ACHIEVING BUSINESS EXCELLENCE ONLINE
Healthcare
ISSUE 1 | www.bus-ex.com
from bench McGill University Health Centre: Planning a new standard of healthcare for Montreal
SEHA: Health oasis
Lancet Laboratories:
Diagnostic excellence
julphar:
An injection of insulin
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Always in demand
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ith job cuts making daily headlines in industries as diverse as manufacturing, retail and banking, there’s one sector that’s not in decline— healthcare. As long as human beings continue to be born, suffer and die, there will always be an increasing demand for healthcare. One region undergoing something of a healthcare boom is the Middle East, where we focus on new hospitals in Dubai and Abu Dhabi, Emirates determined to provide their citizens with healthcare services to match anything available in the West. The growing demand for healthcare brings work not only to medical professionals themselves, but also to the contractors involved in the construction of new facilities, and the suppliers of medicines, equipment and services that keep them running. This collection of articles pulls together examples of best practice in healthcare administration, drug manufacture, diagnostic services and biotechnology research, in India, Africa and Europe, as well as the Middle East. Whatever aspect of healthcare is your focus, you will find something here to arouse your interest.
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8 McGill University Health Centre From bench to bedside
MUHC is planning to deliver a new standard of healthcare at the Glen Site in Montreal, due to be ready for patients by 2015.
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18 Cerner Middle East A new concept of care
This global health information technology system provider is helping health care providers offer a safer and more cost-efficient service.
28 Julphar
An injection of insulin
28 4 | healthcare
Soaring demand for insulin across the Middle East will be met in part by a new state-of-the-art manufacturing facility.
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46 Cleveland Clinic Abu Dhabi A new healthcare landscape
This brand new, world-class hospital will offer first grade health services to its patients from a state-of-the-art facility.
56 SEHA
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Health oasis
The national health service of Abu Dhabi is providing its citizens with the best medical facilities possible.
70 American Hospital Dubai Where care matters most
Bringing the highest standards of healthcare to a region which has traditionally offered poor or indifferent levels of medical care.
78 Lancet Laboratories
The key to diagnostic excellence
Moving into Nigeria will be a step change for one of the leading pathology services operating throughout Africa.
88 Natalspruit Hospital A new dawn in healthcare
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South Africa is focusing on improving living standards for its more disadvantaged citizens through improved healthcare facilities.
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contents
98 Penn Pharma Penn pals
A pharmaceutical services company with something for everyone, from entrepreneurial sole scientists to multinationals.
106 Biocon
Pharmerging
The new buzz in the pharmaceutical industry is how best to capitalise on demand from newly affluent emerging markets.
128 Hikal Ltd
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New vistas of growth
Achieving innovation and growth in a competitive environment does not have to come at the price of environmental sustainability.
138 Life Technologies: Invitrogen Mechanisms of life
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Given the right tools, India’s scientists, doctors and pharmacology researchers can make swift progress in their research.
146 Fortis Healthcare Healthy processes
A provider of world-class medical care using economies of scale and improving efficiency to bring costs down.
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8 | Healthcare
McGill University Health Centre
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Research Institute
McGill University Health Centre
E
very once in a while a truly unique healthcare project will appear on the horizon. One such project coming into view for the people of Montreal is the McGill University Health Centre’s (MUHC) new development at the Glen Site. This iconic healthcare campus, under construction since the summer of 2010, will become one of the most technologically advanced and patient-friendly facilities in North America. It will also be a place that embraces innovation and discovery with the amalgamation of MUHC’s new world class Research Institute. The $2.355 billion dollar project is being implemented through a public private partnership (PPP) between the MUHC and the McGill Health Infrastructure Group. The private partner has the mandate of designing, building and maintaining the hospital complex for 30 years, although the MUHC is very much involved in the planning of the hospital complex. The Research Institute also received $100 million from the Canada Foundation for Innovation - the largest grant ever awarded by the CFI to a single institution - which was matched by $100 million in funding by the Quebec government and bolstered by $50 million from donors. Meantime, the hospital center will benefit from new equipment to the tune of $190 million. The Glen Site is a 43 acre, 2.4 million square foot site situated a few minutes from downtown Montreal. The generous and expansive setting has allowed the designers to incorporate new homes for The Montreal
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Children’s Hospital, The Royal Victoria Hospital, the Montreal Chest Institute, and a new Cancer Centre as well as the aforementioned Research Institute. The setting and position of the new facility is very deliberate and ease of public access was always a primary concern. Its alignment to commuter rail, subway and 11 bus lines plus four major highways is significant. Also of great importance is how the new development interacts with the surrounding environment, as Hamilton explains. “Coming onto the site from
the public realm and surrounding urban neighborhoods, there’s a very natural step down into a large amount of green space facing the main entrance. This leads to a generous simple and intuitive network of interior streets and atria. It achieves clarity of movement that is extremely simple and well resolved.” The facility as a whole will cater to many specialized departments, each with very different functions and practices. Each individual pavilion will carry an approximate footprint of 40,000 square
“The whole facility has been laid out with patients, their families and staff in mind”
Cancer Centre
12 | Healthcare
McGill University Health Centre
Adult room
feet spread across four to twelve floors. The genius within this part of the design is how each individual center interconnects with the next, simplifying the movements and flow of care givers and professionals alike. There is also a dual benefit in terms of way finding practicalities for patients and their families, another example of the patient being the primary concern. “The whole facility has been laid out with patients, their families and staff in mind. We created a back of house spine where only staff, patients on stretchers and materials handling will travel so we’ve essentially separated the flows from the public, which enhances the patient-centered experience,” says Franco. Hamilton adds that “the balance between a demanding technological healthcare program and respecting the
neighborhood and public experience has been really successfully achieved.” The overall design is littered with examples of patient-centered practices, with multiple benefits from the use of green space to the vast amount of natural light used throughout the buildings. Such aspects work in favor of the patient by the creation of a calm healing environment, but also count toward the sustainable nature of the project which is aiming for LEED Silver status. Another standout feature is that the whole campus will feature single bed rooms, something that very few healthcare facilities on this scale can boast. “We believe this is a visionary approach in which we are leading the way compared to many sister institutions in North America,” states Hamilton. “From an evidence-based
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“We believe this is a visionary approach in which we are leading the way compared to many sister institutions in North America” design perspective it’s associated with better quality interaction between patient and care giver, lower stress for the patient, shorter stays, and better recovery. A model absolutely in favor of the patient.” The way the design works for the care givers is also of paramount importance to any successful and efficient healthcare facility. This is well evidenced at the MUHC. The deliberate proximity of related
14 | Healthcare
and shared services, ergonomic spaces and core technologies will encourage shared best practice across clinical departments as well as having dual benefits for teaching and research. One example of this in practice is in the linear design of the Emergency department, whereby the separate pediatric and adult ERs have the flexibility to expand and contract, allowing for extra space in any given area dependent on demand.
