility for

patients suffering with HIV/AIDS in Chennai.

Thefacility,inauguratedbyMr.VayalarRavi,Unionministerofoverseasaffair

s&civilaviation,inauguratedthefacility.ThefacilitystartedwithtwoHIV/

AIDSpatientsandtodayprovidestreatmenttomoretha

n6patients.ThisparticularfacilityofTANKERfoundationtodayhasbecomeonlyfacilityprovidingqualitydialysistrea

tmentataffordablecosttoHIV/AIDSpatients.Moreoverthereisnodiscrimination done in treatment fees between

HIV/AIDS patients and other patients.


36


Treatment Package

PatientsbeingtreatedatTANKERFoundationdialysi

sfacilityarechargedRs.375perdialysistreatmentwhichisalmosteighttimeslessthanwhatisgenerallychargedbyot

herhospitalsfromHIV/

AIDSpatientsforsimilartreatment,ifatalltheyprovideso.ThemedicinesupplyistakencarebyTamilNaduAidsContr

olSociety.Thenominalcostchargedforthetreatmentincludeschargesforalltheaccessoriesusedindialysisandoth

ermedicineslikeerythropoietininjections,ironsourceinjectionsandantihypertensivedrugs.

Impact of Initiative

The dedicated facility has become only center

providinglowcostqualitydialysistoHIV/AIDSpatients.

The facility is seen as single referral center for dialysis for HIV/AIDS patients in Chennai city.

Thereis a significantimprovementinthelifestyle and confidence levels of patients being

treatedinthefacility.

With high quality standards in place till date thereisnorecordedinfectiontodoctorsortheclinicalstaff

treating the patients, reinstating the fact that providing qualitydialysis to HIV/AIDS patients

istotallysafefortreatingpractitioners.

Observations

It the qualityand hygiene standards are maintained properly then there is no excess risk

ofinfections from HIV/AIDS patients to the treating doctors and clinical staff.

With increasing life expectancy of HIV/AIDS patients, after introduction of HAART and

ART,demand for dialysis treatment from the segment has increased and in future is bound to

furtherincrease.

With world class qualitystandards in place, positive as well as normal patients can be

provideddialysis treatment on the same machine.

There is a social stigma and fear in dialysis patients of getting infected if they are being treated

onsame on which a dialysis patient is being treated. And a zero tolerance level for this.

Great amount of awareness & education work isrequired for general public in general and

dialysispatients in specific that if quality standards are followed HIV+ as well as a normal ESRD

patientcan be treated on the same machine.

If a clinicismaintaininghighqualitystandards,ideallyasrecommendedbyCenterforDiseaseControl

(CDC, USA) then there is no requirement of routine screening for HIV positivity in dialysispatients.

Confidentialityofthepatient’sclinicalconditionshallbemaintainedveryspecifically.

Patients infected with HIV/AIDS can be dialyzed by either Hemo-dialysis or Peritoneal dialysis

asnormal patients.

There is no need for positive patients to be isolatedfrom other patients, as this creates

socialinhibition.

Single use of dialyzer is always recommended but with proper dialyzer reprocessing

anddisinfecting procedures in place clinics

mayincludeHIV/AIDSpatientsinthedialyzerreuseprogram.

With the success of the initiative the foundation looks ahead to spread the treatment and care

facilitiesacross the state.

37


ShanthaBiotechnics

ThegenesisofShanthaBiotechnicsLtdcanbetracedbacktotheinitiativesofDr

.KIVaraprasadReddy,theFounderandManagingDirector.Dr.Varaprasad,anelectronicsengineerbyprofession,e

stablishedthecompanyin1993withamissionstatement–‘Todevelop,produceandmarketcost-

effectivehumanhealthcare products that conform to internationalstandardsofhighorder.’

ShanthaBiotechnics,AnISO9001certifiedcompany,hasdevelopedandcommercializedIndia’sfirstrecombinant

Hepatitis-

Bvaccinefollowedbyhumaninterferonalpha,Erythropoietin,choleravaccine,measlesvaccinebesidesTetravalen

tvaccine(DPT+Hepatitis-B)andPentavalentvaccine((DPT

+Hepatitis-B+Hib).IthappenstobeWHO-Genevapre-qualifiedsupplierofHepatitis-Bvaccineandcombination

vaccines.

TheseedsofthisambitiousventureweresowninGenevaa

taconferenceonglobalprogramsforimmunization.ThisiswhereVaraprasadfirstrealizedthepressingneedforanaff

ordableHepatitis-BvaccineforIndia.Atthatpointintime5%ofIndianpopulation(45million)wasHepatitis-

Bviruscarriers.ButthevaccineisnotyetincludedinIndia’sNationalImmunizationProgramnotwithstandingWHO’sd

irectiveduetothepricefactor.Theimportedvaccinewasverycostlyandunaffordableeventouppermiddle-

incomegroups.Indigenousvaccineswerenotavailable.InthosecircumstancesShanthaBiotechnics took birth.

