Management Discussion and Analysis Industry Structure & Developments General Overview — The Healthcare Ecosystem in India India has progressed on several parameters since economic liberalisation started in 1991. However, even as the country has made giant strides in manufacturing, services, research & development and in developing a vibrant economic landscape, it continues to progress slowly on several social indicators. In India, the under-development of healthcare infrastructure is largely attributed to under investment by the public sector. India lags far behind as far as healthcare spending is concerned in comparison to the global average. In India, healthcare spend as a percent of total GDP stands at 3.8% as compared to the global average of 8.6%.The per capital healthcare expenditure in India stands at $58 as compared to $1,025 which is the global average. Bed availability in India stood at 7 per 10,000 in 2015 which was significantly lower than the global average of 27 beds for a population of 10,000. In terms of availability of medical staff, the number of doctors and nurses available for every 10,000 population was at 7 and 17.1 in India compared to the global average of 13.9 doctors and 28.6 nurses per 10,000 population. The relatively lower penetration of Medical Insurance has resulted in high out-of-pocket health expenditure at 86% as compared to 52% which is the norm globally. Due to the large deficit in investment in healthcare in India and the lack of emphasis by the public healthcare sector on elevating socio economic indicators, there has been a significant gap in the supply of healthcare services of an acceptable standard leading to a significant emergence of private healthcare service providers in the country. Today, the private healthcare sector in India has evolved into a vibrant industry accounting for around 70% of the country's total healthcare expenditure. Large investments by the private sector players are likely to contribute significantly to the development of the sector which is poised to reach $280 billion by 2020, witnessing a compounded annual growth rate (CAGR) of 22.9 per cent during 2015-20. This is mainly due to the brvalence of favourable dynamics which are expected to sustain the demand for healthcare. Having seen the private sector deliver outstanding results with limited resources, the bar has been raised for standards of healthcare for citizens of the country. The public sector has recalibrated its focus and accelerated its effort and outlay towards the sector. The Government of India in the 12th five year plan (2012-17) has focused on providing universal healthcare, strengthening healthcare infrastructure, promoting R&D and enacting strong regulations for the healthcare sector. The NITI (National Institution for Transforming India) Aayog has allocated $55 billion under the 12th Five-Year Plan to the Ministry of Health and Family Welfare, which is about three times the actual expenditure under the 11th Five-Year Plan. Additionally, the Government of India has also been actively integrating other landmark legislation to support the evolution of the healthcare ecosystem in the country. The initiative to leverage the Aadhar Card to provide Healthcare under the Primary Health Centre (PHC) plan is an encouraging move. Under the PHC Plan, the Government plans to have 1 PHC for a population of 5,000 people in the rural centres and 1 PHC for every 10,000 people in the urban areas. An increased healthcare spend as a percentage of GDP, enhancing legislation to encourage growth of the sector, rapid adoption of technology, easing the flow of capital into the sector and incentivizing the development of required skills to address the shortage of medical personnel while simultaneously enhancing workforce utilization are key areas of focus which will fuel the next stage of growth in the sector. The Government and the private sector will need to collaborate in order to address the large and dynamic challenges that the country is facing today in the healthcare sector. The Healthcare Services delivery landscape in India The Healthcare sector in India is categorized under Hospitals, Pharmaceutical companies, Standalone Pharmacies, Medical Insurance,Retail Healthcare, Medical Tourism and Telemedicine. While the retail healthcare formats like of primary healthcare centers, day care and short stay surgery centers and home healthcare are gaining significance in recent years, Hospitals stills remain the brdominant outpost for the delivery of healthcare services in India. Within hospitals, the private sector accounts for a majority of the total healthcare expenditure in India. In India, the public health expenditure as a percent of total health expenditure has been increasing over the last few years. This expenditure increased from 27 percent in 2011 to 30 percent by 2014 There have been some important initiatives undertaken by the Government of India to improve the availability and accessibility to Healthcare while ensuring improvement in Human Development Measures. The eradication of polio, notable reduction in HIV / AIDs incidence, encouragement of traditional healthcare systems and practices and initiatives to reduce br-natal mortality rates have been significant initiatives showing up as green shoots across the healthcare landscape. There have been endeavours to leverage private sector efficiencies and capacities through the Public Private Partnerships (PPPs) model. The inconsistency in the distribution of healthcare services across the country is a major concern which needs to be addressed. Existing infrastructure in the rural areas does not make it conducive for quality healthcare to sustain, causing inadequacies in meeting the ever growing needs of a major portion of the Indian population. The urban areas on the other hand, which account for a smaller proportion of the population, has been enjoying better availability of healthcare infrastructure. None-the-less, the private healthcare sector in India, is gearing up to match global healthcare delivery models. The growth of the private sector is expected to continue going forward. They possess technical and managerial skills, and are innovative and flexible in the deployment of resources. They are perceived to provide personalised quality services with greater efficiency than public hospitals. The private healthcare sector is expected to grow consistently with support of macro-economic policies that recognize the healthcare sector as an industry and provides for stimulus to private sector investment through tax concessions. Additionally, the willingness of the people to pay for health services, along with support from the government aimed at de-bottlenecking the sector will add impetus to the growth of the private sector. The hospital and diagnostic centers space attracted foreign direct investment (FDI) worth $3,074.01 million or Rs. 163.14 billion between April 2000 and March 2015, according to data released by the Department of Industrial Policy and Promotion (DIPP). This industry is growing at a tremendous pace owing to its extended coverage, range of services and increasing expenditure by public as well private players. Large investments by private sector players are likely to contribute significantly to the development of India's hospital industry, as they already rebrsent around three-fourths of the healthcare services market. Some of the key characteristics of the healthcare sector in India are as follows - Population growth, demographics & rising per capita income Nearly 8 per cent of the Indian population was above the age of 60 years in 2011. This proportion is expected to climb to 12.5 per cent by 2026. Given this, India is faced with the dual challenge of making good the current deficiency in healthcare infrastructure as well as in planning for future requirements. While it is considered as a country with a large proportion of population below the age of 30, the country will have a significant population of middle-aged persons leading to a corresponding increase in demand for healthcare delivery systems and services.The per capita income in India has grown by 60% from $797 in 2006 to $1,262 in 2014 and with a growing younger population this growth in per capita is expected to rise further leading to a rise in the demand for healthcare delivery and better infrastructure in the future. Gap in Health Infrastructure between urban and rural areas The per capita income is higher in the urban cities as compared to the rural areas and supported with a better infrastructure, the concentration of private healthcare service providers has been largely towards urban areas. These areas are now home to a wide variety of healhcare facilities offering single specialty, multi-specialty,primary care, quaternary care alongwith personalised value added services. On the other hand a historically low public spend, lack of infrastructure and the focus of private players on urban areas has left rural India far behind in the healthcare space. Thus there is a vast disparity in offerings between the metros and urban centers vis-a-vis the semi-urban and rural areas in the country. Business Models Innovated for better outcomes The last two decades have seen the emergence and growth of private hospital chains, single specialty chains and boutique healthcare centers in India. Unlike the traditional standalone hospital offerings, today private players are adapting their health care service delivery models to