Aster DM Healthcare (Aster), one of the largest and fastest-growing integrated healthcare providers in GCC and India, has received board approvals from its subsidiary Affinity Holdings Private Limited (Affinity) and approval from its Board of Directors to separate the India and GCC businesses into two distinct and standalone entities.

Under the separation plan, Affinity has entered into a definitive agreement with a consortium of investors led by Fajr Capital, a sovereign-owned private equity firm headquartered in the UAE, to invest in Aster’s GCC business. The Fajr Capital-led consortium also includes Emirates Investment Authority, Al Dhow Holding Company (the investment arm of AlSayer Group), Hana Investment Company (a subsidiary of Olayan Financing Company) and Wafra International Investment Company.  The board of Affinity and its representatives who negotiated the transaction formed a positive view of the favourable valuation and other terms offered by the Fajr Capital-led consortium.

Related: UAE’s PureHealth acquires UK’s private healthcare group for US$1.2 billion

Aster DM Healthcare was established by Dr Azad Moopen in 1987 as a single clinic in Dubai, UAE. The company has since grown to become a leading integrated private healthcare provider, offering a full spectrum of primary, secondary, tertiary and quaternary healthcare services that cater to the diverse needs of its patients. In India, Aster has a substantial and growing network in five South Indian states through its 19 hospitals, 13 clinics, 226 pharmacies and 251 patient experience centres. Meanwhile, in the Gulf, Aster has developed a strong reputation and presence, with 15 hospitals, 118 clinics and 276 pharmacies across the UAE, Saudi Arabia, Qatar, Oman, Bahrain and Jordan.

Upon completion, the separation of the India and GCC businesses will establish two distinct regional healthcare champions that will benefit from the strategic and financial flexibility to focus on growing market demand and the priorities of patients. Both the India and GCC entities will be operated by separate dedicated management teams and will also benefit from a dedicated investor base that will aid future growth in the Indian and GCC markets, respectively, both of which hold significant growth potential.

The GCC and India healthcare markets are distinct and have different growth dynamics, warranting different business strategies. With a population strength of 1.4 billion, India will remain a priority market in Aster DM Healthcare Ltd.’s growth journey. The company plans to ramp up bed capacity in India by almost one-third, by adding more than 1500 beds by FY27. In the GCC, Aster DM Healthcare FZC will bolster its expansion plans in key markets, such as the UAE and Saudi Arabia, while enabling greater access to quality and comprehensive healthcare across physical and digital channels.  

Post completion, Dr. Azad Moopen will continue as the Founder & Chairman of Aster, overseeing both India and GCC entities. Alisha Moopen will be promoted to Managing Director and Group CEO of the GCC business to lead a long-term strategy that will unlock value as a pure-play GCC operating company. The Indian entity will continue to be led by Dr. Nitish Shetty as Chief Executive Officer, who will focus on the growth of the India business, aimed at creating value for its shareholders.

EY and PwC provided independent valuation advice, and ICICI Securities provided fairness opinions for the valuation guidance. Baker & McKenzie LLP was Affinity’s lawyer on the transaction. Cyril Amarchand Mangaldas was Aster’s lawyer on the transaction. AZB & Partners were the advisors to independent directors. Moelis & Company and Credit Suisse acted as the sell-side advisors. HSBC Bank Middle East Ltd., Allen & Overy LLP and PwC acted on behalf of the Fajr Capital consortium.

Dr. Azad Moopen, Founder and Chairman of Aster DM Healthcare, said: “The strategic decision to segregate the India and GCC operations was based on the rationale to establish a fair value for both entities, creating two pure-play geographically focused entities that are able to leverage the growth opportunities in their respective markets. In India, we, as Promoters, remain committed to our growth plans and hence had increased our stake to 42% earlier this year. Major institutional shareholders continue to remain invested, reflecting overall confidence in the Company’s India business model and go-to-market strategy spanning all segments of the healthcare space.”

Dr. Azad Moopen

“For the GCC, Fajr Capital has been selected by the board of Affinity as our trusted private equity partner to lead a consortium of investors to invest in the GCC business. We are confident, given their demonstrated expertise and are excited by their commitment to empowering our expansion plans within the GCC’s dynamic healthcare landscape, especially in Saudi Arabia. The Moopen family will retain a 35% stake in the GCC Business. Together, we envision a future where Aster’s business in the GCC continues to deliver best-in-class healthcare services to its patients across the region, underpinned by Fajr Capital’s strong market presence and network. Alisha will lead on these ambitions and oversee the next phase of our growth trajectory in the GCC.”

Alisha Moopen, who will serve as the Managing Director and Group CEO of Aster’s GCC business, said: “While the India business of Aster DM Healthcare has made steady progress in growing multifold within a short period of time, the segregation will enable our GCC operations to seize a significant opportunity to unlock value through its geographic expansion, diversify revenue through targeting different economic segments while expanding into tertiary care and digital health. In our journey with the GCC business, we are glad to be joined by Fajr Capital who are renowned for their expertise in facilitating business growth. With our upcoming expansions in the KSA market, we are confident that their strategic counsel would be of utmost value.”

Alisha Moopen

Iqbal Khan, CEO of Fajr Capital, said: “The Moopen family has built a world-class company, with a rich legacy of delivering high quality healthcare to millions of patients. Large family-led platform businesses is an area where we have deep experience and we believe that Aster has significant potential to meet the growing demand for integrated healthcare services across the Gulf region. We are grateful to the Moopen family for their trust and look forward to working with them, our consortium partners and the management team to accelerate Aster’s ambitions through continued investment, innovation and expansion.”

Related: Entering New Markets: The UAE Healthcare Market

Dr. Nitish Shetty, CEO of Aster DM Healthcare Ltd. in India said: “The Indian healthcare market presents an unprecedented growth opportunity as our citizens seek quality healthcare services at affordable cost.  Aster DM Healthcare has perfected a carefully designed healthcare ecosystem, spanning the entire patient life cycle. The Company is uniquely positioned to provide holistic healthcare solutions, including primary, secondary, tertiary, and quaternary care and investing heavily in new-age technology like Artificial Intelligence and Machine Learning to bring innovative medical solutions to the forefront, addressing critical healthcare challenges and contributing to improving patient outcomes. Our five-year topline and bottom-line CAGR is a testament to the robustness of this business model. The restructuring provides the Indian balance sheet with the flexibility to align its capital allocation policies to emerging growth opportunities.”