Buyingtechnologyfromabroadwouldhavepushedupthecostoftheproduct.Sotomakethevaccineaffordabletoco

mmonman,Varaprasaddecidedtodevelopthetechnologyin-

houseratherthanimportingita

tahighercost.HisearlyyearsinR&DaselectronicsengineerinDefenseElectronicsLabs,hadgivenhimconfidencein

IndianScientifictalentandhewasconvincedthatwecouldputIndiaonthemapforGeneticEngineering,ifproperatmo

spherewasprovided.Thusheunwittinglyheraldedbiotechrevolutionin India.

Thejourneywasnoteasy.FundingwasmajorhurdleasbiotechwasunheardofinIndiathosedays.Thankstoinvestor

sfromOmanandTechnologyDevelopmentBoardinMinistryofScience&Technology,Shanvac-

B,firsteverindigenouslydevelopedHepatitis-

BvaccinecouldseethelightofthedayinAugust1997.ByadoptingnovelmarketingtechniqueslikeMassVaccination

Campstoreachtheconsumer,Shanthacouldcutdownsupplychainexpenses.Also,itcreatedmuchneededawaren

essoftheimportance of Hepatitis-B eradication among masses.

EvenwhilesellingShanvac-

Bvaccineat1/1

0thofthecostofimportedvaccine,theymaintainedinternationalstandardsintermsofqualityandtoreachthebenchm

ark,successfullygonethroughWHOpre-

qualificationformostoftheirproducts.WhenPfizeraskedthemtoproduceHep-

Bvaccineundertheirbrandname,theassociationhelpedShanthatoperfectsystems,proceduresanddocumentatio

napartfrom bettering quality of the product.

Shanvac-

BbecameoneofthefastestgrowingbrandsintheIndianpharmaindustry,anditssuccessattractedfournewIndianco

mpaniestolaunchtheircompetingHepatitis-Bdrug.GSK’sshareinIndiaforHepatitis-

Bfellfrom100%in1997tojust10%in2000.Over1998-2000,Varaprasadreceived47awards.Thisincludedthefirst-

everNationalTechnologyawardreceivedfromthePrimeMinisterinMay1999forhome-

growntechnologies.In2000,Erns

t&YoungbestowedEntrepreneuroftheYearAwardonhimforhiscontributionstothefieldoflife-sciences.

Varaprasadwasawarded‘Padmabhushan’in2005andVaraprasadandShanthatogetherwonmorethan250award

sbynow.Withoutrestingonlaurels,theypursuedtheirpathvigorouslyandcarvedanicheforthemselvestoattractthe

attentionofinternationalPharma majors.

Shanthareinvests25%ofrevenuesbackintoR&D–

thehighestofanycompanyinthecountry.InIndia,R&Daveragewasonly0.1to0.2%,andintheUS,mostmajorcompa

niesputonly4to5percentinto


38


R&D.TheresearcheffortsatShanthaarefurtherstrengthenedbycollaborativearrangementsandallianceswithlead

ingresearchinstitutionsinIndiaandabroad.Currently,ShanthaBiotechnicsisfocusingits R&D efforts in the

development of vaccines only.

ShanthacaterstomajorinternationalmarketsincludingAsia-

Pacific,Africa,CISandLatinAmericainadditiontosupranationslikeUNICEFandPAHO.Itexpandeditsvaccinesport

foliobylaunchingcombinationvaccinesandnewgenerationvaccinesproducedindigenouslyatitsWHOcGMPplant

nearHyderabad.

ApartfromthesingledoseHepatitisvaccineShanthaBiotechnicsisworkingontyphoidconjugate,acellularpertussis

andcomplaintbasedDPT.Rotavirusvaccinewillalsobeanimportantpartofthecompany'sportfolio,apartfromHum

anPappilomaVirus(HPV).AmongtheotherproductsinthepipelineareJEvaccines,vaccineforvaricella-

zosterandheat-stablevaccines.

InSeptember2009,France’slargestandworld’s4thpharmamajor,Sanofi-

Aventis,hadacquiredan80%stakethatanotherFrenchfamilybusinessMerieuxAllianceheldinShanthaBio.

SanofireaffirmeditscommitmenttoVaraprasad’spublichealthmissionofprovidingaffordabledrugs.Itplannedtode

velopShanthaBiointo a globalR&Dhub,andtoexpand in India and in other emerging markets.