cater to the growing needs of young India. The idea is to create an awareness of the importance of healthcare and make it more conducive to the needs of the people. These business models have proven effective in increasing efficiencies through higher volumes resulting in reduced costs £ and at the same time delivering comparable quality standards and success rates. The services of most hospitals at a single location are being replaced by multiple touch points such as Standalone clinics, diagnostic centers and pharmacies. Rapid emergence of Medical Tourism India is highly cost competitive compared to the developed countries and certain Asian countries and hence constitutes a very attractive destination for foreign patients which has given rise to the medical tourism industry. According to an MTA (Medical Tourism Arrivals) patient survey report, nearly 80% of the demand for medical tourism is driven by cost savings and the table below gives a very good rebrsentation of the same. Superior quality healthcare, coupled with low treatment costs in comparison to other countries, is benefiting Indian medical tourism which has, in turn, enhanced the prospects of the Indian healthcare market. Treatment costs for major surgeries in India are approximately 20 per cent of that in developed countries. As per a recent KPMG Report, the size of the medical tourism market was estimated to be around $3.6 billion in 2015 which is expected to reach $10.6 billion by 2019 rebrsenting a CAGR of 30%. India has developed a strong brsence in providing advanced healthcare services, for example, organ transplants and cardiovascular procedures with success rates comparable to that developed countries. Moreover, reduced waiting time in hospitals for admissions and treatment makes the country an attractive destination for medical tourism. The role of the government towards supporting the medical tourism industry has also been increasing. The government has introduced a separate category of medical visa: M-visa which can be extended for an additional 12 months beyond the one year issue period. A faster clearance process has been initiated for medical tourists at the airports. Moreover, ease of connectivity combined with well-developed infrastructure (medical and non- medical) in several regions has enabled growth in medical tourism. Good connectivity to several GCC countries and a possible extension to other countries in Africa and South East Asia regions would help in tapping a large volume of medical patients in these regions who seek better medical facilities. Increasing influence of Technology in healthcare delivery The market for medical technology in India is small at brsent, but rapidly expanding. It is important for healthcare players to understand the importance of the medical technology landscape and keep upgrading their technological know how to keep pace with their global peers. The Government of India, in its endeavour to contribute towards this space, has rightly taken certain initiatives to bring about improvement in the healthcare sector. One such initiative is the launch of 'Sehat" in 2015, - a telemedicine initiative. Telemedicine can provide access for basic, specialty and super-specialty requirements to the rural population. Telemedicine has enormous potential in meeting the challenges of healthcare delivery to rural areas. Technology is advancing rapidly and the ability of the physician to take decisions regarding their patients condition is much greater now. The government also offers income tax incentives for domestically manufactured medical technology products. Increasingly robotic technologies are being utilized in functions such as medication distribution, surgery and even diagnosing patients. Robotic Surgery has been developed to overcome both the limitations of Minimally Invasive Surgery (MIS) and enhance the capabilities of surgeons performing open surgeries. Greater adoption of Robotic surgeries would provide an impetus to the growth of medical tourism in India. A shortage in the number of doctors and medical practitioners poses constraints on the quality of treatment provided by hospitals and nursing homes. This situation is compounded manifold in rural regions which don't have access to tertiary healthcare facilities .The initiative that has been introduced to combat the shortage of doctors in distant areas is to link up these centres with a central command center of a well-equipped hospital -usually in urban areas, through a facility called as an eICU. Simply put, an eICU facilitates the real time monitoring of a patient's vital parameters and condition - from a remote location, through doctors located in a different place known as the command center. Such initiatives have proven to be a blessing for patients who need immediate assistance and do not have access to specialists, surgeons etc. Digital Health Knowledge Resources, Electronic Medical Record, Mobile Healthcare, Electronic Health Record, Hospital Information System are some of the technologies gaining wide acceptance in the sector. Standalone Pharmacies Although largely fragmented, standalone pharmacy stores comprise a major chunk of the overall market. This sector has delivered a CAGR growth of 19.4% during 2010-15 and is projected to exhibit a CAGR of over 14.22% during 2015 - 2020. This is attributed to the robust expansion plans of the Standalone Pharmacy players coupled with increasing health awareness amidst consumers. There has been competition amongst stores and consolidation among private players. Moreover, introduction of private label brands is further anticipated to boost the overall Standalone Pharmacy market in the coming years. The Industry continues to be fragmented in nature due to the overwhelming brsence of the unorganized segment or stand-alone units. However, organized players are gaining increased acceptability amongst the Indian consumers and have been gradually expanding their market share. With a specialized focus on the quality of retail services they have brought customer centricity to the fore. The market for Standalone Pharmacies is likely to be enhanced with the increase in government spending on the health care sector along with initiatives taken to increase health related awareness in rural regions of the country. Additionally, the increasing disposable income of the Indian population has contributed significantly to the growth of the market due to the rising need for personal healthcare. Emerging health trends are also the main causes observed as the key growth drivers of the Standalone Pharmacy market in India as they drive the sale of medicines. This trend has developed due to a huge increase in the scale of urbanization and working population in the country. The growth of the Indian OTC market has been one of the fastest in the world. The concept of the online pharmacies which has changed the global pharmaceutical distribution chain quite significantly is yet to meaningfully emerge in India. According to market sources, it is expected that the online pharmacy model could account for 5 to 15 per cent of the total pharma sales in India, largely by attracting discerning customers and enhancing access to a part of the under-served population. With the Indian population getting more tech savvy, private players will soon have to cater to this growing need of their customers. The online pharmacy stores market in India is primarily developing in metro cities and large urban areas across the country. Health Insurance The past few decades have seen insurance come a full circle. Together with banking services, insurance services add about 7% to the country's GDP. A-well developed and evolved insurance sector is a boon for economic development as it provides long-term funds for infrastructure development, and at the same time strengthens the risk taking ability of the country. The general insurance business in India is currently at Rs.780 billion in terms of Gross Written Premiums and it is growing at a health rate of 17%. Health insurance is one of the fastest growing segments of general insurance. There is no doubt that health insurance is an indispensable healthcare financing tool. Over the last few years, awareness and acceptance of health insurance has increased manifolds especially amongst the urban Indian population. Also, health insurance brmiums have been registering a significant CAGR of 24.6% in the brceding 10 years. Having said that, health insurance penetration remains well below global standards. Today almost 80% of the Indian population is still not covered under any public or private health insurance scheme to support health expenditure. This provides a significant opportunity for development of the health insurance market in India. It can be noted that brmium collection in health segment continued to surge ahead, registering a growth of 22.4% from Rs.202.56 billion in FY 2014-15 to Rs.247.84 billion in FY 2015-16. Also, the market share of health segment in the non-life segment in FY 2015-16 is 27.8% registering a marginal increase form the brceding year's share of 26.73%. During FY 2015-16, stand-alone health insurers contributed 16.01% of total health insurance brmiums, which increased by 2.07% over the brvious year's market share. Future scope of health insurance With about 28% market share in the non-life industry at brsent, the health insurance segment in India has a significant role to pay in covering various sections of the population who are not covered