1. Healthcare Sector - Vibrant Gujarat

1. Healthcare Sector :Indian Overview

Overview: Factors for growth in healthcareTotal global healthcare expenditure represent around10% of world GDP. Indian health sector is expected toIncreasingpopulationcreate 40 million new jobs by 2020.IncreasingdisposableincomeFocus onPPPIndia’s medical device market is currently the 4thlargest in Asia with 700 medical device makers, tionSources: www.pib.nic.inFactors forprojected growthin healthcareGrowinghealthissuesranks among the top 20 in the worldIndia has got many enabling factors to support itsgrowth in health sector. It is equipped to deliver onThrust onmedicaltourismCheapercost oftreatmentglobal demand.418 State-of-the-art Maternal and Child Health Wingshave been sanctioned in 2012-13 across 11 States

Strong Policy SupportEncouragingthe privatesectorEncouraginginvestments inrural areasTax incentivesIncentives inthe medicaltravel industrySources: www.ibef.org The benefit of section 10 (23 G) of the IT Act has been extended to financialinstitutions that provide long-term capital to hospitals with 100 beds or more Government is encouraging the PPP model to improve availability ofhealthcare services and provide healthcare financing The benefit of section 80-IB has been extended to new hospitals with 100beds or more that are set up in rural areas; such hospitals are entitled to100% deduction on profits for 5 years Customs duty on life-saving equipment has been reduced to 5% from 25%and exempted from countervailing duty Import duty on medical equipment has been reduced to 7.5% Incentives and tax holidays are being offered to hospitals and dispensariesproviding health travel facilities

FDI Inflows & Health Insurance100% Foreign Direct Investment (FDI) is permitted forall health-related services under the automatic route.Demand growth, cost advantages and policy supporthave been instrumental in attracting FDIFDI inflows (Apr 2000 – Mar 2013) into thehealthcare sectorThe health insurance premium has registered aCAGR of 32 % for the past 8 financial years. Indianhealth insurance industry with gross premiums hasincreased by 16 % from USD 2.1 Billion in 2011-12to USD 2.4 Billion in 2012-13CumulativeFDI flows(USD billion)0.212.42.11.81.9 0.51.310Share of totalFDI inflows(%)15Drug & PharmaceuticalsHospital & diagnostic centresMedical & Surgical AppliancesSources: Department of Industrial Policy & Promotion (DIPP)FY09FY10FY11FY12FY13Health Insurance Premium (USD Billion)

Opportunities in Healthcare Additional 1.8 million beds needed for India to achieve the target of 2 beds per 1,000people by 2025HealthcareInfrastructure Additional 1.54 million doctors required to meet the growing demand for healthcare Investment of USD 86 billion required to achieve these targets Less than 15% of the Indian population is covered through health insuranceHealth Insurance The total market size of the insurance sector in India was USD 66.4 billion in FY 13. It isprojected to touch USD 350–400 billion by 2020. Indian medical tourism industry is expected to register a CAGR of more than 20% duringMedical Tourism2013-2015 Cost of surgery in India is nearly (1/10)th of the cost in developed countriesResearch &Development Contract research is a fast growing segment in the Indian healthcare industry Cost of developing new drug is as low as 60% of the testing cost in the USA About 60% of global clinical trials is outsourced to developing countriesSources: From research report “Booming Medical Tourism in India”, www.ibef.org

2. Healthcare Sector :Gujarat Scenario

Gujarat Public Health InfrastructureGujarat state is in the forefront of establishing and maintaining good health infrastructureState Medical leHealth re1208AYUSH Facilities:Ayurved Hospitals : 40 ; Ayu Dispensaries : 523; Homeopathy Hospitals : 4; Homeo Dispensaries : 216Grant-in-Aid (GAI) Hospitals: 119Sub –Centre7744