LegendarySanofiPasteuris‘the’vaccinecompanywithmorethanacentury-

oldexperienceindevelopment,productionandmarketingofvaccines.Shantha’sworld-

classmanufacturingfacilitiescomplyingwithUSFDAstandardscanbebestoptimallyutilizedbySanofiPasteurform

eetingglobalvaccinedemand.ShanthacanbecometheextendedplatformofSanofiPasteurinSouthernhemispher

eto serve the global vaccine requirements.

OneofShantha’spremiumproducts,Pentavalent(Hep-

B+DPT+Hib)vaccinecanbecombinedwithSanofi’sIPVvaccinetocomeoutwithHexavalentvaccine.Suchmanym

orewinningcombinationscanemergetoservethehumanity.TheproductportfoliosofSanofiandShanthaarecomple

mentarytoeachotherandtheirworkingtogetherwillmaximizebenefitsofvaccination.Thiscutsdownthecostofdevel

opmentofvaccinesandtheultimatebeneficiaryisthecommonmanindevelopedaswellasdevelopingnations.

39


GoingGlobal-theIndianMNC

VLCCHealthCareLimited

Date of registration of the company- 23/ 10/

1996Date of Commencement of Business- 23/ 10/

1996

Mission: TransformingLivesImpact:VLCChashelpedimproveIndia’swellnessquotient,helpingmillionsmakethetransitiontohealthy lifestylesLegacy: Undisputed pioneers

TheVLCCsuccessstorystemsfromitsunwaveringbrandcommitmenttotheideaof‘TransformingLives’

–

thegroup’sguidingvision.TheVLCCtransformationcentersseamlesslymarriedthescientificslimmingprogramswi

thcuttingedgeskinandhairtreatments.VLCCcontinuestopursuethemissionwithitsnetwork spread over 225

centers across 100 cities in 8 countries.

VLCC’sfounderandmentor,VandanaLuthraopenedIndia’sfirstTransformationCentreinNewDelh

iin1989,atatimewhentheIndianmarketforwellnesssolutionswasstillnascent,andtheconceptofcombiningfitness

andbeautyasanapproachtoholisticwellness,asinitiatedbyher,wasacompletelynew paradigm.

Today,VLCCisapioneerintheglobalwellnessarenawithpresenceinthreerelatedbusinessesinthe‘wellness’

domain:

- Slimming, skin & hair services;

- Education&traininginstitutes;

- Manufacturing&retailingofpersonalcareproducts.

VLCCcentersareope

n7daysaweek,andserviceover75,000customervisitseverymonth.Inaworldruledbychanginglifestylesandinstan

tremedieslikecrashdietsandappetitesuppressants,theUSPoftheVLCCweightmanagementprogramhasalways

beentheirholisticandscientificapproachtowardstransformation.Theirslimmingprogramsarebasedonscientificpr

inciples,usinglifestyleanddietarymodifications,anddonotinvolveanysurgicalproceduresorcrashdiets,nordothey

requireconsuminganymedication,dietpillsorhungersuppressants.VLCC’sslimmingbusinesshelpstheearthbec

omelighter by over 90,000 kgs every month.

VLCC International

Theyear2006markedVLCC’sforayintooverseasmarkets,withtheopeningofitsfirstcentreinDubai.VLCC'smajorf

ocusistotacklethescourgeofobesityanditmadeeminentsensetolookattheMiddleEastmarketasitsfirstoverseasf

oray,giventhatobesityintheMiddleEastisratedasbeingamongstthehighest in the world. In UAE specifically,

over 60 percentofthepopulationiseitheroverweightorobese.

Today,VLCCisaninternationalbrandwithpresencespreadover16centersintheinternationalmarketwith10center

sintheUAE,twoeachinOmanandBahrainandoneeachinQatarandNepal.TwoVLCCcentersinSriLankaandonein

BangladeshwillbeoperationalbyMarch2011.Bytheyear2012,VLCCexpects to expand its presence to 28

locations across the MENA and SAARC countries.

40


Largest Organised Player

TheVLCCservicesbusinesshasaretailfootprintofamillionsquarefeetofretailspaceacrossthecountry–

fromJammuinthenorthtoTrivandruminthesouthandfromShillongintheeasttoSuratinthewest,apartfromitspresen

ceintheMiddleEast.VLCCisnowwellrepresentedacrossthecountry,with34locationsinsouthIndiaalone.Regiona

lbusinessheadsandofficesenablepromptandefficientservicedelivery.

