BW Healthcare Oct - Nov 2023

fiffffl ffiflffl ffi ffiffffl fiffffl OCTOBER-NOVEMBER 2023 | Rs 300 LEADING WITH THE HEART LEADING DR. DEVI SHETTY Founder, Chairman, and Executive Director of Narayana Health on Cardiac care in India and advancements in heart treatment HEALTHCARE WORLD 30 UNDER INSIDE 30 DR. ASHOK SETH Chairman Fortis Escorts Heart Institute on quality stents SANJEEV PANCHAL Country President & MD AstraZeneca India on Innovative Medicine

WWW.BWHEALTHCAREWORLD.COM BW H E A LT H CA R E OCT-NOV 2023 3 PROGRESS AND CARE EDITOR-IN-CHIEF’S NOTE Dear reader, India has a high burden of cardiovascular disease (CVD), which is the leading cause of death. Environmental and lifestyle factors are a leading cause for a number of people to be struck with the disease even at a young age. Over the last few years, there has been a lot of dialogue about CVD in the medical fraternity. Research has led to a fair amount of advancements in the field. In the current issue, we focus on the advancements and innovations in the field. We feature the renowned cardiac surgeon Dr. Devi Shetty who is the Founder, Chairman and Executive Director of Narayana Health. He talks about cardiac care in India and the advancements in heart treatment. He believes the Indian healthcare, especially heart treatment, is as good as or to some extent more advanced than what one gets in the first world countries. Dr. Shetty is confident that India stands as the world’s most cost-effective healthcare destination, with no other place matching the value we provide for the fees we charge. India has made remarkable strides in the field of cardiology. Leading medical institutions and dedicated healthcare professionals have advanced research, treatments, and access to cardiac care. Pioneering cardiac surgeries, including minimally invasive procedures and heart transplants, have saved numerous lives. The nation’s focus on preventive cardiology, lifestyle modifications, and awareness campaigns has contributed to reducing the burden of heart diseases. Telemedicine and telecardiology services have expanded access to specialized care, especially in remote areas. India’s commitment to affordable and quality cardiac care is evident, making significant contributions to improving the overall cardiovascular health of its population. In addition to our focus on cardiac care in India, we spotlight the BW Healthcare World 30 Under 30 summit and awards. This event focuses on celebrating young people in the field of medicine who are pushing boundaries and excelling in their field. The issue also features writings by industry experts on various aspects of the healthcare industry. Happy reading. “Health is the greatest possession. Contentment is the greatest treasure. Confidence is the greatest friend.” Lao Tzu [email protected] ANNURAG BATRA

4 BW H E A LT H CA R E OCT-NOV 2023 WWW.BWHEALTHCAREWORLD.COM Prioritise Holistic Health FROM THE CEO’s D E S K Come September, we prepare for World Heart Day. Cardiology is one area within medical care that has seen commendable advancement whether it is in terms of medicine, surgeries, diagnostics and remote monitoring leading to continual care at home among many others. It is one domain where advancement has brought hope of a disease getting managed. Our nation is considered the diabetic capital of the world. The two conditions – diabetes and hypertension that are considered to be the most common causes that lead to cardiac related health challenges. This is where I have observed development happen beyond modern medicine. Meditation, yoga, alternative medicine and therapies are being used to work towards relieving stress and having an active lifestyle. Innovative mobile applications are also helping people remain calm. This makes holistic health becoming a priority. The HealthTech development is making heart conditions predictable. This is a big development in my opinion. If we are able to predict a condition, we are in a better position to manage and save lives. In other words, predictability leads to prevention. Another challenge that I find today is the lack of trust in the healthcare facilities. Patients and their families find it hard to trust procedures being advised. This is also, at times, leading to delayed treatment and loss of life. I remember talking to Dr. Devi Shetty of Narayana Health, to understand his vision on how healthcare is evolving in India. When asked about the lack of trust in the current healthcare system he spoke about his vision and how it addresses this specific area. He talks about how engagement between hospital, insurer and patient is creating lack of trust and how an operator driven insurance model could not only solve this challenge but also make healthcare delivery more efficient and be focused on prevention and home care for most treatments. BW HealthcareWorld also has spoken to thought leaders in genomics, pharmaceuticals, device manufacturers etc., and their thoughts have been captured in this issue. We have also tried to understand the culture of popping pills. You will read about this in this issue. I would also like to invite ideas on how we can make BW HealthcareWorld more relevant and engaging for you. If you have ideas or contributions to make this issue even better, do email me on my email I share with my signature. What can be better than getting you, our reader, to let us know what will be of interest to you. Happy reading. Wishing you health and happiness. Harbinder Narula CEO, BW Healthcare World &BW Wellbeing [email protected]

For Speaking and partnership opportunity: Sanjana Deb, 8910172015 [email protected] CEO, BW Wellbeingworld & BW Healthcareworld BRAHMA KUMARI SHIVANI ANKUR WARIKOO SISTER JAYANTI DR. HANSAJI YONGENDRA LAVLEEN KAUR LUKE COUTINHO DR. KIRAN BEDI GAURAV BHAGAT SHANTANU NAIDU SHWETAMBARI SHETTY NIDHI MOHAN KAMAL MUKESH BANSAL SUHANI SHAH VIKAS BAGARIA CHEF HARPAL SINGH SOKHI VIJAY THAKKAR SANJEEV KAPOOR GURUDEV SRI SRI RAVI SHANKAR GAURANGA DAS

6 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM BW Businessworld does not accept responsibility for returning unsolicited manuscripts and photographs. All unsolicited material should be accompanied by self-addressed envelopes and sufficient postage. Published and printed by Annurag Batra for and on behalf of the owners, BW Businessworld Media Private Limited. Published at 74-75 Amrit Chamber Scindia house CP New Delhi 110001, and printed at Infinity Advertising Services Private Limited. Editor : Annurag Batra. © Reproduction in whole or in part without written permission of the publisher is prohibited. All rights reserved. BW Businessworld Media Private Limited EDITORIAL OFFICES BW Businessworld Media Pvt. Ltd. 74-75, Scindia House, Connaught Place, New Delhi-110001 Phone: 9818063325 ADVERTISEMENT/CIRCULATION / SUBSCRIPTION ENQUIRIES BW Businessworld Media Pvt. Ltd. 74-75, Scindia House, Connaught Place, New Delhi-110001 Phone: 9818063325 SUBSCRIPTION SERVICE Vinod Kumar +91 9810961195, [email protected], [email protected] Subscription rates: ONE YEAR - Rs 2,899 TWO YEARS - Rs 5,599 THREE YEARS - Rs 8,199 HUMAN RESOURCES: Namrata Tripathi ([email protected]) LEGAL ADVISOR: Sudhir Mishra (Trust Legal) OCT-NOV 2023 GROUP CHAIRMAN & EDITOR-IN-CHIEF: Dr. ANNURAG BATRA CEO, BW COMMUNITIES Bhuvanesh Khanna CEO & CHIEF INNOVATION OFFICER Hoshie Ghaswalla (CEO-BW Engage) GROUP EDITORIAL DIRECTOR Noor Fathima Warsia BW HEALTHCARE WORLD: Sr. Associate Editor: Jyotsna Sharma Editorial Lead: Shivam Tyagi Industry Interactions: Smridhi Sharma Jr Correspondent: Bhupendra Paintola Art Director: Shivaji Sengupta EXECUTIVE EDITOR: Suman K. Jha EDITORIAL TEAM Sr. Associate Editors: Ashish Sinha, Meha Mathur Sr. Correspondents: Rohit Chintapali, Deep Majumdar Correspondents: Abhishek Sharma, Arjun Yadav DESK TEAM Deputy Editor: Mukul Rai Associate Editors: Madhumita Chakraborty; Smita Kulshreshth ART TEAM Art Directors: Dinesh Banduni, Shiv Kumar Assistant Art Director: Rajinder Kumar Infographics & Data Visualiser: Arun Kumar Assistant Images Editor: Sanjay Jakhmola PHOTO TEAM Sr. Photo Researcher: Kamal Kumar BW ONLINE: Assistant Editor: Poonam Singh VIDEO EDITORIAL TEAM Video Team: Anurag Giri, Pappu Kumar Singh, Sunny Kumar Paswan Sr. Cameraperson: Ratneshwar Kumar Singh BW APPLAUSE & EVERYTHING EXPERIENTIAL: Ruhail Amin BW AUTO WORLD: Utkarsh Agarwal BW DISRUPT: Resham Suhail BW EDUCATION: Upasana BW HOTELIER: Editor: Saurabh Tankha Editorial Lead: Bulbul Dhawan Operations Controller: Ajith Kumar LR BW LEGAL WORLD: Editorial Lead: Kaustubh Mehta BW MARKETING WORLD: Soumya Sehgal, Reema Bhaduri BW PEOPLE: Sugandh Bahl Vij, Krishnendra Joshi, Himanshu Ojha, Shruti Tripathi BW WELLBEING: Kavi Bhandari VC WORLD: Nitesh Kumar BW SECURITYWORLD: Shilpa Chandel BW POLICE WORLD: Ujjawala Nayudu DIRECTOR: Prasar Sharma GROUP SR. VICE PRESIDENT - STRATEGY, OPERATIONS & MARKETING Tanvie Ahuja ([email protected]) CEO, BW HEALTHCARE WORLD & BW WELLBEING WORLD: Harbinder Narula DIRECTOR, ADVERTISING & REVENUE: Aparna Sengupta DIRECTOR, PROJECTS & COMMUNITIES: Talees Rizvi VICE PRESIDENT STRATEGIC PROJECTS: Uday Laroia MARKETING & DESIGN TEAM: Kartikay Koomar, Mohd. Salman Ali, Moksha Khimasiya, Shweta Boyal, Alka Rawat, Arti Chhipa, Sunny Anand, Himanshu Khube Asst Manager - Design: Kuldeep Kumar EVENTS TEAM: Tarun Ahuja, Devika Kundu Sengupta, Pawan Sharma, Preksha Jain, Akash Kumar Pandey, Mohd. Arshad Reza, Sneha Sinha, Nandni Sharma, Nivish Singh, Mahek Surti, Atul Joshi, Mir Salika, Biren Singho, Abhishek Verma, Neeraj Verma, Prashant Kumar, Mayank Kumar SALES TEAM NORTH: Ravi Khatri, Anjeet Trivedi, Rajeev Chauhan, Amit Bhasin, Somyajit Sengupta, Priyanshi Khandelwal, Sajjad Mohammad WEST: Kiran Dedhia, Nilesh Argekar SOUTH: C S Rajaraman BW COMMUNITIES BUSINESS LEADS Priya Saraf (BW Education), Gareema Ahuja (BW LegalWorld), Chetan Mehra (BW Disrupt) CIRCULATION TEAM General Manager - Circulation, Subscription & Sales: Vinod Kumar ([email protected]) NORTH-EAST: Vijay Kumar Mishra, Mukhtadir Malik, Kamlesh Prasad WEST: Arvind Patil, Gorakshanath Sanap SOUTH: Sarvothama Nayak K, Anup Kumar Production Manager: Shiv Singh FINANCE TEAM Ankit Kumar, Ishwar Sharma, Shrikant Sharma, Vijay Jangra IT SUPPORT: Brijender Wahal ADMIN SUPPORT: Assistant to Chairman & Editor-in-Chief: Aman Mishra ([email protected])