The separation will also offer Aster India an opportunity to potentially expand its institutional investor base to include investors who are mandated to invest in India only or majority businesses. Shareholders of the India business will benefit from better reporting of operating and financial parameters for the listed entity.

The transaction is subject to shareholder approval in India, regulatory compliances and other customary conditions to closing. The Company expects the transaction to close by March 2024.

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With an estimated population of approximately 32.2 million (based on the KSA census 2022 issued in May 2023), the Kingdom of Saudi Arabia is the largest country in the GCC. Under Vision 2030, the country is going through fundamental structural changes in all sectors including healthcare.

The healthcare sector in KSA is undergoing an evolution on the back of rapid advancements in technology and research and development (R&D) in line with global and regional trends. However, COVID-19 has also exposed the vastly diverse structure of healthcare systems and increased the importance of R&D and the provision of specialised services within generalised healthcare.

Related: Saudi Arabia navigates new frontiers in healthcare

Long-term care (LTC), rehabilitation and home care (HC) are among the main focal points for the diversification and enhancement of the healthcare system in KSA. A key driver is the changing demographic profile through a decreased fertility rate and increased life expectancy. As a result, the population above 60 years is expected to increase from 4.5 per cent in 2020 to 10.4 per cent by 2030.

This shift will have a significant impact on disease patterns and the type of healthcare services required. As almost 80 per cent of a person’s healthcare requirements typically occur after the age of 60, this will increase the demand for LTC, rehab and HC. This is especially true in the case of KSA with its high prevalence of lifestyle-related diseases including diabetes, coronary and obesity-related illnesses. These are in addition to existing demand from disabilities which also require LTC, rehab and HC.

Public Private Partnership (PPP)

Public Private Partnership (PPP), is one of the cornerstone policies of Vision 2030. A part of the Saudi government’s strategy for transforming and growing the economy by developing the overall healthcare system including LTC, rehab, and HC is through PPP.

The Saudi Ministry of Health’s (MoH) Private Sector Participation (PSP) initiatives aim to increase the share of the private sector in healthcare delivery via public-private partnership (PPP). This is focused on enhancing extended care by improving the overall provision and quality of the services. Improvement in the provision of quality long-term care is expected to not only optimise and better utilise the capacity of tertiary care hospital beds but also enhance the quality of post-acute care and home care treatments.

Development of the long-term care, rehabilitation, and home care sectors in KSA can act as a change catalyst to the healthcare sector from elderly to acute care. Though a gradual shifting of bed-bound patients from hospitals to specialised LTC and rehab facilities and ultimately treating them at home, thus reducing the pressure on both acute care, LTC and rehabilitation hospitals.

Rising interest in Riyadh and the Eastern Region

Upon the announcement of three PPP projects launched by the Saudi Ministry of Health (MoH) in cooperation with the National Center for Privatization & PPP (NCP), 200 local and international companies submitted 424 EOI for three privatisation projects for the Ministry of Health.

The projects are based in the “Second Health Cluster” in the Riyadh region, and the “First Health Cluster” in the Eastern region in Dammam. Submissions totalled 424 for all three projects, which is a considerably large number and indicative of the appeal of investment opportunities in healthcare and trust in the overall ecosystem and regulations in the Kingdom.

The response is from companies from 21 countries from Asia, Europe, Australia and North America; however, Saudi companies represented the majority of submissions reaching about 70 per cent. Around 139 companies are from 16 countries, including Saudi Arabia, the UAE, Bahrain, Kuwait, the US, Canada, the UK, Portugal, Italy, Saint Lucia, Turkey, India, South Korea, Singapore, Thailand and Australia. All expressed their interest in the first project, which includes the design, development, financing, maintenance and operation (medical and non-medical) of long-term care and skilled nursing homes with a capacity of 200 beds, and nursing care centres with a capacity of 100 beds (for each health group).

Around 131 companies from 17 countries, including Saudi Arabia, the UAE, Bahrain, the US, the UK, Canada, Kuwait, South Korea, Switzerland, Singapore, Australia, Italy, India, Portugal, Turkey, Thailand and Germany, expressed their interest to invest in the second project, which includes the design, development, financing, maintenance and operation (medical and non-medical) of medical rehabilitation hospitals with a capacity of 150 beds and 120 thousand therapy session for outpatients (for each health group).

The third project of home healthcare is in the form of a contract for the provision of medical services, for 5,000 active patients (for each health group), to which 154 Saudi and international companies from 14 countries showed interest. These countries include Saudi Arabia, the UAE, Bahrain, the US, Canada, the UK, Portugal, Italy, France, Turkey, India, South Korea, Thailand and Australia.

Gap analysis and conclusions

Due to the shortage of long-term care, rehabilitation and home care services in KSA, patients in need of long-term care utilise acute care facilities, creating a burden on acute care facilities. Based on various reports and discussions with hospital operators, patients who could be better served in LTC and rehab facilities occupy an estimated 20 per cent to 30 per cent of public hospital beds in KSA.

The cost of patients who need LTC and rehab, but are instead treated in general hospitals, is significantly higher compared to a long-term care facility. This is a crucial issue; all government budgets are under pressure while demand for healthcare continues to rise.

Related: Embracing the future: Saudi Arabia's digital healthcare revolution

Capital and operating costs of setting up LTC and rehab facilities are up to 30 per cent or less when compared to an acute care hospital. The need for infrastructure to support the provision of LTC and rehab facilities is one of the main policy drivers for various governments in the GCC. For example, Dubai has prioritised investments in setting up LTC and rehab patient services under its latest investment guide. As part of the privatisation process in KSA, the Ministry of Health is seeking to engage operators for LTC and rehab facilities and home care.

