Emrging Trends in Healthcare

2011KPMG,anIndianPartnershipandamemberfirmoftheKPMGnetworkofindependentmemberfirmsaffiliatedwithKPMGInternationalCooperative(KPMGInternational),aSwissentity.Allrightsreserved.
Acknowledgement
Indias 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
Indiascompetitive advantagelies in the

lowerproductionandresearchcost, itslargepool of low
costtechnicalandscientificallytrainedpersonnel,andlargenumberofco
mpliance
c rtifiedmanufacturersandserviceproviders,whichmakeus
different fr m others.ASSOCHAMfeelsthat technology
incubation is nolongerconfined to a fewinstitutions;it is a
respo sibility that we have to share, if we wish to see a better
and a healthyfutureahead.There is animmenseneed
todevelopskilledmanpowerintheareaofhealthcareand
modernaswellastraditionalmedicines. I am gladthatthisSummiton
Emrgingtrends in Healthcarewillbringforththejourneyfrom
researchdesk to th
bedsideofpatient,as wewilllookat
heathcareatthefrontline
to
identifysomecommonchallengesthatmayhelpexplainthe
complexnature of healthcareandthescaleofthechangechallenge.
I wish to
thankKPMGforunanimouslycontributingtowardsthisKnowledgePape
r,whichgives a rich andcomprehensiveinsight
ofthe tren inhe lthcare. I wouldalsotaketheopportunity to
thankQCI fo supportingthisevent.Thecasestudies
c ntributedbythedynamicstakeholdersshow theirvibrant
effortsand c mmitmenttowardsproviding the bestof their
srvices a d supporttowardsimprovingthehealthcarescenario
ofIndia, I wish th m greatsuccessahead.Lastbutnottheleast,
I wish to extend a tokenofappreciation for theHealthcare/
Bio harma t am fortheireffortandinteractionwiththe
Healthcare/Bio P armaindustryat differentlevels.
(D.S.Rawat)Secretary
GeneralASSOCHAM
Contents
Introduction
Changing disease patterns: Implication for healthcare infrastructure
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. VLCC
40
Introduction
The 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
1
TheIndianHealthcaresectorcurrentlyrepresentsaUSD40Billionindustry .Abreak-upofthesectorasof 2009 is

provided:
HealthcareIndustryBreak-up
Insurance&
MedicalEqui
pment15%
Diagnostics
10%
Hospital
50%
Pharma25
%
Source: IDFC Securities Hospital Sector November 2010

Indiashealthcarespendissignificantlylowwhencomparedtotheglobal,developedandothersimilaremergingecon
omies.Tofurtherillustratethispoint,wehaveexaminedtheIndianhealthcarespendonvarious parameters.
TheIndianhealthcarespendislessthanhalfthe globalaverageinpercentagetermswhencomparedon apercent
of GDP basis.
Source: IBEF
1
Spendingasa%ofGDP
18.00%
15.70%
14.00%
12.00%
9.70%
10.00%
8.40%
8.40%
8.00%
6.00%
4.30%
4.10%
4.00%
2.00%
0.00%
China
Brazil
India
USA
UK
Global
Source: WHO World Health Statistics 2010

Thehealthcarespend,whencomparedonthebasisofpublicprivatecontribution,alsodepictsaskewedpicture.Asisnotedfromthecomparisonbelow,PrivateSectorcontribution
tothehealthcaresectorat~75percentisamongstthehighestintheworldinpercentageterms.Publicspending,onthe
otherhand,isamongst the lowest in the world and is ~23 percentage points lower than the global average.
Comparisonof HealthcareSpend
90.00%
81.70%
80.00%
73.80%
70.00%
60.00%
50.00%
55.30%
44.70%
58.40%
45.50%
41.60%
40.00%
59.60%
54.50%
40.40%
26.20%
30.00%
18.30%
20.00%
10.00%
0.00%
China
Brazil
India
USA
UK
Global
PublicSectorspending PrivateSectorSpending

Finally,thehealthcarespendexaminedonapercapitabasis,bothintermsofUSD(ataverageexchangerateconversi
on)andintermsofPurchasingPowerParity(PPP),isamongstthelowestglobally.Further,whencomparedtotheglob
alaverage,thepercapitaIndianhealthcarespendis~95percentloweronanaverage exchange rate basis and ~87
percent lower on a PPP basis.
PerCapitaSpending(US$)
8,000
7,285
7,000
6,000
5,000
3,867
4,000
3,000
2,000
802
606
1,000
108
40
China
Brazil
India
USA
UK
Global
PerCapitaSpending(PPP)
8,000
7,285
7,000
6,000
5,000
4,000
2,992
3,000
2,000
1,000
863
837
233
109
China
Brazil
India
USA
UK
Global

Indiashealthcarespendingis,however,growingatahealthyCAGRof~14percentfrom5.5percentoftheGDPin200
9to 8 percentin2012.
Growth in the Healthcare Industry

Asstatedearlier,theIndianHealthcareIndustryiscurrentlyestimatedatUSD40Billion.Theindustryisexpectedtogro
3
wto~USD79Billionby2012and~USD280Billionby2020 .TheaverageCAGRforthenext 10 years, therefore, has

been estimated at ~ 21 percent.
IBEF November 2010

IBEF_November 2010
HealthcareIndustry
300
280
250
200
CA G R 21%
150
100
79
40
50
0
2010
2012E
2020P
Source: IBEF
Drivers of growth for the Healthcare Sector

AcombinationofdemographicandeconomicfactorsisexpectedtobringaboutincreasedhealthcarecoverageinIndi
awhichisexpectedtodrive the growth of the sector
Demographic factors:
IncreaseinPopulation:Expectedincreaseinpopulationfromabout1.1billionin20094
2010to1.4billionby2026
Shiftindemographics:60percentofthepopulationintheyoungeragebracketandanexpectedincreaseofgeri
atricpopulationfromcurrent96milliontoaround168millionby2026.Thisrepresentsa huge patient base and
5
creates a market for preventive, curative and geriatric care opportunities

Riseindisposableincome:HouseholdsintheaboveINR200,000perannumbracketcanbenefitfromanincre
aseindisposableincomefrom14percentin2009-2010Eto26percentin2014-2015Pmaking healthcare more
affordable
Increaseinincidenceoflifestylerelateddiseases:Thereislikelytobeamarkedincreaseintheincidenceoflifestylerelateddiseases,suchascardiovascular,oncologyanddiabetes,whencomparedtothecommunicableandinf
ectiousdiseases
RisingLiteracy:Growinggeneralawareness,patientpreferencesandbetterutilisationofinstitutionalised
7
care as a result of increase in literacy rates
Economic factors:
Taxbenefits:Lowerdirecttaxes,higherdepreciationonmedicalequipment,incometaxexemptionfor 5 years
8
to hospitals in rural areas, etc. are being provided by the Government to the sector
MedicalTourism:Indiaemergingasamajormedicaltouristdestinationwithmedicaltourismmarketexpected
9
to reach USD 2 billion by 2012
Crisil Research Hospitals Annual Review November 2010

KPMG Analysis
6
Crisil Research Hospitals Annual Review November 2010
7
NFHS Survey
8
KPMG Analysis
9
IDFC Securities Hospital Sector November 2010
5
Insurancecoverage:Increaseinhealthinsurancecoveragewithanumberofprivateplayersandforeignplayer
senteringthemarkettocatertoincreaseddemand.Thesectorisexpectedtoseeandincreaseinthepenetrationfr
omthecurrent10percent15percenttoalmost50percentataCAGRof24percent.Ataninstitutionallevel,insurancepenetrationislikelyto
continuetoincreasefrom5percentto15percentto20percent.Intertiarycarethisisalmostashighas40percent10
55percentwith the inclusion of employer paid coverage.
Emerging Trends in Healthcare: Challenges and Interventions
WhiletheIndianHealthcaresectorispoisedforgrowthinthenextdecade,itisstillplaguedbyvariousissues
challenges:
Dual Disease Burden:
and
UrbanIndiaisnowonthethresholdofbecomingthediseasecapitaloftheworldandfacinganincreasedincide
nceofLifestylerelateddiseasessuchascardiovasculardiseases,diabetes,cancer,COPDetc.Atthesameti
me,theUrbanPoorandRuralIndiaarestrugglingwithCommunicableDiseasessuchastuberculosis,typhoi
d,dysenteryetc.RuralIndiaisalsoseeingahigheroccurrenceofNon-CommunicableLifestylerelateddiseases.ThisrepresentsaseriouschallengethattheIndianHealthcare system would need
to address
LackofInfrastructureandManpower:Accessibilitytohealthcareservicesisextremelylimitedtomanyruralar
easofthecountry.Inaddition,existinghealthcareinfrastructureisunplannedandisirregularlydistributed.Furthe
r,thereisaseverelackoftraineddoctorsandnursestoservicetheneeds of the large Indian populous.
Theprivatesectorhasevolvedamultiprongedapproachtoincreaseaccessibilityandpenetration.IthastackledtheissueofLifestylerelateddiseaseswitht
hedevelopmentofhigh-endtertiarycarefacilities.AlsonewdeliverymodelssuchasDaycarecentres,singlespecialtyhospitals,end-oflifecarecentres,etc.areonthehorizontoservicelargersectionsofthepopulationandaddressspecificneeds.
11
ThePublicSectoriskeentocontinuetoencourageprivateinvestmentinthehealthcaresector andisnowdeveloping
PublicPrivatePartnershipsi.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.
10
KPMG Analysis
National Health Policy, 2002
11
Changing disease patterns:

Implication for healthcare
infrastructure
Changesinthelifestyleofthepeopleareresultinginadualdisease
burden.Thisemanatesfromthecomplexityofcommunicableandnoncommunicablediseasesintheruralandurbanregionsofthecountry.
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
Life expectancy at birth (years)
Infant Mortality Rate
(probabilityof dying by age 1
per 1000 livebirths)
Maternal Mortality Rate
(per100000 births)
Year
2008
2008
200009
Source: WHO, World Health Statistics, 2010
India
64
Developed
Economies
US
UK
Emerging Economies
Japan
83
Braz
il73
Russi
a 68
Chin
a74
18
18
77
24
34
78
80
52
254
13
These issues have been examined and discussed in the sections below.
Changing Disease Pattern: The Dual disease burden

Indiasurbanpopulationhaswitnessedanincreaseof4.5timesover195112
2001comparedtoa3timesincreaseinthetotalpopulationoverthesameperiod .Withincreasingurbanizationandth
eproblemsassociatedwithmoderndaylivinginurbansettings,thediseaseprofilesareshiftingfrominfectioustolifestyle13
14
related. Itisestimatedthatby2012,50%ofthespendingoninpatientbedswouldbeforlifestyle-related diseases .
12

14
Strategic Healthcare Solutions Private Limited, Article Healthcare: Destination India, 2007
13
Indiafacesthefollowingchallengesindiseasecontrol:
TacklingmaternalandinfantmortalityaswellascommunicablediseasessuchasTuberculosis,vectorbornediseasesofmalaria,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
15
influenza, SARS, and H1N1 influenza
Burden of Non Communicable Diseases

Disease
Number of Cases
Cardiovascula
r
3,80,41,09
0
Diabetes
COPD
Cancer
3,10,39,93
2
1,70,20,00
0
20,16,700
Deaths 2005*
20,89,5
0
8
Projected
Numberof
Cases6,40,71,98
2015**
1
N/A
N/A
5,38,85
8
Projected
Deaths20
15**
34,20,752
4,58,09,14
9
2,22,10,00
0
24,96,133
N/A
N/A
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
16
thedemographic trends and lifestyle changes in India .
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
17
per1000populationagainsttheglobalaverageof1.23 which suggests an evident manpower gap.

Indicators
HospitalBedDe
nsity(per10000
population)
DoctorDensity
(per10000pop
ulation)
Year
India
USA
UK
Brazil
China
2000-2009
12
31
39
24
30
2000-2009
27
21
17
14
15
AR, Government of India Ministry of Health and Family Welfare, September 2010
WorldHealthOrganisation,WorldHealthStatistics2010
17
CII, Technopak report
16
7
Indicators
Birthsattende
dbyskilledheal
thpersonnel(p
ercent)
Noofdoctors
No.ofNurses
No.ofDentists
Avg.no.ofdoct
orsperbed
Year
2000-2009
2009
India
USA
47
UK
99
2009
6,43,52
0
13,72,05
2009
55,3
2009
Brazil
NA
7,93,64
8
29,27,00
China
97
1,26,12
6
37,20
98
3,20,01
3
5,49,42
18,62,63
0
1225924
4,63,
25,9
2,17,
1,36,
0.6
0.
0.
0.
0.
2009
1.27
0.
1.
3.
No.ofdoctors
per1000pop
ulation
No.ofnurses
2009
0.6
2.7
1.4
per1000pop
2009
1.3
9.8
Avg.no.ofnur
sesperbed
ulation
Source
:www.oecd.org,www.whoindia.org
In2009,thenumberofbedsavailableper1000peopleinIndiawasonly1.27,whichislessthanhalftheglobalaverageo
18
f2.6.Thereare369,351government beds in urban areas and a mere 143,069 beds inrural areas .
2008
Additional
1.1 million
2018
3.1 million
2028
2 million
BedsRequire
d
Bed/1000po
0.7to1.7
pulation ratio
Source: CII Technopak
Atsixdoctorsper10,000people,thenumberofqualifieddoctorsinthecountryisnotsufficientforthegrowingrequirem
entsofIndianhealthcare.Moreover,ruraldoctorstopopulationratioislowerby6timesas compared to urban
19
areas .
Parameter
Current Annual Production
Tofillthegap
Physicians
30,558
9,93,500
Nurses
1,14,218
2,510,250
18
19
Source:NationalHealthProfile2009
8
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-eastern
20
states .
20
Source:TaskForceonMedicalEducationfortheNationalRuralHealthMissionandTheNationalMedical Journal
of India Vol. 23, No. 3, 2010
9
E erging Trends i Healthcare

Deliv ry
In the last decade, private participation in thehealthcare sector has
ris n significantlyon the back of i creased interest by investorsand
rising 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
2
investments from private players. The investmentsto thisscale are expected to increase the bed ratio
from 0.9 bedsper 1000peopleto 1.85 bedsper 1000people.
Moreover, large scale investmentsin infrastructure are
requirdevelopedcountries.
22
d to make healthcare facilities on par with
Source: Centrum Healthcare Sector October2010
Foreign DirectInvestment(FDI)
TheFDIinflowsinthehospitalsect
rhavenotbeensignificantlyhighdespitegovern
entincentivesto
attractFDIinvestments(including100percentFDIinmosthealth-relatedservices).Therearec
limitednumberof100percentforeign-ownedh
rrently
althcareplayersintheIndianmarket.However,this
scenarioisexpectedtochangegiventheattractivenessofthesector.Manyforeignplayersaremakingaforayintothe
marketthroughjointventureswithlocalhealthcareunits.Forexample,Singapore'sPacificHealthcaremadeitsfirstfo
rayintotheIndianmarket,openinganinternationalmedicalcentre,whichisa
21
Source: Centrum HealthcareSector October2010
1
0
22
Source: Centrum HealthcareSector October2010
1
1
jointventurewithIndia'sVitaeHealthcare,intheIndiancityofHyderabad.SingaporebasedParkwayGroupHealthcarePTELtdhadenteredtheIndianhealthcaremarketin2003throughajointventurewi
ththeApollogrouptobuildtheApolloGleneagleshospital,a325-bedmulti23
specialityhospitalatacostofUSD29million andislookingatajointventureforanothertertiarycarehospitalinMumba
i.Many
internationaldiagnosticcareplayershaveentereare
Indiaandothersincludingmedicaleducationplayers
looking keenlyat sectoral entry points.
Source: Indiastat
*FDIforHospitalsandDiagnostic Centres, Medicaland Surgical Appliances, Drugsand Pharmaceuticals
M&ADeals
Pharma,biotechandhealthcaresectorhasseensignificanttractionoverthelastfouryearswithdealvaluesrangingfr
omUSD1.5billionin2007toUSD6.2billionin2010.Healthcareservicesaccountedfor14percentofthetotalM&Adeal
valuein2009.Pharma,biotechandhealthcaresectorsawinboundM&Adealsto
thetotalM&A deal value in 2010.
thetune
of
52
percent
of
24
2007
Nu m
ber
NA
o
Value (USD billin)
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.
23
24
Source: IDFCSecuritiesHospital SectorNovember2010

Source: 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,theexpenditurebudget
oftheMinistryofHealthandFamilyWelfareforhealthresearchincreasedby25percentY-o25
YcorrespondingtoUSD110millioninabsoluteterms. NotableresearcheffortsinthelastfewyearsincludeWellque
stsresearchcentreinHyderabadandBioconIndiasandBristol-MyersSquibbs joint R&D centre at Biocon's
26
SEZ in Bangalore .
Moreover,risingR&DcostsanddecliningR&Dproductivity,hasledtooutsourcingbeing
a
keystrategyforimprovingprofitabilityforglobalinnovatorcompanies.ThishasbeenakeydriverforthegrowthofContr
actResearchandManufacturing Services (CRAMS) in India.
Contract Research in India

ContractResearchisafastemergingbusinessopportunityforIndiancompanies,particularlyformidsizedcompanie
s.
ThemarketsizeofcontractresearchinIndiain2009wasUSD0.9billioncomparedwithUSD0.6billionin2008,agrowt
hof50%.PlayersintheIndianCROmarketintheyear2005were20andincreasedto100in the year 2008. These are
expected to be in the range of 150-200 in the year 2012.
Hospitalchainsareventuringintocontractresearchtoreducetheiroperationalandclinicalcosts.FortisHealthcareha
sbecomethelatestentrantincontractresearchwithitsFortisClinicalResearchServices.ApolloHospitalssitemana
gementorganizationApolloSpectraResearchFoundation
hasbeenmanagingclinicaltrialsforsomeyearsnowandtheMaxgroup,ownerofMaxchainofhospitals,hasacontrac
t research organization called Neeman Medical International.
About60percentoftheglobalclinicaltrialsmarketisoutsourcedtodevelopingcountrieslikeIndia.Indiangenericphar
macompanieslikeDaiichiSankyo,DrReddysalongwiththeglobalplayerssuchasPfizerand Merck are involved in
27
the outsourcing in the Indian market .
25
Economic Intelligence Unit Healthcare November 2010

Cygnus, Industry Insight - CRAMS 2010
27
Cygnus, Industry Insight - CRAMS 2010
26
12
Emerging Trends in Clinical Research

Clinicalresearchinmanyspecialitieshasledtoimproveddiseasemanagementandpatientcare,reducedALOS,bett
erBTR(BedTurnOverRates)makinghealthcaredeliverymoresustainable.Thisalsosignificantly improves the
DALY (Disease Adjusted Life Years).
ResearchinbetterdiagnosticcarehasbeeninbothlaboratorymedicinemovingtohighergenerationELISAs,NAT(N
ucleicAcidTesting),movingtomoleculardiagnostics,immunologyandantigentesting,evolvingdiseasemarkersan
dsoon.Ontheradiologyfronttootherehavebeensubstantialimprovementsfromtraditionalmethodstocomputerisa
28
tion,PACS(PictureArchivedComputerisedSystem),betterradiation dose control and so on.
Stem Cell Research

Stemcelltherapyinvolvestherebuildingorreplacingofcellsdamagedduetogeneticanddegenerativedisordersincl
udingagerelatedfunctionaldisorders,autoimmunediseases,cardiovasculardisorders,ParkinsonsandAlzheimersdiseas
es,differentcancersetc.Scientistsareworkingtocreatestemcelltherapies that might help tackle a variety of
disorders,andwillhelpintheregenerationof a neworgan.
InIndia,theDepartmentofBiotechnologyhasallocatedmorethanUSD66Millionoverthelastfiveyearstowardsbasic
andappliedresearchinstemcelltechnology.Thefocusistounderstandthefundamentalsofstemcellsfunctionandco
nductclinicaltrialstogaugetheeffectivenessofthetherapy.NationalCentrefor Biological Sciences (NCBS) in
29
Bangalore is involved in this .