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8 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM OCT-NOV 2023 28 10 12 38 90 92 96 40 48 14 18 CONT COVER STORY COLUMNS HEALTH BULLETIN TRANSFORMATION IN HEALTHCARE Dr. Devi Shetty, Founder, Chairman and Executive Director of Narayana Health on advancements in cardiac care fiffffl ffiflffl ffi ffiffffl fiffffl OCTOBER-NOVEMBER 2023 | Rs 300 LEADING WITH THE HEART LEADING DR. DEVI SHETTY Founder, Chairman, and Executive Director of Narayana Health on cardiac care in India and advancements in heart treatment HEALTHCARE WORLD 30 UNDER 30 INSIDEDR. ASHOK SETH Chairman Fortis Escorts Heart Institute on quality stents SANJEEV PANCHAL Country President & MD AstraZeneca India on Innovative Medicine DR. MAHIPAL SACHDEV Chairman & MD, Centre for Sight Group of Eye Hospital GAURAV KAUSHIK CEO & MD, Meteoric Biopharmaceuticals SUBHAKANTA BAL MD, Rothschild & Co. SRINIVAS IYENGAR VP and Head of Healthcare & Lifesciences, Happiest Minds Technologies SUDHANSHU MITTAL Head & Director Technical Solutions, Nasscom DR. HRISHIKESH PAI President, Fogsi MINNKU BUTTAR, Founder & Director, The Circle of Joy Retreats MONIQUE JHINGON, Lifestyle Consultant and Nutritionist MEENA GUPTA, President, Society for Complementary Therapies

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCAREOC T-NOV 2023 9 India’s Cybersecurity Skill Shortage Carbon Footprint Of Hospitals Needs A Relook The pages in BW Businessworld that are labelled BWi or Promotions contain sponsored content. They are entirely generated by an advertiser or the marketing department of BW Businessworld. Also, the inserts being distributed along with some copies of the magazine are advertorials /advertisements.These pages should not be confused with BW Businessworld’s editorial content. Cover design by SHIVAJI SENGUPTA 56 20 42 98 TOTAL NO. OF PAGES INCLUDING COVER 100 ENTS SPOTLIGHT In Conversation: 24 Dr. Sanjeev Panchal President & MD AstraZeneca India 34 Dr. Emmanuel Rupert Group CEO Narayana Health 36 R. Venkatesh, Group COO Narayana Health 46 Henry Charlton SVP & Chief Commercial and MarketingOfficer,Intuitive 50 Dr. Justin Gainor Asst. Prof. Harvard Medical School 54 Sudarshan Jain Secy. General of Indian Pharmaceutical Alliance LAST WORD Dr. Ashok Seth Chairman, Fortis Escorts Heart Institute The BW Healthcare World 30 Under 30 recognises and celebrates healthcare professionals under the age of 30 who have redefinedandexcelled in their domains In-depth

10 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM G20 Health: Digital Health & The Missing $200 Million Fund By Bhupendra Paintola HEALTH BULLETIN The recent G20 health track marked progress in promoting international cooperation in health emergencies. However, it encountered challenges in advancing a $200 million fund for a digital health program I n a pivotal moment for global health diplomacy, India, under its G20 presidency, has spearheaded a call for equity in access to diagnostics, drugs, and vaccines in response to the Covid-19 pandemic. The declaration issued during India’s G20 presidency emphasised three critical health priorities: enhancing primary healthcare, strengthening the health workforce, and expanding essential services beyond pre-pandemic levels. The recent G20 health track marked progress in promoting international cooperation in health emergencies. However, it encountered challenges in advancing a USD 200 million fund for a digital health programme and establishing a permanent platform for sharing knowledge, intellectual property rights, and resources related to vaccines, diagnostics, and therapeutics under the Delhi Declaration. Deepak Sood, Secretary-General of ASSOCHAM, pointed out, “For its substantial investments and initiatives in the digital health space, including the National Digital Health Mission (NDHM), India may have chosen to prioritise its own resources and strategies over a global fund. This approach could help India maintain sovereignty and control over its digital health infrastructure.” Sood further emphasised that India is actively seeking private sector investments and partnerships to support its digital health initiatives, making a dedicated global fund less critical. A World Bank report, released in conjunction with the health ministers’ meeting, applauded India’s Ayushman Bharat Digital Mission for its efforts in bridging health information gaps and connecting health data. Notably, platforms like Co-Win and e-Sanjeevani emerged as game-changers during the Covid-19 pandemic. Dr. Mansukh Mandaviya, Union Minister of Health & Family Welfare, stated in a written article, “India is willing to share its learnings and resources to build similar digital health ecosystems for the world, particularly in low- and middleincome countries, so that vulnerable populations can benefit from cutting-edge digital solutions and innovations, bringing us closer to the dream of universal healthcare coverage.” Sood delineated that India actively shapes the global digital health landscape by sharing its substantial IT industry and skilled professionals to develop cost-effective solutions. He mentioned that India’s role encompasses expertise sharing in large-scale digital health projects, international collaborations with organisations like the WHO to establish global standards, the creation of affordable solutions for resource-constrained settings, and the pioneering of telemedicine for improved healthcare access globally. India’s G20 presidency has undoubtedly left an indelible mark on global health diplomacy, including equity, collaboration, and the advancement of digital health solutions. As the world faces ongoing health challenges, India’s leadership continues to inspire and guide the path towards a healthier, more equitable future for all.

Report Highlights Neglected Health Needs Of Children With Developmental Disabilities By Kavi Bhandari WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCAREOC T-NOV 2023 11 Older Adults With COPD Had Depression During The Pandemic By Kavi Bhandari A new report publ i s h e d b y t h e World Health Organization (WHO) and UNICEF highlights the global prevalence of developmental disabilities among children and young people. It sheds light on the urgent action needed to address disparities in their access to healthcare, health outcomes, and exposure to social determinants such as poverty.Children and young people with developmental disabilities have underlying health conditions which affect the developing nervous system and cause impairments in motor, cognitive, language, behaviour and/or sensory functioning and associated disabilities. In interaction with various barriers and contextual factors, these impairments may hinder a child’s full and effective participation in society on an equal basis with others. The most common underlying, avoidable causes of death in children and young people with developmental disabilities include epilepsy, choking, respiratory infections and injuries.Health disparities also extend into adulthood, increasing the risks of conditions such as diabetes, heart disease, obesity, respiratory illnesses, and mental health conditions. at 875 people with COPD from the Canadian Longitudinal Study on Ageing, a national study of Canadian seniors. Researchers discovered that 1 in 6 people with COPD who had no prior history of depression. Women with COPD also had nearly double the risk of recurrent depression when compared to their male counterparts. The study’s researchers highlighted several risk factors for both incident and recurrent depression among those with COPD, including loneliness, family conflict, and functional limitations.Among individuals with no history of depressionexperiencing disruptions to healthcare access was associated with approximately double the risk A of incident depression. ccording to a new study,older persons with COPD were at a higher risk of depression during the early phases of the COVID-19 pandemic. This study was published online in the International Journal of Chronic Obstructive Pulmonary Disease (COPD).The study looked

12 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM COLUMN By Dr Mahipal S Sachdev With about 77 million people in India aged 60 years or above, they represent a large group vulnerable to vision-related disorders, and the number is expected to reach 180 million by 2026 As we age, our eyes undergo changes that can some - times lead to the development of degenerations and diseases such as those involving the lens, nerves and retina. These changes, if unattended, can potentially result in vision loss or even blindness if not addressed at an appropriate time. Results from a recent study reveal a high prevalence of retinal problems among the elderly population in India. With about 77 million people in India aged 60 years or above, they represent a large group vulnerable to vision-related disorders, and the number is expected to reach 180 million by 2026. HEALTHY AGEING: MANAGING RETINAL DISEASES IN SENIOR CITIZENS

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCAREOC T-NOV 2023 13 The retina is the part of the eye that is responsible for detecting light and sending visual signals to the brain. As we age, the cells in the retina may become damaged, resulting in various retinal diseases. T he s e i nc lude Age-related Macular Degeneration (AMD), Diabetic Macular Edema (DME) and Retinal Detachment (RD). Therefore, prioritising regular eye check-ups is vital. Routine eye examinations allow for the early detection and prevention of these issues, significantly reducing the risk of complications. By monitoring and managing retinal conditions, eye professionals can provide timely interventions and personalised treatment plans. In addition, maintaining a healthy lifestyle plays a crucial role in preventing and managing these conditions among senior citizens. Key practices include consuming a nutritious diet that includes fruits, vegetables and omega-3 fatty acids to reduce the risk of AMD. Managing diabetic retinopathy can be supported by maintaining a diet low in saturated and trans fats. Regular exercise reduces the likelihood of conditions like diabetes and improves blood flow to organs, which helps prevent A MD. Quitting smoking is also essential, as smoking significantly increases the risk of AMD. By adopting these lifestyle parameters and staying proactive with regular eye check-ups, you can take charge of your eye health and effectively manage retinal diseases. Often, the diagnosis of AMD or DME can be overwhelming and emotional for individuals especially when already d e a l i n g w i t h other age-related ailments. As these conditions can have a significant impact on daily a c t iv it ie s a nd quality of life, affected individuals may struggle with mundane tasks like reading, driving, or even recognising faces. These challenges can lead to a sense of dependence on others and cultivate feelings of despair and desolation. It is important to seek emotional support from family, friends, or a mental health professional to help cope with the feelings of anxiety, frustration and distress. With the advent of newer technologies for diagnosing and managing age related eye disorders, all is not as gloomy as it sounds. There are many assistive technologies and vision aids available currently to help seniors manage these challenges and lead a c om for t able life which can be provided by the nearest ophthalmolo g y t e a m . Multiple research projects are ongoing to even revert the progression of diseases previously thought to have no cure. Support Resources There are also many support resources available to help the elderly With the advent of newer technologies for diagnosing and managing age related eye disorders, all is not as gloomy as it sounds. There are many assistive technologies and vision aids available currently to help seniors manage these challenges Prioritising eye health through regular checkups ensures that senior citize ns can e njoy optimal vision, maintain their independence, and enhance their overall quality of life manage their eye diseases. Low vision rehabilitation is a type of therapy that can help one learn new skills and strategies to manage their vision loss, especially in AMD and DME cases. Support groups can also be a valuable resource, providing a space to connect with others who are going through similar experiences. In conclusion, prioritising eye health through regular check-ups ensures that senior citizens can enjoy optimal vision, maintain their independence, and enhance their overall quality of life. By prioritising routine screenings, senior citizens can take proactive steps towards preserving their vision and preventing the progression of retinal diseases. By working together, senior citizens, their families, and healthcare professionals can help manage the impact of AMD and DME on daily life. We need to remember that good eye health means a good life! DR MAHIPAL S SACHDEV Chairman & MD, Centre for Sight Group of Eye Hospitals

