Tejnaksh Healthcare Ltd Management Discussions.

The Indian Healthcare Industry, one of the largest in terms of revenue and employment, is estimated to be USD 280 billion in size by 2020, according to Federation of Indian Chambers of Commerce & Industry (FICCI)-KPMG report "Healthcare: The Neglected GDP Driver". The industry is projected to grow at a CAGR of 22% during the period from FY 2016-22 to reach USD 372 billion in 2022 from USD 110 billion in 2016.

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. India ranks 145 among 195 countries in terms of quality and accessibility of healthcare.

• The hospital industry in India, accounting for 80% of the total healthcare market, is witnessing a huge investor demand from both global as well as domestic investors. The hospital industry is expected to reach $132 bn by 2023 from $ 61.8 bn in 2017; growing at a CAGR of 16-17%.

• The Indian Medical Tourism market is expected to grow from its current size of $3 bn to $7-8 bn by 2020

• The diagnostics industry in India is currently valued at $4 bn. The share of organized sector is almost 25% in this segment (15% in labs and 10% in radiology).

• The primary care industry is currently valued at $13 bn. The share of organized sector is practically negligible in this case.

SWOT ANALYSIS FOR THE SECTOR

STRENGTHS:-

• Amongst the top healthcare markets globally in terms of incremental growth

• Improving medical science and technology

• Low-cost, quality healthcare

• Growing number of medical colleges

• Growing private investments

• Availability of highly qualified doctors

WEAKNESSES:-

• Rural urban service imbalance

• 70% of Indias healthcare infrastructure is limited to the top 20 cities

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

• Lack of capital investment

• Lower accessibility

• Lack of skilled professionals

OPPORTUNITIES:-

• Government schemes

• Growing life expectancy

• Growing medical tourism

• Growing middle class income

• Growing lifestyle diseases

• Availability of health insurance

• 100% FDI

THREATS:-

• Regulatory headwinds

• Threat from spread of national and international pandemic

• 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:

V In Union Budget 2020-21, Rs 35,600 crore (US$ 5.09 billion) has been allocated for nutrition-related programmes.

• The Government has announced Rs 69,000 crore (US$ 9.87 billion) outlay for the health sector that is inclusive of Rs 6,400 crore (US$ 915.72 million) for PMJAY in Union Budget 2020-21.

• The Government of India aims to increase healthcare spending to three percent of the Gross Domestic Product (GDP) by 2022.

• In February 2019, the Government of India established a new All India Institute of Medical Sciences (AIIMS) at Manethi, District Rewari, Haryana at a cost of Rs. 1,299 crore (US$ 180.04 million).

• The Union Cabinet approved setting up of National Nutrition Mission (NNM) with a three-year budget of Rs 9,046 crore (US$ 1.29 billion) to monitor, supervise, fix targets and guide the nutrition related interventions across ministries.

• On September 23, 2018, Government of India launched Pradhan Mantri Jan Arogya Yojana (PMJAY), to provide health insurance worth Rs 500,000 (US$ 7,124.54) to over 100 million families every year.

• In August 2018, the Government of India approved Ayushman Bharat-National Health Protection Mission as a centrally sponsored scheme contributed by both center and state Government at a ratio of 60:40 for all States, 90:10 for hilly Northeastern States and 60:40 for Union Territories with legislature. The center will contribute 100 per cent for Union Territories without legislature.

• The Government of India launched Mission Indradhanush with an aim of improving coverage of immunisation in the country. It aimed to achieve atleast 90 per cent immunisation coverage by December 2018 and cover unvaccinated and partially vaccinated children in rural and urban areas of India.

Achievements

• As of July 2019, around 125.7 million families enrolled as beneficiaries under Pradhan Mantri Jan Arogya Yojana (PMJAY). The scheme enrolled 16,085 hospitals, including 8,059 private hospitals and 7,980 public hospitals. It included 19 AYUSH packages in the treatment scheme.

• As of September 2019, about 50 lakh people received free treatment under the Ayushman Bharat - Pradhan Mantri Jan Arogya Yojana.

