Social Infrastructure PDF

Confederation of Indian Industry
Social Infrastructure:
A look at enabling elements
for growth and development
in North India
Knowledge Partner
Table of contents
2014 KPMG, an Indian Registered Partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (KPMG International), a Swiss entity. All rights reserved.
Education- Macro scenario in India and key indicators
03
North India - Economic and demographic profile
05
Private investment opportunities in North India
11
Appendix
13
Healthcare - Macro scenario in India and key indicators
15
Healthcare - India vs other nations Need for change
17
Economic and demographic profile - North India
21
Healthcare and disease trends in North India
23
Key need-Gaps and infrastructure requirements

in north india

25
Emerging healthcare models and opportunities
27
Government initiatives 29
Private player initiatives
30
Key recommendations
31
About KPMG in India
33
Social infrastructure - A look at enabling elements for growth and development in North India | 2
Introduction
India is poised to be the worlds youngest country by 2020 with an average age of 29
years. Currently, a third of the population is under 15, more than half under 24 and every
third person in a city is between 15 and 32. Thus, India is at the peak of its demographic
dividend. This is not only expected to be the largest source of labour in the world, but
also drive demand for products and services, thereby fuelling the overall economic
growth of the country. However, to realise the full potential of its demographic dividend
India will have to focus on social sectors such as education and healthcare.
Promotion of education and skill building initiatives to foster inclusive economic growth
would be critical. While the education sector in India has developed substantially
since independence, the major challenge faced by the government is in bringing
disadvantaged sections of the community into this plan. A few examples of these
challenges include:

Dropout rates in primary and secondary education
Quality of education in public schools
Quality and employability of graduates from institutes of higher education.
As the government alone cannot shoulder the entire responsibility of these challenges,
there is a clear need for more participation from the private sector at all levels of
education and skill building. Realising this, states in Northern Region have taken the
lead in setting up a policy framework to encourage private sector participation in
education sector, under various PPP models. This has opened up several investment
opportunities for private sector.
Along with education and skill development, focus on health is important to ensure
a healthy and productive workforce. As per a study conducted by National Bureau of
Economic Research (NBER) on the effect of non-communicable diseases on economy
based on WHOs EPIC (an excel based interface tool) model of economic growth, the
cost of non-communicable diseases is around USD 6.2 trillion for India for the period
between 2012-2030. Thus, the country has to invest in ensuring that the population is
getting the right education and treatment to support the envisaged growth.
Healthcare delivery to over 1.2 billion people distributed across its wide geography
has always been a challenge for the country. Healthcare expenditure in India is only 5
percent of the countrys GDP as compared to the global average of 10.6 percent. The
highly skewed infrastructure distribution between rural and urban India only adds to
the issues raised by the demand supply gap. The government, along with assistance
from the private sector, has been investing on making healthcare accessible and
affordable. However, the country needs higher investments and intelligent distribution
of resources to bring in focused development in the sector.
Healthcare delivery in northern India has been following a similar trend as the rest of the
country. While cities like Delhi have improved infrastructure, rural areas are yet to have
access to affordable healthcare. The northern states, with a higher than average Net
State Domestic Product (NSDP) of India, have a higher affordability leading to a greater
demand for primary and super specialised care.
Hence, both education & skill development and healthcare sectors offer conducive
climate for investment in the northern states.
01 | Decoding the realty challenge
01
Education
Macro scenario in India and key indicators
Overview
India is a nation dominated by youth, with the largest population
in the world in the age group of 0-24 years, and an estimated
63 percent of the total population will constitute the workforce
by 2022. The education and skill development sector is thus of
critical importance in providing support for enhancing the skills
of the rising population and improving the economic efficiency of
the nation.
The Indian education and skill development sector stood at

INR1.24 trillion in 2008 and is expected to grow at an average
rate of 13 percent to over INR 2.92 trillion in 2014. Central and
state government initiatives, PPP partnerships and increased
focus on skilling have led to strong growth in the vocational
education sub-segment which has been steadily growing at an
average rate of 22 percent annually.
CAGR (2008-14)
13%
K-12
11%
Higher
Education
22%
Vocational
Education
13%
Overall
Education sector - Market size (INR Cr.)

350000
~292,000
300000
10%
~28,000
21%
~60,000
70%
~204,000
~228,000
250000
Rs. Crore
~19,000
200000
~48,000
150000
100000
~124,000
6%
23%
~7,000
~29,000
~160,000
50000
71%
~88,000
0
2008
K-12
2012
Higher Education
2014P
Vocational Education
Growth drivers
The education and skills sector can attribute its growth to
multiple factors- key among those include a young, growing
population, increasing focus on quality education, policy support
and increased participation of private players
Demographic profile- According to International Labour

Organisation (ILO) estimates, by 2020 India will have 116
million workers in the age group of 20-24 years as against 94
million in China. In addition to this, the average age of Indian
population by 2020 will be 29 while many developed countries
will be in early or late 40s. An estimate suggests that India will
need another 50,000 colleges and 1000 universities for its 4045 million college ready students by 2020.
Willingness to spend on education- With globalisation
and technological advancement there is an aspiration to attain
higher standard of living among people. This has created an
awareness about the importance of education and
1. According to the 68th NSSO survey
skilling and hence expenditure on education has been on the

rise. Spending on education in cities was 6.9 percent versus 3.5
percent in villages and together with medical expenditure are the
third largest category in terms of consumer expenditure, next to
durable goods, and clothing and footwear.1

Increased investment by government The new

government is looking to increase education spends to
6percent, and has proposed to create a separate ministry of
skills and entrepreneurship which is likely to boost the growth
of the sector.
Growth of private education providers - The growth in
higher education in the country over the last decade has
been led by the private sector. The private segment currently
accounts for more than a third of overall enrolment and
about 80 percent of enrolments in professional and technical
education.
North India
02
Economic and demographic profile
Demographic profile
An analysis of the demographic profiling of the North India
reveals the following:

The northern states together constitute over 30 percent of

Indias population. Particularly Uttar Pradesh is one of the most
populous states with a population of nearly 200 million
Higher education is a sector of prime importance in the north

where more than two thirds of the population is between the
ages of 15 and 59.
Barring the hilly states, population density in other states is

much higher when compared to the national average. Two
of the nations most densely populated regions- Delhi and
Chandigarh are also located in the heart of the north
In states such as Uttar Pradesh and Rajasthan, where more

than one third the entire population is between the ages 0-14,
the school (K12) sector will be of critical focus.
Population
(0-14) (Years)
Population
(15-59) (Years)
Population
(60+) (Years)
Sex Ratio
(Females per
1000 males)
2009
2009
2009
2011
2.0%
31%
65%
7%
877
550
1.4%
26%
67%
8%
893
68,621
201
2.1%
35%
63%
7%
926
Uttar Pradesh
1,99,581
828
2.0%
36%
62%
6%
908
Delhi
16,753
11,297
2.1%
29%
65%
6%
866
Himachal Pradesh
6,857
123
1.3%
27%
70%
8%
974
Jammu & Kashmir
12,549
56
2.4%
NA
NA
NA
883
Uttarakhand
10,117
189
1.9%
NA
NA
NA
963
Chandigarh
1,055
9,252
1.7%
NA
NA
NA
818
India
12,10,193
382
1.8%
31%
66%
8%
940
Population
(000)
Population
Density
(per sq. km)
2011
2011
Haryana
25,353
573
Punjab
27,704
Rajasthan
State
Yearly growth
(2001-11)
Gross Enrolment Ratio (GER)