14 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM The Indian healthcare sector has witnessed strong M&A activity with a cumulative deal value of $35 billion over the 2018-2022 period. This marks a healthy increase in terms of deal value over the preceding 5-year period. Pharmaceuticals continue to witness strong deal activity across multiple segments including domestic formulations, API or CDMO space and nutraceutical ingredients. Large Indian domestic companies are doubling down on the Indian market driven by a desire to enhance presence, plug specific white spaces from a therapy area standpoint and accelerate beyond organic growth. Some key deals include Torrent Pharma’s acquisition of Curatio Healthcare, Eris Lifesciences’ acquisition of Oaknet Healthcare and Mankind Pharma’s acquisition of Panacea Biotech’s domestic formulation brands. Several of the strategic transactions have been in the form of brand acquisitions to fill specific portfolio gaps and strengthen specific divisions. Several of the larger domestic formulation companies are lookCOLUMN By Subhakanta Bal Large Indian domestic companies are doubling down on the Indian market driven by a desire to enhance presence, plug specific whitespaces from a therapy area standpoint and accelerate beyond organic growth M&A Likely To Grow Strong In Healthcare

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCAREOC T-NOV 2023 15 ing to focus on core portfolios and sharpen capital and resource allocation decisions. This in turn has also resulted in companies divesting select non-core brands, a trend that is likely to continue. Most large Indian pharma companies enjoy a healthy balance sheet, providing the ammunition to fund inorganic growth. This coupled with the fact that there are limited avenues for inorganic capital deployment (with similar risk-reward dynamics) implies that domestic M&A activity is expected to continue going forward. There has also been a fair amount of private equity (PE) activity in the Indian domestic formulations space, including Advent’s acquisition of Bharat Serums and Vaccines, KKR’s acquisition of a controlling stake in J.B. Chemicals & Pharmaceuticals and Temasek’s investment in Integrace Health. SUBHAKANTA BAL Managing Director, Rothschild & Co Most large Indian pharma companies enjoy a healthy balance sheet, providing the ammunition to fund inorganic growth. This coupled with the fact that there are limited avenues for inorganic capital deployment (with similar risk-reward dynamics) implies that domestic M&A activity is expected to continue going forward Pharma B2B has been another area with consistent M&A activity, especially in the Active Pharmaceutical Ingredient (API) segment driven both by PE funds and corporates. The industry has been and continues to be fragmented, providing the opportunity for consolidation. PE activity has been led by funds looking to do platform investments and subsequent bolt-on acquisitions to acquire capabilities and scale up. Trade activity has been primarily driven by a desire to expand in high-growth segments such as HPAPI, oncology, peptides and injectables. Given the supply chain disruptions faced during Covid-19, there is a greater realisation of the need to diversify the supply chain and avoid overreliance on one country or source. Outside of China, India and Italy are two of the major API manufacturing hubs, which is expected to further fuel the demand for APIs from India. This could also drive inbound activity with overseas companies looking to acquire assets, especially those with strong regulatory track records, meaningful regulated markets exposure and presence in high-growth and niche areas. The Pharma B2B industry continues to benefit from a structural move from customers to increasingly outsource manufacturing activities and shift towards an assetlight business model driven by cost pressure, the desire to migrate from a fixed to a variable cost structure and supply chain complexity. In addition, there has been a growing share of mid and small pharma

16 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM companies in the late-stage pipeline, which bodes well for continued growth in outsourcing, as several mid and small pharma companies rely on outsourcing to meet their manufacturing requirements. Also, there seems to be rising demand from customers for integrated service offerings, which would further drive consolidators to fill gaps in service offerings through acquisitions. S o m e o f t h e larger Indian diversified generics majors are also keen on scaling up speciality businesses, especially in the US, through acquisitions or inlicensing, and moving up the value chain. This trend is likely to continue as select companies continue to build a portfolio of innovative branded speciality products and biosimilars. Furthermore, Nutraceutical ingredients have witnessed recent M&A activity in India with transactions such as Novozymes’ acquisition of a majority stake in Synergia Life Sciences and TA Associates’ investment in Omni Active Health Technologies. Several Indian nutraceutical ingredients companies cater to a global customer base, a large and growing opportunity driven by rising consumer awareness and a shift towards preventive care. The space is witnessing interest from global strategies as well as PE funds. Several global ingredients companies have historically been quite acquisitive, enjoy strong valuations and have healthy balance sheets (with low leverage levels). This area could witness meaningful inbound M&A activity with overseas companies looking to acquire assets in India to gain access to niche product portfolios, expand the manufacturing base and drive revenue synergies. Single Specialty Deals Booming Indian healthcare services space has witnessed meaningful transactions recently, including Temasek increasing its stake in Manipal Hospitals and Ontario Teachers’ Pension Plan’s acquisition of a majority stake in Sahyadri Hospitals. Given the level of fragmentation that exists in the Indian hospital sector (with the top 10 corporate hospital chains estimated to account for less than 3 per cent of total hospital beds in India), it is likely that the space will continue to witness consolidation with the larger chains acquiring smaller assets to expand geographic footprint as well as strengthen presence in existing regions. This has been evident through recent strategic activity including Manipal’s acquisition of Vikram Hospitals and KIMS Hospitals’ acquisition of Sunshine Hospitals. There has also been an increasing interest in single-speciality space as the segment matures, assets grow in scale and demonstrate strong unit economics. Several PE investors have invested in single speciality chains with focused segments being mother & childcare, IVF and eyecare. This has been apparent through a slew of recent transactions including GIC’s investment in Asia Healthcare Holdings, TPG Growth’s investment in Dr. Agarwal’s, and Kedaara Capital’s investment in Oasis Fertility. R i s e I n P E A c t i v i t y I n Medtech With relatively lower levels of M&A activity historically (compared to pharmaceuticals and healthcare services), M&A in the Indian MedTech space has historically been focused on consumables and in-vitro diagnostics (IVD) segments. However, with companies scaling up, there is a rise in interest from financial sponsors. Select transactions include Apax Partners’ acquisition of Healthium MedTech, Temasek’s investment in Molbio Diagnostics and Warburg Pincus’ investment in Meril. Inbound trade M&A activity in the MedTech space in India could rise as select overseas companies look to expand their footprint and get access to commercial infrastructure in India along with the ability to cater to other markets from India. Select outbound acquisitions are also expected as some of the larger Indian MedTech companies look at acquiring specific product/ technology capabilities. In summary, overall deal activity in the Indian healthcare sector is likely to continue at strong levels and could potentially even increase in certain segments. COLUMN

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18 BW HE ALTHCARE OC T-NOV 2023 WWW.B WHE ALTHCARE WORLD.C OM Gaurav Kaushik The perception of blockchain technology has experienced a remarkable shift in recent years. No longer confined to its association with cryptocurrencies, blockchain has emerged as a powerful and transformative Blockchain technology significantly drives transparency, efficiency, and trust within biopharma, particularly in supply chain management, clinical trials, and data security COLUMN Transforming Biopharma: Unleashing Power Of Blockchain a revolutionary transformation empowered by blockchain technology. Blockchain technology significantly drives transparency, efficiency, and trust within biopharma, particularly in supply chain management, clinical trials and data security. With its decentralised technology comparable to artificial intelligence, big data and cloud computing. Its potential has captivated industries of all sizes as they strive to harness its capabilities for their benefit. Among these industries, the biopharmaceutical sector has become a standout candidate for

WWW.B WHE ALTHCARE WORLD.C OM BW HE ALTHCAREOC T-NOV 2023 19 The risk of data breaches and unauthorised access is mitigated by securely encrypting and distributing clinical data across the blockchain network. Companies and researchers retain control over their data, enabling them to selectively share information while ensuring privacy and confidentiality and immutable ledger, blockchain offers a transformative solution to the challenges faced by the industry. When implemented correctly with appropriate checks and balances, the practical applications of blockchain technology hold the potential to usher in a new era of transparency, security, and discovery within biopharma. The applications of blockchain in the biopharma industry are diverse and far-reaching. One such application is the establishment of a secure and transparent supply chain ecosystem through blockchain. The decentralised nature of blockchain enables real-time traceability and authentication of products and their ingredients. Furthermore, blockchain facilitates streamlined contract management by automating smart contracts. It’s immutability and cryptographic security provide tamper-proof audit trials, empowering stakeholders with accurate and verifiable data. Additionally, the decentralised ledger of blockchain can optimise inventory management, reducing wastage and optimising stock levels. In the realm of clinical trials, blockchain technology offers unprecedented transparency. By enhancing data integrity, transparency, and patient consent management, blockchain ensures researchers can securely record and share trial data on an immutable network. This eliminates the risk of data manipulation, guarantees data integrity, and builds trust among participants, researchers, regulators, and sponsors. Real-time access to trial data enables efficient collaboration and faster decision-making, ultimately expediting the discovery of new treatments and therapies. The biopharma industry handles sensitive and confidential data that necessitates the utmost security. Here, the blockchain’s decentralised architecture and cryptographic protocols play a crucial role. The risk of data breaches and unauthorised access is mitigated by securely encrypting and distributing clinical data across the blockchain network. Companies and researchers retain control over their data, enabling them to selectively share information while ensuring privacy and confidentiality. Despite the immense potential of blockchain in biopharma, several challenges remain, including regulatory frameworks, scalability, interoperability, and industry collaboration. Overcoming these challenges necessitates the establishment of industry-wide standards and fostering collaboration between biopharma companies, regulators, and technology providers. Regulatory frameworks must adapt to accommodate the unique aspects of blockchain technology while upholding participant privacy, data security and compliance. By embracing blockchain technology, the biopharmaceutical industry stands to unlock significant benefits. It is crucial for biopharma companies to actively explore and adopt blockchain solutions, develop clear implementation plans and collaborate with stakeholders to maximise the potential of this ground breaking technology. As the biopharmaceutical industry undergoes a profound transformation driven by blockchain technology, a future of innovative therapies, improved outcomes, and a more sustainable ecosystem comes into view. Embracing blockchain technology promises to revolutionise the industry, paving the way for advancements that will shape the future of biopharma. GAURAV KAUSHIK CEO & MD, Meteoric Biopharmaceutical

