tejnaksh healthcare ltd cash flow Management discussions

INDUSTRY OVERVIEW:

Healthcare has become one of Indias largest sector, both in terms of revenue and employment. Healthcare comprises hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The Indian healthcare sector is growing at a brisk pace due to its strengthening coverage, services and increasing expenditure by public as well private players.

Indian healthcare delivery system is categorised into two major components public and private. The Government, i.e. public healthcare system, comprises limited secondary and tertiary care institutions in key cities and focuses on providing basic healthcare facilities in the form of primary healthcare centres (PHCs) in rural areas. The private sector provides majority of secondary, tertiary, and quaternary care institutions with major concentration in metros and tier I and tier II cities.

Indias competitive advantage lies in its large pool of well-trained medical professionals. India is also cost competitive compared to its peers in Asia and Western countries. The cost of surgery in India is about one-tenth of that in the US or Western Europe.

The public healthcare facilities in India have been unable to scale adequately to serve the needs of the large population; reaching the interiors of the country has been another challenge. Additionally, several of these facilities are understaffed, poorly equipped in terms of basic infrastructure and equipment, and in need of enhanced quality standards and protocols. This unmet opportunity combined with strong fundamentals has largely led to the private sector taking center stage in the healthcare landscape. The late 1990s witnessed improvement in the economic conditions and made private healthcare affordable to many Indians. These hospitals turned into Centres of Excellence and over time, became preferred choice for patients and communities over Government hospitals. The private service providers dominate the Indian Healthcare industry and they are using innovative means to overcome some of the operational challenges. These healthcare institutions provide world class facilities, employ highly skilled and globally recognized professionals, leverage advanced technology in treatments, and maintain high standards of quality. The private sector players have been able to occupy a major share of nearly 80% of the countrys total healthcare market. They also account for almost 74% of the countrys total healthcare expenditure. Their share in hospitals alone is estimated at 74% while its share of hospital beds is estimated at 40%.

Today, the healthcare sector in India offers a potent mix of opportunities and challenges. The significant gap between required and actual healthcare infrastructure has driven considerable investment over the years into assets like hospitals and other facilities. Healthcare in India today provides corporations with a unique opportunity for innovation, differentiation and profits; it has become a preferred sector for strategic and financial investments.

Medical tourism (also called medical travel, health tourism or global health care) is a term initially coined by travel agencies and the mass media to describe the rapidly-growing practice of traveling across international borders to obtain health care.

Such services typically include elective procedures as well as complex specialized surgeries such as joint replacement (knee/hip), cardiac surgery, dental surgery, and cosmetic surgeries. However, virtually every type of health care, including psychiatry, alternative treatments, convalescent care, and even burial services are available. As a practical matter, providers and customers commonly use informal channels of communication-connection-contract, and in such cases, this tends to mean less regulatory or legal oversight to assure quality and less formal recourse to reimbursement or redress, if needed.

Over 50 countries have identified medical tourism as a national industry. However, accreditation and other measures of quality vary widely across the globe, and there are risks and ethical issues that make this method of accessing medical care controversial. Also, some destinations may become hazardous or even dangerous for medical tourists to contemplate.

SWOT ANALYSIS FOR THE SECTOR

STRENGTHS:> Widespread network

> Proficient medical team with rich medical expertise

> Low-cost, quality healthcare

> Growing number of medical colleges

> Growing private investments

> High brand salience

> Availability of highly qualified doctors

> Proficient medical team with rich medical expertise

> Technological experience

WEAKNESSES:

> Rural urban service imbalance

> Capital intensive nature of industry

> Lower public expenditure on health equating to just 1.28% of the GDP

> Lack of capital investment

> Lower accessibility

> Heterogeneous markets

OPPORTUNITIES:

> Government schemes

> Growing life expectancy

> Growing medical tourism

> Growing middle class income

> Growing lifestyle diseases

> Availability of health insurance

> Underserved and poorly-served markets

THREATS:

> Shortage of skilled manpower

> Regulatory headwinds

> Capital intensive industry

> Imbalance in cost expectation and service

> Threat to doctors from mob lynching

GOVERNMENT INITIATIVES:

Some of the major initiatives taken by the Government of India to promote Indian healthcare industry are as follows:

Some of the major initiatives taken by the Government of India to promote the Indian healthcare industry are as follows:

• In the Union Budget 2022-23:

o Rs. 86,200.65 crore (US$ 11.28 billion) was allocated to the Ministry of Health and Family Welfare (MoHFW).

o Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was allocated Rs. 10,000 crore (US$ 1.31 billion) o Human Resources for Health and Medical Education was allotted Rs. 7,500 crore (US$ 982.91 million). o National Health Mission was allotted Rs. 37,000 crore (US$ 4.84 billion).

o Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) was allotted Rs. 6,412 crore (US$ 840.32 million).

o The Government of India approved continuation of National Health Mission with a budget of Rs.

37,000 crore (US$ 4.85 billion).

o Rs. 5,156 crore (US$ 675.72 million) was allocated to the newly announced PM-ABHIM to strengthen Indias health infrastructure and improve the countrys primary, secondary and tertiary care services.

• In July 2022, the World Bank approved a US$ 1 billion loan towards Indias Pradhan Mantri-Ayushman Bharat Health Infrastructure Mission.

• In November 2021, the Government of India, the Government of Meghalaya and the World Bank signed a US$ 40- million health project for the state of Meghalaya. Project will improve the quality of health services and strengthen the states capacity to handle future health emergencies, including the COVID-19 pandemic.

• By September 21, 2021, the Health Ministrys eSanjeevani telemedicine service crossed 12 million teleconsultations since its launch, enabling patient-to-doctor consultations from the confines of their homes, and doctor-to-doctor consultations.

• In September 2021, Prime Minister Mr. Narendra Modi launched the Ayushman Bharat Digital Mission. The mission will connect the digital health solutions of hospitals across the country with each other. Under this, every citizen will now get a digital health ID and their health record will be digitally protected.

• In September 2021, the Telangana government, in a joint initiative with World Economic Forum, NITI Aayog and HealthNet Global (Apollo Hospitals), launched Medicine from the Sky project. The project will pave the way for drone delivery of life saving medicines and jabs in far-flung regions of the country.

• According to a spokesperson, the Indian government is planning to introduce a credit incentive programme worth Rs. 500 billion (US$ 6.8 billion) to boost the countrys healthcare infrastructure. The programme will allow firms to leverage the fund to expand hospital capacity or medical supplies with the government acting as a guarantor and strengthen COVID-19-related health infrastructure in smaller towns.

• In July 2021, the Ministry of Tourism established the National Medical & Wellness Tourism Board to promote the medical and wellness tourism in India.

• In July 2021, the Union Cabinet approved continuation of the National Ayush Mission, responsible for the development of traditional medicines in India, as a centrally sponsored scheme until 2026.

• In July 2021, the Union Cabinet approved the MoU between India and Denmark on cooperation in health and medicine. The agreement will focus on joint initiatives and technology development in the health sector, with the aim of improving public health status of the population of both countries.

• In June 2021, the Ministry of Health and Family Welfare, in partnership with UNICEF, held a capacity building workshop for media professionals and health correspondents in Northeastern states on the current COVID-19 situation in India, to bust myths regarding COVID-19 vaccines & vaccination and reinforce the importance of COVID-19 Appropriate Behaviour (CAB).

RECENT DEVELOPMENTS

Between April 2000-March 2022, FDI inflows for drugs and pharmaceuticals sector stood at US$ 19.41 billion, according to the data released by Department for Promotion of Industry and Internal Trade (DPIIT). FDI inflows in sectors such as hospitals and diagnostic centres and medical and surgical appliances stood at US$ 7.93 billion and US$ 2.41 billion, respectively. Some of the recent developments in the Indian healthcare industry are as follows:

• As of July 20, 2022, more than 200.61 crore COVID-19 vaccine doses have been administered across the country.