Based on Colliers' estimates using the age-standardised OECD average, KSA would require an additional 21,300 to 40,200 long-term care (LTC) and rehabilitation beds by 2035, which will require an additional investment of approximately US$11.6 billion to US$22.5 billion by 2035.

An important aspect will be improving home care (HC) services; presently, the capabilities, resources, and efficiency in home care vary across regions with limited services provided.

Due to a lack of efficient operational procedures and proper information systems, the utilisation of home care personnel remains low. An improved home care provision will reduce the pressure on both acute care and LTC and rehabilitation hospitals. The target under the PSP initiative is to increase home care coverage annually from 35,000 in 2019 to 133,000 and 145,000 by 2030.

In November 2020, the Ministry of Human Resources and Social Development (MHRSD) announced the implementation of a uniform model for elderly care in KSA in collaboration with the private and non-profit sectors. In Colliers’ opinion, this initiative is expected to improve the efficiency and quality of services provided to the elderly in the Kingdom with better utilisation of tertiary care, LTC and rehab facilities.

In 2023, the Ministry of Health Saudi Arabia, in collaboration with the National Center for Privatization & PPP, launched the Expressions of Interest (EOI) for long-term care, medical rehabilitation and home healthcare projects in the Riyadh and Eastern Region. The details of the projects are as follows:

1. Long-term care (LTC) and skilled nursing home (SNH) projects: The project includes the design, build, finance, operate (clinical and non-clinical) and maintain (DBFOM) of 200 beds for the LTC facility and 100 beds for SNH (for each region).
2. Medical rehabilitation hospital: The project includes the design, build, finance, operate (clinical and non-clinical) and maintain (DBFOM) of 150 beds and 120,000 outpatient rehabilitation sessions annually (for each region).
3. Home healthcare (HHC): Clinical operation and maintenance of 5,000 active patients (for each region).

These projects will be the first across the second health cluster (Riyadh), in the central regions and in the first health cluster (Dammam), in the eastern region. The projects aim to contribute to a key objective of Vision 2030, by increasing private sector participation in the healthcare sector. MoH and NCP announced in May 2023, that a record number of 200 companies submitted 424 expressions of interest in three healthcare Public Private Partnership (PPP) projects in Riyadh and Eastern regions.

The rise of new markets in Saudi Arabia

The greatest challenge lies in the shortage of manpower as the number of physicians and specialised nurses, and allied healthcare personnel for rehabilitation is insufficient. With new hospital developments underway, the competition to hire experienced and skilled physicians, nurses and allied workforce is further set to intensify.

Currently, the market is in its nascent stage, and many existing LTC, rehab and HC facilities lack advanced medical capabilities. As the market matures, more centres providing specialised comprehensive rehabilitation, such as neurorehabilitation, cardiopulmonary, paediatric and musculoskeletal rehabilitation, will enter the market.

Mansoor Ahmed is the Executive Director (Advisory & Valuation), Middle East & Africa (MEA) region and Head of Development Solutions — Healthcare I Education I PPP at Colliers

This article appears in the latest issue of the Omnia Health Magazine, read more here

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Extended longevity has always been a fascinating topic for many people around the world. When the Netflix documentary ‘Live to 100: Secrets of the Blue Zones’ was released in August 2023, it quickly became a top streaming pick. In the four-part series, viewers were introduced to the places in the world with the highest number of centenarians, i.e., people who live to 100 years of age or more. The docuseries host Dan Buettner has spent over 20 years investigating the reasons why people lead remarkably long, healthy lives in five longevity spots, also known as the blue zones. According to the National Geographic Fellow and New York Times bestselling author, the blue zones include Okinawa (Japan), Sardinia (Italy), Nicoya (Costa Rica), Icaria (Greece), Loma Linda (California), and Singapore. For instance, there are nearly 68 centenarians for every 100,000 residents in Okinawa, as compared to roughly 34 for every 100,000 residents in Sardinia.

Although most places in the world may not be home to as many centenarians or elderly adults as in the blue zones, the fact of the matter is that life expectancy worldwide has been steadily increasing over the past six decades. As Figure 1 shows, the average life expectancy among the 95 million Japanese inhabitants was already 68 years of age in 1961 versus an average of 53 years of age globally. Exactly 60 years later, in 2021, the average life expectancy in Japan, with a population of 125 million people, reached 84 years of age.

Related: Harnessing the power of AI for healthy longevity

The UAE experienced an even more dramatic increase during the same period. In 1961, the Gulf country’s average life expectancy among its 141,000 inhabitants was barely 50 years of age. In 2021, it had a greater share of older adults at 79 years of age among a significantly larger population of 9.3 million. Although data from the World Bank revealed a shortened life expectancy across many countries in 2021 as compared to 2020 due to the COVID-19 pandemic, as of 2022 onwards, people’s life expectancy has increased again.

Figure 1: Life expectancy in select Gulf countries versus the major global economies

Although the world is certainly getting older, as is evidenced by overall growing life expectancy worldwide, the pace is not equally distributed among different countries and regions. This is particularly the case if we begin to put our focus on the median age, which divides a population into two parts of equal size. For instance, Figure 2 shows that the median age in developed countries like Japan, Germany, and Italy (i.e. those who are older than 47 years of age) is higher than in low-income economies like Nigeria and Angola, which have a median age of less than 20.

Although it may be argued that wealthier countries tend to have a higher median age than their poorer counterparts, Figure 2 shows that some affluent countries like Saudi Arabia, Singapore, and the UAE have managed to keep their median age (still) low (i.e. under 40 years of age) as compared to other high-income economies. For this reason, it is important to keep in mind that investment opportunities related to extended longevity mirror the unique demographic portrait of each country and region.

Figure 2: Median age in select countries (2022)

Since the number of chronic diseases is likely to grow in tandem with the inevitable forces of demographic ageing and shifting lifestyles, among an increasingly technology-savvy population in the 21^st century, the call for consumers to lead a longer, healthier way of life will surely get louder. After all, if people are living longer, it would be helpful to have a health span that is free from undesirable conditions ranging from diabetes and obesity to cancer and hypertension. For instance, the World Health Organization estimates that obesity, which is defined as a body mass index (BMI) greater than or equal to 30 kg/m², has nearly tripled since 1975, affecting over 650 million people worldwide.