20 BW HE ALTHCARE OC T-NOV 2023 WWW.B WHE ALTHCARE WORLD.C OM IN-DEPTH By Bhupendra Paintola The healthcare sector, a treasure trove of sensitive personal information, faces escalating cybersecurity threats as cybercriminals seek to exploit valuable data. What makes them alluring targets for malicious actors are patient health records, medical histories, insurance details and more. The nature of Personally Identifiable Information (PII) held by healthcare companies today is highly sensitive and private. Attackers can quickly use this to profile cyber victims and conduct personalised attacks with a very high degree of success. Enterprises in the country experienced over 2000 attacks every week in Q1 2023, marking an 18 per cent increase compared to the previous year. The healthcare industry was a prime target, with 7.7 per cent of attacks directed towards it, as per TeamLease Digital. Recently, Amit Shah, Union Minister of Home Affairs, Enterprises in the country experienced over 2000 attacks every week in Q1 2023, marking an 18 per cent increase compared to the previous year. The healthcare industry was a prime target, with 7.7 per cent of attacks directed towards it India’s Cyber Security Skill Shortage & AI Posed Risks In Healthcare expressing apprehensions around cyber security, conveyed that many countries have become victims of cyber attacks and that this threat is hovering over all major economies. “The World Bank estimates that cyberattacks could have caused losses of around $5.2 trillion to the world during 2019-2023. The use of cryptocurrency by malicious threat actors further complicates its detection and prevention,” Shah said. Shah added that 840 million Indians have an online presence, and by 2025, another 400 million Indians will enter the digital world which means the possibilities of cyber threats will also increase. Nikhil Kurhe, CEO, Finarkein Analytics, emphasised the impending importance of cyber security and stated, “Cyber security is of paramount importance, especially in PII data like health data. Unfortunately, for the longest time, IT and data infrastructure were not a primary focus as they weren’t core to their business. That is changing,

WWW.B WHE ALTHCARE WORLD.C OM BW HE ALTHCAREOC T-NOV 2023 21 The World Bank estimates that cyberattacks could have caused losses of around USD 5.2 trillion to the world during 2019-2023. The use of cryptocurrency by malicious threat actors further complicates its detection and prevention AMIT SHAH Union Minister of Home Affairs Govt of India though, as secure encryption protocols are baked into DPI rails like ABDM to ensure safe health data communication. Awareness around the same for the general public is needed, though, to drive adoption combined with benefits.” Cybersecurity Skill Shortage Although India had 40,000 job openings for cybersecurity professionals as of May 2023, 30 per cent of these vacancies could not be filled due to a huge skill shortage, reported TeamLease Digital. The demand for cybersecurity professionals has far exceeded the supply, causing many businesses to struggle to recruit qualified personnel. “Cyber Security skill sets that are in high demand include data privacy, cloud security, AI security, and network security. The top job roles include IT auditor, Information Security Analyst, Network/IT Security Engineer/Specialist, Security Testing/Penetration Tester, and Computer Forensics analyst,” conveyed TeamLease Digital on the basis of their analysis. “It is in everyone’s interest to make sure that healthcare workers are keyed in on the various online risks. Social engineering is another attack vector leveraged by criminals where people are less aware of common good practices. Great and consistent awareness campaigns can pretty much eliminate this angle,” Kurhe commented on the awareness of health professionals. Threats from AI & Medical Devices Professionals have been using AI to improve their productivity, software development, and even business communications for the past few months. The chatbot keeps a record of all user inquiries and AI responses. As a result, any illegal access could possibly endanger sensitive data. Later, companies and their personnel may be the target of this sensitive information. According to the most recent Group-IB research, ChatGPT is extremely well-liked among dark web communities. Kiran Vangaveti, CEO and Founder of BluSapphire Cyber-Systems commenting on complicated threat actors, added, “Today’s threat actors are sophisticated. Implementing robust AI/ML-driven security operations centred with a constant vigil on potential behaviour anomalies inside IT/IoMT infrastructure is a must, allowing better visibility and faster cyber threat detection and response. Alongside this, it is important to have access control measures like strong passwords, multifactor authentication, and role-based access control, which limit data access to authorised personnel only.

22 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM Implementing zero-trust networks shall allow secure network channels and regular patching, and system updates are essential to address known vulnerabilities while safeguarding the overall infrastructure.” India has one of the world’s top 20 markets for medical devices and is the fourth-largest in Asia. The medical devices sector in India is projected to reach $50 billion by 2025, according to the India Brand Equity Foundation. Many personal medical technology devices contain software as a medical device (SaMD) and software in a medical device (SiMD) are typically connected to the internet, mobile phones, servers and the cloud. These devices include oximeters, hearing aids, glucometers, medical monitoring watches, and implants. Experts convey that rapid economic growth, rising middle-class incomes, an elderly population of over 100 million, and increased market penetration of medical devices have left the population vulnerable. Data Protection Law And Risk Management The Information Technology Act and the Contract Act regulate data protection and cyber-security, even though the central government is currently pushing for the digitisation of health information. Commenting on the requisites of the law, Kurhe stated, “We need a general data protection bill with the right mechanisms to encourage compliance and good behaviour while also ensuring that bad behaviour from malicious actors and lapses in security are punished punitively. If there are only wrist taps, incentives for the adoption of good cyber security practices fall short as the cost of compliance and upgrading can become a factor. A further specialised law for healthcare can be proposed, due to the nature and vulnerability of health infrastructure. However, laws must align with rewarding good behaviour and the adoption of best cybersecurity practises.” Vangaveti underlines the importance of risk management for organisations, mentioning, “Compliance, regulatory certifications, and laws provide a minimum level of security but do not and cannot assure a standard of due care, especially with respect to cyber security. Primarily because cyber security is rapidly evolving, and compliance requirements alone cannot keep up with the fast-paced change. Also, compliance focuses on controls, not risk. Organisations should also focus on risk management, employee training, proactive monitoring, and other security initiatives to reduce the risk of a data breach.” Cyber security is of paramount importance, especially in PII data like health data. Unfortunately, for the longest time, IT and data infrastructure were not a primary focus as they weren’t core to their business. That is changing, though, as secure encryption protocols are baked into DPI rails like ABDM to ensure safe health data communication. Awareness around the same for the general public is needed, though, to drive adoption combined with benefits NIKHIL KURHE CEO Finarkein Analytics It is important to have access control measures like strong passwords, multi-factor authentication, and role-based access control, which limit data access to authorised personnel only. Implementing zero-trust networks shall allow secure network channels and regular patching, and system updates are essential to address known vulnerabilities while safeguarding the overall infrastructure KIRAN VANGAVETI CEO and Founder BluSapphire Cyber-Systems IN-DEPTH

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ffiflffffi   fifffflffififlfiff fifffflfflffiflflffiffi U N D E R fifffflffiflffl PROF. RAMESH K. ARORA Chairman Management Development Academy Jaipur DR. MUKESH BATRA Founder & Chairperson Dr. Batra's Healthcare DR MOHIT GUPTA Professor of Cardiology GB Pant Hospital New Delhi PT. (DR.) RK SHARMA Remedial Astrology (Gem Therapy) SUZY SINGH Acclaimed Mental Health Therapist Grief Expert, International Author & Karma Scholar Suzyheals JC CHAUDHRY Founder & Chairman Chaudhry Nummero Pvt Ltd RACHNA CHHACHHI Cancer, Nutrition & Mental Health Therapist PAWAN GOYAL Astrologer ASHTAR TASHI Spiritual Diva & Soul Mentor Thought Leader, Joyologist Intuitive Healer, Author HARBINDER NARULA CEO, BW Wellbeingworld & BW Healthcareworld DR. ANNURAG BATRA Chairman & Editor-in-Chief BW Businessworld & Founder, exchange4media NOOR FATHIMA WARSIA Group Editorial Director BW Businessworld fflffl DR. MICKEY MEHTA Global Leading Holistic Health Guru & Corporate Life Coach

24 BW HE ALTHCARE OC T-NOV 2023 WWW.B WHE ALTHCARE WORLD.C OM INTERVIEW By Shivam Tyagi “We Want To Be Pioneers In Science” At what rate do you think the pharmaceutical industry is growing and what is AstraZeneca’s growth looking like? Which areas are the levers for your growth? As per the latest data, the pharmaceutical industry is growing by almost double digits, which is a good sign for the industry. And, for AstraZeneca we have been growing by more than 20 per cent. The Indian pharmaceutical market is clearly seeing some policy changes and we are also seeing innovative medicines coming to our country to help more patients. AstraZeneca specifically is ensuring that we bring innovative medicines as fast as possible and our growth actually is driven by bringing those innovative medicines to India. For us the growth is coming from a wide therapy area, we are trying to become a more specialist organisation. We bring innovative medicines especially in oncology and previously we have been launching new products in lung cancer but now we are also bringing drugs for gastrointestinal cancers as well as for breast cancer. We have recently announced our entry into rare diseases with a new launch this In an exclusive interaction with BW Healthcare World, Sanjeev Panchal, Country President and MD, AstraZeneca India talks about the growing pharma industry, plans for investment in India, expectations from the new drugs bill and new launches for the company

WWW.B WHE ALTHCARE WORLD.C OM BW HE ALTHCAREOC T-NOV 2023 25 We understand the unmet needs in India and then address that by a specialist disease area. While more products will be coming in oncology, in future, we will have more products coming even in biopharmaceuticals, vaccine therapies and immunology year and we also got approval for a heart failure and chronic kidney disease (CKD) treatment. As we go ahead, we are also looking at biopharmaceuticals in respiratory and immunology. We have our biologics which are for severe asthma, and we also have products for heart attacks. Going forward, how are you planning to grow your product portfolios? The way we want to drive AstraZeneca currently and in the future is that we want to be pioneers in science, which can be oncology, rare disease, biopharmaceutical within cardiovascular, renal and metabolism (CVRM), and also in respiratory and immunology. We understand the unmet needs in India and then address that with a specialist disease area. While more products will be coming in oncology, in future, we will have more products coming even in biopharmaceuticals, vaccine therapies and immunology. What does India require to make innovative medi- cines of its own? Why do you think the average R&D budgets in India are not moving up? India’s environment is becoming more conducive for R&D and we have seen that innovative medicines have been coming from multinational companies to India. It’s not at the pace which we would want of course, but I clearly see progress is being made, what we saw in the Chandrayaan-3 mission is a great example. But I believe it needs to come that fast into the pharmaceutical industry as well. We need cutting-edge research infrastructure and state-of-the-art technology coming into India and it’s also important that we have more public-private partnerships, and we work together to bring innovation to India. We need to ensure that we partner a lot to bring from the lab to the patient. SANJEEV PANCHAL Country President and MD, AstraZeneca India