McGill University Health Centre
MUHC Glen Site Dec 2011
“There’s been a lot of emphasis on key adjacencies with a view to enhancing collaboration between teams and simplify the patient experience. For example, the Emergency rooms are vertically adjacent to the imaging services and the operating suites. These are linked by patient transfer elevators including a trauma elevator, and in turn the ORs are horizontally adjacent to the critical care unit,” explains Franco. Looking in from the outside, it is easy to admire the detail within the design and applaud the various healthcare design specialists and architects responsible. It does however come as a surprise to discover that this process was conducted over several years and was the result of expansive consultation with a vast
spectrum of stakeholders. “There was an exhaustive and extensive design and development phase where we engaged some 500 clinicians and over 80 user groups that worked through design and development. All of those folks have been intrinsically involved in the evolutions of the design of their spaces and they are now our champions,” says Franco. This level of consultation has meant that the project has become truly inclusive and perhaps goes some way to explaining why it has received such vocal support from those within MUHC and also the community at large. Everything the MUHC does seems to have the patient and wider community as the primary concern. Therefore the emphasis on education going hand in hand
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Aerial of Glen - Summer 2011
McGill University Health Centre
$2.355 Billion Value of MUHC project with the daily workings of the hospital is a natural one. One of the objectives from the very start has been to create an academic medical center that integrates providing the best medical care alongside integrated teaching and research services. Hamilton is very clear on the obvious benefit of such a model. “Our unique model will allow us to deliver on what we are very good at—bringing research innovation from bench to bedside.” The current plans are for construction to be complete by the end of 2014, and for the summer of 2015 to see the first patients to benefit from the new complex. Its very nature as an academic medical center means that it represents the future of healthcare for the province of Quebec. The current plans also allow for MUHC Glen Site to grow and develop further within the land on which it sits, meaning that as the new building settles into its environment, it has room to grow in harmony with the city around it. For more information about McGill University Health Centre visit: www.muhc.ca
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A new concept of care
Health care providers must constantly strive to offer a safe, accurate and cost-efficient service to their patients. One company helping to facilitate that goal throughout the Middle East is global health information technology system provider Cerner, as Richard Halfhide reports
18 | Healthcare
Cerner Middle East
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Greg White, vice president and managing director of Cerner Middle East and Africa
Cerner Middle East
C
erner is one of the world’s leading health care information technology system providers, and its mission statement— ‘Health care is too important to stay the same’—perfectly sums up its forward-thinking ethos. What started as an entrepreneurial spark over 30 years ago has grown today into a multi-billion dollar company with a vision to transform the face of health care delivery. Today, Cerner is proudly represented in 23 countries worldwide and its solutions can be found in more than 9,300 healthcare facilities, including 2,650 hospitals and 3,750 physician practices. Figures just released for bookings in 2011 show an impressive 37 per cent rise from 2010 to $2.72 billion. But the numbers only tell part of the story behind Cerner’s success. Its Middle East operations in particular have seen several exciting developments in recent years. “While there has been a noticeable recent boom in health care investment in the region, Cerner has offered tailored solutions to clients in the Middle Eastern region for the last 20 years,” says Greg White, vice president and managing director of Cerner Middle East and Africa. Building upon this sustained success, Cerner Middle East has had an operational headquarters in the region for the last seven years. Today, it partners with over 130 facilities throughout the United Arab Emirates, the Kingdom of Saudi Arabia, the State of Qatar and Republic of Egypt. A major driver behind Cerner’s success in the Middle East is the fact that its systems
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An electronic health record enables a holistic view of patient health
are able to serve the needs of the entire spectrum of health care facilities, from small individual clinics to large hospitals and even national health systems. Earlier this year, the company signed a landmark agreement to digitise the entire health care system in Qatar, which encompasses all Hamad Medical Corporation (HMC)’s hospitals and primary health centres. “Strong regional partnerships and support
for government initiatives to develop the health care industry are key pillars of Cerner’s growth strategies in the Middle East region,” explains White. “Through a seamless electronic health record system, HMC will have the opportunity to enhance the safety, quality and efficiency of its facilities. We are delighted to support its transformation into one of the leading academic health systems in the world.”
“We’re actively working with our clients to help them improve the health of their communities” 22 | Healthcare
Clinic
Cerner Middle East
cal data is stored in one location
Care givers can make more informed decisions
Improved safety and appointments, current increased efficiency are medications, allergies, test key watch words when results and scanned images. talking about what Cerner’s One key advantage offered technology brings to the to care givers by this system Number of countries table; however they only is the ability to gain a truly where Cerner is offer a very broad view of holistic view of the patient’s represented worldwide what the company is able to health through access to deliver. Numerous solutions the data. With real-time have been carefully information updated to the developed for use in a variety of clinical record, care givers are able to make effective and administrative environments to serve and appropriate health care decisions far more quickly and accurately than would specific needs. One of Cerner’s core solutions is an otherwise be the case. electronic health record (EHR), which Solutions that run on the Cerner enables all of a patient’s clinical data Millennium platform can be implemented to be stored in one location. This can across an entire health system to both include a patient’s medical history, future retrieve and disseminate information,
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meaning different departments can access and interact with a patient’s EHR while using solutions unique to that department. “By connecting individual departments in a hospital or health system, Cerner solutions can be deployed that provide subjective information and real-time, measurable data,” White explains.
