Future of hospital infrastructure in India

Faizal E KotikollonWednesday, December 20, 2017, 08:00 Hrs  [IST]

With a population of 1.2 billion, and growing by almost 18 million per year, India will be the most populous nation by 2030, with as many as 1.4 billion or more inhabitants. Indian civic infrastructure, however, has not developed at the same pace and is not strong enough to cater to the nation’s growing needs. While many aspects contribute towards this deficit, a primary factor is the time and cost taken to build and deliver competent infrastructure facilities.

In urban areas, the ageing and under invested civic infrastructure is getting worse due to rapid urbanisation and is already showing signs of collapse. Lack of affordable necessities and constant strain on infrastructure is not only making the lives of people challenging, but it is also rendering our cities as less liveable. To achieve and sustain a double-digit economic growth, we need to keep the wheels of the economy moving. We need to ensure that our cities have necessary facilities in health, education, residential, and commercial infrastructure that support progress making it attractive both for highly-skilled talent and business investments.

A principal focus area is the healthcare sector. Today, due to the widespread and growing migration to cities our government is unable to offer essential civic services such as drainage, roads, electricity and clean water supply. It makes millions of Indians acutely vulnerable to health crises and epidemics. Our country's healthcare facilities are disproportionate to the size of the population, and the quality is far below global standards. The primary challenge that plagues the Indian healthcare infrastructure sector is the gap between the supply and demand. Indian healthcare system have only 1.3 hospital beds per 1,000 people, which is significantly lower than the 3.5 beds defined by the World Health Organization.

In India, the main challenges of healthcare development are the costs involved in the building and upgrade of healthcare infrastructure, the disruption caused by conventional construction methods, the lack of transparency, corruption and a generally chaotic development environment. Upgrading of healthcare infrastructure has tremendous pay-offs in the long-term and investments in this sector are crucial. Revamping India's healthcare facilities will not only raise the quality of life for all but will also make the healthcare industry in India, a key enabler for economic growth.

Now more than ever, it is imperative to explore newer alternatives to bridge the critical gaps in infrastructure, especially with respect to the availability of healthcare centres. The best way to deliver international standard healthcare, for superior patient experience and treatment is to employ patient-centric design and supplement it with off-site building technology to ensure a fast and reliable solution. This model is the only practical way to meet the healthcare needs of India’s fast-growing population.

Off-site construction is the process of planning, designing, fabricating, transporting and assembling building elements at a factory rather than at the construction site. It cuts the delivery time by 50 per cent and reduces cost up to 30 per cent while producing high quality and custom built buildings. Off-site building includes the integration of automation, robotics and tools such as Building Information Modelling (BIM), for manufacturing a variety of infrastructure including hospitals, homes, schools and commercial buildings.

This builds on the modular development concept, which uses the three principles of standardization, industrialization, and commoditization to drive down development costs while improving the quality, efficiencies, and sustainability of the facility. Standardized modular designs, complying with international standards can eliminate the time and cost spent.

Conventional construction is a relatively dangerous activity. There are many tasks which inherently require risks and, while many improvements in site safety are being made, worker conditions are still precarious, an issue that is intrinsically absent in off-site manufacturing. A comparison with modern manufacturing practices suggests that working in a factory is less likely to pose a risk in contrast to working on a building site. Therefore, if buildings are constructed in future using off-site methods in a controlled factory environment, the health and safety record of the building industry will improve and, ultimately converge to the norms in the manufacturing industry.

While off-site manufacturing in healthcare is still new in India, it is widely used in western markets. It is a tried and tested method that best suits the needs of the Indian market. The international design concept for healthcare facilities puts the patient experience at the core of development, taking into account aspects such as accessibility and floor to space ratio. Off-site manufacturing and specifically BIM technology allows companies to plan these elements down to the smallest detail, even from an aesthetic standpoint. Building information modelling (BIM) can be used to determine everything from the geometry, the shape, to the ceiling-floor height of the building. At this stage, you can also factored in details such as how many operating rooms are required, or where the waiting rooms should be located. This helped to mitigate design changes later, which can be both costly and time-consuming. At the design phase, software to check for structural quality and stability, as well as to gauge the building’s behaviour in seismic conditions. Clash detection tests can be carried early on, to identify structural gaps right at the start, this helped to deliver huge cost savings compared to conventional design.

Some large-scale private super speciality hospitals when opting for new projects and redesign have implemented off-site manufacturing of the entire structure and interiors. The chief advantages of this process are better standardization and industrialization allowing rapid scaling up, and commoditization leading to cost benefits in delivery, maintenance, operations and sustainability of the healthcare facilities.

Global reports suggest that the international market for medical tourism is pegged around US $ 60 billion. Closer home in India, it's already a US $ 3 billion industry and expected to become a US $ 9 billion opportunity by 2020 with FICCI reporting that over 5 lakh international patients, visit the country from Asia and the Middle East, yearly for treatment. The Indian government has also taken steps to make medical travel to the country easier by streamlining and offering e-services for visa processes. India can become a leading medical tourism destination if it can manage the healthcare infrastructure gap it is facing and attract tourists from world-wide.

India's healthcare sector is on the cusp of rapid growth, rising income level, greater health awareness and improved access to insurance are the key contributors. The private sector has emerged as a vibrant force in India's healthcare industry, lending it both national and international repute and it accounts for almost 74 per cent of the country’s total healthcare expenditure. Further, the presence of world-class hospitals and skilled medical professionals has strengthened India’s position as a preferred destination for medical tourism.

Off-site manufacturing and modular construction in healthcare will be a significant catalyst to the sector's success. It will be the cornerstone on which India builds its position as a leading player in the global healthcare market.

(Author is founder and CEO of KEF Infra)