26 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM For example, AstraZeneca has its open innovation platform called A.Catalyst Network - a global network of more than 20 health innovation hubs of the company. For AstraZeneca, globally we did $44 billion in sales in 2022 and we put almost 10 billion back into science. So the way we spend as a company globally in R&D is very critical. The government waived off GST from a rare disease cancer drug recent- ly and also reaffirmed that patients can import rare disease drugs for personal use without paying GST. What is your take on this? I would say it’s a welcome move as it is a big relief for patients who are fighting such life-threatening diseases. But we also hope that this could be extended to benefit more patients, not for one drug but for more drugs for cancer and other rare diseases. If we can do this exemption beyond personal use import alone, then this would help us to bring access to rare diseases and cancer medicine to more patients. The New Drugs, Medical Devices and Cosmetics Bill has been in the works for a while now. What are your expectations in terms of regulation or what would you say the industry’s expectations are from the bill? I think we still need to wait to see how the bill comes up in the parliament. And we know that the existing law is an 80-year-old Drugs and Cosmetic Act of 1940 and Rules of 1945. So first, we need to see the new bill then only I can comment clearly but we expect that the bill will bring a new regulatory framework for medical devices. We also expect stricter quality control and more transparency in the approval process, which is very important for India as this will help more patients get high-quality standard drugs. I think there should be a more regulated environment as it will bring more trust to the pharma industry and raise the overall profile of the Indian pharmaceutical industry across the world. What are your plans in terms of investments in your portfolio going forward? How much will AstraZeneca India invest in it? Our investment in India is across different areas of our enterprise. We have a commercial organisation, which is led by me and then we have operations in which we manufacture some of our products here or bring bulk tablets to India and do the packaging. We also have a clinical trial team and we are making a huge investment there to bring more clinical trials to India so that we understand local unmet needs across the therapy areas. The second part is because we’re doing clinical trials in India, it gives us an opportunity to launch our drugs much faster, innovative medicines, so just to give you a number, we are planning to bring in more than 15 new launches in India between 2023-25. As of now, five of them have already received approval from the Drug Controller General of India (DCGI) this year. India is an important market for us and we are excited that we can help to bring innovative science to patients where we can make the most meaningful difference. Then there is the R&D and we are working on expanding the R&D footprint in India. Also, we are making a big investment in our innovation and technology centre. Overall, this will generate opportunities for employment in our country. Any drug that seems promising to you and might turn out to be very good for the organisation going forward? One of the drugs is a cancer drug, trastuzumab, which is used for the treatment of metastatic breast cancer. I think that there is a high unmet need in India when it comes to medicines for metastatic breast cancer and we believe that trastuzumab could really help the number of patients in India. We are also working on one of the diabetic drugs, which can also be prescribed for heart failure, which is again a disease burden problem in our country. So these are quite exciting developments which will help in the effective treatment of patients INTERVIEW We are planning to bring in more than 15 NEW LAUNCHES IN INDIA between 2023-25. As of now, five of them have already got approval from the Drug Controller General of India (DCGI) this year

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28 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM COVER STORY By BW Team In an exclusive conversation with BW Healthcare World, Dr. Devi Shetty, Founder, Chairman and Executive Director of Narayana Health speaks on cardiology and the changing landscape of healthcare services along with technological advancements in the field of cardiology Healthcare Is Poised For A Radical Transformation I n the last few years India has made remarkable strides in the field of cardiology. The medical fraternity has invested time in researching preventive treatment options and worked to make cardiac care accessible. Pioneering cardiac surgeries, including minimally invasive procedures and heart transplants, have saved numerous lives. Environmental and lifestyle factors are a leading cause for a number of people to be struck with cardiovascular disease even at a young age. Most young people these days are stressed out with work and are living undisciplined lives. This results in them facing a myriad of cardiac issues. In addition to advancement in medical treatment there is a pressing need to educate people about how their lifestyles are contributing to them becoming unwell. Even though India has a high burden of cardiovascular disease, in recent years, focus on preventive cardiology, lifestyle modifications, and awareness campaigns have contributed to reducing the burden. Telemedicine and telecardiology services have expanded access to specialized care, especially in remote areas. India’s commitment to affordable and quality cardiac care is evident, making significant contributions to improving the overall cardiovascular health of its population.

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCAREOC T-NOV 2023 29 DR. DEVI SHETTY Founder, Chairman and Executive Director Narayana Health

30 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM COVER STORY How do you see technology advancements like robotic surgeries when it comes to surgery? Where are we head- ing and what is your opinion on technology and the role it is playing in today’s world? The tools doctors have today and the impact of that on a patient’s recovery following any major illness is nothing short of magical. Advancements in healthcare have revolutionised procedures like heart surgeries. What seemed inoperable then can now be done easily. What used to take hours for heart surgeons can now be completed in just 15 minutes in a cath lab, allowing patients to leave the hospital within days. This transformation is due to the synergy between medical professionals and technology and exposure to complex cases. Innovations and early diagnosis tools, like echocardiography, have played a pivotal role. Patients now trust these advancements, making decisions faster and easier for both doctors and patients. What in your opinion is the future of de- vices and therapeutics specific for cardiovascular in India? Medical advancements, including implants and devices, are set to transform healthcare. In the near future, hospitals will see a significant shift. Currently, a typical 100-bed

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCAREOC T-NOV 2023 31 hospital has around 70-80 ward beds and 10-40 per cent ICU beds. However, in the next 5-7 years, we anticipate that around 90 per cent of beds will become ICU beds, while ward beds will transition to home care with remote monitoring by doctors. This change will allow patients to recover at home while being continuously monitored. For instance, in heart hospitals, the risk of sudden cardiac arrests within the hospital will soon be eliminated. Instead of manual checks by nurses, patients will wear a small patch providing real-time data, including ECG, oxygen saturation, respiratory rate, and more. Analytics will generate a patient score, displayed at the nurse’s station with colour-coded alerts. Green means no immediate concern, while red signals attention is needed. This shift towards proactive monitoring will save lives by detecting issues before they escalate, as sensors tirelessly analyse minute details. This technological advancement promises a remarkable transformation in healthcare. Do you think something needs to happen in the public health domain so that you can impact the three and have healthier citizens in our country? Yes, in my opinion addressing affordability is crucial to improving healthcare in our country. The lack of affordability is a major reason why many hospitals are not being established. However, India is poised to become a global leader in disconnecting healthcare from wealth. In the next five years, every Indian will have health insurance. Significant changes have taken place in India’s health insurance sector, driven by passionate advocates of universal healthcare. This shift aims to redefine the current healthcare insurance model. The existing system has three key stakeholders: hospitals, insurance companies, and patients. Unfortunately, there is a lack of trust among these parties. Hospitals doubt the intentions of insurance companies, insurance companies are sceptical of hospitals, and patients have trust issues with both. This dynamic is unsustainable. The transformation will occur when hospitals take on the role of health insurance providers. When hospitals become accountable for the well-being of their subscribers, the entire paradigm shifts. Hospitals will invest heavily in primary care and early detection to keep patients healthy and out of the hospital. This realignment of interests between healthcare providers and patients is the key to a more accessible and affordable healthcare system in India. Do you think the medical education system needs to undergo change and if so, what kind of changes should be made to ensure quality is not compro- mised? Just because of quantity? There appears to be a significant gap not only between the demand and supply of doctors but also between what medical schools teach and what doctors practice today. This gap extends beyond just medical procedures and encompasses evolving technologies and skill sets required in modern healthcare. In our hospital, we’ve taken a proactive approach to address this issue in nursing education. Our nursing colleges provide a comprehensive education that includes six months of foundational learning and substantial time spent in our ICUs as assistants to experienced nurses. By the time our nurses complete their BSc in nursing over four years, they Advancements in healthcare have revolutionised procedures like heart surgeries. What seemed inoperable then can now be done easily. What used to take hours for heart surgeons can now be completed in just 15 minutes in a cath lab

32 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM COVER STORY are akin to professionals with three years of practical experience managing critically ill patients. Upon graduation, our nurses are immediately employed with a starting salary of nearly two lakh rupees. This model emphasises the importance of practical, hands-on training. Unfortunately, medical education often feels like teaching someone to swim in a classroom for ten years. When doctors eventually face real-world medical practice, they might feel ill-prepared. To bridge this gap effectively, medical education should transition to a more bedside-centric approach, where students learn by doing. This shift is already happening, and I believe it’s only a matter of time before these changes become more widespread and recognized in the medical field. You mentioned the trust deficit in the healthcare system today. How can the healthcare system actively work to rebuild patients’ diminishing trust in their healthcare providers? Building trust in healthcare requires eliminating the constant financial transactions between hospitals and patients. My vision is for a system where doctors primarily discuss treatment options, not money. Everyone should have health insurance, making a single annual payment, and hospitals should eliminate cash transactions to create a more patient-focused, trustbuilding healthcare environment. Any brand defines the culture of the institution and also the ethos of the founders and the leadership. And what is it that Narayana Health aims to stand for? We aspire to be wellness partners, not just hospital managers. Our vision extends far beyond hospital walls. We aim to be there for patients whenever they need us, even at 2 AM or while travelling. We have created digital tools for 24/7 connectivity. Healthcare is poised for a radical transformation with the seamless integration of doctors, nurses, technicians, administrators, patients, and machines through a digital platform. We have spent 20 years developing this platform, and we believe it will be a game changer. In the future, the world’s largest healthcare provider may have no beds; it will be software-driven. That’s our goal, and our redefined brand will reflect this vision. Are there any challenges as a hospital? As a person who’s leading the hospital, there’s a lot of responsibility in running the hospital that you feel needs to be addressed by the government. Is there any ask from the government? We are thankful to the government for reshaping the role of IRDA. The primary issue in Indian healthcare is financial accessibility. As soon as people have the means to pay through insurance or other channels, hospitals will proliferate, and skilled doctors will return from abroad. This transformation, I believe, will materialise within five years. We are heading towards World Heart Day. So, what would be your message to the medical fraternity and to the patients for the world? My message is how fit you feel has nothing to do with how fit you are. So to take care of your heart please go for a preventive healthcare check-up irrespective of your age. We aspire to be wellness partners, not just hospital managers. Our vision extends far beyond hospital walls. We aim to be there for patients whenever they need us, even at 2 AM or while travelling. We’ve created digital tools for 24/7 connectivity. In the next 5-7 years, we anticipate that around 90 per cent of beds will become ICU beds, while w a r d b e d s will transition to home care with remote monitoring by doctors Conversation with Harbinder Narula

