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Vibrant Gujarat

Gujarat, being an economically stable, industrially and agriculturally developed state, has become one of the most favored medical destinations too in the recent times. Sonal Shukla analyses the healthcare boom in the state

Gujarat, a state which has achieved a stupendous 12.5 per cent industrial growth rate from 2002 -2007, a GDP growth of 10.2 percent and a contribution of almost 20 per cent of Indian exports, has a similar success story to share when it comes to healthcare.

From Strength to Strength

This land of Mahatma has always played an important role in the economic history of India. Today, Gujarat is believed to be fast transforming into a healthcare hub with the focused Government-led healthcare initiatives with leading corporate healthcare groups entering this market. The state currently has 13 medical colleges, 1,072 PHCs; 7,274 sub centres, 273 Community Health Centres (CHC) and 85 mobile healthcare units. Experts agree to the fact that the healthcare landscape in Gujarat has been changing rapidly. "The State Government has undertaken several initiatives to make Gujarat a global healthcare destination. Gujarat is fast evolving in terms of number of hospitals, healthcare centres and beds and is expected to continue a positive trend in future," shares Pradip Kanakia, Head of Healthcare, KPMG India.

The available medical infrastructure and easily accessible healthcare facilities have remarkably improved the health index of the population over the last few years. Well developed ports, roads, airports, rails are also said to be responsible factors. Gujarat, being an economically stable, industrially and agriculturally developed state, has therefore become one of the most favoured medical destinations. From dominance of small nursing homes, 25-years back, today Gujarat has made a rapid progression to the state-of-the-art tertiary care corporate hospitals getting established in major as well as two and three tier cities. Experts give credit for this rapid development to the changing mindset of the patients who have become quality conscious and more aware of their healthcare needs. Besides, growing per capita income and want of specialised and sophisticated healthcare has given further impetus to this healthcare boom. "Currently, Gujarat healthcare market is standing on a verge of great take off. Medical tourism, enhancement of existing medical infrastructure, involvement of state Government in improving other facilities has significantly boosted healthcare market in Gujarat," says Dr Praful Pawar, CEO, Apollo Hospitals, Ahmedabad.

Sterling group is coming up with two more hospitals in Bhavnagar and Baroda

Shalby Hospitals is coming up with three new multi speciality hospitals-two in Ahmedabad and one in Surat

Apollo is exploring opportunity to start Reach Hospitals in Gandhidham, Kutch, Rajkot, Baroda and Surat

Land of Opportunities

Major corporate hospital groups such as Sterling, Apollo and Wockhardt have made significant investments in setting up state-of-the-art hospitals in major cities of Gujarat. The other major private players in this market are Shalby Hospitals, SAL Hospital, Medisurge hospital, Krishna Heart Institute. Sterling Addlife India Limited that owns and manages the largest chain of corporate hospitals in Gujarat, in terms of bed strength and markets covered, under the brand name of Sterling Hospitals, today boasts of 725 operational beds in Rajkot, Baroda, Ahmedabad and Mundra SEZ. "We are coming up with three more hospitals in Surat, Bhavnagar and Baroda, which will further ramp up the capacity to more than 1,000 beds by the end of this year. We plan to build a chain of corporate super-speciality hospitals in Gujarat. We strongly believe that we are operating in an underserved market and outstanding opportunity for private healthcare delivery exists in every city in Gujarat in which we have entered and planning to enter to deliver best in class healthcare," according to Rajiv Sharma, CEO, Sterling Addlife India Limited. Sterling Hospitals Group plans to invest close to Rs 200 crore in various green field and O&Ms in the state. "We are going to leverage our brand to workout a sustainable model by charging for it," he adds further.

Ahmedabad-based 240-bed Shalby Hospitals, which started as a single speciality hospital giving orthopaedic care, is also on an expansion spree. The hospital is coming up with three new multi speciality hospitals— two in and around Ahmedabad and one in Surat. "We are planning to add 600-700 beds together in all these three hospitals. The construction will start in a couple of months and we plan to complete it within 15-18 months," shares Dr Vikram Shah, Chairman, Shalby Hospitals, Ahmedabad.

Promising Pockets
The improved per capita income and rapid industrialisation has made major cities like Ahmedabad and Surat instant hits amongst corporate players. However, other prominent cities like Mundhra and Kutch region, Saurashtra, Baroda and Bhavnagar have also grabbed attention of the market leaders. "Baroda and Surat are emerging centres, especially Surat with the overall boom in the business in this city as well as its close proximity to Mumbai, which is a big advantage," shares Dr Anil Chadha, Hon Medical Director and Consultant Plastic Surgeon, Rajasthan Hospital.