• As of July 2022, the number medical colleges in India stood at 612.

• In July 2022, the Indian Council of Medical Research (ICMR) released standard treatment guidelines for 51 common illnesses across 11 specialties to assist doctors, particularly in rural regions, in diagnosing, treating, or referring patients in time for improved treatment outcomes.

• In July 2022, the National Pharmaceutical Pricing Authority (NPPA) fixed the retail prices for 84 drug formulations, including those used for the treatment of diabetes, headache, and high blood pressure.

• In March 2022, Hyderabad-based pharmaceutical company Biological E applied for emergency use authorisation (EUA) for its Covid-19 vaccine Corbevax for the 5-12 year age group.

• In January 2022, Phase 3 trials commenced of Indias first intranasal vaccine against COVID-19 that is being developed by Bharat Biotech, in conjunction with the Washington University School of Medicine in St Louis, the US.

• Startup HealthifyMe, with a total user base of 30 million people, is adding half a million new users every month and crossed US$ 40 million ARR in January 2022.

• The number of policies issued to women in FY21 stood at 93 lakh, with one out of every three life insurance policies in FY21 sold to a woman.

• In December 2021, Eka Care became the first CoWIN-approved organization in India, through which users could book their vaccination slot, download their certificate and even create their Health IDs.

• As of November 18, 2021, 80,136 Ayushman Bharat-Health and Wellness Centres (AB-HWCs) are operational in India.

• As of November 18, 2021, 638 e-Hospitals are established across India as part of the central governments Digital India initiative.

• In November 2021, Aster DM Healthcare announced that it is planning Rs. 900 crore (US$ 120.97 million) capital expenditure over the next three years to expand its presence in India, as it looks at increasing the share of revenue from the country to 40% of the total revenue by 2025.

• In September 2021, Russian-made COVID-19 vaccine, Sputnik Light received permission for Phase 3 trials in India.

• In September 2021, Biocon Biologics Limited, a subsidiary of Biocon, announced a strategic alliance with Serum Institute Life Sciences, a subsidiary of Serum Institute of India (SII). The alliance is expected to strengthen Indias position as a global vaccine and biologics manufacturing powerhouse.

HEALTHCARE DELIVERY IN INDIA

Healthcare Delivery system comprises institutions, organisations and persons that operate within the healthcare system, and are responsible for the promotion of health, prevention of illness, detection and treatment of disease and rehabilitation. Healthcare Delivery infrastructure in India has been lagging behind when compared with many countries that are poorer than India in other economic parameters. Indias

FINANCIAL POSITION:

During the financial year 2021-22, your Company has achieved total turnover of Rs. 825 Lakh and has incurred net profit of Rs. 251.88 Lakh. The Company has net worth of about Rs. 1,955.30 Lakh as on March 31, 2022.

OUTLOOK FOR THE COMPANY:

With financial sustainability, care delivery, patient centricity, digital transformation, and regulatory compliance at the top of the agenda, health care sector leaders need to collaborate with all stakeholders — both within the health care ecosystem and those in converging industries — as they look to shape the future of health care and establish a sustainable smart health community.

There is an exponential increase in the pace and scale with which digital health care innovations are emerging. Digital technologies are supporting health systems efforts to transition to new models of patient-centered care and helping them develop "smart health" approaches to increase access and affordability, improve quality, and lower costs. From lockchain, RPA, cloud, artificial intelligence (AI), and robotics, to internet of medical things (IoMT), digital and virtual reality are just some of the ways technology is disrupting health care. These technologies are helping with diagnosis and treatment, helping with speed, quality and accuracy, and improving the patient experience.

Tejnaksh has managed to continue its growth in the year under review, despite the challenges coming from the coronavirus outbreak. The Company is confident of its service capabilities and domain expertise that has created a niche in the healthcare market. It is committed to outperform the industry average growth in the coming fiscal year backed by its unique business model and service edge.

