Tejnaksh Healthcare Ltd 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.

As of June 15, 2021, >26.69 crore (26, 69, 14,930) COVID-19 vaccine doses have been administered across the country.

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:

In June 2021, the government invited bids for using drones to deliver COVID-19 vaccines and drugs to remote and difficult-to-reach areas to ensure last-mile coverage in select locations of the country. As of May 2021, 11.9 lakh Health IDs have been generated and 3,106 doctors and 1,490 facilities have registered on the National Digital Health Mission (NDHM) platform.

In May 2021, Defense Minister Mr. Rajnath Singh launched ‘Services e-Health Assistance & Tele-consultation (SeHAT) OPD portal to provide telemedicine services to armed forces personnel and veterans.

On May 12, 2021, the Drugs Controller General of India (DCGI), accepted recommendation of Subject Expert Committee (SEC) and accorded permission to conduct the Phase II/III clinical trials of Covaxin (COVID vaccine) for the age group of 2-18 years to its manufacturer, Bharat Biotech Ltd. On May 17, 2021, the Defence Ministry launched the first batch of anti-COVID drug, 2-deoxy-D-glucose (2-DG) that was developed by the Institute of Nuclear Medicine and Allied Sciences (INMAS), a lab of Defence Research and Development Organisation (DRDO), along with Dr. Reddys Laboratories (DRL), Hyderabad.

In May 2021, the government announced its plan to ramp up supply and availability of Amphotericin-B, the anti-fungal drug, for treatment of the ‘Black Fungus disease. It has also given the license to five manufactures to produce the drug within the country.

In March 2021, various states and UTs started implementation of the ‘Intensified Mission Indradhanush 3.0 a campaign aimed to reach those children and pregnant women who were missed out or have been left out of the routine immunisation programme due to the COVID-19 pandemic. This is aimed to accelerate the full immunisation of children and pregnant women through a mission mode intervention. In March 2021, the Parliament passed the National Commission for Allied, Healthcare Professions Bill 2021, which aims to create a body that will regulate and maintain educational and service standards for healthcare professionals. In the Union Budget 2021, investment in health infrastructure expanded 2.37x, or 137% YoY; the total health sector allocation for FY22 stood at Rs. 223,846 crore (US$ 30.70 billion). The government announced Rs. 64,180 crore (US$ 8.80 billion) outlay for the healthcare sector over six years in the Union Budget 2021-22 to strengthen the existing ‘National Health Mission by developing capacities of primary, secondary and tertiary care, healthcare systems and institutions for detection and cure of new & emerging diseases.

In Union Budget 2021-22, the government announced its plans to launch ‘Mission Poshan 2.0 to merge ‘Supplementary Nutrition Programme with ‘Poshan Abhiyan (Nutrition Mission) in order to improve nutritional outcomes across 112 aspirational districts.

The Government of India approved continuation of ‘National Health Mission with a budget of Rs. 37,130 crore

(US$ 5.10 billion) under the Union Budget 2021-22.

In the Union Budget 2021, the Ministry of AYUSH was allocated Rs. 2,970 crore (US$ 407.84 million), up from Rs. 2,122 crore (US$ 291.39 million).

RECENT DEVELOPMENTS

Between April 2000 and December 2020, FDI inflows for drugs and pharmaceuticals sector stood at US$ 17.99 billion, according to the data released by Department for Promotion of Industry and Internal Trade (DPIIT). Some of the recent initiatives in the Indian healthcare industry are as follows:

By June 2021, the Health Ministrys eSanjeevani telemedicine service crossed 6 million (60 lakh) teleconsultations since its launch, enabling patient-to-doctor consultations, from the confines of their home, and doctor-to-doctor consultations. In April 2021, Tata Digital infused Rs. 100 crore (US$ 13.45 million) debt in 1mg, the online medicine start-up, and was in the final stages of acquiring a controlling stake in the company. In April 2021, the Minsitry of Ayush and Council of Scientific & Industrial Research completed multi-centre clinical trial of a AYUSH 64 (a medicine) and found it useful for treatment of mild-to-moderate COVID-19 infections. By March 2021, India exported more vaccines than it had administered to its citizens 60 million doses had been dispatched to 76 countries, while 52 million doses had been administered to Indian citizens. Apart from vaccines, drugs indicated for Covid-19 treatment too witnessed an uptrend in exports. For example, Remdesivir exports doubled in March 2021 to $14.8 million from $5.75 million in February 2021 In March 2021, Union Health Minister Harsh Vardhan informed the Rajya Sabha that 157 medical colleges are under various stages of implementation across India. Of this, 58 colleges are in the first phase of implementation, 24 in the second phase and 75 are in the third phase. In March 2021, gross written premiums of health insurance companies in the non-life insurance sector increased by 41% YoY to Rs. 2,185.05 crore (US$ 294 million), driven by rising demand for health insurance products amid COVID-19 surge.