Although obesity is often associated with high-income economies, Figure 3 shows that the health condition is, in fact, on the rise in low- and middle-income countries as well, particularly in urban settings. Although the average median age of the inhabitants in Japan, Italy, and Germany is higher than those in countries like Mexico and Nauru, the obesity prevalence rate in the former group remains lower.

Figure 3: Obesity rates in select countries

Hypertension is another health condition that affects many individuals around the world. According to the World Health Organization, around 1.3 billion people between the ages of 30 and 79 worldwide have hypertension, with nearly half of them oblivious to their health condition. If high blood pressure is left untreated, it can cause other health conditions, like cardiovascular and kidney diseases and stroke. The importance of maintaining one’s blood pressure within a healthy range was once again emphasised by the findings in a recent article published by a peer-reviewed medical journal.

According to the study, which included over 30,000 test participants across 15 countries around the world (such as Brazil, China, Germany, and the US), people with uncontrolled hypertension are 42per cent more likely to develop dementia. On the other hand, patients whose blood pressure is controlled through medication face the same level of risk as healthy individuals. In other words, the findings suggest that taking drugs to reduce hypertension could lower the risk of developing dementia as compared to those who leave their elevated blood pressure untreated.

Related: A tech war on the horizon: Can humanity outsmart death?

The megatrend of population ageing is an inevitable reality that cannot be cast aside. A world in which there are many older adults, as well as individuals with longer lifespans, will affect consumer patterns and involuntary changes due to the growing prevalence of chronic diseases and the need for care. It is, therefore, never too early nor too late in one’s life to begin adopting healthy habits, e.g. regular physical exercise, better dietary choices like reducing the daily intake of salt and sugar, and participation in community activities or intergenerational gatherings to combat loneliness, as Dan Buettner has observed in the blue zones.

Not only do these habits help individuals achieve a longer life expectancy, but they may also enable some of them to reach 100 years of age or more, like those centenarians in the blue zones. This trend inevitably presents investment opportunities that span the areas of healthcare, elderly care, beauty, leisure, food and nutrition, and financial planning over the longer term.

Do you know the key business segments underpinning extended longevity?

While individuals can turn to a wide range of activities, such as intermediate fasting to enter a state of ketosis (a metabolic state where our body burns fat for energy instead of glucose), there are also other products and services that can help extend their health and lifespan. Given the growing interest in longevity and the long-term structural trend of changing demographics and lifestyles, Julius Baer has identified five business segments to keep an eye on:

Healthcare: Medical care services for various age-related chronic diseases and health conditions are likely to gain importance as the world’s population grows older. Diseases may include Alzheimer’s, cancer, and diabetes, as well as age-related conditions related to sight, hearing, and mobility. For instance, the Alzheimer’s Association estimates that this disease will cost the United States US$1 trillion by 2050, up from US$345 billion in 2023.

Elderly care: Population ageing presents favourable tailwinds for the long-term care sector amidst shifting social trends characterised by smaller household sizes and scattered families. As populations' age and dependency ratios increase, it is thus important that public health authorities ensure that available care can cater to older adults’ desire to remain independent by raising the focus on in-home care services and other community-based types of care.

Beauty: Consumers’ desire to continue to look their best through products such as anti-ageing creams, moisturisers, and serums strengthens this industry. Asia-Pacific, North America, and Western Europe account for nearly 80 per cent of the global beauty market, which is estimated to be worth US$420 billion.

Leisure: Greater discretionary income among older adults means more opportunities for leisure-time activities, such as cruises and wellness. More than half of cruise passengers, for instance, are above the age of 50.

Nutrition: Supplements may address the deficiencies in vitamins and minerals faced by older adults due to their growing inability to digest food nutrients.

Financial planning: Saving or investing for retirement requires early preparation to achieve an acceptable standard of living, fill pension gaps, and overcome the limitations of stretched welfare systems.

Dr. Damien Ng is a Thematic Research Analyst in Julius Baer’s Next Generation Research. Damien focuses on demographics, healthcare and consumption issues under the ‘Shifting Lifestyle’ theme, as well as global education under the ‘Inequality’ theme.

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Healthcare providers around the world are all under common pressure known as the “triple squeeze. Rising incidents of chronic illness, an ageing population, and a shortage of clinical staff all mean our heroes are doing more with less. Everyone wants solutions that save these frontline workers time and resources, allowing them to do what they do best, which is to give their time to patients.

And while efforts to get things back to pre-pandemic operational scale have been monumental across the global healthcare community, there remains much more to be done. According to the BMA, in the UK alone, 7.22 million people were waiting for treatment in February 2023, with three million of these patients waiting over 18 weeks. Around 362,500 of these patients have been waiting over a year for treatment, which is 169 times higher than before the pandemic began. 

So how can you and your team make things more efficient to get more procedures done and to alleviate the queues? Let us begin by looking at how operations are done. 

Related: Tech advancements fuel training in infection control

There are many different types of surgical procedures routinely undertaken, and it is likely that cataract surgery and caesareans are among them (they top the list of procedures across Europe right now). Each has a sterile surgical tool kit associated with it, provided to surgeons after they scrub in. Then, once the operation is undertaken, the dirty instruments are packed up and sent back to sterile services, often at a separate location, to be sterilised in autoclaves before being set up again. Typically, the kits are wrapped in plastic to protect them from airborne germs before being catalogued and stored in anticipation of their next usage. 

Though this sterilisation process is great in theory — “reuse and recycle” is always a winning proposition — there is a lot of room for error. Imagine a procedure that has unexpected complications and implements are temporarily lost when the team is moving the patient to a new location. What happens then? What if surgeons must use the same limited equipment for multiple operations? How do you ensure that trays, with their finite shelf life prior to re-sterilisation, get used in an efficient order? How do you trace trays back to patients to check devices were not left internally or to alleviate a disease concern such as CJD?