The range of solutions available is staggering. There are tools developed for use in pharmacies, emergency rooms, critical care, imaging departments and laboratories—all with specific functions that ensure increased patient safety and maximized efficiency for care givers. In essence, the system allows fragmented care
“IT enables the changes that need to be made in order to drive a shift in overall patient health”
Cerner solutions provide real-time, measurable data
24 | Healthcare
Cerner Middle East
Investment in healthcare infrastructure is growing in the Middle East
systems to fully interact and coordinate with one another. Processes are streamlined, helping to reduce error, variance and waste— priorities high on the list for any health care provider. Cerner systems facilitate faster ordering, documentation and billing, resulting in a swifter, more efficient service. The benefits of Cerner’s systems to the institutions and their physicians and administrative staff are clear; however it should not be forgotten that the end result is also a highly improved patient experience—always a critical factor within health care delivery. Patients can be assured
that confidentiality requirements are being met, and that their care is being assessed in a far more holistic, and therefore accurate, context. However, White is keen to stress that Cerner is so much more than just a provider of IT products. “Viewing our solutions simply as IT projects is a poor way to explain what we do. We’re actively working with our clients to help them improve the health of their communities. IT enables the changes that need to be made in order to drive a shift in overall patient health.” Cerner has a network of dedicated
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A Cerner solution in use
Cerner Middle East
130+ Number of facilities Cerner partners with across the Middle East
support staff who work alongside clients on a daily basis; and this team has doubled over the past 18 months. The team consists of predominantly long-term associates who have experienced the growth of the company. “These are Middle East-based people who bring years of experience to the table and have now raised the bar of success,” asserts White. As investment in health care infrastructure grows throughout the region, it seems that Cerner is destined to grow alongside it. One of its key goals for the future is to expand into Africa, a region also within White’s remit. He estimates that Cerner has spent somewhere in the region of $2.5 billion on research and development over the past decade, a staggering investment that more than backs up the company’s belief that health care is indeed too important to stay the same. And for those who interact with Cerner’s technologies, it seems that the face of health care will never be the same again. For more information about Cerner Middle East visit: www.cerner.ae
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An injection of insulin With diabetes on the rise across the Middle East, one company is hoping to help meet soaring demand for insulin with a state-of-the-art manufacturing facility that is the first of its kind in the region
28 | Healthcare
Julphar
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Biotechnology plant
Julphar
O
besity-related diabetes is on the rise in the Middle East. The World Health Organisation estimates that almost one-fifth of the region’s population is affected by the disease. And the International Diabetes Federation believes that the number of diabetics in the UAE will soar by a staggering 80 per cent by 2030. It comes as no surprise then, that insulin is one of the region’s most sought-after medications. And one company looking to meet that demand by becoming the Middle East’s first manufacturer of insulin is Gulf Pharmaceutical Industries, or Julphar, as it is more widely known. Based in Ras Al Khaimah in the UAE, Julphar was established in 1980—the first pharmaceutical manufacturing company to be set up in the Arab Gulf States. Today it continues to be a leading pharmaceutical producer in the region, with nine production facilities located in the UAE. Marketed across five continents, Julphar’s 200-plus products target a number of major therapeutic areas, including anti-infection, the central nervous system, endocrinology, joints and the musculoskeletal system, the respiratory system, the oral cavity and gastrointestinal tract, immunosuppression, nutrition and blood, local anesthetics, skin, and para-medical products. The company, which is the largest drug manufacturer in the Middle East, has the capacity to produce a total of 4.8 billion units of various dosage forms each year. Last year, Julphar announced record
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Expertise in plant engineering. In the area of Biotechnology, Linde can provide state-of-the art plants for pharmaceutical and industrial biotechnology across the globe and also as turnkey projects. Linde Engineering has long year experience and a long list of first-class references, including plants for insulin, EPO, vaccines, monoclonal antibodies, proteins derived from blood plasma, food additives, biofuels, biogenic hydrogen, bioethylene and biopolymers.