On March 17, 2021, the Health Ministrys eSanjeevani telemedicine service crossed 3 million (30 lakh) teleconsultations since its launch, enabling patient-to-doctor consultations from the confines of their home, and doctor-to-doctor consultations. In March 2021, Virchow Biotech, a Hyderabad-based firm, and the Russian Direct Investment Fund (RDIF) announced a collaboration to manufacture up to 200 million doses of the Sputnik V vaccine in India. In February 2021, India approved the commercial supply of 24 million doses of COVID-19 vaccines to 25 countries, more than 2x the 10.5 million vaccines exported in January 2021. Through this, seven countries, including Brazil, Morocco and South Africa, were sent >~10 million doses on a commercial basis. On February 2021, the National Backward Classes Finance and Development Corporation (NBCFDC) signed a MOU with Apollo Medskills Pvt Ltd. to co-fund a COVID Vaccine Administration training programmes for nurses, medical & nursing students and pharmacists belonging to the NBCFDC target community. In February 2021, the Competition Commission of India (CCI) approved acquisition of Varian Medical Systems, Inc. by Siemens Healthineers Holding I Gmb (SHS GmbH). In February 2021, the Minister for Commerce and Industry of India, Mr. Piyush Goyal, and the UK Secretary of State for International Trade, Ms. Elizabeth Truss MP, completed a meeting to discuss the bilateral trade and economic relations of India UK trade and investment relationship. The Ministers also welcomed enhancement of bilateral health cooperation between the two countries, such as on vaccines, which is allowing India to serve as a global source of strength in overcoming COVID-19-imposed challenges. In February 2021, Prime Minister Narendra Modi laid the foundation stones for two hospitals and launched

‘Asom Mala, a programme for state highways and major district roads, in Assam. He also added that ~1.25 crore people in the state are being benefitted from Ayushman Bharat Scheme.

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

The COVID-19 pandemic has caused immense disruption and highlighted the importance of adequate resources for managing such crises without excessive economic disruption.

COVID 19 had a very major impact on 20-21.The ongoing pandemic made most of the its dent, during the first two quarters of the financial year 20-21, a recovery made was during the last leg of financial year 21 before the second wave gripped us.

The company is being pro-active to take all necessary actions and negate the ill effects of Covid-19 and ensure functioning, but at the same time are being cautions of the pandemic in the future.

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 2020-21, your Company has achieved total turnover of Rs. 871.15 Lakh and has incurred net profit of Rs. 200.42 Lakh. The Company has net worth of about Rs. 1702.56 Lakh as on March 31, 2021.

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 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%.

The Government of India is planning to increase public health spending to 2.5% 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 for May 2021 is Rs. 1 = US$ 0.01365

 

References: Department for Promotion of Industry and Internal Trade (DPIIT), RNCOS Reports, Media Reports, Press Information Bureau (PIB), Union Budget 2021-22

MARKET SIZE:

The healthcare market can increase three-fold to Rs. 8.6 trillion (US$ 133.44 billion) by 2022. In Budget 2021, Indias public expenditure on healthcare stood at 1.2% as a percentage of the GDP.

A growing middle-class, coupled with rising burden of new diseases, are boosting the demand for health insurance coverage. With increasing demand for affordable and quality healthcare, penetration of health insurance is poised to expand in the coming years. In FY21, gross written premiums in the health segment grew at 13.7% YoY to Rs. 58,584.36 crore (US$ 8.00 billion). The health segment has a 29.5% share in the total gross written premiums earned in the country.

The Healthcare sector is divided into three major categories: primary, secondary and tertiary.

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