VLCCPersonalCarehasmanufacturingfacilitiesinDehradunandHaridwar.Itscurrentdistributionnetworkcoverso

ver20,000retailersand300distributorsinIndia,Nepal,SriLankaandtheGCC.This business network is being

expanded continuouslytokeeppacewiththedemand.

TheVLCCGroupcurrentlyhasover3000directemployeesincludingover700inoverseasoperations,andnearly400

0indirectemployeesfrom29nationalities,withmajorityofthesebeingdoctors,nutritionists, psychologists,

cosmetologists, physiotherapists and the like

Interwoven Social Responsibility

AtVLCC,CorporateSocialResponsibilityisdefinedaroundtwodimensions–

oneisthemissiontoeradicateobesityandspreadawarenessaboutobesity,diseaseslinkedtoit,anditslifestylerelate

dcauses.TheotherdimensionofitsCSRinitiativesfocusesoncreatingopportunitiestosupporttheunderprivilegeds

ectionsofoursociety,workingtoalleviatepoverty,andinparticularfortheempowermentof women.

Somekeyhighlights:

▪ VLCC centers offer slimming, skin and hair care services

▪ Over 225 centers spread across the globe

▪ VLCC makes the earth lighter by 95,000 kilos (weight loss) ever year

▪ More than 10,00,000 satisfied customers served since inception

▪ Allcentersarecompanyownedandmanagedwiththeexceptionof35franchiseesinTierIIandTier III cities

in India.

Businesses:

o VLCCSlimming,Skin&HairServicesCentersofferweight-losssolutions,beautytreatmentsandregular

beauty salon services.

o VLCCInstitutesofBeaut

y&Nutritionofferprogramsinbeautyandnutrition.Withapresencespreadacross49campusesin38citiesinIndia,itistodayAsia’slargestvocationaltrainingnetwork of its kind.

o VLCCPersonalCareisaproprietarylineofover100herbalandayurvedicskin-care,hair-careandbody-

careproducts.TheseproductsareavailableatallVLCCcentresandarealsoretailedthrough20,000plussto

resacrossIndiaandoverseas.‘SHAPEUP’,itsflagshiplineofbodyshaping products is a category leader.

o TheVLCCDaySpasinMumbai,Delhi,KolkataandGurgaon

,aluxuryofferingfromthehouseofVLCC,offerspatherapiesfromaroundtheworldasalsoadvancedhair,skinandnailservices.Theservicesatthespaareacombinationofthetime-honoredtraditionofpersonaltouchwiththelatest skin care equipment and spa technology for "results-oriented" treatments.

o TheVLCCNutriDietClinicprovidescustomizedsolutionstoaddressesdietneedsfromnormaltomedical/

therapeuticconditions,helpingpeopleadop

tholisticwellnessintheireverydaylives.Itisaimedatimprovingtheoverallwellnessquotientofindividualsthr

oughadvisoryservicesfordietaryintake,customizedonthebasisoftheindividual'sspecificbio-

chemicalparametersandlifestyle.

41


Acknowledgement

VLCCistheworld’sfirstslimming,fitnessandbeautycorporatetogetth

eISO9001:2000andSA:800O(SocialAccountability)certificationforimplementingcorporatesocialresponsib

ilitystandards.TheVLCCGrouphasalsobeenawardedtheISO:14001certificationformeetingglobalenvironment

standards, again a world’s first for a company in its line of business.

42


AboutKPMGinIndia

KPMGi

saglobalnetworkofprofessionalfirmsprovidingAudit,TaxandAdvisoryservices.Weoperatein146countriesandha

ve140,000peopleworkinginmemberfirmsaroundtheworld.TheindependentmemberfirmsoftheKPMGnetworkar

eaffiliatedwithKPMGInternationalCooperative(“KPMGInternational”),aSwissentity.EachKPMGfirmisalegallydi

stinctandseparateentityanddescribesitselfas such.

OurAuditpracticeendeavorstoproviderobustandriskbasedauditservicesthataddressourclients'strategic

priorities and business processes.

KPMG'sTaxservicesaredesignedtoreflecttheuniqueneedsandobjectivesofeachclient,whetherw

earedealingwiththetaxaspectsofacross-

borde

racquisitionordevelopingandhelpingtoimplementaglobaltransferpricingstrategy.Inpracticalterms,thatmeansK

PMGfirmsworkwiththeirclientstoassistthem in achieving effective tax compliance and managing tax risks,

while helping to control costs.

KPMGAdvisoryprofessionalsprovideadviceandassistancetoenablecompanies,intermediariesandpublicsector

bodiestomitigaterisk,improveperformance,andcreatevalue.KPMGfirmsprovideawiderangeofRiskAdvisoryand

FinancialAdvisoryServicesthatcanhelpclientsrespondtoimmediateneedsas well as put in place the strategies

for the longer term.