Our spectrum includes plants for → Industrial biotechnology → Pharmaceutical biotechnology → Chemical synthesis of APIs → Finished dosage forms → Fractionation of human blood plasma
Linde Engineering Dresden GmbH Bodenbacher Strasse 80, 01277 Dresden, Germany Phone +49.351.250-3515, Fax +49.351.250-4814, ledd.biotech@linde-le.com, www.linde-engineering.com
HEADER FOLIO Julphar
LINDE ENGINEERING DRESDEN Linde Engineering in Germany, a leading contractor for process plants for the chemical, gas, biotechnology and pharmaceutical industries, also has a strong presence in the Middle East with well-established offices in the UAE and Saudi Arabia. Linde has more than 20 years of experience in the pharma and biotech industries. For Julphar’s new recombinant insulin plant, Linde Engineering provided the basic and detail engineering, construction site coordination support, and services for commissioning and qualification. In 2009, Julphar Gulf Pharmaceuticals, a pharmaceuticals company based in the Emirate of Ras Al Khaimah, involved Linde to carry out the first engineering tasks for the new recombinant insulin plant in Ras Al Khaimah, UAE. Working closely with Julphar and the technology provider, the basic engineering was produced, then developed further during the detail engineering. A complete 3D CAD model of the new plant was generated, in which all equipment, pipes, cables, walls, cleanroom installations, HVAC systems and all main components were integrated and coordinated by an interdisciplinary team of experienced specialists. The whole project was coordinated in the 3D model which enabled efficient installation on the construction site. The several package vendors were also integrated in the 3D CAD model coordination and the interfaces were defined early so that interferences and gaps were widely avoided, which saved construction time and material cost by
reducing waste material to the absolute minimum. Linde Engineering applies this interdisciplinary workflow and 3D CAD coordination to most projects, has broad experience with the related IT tools, and can carry out such engineering projects efficiently. Linde’s project team communicated closely with various installation contractors, whose construction activities were coordinated by utilisation of the 3D CAD model to a large extent. Commissioning of the new plant was planned early, also using the P&ID database system, linking the automation system and taking into account the IQ and OQ strategy for start-up of the plant. Linde’s experienced process and commissioning specialists worked hand-in-hand with Julphar’s Quality QA/QC/QM team and Julphar’s experienced and newly trained operators, as they did in the planning and execution of start-up. The successful project execution proves that close teamwork between the client team, the engineering contractor, package vendors and specialist firms for the variety of systems in a modern biopharmaceutical plant such as cleanrooms, HVAC, automation and pure utilities can turn a complex and challenging project into a well-organised and focused project meeting the highest quality and PM standards. At over 20,000 square metres, this new state-of-the-art production facility is the largest biotechnological production plant in the whole of the Middle East. E. ledd.biotech@linde-le.com www.linde-engineering.com
JANUARY 2012| |332 Healthcare
Julphar sales growth of 11.3 per cent, Martin Christ with sales of 186 branded With over 60 years of experience, Martin Christ is the generic products and 800 leading producer not only of routine-process freeze dryers drug formulae to more but also of a series of product-specific, highly specialized than 40 countries reaching lyophilizers with far-reaching potential. The range of Dh1billion. The revenue laboratory and pilot units provides innovative control even bolstered the UAE’s systems including a comprehensive selection of PAT-tools. Production units comply with international regulations exports balance sheet by an such as those set by the FDA and GMP and will be impressive Dh900 million. specially designed by our engineering team, following the And now, Julphar individual user’s requirements. Completely integrated looks set to break yet systems (e.g. vial loading systems and isolators) can be more records with its offered. All units are made in Germany under our ISO new $136 million insulin 9001-certified production. manufacturing facility in www.martinchrist.de Ras Al Khaimah—a stateof-the-art biotechnological plant for the production of recombinant human insulin crystals. Julphar first entered the insulin production market eight years ago, importing insulin crystals for the local production of Jusline (Julphar’s recombinant human insulin). With regional demand for high-quality insulin now growing, Julphar is set to become the first company in the MENA region to produce recombinant DNA insulin in-house. Jusline has been approved by many regulatory
“Last year, Julphar announced record sales growth of 11.3 per cent”
Julphar’s products target a number of therapeutic areas
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HEADER FOLIO Julphar
GEA DIESSEL When a company exhibits at a trade show it’s not always possible to identify direct business as a result. Often the benefits come much later and the link between a new contract and the attendance at the show is lost. But, for GEA Diessel, its attendance at ACHEMA in the spring of 2006 was different. GEA Diessel produces and supplies process systems for the production of liquid products for the pharmaceutical and biotechnological industries. Its sales teams were delighted when the managing director of Julphar, the UAE-based insulin manufacturer and one of the Middle East’s largest pharmaceutical companies, walked onto the stand at ACHEMA with a project to discuss. Julphar and GEA Diessel were not strangers: the companies had worked together for many years to develop pharmaceutical plants, including the world’s largest fully automated plant for the production of syrup and suspensions. However, despite being old friends the meeting was exciting and became more so when GEA Diessel discovered the nature of the enquiry. It was for a new plant for the production of insulin. In itself that was not extraordinary but what surprised even the seasoned engineers was the scale of the project. When complete the plant would produce 1,500kg of insulin a year, making it one of the largest of its type in the world. In the autumn of 2006, GEA Diessel began work on the initial concepts and budget calculations. In 2007, the company worked on scaling up the systems from laboratory to production levels and determined important procedural parameters that would serve as a basis for the selection of process equipment. By 2009, all the plans and the engineering for the production plant had been completed.