under any health insurance scheme. According to an IRDA report, with a projected insurable population of about 1 billion for health insurance by 2025, the average life expectancy is expected to reach 74 years by 2020 (from the existing 66 years). Healthcare needs are also expected to witness a significant reduction from out-of-pocket spends, which currently rebrsent around 86% of payments to healthcare service providers. The healthcare sector is growing at a 15% CAGR and from a market size of Rs.5,100 billion achieved in 2012, it is expected to touch a size of Rs.10,300 billion by 2017. Hence there is an immense potential for health insurance to grow. Retail Healthcare The Retail Healthcare business is emerging as a significant opportunity in the healthcare landscape and is providing sizable untapped avenues which will further drive the penetration of Indian healthcare service providers across the landscape going forward. They include Primary Care Clinics, specialised birthing centers single specialty clinics, primary health centers and diagnostic chains, apart from Dental, Daycare and Home Healthcare formats. The delivery format being fairly new, the market remains fragmented given the uneven distribution of income, poor infrastructure facilities, lack of awareness among under privileged patients etc. However, with increasing government involvement in promoting healthcare and newer players entering this space, the trend is changing opening up a universe of opportunities for operators in this space. The retail healthcare industry in India is likely to increasingly contribute to enhancing the penetration of the healthcare sector. The popularity of single specialty healthcare centers over the past few years is offering significant opportunities for not only emerging healthcare businesses across a gamut of sub specialties but also tertiary multi-specialty hospitals to foray into the sector. Under this format, a patient can access services for all healthcare requirements focusing on a specific speciality under one roof. Having met with significant initial success, this model is being followed across various treatment categories with areas such as fertility, maternity, ophthalmology, dental health, dialysis and diabetic care. SWOT Analysi Strengths Brand Salience: AHEL a leading private sector healthcare player in India was set up an era when there was a huge gap between the need for quality healthcare and healthcare services. Since its inception, the Company has setup several pioneering developments in healthcare in the country and has carved several milestones in its journey. Today brand 'Apollo' is associated with excellence in patient care, rapid technological adoption and best-in-class health care services. The benefits of this recognition and position clearly translate into making us the most brferred choice for both local and international patients as well as medical professionals. Large and growing Network: With 69 hospitals, 2,326 pharmacies and 172 clinics / retail healthcare centers across the country, 'Apollo' is truly a pan-India player. Despite its size, it remains amongst the fastest growing in the healthcare space in India. The large network offers advantages through multiple touch points and enhanced reach, benefits of scale, ability to incubate new businesses, elevation of capabilities due to the sheer volumes of medical procedures and a rich resource bank of medical professionals. Integrated offering: The sub-brands under Apollo Clinic include Apollo Sugar, Apollo Diagnostics, Apollo White and Apollo Dialysis. AHLL also runs specialty hospitals Apollo Cradle and Apollo Spectra Hospitals as part of its portfolio. Over the years the group has managed to garner its brsence in GCC, West Asia and African countries as well. This allows it to participate in multiple stages of the patient care processes resulting in better outcomes and an enhanced value proposition both for the patient as well as the service provider. Deep expertise: One of the most respected healthcare providers in the world, Apollo specializes in cutting-edge medical procedures. Apart from being the brferred service provider in India, there are an increasing number of international patients who select Apollo on the basis of quality of care and healthcare outcomes thereby validating the standard of operations not just in India but even globally. Weaknesses Regulatory intensity: With the number of licenses and approvals required to set up a hospital it causes a huge barrier for private players in India to think of expansion.There are multiple rules and regulations for importing medical equipment to setting up parking facilities at hospitals or adding or reducing staff. The lack of co-ordination between various regulatory departments and absence of proactive and forward looking regulation has resulted in loss of some potential opportunity for the healthcare sector. At the same time, lack of agility in unearthing unscrupulous practices as well as failure to halt unfair trade practices by certain participants in the sector has also harmed the perception about service providers in the sector. Shortage of Healthcare Human capital poses a challenge: India is a country with manpower in abundance, given the sheer size of its population. However, what the country lacks is good education for majority of this population or better training institutes for skilled manpower .The healthcare services industry is highly manpower intensive. Skilled manpower includes doctors, nurses and para-medicalstaff comprising lab-technicians, radiographers and therapists all of whom are in short supply in India. The overall requirement for resources makes it challenging to set up and profitably run a hospital in India. Technology obsolescence: Today 'Technology' is at the helm of any growing industry and it has to keep getting upgraded due to the high risk of obsolescence. One of the biggest problems faced by Indian players is availability of good technology and at reasonable costs. We however, use the latest treatment technologies in our hospitals to provide top quality healthcare services. Heterogenous Markets: With the growing population the need for healthcare has been on the rise in India. There are different requirements even in markets which are reasonably proximate. Every market has a unique set of circumstances with variance in demographics, disease profiles, customer attitudes, seasonal variations,price sensitivity and so on. Even hospitals in two different cities in the same state will not be subject to identical operating circumstances. This requires a higher degree of customization and increases the level of monitoring required. Merely having all of the necessary resources is not a guarantee to success. Due to the complexities involved, significant management overview is required in sustaining clinical standards, balancing case mix, ensuring adequate volumes and regularly upgrading technology. Opportunities Deeper Value of offerings: There is significant scope to enhance the value offering for patients by leveraging on technology. This need not necessarily be cost led but can also include faster recovery, lower trauma, more combrhensive offerings from service providers and higher quality of care with better outcomes. Those providers who are able to elevate their offerings on multiple parameters will have an advantage compared to other service providers. NCDs on the rise: The rising number of Non-communicable diseases (NCD) patients suffering from diabetes, cardiovascular diseases and cancer in India is directly proportionate to the changing lifestyle patterns of the working population . This is a huge challenge for the Indian healthcare service providers who will need to address the rising incidence of NCDs. At the same time, it brsents an opportunity for service providers. Under served and poorly served markets: There is a world of difference between the quality of healthcare services available in metro cities and large urban areas compared to some of the semi-urban areas in the country. Patients in such semi-urban areas have the ability and the willingness to pay for good quality healthcare services, however, due to lack of options end up travelling to the cities in search of appropriate treatment. Healthcare service providers who are able to offer services of the desired quality in these areas will benefit from a ready demand for their services. Changing Lifestyles: Given the steady increase in disposable incomes and growing health awareness, there has been a manifold expansion in demand for elective or planned surgeries as well as cosmetic surgeries. Patients are now willing to undergo discretionary and electric treatments to elevate their standard of living and pursue a lifestyle of their choice. This is steadily developing into a deep and lucrative segment of the healthcare services market. Population on the rise: As India crosses the 100 million mark of its ageing population and is expected to be the home for around 143 million elderly by 2020, this fact will also contribute to the increasing demand for healthcare services. India is an ideal Medical Value Travel destination: The Indian Healthcare Industry is well poised to address the billion dollar medical tourism opportunity, with several accredited facilities is witnessing a large development boom of private medical healthcare facilities. Additionally, the inherent cost advantage with brvalence of quality healthcare services makes India a brferred