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34 BW HE ALTHCARE OC T-NOV 2023 WWW.B WHE ALTHCARE WORLD.C OM By BW Team How do you think the healthcare sector has evolved in the last few years globally and how has the position of the Indian healthcare sector changed as the industry has evolved? Covid was the paradigm shift in the way the industry has changed and that was the inflection point for many of the innovations that have happened globally, and the Indian healthcare sector has closely mirrored global innovations and global standards. The major advances have been in the field of digital transformations and digital adoption. In an exclusive interview with BW Healthcare World, Dr Emmanuel Rupert, Group CEO & MD, Narayana Health speaks on the advancements in technology in Indian healthcare and how it is improving outcomes and patient safety Whether it is electronic health records or the use of telemedicine, which was at its peak during the Covid period and though many patients prefer to have in-person consultations nowadays but still, telemedicine has progressed tremendously. Because of this and the various use of healthcare applications through which patients have been engaged either for making appointments or for keeping their personal health records with them on the move, leading to very minimal medical errors. Now all the healthcare personnel have access to the patient’s health records. A lot of investment is happening in the care infrastructure, and we are also expanding across not only our core geographies of Karnataka and West Bengal and the eastern part of the country but we’re also looking into expanding within our existing hospitals. We’re adding new facilities and looking for opportunities which will add value to our entire system. How are technological advancements impacting healthcare delivery? Indian Healthcare Has Mirrored Global Innovations & Standards COVER STORY

WWW.B WHE ALTHCARE WORLD.C OM BW HE ALTHCAREOC T-NOV 2023 35 The advances in minimal access surgeries lead to a faster recovery period within the treatment protocols, it is due to small incisions, reduced pain and faster recovery. Robotics is not only for difficult areas, accessible, inaccessible areas like the Pelvic region, but if you look at it, we have also invested in robotics for knee surgeries. The recovery has been tremendous. You are practically pain-free and your physiotherapy requirements are far lower, and you can go home within a day or two and pharmaceutically you have ultra short-acting drugs for anaesthesia and for various other drugs. The recovery period is far, far shorter and we are able to send patients home. Patient education as to how to take care of themselves at home is also changing as remote monitoring at home is also giving them confidence that we can send them early. And keeping them unnecessarily in the hospital leads to unnecessary morbidities. So, these are all things which are rapidly changing leading to far better outcomes and patient safety. AI is helping us lead towards personalised care, which could further lead to preventive care. Can you share some cases of AI helping us in healthcare delivery? So, there is a lot of AI-based work happening in imaging in which various data sets have been trained for early detection of either a disease process or things which cannot normally be detected by a human high or because you look at too many points of interest. An AI in imaging can look at hundreds of points of interest, while a human eye may not be able to catch up with something like that. So, the imaging experts - radiologists are going to adopt. When they adopt a technology like this, it adds to their experience and they will be able to come up with early detections of many of the diseases which are there. But all these things are possible only if you have large data sets. So, digital transformation and digital adoption of capturing data is the first and most crucial part for us to do that. One of the most important things we have done is we have put a lot of effort into the adoption of various digital initiatives. We have linked almost all the equipment which is used in ICUs and very critical areas to our hosWe are also expanding across not only our core geographies of Karnataka and West Bengal and the eastern part of the country but we’re also looking into expanding within our existing hospitals. We’re adding new facilities and looking for opportunities which will add value to our entire system pital information systems. So, one does not need to have a very cumbersome process of capturing data. All our data is captured on a digital platform. The use case is - we have so much of ECGs being recorded every day across our patients. We see almost 3 million patients across our network in a year and practically, maybe more than 50-60 per cent of them will get an ECG. We started to capture these things in a DICOM image and our analytical experts along with our clinicians were able to train the model and the only other model was with Mayo Clinic. With this model, we are able to predict the functioning of the heart. So, we’ve seen the ECG pattern and we’ve seen the ejection fraction of a patient. Now we can predict that very accurately. So, if somebody is in the ambulance and they have ECG, it will tell you whether the heart function is low or high and if it is very low or very high then you need to go to a higher centre for care. So, a lot of innovations are coming in. This is a major work in progress over the next decade. You will see a major transformation in the way technology is used in medicine to prevent disease and early detection of disease. Conversation with Harbinder Narula

36 BW HE ALTHCARE OC T-NOV 2023 WWW.B WHE ALTHCARE WORLD.C OM We will try to do focussed expansions in places where we already have a strong presence, which is the eastern and southern part of India The Future Of Medicine Is Digital COVER STORY By BW Team Narayana Health, one of the biggest healthcare providers in India with a dominant presence in the southern, western and eastern part of the country went through a massive rebranding on 13 September 2023. The healthcare provider operates 47 healthcare facilities with 21 hospitals, 4 heat centres and 22 primary healthcare units. The rebranding exercise encompasses a new logo and reaffirmation of Narayana Health as an umbrella brand name for all its hospitals and other businesses. In light of this rebranding BW Healthcare World spoke to the group’s Chief Operating Officer, R Venkatesh on the rebranding’s impact on business and the why behind it. Venkatesh says that the rebranding exercise will standardise all healthcare verticals of Narayana Group with ‘One name,One Heart and One Mission’. “Narayana will serve as the universal nomenclature, ensuring consistent messaging across all healthcare verticals. All hospital units across the country will adopt the standardised name Narayana Health. It harmonises with our future vision of delivering integrated care wherein we take full responsibility for every aspect of our patients’ healthcare needs from prevention to treatment,” he states. Venkatesh further explained that the hospital group will also be focusing on primary and preR Venkatesh, Group COO speaks to BW Healthcare World on Narayana Health’s rebranding initiative, aggressive expansion plans and managing supply chain costs

WWW.B WHE ALTHCARE WORLD.C OM BW HE ALTHCAREOC T-NOV 2023 37 ventive care communities, and its relationships with stakeholders will be strengthened under the new brand. “In healthcare spending, only around 40 per cent is spent inside the hospital and 60 per cent is spent outside the hospital where we are not completely there. That is where we want to go through integrated care. The new brand identity is very essential during such a stage of diversification to foster growth and presence across the country,” he believes. Aggressive Expansion On Cards Venkatesh says that Narayana Health is aggressively looking at expansion plans in greenfield and in partnership ventures and that the rebranding at this stage is going to strengthen these partnerships in the near future. ment services through inbuilt hospital management software ‘Atma’. The company also has a business intelligence platform for advanced clinical and administrative decision making, he says. “Then there are lab automations to improve throughput and reduce the turnaround time for patients waiting for investigation reports. There are also Self Help kiosks at all hospital receptions for registration, billing and payments of patients that actually changes the overall experience. Narayana Health has invested in technology as we believe that the future of medicine is digital,” he opines. Sailing Through Supply Chain Costs Healthcare providers today are actively looking to cut costs and one department that they aggressively seek to slash costs from is supply chain management. On being asked about Narayana Health’s strategies, Venkatesh states that the organisation has been one of the most robust firms in terms of supply chain management. He says that the hospital chain has gone through challenges in Covid like other chains but the supply chain management since then has stabilised and has been efficient for the group, but headwinds still remain. “There are still a lot of headwinds which work against the cost controls in the supply chain due to issues such as rupee value fluctuations, increase in the duties and several other governing factors which can play a very important role in terms of cost aspects. But having said that, we constantly endeavour in terms of working on cost efficiencies, trying to benchmark costing of procedures with industry standards and see how we can improve on it,” Venkatesh concurs. Speaking about the plans, he explains that the company will improve its throughputs in the existing capacity and also plans tech driven service transformations inbuilt by the organisation for improved patient experiences in all the outpatient areas and in patient areas. “Then comes existing infrastructure upgrades, and finally fit for purpose extensions, both brownfield and greenfield. Looking to add capacity, by increasing the total number beds by more than 40 per cent in the next three to four years to come.” The hospital chain will do focussed expansion in eastern and southern part of India, Venkatesh says. “We will try to do focussed expansions in places where we already have a strong presence, which is the eastern and southern part of India primarily around Calcutta in West Bengal and other major cities of the state and adjoining states while also in Bangaluru in Karnataka. We have facilities in Delhi and in Gurugram as well, so, we will try to focus on building and consolidating these parts of the country,” he informs. Adding to that Venkatesh says the healthcare provider is also building on its clinical expertise, and clinical capabilities through high end equipment while also trying to work on increasing day care and short stay procedures. Tech Driven Health Provider Narayana Health has created many inhouse softwares and applications says Venkatesh and the company is open to sharing these with the industry. He says that the technology is implemented across the board in the organisation from online appointments and payment gateways, patient management or electronic medical records, and queue manageR VENKATESH Group COO Narayana Health Conversation with Shivam Tyagi

38 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM Srinivas Iyengar The adoption of generative AI is unprecedented, and we have hardly experienced anything like this yet How Generative AI Can Shape New Age Of Healthcare We have all witnessed Generative AI in g ener a l a nd C h a t GP T i n particular catching on like wildfire in the last couple of years. In fact, ChatGPT hit 10 million within 40 days of launch and crossed 100 million daily active users within two months – these are unprecedented numbers. There is significant interest to see how Generative AI will impact our lives and businesses across industries are trying to stay ahead of the curve by creating new applications that are built on ChatGPT or Bard. Breaking it down in the parlance of technology adoption curves, Large Language Models (LLMs) have now hit the peak of inflated expectations in no time, and this is typically the stage at which hype overshadows proof and most ecosystem players are looking for practical use cases to build on the momentum. I see there is tremendous potential with Generative AI which will lead to a definitive shift in the way most industries function. Potential impact of ChatGPT in healthcare Usually, the healthcare industry has been a bit slow in embracing new technologies, however with Generative AI and Chat GPT, I see a lot of momentum with the use cases being created. Such enthusiasm and interest are unprecedented in the healthcare space, and I am quite excited to see how things take shape. When traditional AI gathered pace, it was the fastest adoption of a new technology that most of us had witnessed. However, the adoption of generative AI is unprecedented, and we have hardly experienced anything like this yet. Generative AI’s Potential In Healthcare Summarising medical records: It could be as simple as a conversation between a doctor and a patient, there are already LLM tools which can summarise the entire discussion under different buckets like allergies, prescriptions, pre-existing diseases etc and load data into While many use cases can seem to be quite complex, they can be done quite efficiently using LLMs COLUMN