If items are lost, the initial strategy is probably to look for them, which is smart. But this search is going to probably eat up a significant amount of clinicians’ time daily. In one study, nearly four hours were taken up by eight clinicians searching for assets. That is a 12.5 per cent inefficiency – or a business case for another non-clinical teammate. 

If items are not easily – or ever – found, a 'first do no wrong' approach is probably to buy additional stock so no one must spend a second looking. But is this really the best solution? Surgical devices are sold at a premium, making this a very expensive approach. Factor in the unnecessary cleaning of trays due to poor inventory management, and there are additional energy costs and carbon emissions to add to the equation. Then think about an inability to pinpoint where instruments are located, which, worst-case scenario, can add additional procedures like X-rays and a whole heap of extra anxiety. All these elements combined place a heavy burden on an already stretched team and restricted-capacity system.

Speaking of X-rays, there is another sort of invisible wave called radio frequency identification (RFID). An RFID reader can come as part of a wider tracking solution based on RFID technology. In other verticals, such as retail and warehousing, RFID is used in storerooms, giving instant viewing of whatever stock lies hidden from view. Turn on the RFID reader’s item-finder mode, and via a series of beeps, you can track down specific items in no time at all.

To take away 'yet another task for clinicians' by enabling automation, RFID technology infrastructure can be strategically placed around a healthcare facility. RFID antennas and readers placed around entry and exit points of an operating room, storage room, or where it makes sense – for example, at a processing table or at an autoclave — can report item location, even when in motion. Every time an item leaves or returns, it is automatically logged by a unique identification code placed on it via an RFID label carefully designed to withstand whatever the medical device, surgical instrument or kit endures.  

Related: Sterilisation and disinfection vital in hospital infection control

This base RFID infrastructure links to a database where the interesting bit happens. Each asset you are tracking has data associated with it linked to hospital workflows. In the case of surgical trays, this will include where it was last logged, when it was last cleaned, which patients it was used with, and so on. Suddenly you will have instant visibility, alleviating all the aforementioned pains of not knowing where surgical kits are or what state they are in. You now know the kit is clean, it is being used systematically, and all the pieces are present and where it is.

In fact, one hospital in the UK recently completed a sterile services RFID project as part of a much wider location solutions rollout. As a result, surgical trays can now be searched for on a desktop PC, and RFID is used to locate them in storerooms. Even if they are in the wrong place, they will be found. This is a huge benefit to patients, as their operations will not be cancelled due to missing sterile trays and instruments.

Mitigating risk is key as well. For example, should a heart surgery instrument tray be dropped, another one can be located in a matter of seconds, ensuring minimal delay to vital surgery. The hospital’s clinical team says they are already seeing improvements in patient care, as well as time savings and a reduction in procurement costs.

With RFID, there is less time spent hunting for things, and sterilisation becomes more efficient. Plus, all this freed time and resources can be ploughed back into patient care. 

Wayne Miller is the Director of Healthcare Solutions, EMEA, Zebra Technologies.
 

References available upon request.

This article appears in the latest issue of the Omnia Health Magazine, read more here

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Physical examination is the cornerstone of medical evaluation and the principles of this have remained the same for the last few centuries. The purpose of the physical examination is to evaluate patient complaints through observation, palpation, percussion, and auscultation. However, numerous studies have indicated poor diagnostic accuracy of conventional physical examination parameters, especially auscultation. Since many of the 'classic' signs and symptoms were described during an era when late-stage disease presentations were more prevalent, relying solely on them often results in overlooked abnormalities where timely intervention is possible. Adding to the problem, declining physical examination skills among doctors have been widely acknowledged. Therefore, it is unsurprising that requests for radiologic examinations such as ultrasound, CT scans, and echocardiograms have substantially increased over the past few decades.

Nevertheless, hospitalised patients continue to be assessed using the traditional four pillars of physical examination, supplemented by radiological examinations to aid in the diagnostic process. In the last couple of decades, however, there has been a rapid rise in radiological examination requests in healthcare. Data from NHS indicates 43.3 million imaging requests in one year and in the USA alone 70 million chest X-rays are performed each year. In addition, data from the USA indicated over seven million echocardiogram requests annually. Many of these scans turn out to be negative scans but this adds to the costs of healthcare and hospitalisation, which in capitated healthcare systems or countries with limited resources will be difficult to deliver.

Related: Entering New Markets: The UAE Laboratory Services Market

Point-of-care ultrasonography (POCUS) is a clinician-performed limited ultrasound examination intended to answer focused clinical questions at the bedside. It is emerging as a valuable adjunct to physical examination. In fact, POCUS-enhanced physical examination was incorporated into emergency and critical care practices a couple of decades ago with the development of E-FAST and BLUE protocols to evaluate patients with undifferentiated shock or shortness of breath in patients where timeliness of care is very critical.

Advancements in ultrasound technology and miniaturisation of equipment have rendered POCUS an attractive bedside tool that enables prompt diagnosis and monitoring of the response to treatment, ultimately reducing the healthcare cost burden by avoiding unnecessary radiological examinations.

A report from the World Health Organization estimated there are 9.2 million doctors and 18.1 million nurses worldwide. In the UAE, there are over 26,000 doctors and 60,000 nurses. Many of them perform daily physical examinations, and these health professionals these folks need to be upskilled to make POCUS-assisted physical examination a standard of care in hospitalisation patients.

Dr. Siddiq Anwar is a Consultant Transplant and Interventional Nephrologist and is currently working at Sheikh Shakhbout Medical City. During his medical training, POCUS was mostly used for interventional procedures, like vascular access and kidney biopsies. But with the increased availability of ultrasound devices and the pioneering work led by critical care and emergency medicine colleagues, it was clear that the integration of POCUS assessment in clinical settings would be a game changer. When his project, in collaboration with colleagues from Khalifa University and Mohammed Bin Zayed University of Artificial Intelligence, won the hackathon organised by the UAE Ministry of Economy and Ericsson, it helped them secure research funding in terms of POCUS devices from Echonous. It presented a challenge to upskill current doctors in training and established clinicians to use POCUS in their clinical practice. There was no established playbook or curriculum that he could use to establish POCUS training for this demographic. He then reached out to leaders in POCUS education who had been successful in bringing a POCUS revolution not just in their institutions but in multiple centres across the world.