destination among emerging markets. The opportunity is large and the country will have to take appropriate steps to improve procedural efficiency and enhance marketing of services to garner a sizeable share. Threats Heightened competitive intensity : The increasing trend of entrebrneurs and business hourses to enter into the healthcare business has resulted in a spike in setting up of greenfield facilities , JVs and acquisitions. There are even pockets of over capacity in certain metros. In order to make these ventures viable after investing significantly, there is a possibility that some of these players could resort to irrational pricing in order to gain market share. Increasing cost of resources : The emergence of several domestic hospital chains combined with the entry of international players is leading to an increased number of competitors chasing finite resources such as land, quality medical professionals and potential acquisition targets. Demand growth is expected to outpace improved supply of these resources. A failure to acquire resources at fair and reasonable rates will impact the ability to suitably grow and expand our operations . Further, increases in operating costs can impact the Company's operations and financials. Discontinuation of leases: Lands on which some of our hospital buildings and stand-alone pharmacies are operating on are not owned by us. In the event of these leased properties not being renewed in our favour or on terms that are not favourable to us, our business operations may suffer disruptions. Potential loss on the Medical Tourism Opportunity : Several countries in the Asia-Pacific region have realized the opportunity of attracting medical value travelers . These countries provide a number of incentives to domestic service providers in the form of subsidized capital, ease in permissions and tax benefits, given this fact coupled with their enhanced infrastructure and simplified visa norms, makes them well positioned to gain a larger share of the Withdrawal of tax incentives : Since fiscal 2011, we have benefited from the tax deduction of 150% given in respect of capital expenditure incurred on setting up new hospital projects. The resultant deferment of tax helped us to improve our immediate cash flows allowing us more resources to fund growth. This has now been reduced to 100% with effect from the financial year ending March 31, 2017. Any further reduction of tax incentives would result in reduced returns to the business. Industry outlook The healthcare market in India has witnessed a substantial transformation in the last few years. The industry is now growing at a tremendous pace owing to its strengthening coverage, services and increasing expenditure by public as well private players. The country today is faced with two kinds of disease burden communicable and non-communicable, diseases, giving rise to a new pool of patients who demand different types of medical services. As India crosses the 100 million mark of its ageing population and is expected to be the home for around 143 million elderly people by 2020, giving rise to the increasing demand for healthcare facilities, there is a huge potential for healthcare players to service these rising numbers. Moreover, increasing government focus, rising awareness and insurance penetration among the populace are expected to drive this growth in future. Additionally, factors such as attractive investment opportunities, growing innovation and entrebrneurship are expected to increase the market size, thereby increasing the contribution of healthcare to the country's GDP. Large investments by private sector players are likely to contribute significantly to the development of the sector. In India, private healthcare accounts for almost 70 per cent of the country's total healthcare expenditure. Private sector's share in hospitals and hospital beds is estimated at 74 per cent and 40 percent respectively. The main factor contributing to rising medical tourism in India is brsence of a well-educated, English-speaking medical staff in state-of-the art private hospitals and diagnostic facilities. Going forward, apart from M&A deals, Private Equity and Venture Capital funding will be a strong investment driver for the Indian healthcare sector. The sector is expected to be one of the most attractive investment targets with attractive valuations. The sector has attracted close to $1billion into hospital assets from both domestic and foreign financing companies. PE investments have nearly quadrupled from 2011 to 2013 for investments into hospitals and diagnostic chains. Further, the sector has seen close to 100 domestic and inbound M&A deals, with an average deal size of $30 million, totaling to $3 billion since 2010. At brsent there still exists an increasing gap between the expectations of patients and the offerings of traditional models of healthcare delivery. In the wake of these growing concerns and with an urgent need to accommodate the rising healthcare requirements and expectations, an emerging and organized healthcare sector is in play. Moreover, with increasing demand for affordable and quality healthcare, penetration of health insurance is poised to grow exponentially in the coming years Company Overview Apollo Hospitals Enterprise Limited (AHEL), a leading private sector healthcare provider, is the pioneer of corporate healthcare services delivery in India. Promoted by Dr. Prathap C Reddy as a public limited company in 1979, AHEL started as a combrhensive 150-bed hospital with an emphasis on tertiary healthcare at Chennai. From that humble beginning it has emerged as the br-eminent healthcare services provider in Asia. The Group's healthcare framework operates within a three level architecture-primary, secondary, and tertiary health care facilities. The tertiary care hospitals provide advanced levels of care in over 55 specialties, including cardiac sciences, oncology, neurosciences, critical care, orthopedics, radiology, gastroenterology, and transplants. Its brsence includes 9,554 beds across 69 locations, 2,326 pharmacies, 172 primary care & diagnostics clinics, and 148 telemedicine units across 13 countries. To enhance our service to our customers and complement our business, we also provide various other services such as project consultancy services, health insurance services, education and training programs and research services. We are setting up the first Proton Therapy Unit in the Asia-Pacific Region which will be located at a specialized facility in Chennai, India. We are also strengthening our retail healthcare footprint including primary care clinics, birthing centers, day surgery centers and dental clinics. These are housed under Apollo Health & Lifestyle Ltd, which is the retail healthcare arm of Apollo Hospitals. Healthcare Services Our Healthcare services segment consists of hospitals, hospital-based pharmacies and projects and consultancy services. Hospitals As of March 31, 2016 we had a capacity of 9,554 beds in 69 hospitals located in India and overseas. Of the 9,554 beds, 7,620 beds own in 42 hospitals, 160 beds in 7 cradles, 340 beds in 12 day care / short surgical stay centers and 1,434 beds are in 8 hospitals under our management through operations and management contracts Clinical Excellence Clinical Excellence is the edifice around which our healthcare operations are structured. The Apollo Hospitals group diligently adheres to meet the highest standards of clinical outcomes which it has set for itself in various specialties. These standards are constructed with a view to benchmark internal excellence against the best in the world. In order to ensure sustainable clinical outcomes the Company follows an internal quality management process known as the "Apollo Clinical Excellence" program which is referred to as "ACE @ 25". This has been implemented across the entire network of hospitals. ACE @ 25 assesses performance based on 25 clinical parameters which are critical to delivering the very best clinical outcomes. This is supplemented by the Rocket ACE program which is a balanced scorecard for Centres of Excellense ("CoEs") evaluating outcomes based on complication rates, mortality rates, infection rates and related parameters . These are supplemented by the Mortality Review and Incident Reporting systems. We also implement the AQP or Apollo Quality programme which is a 20 parameter reporting dashboard for standardization of processes. Due to this steadfast focus on Clinical Excellence, the Group has an impeccable track record and high success rates even in surgeries of high complexity such as transplants, cardiac care and oncology. This unwavering focus on clinical excellence enables Apollo Hospitals to continuously assess the quality of care provided to patients and allows it to objectively measure the consistency and success of healthcare delivery services. Training & Continuing Medical Education In addition to the focus on clinical excellence, Apollo ensures that its medical professionals and other staff are periodically trained on the newest techniques and procedures in the medical field on a periodic basis. The Group also partners with some of the most renowned institutes in the world for knowledge sharing and to build its repository of medical knowhow and literature. We have signed a MoU with Health Education England to promote interaction in healthcare education between India and England establishing a platform to train the healthcare workforce . Additionally, we have also signed a MoU with U.S based Varian Medical Systems, an educational partnership to introduce a program that will help train radiation technologists in the country. This is going to be the first radiotherapy partnership of its kind in India. Accreditations Six of our hospitals have received accreditations from the Joint Commission International, USA ("JCI") for meeting international healthcare quality standards for patient care and management. JCI is the world's brmier accreditation body for evaluation of healthcare facilities. Our Hospitals at Chennai, Bengaluru, Delhi, Dhaka, Hyderabad, and Kolkata have the accreditation which reiterates that the operational protocols are in line with global best practices. In developing countries like India, where health services are delivered mainly through private health providers, regulation is a vital instrument and function of government policy. The government has set up the National Accreditation Board for Hospitals & Healthcare Providers ("NABH") to establish and operate accreditation programmes for healthcare organisations in India. It is a constituent board of the Quality Council of India Fourteen of our hospitals including Apollo Specialty Hospitals in Madurai, Chennai, Ahmedabad, Noida and Secunderabad have received accreditations from NABH. Strategy The Company remains focused on growth with the objective of simultaneously improving operating efficiencies and clinical outcomes. We aim to achieve this through : Strengthening our brsence in key strategic markets We believe we have a dominant share of the hospital beds available in Chennai, New Delhi, Kolkata, Hyderabad, Bengaluru, Ahmedabad, Pune, Bhubaneshwar, Madurai and Mysore. We intend to continue to strengthen our brsence and increase our market share in these key strategic markets by establishing new healthcare facilities, including retail healthcare centres and increasing bed capacity at our existing hospitals. Currently, we have hospitals located in three (Chennai, New Delhi and Kolkata) out of India's four key metropolitan cities and are of establishing a new hospital in Mumbai in the 2nd Quater of FY 17. We believe that these key metropolitan cities will continue to have a strong demand for high quality tertiary care services such as cardiac surgeries, oncology services and orthopedic surgeries. By strengthening our brsence in these markets, we intend to increase our market share for such tertiary care services. The plans to establish new healthcare facilities are at various stages of implementation and are expected to be completed over the next three years. We expect to increase the bed capacity by around 1,045 beds upon the completion of these projects. We are constantly evaluating new opportunities in our existing and new markets. Our evaluation criteria include location, demographics, revenue potential, and the cost of setting up new facilities. Geographic expansion through setting up hospitals in Tier II and Tier III cities We have developed and are in the process of establishing a network of hospitals under the "Apollo REACH" with the objective of making high quality healthcare services and advanced medical technology available in semi-urban and rural areas. Hospitals established under this initiative will have a capacity of around 100 to 200 beds, and will be located in Tier II and Tier III cities in India. These hospitals will be a combination of new or acquired facilities as well as expansion of some existing facilities. These hospitals will allow us to expand our network and penetrate different markets in the Tier II and Tier III cities. We have identified a number of Tier II and Tier III cities across the country which are currently under-served in terms of healthcare services but have a sizable population accross the large catchment area with spending potential. Based on our experience, capital costs per hospital bed in a Tier II or Tier III city are generally lower compared to a Tier I city. As income levels in these markets rise, purchasing power will accordingly increase; therefore, we expect our revenues generated from providing healthcare services in these markets to increase further. We have already established Apollo REACH hospitals in Tier II cities, including Kakinada, Karaikudi, Karimnagar, Bhubaneswar, Karur, Madurai, Trichy, Vanagaram, Nellore and Nashik. . Focus on continued growth in stand-alone pharmacies We have grown the number of stand-alone pharmacies in our network to 2,326 as of March 31, 2016 with the revenues from our stand-alone pharmacy segment contributing 38% of our consolidated revenues in the Financial Year ended 31st March, 2016. We intend to increase the revenues generated by our existing stand-alone pharmacies through: • Improving the profitabilité of our existing stand-alone pharmacies by introducing in-house brand (private label) products which have superior profit margins and increasing sales through the bulk distribution of medical supplies and consumables to hospitals and other healthcare providers. • Improving operating efficiencies by implementing a centralised database and inventory management system to track inventory and revenue collections across our stand-alone pharmacy network. • Improving our supply chain management by standardising prices across our network and consolidating our vendors. • Monitoring the performance of our stand-alone pharmacies on an on-going basis and closing loss-making and low-growth pharmacies. Increasing patient touch points by way of multiple formats: We aim to increase our brsence and reach across all markets through our retail healthcare subsidiary - Apollo Health and Lifestyle Limited. We recognise the necessity of and have made concerted efforts to build additional formats for healthcare services delivery through this subsidiary which includes primary clinics, lifestyle birthing centers, sugar clinics & short stay surgery centers. We additionally have a strong brsence in standalone pharmacies, health insurance, medical education, telemedicine and projects & consultancy services. We have covered the entire spectrum of the healthcare services business enabling higher points of interactions with patients, better brand equity and referrals into our main hospital. Focus on a portfolio of high value clinical specialties We believe that a combination of factors, including changing demographics, increasing affluence of the Indian population, greater health awareness, an increase in lifestyle-related diseases such as heart disease and diabetes, increasing health insurance coverage and a growing medical tourism market, will lead to an increase in demand for quality healthcare services, particularly tertiary healthcare services. We have therefore identified cardiology, oncology, neurology, orthopedics, critical care and transplants as our key focus areas of our tertiary care hospitals. We internally designate these focus areas as "Centers of Excellence". To maximise our market share of the tertiary care procedures performed in each Center of Excellence, we plan to undertake a number of initiatives to ensure that we provide high quality healthcare services and improve our clinical outcomes, including: • Strengthening each Center of Excellence through the addition of experienced and skilled surgeons and physicians. • Expanding each Center of Excellence practice area to provide combrhensive sub-specialties and treatment services. • Continually investing in the latest medical technology and equipment so as to offer high quality healthcare services to our patients such as construction of the Combrhensive Oncology Center in Chennai which would be equipped with the Proton Beam Therapy, which would be the first of its kind covering South Asia and Africa. • Establishing well-defined clinical guidelines and protocols with a strong focus on clinical outcomes. • Integration of our network of hospitals to enable knowledge sharing and the adoption of best practices for each Center of Excellence across the network through dedicated service line managers. Focus on life enhancing procedures and elective surgeries We believe that with increasing disposable incomes and health awareness, there is a growing demand for elective or planned surgeries. Apart from our focus on Centers of Excellence, we also plan to focus on elective procedures to capture this growing market and build a strong brsence in the elective and life enhancing procedures market. Our hospitals are well-equipped to offer various elective procedures like knee replacements, hip replacements, cosmetic surgeries, dental services and other similar procedures. We intend to increase the volume of such procedures performed in our hospitals by creating specialised centers for such procedures, recruiting more surgeons specialising in such procedures and investing in the latest medical technology to improve our clinical outcomes in these areas. Improve operating efficiencies and profitability We believe that maximising operating efficiencies and profitability across our network is a key component of our growth strategy. We intend to focus on the following key areas to improve our operating efficiencies and profitability: • Improve average revenue per occupied bed per day We seek to improve the average revenue per occupied bed per day through a combination of initiatives, including: Increase focus on high growth tertiary care areas. We continually focus on investing in the latest medical technology, attracting skilled