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCAREOC T-NOV 2023 39 With the amount of personal data that can be generated today – be it social determinants (SDOH) of a patient or data from wearables and other clinical ontological data, we can possibly predict certain diseases including Parkinson’s, strokes and other serious diseases EMRs. In fact, summarising a complex conversation of 30 minutes can be done by the time the doctor ends the call with pleasantries, so all the doctors must do is review and approve the final version. Answering questions: LLMs can understand vast sets of materials that are provided to it and start answering questions. The answers are not just retrieval of data from stored objects, but rather it would complete reasoning-based answers with surprisingly great accuracy. You must understand that LLMs are not fact databases, rather they are a reasoning database. Understanding biomolecular data: LLMs can be used to interpret biological and chemical data such as DNA and proteins and connect them to health conditions. This could help us enormously in drug research and development. LLMs can be trained on omics datasets to predict novel targets and their binding to appropriate candidates, screening against large chemical libraries, fast paced in-silico simulations to predict ADME properties and efficiently handling unstructured scientific data among many other benefits. Diagnosis: LLMs can analyse vast amounts of medical, social, and patient generated health data and assist in accurate diagnosis of diseases. Evidence based decision making is key to accurate diagnosis. For eg: Any subtle abnormalities in ECG could go unnoticed otherwise and LLMs can be more accurate in finding such subtle abnormalities. Personalised treatment planning: A person could be lactose intolerant and the same might not be visible to caregivers during treatment planning. LLMs can be used to build algorithms that pick up and examine a variety of patient related data elements to either forecast probability of complications due to certain treatment pathways or customise treatment protocols based on risk. Early disease detection and risk assessment: With the amount of personal data that can be generated today – be it social determinants (SDOH) of a patient or data from wearables and other clinical ontological data, we can possibly predict certain diseases including Parkinson’s, strokes and other serious diseases or even provide predictions and alerts. While many of these use cases can seem to be quite complex, they can be done quite efficiently using LLMs. Industry leading hospitals and EMR companies are already working closely with LLM technology development companies to build use cases that are quite ahead in the development life cycle. Often, the success of many businesses is dependent upon identifying an inflection point and building the capabilities required to capitalise on the resulting opportunities. We are clearly at an inflection point with the advent of Generative AI and healthcare companies would be wise to leverage its potential to provide personalised and future ready care experiences. SRINIVAS IYENGAR VP & Head Healthcare & Life Sciences Happiest Minds Technologies

40 BW HE ALTHCARE OC T-NOV 2023 WWW.B WHE ALTHCARE WORLD.C OM Sudhanshu Mittal I n recent years, artificial intelligence (AI) has emerged as a transformative force across various industries. The healthcare sector also has not remained untouched and has witnessed remarkable advancements. AI’s impact on primary healthcare has been revolutionary, paving the way for improved diagnostics, personalised treatments, and enhanced patient care. With its ability to process vast amounts of data and learn, AI has the potential physicians make well-informed decisions. AI-powered diagnostic tools can detect patterns that might be missed by human clinicians, leading to early detection and intervention in diseases such as cancer, cardiovascular conditions, and infectious diseases even before any symptoms are visible (which often may be very late in the treatment cycle). In primary healthcare settings, where resources and specialist expertise may be limited, AI-based diagnostics can significantly improve tions, minimising trial-and-error approaches and optimising patient outcomes. AI algorithms can also monitor patients in real-time, analysing physiological data and making recommendations for adjustments in treatment plans, leading to improved patient adherence and better disease management. Remote Patient Monitoring AI has played a crucial role in bridging the gap between patients and healthcare providers, especially in primary care settings. Remote patient monitoring, facilitated by AIpowered devices and applications, allows primary care providers to to revolutionise the way primary healthcare is delivered, making it more efficient, accurate, and accessible than ever before. Diagnostic Efficiency Accurate and timely diagnosis forms the cornerstone of effective healthcare, and AI has proven to be a game-changer in this regard. AI algorithms coupled with machine learning enable primary healthcare providers to analyse patient data, including medical history, symptoms, and test results, with exceptional precision. By analysing this data against vast databases and medical literature, AI can suggest early diagnoses, helping patient outcomes by acting as assistant to the specialist by analysing the medical imaging scans, such as X-rays or MRIs. Personalised Treatment One of the key advantages of AI in primary healthcare is its ability to deliver personalised treatment plans tailored to individual patients. By leveraging patient data and algorithms, AI can analyse vast amounts of information, such as genetic profiles, medical histories, and lifestyle factors, to recommend treatment options that are best suited for each patient. This level of personalization empowers primary healthcare providers to offer targeted intervenLeveraging AI To Revolutionise Primary Healthcare AI’s impact on primary healthcare has been revolutionary, paving the way for improved diagnostics, personalised treatments, and enhanced patient care COLUMN

WWW.B WHE ALTHCARE WORLD.C OM BW HE ALTHCAREOC T-NOV 2023 41 mary care providers can focus more on direct patient care and spend valuable time building relationships and delivering personalised healthcare. The integration of AI into primary healthcare has immense potential to transform the way healthcare is delivered. By leveraging its capabilities in diagnostics, treatment planning, remote patient monitoring, and resource optimisation, AI enables primary care providers to deliver more accurate, efficient, and patient-centred care. As we use AI capabilities, it is also very well understood that AI can never replace human healthcare providers but rather act as a valuable tool to augment their skills and expertise. Collaboration between AI systems and healthcare professionals is crucial to ensure the ethical and responsible use of AI in primary healthcare while prioritising patient privacy and data security. As AI continues to evolve and its applications in healthcare expand, primary healthcare stands to benefit significantly from the increased accessibility, accuracy, and efficiency that AI brings to the forefront. The future of primary healthcare is undoubtedly intertwined with the possibilities presented by AI, promising a new era of improved healthcare outcomes for patients worldwide. track patients’ health conditions outside of traditional clinic visits. Wearable devices, sensors, and mobile applications collect and transmit real-time data, such as heart rate, blood pressure, and glucose levels, to healthcare providers. These can also monitor health behaviours, such as exercise routines, sleep patterns, and medication adherence to enable the consulting physician to predict the potential problems. This continuous monitoring not only enhances patient convenience but also enables early detection of potential health issues. AI algorithms analyse the incoming data, alerting healthcare professionals to any concerning patterns or anomalies, which can then trigger proactive interventions. This approach reduces the burden on primary care facilities, ensures more precise monitoring, and empowers patients to take an active role in their own healthcare management. Healthcare Resource Optimisation Primary healthcare often faces challenges such as limited resources, staffing shortages, and long waiting times. AI driven virtual assistants and chatbots can help address these issues by providing patients with instant responses to their queries, offering basic medical advice, and helping schedule appointments. AI-powered systems can analyse appointment scheduling data, patient flow, and historical data to predict demand, enabling clinics to optimise staffing levels, reduce wait times, and improve overall patient experience. Additionally, AI can automate routine administrative tasks, such as data entry, appointment reminders, and prescription refills. By freeing up administrative burdens, priAI-powered systems can analyse appointment scheduling data, patient flow, and historical data to predict demand, enabling clinics to optimise staffing levels, reduce wait times, and improve overall patient experience SUDHANSHU MITTAL Head & Director Technical Solutions, nasscom CoE IoT & AI

42 BW HE ALTHCARE OC T-NOV 2023 WWW.B WHE ALTHCARE WORLD.C OM INDEPTH By Shivam Tyagi In terms of annual Scope 2 Greenhouse Gas (GHG) emissions, hospitals released 7.7 million tonnes of carbon dioxide (CO2) into the atmosphere in the financial year of 2019 to 2020 The Indian hospitals consumed 9 per cent of India’s commercial electricity consumption in FY 2019-20, a new report titled ‘National Hospital Energy Consumption Survey’ by National Centre For Disease Control (NCDC) has revealed. The study conducted jointly by NCDC, Centre for Chronic Disease Control (CCDC) and Alliance for an Energy Efficiency Economy (AEEE) found that in terms of annual Scope 2 Greenhouse Gas (GHG) emissions, hospitals released 7.7 million tonnes of carbon dioxide (CO2) into the atmosphere in the financial year of 2019 to 2020. Over the course of 2.5 years, a total of 623 hospitals subsuming 357 public and 266 private were surveyed for the report. Scope 2 emissions are indirect emissions produced by purchased energy that an organisation buys and consumes. Overall the healthcare industry is responsible for close to 5 per cent of global GHG emissions which is bigger than industries like shipping and aviation. The survey found that electricity from the grid, on-site solar PV, and on-site diesel generators comprise more than 90 per cent of a hospital’s energy supply. Notably, the penetration of on-site solar PV was lesser in public hospitals at 11 per cent than in private hospitals at 17 per cent. The study also found that in public hospitals the maintenance of the Carbon Footprint Of Hospitals Needs A Relook Carbon Footprint Of Hospitals Needs A Relook

WWW.B WHE ALTHCARE WORLD.C OM BW HE ALTHCAREOC T-NOV 2023 43 The government entities need to take the lead in collecting this data. There are many institutions in India, AEEE and CCDC are two of them. So this has to be a multidisciplinary effort as we have more than 250,000 healthcare facilities Investing in energy efficiency for hospitals may prove expensive to start with, but in the long run, the returns on investment in terms of energy cost savings, and environmental friendliness will all come as a boon POORNIMA PRABHAKARAN Senior Research Scientist CCDC SATISH KUMAR President and Executive Director AEEE solar PV plant was not effectively conducted in public hospitals. Some of the hospitals surveyed even indicated that the solar PV plants’ components needed detailed repairing and replacement. It was also observed that the healthcare facilities are not using solar PV systems as a source for backup and are relying only on diesel generators during the hours of power supply failure to provide critical services. “I think it’s due to a trust deficit as well as the solar PV systems not integrated with onsite battery systems which makes the reliability come down. Healthcare services are critical and cannot be put on chance and that’s the reason they prefer to rely on on-site diesel generators,” stated Akash Goenka, one of the lead contributors of the report and Team Lead at AEEE. The NCDC report further noted that non-renewal of annual maintenance contracts was common in public hospitals which indicates that deploying solar energy in the public health system needs an integrated approach through governance and financing mechanisms to ensure sustained uptake and scale-up. “About 11 per cent of public hospitals have on-site solar PV systems, but they are not maintained very well, sometimes they are defunct, broken, or their O&M is not done regularly. And that’s the reason why we have recommended as part of this report, that the tendering process should include at least a minimum five-year Annual Maintenance Contract (AMC), which has to be provided by the organisation installing the solar PV,” Goenka explained. Energy Consumption By HVAC Systems In many large hospitals, the major energy consumption is driven by the Heating, Ventilation, and Air Conditioning (HVAC) systems. The survey found that Direct Expansion (DX) air conditioning systems, which encompasses, Window ACs, Split ACs, Packaged ACs, Variable Refrigerant Flow (VRF), and others, emerged as the most prominent HVAC type in the surveyed hospitals. Private hospitals exhibited a lower percentage of No HVAC facilities, with 21 per cent without any HVAC systems, compared to 44 per cent of public hospitals. Private hospitals also had a relatively higher prevalence of central air-conditioning systems, accounting for 14 per cent of their installations, in contrast to the 7 per cent observed in public hospitals. Moreover, in private hospitals, the average air-conditioned area is approximately 34 per cent, the study noted. Hospitals’ Unaware About BEE Rating Systems While analysing the BEE star ratings, the survey found that more than half

