Bhubaneswar: Boomtown for Healthcare
Industrial and infrastructural development has boosted the
healthcare market in Bhubaneswar, attracting corporates to set up base in the
temple city. Rita Dutta checks out the exciting developments
with 600 temples and replete with history, Bhubaneswar has been a favourite
tourist destination for ages. However, despite being the capital of Orissa,
healthcare in the temple city was quite dismal, until recently.
The Dark Age
The healthcare facilities of Bhubaneswar were confined to doctor-owned nursing
homes and Government hospitals that provided at best only secondary care. Even
the medical college hospitals were located outside the capital; SCB is in Cuttack,
VSS in Sambalpur and MKCG is in Behrampur. The city and the state lacked super
speciality treatment even in early 2000, except for Kalinga Hospital, Bhubaneswar.
Despite contributing 3-4 per cent of the current 25 lakh cancer patients of
the country, the state did not have a comprehensive oncology care facility,
even five years back. The state, where poverty and malnutrition are overwhelming
hurdles, has also been grappling with increased incidence of TB, malaria, and
high infant and maternal mortality rates.
People from this state travelled all the way to Delhi, Chennai, Hyderabad or
Visakhapatnam seeking super speciality care. Says Dr PK Mishra, Medical Superintendent,
Aditya Care Hospital, Bhubaneswar, "The only option for treatment for patients
requiring renal transplants, which is acute in this coastal belt, was outside
the state. While those unable to afford cardiac treatment went to AIIMS, those
who could afford it went mainly to Apollo, Chennai. For ophthalmology, patients
mainly preferred to go to Chennai's Sankara Nethralaya or Hyderabad's LV Prasad
Eye Institute. And for oncology, people mostly chose Tata Medical Hospital,
Mumbai." The state did not have cutting edge technology for diagnostic
purpose. "One exception was that SB Medical College Hospital was the first
hospital in Eastern India to install a CT Scan even in 1960s, but that was being
used for the department of neurology," says Dr Mishra.
Now, why did a state with a 40 million population not develop its healthcare
facilities, even in its capital? Lack of good infrastructure and slow industrial
growth acted as an impediment for investment in healthcare. Abundant natural
resources like iron ore and coal in the state also made healthcare investment
look less lucrative. As Dr MP Tripathy, Medical Director, Aditya Care Hospital,
puts it, "Healthcare is not seen as a very profitable venture in comparison
with other industries. What makes it worse is the long gestation period of five
to seven years. Thus, local industrialists are always more interested in tapping
the state's natural resources and earning a fast buck than investing in healthcare."
Lack of professional managers and good clinical acumen (as most Oriya doctors
preferred to work outside the state) also thwarted any good intention of starting
a multi super speciality hospital in Bhubaneswar. Opines Dr Saheb Sahu, MD,
Kalinga Hospital, Bhubaneswar, "Other deterrents are reluctance of doctors/professional
managers to shift base from other parts of the country to a tier II city like
Bhubaneswar and banks not being forthcoming in giving funding to hospitals."
change has been powered by investment flow, rising employment
opportunities, and other factors"
- Bipul K Jha
Healthcare Practice, South Asia & Middle East
Frost and Sullivan
initiatives have paved the way for corporate healthcare groups to venture
- Dr Bidhan Das
However, recent industrial, infrastructural and educational
development in Bhubaneswar, has made the city, considered to be one of the cleanest
and planned cities of modern India and one of the fastest developing cities
of India, the epicentre of healthcare revolution in Orissa. Says Bipul K Jha,
Industry Analyst, Healthcare Practice, South Asia & Middle East, Frost and
Sullivan, "This change has been powered by the huge investment flow, rising
employment opportunities, and increasing foothold of service-based sectors,
which has in turn led to rise in purchasing power and increased standards of
Bhubaneswar, now being dubbed 'the rising star of the East',
has attracted a whopping Rs 6,00,000 crore investment from across all industries
like IT, technology, steel, aluminium, tourism, health and education sectors.