ROAD AHEAD

India is a land full of opportunities for players in the medical devices industry. The country has also become one of the leading destinations for high-end diagnostic services with tremendous capital investment for advanced diagnostic facilities, thus catering to a greater proportion of the population. Besides, Indian medical service consumers have become more conscious towards their healthcare upkeep.

Indias healthcare sector is very diversified and is full of opportunities in every segment, which includes providers, payers, and medical technology. With the increase in the competition, businesses are looking to explore the latest dynamics and trends which will have a positive impact on their business. The hospital industry in India is forecast to increase to Rs. 8.6 trillion (US$ 132.84 billion) by FY22 from Rs. 4 trillion (US$ 61.79 billion) in FY17 at a CAGR of 16-17%.

The Government of India is planning to increase public health spending to 2.5% of the countrys GDP by 2025. References:Department for Promotion of Industry and Internal Trade (DPIIT), RNCOS Reports, Media Reports, Press Information Bureau (PIB), Union Budget 2022-23

MARKET SIZE:

The Indian healthcare sector is expected to record a three-fold rise, growing at a CAGR of 22% between 2016-22 to reach US$ 372 billion in 2022 from US$ 110 billion in 2016.

By FY22, Indian healthcare infrastructure is expected to reach US$ 349.1 billion.

As of 2021, the Indian healthcare sector is one of Indias largest employers as it employs a total of 4.7 million people. The sector has generated 2.7 million additional jobs in India between 2017-22 — over 500,000 new jobs per year.

In the Economic Survey of 2022, Indias public expenditure on healthcare stood at 2.1 % of GDP in 2021-22 against 1.8% in 2020-21 and 1.3% in 2019-20.

In FY21, gross direct premium income underwritten by health insurance companies grew 13.3% YoY to Rs. 58,572.46 crore (US$ 7.9 billion). The health segment has a 29.5% share in the total gross written premiums earned in the country.

The Indian medical tourism market was valued at US$ 2.89 billion in 2020 and is expected to reach US$ 13.42 billion by 2026. According to India Tourism Statistics at a Glance 2020 report, close to 697,300 foreign tourists came for medical treatment in India in FY19. India has been ranked 10th in the Medical Tourism Index (MTI) for 2020-21 out of 46 destinations by the Medical Tourism Association.

The e-health market size is estimated to reach US$ 10.6 billion by 2025.

As per information provided to the Lok Sabha by the Minister of Health & Family Welfare, Dr. Bharati Pravin Pawar, the doctor population ratio in the country is 1:854, assuming 80% availability of 12.68 lakh registered allopathic doctors and 5.65 lakh AYUSH doctors.

Primary Healthcare:

Primary care facilities are outpatient units that offer basic, point-of-contact medical and preventive healthcare services, where patients come for routine health screenings and vaccinations. This is the first point of contact between the populace and the healthcare service providers. These facilities do not have intensive care units (ICU) or operation theatres.

Their infrastructure offers basic medical and health prevention services through a network of Sub Centers and Primary Health Centers in rural areas, whereas in urban areas it is provided through Health Posts and Family Welfare Centers. Primary Care Centres also act as feeders for secondary / tertiary care hospitals, where patients are referred to for treatment of chronic / serious ailments.

Secondary Healthcare:

Secondary care facilities diagnose and treat ailments that cannot be treated in primary care facilities. These act as the second point of contact in the healthcare system. In India, the health centers for secondary health care include District Hospitals and Community Health Centres at the block level.

This infrastructure provides inpatient as well as outpatient medical services which includes simple surgical procedures. Some of medical specialties offered under secondary healthcare include internal medicine, pediatrics and limited coverage of other specialties like urology, cardiology, and other specialties.

Tertiary Healthcare:

Tertiary care hospitals provide advanced healthcare services, usually on referral from primary or secondary medical care Providers. Specialized Intensive Care Units, advanced diagnostic support services and specialized medical personnel are key features of tertiary health care. Single-specialty tertiary care hospitals treat a particular ailment such as cardiac, cancer, etc. On the other hand, there are multi-specialty tertiary hospitals that offer all medical specialties under one roof and treat complex cases such as multi organ failure, high-risk, and trauma cases. In India, under the public health system, tertiary care service is also provided by medical colleges and advanced medical research institutes.