44 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM of the hospitals installed ACs labelled as 3-5 stars but many were also unaware of the ratings. “Notably, the survey revealed that information regarding BEE star ratings was unavailable for approximately 18 per cent of the installed cooling capacity of Split ACs in public hospitals. In private hospitals, a smaller percentage of 6 per cent for Split ACs and 5 per cent for Window ACs were reported as ‘Not Aware’ of BEE star ratings,” the findings of the report said. Goenka highlighted that the heads of the many small hospitals are multitasking with their core expertise being medical treatment and not energy efficiency. He said the expertise tends to increase with the size of hospitals where there is an engineering staff or an O&M staff available but particularly in the subcentres or primary health centres, the resident doctors are entrusted with running the facility. On being asked about domain expertise in hospitals around sustainability Goenka said, “I am not so sure if Chief Sustainability Officer was the norm. Maybe it is a growing trend, but at the time when we went, maybe there were some but there weren’t too many clearly. The likes of Apollo, Medanta, and Fortis have a keen interest in the subject but that needs to be expanded from one-off interventions to sustained continuous interventions where one is continuously tracking energy consumption.” Poornima Prabhakaran, a lead contributor to the report and Senior Research Scientist, CCDC said that investing in energy efficiency for hospitals may prove expensive to start with, but in the long run, the returns on investment in terms of energy cost savings, and environmental friendliness will all come as a boon. Highlighting some of the challenges Prabhakaran added that some states have shown progress but all states have not been able to increase solar energy penetration, maybe because of funding constraints, capacity issues or the actual implementation on the ground. Transparency In Energy Data Among the recommendations made by the report which suggest striving for energy efficiency, tracking energy consumption and energy transition, the report also calls for a transparent energy data regime. The report calls on the government to establish standardised protocols for data measurement, monitoring, and reporting by hospitals. Satish Kumar, President, and Executive Director, AEEE said, “Our recommendation is that government entities need to take the lead in collecting this data. There are many institutions in India, AEEE and CCDC are two of them. So this has to be a multidisciplinary effort as we have more than 250,000 healthcare facilities. But a sample size of less than 1,000 can collect data pretty well for all states.” Prabhakaran further said that within the program itself, it can be mandated that all healthcare facilities should document their energy consumption, weekly or monthly. About 11 per cent of public hospitals have on-site solar PV systems, but they are not maintained very well, sometimes they are defunct, broken, or their O&M is not done regularly AKASH GOENKA Team Lead AEEE INDEPTH

46 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM By Team BW The world of competition is nothing new and we strive to be the first choice and we put ourselves in the positions of our surgeons and hospitals INTUITIVE STRIVES TO BE THE FIRST CHOICE How big is the opportunity for Intuitive in India for growth? From what I have seen so far from my visit to India where I met surgeons and saw their passion, if that is any indication of what’s-possible, the opportunity is tenfold of what we see today, and I am confident of that. Do you get any pushback from the surgeons to adopt robotics? Yes, there’s always pushback. If you think about how people adopt any technology, you always have visionaries, you always have laggards, and then you have the people in between. And everybody adopts for different reasons. But if I were to go back a decade and then compare and contrast today, the conversations have changed. First off, I truly believe every surgeon wants to do what’s best for their patient. So, they care about outcomes. There’s now India specific data that shows that the outcomes are better against the open surgery and the laparoscopic results. Surgeons are able to show that not just to patients, but their peer surgeons. Hence, first off the pushback is decreasing because the confidence in the DA Vinci robotic surgery is increasing. Secondly, I think the outcomes, the ability of surgeons, the confidence that they’re going to be able to get the outcomes through the ecosystem, and then the third, the fact that there is now more access In a conversation with BW Healthcare World, Henry Charlton, SVP and Chief Commercial and Marketing Officer, Intuitive speaks on the robotic assisted surgeries and its increasing outcomes.

WWW.BWHEALTHCAREWORLD.COM BW HE ALTHCAREOC T-NOV 2023 47 The manufacturing decision will be independent because we’re holding ourselves accountable to the present and are we actually delivering upon the present mission? And then we will look at manufacturing India as a completely separate conversation the reduction in post operative care and we hold ourselves accountable to each one of those. We try to deliver on the results, deliver on the expectations the hospitals have and the surgeons have, and be measured by it. And how would you further this ecosystem? Are there any initiatives that you’re looking at? Ecosystems are evolutionary. The question is, how did we come up with an ecosystem, every day we are learning. Over the last 20 years, there have been tens of thousands of surgeons, nurses and care teams who have gone through our training programs. So, we learn how they learn. And very few humans learn the exact same way. So one has to have a framework - the ecosystem that is the technology, and it’s not just what they use to operate, it’s the digital infrastructure behind it to help educate them. It’s the investment in education talent and training centres. Then there are global partnerships. The Royal College of Surgeons recently gave global accreditation to intuitive training centres. The centres now will be able to leverage the learnings of NHS England. The problems we’re trying to solve are the same globally. So, streamlining that ecosystem and delivering it here in India is what it’s all about and that is going to require investments in India and then bringing investments into India. have a leadership status in India and what are the initiatives that you are taking on to ensure that this leadership status is maintained for Intuitive? I’ve been with Intuitive for almost 20 years now and there have always been alternative choices. May not be robotic, but there were alternative surgical approaches. The world of competition is nothing new and we strive to be the first choice and we put ourselves in the positions of our surgeons and hospitals. The way that we want to be measured is based upon the objectives hospitals are trying to achieve. Most hospitals and healthcare systems, private or public, are trying to improve patient outcomes in a quantifiable manner. They’re trying to improve the efficiency and wellness of their care teams. While also improving the overall patient’s experience, not just in the hospital, but also through insurance and with the government support envisioned, I believe those three things are changing that conversation. But you will always have resistance. We know the Indian government has been talking about making India. So how do you see India as a priority and focus when it comes to manufactur- ing? I can’t speak about that right now, is the short answer. What we’re focusing on right now is making sure that for the DA Vinci robots and the programs that are here, every program becomes the best advertisement and that means the surgeons that are getting trained are getting great outcomes. They’re doing it in the most efficient manner within the hospital, and it’s done in the most cost effective manner. The manufacturing decision will be independent because we’re holding ourselves accountable to the present and are we actually delivering upon the present mission? And then we will look at manufacturing India as a completely separate conversation. In the robotic space, you Conversation with Harbinder Narula

48 BW HE ALTHCARE OC T-NOV 2023 WWW.B WHE ALTHCARE WORLD.C OM COLUMN By Dr Hrishikesh Pai Healthcare practitioners and the government need to strengthen their resolve to ensure every woman has access to highquality, safe, and respectful care no matter where she seeks it Access to quality maternal health is every woman’s right and not just a luxury available to some. In the global discourse on human rights, one aspect that doesn’t receive as much attention as others is respect in maternal care. The concept of respectful maternal care has evolved significantly over the past few decades to include diversified perspectives and frameworks from communities across the globe. Respectful Maternity Care (RMC) has evolved from being an essential aspect of quality healthcare to being recognised as a fundamental human right of every childbearing woman. The global discourse on respect in maternal care prompted the World Health Organization (WHO) to release a statement in 2014, urging the prevention and elimination of disrespect and abuse during childbirth. Rethinking Respect In Maternal Care Respectful Maternity Care (RMC) has evolved from being an essential aspect of quality healthcare to being recognised as a fundamental human right of every childbearing In 2016, WHO further reinforced this by issuing enhanced guidelines that emphasised the importance of ensuring respectful and dignified treatment for expectant mothers and newborns. Unfortunately, women and newborns from underserved, marginalised, and ethnicminority communities often fall victim to obstetric violence, enduring disrespect and abuse during maternal care. Due to limited alternatives, they either endure this suffering or opt out of accessing maternal facilities during childbirth altogether. This dire situation contributes significantly to the persistently high rates of maternal mortality, making it one of the most pressing health tragedies of the 21st century. In the context of India, there has been remarkable progress in the field of healthcare services in recent decades which has resulted in a considerable drop in maternal and neonatal morbidity and mortality rates. Concerted efforts to provide accessible quality maternal and newborn

WWW.B WHE ALTHCARE WORLD.C OM BW HE ALTHCAREOC T-NOV 2023 49 ternity caregivers can either empower and comfort her or inflict lasting damage and emotional trauma. According to a study, mistreatment of parents and newborns during birth is often ‘normalised’ in the hospital culture and accepted as a given if one wants to avail the healthcare services offered by the health system. The matter is further exacerbated by a lack of awareness of patients’ rights, gender discrimination and deficiency in clinical empathy skills. To establish a culture of respectful care a comprehensive multi pronged approach can be leveraged to ensure that the patient is always held in utmost priority. The first step to this begins by foregrounding the necessity to build awareness within the community. Women and their families should be empowered to demand respectful maternity care (RMC) as their basic right. This starts with sensitising them to the concept of respectful maternal care and the rights of expectant mothers. Secondly, a holistic capacity-building outlook for healthcare providers needs to be adopted, with a focus on both - soft and technical skills, since they are at the frontline of the birthing process. In this context, training and sensitisation programs to inculcate values of respectful and compassionate care become essential. In India, recently a few quality improvement initiatives with specific modules on respectful maternal care have come up which focus on encouraging and welcoming the presence of a birth companion during labour, treating the pregnant woman and her companion cordially and respectfully, ensuring privacy and confidentiality for the woman during her hospital stay, explaining danger signs and important care activities to the woman and her companion. Lastly, to systematise respectful and dignified care, changes must be brought in at the policy level. WHO’s “Quality of Care Framework” for maternal and child health includes both the provision of care, and the experience of care as equal determinants of quality of care. This is significant as it positions RMC as a critical quality of care issue and not exclusively as a human rights issue. While there have been positive strides to provide equitable and respectful care to mothers across communities in India, there is a lot left to be done. There is an imminent need to break the silos and propagate multisectoral collaboration to improve health equity and quality care for women. Healthcare practitioners and the government need to strengthen their resolve to ensure every woman has access to high-quality, safe, and respectful care no matter where she seeks it. According to a study published by the Lancet, globally greater than one-third of all women experience mistreatment during facility-based childbirth. This figure indicates that there is a long way to go in making maternity care more respectful and dignified health services and minimise preventable maternal deaths under the National Health Mission (NHM) have led to the MMR declining from 130 in 2014-16 to 97 per 100,000 live births in 2018-20. However, many women still experience disrespectful, abusive, or neglectful treatment in health institutions during childbirth. According to a study published by the Lancet, globally greater than one-third of all women experience mistreatment during facility-based childbirth. This figure indicates that there is a long way to go in making maternity care more respectful and dignified. Childbirth marks an intensely vulnerable time for a woman and memories surrounding the experience stay with her throughout her life. Her interactions with maDR HRISHIKESH PAI President FOGSI

50 BW HE ALTHCARE OC T-NOV 2023 WWW.BWHEALTHCAREWORLD.COM By Harbinder Narula In an exclusive conversation with Harbinder Narula, Dr Justin F Gainor, Assistant Professor, Medicine, Harvard Medical School and Assistant in Medicine, Massachusetts General Hospital speaks on the evolving realm of diagnosing and treating lung cancers with targeted therapies and immunotherapies DR JUSTIN F GAINOR Assistant Professor, Medicine, Harvard Medical School and Assistant in Medicine, Massachusetts General Hospital