Huge capex by the large industrial houses in the core infrastructure sector
has witnessed a rise of 11.5 per cent in the last two years. The per capita
income of the state has shot up from Rs 10,567 in 1999-2000 to Rs 16,149 in
2007-08. The population has grown by nearly 8 per cent in the last decade; the
metro area of Bhubaneswar has mixed culture population base of 19 lakh, housing
almost 11 percent of the urban population of the state. "Moreover, one
corporate hospital (Kalinga Hospital) has set an example for other players by
being an early market entrant and doing good business," says Jha.
It is a highly under-served market with its ratio of beds
per 1,000 population being two-thirds of the national average of 0.86. What
is attracting corporates like Apollo, AMRI, Narayana Hrudayalaya, Vedanta Aluminium,
Asian Heart and Global to set up base here is the untapped potential. Says Dr
K Ravindranath, Chairman, Global Hospital, who is setting up a 200-bed hospital
in Bhubaneswar, "Our hospitals in Chennai and Hyderabad have always been
getting a steady stream of patients from Eastern India, which constitutes one
third of India's population. Eastern India is also frequented by patients from
Nepal and Bangladesh. So it makes complete business sense to foray into Bhubaneswar,
before anyone else does."
Explains Dr Ramakant Panda, Vice Chairman, Asian Heart Institute, Mumbai as
why he has planned a hospital in Bhubaneswar. "There is a dire need for
hospitals with good infrastructure in Bhubaneswar. Moreover, being from Orissa,
I want to do my bit for the State."
Adds Harihar Rath, Deputy General Manager, Marketing, Apollo
Hospital, Bhubaneswar, "Lacunae of healthcare services and the rising disposable
income of people of the regions are the main reasons for healthcare investment
in the area. With more IT and BPO firms setting up offices in Bhubaneswar, the
paying populace has also increased."
Kalinga Hospital is the first corporate hospital of Orissa
LV Prasad Eye Institute has a comprehensive eye cancer programme for children
Apollo Hospital has installed Orissas first 64 slice CT scan
Aditya Care has pioneered Orissa's first EP study and RFA
Hemalata Hospitals is the only centre in Orissa to have a linear accelerator
AMRI is coming with a 300-bed hospital in the temple city
Desun is coming with a tertiary care hospital in Bhubaneswar
Naryana Hrudayalaya has also planned a tertiary care hospital
is in dire need for hospitals with good infrastructure"
- Dr Ramakant Panda
Asian Heart Institute
physiology study and primary CABG are still not that widely available in
- Dr PK Mishra
Aditya Care Hospital
The present Chief Minister, Naveen Patnaik, has played a crucial
role in giving the much-required thrust, according to Dr Bidhan Das, Managing
Director, Octavo Solutions, a consultancy firm that has done some projects in
Orissa. "The Government's efforts to improve infrastructure in the city
have induced private realtors like DLF to invest. The entry of retail chains
like Reliance, Big Bazaar, and Pantaloons has helped the Government to support
the economy of Bhubaneswar. The uplift of the economy has attracted corporates
to invest in healthcare," says he.
An important step to extricate the state from the healthcare
morass was taken by the State Assembly in December 2008, when it decided to
spend nearly 49 per cent of Government funds on development of healthcare infrastructure.
"The Government has also extended support to medical institutes encouraging
research activities, undertaking different Public-Private-Partnership projects
to meet the growing needs of health services which include re-enforcement of
National Health Programme for eradication of malaria and TB, accreditation of
private NGOs for institutional delivery of health services and introduction
of Janani Express providing free transport to pregnant mothers to city hospitals
for quality care. Various initiatives of the Government paved the way for corporate
healthcare groups to venture into Bhubaneswar due to its location, planned civic
infrastructure, rapid industrialisation and urbanisation," adds Dr Das.