Analysis
With higher education as a sector with a swelling future demand,
it is essential that the infrastructure and regulatory framework be
developed in a phased manner to meet the potential demand. An
analysis of the GER in the northern region reveals that
In higher education sub-segment, Uttar Pradesh has the

lowest GER among the North Indian states. At 12 percent
which is significantly below the Indian GER of around 18
percent, it is a cautionary statistic considering Uttar Pradesh
will be the youngest state by 2026, with a median age of
26.85 years. It is imperative that the youth of the state are
equipped with higher education and skills failing which they
will not be able to contribute productively to the economy and
will instead result as a liability for the state and the nation as a
whole
While most of the states GER are range between 14-24

percent, Chandigarh has the highest in the northern region
with 46 percent in higher education. As one of the most
densely populated cities in the North, the city has the
opportunity to draw further investment to the region in the
sphere of higher education
In secondary education, UP and Punjab score below the

Indian GER of 53 percent while Himachal Pradesh scores 89
percent
While Delhi and Himachal Pradesh have 100 percent GER

in primary education, Haryana, J&K, Punjab, Rajasthan and
Chandigarh are below the Indian GER of 94 percent, possibly
due to inaccessibility of schools for remote rural regions,
particularly in J&K and Rajasthan.
State-Wise Gross Enrolment Ratios

(in per cent)
18
14
46
24
15
89
82
14
15
12
53
49
91
97
18
15
67
107
53
66
Delhi
Haryana
86
HP
53
50
105
86
73
78
J&K
Primary GER
Punjab
Secondary GER
Rajasthan
UP
98
93
Uttarakhand
Chandigarh
Higher education GER
Source: Statistics of School Education 2010-11, MHRD; UGC annual report 2011-12
School Education GER

An analysis of GER across school levels suggests that while
there is 100 percent enrolment at the primary level, the figures
start dipping increasingly at the middle, secondary and higher
secondary levels.
Social perceptions, affordability, limited access to schools
in remote areas are few factors that can be attributed to the
increase in drop-out rates. Holistic policy initiatives aimed at
strengthening the school sub-segments infrastructure and
foundation can help arrest the dropout rates by 2022 and achieve
the target GER set out by the government in the 12th Five year
plan.
SCHOOL
94
India
7 | Social infrastructure - A look at enabling elements for growth and development in North India
School Gross Enrolment Ratios

400
335
350
296
85%
34
90.56%
52
99.56%
85
100%
164
300
31
248
Millions
250
200
19
39.30%
32
65.00%
42
75
85.50%
62
150
65%
Is the target GER for Higher

secondary school (XI-XII) by 2017 as
laid by 12th five-year plan
90%
Is the target GER for Middle school

(VI-VIII) by 2017 as laid by 12th fiveyear plan
87%
Is the expected gross enrolment ratio

in overall school education by 2017
100
148
116%
135
50
0
2012
Primary School
2017(E)
2022(E)
Secondary School
Middle School
Higher Secondary
Higher Education GER

The number of enrolments in 2011-12 in higher education in India
was 20 million, up from 12 million in 2005-06 as per UGC annual
report, growing at a CAGR of 9 percent. The GER in 2011-12 as
per Planning Commission Estimates was 17.9 percent and the
government has set itself a target GER of 30 percent by 2020,
which translates to nearly doubling the GER within the next
6 years. Currently, India ranks far behind its peers including
China and Russia, with respect to GER. There is a sharp need
to achieve its set target and maintain a growing momentum in
the next few decades in order to rank comparably with its peer
nations.
Number of Enrolled Students in Higher Education and

Gross Enrolment Ratios
42
HIGHER EDUCATION ENROLLMENT
In millions
13%
9%
12
05-06
13
06-07
14
07-08
16
08-09
17
09-10
19
10-11
20
11-12
20-21
18%
GER (2011-12) for higher education
30%
is the target gross enrolment ratio in

the higher education
42mn
is the expected enrolment numbers

in 2020-21 to meet the target GER
Vocational Education GER

In the Indian education system vocational education has
remained divorced from the traditional teaching curriculum and is
often opted for as an additional degree. It suffers from an image
crisis which is detrimental to the skilling initiatives taken by the
government and the private players. The government has set
itself a target to skill 500 million by 2022 but only 23 percent of
the population who is receiving or has already received some
form of technical education, chose to attend industrial training
institutes (ITIs). An estimated 40-60 lakh people received formal
vocational training in the past year.
The Indian vocational education sector requires further
strengthening and a strong shift in perception to ensure that
the government targets are met. Nations like Germany, Japan
which have a strong technical education backbone provide high
quality training to build a skilled and specialised workforce. The
vocational sector in India must also take into consideration the
qualitative factors such as aspirations and public perceptions in
further developing the sector.
Seating capacity in India for vocational training courses

offered by ITI and ITC framework
Childcare, Nutrition,
Pre-Schools &
Creche 2%
Rest 14%
Beautician, Hairdressing
& Related Work 3%
Driving and Motor
Mechanic Work 6%
Mechanical
Engineering 12%
Electrical & Electronic

Engineering 15%
Office & Business

Related Work 3%
Health & Paramedical
Services Related
Work 8%
Artisan/Craftsman/
Handicraft
& Cottage
Based Production
Work 2%
Computer 26%
Civil Engineering
& Building
Construction 3%
Textile 6%
Number of students enrolled and

number of institutions in Northern
Region
Higher Education
The North is characterised in the recent years by a drastic
increase in the number of colleges (~70 percent compared to
the national growth of 37 percent) with a major dominance of
private colleges.
Key statistics:

North India constitutes 30 percent of Indian colleges and

accounts for 30 percent of Indian higher education enrolments
There has been a 50 percent increment in the no. of

enrolments both at the national level and in North India during
FY09-12
Private colleges in North India constitute ~70 percent of the

total colleges.
Total number of students enrolled
4.14
20.33
6.17
North
2008-09
India
North
The school segment in the north is spread across a large

spectrum, from super premium international schools to rural
government institutions. One third of the total number of schools
in India are located in the North, with the segment growing
steadily over the past five years.
Total number of enrollments
Northern region constitutes ~34 percent of the enrolment in

K-12 schools pan India
Number of K-12 schools has increased at a healthy rate of ~5

percent over last few years
The enrolments in North has increased at 5 percent in

comparison to Indias increment of 3 percent in K12 education.
248
83
2008-09
India
Vocational/Professional Education:
The number of polytechnic colleges and technical institutes
are higher in the southern regions of India, with the north
constituting less than one third the total number of polytechnics.
Specialising in engineering and medicine is lagging behind
in polytechnics, with more than 55 percent of the institutes
focused on Management. However, increasing policy focus
and the rise of public-private partnerships have led to a swell in
the number of institutions and enrolments, in the recent years,
particularly technical institutes (for undergraduate studies).
448
422
2011-12
2008-09
1399
1331
In 000
In Millions
India
Total number of Schools
240
North
2011-12
Key Statistics:
School Education (K-12)
79
10,489
6,121
2011-12
2008-09
35,539
25,951
In Numbers
In Millions
15.76
Total number of colleges
North
2011-12
India
Key Statistics:

Number of technical institutes(undergraduate) in India has

grown from 3,536 in 08 to 4,506 in 11 at a CAGR of 8 percent
Number of postgraduate technical institutes pan India has

grown from 6,413 in 08 to 7,516 in 11 at a CAGR of 5 percent
Number of polytechnic institutions in India has grown at a

CAGR of 2 percent from 2,969 to 3,139 in the same period.
Segmentation of college by specialisation in North
Polytechnic Colleges
Medical 3%
Management 55%
Engineering 32%
Pharmacy 10%
North India
India
No. of Polytechnic
Institute
981
3139
No. of Total
Enrollments
354,994
2,235,216
Projected gap in enrolment and

education infrastructure till 2021
percent of the enrolment gap is from the state of UP and hence
significant capacity creation is required in the state.
Significant capacity creation is required in K-12 segment as there

is a perceived increase in enrolment numbers to the tune of 11.3
million across North India by 2021 to achieve overall 98 percent
GER. In traditional colleges, the gap in enrolment is 2.9 million to
achieve 30percent GER in higher education by 2021.
To achieve 30 percent GER in higher education by 2021,

significant investment should be made in polytechnic colleges
to support the gap of 2.1 million in terms of numbers. In
management colleges, the total gap stands at 0.23 million.
The gap in enrolments for North India is 1.25 million for

engineering and 0.3 million for medical to achieve 30 percent
GER in higher education by 2021. UP leads the enrolment gap
numbers in both engineering and medical colleges. Almost 60
The following table summarizes the enrolment gap (in 000s) as of 2021 across the education sector in India Northern Region
State
K12
Engineering
Delhi
444
78
20
15
132
186
Haryana
711
72
18
14
122
171
--
10
17
24
107
28
48
68
Punjab
1,147
54
14
10
91
128
Rajasthan
1,488
226
56
42
381
536
UP
7,114
776
194
146
1,310
1,844
Uttarakhand
50
12
16
Chandigarh
257
--
--
--
--
11,317
1,252
313
235
2,112
2,973
HP
J&K
Total
Medical
Management
Polytechnic
Traditional
03
Private investment
opportunities in North India
Advantage North India

The Northern region has seen rapid growth of educational
institutions in the recent years. The students from North
Indian institutions are considered to fare better while the state
governments invest heavily in education initiatives.
Higher spend on education

According to estimates, the states in the northern region on
an average, spend higher on education than the rest of the
country. In 2010, the national average spend on education was
0.7 percent of GDP, while Delhi, Haryana and Punjab spent 1.17,
2.05, 2.23 percent of their GDP on education respectively. The
highest spend however is by UP and Bihar where the literacy
rates are some of the lowest in the country. While UP spends
3.67 percent of its GDP in modernisation of education system,
Bihar doles out as much as 5.7 percent.
Supporting policy framework

A majority of the Northern states have taken special care to
introduce policy measures that can support the growth of the
education sector. Supportive policies include subsidies and tax
waivers for setting up educational institutions and removing
rigidities in law that prevent investment. For example, Rajasthan
has recently decided to repeal the central apprenticeship act in
a bid to create a more flexible environment for training industrial
apprentices and thus increasing the total workforce qualitatively
and quantitatively. Further details of state specific policies are
outlined in the appendix.
North Indian students competitive advantage

According to a study, released in January 2014, done jointly by
HR consultancy firm PeopleStrong, Wheebox.com and industry
body CII --which captures the hiring and talent trends within
the country-- students from the north perform better than their
southern counterparts. Students from northern states Punjab,
Haryana, Delhi, UP and Rajasthan were found to be more likely
to qualify for the employable grade, with an overall score of 60
percent and above. (All students were tested on Mathematics,
English and computers besides their own domain knowledge
and behavioural skills.)
Assessment of the candidates knowledge in three core
subjects Mathematics, English and Computers reveal that
north Indian states dominate in the top five list. Rajasthan tops
with its students scoring the best in all the above three core
areas, reflecting a better overall education quality in the state.
Growth in cross cultural & affluent population
Emergence of
cities like Noida,
Gurgoan etc as
an Industrial and
Services hub
Rise in Affluent
population
with cross
cultural
background
Demand for
education
at global
standards
Demand for
high quality
education
Driven by an increase in the number of MNCs setting up base,

in cities like Noida and Gurgaon; there has been a rapid increase
in affluent population with cross cultural background. This has
increased the demand for education with global standards.
Also key North Indian states such as Rajasthan, Haryana and
Punjab have focused initiatives to emerge as education hubs by
encouraging private players to invest in building the educational
infrastructure in the states.
This has resulted in the rise in number of private school chains
with international curriculums like Amity International, Pathways,
Ryan International and Manav Rachna School. Also in the higher
education space, a number of private universities like Amity,
Sharda in Uttar Pradesh; Shiv Nadar University, O.P. Jindal Global
University, Apeejay Stya University, GD Goenka University in
Haryana; Chitkara in Himachal Pradesh; NIIT, Raffles in Rajasthan;
Lovely Professional University, Chitkara in Punjab have been
established.
Driven by favourable demographic and economic development;
the following opportunities for private participation in education
is expected to increase further in several areas.
Establishing
formal education
institutes and
expanding existing
ones under PPP
model
Punjab Technical University (PTU) has announced that it has

signed a MoU with University of California, Santa Cruz (UCSC)
for setting up an Institute of Excellence (IOE) at Chandigarh. It
will be set up at the New Chandigarh Education City that will
be spread over 2000 hectares in the city and the government
has assured the foreign institutes of all possible help - be
it permissions, sanctions and clearances; or infrastructure
including land. The Punjab state government shall bear all the
cost
In 2012, the Himachal Pradesh government had announced

that 33 Government ITIs were being upgraded under the PPP
mode in the state. A provision of INR 41.25 crore has been
made for upgrade of infrastructure, procurement of equipment
and civil works in these ITIs.
Providing course content,

development, training services,
training personnel etc.
Investment
Opportunities
Partnering with
foreign players to
establish local
campuses/
institutes
Developing infrastructure,
executing management contracts
The results signify the investment opportunities by private

players in the northern region which could change its education
and skill development landscape; especially through publicprivate partnerships.
Examples of public-private partnerships in North India

Realising the urgency of the task at hand to educate and skill
its youth the state governments of north India have also roped
in private players to achieve its goal. Some of the public-private
partnerships are highlighted below:

Amity University has signed a pact for establishing an

educational complex in Kanpur for INR 2,000 crore at the
recently held investors conclave in Uttar Pradesh
In Haryana - an Indian Institute of Information Technology