Sterling Hospitals is planning to increase its presence substantially in Kutch area. "Sterling has started a hospital in Mundra which is the largest SEZ in India and are in process of building a Hospital at Bhavnagar", says Rajiv Sharma, CEO, Sterling Addlife. Apollo Group is keen on tapping areas like Gandhidham, Kutch, Rajkot, Baroda and Surat and is looking at opportunities to establish the concept of Apollo Reach Hospitals in the region. "In Gandhidham, we are going for 100-bed secondary and some tertiary care hospital," shares Dr Pawar.

It has been reported that Artemis Health Science is planning to set up a Rs 500 crore medical education hub on the Baroda-Ahmedabad highway in Gujarat. The medicity envisions a research centre, a medical college, nursing college, pharmacy college, medical administration college and a hospital which will have over 500 beds. Bombay Hospitals has signed an MoU to establish an Under Graduate and Post Graduate Medical institute with MS Hospital. Twenty-five-year-old and 210-bed Rajasthan Hospitals, which is a major trust hospital, has plans to expand its bed strength to 250 beds. The hospital is planning for a separate cardiac wing, new ophthalmic centre, bone marrow transplant and stem cell unit. "Ahmedabad is a big city and we would like to start two-three OPD and emergency management city centres in Ahmedabad. We see a big opportunity in critical and emergency care management," shares Dr Nitin Shah, Director, SAL Hospital, Ahmedabad.

Government Backing

The State Government is also reported to be joining hands with private players to set up medical education facilities in the State. According to Dr MM Anchalia, Medical Superintendent, Civil Hospital, investment is happening from both private and Government. "Our State budget has doubled in the last two years for healthcare sector. We are getting aid from Central Government and World Bank." In the year 2009-10, the health department of Gujarat Government has planned to extend the services and start new medical colleges. "One such college is likely to come next year in Patan. The plans are on for four medical colleges in Ahmedabad, Gandhinagar, Vadodara and Valsad. Hopefully one or two should start next year," adds Dr Anchalia.

Civil Hospital, Ahmedabad is getting aid from the Central Government under Pradhanmantri Swasthya Sudhar Yojana'. Started in 2005-06, the hospital has till date received Rs 100 crore from the centre.

Under this scheme, a hospital is identified from each state and is given aid by the Central Government to develop one AIIMS-like institution. The hospital has also received aid of Rs 20 crore from the State Government of Gujarat to develop it as Asia's largest medicity. Currently, the hospital is going for a three-fold development which includes strengthening the existing infrastructure, getting newer and advanced equipment and increasing existing capacity.

Narayana Hruduyalaya, Fortis Healthcare, and Artemis Group of Hospitals are planning to set up medical colleges in the State. The Chiranjeevi Scheme, which has been touted as one of the few PPP success stories in healthcare, has significantly reduced the rate of maternal and infant mortality. As per the scheme, the Government and private sector have collaborated successfully in providing safe child delivery services.

Disease Patterns
Lifestyle diseases like diabetes and heart diseases are on the rise in Gujarat region. The state is also said to be a big centre for orthopaedic diseases. According to Dr Pawar, "Out of 14,000 knee replacements done in Western India, almost 7,000 are done in Gujarat and majority of them I am sure are done in Ahmedabad." Tapping this segment Apollo has started the concept of 'Knee Clinic' in its Ahmedabad facility. Experts also feel that there is an unmet need in the area of cancer and radiation oncology. Medisurge super speciality hospital is planning for a 100-120 bed new cancer hospitals in Ahmedabad, Baroda, Surat and Rajkot which will provide medical, surgical and radiation oncology treatments. The Ahmedabad Cancer Hospital by the group will be the first one to go on the floor in another one year.