Dr. Siddiq Anwar

POCUS education in Europe

Dr. Hatem Soliman–Aboumarie is a Consultant Cardiothoracic Intensivist at Royal Brompton and Harefield hospitals in London and a leader in Critical Care Echocardiography and POCUS education. He has been instrumental in setting up Royal Brompton and Harefield Hospital POCUS Academy in the UK and helped set up the POCUS Academy at Sheikh Shakhbout Medical City with Dr. Anwar in the UAE.

Dr. Hatem Soliman–Aboumarie

Dr. Soliman-Aboumarie shared: “In the UK, point-of-care ultrasound has grown over the last years, and in several hospitals, it is now embedded in daily clinical practice. In our experience at a quaternary cardiothoracic specialist hospital, we started a training programme for our multidisciplinary team of physiotherapists, nurses, and medical professionals on lung ultrasound. Over the last three years, we had 15 practitioners accredited by the Intensive Care Society accreditation in focused lung ultrasound. We believe that one of the main barriers to using point-of-care ultrasound is the culture change within the healthcare system, therefore, training the multidisciplinary team is essential to leverage the skillset of the wider team as well as spread the practice of POCUS for the wider members of the healthcare team.

“Some data showed the value and safety of point-of-care lung ultrasounds performed by physiotherapists and nurses. We also established a new governance framework and a standard operating procedure for the safe use of this modality within critical care physiotherapy. Training and accreditation should go hand in hand with ongoing quality assurance and governance to ensure the best quality of care delivered whilst also ensuring the safe application of these new tools at the bedside by the wider members of the multidisciplinary team.”

POCUS education in the US

Dr. Abhilash Koratala is an innovative leader in medical education who has been at the forefront of bringing POCUS into Internal Medicine and Nephrology. His award-winning website nephropocus.com and Twitter account @NephroP is a free knowledge repository he has created to democratise POCUS education.

He shared: “The current challenges in bringing POCUS training to upskill the existing workforce include a limited number of trained faculty, access to standardised training programmes, and integrating POCUS into the workflow of existing healthcare systems. However, efforts have been made to overcome these challenges through various means such as social media, continuing medical education (CME) programmes, and advocacy.”

Dr. Abhilash Koratala

Social media platforms like Twitter, YouTube, and LinkedIn provide a space for clinicians, educators, and researchers to share POCUS-related content such as case vignettes, videos, research articles, and clinical insights. These platforms enable the rapid dissemination of information and foster learning among a global community of POCUS enthusiasts. However, not all information shared on these platforms may be accurate and requires considerable discretion on the part of the learner. Moreover, social media-based learning often lacks standardisation in terms of content, terminology, and teaching methods. This can lead to inconsistencies in the way POCUS concepts are presented and understood, resulting in substantial heterogeneity and knowledge gaps.

CME programmes have been organised to provide structured POCUS training to healthcare professionals. These include hands-on workshops, lectures, and online courses to enhance the skills of learners. Through these initiatives, clinicians have the opportunity to learn and practice POCUS techniques under the guidance of experienced instructors. One drawback of these programmes is the lack of ongoing longitudinal training. Similar to any other skill, proficiency in POCUS diminishes over time without consistent practice. Furthermore, unsupervised practice without a comprehensive understanding can foster overconfidence and potentially endanger patients.

Advocacy efforts have also been instrumental in promoting the importance of POCUS education. Key opinion leaders and various professional societies have advocated for the integration of POCUS into medical education curricula and clinical practice guidelines. Nevertheless, it remains a work in progress.

Related: Enhanced myositis diagnostics with new biomarkers

Ultimately, the responsibility of training the current workforce rests with individual institutions. While making use of available resources such as curated social media content, CME programmes facilitated by professional societies, and guidelines, institutions should design their training pathways. Such local or regional initiatives can be better tailored to the specific requirements of physicians and clinicians from different specialities, considering their prior experience with POCUS. These programmes should provide longitudinal training and progressive supervision until learners are competent in performing and interpreting the studies. With a growing pool of trained clinicians, there will be greater availability of experienced practitioners who can teach POCUS to others, resulting in a more sustainable and self-sufficient training ecosystem. Furthermore, it is crucial to establish comprehensive multidisciplinary quality assessment programmes to maintain the highest standards of study quality. While the expenses associated with training may seem significant, the long-term benefits in terms of improved patient care and overall healthcare efficiency make it a worthwhile investment.

POCUS education in Latin America

Dr. Eduardo R. Argaiz is a nephrologist based at the National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico, and a Board Member of the Mexican Society of Echocardiography — Academic Committee. He is one of the emerging leaders from the next generation of educators advocating using POCUS as a bedside clinical assessment tool. Sharing his thoughts on how POCUS education is growing in Latin America, he said: Even though point-of-care ultrasound (POCUS) is increasingly being adopted in many clinical settings in Latin America, it is still significantly underutilised. A recent survey revealed that even in a relatively more developed region such as Brazil, up to 60 per cent of Intensive Care Units do not have access to ultrasound equipment. This same survey also revealed that most clinical applications for ultrasound are still focused on guided procedures such as central venous catheter placement.

Today, however, things might be turning brighter. In the last couple of years, we have experienced a large increase in demand for POCUS training in the region, largely driven by our social media efforts to educate and promote its use. Evidence of the impact that social media has had on disseminating POCUS education in Latin America can be easily obtained using Altmetric, a tool that monitors the reach and impact of scientific publications involving online interactions. By using this tool, we can see that our POCUS-publications rank in the top one per cent of publications, with the majority of online interactions originating from Mexico.