(IIIT) is being established at village Kilord, district Sonipat in
PPP mode by Ministry of Human Resource and Development
Government of India for which Gram Panchayat has offered a
land measuring 128 acres, 7 kanal, 6 marla
1000 schools in Punjab in PPP mode whereby 5 acres of land

offered on lease and 20 percent of the poor children to get free
education
In Jammu and Kashmir Reliance Industries is planning to set

up an institute of management and information technology
with an intake capacity of 250 students in the state. The
institute will offer courses in five streams of information and
communication technology, biotechnology, health, tourism and
medicinal and aromatic plants
After residential schools, the Uttarakhand government is

planning to run its primary schools under the PPP mode. In the
first phase, eight primary schools in Dehradun district would
be operated under a pilot project scheme
HCL Technologies worked with the state government of Uttar

Pradesh to fund IT education in 120 primary schools on a PPP
model
Case Study: Technical partnership and PPP for aviation training in

North India
InterGlobe Enterprises and CAE, a Canada-based civil and military
aviation simulation training company, has launched Indias largest
pilot simulation training facility in Greater Noida, Uttar Pradesh.
The centre, CAE Simulation Training Private Limited (CSTPL), is a joint
venture between InterGlobe Enterprises and CAE. An investment of
over US$ 25 million has already been made in setting up the facility
and equipment.
With its six simulator bays, the centre will have the capacity to train
over 5,000 aviation professionals per year, and will be the largest
such facility in India. This will also be the first centre in India to impart
Airbus certified training. The centre started operations in August 2013
and already provides training to IndiGo pilots.
CSTPL is the fifth aviation training location that CAE operates in
India. CAE also operates a joint venture helicopter training centre in
Bengaluru equipped with the first advanced, full-fidelity helicopter
simulators in India. In partnership with the Government of India, CAE
also operates ab-initio flight schools in Gondia and Rae Bareli.
Case Study: Establishment of formal institutes and foreign

partnerships in higher education
The Shiv Nadar University (SNU) was started in 2011 in Dadri,
Uttar Pradesh through a state act. UP is one of the highly populated
states in the North with a very high portion of the population
between the ages of 15-59, making it an ideal destination for higher
education institutions. The university is a private foundation aimed
at participation in public and private/civil society organisations
and commercial enterprises with an INR 31 Crore fund for granting
scholarships.
The university since 2011 has introduced 14 undergraduate courses
across their five schools spanning Engineering, Natural Sciences,
Communication and more recently, Humanities & Social Sciences
and Management & Entrepreneurship. The promoter Shiv Nadar has
pledged INR 3,000 Crore to develop education institutions including
the university which has so far received INR 512 Crore and it is
envisaged that the university will launch its school of Law in 2015.
The university in an effort to build investments and partnerships has
collaborated with several top foreign universities including Carnegie
Mellon University, University of Pennsylvania (Annenberg School
for Communication) and Duke University. The partners set up a joint
Center for Global Communication Research at SNU in 2012.
04
Appendix
State-wise Policy/Educational
Initiatives
Apart from implementing various educational and skill
development initiatives taken by the central government, state
governments in northern India have initiated various measures
to improve the education standard of their respective states.
Listed below are a few examples initiated across the northern
states:
Rohtak, Jind, Yamuna Nagar, Karnal, Jhajjar, Mahendergarh and

Bhiwani district are being established. Subsequently all other
districts will have a kisan school

Rajiv Gandhi Education City coming up on a 2000 acre campus

in Kundli would be the single largest higher education complex
in the world to serve about 1.5 lakh students in 10 universities
State Government has decided to establish National Law

University at Sonipat which will be a State funded University
and will be raised with Government grant of INR100-110 crore.
This University will be developed as centre of excellence
The state has signed a memorandum of understanding (MoU)

with Michael and Susan Dell Foundation to improve the quality
of education in the states government schools .The foundation
will target 16 lakh children studying in 12,000 state-run primary
and middle schools across Haryana as part of the quality
improvement programme
Indian Institute of Management, Rohtak is being established

by the Ministry of Human Resource Development,
Government of India over a sprawling area of 200 acres at
Rohtak. The State Government has made the land available
free of cost
Indian Institute of Information Technology (IIIT) is being

established at village Kilord, district Sonipat in Public Private
Partnership (PPP) mode by Ministry of Human Resource
Development, Government of India for which Gram Panchayat
has offered land measuring 128 acres, 7 kanal, 6 marla
National Institute of Design (NID) is being established in

Umri (on NH-1) in district Kurukshetra. Land measuring 20.5
acres has been provided by the Gram Panchayat, Umri for
establishing this institute of national importance.
Rajasthan

As per Rajasthan governments State Policy provisions have

been made to allot 10 acres of land, free of cost, to the private
investor for setting up a polytechnic college in backward
districts
Free buildings will be provided if the private investor prefers to

establish Women Polytechnic in the lagging district
Udyog Sansthan Sahabhagita Yojana for private parties to run

second shift in existing government ITIs
Scheme for establishing engineering college under PPP mode

in 18 districts where facility of engineering college is not
available, with provision of providing 10 acres of land free of
cost
Scheme for adoption of ITIs by private sector
The state is looking at building a new IIIT at Kota.
Haryana

A state-level School for Teacher Education of international

standards is coming up at Silani Kesho, Jhajjar. The school
would provide pre-service training to prepare professionally
competent teachers to meet the manpower requirement of
future pace setting schools being established in the state. In
addition, it would provide in-service training, research and
also organise other school development programme. This
innovative 4 year integrated programme leading to B.A./B.
Sc./B.Com./B.Ed. degrees is being started from the academic
year 2013-14
For providing education in rural areas and to bridge rural
and urban gaps, Kisan schools are being established. These
schools will have excellent physical infrastructure, better
equipped labs and sports activities. Hostel accommodation
for students and transport facilities will be provided to the
students, if necessary. Initially 7 Kisan schools one each in
Punjab

1000 schools in PPP mode whereby 5 acres of land offered on

lease and 20 percent of the poor children to get free education
Under the EDUSAT scheme 3823 virtual classrooms have

been setup benefiting 3 lac students
The Punjab Agricultural University at Ludhiana is well known

for its outstanding contribution to education, research and
extension services in the field of agriculture
The state government is planning to set up an Indian Institute

of Information Technology (IIIT) in Kapurthala.
Himachal Pradesh

The Skill Development Allowance scheme is a flagship

programme of the Government. A budgetary provision ofINR
100 crore has been made for this scheme for the financial
year 2013-14. Its purpose is to aid the educated unemployed
youth of Himachal Pradesh to enhance their employability and
income through skill development
Himachal Pradesh is placing special emphasis on girl
education, with the implementation of National Programme
for Education of Girls at Elementary Level (NPEGEL) in eight
educationally backward blocks, where rural literacy rates were
below the national average
The state is planning to establish 16 new universities in an

effort to boost vocational and higher education
Private participation is being encouraged in technical and

vocational education.
Uttar Pradesh

The Rajiv Gandhi Institute of Petroleum Technology was set

up by the Ministry of Petroleum and Natural Gas (MOP&NG),
Government of India-at Jais, Rae Bareli district, Uttar Pradesh
through an Act of Parliament. RGIPT has been accorded
Institute of National Importance Status along the lines of
the Indian Institute of Technology (IIT) and Indian Institute of
Management (IIM)
Private university Amity has signed a pact for establishing an

educational complex in Kanpur for INR 2,000 crore recently.
Uttarakhand

Government of India has proposed to set up a textile skill

training programme in Uttarakhand at an estimated cost of
USD18.4 million. Around 15,000 people are expected to be
trained under the programme in the next five years
For the year 2012-13, the state government has allocated USD
814.3 million for school education and USD 47.3 million for
higher education.
Jammu and Kashmir