physicians and surgeons and developing our expertise in high growth tertiary care areas to serve the increasing demand for sophisticated clinical care and procedures. By implementing our strategy to focus on high growth Centers of Excellence and other technology and specialist skill-driven clinical areas, we intend to improve our case mix and increase revenues per occupied bed per day. - Reduction in Average Length of Stay ("ALOS"). As a significant portion of in-patient revenues are derived from medical services provided in the initial two to three days of a patient's stay in the hospital, we plan to reduce the ALOS at our hospitals, thereby increasing patient turnover rate and the revenue per occupied bed per day, by capitalising on improvements in medical technology and focusing on minimally invasive surgeries, which reduces surgical trauma to patients and patient recovery time. • Maximise efficiencies through greater integration, better supply chain management and human resource development We plan to maximise efficiencies at our hospitals and pharmacies through greater integration across our network. Our hospitals and pharmacies are large consumers of drugs and medical consumables like stents, implants, sutures and other surgical materials. To minimise costs and leverage on economies of scale, we intend to focus on standardising the type of medical and other consumables used across our network, optimising procurement costs, consolidating our suppliers and optimising the use of medical consumables by establishing guidelines for medical procedures across our network. To improve the productivity of our employees, we plan to place greater emphasis on training our employees in best practices and implement programs to provide incentives for performance. We have also introduced an initiative to encourage our doctors to be more involved in administrative matters such as scheduling surgeries and in the management of the hospitals as we believe that this will help to improve clinical outcomes and service standards. Optimisation of asset utilisation in mature facilities and combrssing time-to-maturity of new facilities We have specific plans in our mature facilities to further deepen our brsence in Cardiology, Neurosciences and Oncology. We have created value differentiators and set service standards for enhancing patient satisfaction in terms of time-to- serve. We will also leverage on our personalised health checks and tertiary care OP services to target superior topline contribution from out patients. This will ensure higher market share in select acute care services. Our focus will be to stabilise and combrss time-to-maturity at the new facilities. We plan to recruit specialist consultants for the Centers of Excellence at our new hospitals to ensure a superior specialisation mix from the very beginning and driving higher revenues. The phased commissioning of the additional beds linked to occupancy levels at new facilities will keep the fixed costs lower to achieve our objective. Focus on medical value travelers According to CRISIL, India is fast emerging as a major medical tourist destination. We believe that India is highly competitive in terms of healthcare costs compared to other developed and developing countries, such as the United States, the United Kingdom and Singapore. A number of our facilities have been accredited by various Indian and international accreditation agencies such as the JCI, the NABH and the NABL, which we believe helps us to attract medical value travelers. We intend to focus on attracting more medical value travelers from select markets including those in the Middle East, Africa and Southeast Asia by increasing our marketing efforts in these regions. We believe that medical value travelers will help to contribute to higher revenues per bed day and increase our profitability. Expansion Plans Concurrent to our stated strategy of initiating capacity creation, we are executing a multi-pronged expansion plan. In addition to a strong base of 9,554 beds across 69 hospitals as on March 31, 2016, we plan to add another 1,045 beds in the coming 3 years across 3 hospitals which will expand the overall network of hospitals to 72. During the year, we completed the acquisition of a 51% majority equity stake in Guwahati based Assam Hospitals Ltd. Assam Hospitals runs a 220 bedded tertiary care hospital which recorded a turnover of Rs.869 million and a profit of Rs.18 million for the year ended March 31, 2016 . Our focus now is to concentrate on operationalising the new capacities added and growing and consolidating our leadership position in these markets. Capital Expenditure Apart from the expansion plans outlined above we have made investments to increase bed capacity in existing centres and incurred maintenance and refurbishment costs. We have invested in new technologies, modernization of facilities and expansion of services, We believe that these investments will help us to attract and retain doctors and the make our hospitals a brferred choice for patients. Our Board has approved a capital expenditure of around Rs.15,204 million for our expansion plans stated above. Of this Rs.5,841 million has already been invested and the balance will be invested in a calibrated manner over the next three years. This will be financed from existing funds, internal accruals as well as through debt funds. Capital expenditure primarily relates to expansion activities. The amount and purpose of these expenditures may change in accordance with business requirements Apollo Reach Hospitals The Apollo "REACH" Hospitals initiative is aimed at setting up a network of secondary care facilities with around 100 to 200 beds each in Tier II and Tier III cities in India. This will serve patients from these areas at their home locations and eliminate the need for travel in search of healthcare. This model aims to improve access to the healthcare for larger segments of the population while simultaneously extending the Apollo Brand to more corners of the country. The REACH model also allows for moderation of capital intensity when setting up a hospital as it only undertakes primary and secondary care in the initial stages. A reduction in the capital deployment and the break even point allows operational flexibility. Further, several of these hospitals are eligible for tax benefits which enhance the economic viability and schedule for cash deployment. We have REACH hospitals in Tier II cities including Kakinada, Karaikudi, Karimnagar, Bhubaneswar, Karur, Madurai, Trichy, Nellore, Nashik and Vanagaram, a suburb of Chennai. Medical Tourism Realizing the importance and growing need for medical tourism in the country the group has taken certain initiatives towards boosting medical tourism while putting India on the world map as far as healthcare services is concerned. The Group undertakes several camps in overseas markets to build the doctor connect for patients. Apollo Hospitals has served patients from over 120 countries and offers a wide range of services including brventive health checks, Organ transplantation (kidney, liver and cornea transplantation), Robotic Surgery, Cancer Treatment, Joint Replacement Surgery, cosmetic procedures, eye procedures, Brain & spine surgeries etc of a high standard at its accredited facilities. Apollo Health City, Hyderabad, for the third time has been adjudged as the 'Best Medical Tourism Facility' in India by the Government of India during 2013-14.Earlier the Hospital was conferred the award in the years 2009-2010 and 2011-2012. The Indian Railway Catering and Tourism Corporation (IRCTC) has partnered with AHEL to offer hassle-free travel for people who travel for medical care. IRCTC is also looking to expand the service to neighboring countries such as Sri Lanka and Bangladesh in collaboration with certain airline services. Under the memorandum of understanding (MoU) with Apollo, IRCTC will operate a chartered coach from Kolkata to Chennai every 14 days and integrate its offerings with the brventive health check-up packages of Apollo Hospitals to offer a combrhensive package to travelers. Standalone Pharmacies Apollo has been strategically brsent in the Standalone pharmacy business for over 2 decades. Upon attaining critical mass, it has driven growth at an accelerated pace which resulted in a phenomenal performance in the last few years. The pharmacy business has grown at a CAGR of around28% over the last four years on the back of consistent addition of new pharmacies and timely closure of non-performing pharmacies. As of March 31, 2016 the pan-India network of stores stands at 2,326 stores. Our product mix has also seen a favourable trend with the introduction of wellness and self-branded products. When we started our operations, we were primarily selling pharmaceutical products which has now evolved to include wellness products. We also tailor our product mix for each pharmacy. The product mix and display in pharmacies will differ from region to region. Apart from this, 40-45% of our business is from repeat customers. We have a cluster analysis mechanism and each cluster is managed by an independent manager. We have standardised our systems for tracking the viability of each store in terms of its real estate costs, supply chain, cost-benefit ratios and various other operating metrics. The acquisition of the Hetero Pharmacy chain has helped us consolidate our market position, especially in and around the states of Andhra Pradesh, Telengana and