KPMGinIndia

,aprofessionalservicesfirm,istheIndianmemberfirmofKPMGInternationalCooperative(“KPMGInternational.”)w

asestablishedinSeptember1993.Asmembersof a

cohesivebusinessunittheyrespondt

oaclientserviceenvironmentbyleveragingtheresourcesofaglobalnetworkoffirms,providingdetailedknowledgeof

locallaws,regulations,marketsandcompetition.Weprovideservicestoover5,000internationalandnationalclients,

inIndia.KPMGhasofficesinIndiainMumbai,Delhi,Bangalore,Chennai,Hyderabad,Kolkata,Pune,KochiandCha

ndigarh.ThefirmsinIndiahaveaccesstomorethan5,000Indianandexpatriateprofessionals,manyofwhomareinter

nationallytrained.Westrivetoproviderapid,performance-based,industry-

focusedandtechnolog

yenabledservices,whichreflectasharedknowledgeofglobalandlocalindustriesandourexperienceoftheIndianbu

sinessenvironment.


43


ASSOCHAMTHE KNOWLEDGE ARCHITECT OF CORPORATE INDIA

EVOLUTION OF VALUE CREATOR

ASSOCHAMinitiateditsendeavourofvaluecreationforIndianindustryin1920.Havinginitsfoldmorethan300Cham

bersandTradeAssociations,andservingmorethan350000membersfromalloverIndia.Ithaswitnessedupswingsa

swellasupheavalsofIndianEconomy,andcontributedsignificantlybyplaying a catalytic role in shaping up the

Trade, Commerce and Industrial environment.

Today,ASSOCHAMhasemergedasthefountainheadofKnowledgeforIndianindustry,whichisallsettoredefinethe

dynamicsofgrowthanddevelopmentinthetechnologydrivencyberageof'KnowledgeBased Economy'.

ASSOCHAMderivesitsstrengthfromitsPromoterChambersandotherIndustry/RegionalChambers/

Associations spread all over the world.

VISION

Empower enterprise by inculcating knowledge that

willbethecatalystofgrowthinthebarrierlesstechnology driven global market and help them upscale,

align and emerge as formidable player inrespective business segments.

MISSION

As a representativeorganofCorporateIndia,ASSOCHAM articulates the genuine, legitimate needs

andinterests of its members. Its mission is to impact the policy and legislative environment so as to

fosterbalanced economic, industrial and social development.We believe education, IT, BT, Health,

CorporateSocial responsibility and environment to be the critical success factors.

MEMBERS - OUR STRENGTH

ASSOCHAM represents the interests of more than 350000 direct and indirect members. Through

itsheterogeneous membership, ASSOCHAM combines

theentrepreneurialspiritandbusinessacumenofowners with management skills and expertise of

professionals to set itself apart as a Chamber with adifference. Currently, ASSOCHAM has 90 Expert

Committees covering the entire gamut of economicactivities.Ithasbeenespeciallyacknowledgedas a

significant voice of the industry in the field ofInformationTechnology,Biotechnology,Telecom,Banking &

Finance, Company Law, Corporate Finance,Economic and International Affairs, Tourism, Civil Aviation,

Corporate Governance, Infrastructure, Energy

& Power, Education, Legal Reforms, Real Estate & Rural Development etc

44

ContactUs

VikramUtamsinghHeadof MarketsKPMGinIndiaT:+912230902320E:[email protected]

VikramHosangadyHeadofHealthcareSectorKPMGinIndiaT:+9144 39145101E:[email protected]

AmitMookimDirector,AdvisoryKPMGinIndiaT:+91223090 2141E:[email protected]

JagrutiBhatiaAssociateDirector,AdvisoryKPMGinIndiaT:+91223090 2145E:[email protected]

kpmg.com/in

Theinformationcontainedhereinisofageneralnatureandisnotintendedtoaddressthecircumstancesofanyparticularindividualorentity.Althoughweendeavortoprovideaccurateandtimelyinformation,therecanbenoguaranteethatsuchinformationisaccurateasofthedateitisreceivedorthatitwillcontinuetobeaccurateinthefuture.Nooneshouldactonsuchinformationwithoutappropriateprofessionaladviceafterathoroughexaminationoftheparticularsituation.


TheKPMGname,logoand“cuttingthroughcomplexity”areregisteredtrademarksortrademarksofKPMGInternational.

emrging trends in healthcare

Documents

area of healthcare

healthcare biopharma

healthcare scenario

complex nature of healthcare

different levels

research cost

whichmakeus different

th bedsideofpatient