Medical and Para Medical CollegesTotal of 19 Institutions with 2930 Seats 6 Government Colleges (1080 Seats) 5 Gujarat Medical Education & ResearchSociety (GMERS) Medical Colleges (750) 4 Private Colleges (500 Seats) 3 Municipal Corporation College (450seats) 1 Deemed University (150 Seats)Total of 13 Institutions with 1240 Seats 2 Government Colleges (200 Seats) 1 SGDHER (100 seats) 1 Municipal Corporation College (100Seats) 8 Private Colleges (740 Seats) 1 Deemed University (100 Seats)Total of 34 Institutions with 1730 SeatsTotal of 41 Institutions with 1855 Seats 8 Government Colleges (390 Seats) 33 Private Colleges (1465 Seats) 5 Government Colleges (360 Seats) 1 Municipal Corporation College (50Seats) 26 Private Colleges (1270 Seats) 2 Deemed University (50 Seats)As on 10th August, 2014

Para Medical Colleges & Indian Systemof Medicine & HomeopathyTotal of 17 Institutions with 1625 Seats4 Self Financed Institutions 4 Grant-in-Aid Colleges (400 Seats) 13 Self Financed Colleges (1225 Seats)with a total of 125 SeatsPara MedicalColleges &ISM&HTotal of 10 Institutions with 465 Seats1 Government College with a total of 10Seats 4 Government Colleges (180 Seats) 2 Grant-in-Aid Colleges (85 Seats) 3 Self Financed Colleges (150 Seats) 1 University Ayurveda College (50)As on 10th August, 2014

Private Industry Players

Fostering Partnerships: Innovative PPP modelChiranjeevi YojnaJoint collaboration (PPP) between Government of Gujarat and PrivateGynecologists/Trust HospitalsService Coverage through outsourcing- for normal delivery, EmergencyObstetric Care and Neonatal CareBelow Poverty line family and non- income tax paying TribalsVoucher System (Cash Less)A package of INR 3.80 lacs (USD 6333) is given for 100 deliveriesLinked with 108 emergency transportBalSakhaYojna Provided facilities for proper check up of newborns and infants bypediatriciansMain aim of the scheme is to bring down the Infant Mortality Rate (IMR)and the Maternal Mortality Ratio (MMR)

Fostering PartnershipsPerinatal Referral Services 108: A PPPInitiative with GVK-EMRI Existing Fleet of :525 AmbulancesTotal Emergencies Attended :43,44,255Pregnancy Related Cases :14,97,824Deliveries in Ambulance & at Scene:45,272 Response time :Urban areas 13.37 minutes& Rural areas 23.42 minutesState of theArt – PPPInstitutionsCurrent infrastructure proposed investment technology and management expertise enhanced resource utilization andimproved access to healthcareKHILKHILAT”: Drop Back ServicesCM – SETU: Chief Minister Services of Experts at Treatment UnitA Free drop back facility service fordeliveries in Government Health facility To address shortage of specialists, CM SETU scheme has beenlaunched by the state. Experts from Private institutes likeGynecologist, Physician, Surgeon, Orthopedician, Pediatrician,Ophthalmic Surgeon, Anesthetist, ENT Surgeon, Dermatologist,Psychiatrist, Radiologist, Pathologist are outsourced to providespecialist services & patients' treatment cost is borne by the stategovernment.

Mukhyamantri Amrutum (MA)Cashlesshospitalizationbenefit ofINR 200,000 (USD3333) per BPLFamily (5)per annum100% StatefundedSchemeMukhyamantriAmrutumProvision fortransportallowance ofRs.300 per visit63 SuperSpecialtyHospitalsEmpanelledProvides tertiarycare treatment forcatastrophic diseasesTo all BPL families andall females and childrenup to 21 years offamilies having incomeless than 1.20 lacs (USD2000)Pre-existingdiseases arecovered fromday one544 proceduresin thePrivate/ GovernmentEmpanelledHospitalCurrent Statusof the SchemeMore than2.144 MillionBPL familiesenrolled35,607 claimsamounting toINR 71.08 Crores(USD 11.84 million)haveoccurred till August2014