The government has approved an ambitious INR1,039 crore

plan to establish new universities, technical colleges, model
degree colleges, polytechnics and upgrading the existing
higher educational system in the state
Seasonal schools have been opened for people in the hilly

areas and the under-privileged population
Two central universities have been set up to boost the

educational infrastructure in the state, one in Kashmir
division and another in Jammu division. They have instruction
and research facilities in emerging sectors such as IT,
biotechnology and nanosciences.
05
Healthcare
Macro scenario in India and key

indicators
Introduction
Healthcare in India today provides existing and new
players with a unique opportunity to achieve innovation,
differentiation and profits. In the next decade, increasing
consumer awareness and demand for better facilities
will redefine the countrys second largest service sector
employer.
Indias primary competitive advantage over its peers lies in its
large pool of well-trained medical professionals. Also, Indias cost
advantage compared to peers in Asia and Western countries is
significantly lower cost of surgery in India is one-tenth of that
in the US or Western Europe.
The diagnostics sector in India has also been witnessing
immense progress in innovative competencies and credibility.
Technological advancements and higher efficiency systems are
taking the market to new heights.
The private sector has emerged as a vibrant force in Indias
healthcare industry, lending it both national and international
repute. Also, hospital and diagnostic centres attracted foreign
direct investment (FDI) worth Rs. 11,272.32 crore (USD 1.87
billion) between April 2000 and Feb 2014.
However, there is still a significant scope for enhancing
healthcare services considering that healthcare spending as a
percentage of GDP is rising. This presents vast opportunities for
investment in healthcare infrastructure in both urban and rural
India.
In northern India, the health care delivery sector, including
hospitals and diagnostic services, is growing rapidly. The
north has begun seeing proliferation of specialty hospitals and
healthcare centres, with major players such as Fortis, Apollo,
Medanta and Metropolis investing in this space.
Many state governments in the North have been encouraging
hospitals to get accreditations to prove that their healthcare is
good enough for visiting tourists.
Healthcare market in India

200
180
179
160
140
CAGR 12%
120
100
81
80
65
60
40
72
54
40
43
44
2007
2008
2009
20
0
2010
2011
2012
2013
2020
Source: JP Morgan, Aranca Research
The Indian healthcare industry has been growing at a CAGR of 12

percent and is expected to grow at the same rate going forward.
It expanded from USD 40 billion in 2007 to USD 81 billion in 2013
and is expected to reach USD 179 billion by 2020.
The size of the healthcare market is estimated to increase from
USD 81 billion in 2013 to USD 179 billion in 2020.
Composition of Healthcare market
Insurance 4-5%
Diagnostics 3-5%
Devices 9-10%
Pharma 13-15%
Source: JP Morgan, Aranca Research
Delivery 65-70%
Healthcare delivery comprises majority of the pie of the

healthcare market in India with 65-70 percent of the total
healthcare revenues followed by pharmaceuticals with 13-15
percent. Medical Devices also hold a considerable share with

9-10 percent, followed by Medical Insurance at 4-5 percent and
Diagnostics at 3-5 percent.
The growth in Indian healthcare is driven by a combination of macro and micro economic factors
Increasing incidence
of lifestyle & noncommunicable disease
Growing
population
and rising
life
expectancies
Changing
diseases
profile
Increased
affordibality
Demographic
transformation
Rising
income,
growing
middle
class and
increased
insurance
Drivers of the
Healthcare Industry
Particularly
for preventive
care and
diagnostics
Increased
penetration of
private players
& government
initiatives
Increased
Awareness
Influx of
medical tourist
Currently serving more
than 8,50,000 foreign
patients every year
Augmented by
government initiative
& evolving healthcare
delivery models
Healthcare
05
India vs other nations Need for

change
In terms of healthcare expenditure, India not only lags far behind

the developed countries, it even fails to meet the global average
spend (5 percent of GDP as against the global average of 10.6
percent). Moreover, this expenditure is highly skewed with
more than two third of the contribution coming from the private
sector. This is in contrast to that of developed countries in which
healthcare expenditure is a state priority. Also, out of pocket
expenditure forms the major share of private sector spending
showing the low penetration of insurance in the country. Thus,
the healthcare market is yet to achieve its true potential since
out of pocket expenditure leads to a tendency of procrastination
and avoidance of elective care like knee replacement, preventive
care etc.
The healthcare delivery market in India has been growing

at 15 percent in the last 5 years (from 2009-2014), faster
than the overall healthcare market. However, the country
still lags behind many of the developed and developing
countries in terms of both overall healthcare expenditure
and supply of infrastructure.
Healthcare Expenditure
Format of Expenditure
(Private > Public)
Private expenditure (Out of pocket >
Insurance)
Healthcare expenditure
Healthcare expenditure as a % of GDP
20
18
17.9
17.9
18
17.9
18
16
14
12
10
9.6
9.5
9.6
9.4
9.6
9.4
9.7
9.7 9.1
9.6
9.7
9.1
8
6
4
5.1
5.2
5.3
5.4
4.2
4.1
4.1
4.1
5.6
4.2
2
0
2010
2011
UK
Source: EIU estimates
USA
2012
Srilanka
China
2013
Japan
2014
Brazil
India
Global average spend on healthcare is around 10.6 percent of their GDP. India fares the lowest amongst some of the developed
countries in the world and spends less than half of the global average.
Private Healthcare Expenditure Comparison
Type of private healthcare expenditure in India
70%
India
Japan
18%
54%
Brazil
44%
China
Insurance 14%
Out of pocket 86%

58%
Srilanka
52%
USA
17%
UK
0
20%
40%
60%
80%
Source: WHO 2014 Statistics
India has as high as 70 percent of the healthcare expenditure

coming from the private sector as compared to the global
average of 38 percent and is the highest among all compared
developed countries. Also, out of the private expenditure, as
high as 86 percent is out of pocket showing low penetration of
insurance in the country. Government expenditure however has
been increasing over the years and much more investment is
required from the public sector to fill the gap.
Number of beds per 000 people
India
0.7
2.3
Brazil
13.7
Japan
Healthcare infrastructure in India

There is an acute shortfall of healthcare infrastructure and
healthcare personnel in the country. India not only lags far behind
developed countries like UK and USA, it also lags behind the
global average and comparable countries like Brazil and Sri Lanka.
The planned additions in infrastructure including medical and
nursing colleges till 2020 are not enough to meet the demand
of the country. While 70 percent of the countrys population
lives in rural areas, only 30 percent of the overall healthcare
infrastructure is available to them.
3.8
China
3.6
Srilanka
2.5
USA
UK
0
10
15
Beds per thousand
A lack of supply coupled with a

highly skewed distribution between
urban and rural areas creates a need
for efficient delivery formats in the
country.
India has the lowest number of beds per 1,000 people among
the profiled countries. India has only 0.7 beds per thousand
population as compared to the global average of 2.6.
India needs to add 1.7million beds to achieve the target of