AvarietyofinstitutessuchasAIIMS,L.V.PrasadEyeInstitute,CentreforStemCellResearchatCMCVelloreandNati
onalCentreforCellSciences(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
verify if the procedure is stable enough for wider application.
and
Theprivateeffortshavebeen
a
greathelpinthiscontext.DrSatishPatkietalandDrNareshTrehanhavedemonstratedsuccessfulmodelsforstemcellresearchinIndiawithtestsonendometri
umandbonemarrowcellsrespectively.Reliancelifescienceshavebeengiventhenodforventuringintostemcellrese
arch in India
StoringthestemcellscanbeofgreatbenefittothehealthcarefraternityCompanieslikeRelianceLifeSciences,Lifecel
lhaveandStemadehavecreatedfacilitytostorestemcellsfromumbilicalcordandmilkteeth.Stemcellbankingthereforeisemergingasahotdestinationforinvestments.ItsmarketinIndiaistoutedtobeaboutUSD22M
30
illion,andisgrowingatover40percentperyear .
28
Source: Cygnus, Industry Insight - CRAMS 2010

Source:DepartmentofBiotechnology,AnnualReport2010
30
Source: DNA, Stem-cell bankers seek to tap India September 2010
29
13
Drug Eluting Stents

31
Deathsduetocardiacailmentswillincreaseby100percentinIndiaby2015 .Drugelutingstents(DES)are
increasingly being used in the treatment of coronary artery diseases.
OneofthemajorbenefitsofDESisthattheprocedureisminimallyinvasiveandtheperformanceisequalorbetterthanb
aremetalstents(BMS).Eventhoughpolymersareimportantinkeepingthedrugintact,polymerfreeDESarelikelyto
minimizeDES-relatedcomplications.AninterestingfacetofresearchisbeingundertakenatSuratbasedEnvisionScientific.Thejudiciousapplicationofnanoparticleswillincreasethecellabsorptionandthusreducet
hecomplicationsofthedrugandpolymersNanocarrierdeliverycanbeusedfordifferentmedicalapplications.Comp
anieslikeEnvisionscientific,BBraun,areaddressingthesekeyissueswithlandmarkresearches.Thelatestresearchinthisfieldisdrugelutingballo
32
on (balloons without stents) which will travel the artery and act at the wound site.
Hospitals and Research

InIndia,manycorporatehospitalsandmajorpublichospitalsareactivelyinvolvedinconductingclinicaltrials
various drugs.
of
PrivatecorporatehospitalssuchasApolloCare,NarayanaHrudayalaya,UshaCardiacInstitute,ShankarNetralaya
,Indraprastha,BreachCandy,andBayerdiagnostics as well as public hospitals such as All
IndiaInstituteofMedicalSciences,NizamInstituteofMedicalSciencesandmanyoftheMedicalcollegesandteachin
33
g hospitals are actively involvedinvariousstagesofclinicaltrials .

Manyofthemhavestate-of-theartinfrastructurefacilitiesforconductingclinicaltrialsandtreatingpatients.Thesehavenotonlyhelpedinimprovingp
atientoutcomesbutalsohelpedintacklingincreasedvolume of patients suffering from debilitating diseases.
Developments in Private Healthcare

Evolving Delivery Models
Day care Centres
Need:Theconceptofout-patientsurgeriesisgrowingworldwideasinpatientfacilitiescanbeexpensiveandinconvenientinsomecases.Alargenumberofsurgeriescannowbeperformed
withoutthepatienthavingtobeadmittedatallwiththehelpofDaycareSurgeryCentres.Thisdeliverymodelisadvanta
geousforbothhealthcareprovidersandconsumers.Itisestimatedthatby2020,75percentofallsurgicaloperationswi
34
llbecarriedoutinambulatorysurgerycentres/units .Todayoveraquarterofthesurgeriesarecontributedbyophthal
micprocedures.Thecostadvantageofdaysurgeryisbestachievedin
free-standing
centres
or
freefunctioningunitswithinhospitals.
31
Source: Express Pharma Online, Lupin launches Ivabrad, 2008

Source: KPMG Analysis
33
Source: Cygnus, Industry Insight - CRAMS 2010
34
Source: indianhealthcare.in
32
14
InIndia,theconceptofstandalonedaycaresurgerycentresiscurrentlyinitsinfancy.Manyofthemajorhospitalshaveaseparatedaycaresurgeryc
entrewhichcaterstothemanagementofambulatory(alsocommonlyreferredtoassamedaysurgery)procedures.I
35
nIndia,about20percentofallsurgicalprocedures are performed on outpatients .

36
Studiesrevealthattreatmentinthesecentreswouldcostabout47percentlessthaninhospitals ..This
37
model can be economically efficient for the Indian healthcare which is scarce in resources .
Potential Benefits:
The range of services provided and the cost arethe prime benefits of the day care services.
Inahospitalwiththedaycareservicesthesurgerydepartmentprovidesservicesforeyesurgery,includingremovalof
cataracts,eyemusclesurgery,Arthroscopicsurgeries,Generalsurgery,Cosmeticsurgeryandremovalofforeignbo
dies,providingthepatientwithplethoraofservicesinasmalltimeframe.
Anaveragecorporatehospitalontheotherhandtakesaminimumof18monthsinthemakingandaminimumofthreeto
fiveyearstobreakeven.Companyexecutivespointoutthateveninahospitalsetuparound75percentofrevenueisfin
allymadefromthesurgeries.Thisfactfurthersupportsthegrowthofday care centres.
CapexandEBIDTA:DuetothedependencyonthespecialityandlevelofcarethataDayCareCentrewouldcatertoitis
difficulttopendownanindustryaverageontheCapexbutafairindicatorwouldbeINR
3.5 4.5Million/bedforaninternationalstandarddaycarecentre.EBIDTAmarginsforDayCarecentresrange between
38
25 percent and 30 percentwith a pay back of ~34 years .

Case
39
Studies :
NOVA DAY CARE CENTRE
ThepromotersandtheUS-basedprivateinvestmentfirm,plantosetuparound100daycaresurgerycentresinthenextthreetofouryearswithaninvestmentofoverINR800crore.Thecompanyexecutive
s'claimthatthepatientscouldsaveabout1520percentinsurgerycostsatNova'sdaycarecentrescomparedtothecorporatehospitalsrates.
"Thelowcostmodelandthehighefficiencyratesof450surgeriespermonthpercentrewouldmakeitabefittingmodelforIndi
a,whichhasabedtopopulationratioof0.7perthousandpersonscomparedtotheworldaverageof3.3.Overnightro
omcostsandrelatedoverheadcostsareeliminatedandthemodelenables surgeons to attend to more patients
in less time.
Itessentiallyaspirestofocusonminimallyinvasivesurgeries,whichusethetechnologicaladvancesinmostoptimu
mmanner.ThedaycaresurgerymodelhasamarketpotentialofINR42,000croreinthecountry.
(SureshSoni,chairmanandcofounder,NovatoldFE.)Inthefirstphase,thegroupplanstobuild25centresin10majorcitiesinthenexttwoyears.Th
35
Source:indianhealthcare.in
Source:indianhealthcare.in Daycare Surgery 4 Centres, 2010
37
Source: Article by Express Healthcare
38
39
Source: Company Websites
36
15
MedicalCentres,aspecialiseddaycaresurgerycentre chain,andMaxHealthcareInstituteLimited(MHC)recentlyan
End of life care centres

Need:Inmedicine,end-oflifecarereferstomedicalcarenotonlyofpatientsinthefinalhoursordaysoftheirlives,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,palliativecarecanreducecostsassoci
atedwithhospitalstaysandemergencyadmissionsmuchpalliativecarecanbeandisgivenat home.
InIndia,over138organisationsprovidehospiceandpalliativecareservicesin16statesorunionterritories.Theseser
vicesareusuallyconcentratedinlargecitiesandregionalcancercentres,withtheexception of Kerala, where
41
services are more widespread .

Palliativecare structure inIndia
PallativeCareSetting
Regionalcarec
entres&freestandinghospi
ces
DayandHome
CareServices
Single Speciality Hospitals
OutreachClinics
Government&P
rivate Hospitals
Need:SinglespecialityhospitalsareasmallbutrapidlygrowinggenreamongtodayshospitalsinIndia.Thegrowingn
umberofspecialitycentresandhospitalssignalsamovetowardsmaturityofthehealthcareindustry
with
an
increasing complexityof business and consumer affordability.
40
41
Source: Financial Express February 5, 2010

Source:DepartmentofSocialPolicy&SocialWork, University of York, York, United Kingdom
16
Specialityhospitalformatsrangefromlow-riskspecialityincludingeyecare,dermatology,motherandchildtohighendspecialityincludingcardiology, cancer and transplant medicine.