Care with Quality

It won't be an exaggeration to say that the healthcare sector in Gujarat has come in the limelight by adopting global practices to deliver seamless patient care of quality. "Gujarat's medical expertise and the strength of its facilities are arguably better than those of some of the South - East Asian Nations and Gujarat hospitals are trying to do a lot more hard selling abroad," says Kanakia. They are seeking to achieve this by measures such as creating centre of excellence in respective fields, developing a network, customising packages and providing a stamp of quality through accreditation from global certification agencies such as JCI. Not only corporate hospitals like Sterling, Medisurge, Apollo, Shalby but also major trust hospitals like Rajasthan Hospital and 2,040-bed Civil Hospital, which is also known as Asia's largest hospital, are in the process of getting either NABH or JCI accreditations in the next one or two years span. Civil Hospital has done first round of accreditation for its blood bank and is now going for final accreditation. It has plans to go for its lab accreditation and finally accreditation of the entire hospital. Today, hospitals like Shalby is known for its joint replacement surgeries and dental care. Krishna Heart Care Centre has established its name in the area of cardiac care. After getting a strong backing from HCG Global group, Medisurge group is trying to establish its presence in cancer care by establishing three cancer care hospitals. HCG Global acquired Medisurge Hospital, a local hospital in 2007.

Medical Tourism

"Out of 14,000 knee replacements done in Western India, almost 7,000 are done in Gujarat"

- Dr Praful Pawar

Apollo Hospitals

"We believe that opportunity exists in every city in Gujarat in which we have entered and planning to enter"

- Rajiv Sharma

Sterling Hospitals

"Gujarat is fast evolving in terms of number of hospitals, healthcare centres and beds and is expected to continue a positive trend in future"

- Pradip Kanakia
Head of Healthcare
KPMG India

In tune with the national goal to promote India as the most favoured medical tourism destination, Gujarat has aggressively pushed the concept of medical tourism by using its well known 'Vibrant Gujarat' annual event. Government and private healthcare organisations have come together to attract patients from abroad with measures such as creating accredited centres of excellence in the respective fields and by aggressively promoting Indian systems of medicine specifically, Ayurveda, naturopathy and yoga.

Apollo Hospitals, Ahmedabad attracts high number of foreign tourists for various kinds of surgeries and health checkups. The hospital is planning to ramp up its platinum wing meant for international patients by total 26 beds in the coming few months. "People are now aware of the quality of health facilities being provided in Gujarat, helped by English-speaking doctors and staff and an almost zero waiting period," says Kanakia. The major factor for increasing medical tourists to the state is the low cost of cardiac surgery, angiography, joint replacements, radiation and other medical services, which is a fraction of what they would have to incur abroad.

Shalby Hospitals, known for its joint replacement, has witnessed 10-15 per cent increase in the medical tourism patients since its inception. The hospital has an international patient co-ordinator especially roped in and fully dedicated to its international clientele. Besides, the other major reason for medical tourism in Gujarat to flourish is the increasing number of NRGs or Non Resident Gujaratis settled abroad are preferring their homeland not just as a treatment option but also for putting investments to establish hospitals.

Krisha Heart Care Centre is one prominent example of NRG-led speciality care hospital. "Around 6.5 million Gujaratis are NRGs. They visit their native place, especially in the month of November and December. This is the period when besides vacationing, they also prefer getting treated. However, the repeat cases only come through word-of-mouth publicity," says Dr Pawar.

Challenging Grounds

Today, one of the key challenges faced by all the healthcare players wishing to penetrate this market is the shortage of trained manpower especially when they are planning to expand in tier two and tier three cities. Gujarat healthcare is also believed to a 'doctor driven' market. Experts agree that physician is a key link in the success of corporate healthcare in this market. Says Dr Shah, "It is a 100 per cent doctor-driven market and is a difficult one to penetrate and sustain if you have not involved the well known doctors." Agrees Dr Pawar, "Gujarat is still a doctor- driven market and not institution driven and this poses a huge challenge for corporates who are willing to enter this market. Doctors also do not prefer to join as full-time consultants in the hospital."

The ever increasing real estate and electricity costs are the other major deterrents. "We need to have deep pockets. As real estate prices will impact the per bed cost, therefore the kind of infrastructure built and technology brought in will impact the break even and profitability. One needs to invest prudently and manage cost well and be prepared to invest for long term in this market, "shares Sharma.


The fledgling healthcare industry in the state of Gujarat is set to become a leading sector, which other states can look up to replicate. "We are witnessing a change in this market which will soon shift its focus from doctor-centric to patient-centric healthcare. Gradually, we shall also see nursing homes disappearing and corporates gaining a stronghold in this market," quips Dr Bharat Gadhavi, CEO, HCG Medisurge Hospitals. Gujarat, thus, with all its right growth enablers and strong building blocks can become a serious global healthcare hub in India. However, this would call for serious continuing transformation efforts on the part of the Government and private players to change mindsets of foreign investors and patients in order to attract global capital, talent and business flow.



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