Giving insights into various aspects of healthcare industry and clinics in India, Neeraj Garg, CEO of Apollo Health and Lifestyle (AHLL), in an online interview with A Raju sheds light on the present healthcare scenario in India and initiatives taken up by AHLL in enhancing the standards of healthcare both in primary and secondary care segments in the country.
Apollo Health and Lifestyle has been in the forefront in providing quality healthcare services with highest standards. As a leader how do you view the present scenario of healthcare and hospital industry in India and the plans for AHLL in the coming days?
There continues to be a significant gap in the availability of high quality healthcare facilities, in both urban and rural India, for both tertiary care and secondary / primary care. AHLL is focused on, and continues to invest and grow in the primary care and specialty formats in secondary care. We believe there is a huge potential for a leader like the Apollo Clinics to grow our network of over 100 clinics as both multi-specialty clinics which provide ‘expert care’ in the neighbourhood as well as centres of excellence which provide disease management programmes in diabetes (through our Sugar Clinics), asthma and COPD (BreatheEazy Clinics) etc. On the secondary care side, AHLL was the pioneer in creating the concept of ‘premium birthing centres’ in India when we established the first Cradle over eight years ago. The entire segment that is flourishing today was conceived by AHLL. This is a high priority area for us going forward and in the next five years’ time, we would like to have over 40 Apollo cradle centres in India across all formats. We are focused on providing the highest quality of medical care, accompanied by high levels of service and personalization.
Could you please give your comments on the healthcare infrastructure available in India?
There is a lot of variability in the quality of healthcare infrastructure in the country. While on one hand, there are high-end tertiary care hospitals, such as the Apollo Hospitals which have infrastructure and medical outcomes which are as good as the best centres in the U.S., there are many hospitals, often government run, which don’t have even the basic medical infrastructure. There are also many small-size centres that operate in the country with poor levels of regulatory oversight. I think there is thus a need to promote private investment to increase the availability and quality of healthcare infrastructure in the country, while the government focuses on improving the quality of its existing infrastructure
How do you view the quality human resources available in the medical field? Do you think India has the required numbers of doctors, nurses and paramedical staff as per the WHO norms?
Though India has very high quality doctors and nursing staff, we don’t have enough for a country with our population. This is a problem in both urban and rural India. In urban India, there aren’t enough specialists, even though we have in recent years seen some of the best specialists from the U.S returning to India to work at hospitals like Apollo, while in rural India, there aren’t enough general practitioners. To improve the quality of primary healthcare, there is an urgent need to create a larger pool of doctors in the category of ‘Family Medicine’ which is the backbone of the primary healthcare system (National Health Services – NHS) in a country like the U.K. We also need to strengthen our processes for continuing medical education of doctors, which is essential to ensure that doctors remain abreast of the latest in the field of medicine.
What are your comments on recent Drug Price Control Order issued by the central government to provide more than 300 essential life saving drugs at subsidized rates to the poor patients? What way could this order impact on the pharmaceutical and hospital industries?
Our chairman, Dr Prathap C. Reddy, created Apollo with the vision of providing world-class healthcare in India, at a cost that Indian’s could afford. We have always maintained that one needs to offer healthcare facilities to all classes of patients, so that everyone gets the benefit of the same. We are proud of the fact that we have patients from all economic levels in our hospitals. I think the Government has the same objective. There are multiple ways to achieve this objective, and the DPCO is definitely one of the routes for this. The key thing however to remember is that drug pricing alone will not solve the healthcare crisis unless access to doctors and drugs is improved.
How do you view the prospects of growth in the hospital industry at the backdrop of steep downfall of Indian rupee against dollar?
For the domestic patients, the fall in the value of the rupee will increase the cost of some of the treatments as a lot of the equipment and even some of the drugs / consumables are imported. However, at the same time, this provides an opportunity for the hospital industry in India as the cost of treatment in India for foreign patients will become even lower than it already is. The fall in the value of the rupee does reiterate the imperative for global equipment manufacturers to increase the share of local manufacturing in their product portfolios.
With many super specialty and multispecialty hospitals emerging with world class hospital infrastructure, in Andhra Pradesh, Hyderabad in particular is fast emerging as the healthcare hub of India. Do you think Hyderabad has the potential to become the medical tourism capital of India?