The project was to provide all clean utility systems and to manage the process integration of all the main systems, including fermentation, harvesting, chromatography, filtration and freeze drying, for the new US$136 million insulin plant at Ras Al Khaimah in the UAE. It was to be one of the most modern biotechnological plants designed for producing recombinant human insulin crystals. It was to have a floor space of 20,000 square metres including 5,000 square metres of clean rooms and around 17 kilometres of clean piping. It was a truly massive project. Ralph Schulze, head of Pharma and Biotechnology at GEA Diessel, takes up the story: “In autumn 2010, GEA Diessel started working on site. It was a big challenge for us,” he explains. “We had to lead a team of 100 engineers and fitters, carefully managing them all in accordance with their abilities and expertise. We also had to maintain a high degree of flexibility as certain process areas had to be optimized and modified to meet specific requirements. By the end of 2011, all main work was completed.” Schulze added that the project was completed successfully and that he was very grateful for the excellent cooperation he had had from the Julphar technical team, especially Mr Hasan Jibreel, the director of projects; and Mr Essam Hammad, the director of the insulin plant. “We were able to complete the project in a very short time because of the experience the GEA Diessel and the Julphar engineers had in working together in the past,” says Schulze. “We wish Julphar every success in the qualification of the biotechnological plant and with the insulin production.” www.diessel.com
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GEA WESTFALIA SEPARATOR GROUP
CP-214-1-001
CP-214-1-001
In Ras Al Khaimah, Julphar uses the the precipitation of the insulin crystals technology of recombinant DNA (r-DNA), in the clean room, two chamber-type by injecting the insulin gene into a suitable separators BKA 28 are then used to carrier substance, in this case Escherichia separate the crystals and thus produce coli. Its genetic constitution is modified concentrated insulin. Whereas the in such a way that it produces the human separators in the first two stages were hormone insulin. In various stages, the supplied as compact package units, the bacteria then multiply in fermenters, and chamber-type separators are standalone are subsequently recovered and purified machines with the corresponding in separators. Separators thus constitute blocks and unit. After Steam-sterilizable separatorsvalve for the pharmaceutical and control biotechnology industries the core processes in the production of CIP or GEA has Whether SIPWestfalia – ValueSeparator in Every Group Process insulin. Because GEA Westfalia Separator provided intense training to the operating Whether in the production of vaccines or pharmaceutical proteins: steam-sterilizable separators from Group is known as the world-wide personnel, operations incomfort. Ras The Alcentrifuges Khaimah GEA Westfalia Separator Group stand for increased efficiency, safety and are specifically designed according to GMP standards for use in aseptically closed processes. technology leader in the production of will start providing product in mid-2012. The processing stands for an extremely gentle treatment of sensitive organisms. The result: high insulin, Julphar decided to use the knowyields of active ingredients. Entirely in accordance with our philosophy of Liquids to Value. how of the company from Oelde with ws.info@geagroup.com centrifugal technology in its new plant. www.westfalia-separator.com GEA Westfalia Separator Group GmbH www.westfalia-separator.com GEA Westfalia engineering for a better world Separator Group has installed a total of five separators in Ras Al Khaimah, to the north of Dubai. A nozzle-type separator CFA 65 with viscon® technology is used for separating the coli bacteria from the fermentation broth; in this solution, the solids are continuously Steam-sterilizable separators for the pharmaceutical and biotechnology industries discharged with a Whether CIP or SIP – Value in Every Process constant concentration. Following the Whether in the production of vaccines or pharmaceutical proteins: steam-sterilizable separators from GEA Westfalia Separator Group stand for increased efficiency, safety and comfort. The centrifuges homogenisation stage, are specifically designed according to GMP standards for use in aseptically closed processes. two self-cleaning The processing stands for an extremely gentle treatment of sensitive organisms. The result: high yields of active ingredients. Entirely in accordance with our philosophy of Liquids to Value. separators of the type CSE 80 separate the GEA Westfalia Separator Group GmbH inclusion bodies from www.westfalia-separator.com the cell fractions and engineering for a better world wash them. Following
Julphar
Julphar Insulin Plant
health authorities and is registered in more accessible price, and also supports regional than 14 countries worldwide. governments with a strategic solution to “This new facility strengthens Julphar’s reducing the diabetes burden and increasing commitment to diabetes management, not the accessibility of insulin therapy. only in the UAE, but also on an international Julphar hopes that the factory, which has scale,� says Dr Ayman Sahli, CEO of Julphar. the capacity to produce up to 50 million A clinically-validated recombinant DNA vials of the raw material for insulin each insulin, Jusline is available in 10ml vials of year, will fill a gap in the local market, 100 u/ml in three different formulations: where over 90 per cent of pharmaceuticals Jusline R (regular), Jusline are currently imported. At N (basal) and Jusline 30/70 the time of writing, the plant (biphasic), covering all was just weeks away from insulin requirements for commencing production. diabetic patients. Julphar All sub plants within the says that Jusline offers new complex are supplied Projected rise in number high quality recombinant through centrally connected of diabetics across the human insulin to healthcare corridors, technical shafts UAE by 2030 and underground tunnels, providers and patients at an
80%
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JULPHAR Julphar
SIEMENS Siemens is a leading supplier to manufacturers in the life sciences industry, with product and solution offerings in the area of automation (building and process), drives, electrical infrastructure, power distribution, fire, safety, logistics, water systems and industrial IT. In addition to a broad and innovative product portfolio, Siemens offers services and competencies from dedicated engineering services to a multi-disciplinary optimisation approach throughout bio and pharmaceutical manufacturing to address the key issues of the industry and improve business. This covers not only state-of-theart technology but also work on strategic, long-term and comprehensive concepts to benefit the customer’s business worldwide. Siemens is a trusted partner for Julphar in automation projects. Several production facilities are already equipped with Simatic controllers and automation solutions e.g. the “Julphar VI” multipurpose manufacturing plant for liquid and semi solid pharmaceutical dosage forms. The new insulin production plant “Julphar XI” is one of the most modern biotechnological plants designed for producing recombinant human insulin crystals. Siemens’ first class knowledge and experience in biopharmaceuticals combined with innovative automation products and solutions were the main reason that Julphar decided for the Siemens automation solution based on Simatic PCS 7, including Batch and Route Control. According to Dr.