School Health Program (SHP) RBSKSalient Features & OutcomesSalient FeaturesBeneficiaries Bouquet “Newbornto 18 Years”Covers More than 15.6 Millionchildren of Gujarat, about 26 %of total populationAll districts and Corporations areinvolved in this program &Community Awareness andParticipation Activities areorganizedHealth and Life-Skills educationHealth & Referral Card withtracking for Super-SpecialtyReferralsHealth Screening and Medicalcheck up based on 4D’s:Defectsat Birth, Diseases, Deficienciesand DisabilitiesSuper-Specialty treatment forHeart, Kidney and CancerDisease including RenalTransplant, Liver transplant,Cochlear implant and Clubfoot(2013-14)SHP to School Health Week:A Flagship ProgrammePrimary SchoolChildren: 90,26,049Secondary and HigherSecondary School Children:25,56,287New born to 6 years AnganWadi Children: 39,55,276Free Spectacles DistributionNon School goingchildren:65,295Madressa: 16,318Children/ JuvenileHome etc : 3,050

Sickle Cell Anemia (SCA) Control Program 50% of the world Sickle 30% of sickle disease children among the tribal 20% of Sickle disease childrengene carriers in Indiadie by the age of two yearscommunity die before they reach adulthoodComponents of the ProgramCrisis Management Supportive & Referral Treatment Regular follow up and counseling Pneumococcal vaccinationCrisisManagementPreventionPrevention through: Marriage Counseling Genetic Counseling Building CommunityAwarenessEarly diagnosis through New Born Screening Prenatal Diagnosis Antenatal Screening Adolescent Screening Mass Screening on missionEarly DiagnosisRegularTrainingmodeTribal Population isthe target groupSCA seen in all 14 tribal districts – all coveredunder Sickle Cell Anemia Control ProgramRegular Training Doctors and Paramedical staff Health care providers & ASHA VHSNC members & TeachersBut any person suffering fromSickle Cell Anemia is the mainbeneficiary

Sickle Cell Anemia Control ProgramYear Wise Screening of Tribal 112011-120.260.50.141Population screened (In Million)Expon. (Population screened (In Million))Recipient of the Prime Minister Award for Excellence in Public ion Screened22.07Quantum Jump since 201213 after outsourcing1.94More than 6.3 Million tribals screened of which 5,80,580 Sickle Cell trait and 29584 sickle celldisease detected

National Public Health ProgramNational Vector Borne Disease Control Programme (NVBDCP): During 2012, 0.36 Million Long LastingInsecticide treated Nets (LLINS) were distributed in high risk areas. 0.9 Million beneficiaries were protectedRevised National T.B. Control Programme (RNTCP): Total 0.16 Million lives savedsince the inception of RNTCP.National Leprosy Eradication Programme: 4597 leprosypatients are under treatment in the State.National Blindness Control Programme: In 2012-13 up to October- 12, statehas performed 0.4 Million cataract operations. Out of which, 99.41% wereoperated with IOL.Sources: Socio-Economic Review 2012-13

Gujarat Medical Service Corporation Limited (GMSCL) Rational Use of Drugs and Standard Treatment Guidelines Procurement of quality Branded Generic Drugs/ Promotion ofGeneric Drugs Procurement of Medical Instruments and Maintenance Diagnostics Centers and Services Strengthen Supply Chain Management to ensure smooth andtimely supply of Drugs & Instruments to Public Health Institutes

Information and Communication Technology (ICT)Enabled Services

Healthcare Sector: Awards and AccoladesPrime Minister Award for Excellence in PublicAdministration for the year 2009-10 toSickle Cell Anemia Control Program, GujaratAward for best practicesin Healthcare delivery in2011 in AhmedabadChiranjeevi Yojna:Asia Innovation Award 2006 (Singapore)Prime Minister’s Award, Administrative Excellence in 2009Award at IndiZen 2014for operationalexcellence in PuneFICCI Healthcareexcellence Award forCHC Bardoli 2013