Themid-levelspecialitiesareofferedinamultispecialityhospitalformat.Thelowriskspecialitymodelsrequirelowcapitalexpenditureandhavecomparativelylowoperatingcostsasinpatientstayisrarelyrequiredfordayprocedures.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.TypicalEBID
TAmarginsrangefrom30percentto34percentalthoughsomespecialitieshavehighermargins. Pay Back period is
42
estimated at 23 years which may vary with the speciality .

Case Studies:
43
Arvind eye care

3,950bedsatfivehospitals.
Examines more than two million patients annually.
Arvindsurgeonperformsanaverageof2,000ormoresurgeriesperyear,measuredagainsttheIndiannational
average of 250.
Bydevelopingacorecompetencyexpandingaccessinafocusedareaofcareorganizationsindevelopingcountri
escanmarshalneededresources.
BeingaspecialtycaresystemhasmadeiteasierfororganizationssuchasArvindtostandardizemanagementan
dclinicalprocesses,trainaspecializedparaprofessionalworkforce,pursuelower-costtechnology, and build
volume with focused community outreach and education
Mohans 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.
42
43
Surgeries related to diabetic foot complications, general and eye surgeries (cataract and
glaucoma)are routinelydone.

17
Ayurvedic and Wellness Care

Ayurvedictreatmentsare5,000yearsoldinIndiawiththebulkoftheayurvedictreatmentmarketconcentratedinSout
44
hIndia,mostlyinKerala .PEfirmsarealsoinvestinginthisspacewhilemergerswith ayurveda pharmacies are

also taking place.
45
Ayurvedicmarket(whichisapartoftheBeautyandRejuvenationmarket)isestimatedatINR40Billionin2009 .Indiai
sapopulardestinationforayurvedictherapiesleadingtoalargenumberofforeigntouristsvisitinglocalspasandayurv
edictreatmentcentres.InboundmedicaltourisminIndiaisthereforegrowingat a 12 percent CAGR.
TheStategovernmentofKeralaalsohastakencertaininitiativestoencourageAyurvedicspasandresortsas
touristdestination.Spa'sinKeralareceive government approval when they are set up.
Ayurvedacentreswhichareapproved/certifiedbytheStateDepartmentofTourismareeligibleforclaiming10percent
stateinvestmentsubsidyorelectrictariffconcessionandconsideredduringpublicityand promotional activities
through print and electronic media by the Department
Keralagovernmenthasevencollaboratedwithlargeprivateplayersinordertodevelopresortspas.Inordertoattractto
uristsintoIndia,theGovernmenthasintroducedvariousschemesandtoimplementthemithasalsotiedupwithleadin
gwellnesscentres.TourismministrylaunchedapromotionalschemeofferingonenightfreestayataspacentreinIndi
46
aifatouristbooksthreenightsatacertainwellnesscentres
Hospitals are also setting up wellness centres to cater to the requirements of the medical tourists
ApolloHospitalshasanentitycalledApolloWellnessPluswhichhasfitnessandayurvedictreatmentcentres
ManipalHospitalsprovidesayurvedictreatment,fitnesssolutionsthroughManipalCureandCare
47
48
Case Studies :
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
44
Source: Research on India, Wellness Services Market Report, 2010

46
Source: Kerala Tourism; India PR Wire Bharat Hotels; Kerala government to develop resort;
May2009;AlishaTravels
47
48
45
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
49
3billionforsixupcomingAIIMS-likeinstitutesandup-gradationof13existingGovernment Medical Colleges .

TheUnionCabinetonOctober20,2010approvedtheproposaloftheMinistryofHealthandFamilyWelfaretodeclare
NationalInstituteofMentalHealthandNeuroSciences(NIMHANS),BangaloreasanInstituteofNationalImportanc
eonthelinesofAllIndiaInstituteofMedicalSciences,NewDelhi,PostGraduateInstituteofMedicalEducationandRe
search,ChandigarhandJawaharlalInstituteofPostgraduate Medical Educationand Research, Puducherry.
Private-Public Partnerships
TheIndianGovernmentisfocusedondevelopingthePPPmodeltocoverthedemandsupplygapprevalentinthehealthcaresector.Privatesectorexpertisecoupledwithefficienciesinoperationandmaint
enancewouldleadtoimprovedhealthcareservicesdeliverytothemasses.Thismodelcanactasacatalystinthecreat
ionofnewcapacityandimprovementofefficiencyintheexistinginfrastructureestablished.TheGovernmentalsoem
bracedPPPmodeltocounterepidemicslikeH1N1swineflu,HIV,etc. However, it is evident that this model be far
more beneficial.
ThecriticalsuccessfactorsforPPPare:
Political Commitment and introduction of requisite regulations
49
Source: 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

50
Few successful PPP projects are mentioned below :
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
50
Source: Technopak Report A Peek into the Future of Healthcare: Trends for 2010
20
Building Functional Efficiencies

Whileinfrastructureimprovement,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
51
eMoolchandHospital;Fortishospitalsetc.havealreadybeenaccreditedbythisbody .
Trends of Accreditation
Todate,only17IndianhospitalsareJCIaccreditedandallarelargecorporateentities,includinghospitalsintheApollo,Fortis,andWockhardtHospitalsyste
52
ms .
AsofMarch2007,over700IndianhospitalshadappliedforNABHaccreditation.TheNABHisinvolvedintheaccredita
tionofbloodbanks,diagnosticcentres,nursinghomes,dentalclinics,andAyurvediccentresinadditiontoprivatehos
53
pitals,nursinghomes.AsofJanuary1,2008,only12medicalfacilitieshavebeenaccreditedbyNABH .
Advantages of Accreditation
Patientsbenefitintermsofhighqualityofcareandpatientsafety.Theyareservicedbycredentialmedicalstaffand
theirrightsarerespectedandprotected.
Accreditationresultsinhelpingcontinuouslyimprovetheoverallservicesofthehospitalinordertoprovidehighqu
alitycarewithleastpossiblerisks.Accreditationprovidesanobjectivesystemofempanelmentbyinsuranceand
otherthirdparties.Itprovidesaccesstoreliableandcertifiedinformationonfacilities,infrastructureandlevelofcar
ewitheducationongoodpracticestoimprovebusiness operations.
51
Source: http://www.jointcommissioninternational.org
Source: http://www.jointcommissioninternational.org
53
Source: Gluck: An article from the Saint Louis University Journal Of Health Law & Policy
52
2
1
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
54
ntofIndias1.1billionpeoplearecoveredthroughhealthinsurance .Itmostlycoversgovernmentemployees,share
ofpublicfinancingintotalhealthcareisjustabout1percentofGDP.Over80percentofhealthfinancingisprivatefinanci
ng,muchofwhichisout-of-pocketpaymentsandnotbyany pre-payment schemes.
55
HealthcareFinancing
Social
1%
OutofPocket8
0%
Other
17%
State
12%
Local
2%
Centre
2%
Insurance
3%
Source: Centrum Healthcare Sector October 2010, KPMG analysis

However,healthcareinsuranceisslowlypickinguppaceinIndia.Accordingtothe2010statisticsreleasedbytheIRDA
(InsuranceRegulatoryDevelopmentAuthority),thetotalhealthinsurancepremiumswrittenbynonlifecompaniesandstandalonehealthinsurancecompaniesgrewby25.2percentinFY2010overFY 2009.
54
Source: www.indianhealthcare.in
Source: Emerging Health Insurance in India Anoverview,ByJ.Anita,ActuariesofIndia,GlobalConference
of Actuaries
55
22
HealthcareInsurancePenetration
9.00%
8.00%
7.00%
6.00%
CA G R 19%
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
56
are now actively drivingthe health insurance market in India .

RSBYmayalsobeextendedtoNationalRuralEmploymentGuaranteeAct(NREGA)workerswhoworkedunder the
scheme for 15 days in a year.
Theinitiativescanhelpaddresstheneedsofthepeoplebelowpovertylineaswellastheothervulnerablesections
the society.
of
Emerging role of TPAs:

TheTPAs(ThirdPartyAdministrators)haveaddedtothechangingscenarioofhealthinsuranceinIndia.Theirroleisgr
aduallychangingfromgreenfieldventurestoanestablishedsystem.Theirwidespreadnetworkwithhospitalsandoth
erhealthcareprovidershavecertainlystrengthenedthehealthinsurancestructure in India.
Major TPAs
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 TPAs in India
10974
Source: IRDA Annual Report 2010
56
Source: Towers Watson New Planned Launches Article 2010

23
Tobringinuniformityandsmoothfunctioningoftheprocess,theIRDA(Insuranceregulatoryanddevelopmentauthori
ty)hasdirectedtheTPAstoformulatestandardguidelinesandformatsforbettercommunication 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
Conclusion
Healthcareisataninfluxofparadigmshiftsintermsofchanging
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:
Thegovernmentplanstoundertakebuilding6superspecialitytertiarycarehospitalswithresearchandeducation
centresacrossthecountry.Thesewouldcatertotheweakersectionsmakinghighendclinicalcareavailabletothe
masses.
Encouragingcurrentinitiativesonpubicprivatepartnerships,forboththecareproviderandeducationsectors,
should continue.
ThegovernmentshouldcontinueflagshipprogrammessuchassuchasRashtriyaSwasthaBimaYojana
(RSBY) and State level Insurance schemeslike the Arogyashri, Chiranjeevi etc.
Atthebaseofthepyramid
Toimproveavailabilityofmedicalstaffinruralandfar-
flungandinaccessibleareas,doctors,specialistsandparamedicalsaregivenmonetarybenefitssuchas25percenthiketothosepostedindifficultareasand50percenthikef
orthoseinareasthatarealmostunreachable by road.
AtruncatedmedicalcoursedesignedbytheCentralGovernmentfromtheChinesebarefootdoctorsmodelthati
57
sassumedtoproduce145,000ruraldoctorseveryyearwhichwouldcovermostprimarylevelneeds .Theexistin
ghealthsub-centres,thefirstpointofcareforvillagers,arenowbeingmanned by Auxiliary Nurse Midwives
(ANM).
ThroughNHSRC,theNRHM(NationalRuralHealthMission)isencouragingalmost200hospitalstogofor
sustainedQualityAccreditationprogram andthisissoughttoextendto400hospitals.
TheCGHS(CentralGovernmentHealthServices)hasmadeitmandatoryforallhealthcareinstitutionsanddiagn
osticcentresprovidingcaretohaveeitherNABH / NABLcertification.
58
Healthcare Education :
Tomeetthedemandformorehumanresources,especiallythedoctorsandnursesthegovernmenthasreducedt
helandrequirementsfrom25acresformedicalcollegesto10acresinurbanareas.TheINC norm of 4 acres for
nursing colleges has also been relaxed.
57
58
Source: FICCI Report, 2010