• The number medical colleges in India increased to 529 in FY19 from 381 in FY13.

• According to Sample Registration System Bulletin-2016, India has registered a 26.9 per cent reduction in Maternal Mortality Ratio (MMR) since 2013.

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

COVID-19 Impact

The healthcare industry cannot be analysed in isolation from the worldwide outbreak of the coronavirus pandemic with more and more positive cases and growing further. The pandemic has jeopardised the global and Indian healthcare system along with all other economic activities. India, with a population of 1.3 billion, is reeling under pressure to deal with such a huge outbreak infecting more than 3.4 million people, because of its inadequate healthcare infrastructure. Considering the fact that European countries have failed to contain the epidemic notwithstanding their state-of-the-art healthcare system, India is focussing on upgrading its healthcare delivery system to survive the crisis and contain the spread. So, the government decided on a twin strategy - a nationwide lockdown to break the chain of infection and a quick ramp-up of its healthcare facilities to face the pandemic during March to May 2020.

As an umbrella support to the economy battling with the pandemic outbreak and lockdown, the government announced a Rs. 20 Trillion stimulus package called "Atmanirbhar Bharat". To slowly pull out the economy from the lockdown impact, the government has laid out a roadmap for a phased reopening of the economy, starting with Unlock 1.0. The industries and organisations have started reopening with strict SOPs, directed by the government.

During the coronavirus emergency and lockdown, normal hospital procedures were on a partial halt and most of the hospitals had to convert portions of their capacity to isolation wards, increasing the number of lifesaving ventilators, bed and intensive care units to fight the virus outbreak. As the country is fighting with fiscal and liquidity stress, job and production loss, falling investment and consumer demand, the healthcare industry is also focussing on surviving the present crisis. A normalcy for the sector can only be projected depending on the extent of the virus trajectory and the countrys ability to contain the spread.

However, there is also an opportunity to convert the challenge into opportunities. Considering the massive industrial base and growing healthcare demand, ramping up the spending on health infrastructure and healthcare R&D with a focus on healthcare equipment and services is needed to support Indias economic recovery and to protect the well-being of its citizens by providing access to high quality and affordable healthcare.

FINANCIAL POSITION:

During the financial year 2019-20, your Company has achieved total turnover of Rs. 1113.77 Lakh and has incurred net profit of Rs. 192.35 Lakh. The Company has net worth of about Rs. 1501.16 Lakh as on March 31, 2020.

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 in the last quarter of the financial year. 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 population. Besides, Indian medical service consumers have become more conscious towards their healthcare upkeep.

Indian healthcare sector is much 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 for the latest dynamics and trends which will have 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 per cent.

The Government of India is planning to increase public health spending to 2.5 per cent of the countrys GDP by 2025.

Indias competitive advantage also lies in the increased success rate of Indian companies in getting Abbreviated New Drug Application (ANDA) approvals. India also offers vast opportunities in R&D as well as medical tourism. To sum up, there are vast opportunities for investment in healthcare infrastructure in both urban and rural India.

Note: Conversion rate used in April 2020, Rs 1 = US$ 0.013123

References: Department for Promotion of Industry and Internal Trade (DPIIT), RNCOS Reports, Media Reports, Press Information Bureau (PIB)

MARKET SIZE:

The healthcare market can increase three-fold to Rs 8.6 trillion (US$ 133.44 billion) by 2022.

Indian medical tourism market is growing at 18 per cent y-o-y and is expected to reach US$ 9 billion by 2020. There is a significant scope for enhancing healthcare services considering that healthcare spending as a percentage of Gross Domestic Product (GDP) is rising. The Governments expenditure on healthcare sector has grown to 1.6 per cent of the GDP in FY20BE from 1.3 per cent in FY16.

Health insurance is gaining momentum in India. Gross direct premium income underwritten by health insurance grew 17.16 per cent y-o-y to Rs 51,637.84 crore (US$ 7.39 billion) in FY20.

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