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.

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:

> The Union Budget 2022-23 allocated INR 86,200 cr to the Ministry of Health and Family Welfare, nearly 16.5 per cent increase in comparison to INR 73,932 cr in FY 2020-21 driven by increased allocation to centrally sponsored public health schemes to continue building sustainable healthcare infrastructure and ensure system preparedness to handle increasing healthcare needs of the country. In the line with the governments continuous efforts for overall health system strengthening, below announcements were made:

> Department of Health and Family Welfare: The Budget 2022-23 allocated INR 83,000 cr to the Department of Health and Family Welfare, nearly 16.5 percent increase in comparison to the budget of INR 71,269 cr in 2021-22 and a marginal increase of 0.1 percent when compared to the revised estimate of INR 82,920 cr in 2021-22.

> Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) was allocated INR 10,000 cr, an increase of 43 percent in comparison to the last years budget (INR 7,000 cr), to boost the medical education infrastructure and set up AIIMS across the country.

> Human Resources for Health and Medical Education was allocated INR 7,500 cr, an increase of 56 percent from last years budget (INR 4,800 cr) to further expand the efforts to bridge the shortage of healthcare professionals in the country.

> Allocation of INR 72 cr towards strengthening of the National Centre for Disease Control (NCDC) Branches

to augment disease surveillance of zoonotic diseases and other neglected tropical diseases surveillance.

> Allocation of INR 37,000 cr for National Health Mission (NHM), increase of 1.2 percent compared to 2021-22.

> Allocation for Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) stands at INR 6,412 cr, increase of 0.2 percent compared to last years budget (INR 6,400 cr), however the revised estimate for 2021-22 is at INR 3,199 cr, highlighting the need to further drive the adoption of the AB-PMJAY.

> Giving further boost to the efforts to the Ayushman Bharat Digital Mission (ABDM), and creating a more modern and inclusive Digital India, allocation for ABDM was increased to INR 200 cr for developing the National Digital Health Ecosystem.

> To strengthen blood transfusion services, a new allocation of INR 404 cr was announced to develop hospital based or stand-alone blood centres.

> Allocation of INR 5,156 cr outlay as part of the newly announced PM Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) in October 2021 to strengthen health infrastructure at mission mode approach and improve primary, secondary and tertiary care services.

> Pradhan Mantri Garib Kalyan Package, launched in Oct 2021 to provide insurance to healthcare workers fighting COVID-19, was allocated INR 226 cr, a decrease of 72 percent (INR 813 cr in budget 2021-22),

> Department of Health Research: The Budget 2022-23 allocated INR 3,201 cr to the Department of Health Research, an increase of 20 percent when compared to the budget 2021-22 (INR 2,663 cr) and 4.0 percent when compared to revised estimates of INR 3,080 cr for 2021-22. As a part of this, a new allocation of INR 690 cr under PM-ABHIM is provided for ensuring biosecurity preparedness and strengthening multi-sectoral pandemic research and institutionalise the One Health platform.

> Implications for the sector

> With the announcement of National Digital Health Ecosystem, the healthcare industry will witness development of a robust platform for managing digital registries of healthcare providers and facilities, unique health identities and universal access to health facilities.

> While the government has shown an interest towards private sector engagement, clear guidance on incentivisation of the private sector in infrastructure development, medical education and healthcare service delivery has not been considered. The increased allocation of 56 percent under PMSSY is expected to foster upgradation of district hospitals with medical colleges and improve quality of medical education in the country.

> The implementation of PM-ABHIM scheme launched in October 2021 with an outlay of INR 64,120 cr is a step in the right direction to boost healthcare infrastructure. However, going forward the success would lie in how the components under the scheme are implemented to build a resilient health system.

> Increased allocation for One Health programme can help in designing and implementing programmes, policies, legislation and research towards various zoonotic diseases which has the potential to jump barriers and cause infections in humans through multi-sectoral approach. With the surge in the number of cases, the government should take stronger steps to bolster the One Health resilience programme and strengthen the surveillance by expanding the One Health programme to combat the spread of emerging diseases.

> Launch of the National tele-mental health programme including 23 tele-mental health centres of excellence with National Institute of Mental Health & Neurosciences ( NIMHANS) being the nodal centre and IIT Bangalore (IITB) being the technical support is a first step for better access to mental health counselling.

> Parity sought to be brought between the two exemption regimes available to non-profit organisations including charitable hospitals under Section 10(23C) and 12AB.

> Rationalisation of compliances for charitable hospitals including accumulation, payments to specified persons (related parties), return filing, taxes on accreted income.

> Contributions by an employer provided for medical treatment in relation to COVID-19 shall not be treated as perquisite in the hands of the employee.

> Contributions provided by employers / contributions up to INR 10,00,000 by other persons on death of an employee due to COVID-19 shall not be taxable in the hands of the family members.

> To summarise, the healthcare sector witnessed an increased public spend with a focus to strategically increase the patient access by developing more hospitals, gauge interest of hospitals/investors by launch of digital health and

mental health programmes and provide employment opportunities by increasing the allocation for human resources.

> Going forward, a clear roadmap for implementing the new and flagship schemes is needed for optimum health outcomes. There is an urgent need to augment additional funding and devise a national agenda around preventive health, testing and screening as these are key to reducing the overall disease burden in India.

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 2022-23, your Company has been able to achieve total revenue of Rs.757.08 Lakhs as compared to Rs. 825 Lakhs in the previous year. The total revenue for the year 2022-23 decreased by 8.00% and Net Profit has Decreased to Rs. 138 Lakhs from Rs. 251.88 Lakhs.

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.

MARKET SIZE:

Healthcare industry in India comprises of hospitals, medical devices, clinical trials, outsourcing, telemedicine, medical tourism, health insurance, and medical equipment. The healthcare sector is growing at a tremendous pace owing to its strengthening coverage, services, and increasing expenditure by public as well private players.

• 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%.

• In 2020, Indias Medical Tourism market was estimated to be worth $5-6 Bn and is expected to grow to $13 Bn by 2026.

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

• 1,56,000 Ayushman Bharat centers, which aim at providing primary health care services to communities closer to their homes, are operational in India.

• More than 390 Mn ABHA numbers generated under the Ayushman Bharat Digital Mission

India is a preferred destination for Medical Value Travel (MVT) where patients from all over the globe come to "Heal in India" and is growing as huge opportunity area in the Healthcare market.

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 center 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, paediatrics 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