2 beds per thousand population by 2020.
Number of nurses per 000 population
Acute need for Healthcare

professionals in the country
Shortfall of number of doctors per thousand 2020
1.7
India
1.40
7.6
Brazil
11.5
Japan
China
1.5
Srilanka
1.6
Incremental Supply0.51mn doctors
Incremental Demand*
of 0.65mn doctors
0.30
1.30
Gap
Demand 2020
1.20
0.30
1.00
0.80
0.70
9.8
USA
0.60
8.8
UK
0
10
0.40
15
Units
0.20
Supply 2012
India also lags behind the developed countries in terms of

number of nurses per 000 people. India has only 1.7 nurses per
thousand population as compared to the global average of 2.8.
The European region has almost thrice the global average.
Number of physicians per 000 population
0.7
India
2.3
Japan
1.5
China
0.7
Srilanka
2.5
USA
2.8
UK
0
Source: WHO 2014, Planning Commission, KPMG Analysis

Note :*Demand based on realistic ratios of doctors to population as opposed to global standards
There is an incremental requirement of 0.9 million doctors over

the 2012 supply to meet the global average number of doctors
in the country in 2020. As per the Planning Commission data, an
incremental supply of 44,000 doctors will be able to meet only
78 percent of the 2020 demand, leaving a gap of 0.3 doctors per
thousand people.
Similarly, an annual supply of 280,000 nurses will be able to
meet only 90 percent of the demand by 2020 and an annual
supply of 30,000 AHPs (Allied Healthcare Professionals) will be
able to meet only 80 percent of the demand in 2020.
1.9
Brazil
Supply 2012
Physicians per thousand
India has the lowest number of physicians per 1,000 people

among the profiled developed countries. The global average is 1.3
physicians per thousand people as compared to only 0.7 for India.
Sr.
No.
Parameters
Healthcare expenditure as a % of GDP 2014
5%
Private healthcare expenditure as a % of total

healthcare expenditure 2014
70%
Out of pocket expenses

Insurance
Numbers
86%
14%
Number of beds per 1000 people 2014
0.7
Number of nurses per 1000 people 2014
1.7
Number of physicians per 1000 people 2014
0.7
Shortfall in number of physicians per 1000 2020
0.3
Thus, there is a need to build 600

additional medical colleges with 100
seats per college to meet the global
average of doctors and nurses per
thousand population in the next 15
years.
Economic and
demographic profile
06
North India
Population
(0-14)%
composition
Population
(15-59)%
composition
Population
(60+)%
composition
Sex Ratio
(Females per
1000 males)
2011
2011
2011
2011
2.0%
29.7%
61.6%
8.7%
877
550
1.4%
25.6%
64.0%
10.4%
893
68,621
201
2.1%
34.7%
57.7%
7.6%
926
Uttar Pradesh
1,99,581
828
2.0%
35.9%
56.2%
7.9%
908
Delhi
16,753
11,297
2.1%
27.2%
65.9%
6.9%
866
Himachal
Pradesh
6,857
123
1.3%
25.9%
63.8%
10.3%
974
Jammu &
Kashmir
12,549
56
2.4%
33.8%
58.8%
7.4%
883
Uttarakhand
10,117
189
1.9%
31.1%
59.9%
9.0%
963
Chandigarh
1,055
9,252
1.7%
25.3%
68.3%
6.4%
818
India
12,10,193
382
1.8%
30.9%
60.4%
8.7%
940
Population
(000)
Population
Density
(per sq. km)
2011
2011
Haryana
25,353
573
Punjab
27,704
Rajasthan
State
Yearly growth
(2001-11)
The demographic profiling of the North India reveals the

following:

The northern states together constitute over 30 percent of

Indias population with UP, the most populous state, having a
population of more than 200 million.
Barring the hilly states, population density in other northern

states is much higher when compared to the national average,
with Delhi and Chandigarh being the most densely populated
regions in the country.
The population consists of a sizeable number of baby boomers,

which consume considerable share of medical services.
Per capita NSDP

(Constant prices,
2004-2005) INR
Per capita NSDP

(Constant prices,
2004-2005) INR
Growth in per capita

NSDP (%)
Govt. Per-capita Health

expenditure (INR)
2012
2013
2013-14
2009
Haryana
64,631
68,040
5.27%
280
Punjab
48,572
50,233
3.42%
360
Rajasthan
29,244
30,120
3.0%
287
Uttar Pradesh
18,866
19,512
3.42%
293
Delhi
1,18,960
1,27,667
7.32%
840
Himachal Pradesh
51,730
54,494
5.34%
884
Jammu & Kashmir
30,335
31,773
4.74%
845
Uttarakhand
56,251
61,106
8.63%
630
Chandigarh
96,206
Not Released
NA
798
India
38,856
39,961
2.84%
503
State
The economic profiling indicates:

The net state domestic product (NSDP) of most of the North

Indian states is well above the overall average of India with
6 north Indian states figuring in the list of top 13 states with
highest per capita SDP.
The growth in NSDP of these states over the last year has also
been significantly above the national average of 2.84 percent.
07
Healthcare and disease

trends in North India
The major communicable diseases in the region are tuberculosis,

diarrhea and viral hepatitis. The major cause of these diseases
is lack of hygienic conditions in urban slums along with unsafe
drinking water.
The major non communicable diseases in the region include
cancer, cardiovascular diseases, diabetes and drug addiction.
Increasing consumption of alcohol, smoking, job stress, lack of
physical exercise coupled with junk food and injudicious use of
chemicals in fields are some major causes for these diseases in
the region.
North India has a highly skewed

infrastructure with cities like Delhi
having much higher than average
healthcare infrastructure and areas
in UP lagging behind with lack of
even basic amenities. Thus, the need
of the hour is more investment in
accessible and affordable healthcare
infrastructure through innovative
operating models like telemedicine,
hub and spoke, advanced primary
care in rural areas, low cost
diagnostic centers to improve
preventive care , medical camps
to create awareness and low cost
single specialty delivery models in
tier-II and tier-III cities.
Key need-Gaps and

infrastructure requirements
in north india
08
Number of hospital beds per 000 people
Number of doctors per 000 people
0.7
India
Rajasthan
Rajasthan
0.5
0.8
Uttarakhand
0.4
Jammu and
0.4
Punjab
0.9
Jammu and
Punjab
1.4
Haryana
0.2
Chandigarh
0.6
2.8
Delhi
0
0.3
UP
0.5
Chandigarh
0.3
0.1
Himachal
0.7
Haryana
0.4
Uttarakhand
1.3
Himachal
UP
0.7
India
0.6
2.8
Delhi
3
No. of Beds
Source: CBHI 2011, Indiastat, KPMG Analysis
The healthcare infrastructure in North India is skewed with