Hyderabad definitely has the potential to be a major hub of medical tourism in India. There is a well developed eco-system in the city, which makes it easier to establish and operate world-class infrastructure. We however also see a lot of potential in Chennai for medical tourism, as we see in Bangalore. In our experience, it is the quality of the hospital, more than the city that drives medical tourism.
It is believed that almost up to 80 per cent of Indian healthcare and hospital industry is dependent on imports for medical equipment, high quality drugs and advanced treatment facilities. What steps should the hospital industry take to make itself self reliant?
We have seen some global companies take steps to shift their manufacturing base to India, at least for the Indian market. This process has to accelerate. We are also now seeing local entrepreneurs develop very interesting and cost- effective solutions specifically designed for the Indian market. I believe the hospital industry has to actively partner with the local entrepreneurs, many of whom have a technology and not healthcare background, to create these solutions.
Coming to Apollo Health and Lifestyle, where do you place your organization in terms of providing quality and standard healthcare in India?
We take pride in the quality of care we provide at the Apollo Clinics, The Cradle and the Apollo Day Surgery Centre. For example, the Apollo Day surgery Centre in Chennai recently completed two years, in which we have done over 5000 surgeries without a single case of infection. This is a strong reflection of the infection prevention protocols that we have created and implemented in our centres. In our Cradle facilities, we run world-class neonatal ICUs (NICU), which today not only provide care to babies born at The Cradle, but also babies born in other nursing homes / hospitals who are brought to our NICU because of the much higher standards of care that are provided. The primary driver of this quality of care, apart from protocols, is the doctors we have and the very highly committed nursing and para-medic staff in all our clinics and Cradles.
What are the major achievements of Apollo Health and Lifestyle during the past one year?
There are many achievements. In 2012 – 2013, we achieved monthly revenues that were our annual revenues just four years ago. That is nearly a 90 per cent CAGR in this period. What is more noteworthy is that we have more than 1000 doctors who work with us to touch the lives of more than one million patients annually.
Could you throw light on some of the major challenges you faced and how do you view the growing competition between the hospitals in India?
Growth and opportunities throw up many challenges. The key challenge for us is to make sure that we continue to capture existing and new opportunities while ensuring that our promise to patients of the highest quality of medical care and customer service is met. This requires us to build and strengthen our processes continuously, innovate how we deliver value to our patients and attract, train and retain the best talent in the industry.
Could you please elaborate on Apollo expansion plans in India?
We operate multiple formats currently – Apollo Clinics, Apollo Cradle and Apollo Day Surgery. We believe there is strong potential in all these formats and we will continue to invest behind all of them. This investment will be both in the form of expanding the network and also enhancing our offering in the existing centres. We believe there is a very large opportunity in the women and child specialty hospital segment where Apollo Cradle is positioned very well to be the market leader. This is going to be an area of significant investment for us, and we are aiming to have a network of over 40 Apollo Cradles’ in the next five years. We are building a strong franchise of specialty clinics which are disease specific and provide integrated disease management programs for diseases like Diabetes and Asthma. The diabetes initiative, under the brand name of Sugar, is also going to a major priority area for us going forward.
What according to you are the major challenges faced by the hospital industry in India and the possible solutions for the same?
There are major challenges, and while there are no quick fixes, I believe that with greater investment and stronger policy level support, some of these issues can be addressed. A key area which needs investment is in skill development. Apollo is already working extensively in this area through Apollo Medvarsity which is working with the National Skill Development Council to impart skill training to healthcare workers – nurses, paramedics, etc. The government also needs to facilitate greater public-private partnerships to address the twin challenges of quality and availability of infrastructure. Another area that we need to focus on is the changing nature of the disease burden in India. Non-communicable diseases like cancer, cardiac disease and diabetes are going to be major killers even in India in the future, and we need to urgently create the infrastructure to address these diseases. And we should not assume that these are diseases of the rich or the urban. We have seen high incidence of these even in rural areas, and in lower income groups. Actively promoting disease management programmes and increasing the skill level of general practitioners to diagnose and refer these patients early can significantly reduce the mortality rate of patients suffering from these ailments.