Ayman, General Manager of Julphar, this is the start of a long-term relationship, initially focused on sucessfully completing what Julphar considers to be one of their most strategic projects during recent years. www.siemens.com/pharma
SIEMENS AG Siemens AG (Berlin and Munich) is a global powerhouse in electronics and electrical engineering, operating in the fields of industry, energy and healthcare as well as providing infrastructure solutions, primarily for cities and metropolitan areas. For over 160 years, Siemens has stood for technological excellence, innovation, quality, reliability and internationality. The company is the world’s largest provider of environmental technologies. Around 40 percent of its total revenue stems from green products and solutions. In fiscal 2011, which ended on September 30, 2011, revenue from continuing operations totaled €73.5 billion and income from continuing operations €7.0 billion. At the end of September 2011, Siemens had around 360,000 employees worldwide on the basis of continuing operations. Further information is available on the Internet at: www.siemens.com
BE WEEKLY || 4111 Healthcare
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Julphar with the central main Bausch + Stroebel building connected to the Bausch + Stroebel specialises in machines for offices, conference rooms, pharmaceutical primary packaging. The product range laboratories and the central includes equipment for washing, sterilizing/depyrogenation, control room. filling, closing and labelling of containers such as ampoules, Manufacturing operacartridges, disposable syringes, vials and bottles of all tions are divided between kinds. B+S systems are designed to comply with the latest FDA and GMP requirements and are available for six suites. Bulk media is all capacity ranges, starting from laboratory testing and formulated in the media clinical batches to fully integrated commercial production. preparation room before With more than 40 years of experience and over inoculation and up-filling 10,000 machines delivered, Bausch + Stroebel is a to pre-fermentation vessels leading manufacturer of high-quality equipment for the for fermentation. Bulk pharmaceutical industry. buffers are formulated in www.bausch-stroebel.com the buffers preparation area before up-filling to storage vessels in the buffer hold suite; and in the fermentation suite, four seed fermentors and four 5,000-litre production fermentors produce 10,000 litres of bacterial broth per batch. In the recovery area, the E.coli is killed and broken down to harvest the pre-proinsulin. The pre-proinsulin is then separated out from the cell debris by centrifugation and filtration, prior to further refolding reactions, where it is treated with buffers to assist it in attaining the correct structure. In the downstream initial purification suite, the pre-proinsulin is purified to Liquid and lyophilized products
“Quality is of the utmost importance to Julphar, and hygiene processes have been considered and catered for during every stage of the plant’s development� Healthcare | 43
get rid of attached peptides; and in the downstream final purification suite, the preproinsulin is cleaved using CPB to modify its primary structure and then separated by chromatography and finally, crystallized. Quality is of the utmost importance to Julphar, and hygiene processes have been considered and catered for during every stage of the plant’s design and development. The chromatographic process is monitored by protein-specific analysis using enzymeimmunological methods that make it possible to detect even the smallest possible by-products. The purity of the insulin is measured at every intermediate stage of production by the in-process control (IPC) laboratory. And all stages of the process use deionized and purified water, with microbiological and physical chemical quality monitored routinely and ozone removed with UV light before it is used. All raw materials and auxiliary materials (such as solvents, acids, bases, salts and buffers) are of pharmaceutical quality or meet internal plant specifications and are checked regularly; and the nitrogen used for inerting is purified through high-efficiency particulate filters before use to prevent contamination by particles. As a rule, all stages of the process are carried out in closed tanks with solid pipe connections, and
manual handling of the product is reduced to a minimum. The material used for the tanks and connecting pipes is corrosionresistant stainless steel with defined surface roughness (internally electropolished for critical process steps), which ensures thorough and complete cleaning. At the plant’s core is a high-capacity process control system, which processes about 10,000 items of input and output information and monitors and controls the
“To achieve its world-class vision, Julphar has worked with a number of world-class suppliers” 44 | Healthcare
Julphar
A group of high level officials from Saqr Hospital visit Julphar
entire manufacturing process. All qualityrelated instruments are calibrated upon putting into service, which is repeated regularly at appropriate intervals. To achieve its world-class vision, Julphar has worked with a number of world-class suppliers. The architects for the plant were Julphar’s Projects and Engineering Department in collaboration with leading engineering consultants LINDE-KCA. Process piping and installation of the plant equipment was undertaken by GEA Diessel of Germany; cleanrooms were provided and installed by Isocap of Belgium; and automation of the plant and control systems along with instrument validation was carried out by Siemens. Main process equipment suppliers included
GE Healthcare for chromatography purification systems; Pall for tangential flow filtration systems; GEA Westfalia for cell separators; Abec for fermentors and process vessels; Martin Christ for lyophilization; Fedegari for autoclaves; and Veolia for the RO system, WFI distiller and clean steam generator. Julphar hopes that the new plant will mark the start of a new era in healthcare for the Middle East, where access to the most important medications is improved and high quality does not have to cost the earth. For more information about Julphar visit: www.jusline.ae and www.julphar.net
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Cleveland Clinic Abu Dhabi
A new healthcare landscape
Cleveland Clinic Abu Dhabi is setting a new standard for healthcare design and delivery, as Suhail Mahmood Al Ansari, executive director of Mubadala Healthcare, and Dr Marc Harrison, chief executive officer of Cleveland Clinic Abu Dhabi, explain to Richard Halfhide
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The hospital is located on Sowwah Island in the heart of Abu Dhabi’s new central business district
Cleveland Clinic Abu Dhabi
A