Delhi having adequate health infrastructure, much higher than
the national average and places like Haryana, Rajasthan and
UP lagging behind.
However, the healthcare market in North India has been

growing owing to increased inflow of investments from
the private sector. The entire region has been witnessing
an increase in the number of hospitals, primary clinics,
diagnostic centers etc. Also, the region has been promoting
healthcare manufacturing industry by developing SEZs for
pharmaceuticals and medical equipments.
2
No. of Doctors
Source: CBHI 2011, Indiastat, KPMG Analysis
09
Emerging healthcare
models and opportunities
Growth in tertiary care hospitals in the urban areas has led to a

high bed density in some parts of the country. Cities like Delhi
and Mumbai have a bed density of more than 3 per thousand
people. Thus, future potential for growth may not mirror past
growth formats. Major healthcare provider Apollo has already
started expanding to cities like Nashik, Trichy, Nellore etc.
through Apollo Reach. Vaatsalya and Narayana Hrudayalaya are
also exploring opportunities in tier II and below areas. However,
penetration in rural areas and other healthcare delivery models

is yet to realise its full potential. Hence, there is potential for
growth across the value chain and potential for penetration in
underserved areas.
Also, there are several emerging models in healthcare rising out
of an increasing incidence of lifestyle disease and an awareness
about specialised care required for those diseases.
Growth
services- Under
Penetrated
GPs and Organised chains
Wellness services- Under
Penetrated
Fitness, Alternate therapy
and Rejuvenation
Rehab & Remote care
Traditional IPD format-
Under Penetrated
Rural under penetrated

Tertiary, Secondary ,
Nursing Home
New and Emerging
Formats- Under
Penetrated
Single Specialty Hospitals
Asset Light outreach
Models
Day care Format
Emergency Medical
Response
Growth
Primary healthcare
Institutional Curative care
Services
Rehabilitation centers
Home care services
Telemedicine
Supporting healthcare delivery
Growth
MEDICAL SUPPORT
HEALTHCARE
DELIVERY
Preventive and Primary care
Growth
Underpenetrated in rural market

Diagnostic centers (Radiology is underpenetrated in urban areas also)
Pharmacy
High Urban penetration; scope in rural areas
Under penetrated market
Though current bed capacity
is 0.9/1000, the benchmark

is already ~3 for urban India
Value discovery in rural
model is yet to be realized
Thus, expansion opportunities in 4
routes:
Expansion
through hospital
chains to slow
down in urban
India
Building of specialty care formats

Expansion along the value chain- pre
and post operative care leading to

holistic patient engagement
Evolution of low cost secondary care
Non existent
Pre and post
treatment
care
models to penetrate tier-II cities and

below through asset light outreach
models
By contrast, many
specialty-driven
care areas are
woefully
unaddressed
~80 organized primary care
clinics for 865mn urban

cases
Disease management and
wellness are nascent
concepts
No organized home care and
rehab format
Single specialty hospitals, day-care centres and low-cost
healthcare models are cropping up as they are PE-friendly
business models which do not require high capex like that of
hospitals and exit can be achieved in a much shorter time.
Private equity has invested around USD 3.5 billion in healthcare
services in the past five years and, of these, the new formats
have managed to grab USD 422 million.
Moreover, these new formats save the pain of traveling to
crowded and far distanced big hospitals and thus it has also
received good response from consumers over the years.
The biggest advantage with these new formats is their ability to
lower the cost of healthcare, offering the same procedures as
multi-specialty hospitals at almost 20-25 percent cheaper rates.
Monthly operating costs of these centres end up 75-80 percent
lower than big hospitals because of the space involved.
Potential for growth in diagnostics and
pharmacy
No scaled care model for
~70mn diabetics
~2,000 tertiary hospitals
for ~50mn heart patients

~11 machines per 000
ESRD patients
60 major cancer centers
for ~3mn cancer patients
Medical Tourism
There are more than 410,000 foreign patients visiting the country
annually to avail treatment at much lower rates as compared
to the western countries. There is an increasing trend towards
getting international accreditations among hospitals in the
north to attract medical tourists in the region. However, other
than Delhi and some parts of Punjab, medical tourism has not
yet picked up in other states of North India. Thus, the Northern
region could be a major driver to the growth of the USD 1.6
billion* medical tourism industry of the country.
*KPMG Analysis
Hence, going forward, opportunities are bound to arise in a bid to taper the
urban rural divide in North India through outpatient clinics, outreach models
and low frills facilities and asset light chains.
10
Government initiatives
The Government of India has taken numerous initiatives to

nurture the Healthcare industry in the country. These policies
will help boost healthcare market and healthcare spending in the
North among other regions.
--
A 260 acre Medicity is being developed in New Chandigarh

and will include world class hospitals and a medical college.
Phase I is underway with the development of a leading
hospital - Tata Cancer Research Centre and Hospital.
--
The Mohali Biotech Park Ltd. a joint venture of Govt. of

Punjab and Govt. of India is setting up a biotech park
at Knowledge City, Mohali, to promote the industry in
agriculture, food, pharmaceutical, energy and allied sectors.
--
Rajasthan has introduced Medicare Relief Society, a

committee entrusted with all the funds, which include
user charges, visiting fees, outpatient fees etc. These
committees have their own bank account and can decide
upon the allocation of funds. The government has also
adopted incentives measures such as allotment of land for
hospitals at concessional fees
--
Himachal Pradesh initiated a scheme called Vikas Me Jan

Sahyog (Peoples participation in development) which
envisages 20 percent of the funds being contributed by
the people and the remaining 80 percent coming from the
State Government. The scheme covers the construction of
hospitals, sub-centres and ayurvedic hospitals in a specific
area.
--
Tamil Nadu has been aggressively promoting medical

tourism by organizing medical tourism fairs and putting up
dedicated medical tourism desks. The state also has an
improved drug distribution system in place under TMSC.
--
Karnataka government launched telemedicine in

association with CISCO, opened a medical education under
ESIC and launched Yeshaswini Health Insurance Scheme
among other initiatives to promote healthcare in the state.
Encouraging Private Players

Insurance, Incentives &
Subsidies
Supporting Medical Education
Other Initiatives
State-specific Initiatives
100 percent FDI in health services under automatic route,

providing long term capital to hospitals, tax benefits to
hospitals in rural areas and encouraging PPP model are some
of the government initiatives to encourage foreign players in
the country.
RSBY(Rashtriya Swasthya Bima Yojana) , relaxation on import
of medical equipments and life saving drugs and tax holidays
to hospitals providing health travel facilities further encourage
investment in the sector.
Relaxation of infrastructure requirement for medical colleges

without compromising on quality supports medical education
and consequent supply of manpower in the country
Other initiatives like ESIS(Employee standard insurance

scheme), CGHS(Central government health scheme), ECHS
(Ex servicemen contributory health scheme), NRHM(National
rural health mission)and NUHM (National urban health
mission)have made healthcare more accessible.
State-specific Initiatives
--
Uttar Pradesh has adopted a 2 pronged vision to upscale

healthcare delivery in the state focusing on technology
as topdown & empowerment as bottom-up approach to
ensure that the state improves on healthcare parameters.
It is working on cloud based IT solutions to monitor the
delivery of services and digitization of medical records.
--
The Union Cabinet has approved the proposal for setting

up of National Cancer Institute (NCI) at a cost of INR 2,035
crore (USD 333.61 million) in the Jhajjar campus (Haryana)
of All India Institute of Medical Sciences (AIIMS). The
project is estimated to be completed in 45 months.
Private player initiatives
11
Primary
Care
HCL Avitas
GVK EMRI
Nova
Specialty
Surgery
Secondary
Care
Tertiary
Care