From a city that lagged behind in diagnostic procedures, today hospitals in
the city have radiology procedures like 64 slice CT, 1.5 Tesla MRI, 3-D ultrasound
and digital mammogram. The cath labs are flat panel, while OTs have laminar
air flow and HEPA filters. All 50 speciality and super speciality treatments
are available now in the leading hospitals. The city's first corporate hospital,
Kalinga Hospital, now offers kidney transplantation, LV Prasad Eye Institute
has taken the lead in dealing with complicated ophthalmic cases, while high
risk cardiac cases are dealt with by Kalinga Hospital, Aditya Care and Apollo
Hospital. With Hemalata Cancer Hospital now providing all three branches of
oncology treatment, especially linear accelerator with IMRT and CT stimulation,
the high cancer burden of the state has been taken care of.
In the current scenario, while existing hospitals are introducing
cutting edge technology, scaling up and even planning larger hospitals, corporates
are rushing in to grab a pie of the market. Diagnostic giants like Dr Lalpathlabs,
Ranbaxy and Piramal Diagnostics have set-ups there. Even stem cell banking,
a relatively new concept, is picking up here. Cryobanks International India,
which deals in umbilical cord blood stem cell banking, has opened a collection
centre in Bhubaneswar. As many as three private medical colleges (Hi-Tech Medical
College, Sum Medical College and Kalinga Institute of Medical Sciences) have
come up in Bhubaneswar in the last few years. Even a slew of nursing colleges
have also been set up to fulfil the skyrocketing demand. The healthcare boom
has paved the path for many NRI doctors (both Oriya and non Oriya) to show willingness
to work in Bhubaneswar, a trend that is a recent phenomenon.
are setting up a multi super speciality hospital at an estimated cost of
Rs 80 crore"
- Sajal Dutta
hospitals in South have been getting patients from Eastern India. So, it
makes business sense to foray into Bhubaneswar"
- Dr K Ravindranath
Here's a look at the players who powered the change.
Kalinga Hospital: It would be no exaggeration to say
that it was Kalinga Hospital that took the first initiative to change the healthcare
firmament of the state. The hospital was conceived and promoted by 62 non resident
Oriyas, who are mostly doctors by profession, based in the US and the UK. With
an aim to provide the latest medical technology to the people of the state and
to stop them from going outside the state seeking treatment, the doctors pumped
in Rs 30 crore to start Kalinga Hospital located at Chandrasekharpur area of
Bhubaneswar, with 160 beds in 1998.
Today, the 250-bed Kalinga Hospital spread over 10 acres
is the first hospital in Orissa to do regular cardiac cath, open heart surgery,
dialysis and kidney transplant, advanced neuro surgery, gastro-intestinal surgery
and cosmetic surgery. It is the only recognised centre in the State for kidney
transplantation. Says Dr Saheb Sahu, MD, Kalinga Hospital, "We have the
distinction of having the first advanced operating microscope for neurosurgical
operations in Orissa. Additionally, we have conducted the state's first open
heart surgery, started first cardiac cath lab, first neuro surgery, first renal
transplant, first medical ICU and introduced first 1.5 Tesla MRI. "Special
neurosurgical investigations include neuropathology, electroencephalography,
4 vessel digital subtraction angiography's carotid doppler. Under the Smile
Train project, the hospital has completed over 3,000 free cleft lip surgeries.
The hospital is keen on getting into phase III trials in clinical research.
"Considering this hospital as a hub, we want to build a slew of 100-bed
hospitals in Northern Orissa," adds Dr Sahu.
LV Prasad Eye Institute: This hospital, set up in July
2006, has taken the city's ophthalmology care several notches higher. This not-for-profit
institute, that conducts 35 per cent of all care at no cost to the patients,
has a unique ocular prosthesis laboratory that offers cosmetic eyes tailored
to the patients' needs. The institute started the state's first community eye
bank for corneal retrieval and transplantation. Named 'Drusti Daan', the eye
bank is housed on campus, but serves all of Orissa. Several surgeries that it
has pioneered in Orissa are Infiniti cataract surgical system, constellation
vitrectomy system and radio frequency devices offering bloodless eye plastic
and orbit surgery.