Source: Government Regulation issued by MedicalCouncilofIndia&IndianNursingCouncil
25
PrivatemedicalcollegesareallowedtoconducttheirownCETandthereservationcriteriaforgovernmentseatsa
ndmanagementquotahavebeenrelaxedwithauniformpredecidedfee.OnlytheNRIreservationismaintainedat15percent.
PrivatemedicalcollegesarenowallowedtoregisterunderSection25Act,unlikeearlierwheretheyhad
under the Charitable Trust banner.
to
be
59
Tax Benefit Interventions :
AllnewhospitalsbeingsetupinTierIIandTierIIItownsofIndiaaregivenafiveyeartaxholidaybythegovernment.T
heUnionBudget2009
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.
60
Import Duty Concessions :
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
Customsdutyon24medicalequipmentlikeX-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,
CentralgovernmenttosetupthefirstspecialiseddevicecentreNationalCentreforMedicalDevicesin Gujarat
61
to promote indigenous R&D efforts
Medical Devices Regulation Bill has been tabled and is under consideration
62
EnablingITdrivenhealthcaretoimprovethereachandcosts.Telemedicine,asabranchofdiagnosisandtreatment,shouldbeencouragedandwidelyimplementedtohelpensure
availabilityandaccessibility 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
59
Thecurrentcompulsoryruralstintformedicalprofessionalstobecontinued.Butneedstobeaugmentedwithbett
erfacilitiesandsupportsystems
Source: Income Tax Act, 1961 read with Income Tax Rules, 1962 & Customs Act, 1962 read
withCustoms Tariff Act, 1975
60
Source: The Customs Act, 1962 read with The Customs Tariff Act, 1975
61
62
26
Givinganinfrastructurestatustotheindustryandalsoencouragesubsidiesonpower,waterandotherutilities to
reduce overall cost of care
Providingincentivestotheindustrytosetupinfrastructuresinruralareas.Thiswouldleadtoamultipleeffectofimp
rovingtheoveralleconomicandsocialstatusalsomakingitattractiveandsustainableformedicalprofessionalst
owork
Makingitmandatoryforalldiagnosticservicestohavearegistrationprocesswhichlaysdownsomeminimumsta
ndardscriteria.Thiswillhelpintheprovision of better qualitydiagnostic services.
Providingacommondiscussionplatformforallqualitycouncilswhichenforce,assessandmaintainqualitystand
ardsinHospitalsandHealthcareInstitutions(includingeducation).
Private Sector Interventions Action Items:
PrivatesectorshouldworkintandemwiththegovernmentonPPPinitiativestoeducatethelaterfordevelopingmo
resustainabledeliverymodels
Provide Hub and Spoke models for both treatmentanddiagnosticcaredelivery
TakeontheresponsibilityofMedicalEducationwhichincludesmedicalprofessionals,nursing,andparamedical
staff
Toformacommonhealthcareforum/platformtocorroboratealleffortswhichrequirepolicydecisionchanges
which would giving more lobbying power
EncourageandextendCSRinterventionsincrossfunctionalformatsforcapacitybuildingofthepublicsectorpers
onnel.Thiscanbedonethroughexchangeprograms,CMEs,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
Withintheirownsetupsencourageaccreditation,makeitmandatoryforcredentialingofMedicalProfessionals
while recruiting/ appointing to help ensure quality standards.
27
CAS EST UDIES
28
AcuityInformationSystemsPvt.Ltd.
AIIMS, New Delhi deploys acuVena - Blood Bank Software
AllIndiaInstituteofMedicalSciences,AIIMS,isconsideredasoneofthemostprestigiousmedicalcollegesinIndiaan
disgloballyrecognizedforprovidingbestinclassmedicalcaretoalargenumberofpatients.Itwasestablishedasanin
stituteofnationalimportancebyanactoftheIndianparliamentwiththeobjectiveofdevelopingastrongcurriculumand
teachingguidelinesforundergraduateandpostgraduateeducationinallbranchesofmedicineinIndia.TheDepartmentofTransfusionMedicineatAIIMSis
runninga full
timeBlood
BankintheInstituteandalsoorganizingteaching,researchactivities.TheBloodBankfunctionsroundthe
clockandisaRegional BloodTransfusionCentreforsouthDelhi.
AIIMSdecidedtogoinforanend-toendcomputerizationofthebloodbankservicesfrommanagementofdonorstomanufacturingofcomponentsaswell
asadetailedtraceabilitytoensuretheconceptofhaemovigilancefromthestandpointofadonorandtherecipient.AIIMSbegantoreviewsomeofthebest-ofbreedbloodbanksoftwareproductsavailableandarrivedatasolutionfromanIndiancompanybythename
acuis.ThenameoftheirbloodbanksoftwareproductwasacuVena.TheteambehindacuVenahadconcentrat
edonthecomplexitiesoftheworkflowsofindependentandhospitalbasedbloodbanks.Theirsolutionhadbeensucce
ssfullyrunningatmanyofIndiasleadingbloodbanksforthepastfiveyears.acuVenahadbeenshowcasedatindust
ryconferencesinIndiaandtheUSAandhadevolvedbestpracticesfromtheindustryovertheyears.Beinganenterpris
eclass,web-basedsoftware;itseemed to fit in line with the vision of the blood bank at AIIMS.
acuVenapresentsitselfasaprocess-driven,featurerichbloodbanksoftwarethathasbeenbuiltonaServiceOrientedArchitecture.Thekeytoitssuccesshasbeentheinp
utsgivenbythecoreR&DteamconsistingofdomainexpertswhoarestalwartsoftheIndianbloodbankindustry.acuVe
nahasmappedkeystakeholderslikedonors,blooddriveorganizersandcareprovidersinitsdesignfromthegroundup.Thisinsuresthatthesestakeholderscanactivelyinteractwiththesystemratherthanthesystembeingrunessenti
allybytechniciansanddataentryoperators.Thesoftwarecanbebroadlyclassifiedintothefollowing subsystems:
Donor Centricity
Oneofthekeystakeholdersinthesystemisthedonor.Thesystemhelpsmarkdonorsaseligibleanddefersthosewho
arenoteligible.TheentiredonorworkflowhasbeentracedontoacuVenaprocess
29
map.Donorquestionnairesarecompletelycustomizable.Donorscanhavetheoptionofselfregistrationeitherviatheweboraninteractivetouchscreenmodule.Itrecordshistoryofpreviousdonationsandrestri
ctsdonorsfromdonatingbeforetheireligibleperiod.acuVenahastheaddedadvantageofnotlosingtrackofdono
rswhoaretemporarilyunfitfordonationbyremindingthemtocomebackwheneligible.
Bag Lifecycle
acuVenamaintainsthedetailedhistoryofabagrightfromthetimethestoresofficerreceivesit,tillit
isfinallyissuedtotheintendedrecipient.Thesystemacceptsdonorsofwholebloodaswellasaphaeresis.Itallowsco
mponentpreparationdependingonthetypeofbagchosen.acuVenaenablestypingofbloodforRedCell,Leuco
cyteandPlateletAntigen.Onecanviewthetransfusioncentre'sstockaccordingtostocklocation,bloodgrouporcom
ponent.Everystageofthebloodbagfromcollection,componentpreparation,storage,stockmovement,crossmatch,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.acuVenaenablesadversetransfusionreactionreporting from the point of care.
Blood Drive (Camp) Management
acuVenahasacomprehensiveblooddrive(bloodcamp)organizationmodulethathelpsbloodbanksorganize
resources (personnel, vehicles, consumables and assets) for blood drives (camps).
DonorLoyalty:acuVenastoresinformationaboutdonorswhoareeligibl
easwellasthosewhomaynotbeeligibletodonatetoday.Thiseligibilityisauto
maticallycalculatedbyanintelligentquestionnairesystemthatcalculatesth
enumberofdaysadonormaybedeferredduetoapreexistingcondition.Sincesuchasystemisrulebased,itallowsthebloodcente
rtochangetheeligibilitydaysdependingontherulessetforthbythegovernin
gregulatory
authority.Storingdataofineligibledonorsnotonlyhelpsthebloodcentercallthembackwhentheyarenext eligible, it
also
enables
the
blood
center
from
pro-activelyknowingthestatusofthedonorifhe/sherevisitsbeforetheyarenexteligibletodonate.Inaddition,thishelpsthebloodcenterconvert(motivate)replacementblo
oddonorsintovoluntaryblooddonorsbycallingthemwhentheyarenexteligibletodonate blood.
FasterTATs(Turn-AroundTimes):Sincethestocklevelsareinstantlyaccessiblewithinandoutsidethe
system,thebloodbankstaffareabletoattendtobloodrequestsinanefficient
manner.Thesystemallowsbloodreservationinadvance.Thesystemhasin
-builtemailandsmsalertsforadversetransfusionreaction,lowstocklevels
and expiring units of blood.
30
ProcessDriven:Havingbeenbuiltwithinputsfromdomainexpertsofthebloodtransfusionin
dustry,thesoftwarehascoveredthevariousstagesofbloodbankinginacomprehensivemann
er.Itcoversredcellantigen,plateletantigenandHLAtyping.Ittakesintoaccountinformedco
nsentofdonorsdependingonthetypeofcollection(wholebloodoraphaeresis),exhaustivein
formationrelatedtobloodcollection,donorreactionsaswellasvariousstagesofthecompon
entmanufacturingprocessdependingonthekindofbagused.Theseprocessdrivenstagesca
nbetracedperbloodunitandtechnicianscanalsogenerateworklistscorrespondingtotheses
tagesthattheychoosetodoinbatches.
EnhancedTraceability:acuVenacoversallthestagesofdonormanagementandcomponentpreparation.Th
ebloodbankpersonnelusingacuVenacantracebackanybloodunittothedonormedicalhist
oryortothedateofpurchaseofthebloodbagfromthevendor.Theintelligentlabelingsystem
alsodisplaysthetestresultsoftheTransfusionTransmittableInfectiousmarkerscarriedouto
nthebloodunitforenhancedsafety.Anyadversetransfusionreactioncanbedocumentedint
hesystemandisonceagaintraceabletothedonorand bloodbag.
GreaterCompliance:Thesystemgeneratesmostoftheessentialreportsrequire
dtobesubmittedtotheauthorities.Manybloodbankseitherdedicatepersonnel
forthisactivityorspendalotoftimecollatingthisdataagainasmostoftheproces
sesandconsumablesofthebloodbankarenotfedintothebloodbankmoduleofth
eHIS.acuVenasprocessdrivenapproachnotonlycapturestheessentialinforma
tion,itgeneratesmost
ofthereportsrequiredbytheauthoritieswhoseekthisinformation.Theserepor
tscanbegeneratedinadditiontothemanualregistersbeingmaintainedbythebl
oodbank.
FocusonPointofCare:DeployingabestofbreedbloodbanksoftwarelikeacuVenaensur
esthatseniorofficialsconcentrateonusingthedataeffectivelytoachievetheirqualityin
itiativesratherthancreatingthereports.Byfreeinguptheirtimefromreportgenerating
activity,italsoenablesthecareprovidersinabloodbankfocusmoretransfusioncareandresearchrelatedactivities.
31
NovartisIndiaLimited
Thematic Areas
Healthcare
Location of Arogya Parivar sites
Uttar Pradesh, Uttaranchal, Bihar, Rajasthan, Gujarat, Maharashtra, Chhattisgarh, Andhra Pradesh,
TamilNadu, Karnataka
Case Study:Arogya Parivar Improving healthcare access for Indias rural poor
Mission:Toimprovehealthcareaccessfortheunderservedmillionslocatedatthebottom-of-the-pyramidusing
social business approach.
Objective:To create health awareness among people and toimprove healthcare infrastructure for
themarginalized rural poor.
Reaching out to rural India
AccordingtotheWorldHealthOrganisation,65%ofIndia'spopulationdoesnothaveaccesstoqualityhealthcare.The
senot-soprivilegedpeoplearedisfranchisedoftheirrighttohealthwithwomenandchildrenbeingamongtheworstsufferersint
he600,000
+
villages
spread
across
the
country.
Low
diseaseawareness,poorhealthcareinfrastructure,lowincome(50%liveonlessthanadollaraday),lackofanadequa
tedistributionsystemexacerbatestheissue.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-thecountercuresforcoughs,colds,allergies,diarrheaandcalciumdeficiencies.Productsalsoincludenonsteroidalanti-inflammatoryagents,anti-fungalandantianxietytreatments.Itcombinessocialentrepreneurshipwithcorporatesocialresponsibilitytospecificallyaddressth
ehealthneedsofruralIndiawhileprovidingopportunitiestoexpandbusiness in an innovative and responsible
way.
Itemploysacombinationoftechniquesusedbypharmaceuticalandconsumergoodscompaniesanditsfundamenta
linnovationrestsonapplyingamarketingmixbasedonthe4AsAwareness,Acceptability,Affordability
and
Availability adapted to low-income markets.
Awareness:ArogyaParivarconductshealtheducationprogrammesatthegrassrootslevelwiththehelpofHealthEd
ucatorsrecruitedfromamongthevillagersthemselves.Educatorsshareinformationonpreventive
health
measures and educate the community on the need for and importance of good health.
Adaptability:Thetherapeuticareaportfolioiscustomisedasperthelocaldiseaseburden.Allcommunicationincludi
ngthatonproductpacks is adapted to local conditions.
32
Availability:Stronglinkswithdoctorsensurelastmileavailabilityandgofarbeyondtraditionalpharmapracticeswhichfocusondoctordetailing.Theextendedsupplyc
hainreachesouttothelocalpharmacyinthe village.
Affordability:Innovativesolutions,strongbrandingandlocalresourcesmakea
difference.Sincevillagersoftenperceivemedicalcareasbeingexpensiveandinaccessible,medicinesaremadeav
ailablein small packs at affordable prices.
ArogyaParivarisorganizedaroundalightcentralmarketingandplanningteamresponsibleforcreatingmaterialsuse
dinthefield:leaflets,posters,trainingmanuals,minimoviesforawareness,includingtranslationinlocallanguages.It
goesbeyondsimplepromotiontothedoctortocreatingawarenessamong the rural population and finally
reaching out to every patient for drug compliance.
Fieldoperationsarestructuredintoindependentcells,eachcoveringaradiusofapproximately35kmor20miles.Eac
hcellismanagedbyasupervisor,assistedbyafewhealtheducatorswhosemainroleistoraisediseaseawarenessam
ongthepeopleincludingpreventionandtreatment,referpatientstodoctors,brief physicians about the program
and meet patients to ensure patient completes prescribed treatment.
The patient at the centre