Manipal Health Enterprises

Medanta
Fortis
Apollo
Ivy
Max Healthcare Institute
Columbia Asia Group
Aerens Gold Souk
International Ltd.
And many others
Metropolis
SRL Limited
Dr Lal PathLabs
Diagnostics
Note: This listing is illustrative
Though the private sector has made investments across the value chain,
tertiary care has gained maximum attention from the private players.
12
Key recommendations
Leverage existing infrastructure for providing effective and

quality treatment
Infrastructure
Development
Expand along the value chain - pre and post operative care
leading to holistic patient engagement
Evolve effective low cost secondary care models to penetrate
tier-II cities and below through asset light outreach models
Invest in diagnostics and pharmacies to support the demand
Build specialty care formats where the breakeven is faster
Improve access to affordable real estate for setting up new

healthcare and diagnostic centres
Encouragement
to Private
Players
Adopt the PPP model to lessen the burden on the government

and bring in efficiencies of the private sector
Improve access to indigenous medical devices by providing
active support for local entrepreneurs for setting up
infrastructure to manufacture indigenous medical devices and
offer them at affordable prices
Address the skill gap through better education and training

methods
Enhanced
Healthcare
Education
Collaborate with reputed international institues and

organisations for delivering high quality healthcare education
Introduce specialised courses such as Healthcare Management,
Hospital Administration and the likes
Conclusion
The striking feature of the healthcare sector is its potential
to grow at an exponential rate in the foreseeable future and
present new opportunities within related industries, which will
emerge as growth drivers. There is immense potential for each
stakeholder (e.g. government, entrepreneurs, healthcare service
providers, pharmaceutical companies, medical equipment
manufacturers, and allied players) to invest in and grow with the

sector. However, given the complex and interdependent nature
of the sector there is a need for a cohesive and collaborative
approach, where all stakeholders effectively work synergistically
and leverage the opportunities to create a lasting impact.
References

http://www.ibef.org/industry/healthcare-india.aspx
http://www.cii.in/Digital_Library_Details.aspx?enc=pZVQM37jtSRTHIkmBsithfJ
Population projection 2021 by National Commission on population 2006 report

School Education Statistics 2007-08, 20011-12, MHRD
mz0qWfG+ttlzF5cKUVII+DWDhpeReQjEpBGYAq+w8
12th Five Year Plan Documents, Planning Commission Website
http://pharmabiz.com/PrintArticle.aspx?aid=68003&sid=21
UGC annual report 2011-12
http://en.wikipedia.org/wiki/List_of_states_and_union_territories_of_India_by_
population
Newspaper Articles:
http://healthcare.financialexpress.com/strategy/2355-healthcare-policies-forprogress
http://www.investindia.gov.in/healthcare-sector/
http://progressivepunjab.gov.in/opportunitiesdetails.aspx?id=12
http://heapol.oxfordjournals.org/content/16/1/87.full.pdf?origin=publication_
detail
Oxford University Press Report 2001 Private initiatives and policy options:
recent health system experience in India

http://makanaka.wordpress.com/2011/05/11/indias-2011-census-the-states-andtheir-prime-numbers/
http://healthcare.financialexpress.com/201109/regionalreview01.shtml
http://dspace.iimk.ac.in/bitstream/2259/580/1/380-404+Annamalai+Murugan.
pdf
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http://forbesindia.com/article/breakpoint/why-singlespeciality-hospitals-areprospering/32646/1
IBEF Report on Indian Healthcare Industry, March 2014

http://www.biospectrumindia.com/biospecindia/news/215655/gvk-emriawarded-ppp-initiative
http://healthcare.financialexpress.com/market-section/808-esic-s-first-medicalcollege-opens-in-bangalore
http://www.outlookbusiness.com/article_v3.aspx?artid=282428
http://texas.construction.com/yb/tx/article.aspx?story_id=id:zI3bMLuQFLtJ2eJe
fPeIcdDAa29XnYqxP__vSCP-D3PTEdemy9Ap1_Pk5uVWZBdO

http://www.memorialhermann.org/news/memorial-hermann-health-system-tolaunch-major-renovation-and-expansion-to-its-texas-medical-center-campus/
http://trauma.memorialhermann.org/life-flight/
http://ehealth.eletsonline.com/2013/01/aster-medcity-to-be-commissioned-by-
oct-2013/
http://www.ndtv.com/article/south/new-medical-township-in-kerala-beckons-
foreign-health-tourists-442858

http://www.lalpathlabs.com/future_plans.aspx
http://www.srlworld.com/content/2/milestones.html
http://www.medicalbuyer.co.in/index.php?option=com_content&task=view&id=
4042&Itemid=48
Times of India: http://timesofindia.indiatimes.com/india/UP-Bihar-spend-highest-
on-education-in-North-India-Assocham/articleshow/5950212.cms
Financial Express: http://www.financialexpress.com/news/doubling-higher-
education-enrolment-to-meet-target-will-cost-r9.5-lakh-cr-by-2020/944254
State Education Department websites
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Confederation of Indian Industry

Education- Macro scenario in India and key indicators

North India - Economic and demographic profile

Private investment opportunities in North India

Healthcare - Macro scenario in India and key indicators

Healthcare - India vs other nations Need for change

Economic and demographic profile - North India

Healthcare and disease trends in North India

Key need-Gaps and infrastructure requirements

Emerging healthcare models and opportunities

About KPMG in India

Dropout rates in primary and secondary education

Quality of education in public schools

Quality and employability of graduates from institutes of higher education.

01 | Decoding the realty challenge

Macro scenario in India and key indicators

The Indian education and skill development sector stood at

Education sector - Market size (INR Cr.)

Demographic profile- According to International Labour

1. According to the 68th NSSO survey

skilling and hence expenditure on education has been on the

Increased investment by government The new

01 | Decoding the realty challenge

Economic and demographic profile

The northern states together constitute over 30 percent of

Higher education is a sector of prime importance in the north

Barring the hilly states, population density in other states is

In states such as Uttar Pradesh and Rajasthan, where more

Jammu & Kashmir

Gross Enrolment Ratio (GER)

In higher education sub-segment, Uttar Pradesh has the

While most of the states GER are range between 14-24

In secondary education, UP and Punjab score below the

While Delhi and Himachal Pradesh have 100 percent GER

State-Wise Gross Enrolment Ratios

Higher education GER

School Education GER

School Gross Enrolment Ratios

Is the target GER for Higher

Is the target GER for Middle school

Is the expected gross enrolment ratio

Higher Education GER

Number of Enrolled Students in Higher Education and

HIGHER EDUCATION ENROLLMENT

GER (2011-12) for higher education

is the target gross enrolment ratio in

is the expected enrolment numbers

Vocational Education GER

Seating capacity in India for vocational training courses

Electrical & Electronic

Office & Business

Number of students enrolled and

North India constitutes 30 percent of Indian colleges and

There has been a 50 percent increment in the no. of

Private colleges in North India constitute ~70 percent of the

Total number of students enrolled

The school segment in the north is spread across a large

Total number of enrollments

Northern region constitutes ~34 percent of the enrolment in

Number of K-12 schools has increased at a healthy rate of ~5

The enrolments in North has increased at 5 percent in

Total number of Schools