Tamilnadu. This move has helped us in ramping up our revenues and operational synergies. The profitability profile of this business has improved steadily due to maturity of stores, increasing proportion of private label products and rationalization of the store network through the discontinuation of unviable stores. We believe there is a high potential for growth in this sector for large organised players like us with superior scale of operations. The business holds tremendous potential given the fragmented nature of the industry and the window to gain market share through differentiated and value added offerings. As the largest and most profitable chain of stores, Apollo has created a unique and distinctive position that will be hard to replicate. Accolades, Achievements & Partnerships In a rare honour, the Government of India issued a commemorative stamp in recognition of our contribution, the first for a healthcare organisation. During the year, the Group was awarded The CIO 100 awards from IDG which recognizes organizations that exemplify the highest level of operational and strategic excellence in information technology. The award was conferred on Apollo Hospitals Enterprise Ltd (AHEL) recognizing it as the Versatile 100 & CIO100 Innovation Architect Special Awardee 2015. Apollo has recently entered into a tie-up with Google for providing health information as part of the search engine's launch of the Health Card in India. This feature will provide credible information to help people understand facts about common illnesses. The aim is to empower people with accurate, appropriate and easy to understand information so as to support them and provide a framework based on which they can have a better conversation with their doctor Projects & Consultancy Our projects and consultancy services business is among the leading healthcare consulting organizations of its kind in the country. We provide combrhensive support and services to the healthcare delivery industry including br-commissioning consultancy services comprising feasibility studies, infrastructure planning as well as design & advisory services (functional design and architecture review), human resource planning, recruitment and training and medical equipment planning, sourcing and installation services. We also provide post-commissioning consultancy services, which include management contracts (providing day-to-day operational support), franchising and technical consultation including human resource planning and training and the establishment of medical and administrative protocols. We provide these services to third party organizations globally for a fee. Medical Insurance — Apollo Munich Health Insurance Apollo Munich Health Insurance came into existence through an alliance between the Apollo Hospitals Group and Munich Health, which is one of the leading insurance companies globally. Apollo Munich has been able to grow ahead of industry growth rates and its insurance products are rated very highly by market participants. Further, it enjoys one of the best claims ratios in the industry as well as strong customer loyalty. It has also been awarded for innovative product offerings. Apollo Munich was able to grow its gross written brmium (GWP) from Rs. 8,611 million in FY 2014-15 to Rs.11,078 million in FY 2015-16. Apollo Munich now has over 101 branches pan India and enjoys a 10% share of the retail health insurance market. Apollo Munich has crossed the 10 billion mark in GWP reflecting a growth of around 29% year-on-year and is committed to deliver high-quality services to its customers through innovative and expert products, integrity in processes and uncomplicated services. Apollo Munich is the fastest insurance company to reach a break-even point and made marginal profits in the last two years. The company achieved an imbrssive growth rate over last five years, a CAGR of 46%. The Government of India had, in March 2015, increased the foreign direct investment limit in the insurance sector to49% from 26%. Munich Health, the joint venture partner in Apollo Munich Health is increasing its stake to 49%. The increased shareholding will strengthen the companies' position and ensure sustainable and profitable growth in the years ahead. Apollo Munich Health Insurance is committed to making quality healthcare easy and accessible and redefining the approach to health insurance in the country. Retail Healthcare - AHLL Apollo Clinics The Apollo Clinic is a trusted neighborhood healthcare partner for family medicine and primary care. It creates the bridge between patients and Apollo Hospitals. The Apollo Clinics will become a platform to address future healthcare challenges in India, particularly the growth of non-communicable diseases. Finally, we believe that the low penetration of brventive healthcare is a key area to address, driving adoption of brventive health checks and vaccination. Apollo Clinics is building a 2 pronged growth plan with owned clinics being established in hospital centric clusters, eg Chennai, Hyderabad, Bangalore, Delhi, Pune. Franchise clinics will be established in Tier 2 / 3 towns where only 1-2 clinics per town are feasible. These will act as feeder markets for the tertiary care hospitals. These franchisees will be created using a 'smart' franchisee model - centralised IT system, tele-medicine unit, quality audit system, centralised service tracking Apollo Diagnostics The Diagnostics market rebrsents a significant opportunity though it is a fragmented market with 85% still in the unorganized sector with the overall market growing over 30% per annum and at an estimated size of Rs.140 billion. Apart from being a large market, there is a strong synergy with the Apollo Clinics - 70% of clinical decisions are based on pathology inputs. Currently, the focus is on building a pathology lab business with a B2C model. The model would be to create owned labs with a front end franchisee collection centre model and building networks in the Top 4-5 towns per state. The aim would be to build a network of around 2,000 collection points in 5 years. Apollo Cradle Apollo Cradle, a hospital for women and children, offers services of international standards in a brmium environment while creating an unforgettable experience for the mother and her family. Apollo group was the pioneer in establishing boutique birthing hospitals in India with the first Apollo Cradle opening in New Delhi in 2002. This concept is well accepted in urban markets and is indeed another stride towards the emergence of specialized hospitals. The maternal care industry is expected to have a CAGR growth of 15% per annum and is estimated to touch a size of Rs.480 billion in the next five years. One of the path breaking Initiatives taken up by Apollo Cradles was to promote Natural Child Birth. Further, the clinical services have been enhanced by focusing on minimal access (Key Hole) Gynecology Surgery. The coming year will see lot of activities to promote Fetal medicine and Uro Gynecology. Apollo Sugar Clinic India has the distinction of being the Diabetes Capital of the World. With an aim to offer care for diabetes by touching more patient lives, we have steadily grown our network and ended FY 2015-16 at 42 Clinics. Apollo Sugar as a brand has made rapid in roads and is now a prominent name in the field of diabetes care. This year we have been able to integrate clinical pathways to our health care delivery system and publish clinical data on the positive impact we have had on the health of patients through our focused delivery model. Diabetes being a life style disorder needing long term monitoring, we have structured our care delivery program with a view to treating patients holistically by enrolling them on to long term packages. The package model has shown better clinical outcomes and has generated a great deal of interest amongst patients. Our call centers supplement our primary disease management program and ensure that patients follow the diet and fitness regimen as brscribed by doctors ensuring adherence to the care protocols. Apollo Spectra Hospitals India has the distinction of being the Diabetes Capital of the World. With an aim to offer care for diabetes by touching more patient lives, we have steadily grown our network and ended FY 2015-16 at 42 Clinics. Apollo Sugar as a brand has made rapid in roads and is now a prominent name in the field of diabetes care. This year we have been able to integrate clinical pathways to our health care delivery system and publish clinical data on the positive impact we have had on the health of patients through our focused delivery model. Diabetes being a life style disorder needing long term monitoring, we have structured our care delivery program with a view to treating patients holistically by enrolling them on to long term packages. The package model has shown better clinical outcomes and has generated a great deal of interest amongst patients. Our call centers supplement our primary disease management program and ensure that patients follow the diet and fitness regimen as brscribed by doctors ensuring adherence to the care protocols. Apollo Dialysis Apollo Dialysis Clinic"is a brand operated under the corporate entity "Apollo Dialysis Private Limited", which has the vision of extending dialysis treatment in places convenient to the patients, and providing quality care with a strong focus on patient services and treatment outcomes. Apollo Dental Operating under the brand name of "Apollo White