All 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.
3.
IntroducenewpacksizessopricepointremainssameasalsoproductssuchasORS(oralrehydration salts)
aimed at the rural market.
Distribution system uses foot soldiers so that itreaches critical economic mass for direct deliveries.
4.
5.
Collaborativeeffortwithlocalsocialdevelopmentagenciesforcommunityparticipationandwiderreach.
Followsapatientcentricapproachthataddressesthecommunityonhealthissues,educatesandmotivatespe
oplefortheiroverallwellbeing,usesdoctorreferralcardstohelptrackpatientsandengageswiththepatienttoensurecompliance.
Reaping results
ArogyaParivarhasenhancedaccesstomedicinesforcloseto50millionpeoplein10Indianstatescovering30,000+vi
llageswith11healthprograms:tuberculosis,skinandgynaecologicalinfections,diabetes,micronutrientsduringpregnancyandchildhood,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,NovartisinIndiahascomeupwithspeciald
rugsandpackagingtomeettheneedsofthisgrowingmarket.Forinstance,thecompanyhasdevelopedaWHOapprovedORS+Zincantidiarrhealformulationinaffordablesachets,andananiseflavor.TheArogyaParivarconceptisawinningone,empowe
ringvillagers,providingemployment,improvingruralhealthcare,andstrengtheningtheNovartisbrandintheremote
stofvillages.Whatmakesitextra special is that the model can be replicated inother geographies facing similar
healthcare challenges.
Arogya Parivar receives accolades

ArogyaParivarhasreceivedinternalandexternalrecognition.ArogyaParivarwasawarded"BestLongtermRuralMarketingInitiative"inIndiafor20062008byRuralMarketingAssociationofIndia(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
diseases(NCCDs).Ev
rvasivechangehasbeentherisingburdenofnon-communicablechronic
nasinfectio
sandnutritionaldeficienciesarerec
deathanddisability,cardiovasculardiseases(CVDs),cancers,diabete
dingasleadingcontributorsto
,nephrologicailments,andother
chronicdiseasesarebecomingmajorcontributorstotheburdenofdisease.Indiatooillustratesthishealthtransition,
whichpositionsNCCDsasamajorpublichealthchallengeofgrowingmagnitudeinthetwenty-firstcentury.
TheWorldHealthReport2001hadindicatedthatNCCDsaccountforalmost60%ofdeathsand46%of
theglobalburdenofdiseases.Seventy-fivepercentofthetotaldeathsduetoNCDsoccuri
developing
countries.Faci gadoubleburden,withaheavyloadofinfectiousdiseasesandanincreasingb
toNCDs,itis
etimated
that India accounts for17%of
globalcardiovascular
rdendue
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 foundations activitiesrange from conducting studiesto identify the cause ofthee
diseasesto
developingprogramsforpromotinghealthybehaviourandworkingwithmedicalpractitionersforbetter
deliver
andoutcomes.TheorganizationhasundertakennicheresearchtitledNCCDsinIndiaA
studyofthegaps,qualityandcostofcareonnon-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 Swast Log,Swasth
h
Deshtospreadawarenessontheriskfactorsleadingtochronicdis
easeswithspecificfocusontobaccoandalcohol
in17
tates ofIndiain
collaboration with NGOs, private
sector partners and government bodies.It