Dr Taraprasad Das, Director, LV Prasad Eye Institute, reveals, "High-end
diagnostic equipment at the institute, not previously available in Orissa, includes
electrophysiology for detection of retinal and visual pathway disorders, Orbscan
for evaluation of corneal contour, Retcam for retinal evaluation of neonates
and small children, IOL Master for precise estimation of intraocular lens power,
and specular microscope for accurate counting of corneal endothelial cells."
The institute has a comprehensive eye cancer programme for children and an integrated
low vision and visual rehabilitation service that offers final help to less
sighted individuals with tailored visual aids and teaches lifestyle management
to incurably blind people. The institute is engaged in both clinical and basic
research. It was the first to report Microsporidia epidemic keratoconjunctivitis
in the world from patients in this part of the country. It has completed clinical
trials on new drugs in uveitis, diabetes, age-related macular degeneration and
"Currently, we are engaged in one clinical trial, in retinal vascular disease.
We have received one Department of Science and Technology (DST) grant for basic
investigations on Staphyllococcus infection of the eye," adds Dr Das.
Aditya Care Hospital: Hyderabad's Care Hospital started
this 100-bed cardiology hospital on a leased property near Municipal Kalyan
Mandap at Chandrasekharpur in September 2007. The list of procedures that the
hospital has pioneered in Orissa include EP study and RFA, Paediatric Cardiology
Intervention and CRT. Besides, the hospital has taken a lead in doing PTCA with
stenting and ICD in cardiology, CABG multiple grafts and paediatric cardiac
surgery like VSD closure, ASD closure and PDA in cardiac surgery, haemodialysis,
laparoscopic surgery and joint replacement surgery.
"The hospital will be scaled up to 300 beds, for which 3.92 acres of land
has been obtained from the Government of Orissa," adds Dr Mishra.
we are engaged in one clinical trial, in retinal vascular disease"
- Dr Taraprasad Das
LV Prasad Eye Institute, Bhubaneswar
of doctors and professional managers to shift base to a tier II city like
Bhubaneswar pose as a challenge
- Dr Saheb Sahu
Kalinga Hospital, Bhubaneswar
Hemalata Hospitals and Research Centre: This super
speciality hospital focusing on oncology is the state's only comprehensive cancer
hospital in the private sector that offers medical oncology, radiation therapy
and cancer surgery under one roof. This 100- bed unit, with a built up area
of 80,000 square metres, was set up in 2005. The project was conceived by Dr
Arabinda Rath and funded by TDB. This is the only hospital in Orissa with a
Says Dr Arabinda Rath, Chairman and MD, Hemalata Hospitals and Research Centre,
"The digital linear accelerator installed in this centre was the first
one with IMRT and CT simulation facility in Eastern India. The RT department
here is very important as the regional cancer centre in Cuttack does not have
a linear accelerator and one needs RT at some point of cancer treatment."
Simultaneously, the hospital has installed the first integrated
CT simulator in the country which is a highly sophisticated and state-of-the-art
unit that creates a 3-D model of the cancer patient and pinpoints the tumour
or the target volume that has to receive the radiation and simultaneously ensures
that the critical structures and normal or healthy tissue are spared. "Through
a powerful computer system called 3D treatment planning system, it then creates
a treatment plan using the 'Inverse Planning Algorithm' that maximises the dose
to the tumour and spares or minimises the dose to the normal and critical structures,"
Dr Rath adds.
Hemalata Hospitals and Research Centre was the first in the state to start the
super speciality OT with HEPA filtration and laminar flow for prolonged and
infection free surgeries. "The fully air-conditioned hospital was the first
to have day care chemotherapy, critical care and pain clinics, and high end
diagnostics for cancer in the city," he adds.