bu Dhabi is a thriving emirate, for what CCAD’s CEO Dr Marc Harrison one that has witnessed a dramatic and Mubadala Healthcare’s executive increase in economic development, director Suhail Mahmood Al Ansari define diversity and population in recent years. as ‘top talent’ to work in. In its primary role as investor in CCAD, In the past, healthcare investment has occasionally struggled to keep pace with Mubadala has many key objectives; but for such accelerated social and economic Al Ansari, there are two crucial bottom change; but times are changing rapidly. lines: “Number one, whatever we invest in The government of Abu Dhabi recognised has to be financially sustainable, including the need to put in place a long-term plan to creating an integrated health system,” he provide quality healthcare for all citizens states. “Secondly, socio-economic impact is extremely important to by 2030, and as part of this vision, the Abu Dhabi us. By virtue of developing Health Services Company a quality healthcare facility (SEHA) was created in which gives patients access 2007. To encourage the to excellent medical care introduction of private close to home, we are Number of people sector healthcare providers, additionally creating many travelling overseas many existing facilities job opportunities for UAE for surgery each year, nationals. By attracting were outsourced to leading according to figures from professionals from all clinical operators around the Health Authority over the world to work at the world to operate and of Abu Dhabi manage; and a mandatory Cleveland Clinic Abu Dhabi, employer-funded health we hope to be able to foster insurance scheme was also launched. a transfer of knowledge ethos.” The initiative created an opportunity for By bringing a standard of care and service Mubadala Healthcare, a government-owned to Abu Dhabi that was simply not available investment and development company, to in the past, CCAD hopes to significantly take this process one step further and form contribute towards the improvement of a partnership with Cleveland Clinic, Ohio, the local healthcare landscape. From the one of the world’s most respected healthcare outset, one of the most crucial mandates institutions. for Mubadala was to tackle the fact that it Together, Mubadala Healthcare and has become the norm for citizens of Abu Cleveland Clinic are the driving force Dhabi to address their healthcare needs behind Cleveland Clinic Abu Dhabi (CCAD), overseas—with Germany, the US and the a brand new world-class hospital that UK being the main locations of choice. In will offer first grade health services to its fact, figures from the Health Authority of patients as well as a state-of-the-art facility Abu Dhabi (HAAD) show that nearly 3,000
3,000
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elegant solutions for technically complex architecture worldwide HDR’s history in the Middle East dates back to the 1980s, with projects such as the King Abdul Aziz University in Saudi Arabia. During the past decade, HDR has been designing elegant, complex facilities in the Middle East. Our signature design process effortlessly responds to a local culture while providing the sophisticated design required by today’s highly competitive global market. Our designs promote shared fundamental values and brand recognition on the international stage with intelligent design that incorporates new sustainable technologies and strategies for energy efficiency. At HDR we are committed to a collaborative design process that results in elegant, high-performance architecture across geographic, political and cultural boundaries. In Abu Dhabi, HDR designed the National Energy and Water Research Centre to carry out the government’s mission to develop renewable and alternative energy resources, storage and distribution systems. Sensitive to the local culture, the laboratory is built to U.S. and international standards. The Centre will enable great science while incorporating principles of sustainable design. In Abu Dhabi and in Dubai, HDR designed new headquarters for the Telecommunications Regulatory Authority (TRA). The new towers are easily
recognizable and expressive of the TRA’s mission and brand. Sleek and modern, the luminescent ‘skin’ wraps the building. Rooted in tradition, the headquarters are infused with innovative technological advancements. HDR also served as the design architect through 30 per cent completion of the Construction Documentation phase of the Cleveland Clinic Abu Dhabi, which exemplifies the best of international healthcare delivery in a world-class hospitality environment. HDR is an employee-owned firm providing architecture, engineering and consulting services from a global network of offices. With over 7,800 professionals committed to elegant design for complex facilities, HDR is world-renowned for its award-winning designs of technologically advanced facilities for healthcare, science & technology, and civic organizations. HDR is ranked No. 4 in Architectural Record’s 2011 Top 250 Design Firms survey. It is also ranked the No. 1 firm for healthcare design in four significant industry surveys: Modern Healthcare, Healthcare Design, World Architecture and Engineering News-Record. www.hdrarchitecture.com
people are currently travelling overseas for surgery each year. “A tremendous amount of patients, historically and today, still travel abroad for medical care. Part of the mandate is to reduce the need to travel and bring quality healthcare home,” confirms Al Ansari. “When American and Western Eurpoean healthcare systems operate facilities overseas, they frequently bring in a couple of executives and run the hospital under the banner of the home institution,” confirms Harrison, who brings years of experience to his role both as a pediatric intensivist and an experienced senior executive at Cleveland Clinic. “But what Mubadala has encouraged us to do is bring in a broad swathe of talent— for example 80 per cent of our institute chairs are Cleveland Clinic people. So we’re bringing the real culture, operating capability and clinical talent here.” The hospital itself is located on Sowwah Island in the heart of Abu Dhabi’s new central business district. The scale of the construction is matched only by the eye-catching design that will make the completed building a landmark in Abu Dhabi. Initially, the hospital will have 364 beds, but the design allows for further expansion to 490 in the future. Complexities
within the design have produced a hospital that achieves simplicity for those that will walk its sleek, glass-lined hallways. “No effort has been spared,” states Harrison. “Thousands and thousands of hours of subject matter expertise have gone into designing the rooms, operating theatres, public spaces, cath labs—you name it. If people aren’t feeling well, at least they are in an environment where they are going
“I am confident that this is going to be the most advanced and patient-centered hospital anywhere in the world” 52 | Healthcare
Cleveland Clinic Abu Dhabi
Thousands of hours of expertise have gone into designing the facilities
to feel cared for.” The design aims to ensure an efficient working environment for staff while promoting healing surroundings for patients. “I am confident that this is going to be the most advanced and patient-centered hospital anywhere in the world,” declares Harrison. “The equipment is first rate; the designs are patient-centered.” Technology is a watchword for both Harrison and Al Ansari. Mubadala, which already operates several technologically advanced facilities including the Tawam Molecular Imaging Centre in neighbouring Al Ain, believes strongly in the use of the most modern technologies, and CCAD demonstrates this in several ways. The hospital is aiming to achieve the LEED Gold standard, an achievement that is
only possible by incorporating the very latest sustainable practices. Some of these features include a double glass skin that reduces energy usage by 20 per cent, the use of solar energy for heating water and the incorporation of technologies to recover grey water. As well as state-of-the-art design and delivery, patients can expect to benefit from the very latest diagnostic and treatment capabilities that utilise advanced technologies in surgery, diagnostics and electronic medical records. This is an area of particular interest for Harrison: “Cleveland Clinic in Ohio is renowned as one of the world’s foremost digitally supported institutions,” he confirms. “Cleveland Clinic Abu Dhabi is going to take this to
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“We are responsibly de-risking our future by creating our own pool of talented individuals” the next level. We’re bringing systems forward that will allow us to provide safety, quality, patient experience and operational excellence, all in an environment where we can monitor performance and satisfaction in real time. We will be setting the standard for IT in healthcare.” Part of the reason Mubadala selected Cleveland Clinic as its partner was its reputation for delivering an unrivalled patient experience. CCAD aims to achieve the same thing via ‘The Cleveland Clinic