population of600,000
coversa
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,
communitiesandsocietiesforpreventionofNCDsandhelptoprovideasupport
iveenvironmentforthepeopletosustainpositivebehaviour.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
entitledNashaMukhtP
diShaan).
Amritsarin
Jan 2010
njab(PunjabdajoshPunjab
The campaign ws directedat
the youthto
channelizethemintoeffectivechangeagentsofhealth.Overaperio
dof5days,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
HIVinfectionorAIDsahealthcatastrophefirstreportedinIndiain1986inthestateofTamilNaduhasspreadacrossthev
ariousstatesofthecountry.India,ifseendemographically,maintainsastatusofsecondlargestcountryisunfortunatel
yalsothirdlargestcountryintermsofPeoplelivingwithHIV/AIDS(PLHAs).
AsperNACOreportprevalencerateofHIV/AIDSinIndiais0.29percent(200809)amountingthetotalpopulationofmorethan2.27millionpeople.Thesituationismoredauntingasnearly89%ofPL
HAscomefromotherwisehighlyproductiveagegroupof1549yearsmakingtheeconomicimpactgraver.MoreoverwithasocietylikeIndiawherestillmajorityoffamilybreadearn
eraremen,outoftotalinfectedpopulationapproximately60%happenstobemale.Althoughwiththeconcentratedeff
ortofNACOandotherorganizations,scenarionowisfarbetterthanitusedtobeinyear2002withaprevalencerateof.4
5percent of countrys population.
TimeisnowtoextendthesupporttoHIV/AIDSpatientsbeyondART,HAARTandPARTandalsofocusingavailabilityof
treatmenttothediseasesthatthispopulationisthusexposedto.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/AIDSpatientsthedemandandsupplygapisveryhighandresu
ltinginhighermortality.
Initiative by FMC India and TANKER Foundation
Astheysayproblemsarethebiggestopportunities,theissuesfacedbypatientsweretriggerforthejointinitiativeofFM
CIndiaandTANKERfoundation.MajorissuewasthatHIV/AIDSinfectedpatientswerebeingdeniedDialysistreatme
ntinprivatehospitalsandthegovernmentfacilitiestoowerenotfullyequippedforthetreatmentdelivery.Realizingthe
demandsupplydisparityandwithavisionofprovidingaffordablequalitydialysistothismuchneededsegment,FMCIn
diaandoneofitscloseassociates,dedicatedtowardsprovidingrenalcareandlowcostqualitydialysis,TANKERFoun
dationjoinedhandsand started a dedicated facility for patients suffering with HIV/AIDS in Chennai.
Thefacility,inauguratedbyMr.VayalarRavi,Unionministerofoverseasaffairs&civilaviation,inauguratedthefacility.
ThefacilitystartedwithtwoHIV/AIDSpatientsandtodayprovidestreatmenttomorethan6patients.Thisparticularfac
ilityofTANKERfoundationtodayhasbecomeonlyfacilityprovidingqualitydialysistreatmentataffordablecosttoHIV/
AIDSpatients.Moreoverthereisnodiscrimination done in treatment fees between HIV/AIDS patients and
other patients.
36
Treatment Package
PatientsbeingtreatedatTANKERFoundationdialysisfacilityarechargedRs.375perdialysistreatmentwhichisalm
osteighttimeslessthanwhatisgenerallychargedbyotherhospitalsfromHIV/AIDSpatientsforsimilartreatment,ifata
lltheyprovideso.ThemedicinesupplyistakencarebyTamilNaduAidsControlSociety.Thenominalcostchargedfort
hetreatmentincludeschargesforalltheaccessoriesusedindialysisandothermedicineslikeerythropoietininjection
s,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.
Confidentialityofthepatientsclinicalconditionshallbemaintainedveryspecifically.
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,theFoundera
ndManagingDirector.Dr.Varaprasad,anelectronicsengineerbyprofession,establishedthecompanyin1993witha
missionstatementTodevelop,produceandmarketcost-effectivehumanhealthcare products that conform to
internationalstandardsofhighorder.
ShanthaBiotechnics,AnISO9001certifiedcompany,hasdevelopedandcommercializedIndiasfirstrecombinantH
epatitisBvaccinefollowedbyhumaninterferonalpha,Erythropoietin,choleravaccine,measlesvaccinebesidesTetravalent
vaccine(DPT+Hepatitis-B)andPentavalentvaccine((DPT
+Hepatitis-B+Hib).IthappenstobeWHO-Genevapre-qualifiedsupplierofHepatitis-Bvaccineandcombination
vaccines.
TheseedsofthisambitiousventureweresowninGenevaataconferenceonglobalprogramsforimmunization.Thisis
whereVaraprasadfirstrealizedthepressingneedforanaffordableHepatitisBvaccineforIndia.Atthatpointintime5%ofIndianpopulation(45million)wasHepatitisBviruscarriers.ButthevaccineisnotyetincludedinIndiasNationalImmunizationProgramnotwithstandingWHOsd
irectiveduetothepricefactor.Theimportedvaccinewasverycostlyandunaffordableeventouppermiddleincomegroups.Indigenousvaccineswerenotavailable.InthosecircumstancesShanthaBiotechnics took birth.
Buyingtechnologyfromabroadwouldhavepushedupthecostoftheproduct.Sotomakethevaccineaffordabletoco
mmonman,Varaprasaddecidedtodevelopthetechnologyinhouseratherthanimportingitatahighercost.HisearlyyearsinR&DaselectronicsengineerinDefenseElectronicsLa
bs,hadgivenhimconfidenceinIndianScientifictalentandhewasconvincedthatwecouldputIndiaonthemapforGen
eticEngineering,ifproperatmospherewasprovided.Thusheunwittinglyheraldedbiotechrevolutionin India.
Thejourneywasnoteasy.FundingwasmajorhurdleasbiotechwasunheardofinIndiathosedays.Thankstoinvestors
fromOmanandTechnologyDevelopmentBoardinMinistryofScience&Technology,ShanvacB,firsteverindigenouslydevelopedHepatitisBvaccinecouldseethelightofthedayinAugust1997.ByadoptingnovelmarketingtechniqueslikeMassVaccination
Campstoreachtheconsumer,Shanthacouldcutdownsupplychainexpenses.Also,itcreatedmuchneededawaren
essoftheimportance of Hepatitis-B eradication among masses.
EvenwhilesellingShanvacth
Bvaccineat1/10 ofthecostofimportedvaccine,theymaintainedinternationalstandardsintermsofqualityandtorea
chthebenchmark,successfullygonethroughWHOprequalificationformostoftheirproducts.WhenPfizeraskedthemtoproduceHepBvaccineundertheirbrandname,theassociationhelpedShanthatoperfectsystems,proceduresanddocumentatio
napartfrom bettering quality of the product.
ShanvacBbecameoneofthefastestgrowingbrandsintheIndianpharmaindustry,anditssuccessattractedfournewIndianco
mpaniestolaunchtheircompetingHepatitis-Bdrug.GSKsshareinIndiaforHepatitisBfellfrom100%in1997tojust10%in2000.Over1998-2000,Varaprasadreceived47awards.ThisincludedthefirsteverNationalTechnologyawardreceivedfromthePrimeMinisterinMay1999forhomegrowntechnologies.In2000,Ernst&YoungbestowedEntrepreneuroftheYearAwardonhimforhiscontributionstoth
efieldoflife-sciences.
VaraprasadwasawardedPadmabhushanin2005andVaraprasadandShanthatogetherwonmorethan250award
sbynow.Withoutrestingonlaurels,theypursuedtheirpathvigorouslyandcarvedanicheforthemselvestoattractthea
ttentionofinternationalPharma 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.
ShanthacaterstomajorinternationalmarketsincludingAsiaPacific,Africa,CISandLatinAmericainadditiontosupranationslikeUNICEFandPAHO.Itexpandeditsvaccinesport
foliobylaunchingcombinationvaccinesandnewgenerationvaccinesproducedindigenouslyatitsWHOcGMPplant
nearHyderabad.
ApartfromthesingledoseHepatitisvaccineShanthaBiotechnicsisworkingontyphoidconjugate,acellularpertussis
andcomplaintbasedDPT.Rotavirusvaccinewillalsobeanimportantpartofthecompany'sportfolio,apartfromHuma
nPappilomaVirus(HPV).AmongtheotherproductsinthepipelineareJEvaccines,vaccineforvaricellazosterandheat-stablevaccines.
th
InSeptember2009,Franceslargestandworlds4 pharmamajor,SanofiAventis,hadacquiredan80%stakethatanotherFrenchfamilybusinessMerieuxAllianceheldinShanthaBio.
SanofireaffirmeditscommitmenttoVaraprasadspublichealthmissionofprovidingaffordabledrugs.Itplannedtode
velopShanthaBiointo a globalR&Dhub,andtoexpand in India and in other emerging markets.
LegendarySanofiPasteuristhevaccinecompanywithmorethanacenturyoldexperienceindevelopment,productionandmarketingofvaccines.ShanthasworldclassmanufacturingfacilitiescomplyingwithUSFDAstandardscanbebestoptimallyutilizedbySanofiPasteurform
eetingglobalvaccinedemand.ShanthacanbecometheextendedplatformofSanofiPasteurinSouthernhemispher
eto serve the global vaccine requirements.
OneofShanthaspremiumproducts,Pentavalent(HepB+DPT+Hib)vaccinecanbecombinedwithSanofisIPVvaccinetocomeoutwithHexavalentvaccine.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: TransformingLives
Impact:VLCChashelpedimproveIndiaswellnessquotient,helpingmillionsmakethetransitiontohealthy lifestyles
Legacy: Undisputed pioneers
TheVLCCsuccessstorystemsfromitsunwaveringbrandcommitmenttotheideaofTransformingLives
thegroupsguidingvision.TheVLCCtransformationcentersseamlesslymarriedthescientificslimmingprogramswi
thcuttingedgeskinandhairtreatments.VLCCcontinuestopursuethemissionwithitsnetwork spread over 225
centers across 100 cities in 8 countries.
VLCCsfounderandmentor,VandanaLuthraopenedIndiasfirstTransformationCentreinNewDelhiin1989,atatim
ewhentheIndianmarketforwellnesssolutionswasstillnascent,andtheconceptofcombiningfitnessandbeautyasa
napproachtoholisticwellness,asinitiatedbyher,wasacompletelynew paradigm.
Today,VLCCisapioneerintheglobalwellnessarenawithpresenceinthreerelatedbusinessesinthewellness
domain:
- Slimming, skin & hair services;
- Education&traininginstitutes;
- Manufacturing&retailingofpersonalcareproducts.
VLCCcentersareopen7daysaweek,andserviceover75,000customervisitseverymonth.Inaworldruledbychangi
nglifestylesandinstantremedieslikecrashdietsandappetitesuppressants,theUSPoftheVLCCweightmanageme
ntprogramhasalwaysbeentheirholisticandscientificapproachtowardstransformation.Theirslimmingprogramsar
ebasedonscientificprinciples,usinglifestyleanddietarymodifications,anddonotinvolveanysurgicalproceduresor
crashdiets,nordotheyrequireconsuminganymedication,dietpillsorhungersuppressants.VLCCsslimmingbusin
esshelpstheearthbecomelighter by over 90,000 kgs every month.
VLCC International
Theyear2006markedVLCCsforayintooverseasmarkets,withtheopeningofitsfirstcentreinDubai.VLCC'smajorfo
cusistotacklethescourgeofobesityanditmadeeminentsensetolookattheMiddleEastmarketasitsfirstoverseasfor
ay,giventhatobesityintheMiddleEastisratedasbeingamongstthehighest in the world. In UAE specifically, over
60 percentofthepopulationiseitheroverweightorobese.
Today,VLCCisaninternationalbrandwithpresencespreadover16centersintheinternationalmarketwith10centers
intheUAE,twoeachinOmanandBahrainandoneeachinQatarandNepal.TwoVLCCcentersinSriLankaandoneinB
angladeshwillbeoperationalbyMarch2011.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 VLCCInstitutesofBeauty&Nutritionofferprogramsinbeautyandnutrition.Withapresencespreadacross4
9campusesin38citiesinIndia,itistodayAsiaslargestvocationaltrainingnetwork of its kind.
o VLCCPersonalCareisaproprietarylineofover100herbalandayurvedicskin-care,hair-careandbodycareproducts.TheseproductsareavailableatallVLCCcentresandarealsoretailedthrough20,000plussto
resacrossIndiaandoverseas.SHAPEUP,itsflagshiplineofbodyshaping products is a category leader.
o TheVLCCDaySpasinMumbai,Delhi,KolkataandGurgaon,aluxuryofferingfromthehouseofVLCC,offers
patherapiesfromaroundtheworldasalsoadvancedhair,skinandnailservices.Theservicesatthespaareac
ombinationofthetime-honoredtraditionofpersonaltouchwiththelatest skin care equipment and spa
technology for "results-oriented" treatments.
o TheVLCCNutriDietClinicprovidescustomizedsolutionstoaddressesdietneedsfromnormaltomedical/th
erapeuticconditions,helpingpeopleadoptholisticwellnessintheireverydaylives.Itisaimedatimprovingth
eoverallwellnessquotientofindividualsthroughadvisoryservicesfordietaryintake,customizedonthebasi
softheindividual'sspecificbio-chemicalparametersandlifestyle.
41
Acknowledgement
VLCCistheworldsfirstslimming,fitnessandbeautycorporatetogettheISO9001:2000andSA:800O(SocialAcco
untability)certificationforimplementingcorporatesocialresponsibilitystandards.TheVLCCGrouphasalsobeen
awardedtheISO:14001certificationformeetingglobalenvironmentstandards, again a worlds first for a
company in its line of business.
42
AboutKPMGinIndia
KPMGisaglobalnetworkofprofessionalfirmsprovidingAudit,TaxandAdvisoryservices.Weoperatein146countrie
sandhave140,000peopleworkinginmemberfirmsaroundtheworld.TheindependentmemberfirmsoftheKPMGne
tworkareaffiliatedwithKPMGInternationalCooperative(KPMGInternational),aSwissentity.EachKPMGfirmisal
egallydistinctandseparateentityanddescribesitselfas such.
OurAuditpracticeendeavorstoproviderobustandriskbasedauditservicesthataddressourclients'strategic
priorities and business processes.
KPMG'sTaxservicesaredesignedtoreflecttheuniqueneedsandobjectivesofeachclient,whetherwearedealingwit
hthetaxaspectsofacrossborderacquisitionordevelopingandhelpingtoimplementaglobaltransferpricingstrategy.Inpracticalterms,thatme
ansKPMGfirmsworkwiththeirclientstoassistthem 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(KPMGInt
ernational.)wasestablishedinSeptember1993.Asmembersof
a
cohesivebusinessunittheyrespondtoaclientserviceenvironmentbyleveragingtheresourcesofaglobalnetworkoff
irms,providingdetailedknowledgeoflocallaws,regulations,marketsandcompetition.Weprovideservicestoover5,
000internationalandnationalclients,inIndia.KPMGhasofficesinIndiainMumbai,Delhi,Bangalore,Chennai,Hyde
rabad,Kolkata,Pune,KochiandChandigarh.ThefirmsinIndiahaveaccesstomorethan5,000Indianandexpatriate
professionals,manyofwhomareinternationallytrained.Westrivetoproviderapid,performance-based,industryfocusedandtechnologyenabledservices,whichreflectasharedknowledgeofglobalandlocalindustriesandourexp
erienceoftheIndianbusinessenvironment.
43
ASSOCHAM
THE 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/Association
s 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
VikramUtamsinghH
eadof
MarketsKPMGinIndia
T:+912230902320
E:vutamsingh@kpmg.com
VikramHosangady
HeadofHealthcareSectorKPMGi
nIndia
T:+9144 39145101
E:vhosangady@kpmg.com
AmitMookimDirect
or,AdvisoryKPMGinIn
dia
T:+91223090 2141
E:amookim@kpmg.com
JagrutiBhatia
AssociateDirector,AdvisoryKPMGi
nIndia
T:+91223090 2145
E:jagrutibhatia@kpmg.com
kpmg.com/in
Theinformationcontainedhereinisofageneralnatureandisnotintendedtoaddressthecircumstancesofanyparticularindividualore
ntity.Althoughweendeavortoprovideaccurateandtimelyinformation,therecanbenoguaranteethatsuchinformationisaccurateaso
fthedateitisreceivedorthatitwillcontinuetobeaccurateinthefuture.Nooneshouldactonsuchinformationwithoutappropriateprofes
sionaladviceafterathoroughexaminationoftheparticularsituation.
2011KPMG,anIndianPartnershipandamemberfirmoftheKPMGnetworkofindependentmemberfirmsaffiliatedwithKPMGI
nternationalCooperative(KPMGInternational),aSwissentity.Allrightsreserved.
TheKPMGname,logoandcuttingthroughcomplexityareregisteredtrademarksortrademarksofKPMGInternational.