HUMAN RESOURCES AND INDUSTRIAL RELATION:

At Tejnaksh, we believe that our success is the end results of the achievement of our team. Our performance metrics are clearly defined and for real achievers we offer an accelerated career growth unhindered by any hierarchy. Tejnaksh offers a merit led environment where talent is respected and achievements are rewarded. Our flat management structure allows genuine appreciation of good work and we believe in delegating responsibilities.

We continually empower our team members to better themselves and offer clear career paths for advancement. The Company takes extreme pride in its greatest resource and asset - the employees. Our constant endeavours have been

towards encouraging a culture of employee recognition & motivation and we are able to achieve this through are well designed policies & processes like Rewards & Recognition and other various employee benefit schemes. We also believe that the young talent has out of the box creativity and we nurture them to have become a proficient leader. We ensure that there is full adherence to the code of business conduct and fair business practices.

All safety and personal protective apparels are provided to the employees working in the related field in order to ensure their life security and surety. Regular safety training is provided to all employees as well as external professional expert was hired to empower the employees to work with managers to create easy-to understand safety procedures and protocols. Encourage people to think first, act second, and consider safety protocols as not just a rote function, but an essential fact of daily practice that will ensure to save their lives. The company has maintained very harmonious & cordial Industrial relations. There is continuous emphasis on development of human resources through training. The issues pertaining to workers are resolved in harmonious and in cordial manner through regular interactions. We believe whatever we achieved from where we started our journey long back is the result of efforts of our team. So, we consistently aim to provide a sustainable environment for learning right from the stage of recruitment to retention.

INTERNAL CONTROL SYSTEMS AND THEIR ADEQUACY:

The Internal audit was carried out by firm of Chartered Accountants, who conduct the audit on the basis of Annual Audit Plan. The processes include review and evaluation of effectiveness of the existing processes, controls and compliances. It also ensures adherence to policies and systems, and mitigation of the operational risks perceived for each areas under audit. Significant observations including recommendations for improvement of the business processes were reviewed by the management before reporting to the Audit Committee. The committee has reviewed the Internal Audit procedures, findings and status of implementation of the agreed action plan.

Section 134(5) (e) of the Companies Act, 2013 requires a company to lay down Internal Financial Controls system (IFC) and to ensure that these are adequate and operating effectively. Internal financial controls, here, means the policy and procedure adopted by the company for ensuring the orderly and efficient conduct of its business including adherence to companys policies, the safeguarding of its assets, the prevention and detection of frauds and errors, the accuracy and completeness of the accounting records and the timely preparation of reliable financial information.

The above requirement has the following elements:

1. Orderly and efficient conduct of business.

2. Safeguarding of its assets.

3. Adherence to companys policies.

4. Prevention and detection of frauds and errors.

5. Accuracy and completeness of the accounting records and timely preparation of reliable financial information.

At Tejnaksh Healthcare Limited, the internal financial controls system is in place and incorporates all the five elements as mentioned above. In addition, the Company has a transparent framework for periodic evaluation of the internal financial controls in the form of internal audit exercise carried out through the year and online controls self-assessment through Controls Manager Software, thereby reinforcing the commitment to adopt best corporate governance practices.

CAUTIONARY STATEMENT

Statements in the Management Discussion and Analysis Report, describing the Companys objectives, projections and estimates, are forward-looking statements and progressive within the meaning of applicable securities laws and regulations. Actual results may differ materially from those expressed in the statement. Important factors that could influence the companys operations include global and domestic demand and supply conditions affecting selling prices, input availability and prices, changes in government regulations, tax laws, economic developments within the country and other factors such as litigation and industrial relations.

On behalf of the Board of Directors,

For Tejnaksh Healthcare Limited

Sd/-

Dr. Ashish Rawandale Chairman