Dr. Eduardo R. Argaiz

As a POCUS educator in the region, my experience resonates with the Altmetric data. The increase in demand for POCUS training has been palpable in Mexico. For example, our efforts to increase POCUS workshops at all national nephrology meetings in Mexico have been met with an impressive turnout. It is not uncommon for many workshop participants to be non-nephrologists who learned about the workshop through social media. This increasing demand for training has also been met by an increasing supply of portable ultrasound equipment as large corporations such as EchoNous and Butterfly Network have entered the region.

Currently, there are only a few structured POCUS training programmes that offer a post-graduate degree in Mexico. One of the largest programmes has been offered by the National Institute of Cardiology in Mexico City since 2017. Additionally, the Argentinian Society of Critical Care Ultrasonography (ASARUC) has experienced impressive growth throughout the whole region. ASARUC was started by Dr. Francisco Tamagnone and colleagues in Argentina to bring POCUS education to a wider audience. They have subsequently gone on to establish centres in various countries across South and Northern America and Europe. While acceptance of POCUS is growing, standardisation and quality control in training are lacking. The single most important effort right now is to develop and incorporate a structured POCUS curriculum into the residency training programmes for every physician in training, especially in the areas of emergency medicine, critical care, and internal medicine branches.

Dr. Francisco Tamagnone

POCUS education in Asia and the Middle East

There are many efforts underway across the region to train the current and future medical workforce to adopt POCUS education in clinical practice. There is the Fundamentals of Point-of-Care Ultrasound (POCUS) Certificate, a one-year programme offered by the Postgraduate Medical Education Deanship at Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU). In addition, the Avatar Foundation is leading an active educational programme to upskill folks in the Indian subcontinent.

Recently ASARUC has established itself in the Middle East, bringing high-quality POCUS education to the region. The highlights of their CME programmes are the high-quality instructors and the use of an on-demand platform, Sonoflix, to deliver their theoretical classes. In addition, their collaboration with the Inteleos Foundation allows the attendees to gain certification with POCUS Academy. They also have CME credits from the Department of Health, Abu Dhabi.

In time all practicing clinicians will be trained in POCUS-assisted physical examination. This will become a requirement for hospital-based doctors and medical professionals, like Basic Life Support Training, and most will require ACLS training to maintain professional credentials and licensure. There is a huge demand for POCUS training, and all courses are currently oversubscribed. This means training the current workforce would require a lot of financial and time commitment. Most medical schools have now integrated POCUS education into their curriculum and so have multiple internal medicine residency programmes across the world.

Making POCUS-assisted physical examination a standard of care for all hospitalised patients will require the collaboration of educators, regulators, and industry to retain the existing workforce. We look forward to collaborating with all like-minded educators, institutions, and industry partners to bring a POCUS revolution across the world.

Register for upcoming courses from the ASARUC POCUS Academy in Abu Dhabi via the following link: ASRAUC- Abu Dhabi 2023.

This article appears in the latest issue of the Omnia Health Magazine, read more here

Back to Laboratory

The continuous availability of critical medical supplies and services, ultimately benefitting patients and healthcare providers alike, hangs on an agile and resilient supply chain. However, we must ask ourselves some hard questions, considering the uncertainties and complexities that shroud the healthcare ecosystem. How can the healthcare sector design a supply chain that is flexible and adaptable, ready to deal with unforeseen interruptions, and able to provide seamless patient care in a world of growing intricacies and uncertainty?

At a projected CAGR of 14.9 per cent over the forecast period, the global market for healthcare supply chain management is expected to increase from US$2.61 billion in 2022 to US$6.90 billion by 2029.

For the global healthcare industry to adapt to unforeseen occurrences like pandemics, natural disasters, and supply disruptions, it is essential to implement a single system for real-time inventory visibility, and digitalisation of processes, using data analytics and artificial intelligence (AI) to forecast demand and potential interruptions. It is also of great importance that continuous efforts towards risk analysis, resilient inventory management, and contingency planning are applied.

Related: Benefits of connected workers in the pharmaceutical industry

Interestingly, putting Africa under the lens of supply chain in healthcare presents unique challenges and opportunities due to the country's diverse geography, infrastructure limitations, and healthcare delivery complexities. It is estimated that Africa produces only six per cent to 20 per cent of its medicinal and pharmaceutical products, while the other 80 per cent to 94 per cent of the continent’s medical needs are met through imports.

Considering this state of affairs, Chukwunonso Umeh, a Procurement and Supply Management professional with the Clinton health access initiative based in Nigeria, shares his opinion on how an agile and resilient supply chain within the continent can be created and managed. “The key to achieving resilience and agility in the health supply chain involves the adoption of adaptable inventory management. It is pertinent to note that maintaining excessively large inventories can tie up capital and lead to wastage or possible expiries of medicines, while too lean inventories can result in stock-outs during emergencies,” he said. “However, adopting just-in-time inventory strategies, buffer stock management, and dynamic demand forecasting can strike the right balance between efficiency and preparedness.”

Overall, specific strategies need to be employed in the African continent when creating a blueprint for an agile and resilient supply chain in the healthcare industry. To overcome the highlighted challenges, healthcare organisations and stakeholders in Africa must predict the patterns of demand and optimise inventory levels using data analytics and forecasting tools. Historical data and population health trends need to be considered as well. For example, a Nigerian healthcare provider can use data analytics to predict the seasonal increase in malaria cases and ensure an adequate supply of anti-malarial medications during peak periods.

Secondly, running regular simulation exercises to evaluate the response plan's effectiveness and pinpointing areas for development are other components to include while building a blueprint for an agile supply chain. This could be in the form of a hospital in Nigeria conducting mock drills to simulate the response to a mass casualty event, which also allows staff to practice their roles and refine the supply chain response. Finally, create thorough emergency plans that cover potential supply chain disruptions brought on by calamities, disease outbreaks, or geopolitical events.

Related: Four steps to enhance sustainable procurement in healthcare

Mobile health technology is an area that needs to be actively explored. Leverage this for real-time data collection and monitoring of supply chain processes. Providing mobile applications to enable healthcare workers to report stock levels, track demand, and provide visibility into inventory management should also be taken into consideration.