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Indiascompetitive advantagelies in the

Changing disease patterns: Implication for healthcare infrastructure

Emerging Trends in Healthcare Delivery

Building Functional Efficiencies

2. Arogya Parivar (Novartis)

3. Chronic Care Foundation

4. Fresenius Medical Care India

TheIndianHealthcaresectorcurrentlyrepresentsaUSD40Billionindustry .Abreak-upofthesectorasof 2009 is

Source: IDFC Securities Hospital Sector November 2010

Source: WHO World Health Statistics 2010

Source: WHO World Health Statistics 2010

Source: WHO World Health Statistics 2010

Source: WHO World Health Statistics 2010

Growth in the Healthcare Industry

wto~USD79Billionby2012and~USD280Billionby2020 .TheaverageCAGRforthenext 10 years, therefore, has

IBEF November 2010

Drivers of growth for the Healthcare Sector

creates a market for preventive, curative and geriatric care opportunities

Crisil Research Hospitals Annual Review November 2010

Emerging Trends in Healthcare: Challenges and Interventions

Changing disease patterns:

Lack of healthcare infrastructure

Lack of trained and qualified manpower

Changing Disease Pattern: The Dual disease burden

related. Itisestimatedthatby2012,50%ofthespendingoninpatientbedswouldbeforlifestyle-related diseases .

IDFC Securities Hospital Sector November 2010

Burden of Non Communicable Diseases

*CVD/diabetes data from 2005; COPD from2006;cancerfrom2004.

thedemographic trends and lifestyle changes in India .

Healthcare infrastructure deficiencies

per1000populationagainsttheglobalaverageof1.23 which suggests an evident manpower gap.

Current Annual Production

Source: CII Technopak

E erging Trends i Healthcare

nd investment servicesas well as medical tourism, the

d to make healthcare facilities on par with

Source: Centrum Healthcare Sector October2010

Source: Centrum HealthcareSector October2010

Source: Centrum HealthcareSector October2010

Source: Grant hornton DealTracker

care hospitals inmetros/tier

Source: IDFCSecuritiesHospital SectorNovember2010

Value (USD billion)

Contract Research in India

the outsourcing in the Indian market .

Economic Intelligence Unit Healthcare November 2010

Emerging Trends in Clinical Research

Stem Cell Research

Bangalore is involved in this .

Source: Cygnus, Industry Insight - CRAMS 2010

Drug Eluting Stents

Hospitals and Research

g hospitals are actively involvedinvariousstagesofclinicaltrials .

Developments in Private Healthcare

Source: Express Pharma Online, Lupin launches Ivabrad, 2008

nIndia,about20percentofallsurgicalprocedures are performed on outpatients .

25 percent and 30 percentwith a pay back of ~34 years .

End of life care centres

To reduce the agony and burdenofprolongeddyingprocess

To develop mental peace at the time of death

services are more widespread .

Single Speciality Hospitals

Source: Financial Express February 5, 2010