In the pipeline is one more linear accelerator and addition of the department
of neuro-oncology with a neuro OT. "We also want to start paediatric oncology,
transfusion and transplants," says Dr Rath. In the long run, he plans to
consolidate current regional dominance as well as enter the national arena by
starting green or grey field projects in oncology in other parts of India.
Apollo Hospital: In March this year, Apollo Hospital
inaugurated the city's largest tertiary care hospital in Bhubaneswar with 150
beds, expandable to 350 beds. This Rs-150-crore project is spread over two lakh
square feet in a sprawling campus of 7.5 acres, providing over 50 specialities.
The hospital has installed the State's first 64 slice CT and paediatric cardiology
unit. It also has a telemedicine facility.
For a state with an alarming Infant Mortality Rate (IMR) of 69, one of the highest
in the country, it is good news that this hospital is focusing on neo-natal
retrieval system, whereby newborns within 50 kilometre radius would be retrieved
and revived by the hospital. The hospital's paediatric interventional cardiology
department would fill a long-standing demand of the region, as other hospitals
in the State are lagging behind in this facility.
In the Pipeline
There are many more hospitals in the pipeline.
AMRI Hospitals: A joint venture between Emami and
Shrachi Group of Industries, Kolkata-based AMRI Hospitals is coming out with
a multi-speciality hospital at Khandagiri Square, a prime location in Bhubaneswar.
This is AMRI's first project outside Kolkata.
Says DN Agarwal, Executive Director, AMRI Hospitals, "This Rs-120-crore
project with 300 beds spread over five acres would have an FSI of 3,50,000 square
feet. This is likely to be commissioned by August 2010."
Sparsh Hospital: Sparsh Hospital, which runs an 80-bed
hospital and claims to have pioneered procedures like Chemoport insertion and
Hicman's catheterisation in Bhubaneswar, has planned a 250-bed set up in the
Chandrasekharpur area of the city. The new project, built at a cost of Rs 40
crore, would house all super speciality facilities under one roof. Says Dr Ghanashyam
Biswas, Director, Sparsh Hospital, "The construction for the new project
will start by 2011 and will be completed by 2013."
Care Hospital: After achieving success with the JV
project Aditya Care, the Care group has planned a multi super speciality hospital
of 200 beds in Chandrasekharpur. The 4.5 acres were acquired around 18 months
back, but due to trespassing, construction has not begun yet.
Ayush Hospital: This group, which runs a 120-bed hospital
at Acharya Vihar Square in Bhubaneswar, has drawn up a plan for its second multi-speciality
hospital in the city at an investment of about Rs 200 crore. The proposed hospital
would be equipped with over 500 beds and it is expected to be operational by
2012. Says Dr Ashok Acharya, MD, Ayush Hospital, "The land is being identified
for the project and construction work for this hospital is expected to start
from next year."
Global Hospital: Hyderabad-based Global Hospital is
building a 200-bed hospital. This project, built at an estimated cost of Rs
100 crore on a leased building, would be focusing on tertiary and quaternary
care (specially renal transplants). Says Dr K Ravindranath, Chairman, Global
Hospital, "This is a JV project with a local group, whose founders are
my patients. This is their first venture in healthcare. The hospital would be
known as Global Hospital." He added that the cost of equipping the hospital
would be borne by Global Hospital. Construction is expected to start by November
this year and commissioning is likely by the end of next year.
Narayana Hrudayalaya: Bengaluru-based Narayana Hrudayalaya
is coming up with a 750-bed health city at Dum Duma at Khandagiri Square. The
hospital, spread over seven acres, would provide multi super speciality treatment.
Says Dr Ashutosh Raghuvanshi, Vice Chairman, Narayana Hrudayalaya, "The
first phase of the hospital with 250 beds is being built at a cost of Rs 80
crore. We would start construction of the hospital after the monsoons, this
year. We would commission the first phase by 2012."