Dental", oral dental care services are provided in two formats: 7 star Dental Spas "Apollo WHITE Dental SPA" and Dental Clinics "Apollo WHITE Dental Clinic" with a vision to light up billions of smiles across India, making it glow on the world map as a nation free of dental problems and pain. It currently operates at 71 locations at brsent in India. Risks Concern The increase in scale and reach of operations increases the overall complexity and results in an intensified risk profile. Business Risk Evaluation and management of such risks is an ongoing process within the organization. To mitigate such risks, your Company has devised and implemented a combrhensive risk management system that has been implemented to ensure that risks are contained within manageable levels. Since it is the primary responsibility of the Board of Directors to ensure that Internal Financial Controls are in place it has constituted a Risk Management Committee, headed by the Managing Director, which will identify, assess, prioritize, manage, monitor and communicate suitable measures to manage such risks. The principal risks and uncertainties that might affect the Company's business are identified below- • New entrants to the market leading to higher competition to impact sustainability could cause a drop in market share • Obsolescence of technology and treatment methods • Inflationary brssures and other factors affecting demand • Increasing cost of resources such as material cost along with transportation and storage • Lack of adequate human capital is another key factor which is of great concern including the need for retention of key staff including medical professionals and • Increased compliance challenges in the regulatory framework Strategic risks are overseen by the Senior Management team which reports to the Board of Directors periodically on the assessment and minimization of such risks. Operational risks are managed through close monitoring of various units on the basis of specific metrics such as patient volumes, patient occupancy levels, ARPOB or average Revenue per Occupied Bed , ALOS or Average Length of Stay, key consultant attrition levels and asset utilization levels. While the scope of work in the business is large, the strategy is centered on strengthening our brsence in key strategic markets with the right balance of risk-reward. However, there may be other risks and uncertainties that may affect the Company's performance and ability to achieve its objectives which may be deemed immaterial. Internal Control Your company has over the last few years been growing organically and inorganically. Hence it is very important that the internal systems are robust and reviewed periodically to ensure that all assets are safeguarded and protected. Your company places considerable emphasis on organization and environment management, control and management of operational performance and information technology system. An extensive budgetary control review mechanism is also put in place for timely review of comparison of actual performance with the forecasted performance. These systems enable the company to comply with internal policies, procedures, standard guidelines and local laws to help protect the company's assets and also guard against divulging of any confidential information. In addition, it provides for adequate checks and balances meant to ensure that all transactions are authorized, recorded and reported correctly Also, due to the enhanced reporting responsibilities laid down by the Companies Act your company has made it a point to evaluate the financial and operational components by an internal and it external audit and periodic review by the management from time to time and ensure that they are aligned with the desired structure. The implementation of the above helps in setting up a robust governance framework including consideration of outsourced processes, assessment of key risks, detailed documentation of risks and mitigating controls strong information technology systems, periodic reviews etc. Finally, the system of internal control is designed to manage rather than eliminate the risk of failure to achieve policies, aims and objectives and to provide reasonable assurance of effectiveness. Human Resources The Human Resource strategy of Apollo is based on the firm belief that our people are our Core strength and is focused on shaping our talent for tomorrow. As on March 31, 2016, the Apollo Group comprises a total employee strength of 43,557 (including our subsidiaries, joint ventures and associates). A holistic approach to People Strategy which includes an Overarching talent management plan and is supported by well-defined Engagement, Rewards & Regonition and Leadership development frameworks is in place to ensure that we continue to excel and provide our Customers an experience that is unmatched. Apollo firmly believes that motivation, engagement and development of our people are the key factors behind our growth. A multi pronged engagement strategy has been developed for all employees. We provide them multiple forums and channels for providing their feedback and sharing their views. Apart from this through our Employee Satisfaction Surveys and Consultant Satisfaction Surveys, we identify challenges faced by our associates and improvise our HR practices for ensuring better engagement. Effective communication channels have been developed so that the employees' feedback reaches the relevant teams and Leadership so that actionables are driven directly from the top. The future is going to be driven by Technology and data and Apollo has made rapid strides in using technology to manage Human Resources. With the implementation of You-r-HR, (our Human Capital Management system) across Hospitals, our entire HR Management Systems are now digitized. This is the largest cloud based HCM implementation in Asia and exemplifies our commitment to the digital revolution. The competition for attracting talent is severe than ever in the Healthcare space. In order to attract the best talent in the country and across the globe, we have created the Apollo Career Website and integrated the same with our online recruitment platform. This has yielded rich dividends in terms of getting the right people for the Organization and has also helped in seamless talent mobility within the Organisation. As always we continue to believe that rewarding and recognizing performance is essential to build a stronger Apollo. A newly defined Performance Management system which is robust and has higher linkage to measurable outcomes has been put in place. We have now moved into an Online Goal & Performance Management (through You-r-HR) which is efficient, effective, transparent, and makes the process employee friendly. Our organizational success depends on the high level of skills, commitment and professionalism of our people. Continuous education is imbibed in our DNA and this has been the central theme of our growth story. This year we launched the Apollo Medical Development Programme (AMDP), a structured soft skill and clinical competencies development programme covering more than 1500 Junior Medical Staff (Doctors) across the Group. The Nursing Continuous Education Programmes in each unit have been modified to become more valuable and impactful. The Nursing Leadership Development Programme has been executed for 2nd level nursing leaders to hone their skills and competencies and brpare them to take up higher responsibilities. We have continued to work on the Chairman's Club, our unique integrated Leadership Development and Succession Planning Programme which has been expanded to include AHLL as well. Being the pioneer in health care service delivery, Apollo Hospitals Human Resource function aim is to go beyond everyday rigour and create an environment where our associates collectively feel a sense of belonging, purpose and are aligned with the Organization's values and mission. We also consistently endeavor to create a culture of innovation and collaboration to sustain our leadership position in the Healthcare space. Thanks to our consistent efforts we have been recognized for the Best Use of Technology for Recruiting (You-R-HR-Recruit), Best Talent Management practice for the Apollo Medical Development Programme and Best Workplace Practices for Apollo Wellness by the Employer Branding Institute and Global Talent Acquisition & RASBIC (Recruiting and Staffing Best in Class) and the Best Career Website by a Corporate HR team at the HR Asia Recruitment Awards 2016 at Singapore. We also won the brstigious International Service Excellence Award in the 2015 Australian Service Excellence Awards for our high standards of management, training and commitment to excellence. We have an exciting road map ahead of us and we look forward to improving our capabilities & strengths, and empowering ourselves to touch more lives as we look forward to this journey of Excellence in Human Care!! Cautionary Statement Some of the statements in this Management Discussion & Analysis, describing the Company's objectives, projections, estimates, expectations and brdictions may be 'forward looking statements' within the meaning of applicable laws and regulations. Actual results may differ from those exbrssed or implied. Important developments that could alter your Company's performance include increase in material costs, technology developments and significant changes in political and economic environment, tax laws and labour relations. |