Other options include fostering collaborations with regional vendors, making investments in programmes for capacity building, and ensuring quality control. Cutting-edge delivery techniques like drone technology to improve last-mile connectivity can ensure that urgent medical supplies reach remote areas quickly while driving the creation of opportunities to enable supply chain strategies to align with national priorities by working with government health agencies.

Collaboration, technology adoption, and community engagement play pivotal roles in strengthening the healthcare supply chain's ability to respond effectively to both routine demands and unexpected crises. With these strategies adapted, an agile and resilient supply chain can be sustained.

References available on request.

This article appears in the latest issue of the Omnia Health Magazine, read more here

Back to Management

Lung cancer remains one of the most common types of cancer, with an estimated 2.21 million new cases recorded in 2020. It also has the lowest survival rates. In fact, the average five-year survival rate for lung cancer worldwide is less than 20 per cent. This number is lower in the Middle East and North Africa (MENA) region, with a five-year survival rate estimated at 8 per cent, suggesting that most lung cancer patients in the region are diagnosed at advanced stages.

Lung cancer is sometimes referred to as the “invisible” cancer as visible symptoms occur once the cancer has already advanced. In 2020, 51,316 new cases of lung cancer were recorded in MENA, representing the second-highest cancer incidence in the region. The incidence of lung cancer has increased dramatically in recent years in the MENA region due to modifiable behavioural factors, causing more than 70,000 deaths in 2020. This makes it the second deadliest cancer in the MENA region, accounting for 10 per cent of all cancer deaths.

Behind these numbers are thousands of real stories of struggle, grief, and perseverance, along with the doctors and families of cancer patients who support their treatment for the best outcome. Lung cancer never rests, and neither can we.

Significant progress has been made in lung cancer therapy

Governments in the region have identified the growing problem and are fully focused on fighting it through awareness, prevention, treatment, research and funding. A range of lung cancer treatment options are available today. Significant progress has been made in lung cancer therapy development within the past decade, including precision medicine evolvement, new targeted therapy and new findings in the field of immunotherapy.

Related: Lung transplantation programme in UAE provides hope to patients with end-stage lung disease

However, healthcare providers cannot take a one-size-fits-all approach to treating cancer patients. Every patient with lung cancer requires tailored solutions, based on their histology, stage, tumour genetics, and type of lung cancer. For example, doctors use molecular testing to diagnose different types of lung cancer and identify the best treatment strategies. It involves analysing the genetic and molecular of tumour cells to better understand the specific mutations or alterations that drive cancer. Because each patient and each tumour are different, everyone will have different treatment options that work best for them, and this technology allows healthcare providers to provide the best plan for their patients.

Precision medicine, sometimes known as personalised medicine, is an innovative approach to tailoring disease prevention and treatment that takes into account differences in people's genes, environments, and lifestyles. The goal of precision medicine is to target the right treatments to the right patients at the right time, with minimal impact. Precision oncology includes the integration of molecular tumour profiles into clinical decision-making in cancer treatment. This new era of precision medicine has seen several new cancer therapeutics being developed for biomarker-defined subsets of patients.

These are incredible advancements in cancer care because they significantly improve the quality of lives of patients and reinforce hope for a brighter future.

That said, the first line of defence to tackle the disease is early detection, which helps in enhancing survival and lowering morbidity; it can decrease lung cancer mortality by 14 per cent to 20 per cent among high-risk populations. The problem is that most people are not aware of the early signs and risk factors, because of which they lose valuable time and see a doctor too late, and, therefore, do not get access to necessary treatment in time.

Smoking remains the leading risk factor for developing lung cancer

Although early lung cancer symptoms (which include persistent cough, shortness of breath, unexplained weight loss and loss of appetite, recurrent respiratory infections, chest pain, fatigue, hoarseness, shoulder or back pain) do not necessarily mean that an individual has lung cancer and are more likely to indicate other conditions, they should not be dismissed, especially if combined with risk factors.

Related: World No Tobacco Day 2023: What governments are doing to tackle the scourge

The leading risk factor for developing lung cancer is, undoubtedly, smoking, with 90 per cent of death cases linked to tobacco use (including cigarette, cigar and pipe smoking). There is also reason for concern regarding the use of e-cigarette devices and vaping fluids. The risk of lung cancer for smokers is considerably higher than for non-smokers. Second-hand smoke can also raise the risk of disease as it has the same chemicals that people who smoke inhale.

For instance, second-hand smoke is known to be the third most common cause of lung cancer in the US. Having a family history of lung cancer is also a risk factor for developing this disease: people who have a relative who suffered from cancer may be twice as likely to develop the disease as others. Other risk factors include living in areas with higher levels of air pollution and exposure to radon, asbestos and other cancer-causing agents that can be found in some workplaces.

Taking action is key to reducing the incidence of lung cancer and save lives

Raising awareness about lung cancer, including sharing information about cancer itself, its symptoms, and ways of prevention and treatment, can save lives. The Take Action campaign, launched by Pfizer — the global biopharmaceutical company — addresses the barriers to early detection of cancer with a focus on lack of awareness.

The project focuses on spreading knowledge about the risks and symptoms of lung cancer, battling stigma and misconceptions about the disease and its treatment, and calls for reducing tobacco use in public. It is also aimed at helping HCPs in building therapeutic doctor-patient communication, as easing patient and family anxieties can empower them to take control of their health while mindfulness-based stress reduction programmes are proven to be effective in reducing cancer-related symptoms.

Lung cancer remains a global health challenge that affects the lives of millions of patients and their loved ones. While great progress has been made in raising awareness about this life-altering disease, it is our collective responsibility to continue raising awareness about its risk factors, warning signs, available therapy options and the role of emotional support in ensuring the effectiveness of treatment.

By educating people, we can reduce the incidence of lung cancer and save lives. Cancer issues can be overwhelming and even hard to think about – but we are here to act and make a difference together.

Hatem El Kadi is the Regional Oncology Medical Lead at Pfizer.

References available on request

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