Desun Hospital: Kolkata-based Desun Hospital and Heart
Institutive has planned a hospital on Bhubaneswar Cuttack Road. The 250-bed
green field project is slated to be commissioned by 2013. Says Sajal Dutta,
CMD, Desan Hospital, "This multi super speciality hospital is being set
up at an estimated cost of Rs 80 crore."
Vedanta Aluminium: Fulfilling the need for a full-fledged
trauma centre, Vedanta Aluminium is setting up a 100-bed state-of-the-art trauma
care centre near Gangapada on National Highway 5. This Rs-75-crore project is
coming up on 10 acres of land.
Asian Heart Institute: Mumbai's Asian Heart Institute
(AHI), established by Dr Ramakant Panda and a few other cardiologists, has also
announced plans of opening a state-of-the-art multi speciality hospital in Chandrasekharpur.
Spread over 1,50,000 square feet, the 400-bed hospital is expected to come up
with an investment of Rs 150 crore. Says Dr Ramakant Panda, Vice Chairman, AHI,
"We have a start-up plan for 200 beds at an estimated cost of Rs 70 crore.
We would eventually expand it to 400 beds, spending Rs 150 crore." About
the significance of the project, he says, "AHI has set a benchmark in providing
quality care in the country. Our project in Orissa would be built on the same
principles as AHI, Mumbai and would offer the patients the same treatment and
care at world class standards."
It will have 12 ultra modern operation theatres, 100 intensive care units, fully
equipped modernised pathology services, radiology, imaging services, blood bank,
24-hour pharmacy services and cardiac ambulance services with mobile cathlab.
Though the foundation stone of the hospital has been laid, progress was stalled
by some dispute regarding the land. "As the land being sought for the project
is a Government land, hence acquiring it is a little issue," says Dr Panda.
UIMS: A group of non-resident Oriyas have joined hands
to set up Orissa's first nuclear medicine centre- Utkal Institute of Medical
AIIMS: The upcoming All India Institute of Medical
Sciences (AIIMS) at Bhubaneswar will have a 978-bed hospital. Besides, 15 super
speciality and 18 speciality wards have also been proposed. The State Government
is supposed to provide 100 acres of land free at Sijua on the outskirts for
the prestigious institute. According to a review meeting, while 93 acres have
already been transferred for construction, the rest will soon be handed over.
The State Government had already provided road connectivity. The much-hyped
project is scheduled for completion by 2012.
To be Overcome
Lack of professional managers, paramedics and nurses has always been a sore
point for development of healthcare in Bhubaneswar. Several specialities like
critical care, accident & trauma, burns care, stem cell and organ transplant,
IVF and cosmetology are still trailing. In oncology, there is still no PET and
PET/CT scanner for molecular imaging available in Orissa. Some procedures are
still not widely available. "Cardiac transplantation is still not available,
while electro physiology study, primary CABG and primary PTCA are not that widely
available," informs Dr Mishra of Aditya Care.
Experts point out factors like endemic corruption among doctors, mainly 'cut'
practice for referrals, and problems in land transgression, that pose hurdles.
However, a key drawback is lack of quality initiatives by hospitals. None of
the hospitals has NABH or NABL accreditation, though hospitals like LV Prasad
and Aditya Care are in the process of getting it.
The Road Ahead
As more hospitals are being set up, more state-of-the-art technology will be
introduced and more choices will be offered to patients. To address the dearth
of paramedic and nursing staff, hospitals are keen on starting paramedical and
nursing colleges. During inauguration of Apollo Hospital, Bhubaneswar, Dr Prathap
Reddy, Chairman, Apollo Hospital Group, pleaded to the Government regarding
land for a medical and paramedical college. Kalinga Hospital, which started
GNM nursing school in 2004, is scaling up its intake from 50 to 100 students
a year. Some are optimistic that the city would become a Mecca for medical tourism
for countries like Bangladesh and Nepal. With big moolah pouring in, a steady
infrastructure and active support from the Government, it can only be sunshine!