54 | Healthcare
Experience’, an in-house programme imported from Ohio where all employees learn to act as a unit. “We show them how they as a team affect the patient’s wellbeing as a caregiver. If they push a broom or work in accounting or are a heart surgeon, they are all caregivers,” asserts Harrison. It is this dual focus on both staff and patient that helps to create a special environment. As Harrison reiterates: “Engaged caregivers give the best care.” For both Harrison and Al Ansari, another
Cleveland Clinic Abu Dhabi
Bringing in the best people is a key priority
key priority is bringing in the best people to work at CCAD. This process has already started in earnest and is evidenced by such eminent appointments as Dr Tomislav Mihaljevic, the world’s foremost specialist in minimally invasive robotic heart surgery. However, there is a longer term plan behind bringing in top talent from overseas, explains Al Ansari. “The importance of creating an environment that is attractive to world-class professionals is vital; but retaining them so they can call Abu Dhabi home is just as important. “As part of economic diversification, there is ongoing investment into education and attractive living spaces,” he continues. “Abu Dhabi has very high standard of living with schools, shopping malls and now a healthcare system. By bringing people
here from all over the world, we can ensure that, long term, the transfer of knowledge and expertise to a more local and regional population is more likely to happen. And at the same time, we are responsibly de-risking our future by creating our own pool of talented individuals.” It is this forward-thinking attitude displayed by both parties that will surely make the partnership of Mubadala Healthcare and Cleveland Clinic a real success—changing the healthcare landscape of Abu Dhabi forever. For more information about Cleveland Clinic Abu Dhabi visit: www.clevelandclinicabudhabi.ae
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Health oasis Jeff Daniels takes a look at how the health delivery system of Abu Dhabi is providing its citizens with the best medical facilities possible
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SEHA
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Physician checking X-rays
SEHA
O
ver 60 years ago, Britain helped change the health expectations of the world by introducing a universal health service to people who previously had nothing. At times, though, buildings and facilities in the NHS don’t seem to have changed all that much in half a century, so it makes an interesting comparison to see how the Emirate of Abu Dhabi is doing it in the 21st century. Abu Dhabi is the largest of the seven Emirates or states that comprise the United Arab Emirates (UAE), founded in December, 1971. The UAE has a population of about five million, of which only about 20 per cent are UAE nationals. With the original objective of providing a free health service to Emirate citizens, the government has invested hundreds of millions of dollars over the past couple of decades. Not surprisingly, Abu Dhabi is investing its resources to develop a healthcare system that is comparable to the best systems in the world. As part of its long range plan, Abu Dhabi is leading the way in the UAE and the region in developing a more modern, responsive healthcare delivery system. In a series of sweeping reforms, it has introduced mandatory health insurance, creating its own government-backed health insurer, DAMAN; a standalone, government regulatory body called the Health Authority – Abu Dhabi or HA-AD; and transferred responsibility for ownership and operation of its public hospitals, clinics and blood banks to a new independent public joint stock company called Abu Dhabi Health
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SEHA Services Company PJSC, Burt Hill whose marketing name is Al Mafraq Hospital will set the benchmark of how SEHA. Seha is an English healthcare will be delivered in Abu Dhabi. In addition phonetic representation of to providing the highest level of care and economies the Arabic word for health. of operation, and a new experience to medical staff The gover n ment ’s and patients, the hospital will become the standard for intention in forming modern healing environments. It will offer an enhanced and comprehensive patient care program in its delivery SEHA is to put the public of excellent urgent care and general medical services. Al healthcare system on a Mafraq Hospital will be a state of-the-art healthcare facility financial and operational that reflects the future of healthcare in Abu Dhabi. footing similar to that of www.burthill.com the private healthcare operators in the market, thereby increasing competition, controlling costs and delivering better results to the patient long term. In doing so, it hopes to reduce the number of people who leave the country each year for treatment abroad and develop confidence and trust in local healthcare delivery. SEHA is the recognized leader in the market at this time with around 80 per cent of all inpatients and 60 per cent of all outpatients in the Emirate served through its facilities. With the increased competition, the challenge is to retain market share but also operate more efficiently to reduce cost exposure while
“Our mission is to continually improve customer care to recognised standards�
Quality healthcare facilities
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SEHA
SEHA is one of the largest integrated healthcare providers in the Middle East
creating a world-class healthcare system. it seeks out partnerships with internationally “Our mission is to continually improve recognised experts. Much of the style comes customer care to recognised international from the US—generally considered to have standards,” explains SEHA’s director of the best medical treatment. As such, SEHA Facility & Construction, Saif Fadel Al calls on the help of institutions such as Hameli. “Our vision is to provide our Johns Hopkins Medicine International customers and communities with world-class and Cleveland Clinic Foundation; but it is healthcare, and quality healthcare facilities just as willing to look to Europe and Asia in are an important ingredient in achieving the shape of Medical University of Vienna, that vision. It is our goal to improve the VAMED and Bumrungrad International. SEHA owns and operates infrastructure and create a healthcare environment for 12 hospitals with 2,644 beds, patients that is competitive 62 ambulatory care, family with the best health systems care and urgent care centres in the world.” and two blood banks. It’s Starting with a blank one of the largest integrated sheet, SEHA has formulated healthcare providers in the Number of hospitals SEHA owns and operates its own way of working. As Middle East with 16,500 doctors, nurses, ancillary part of its business strategy,
12
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SEHA
“Our vision is to provide world-class healthcare” care and administrative personnel. Now though, there are two exciting new developments in progress: SEHA has started the construction of hospitals at Mafraq and Al Ain. Both areas already have hospitals but they will be replaced within three or four years with new, state-of-theart facilities. The design of both hospitals has been recognised by being shortlisted for the prestigious Hospital Build Awards in which Al Mafraq came first in the Best Sustainable Hospital Project category. Al Mafraq is situated close to the future Abu Dhabi Central Business District. Surrounded by sensitively landscaped grounds, the 272,000 square metre hospital
Developing confidence and trust in local healthcare delivery
does not disgrace the high standards of architecture in the UAE. Its four prominent patient towers exude contemporary confidence in the state-of-the-art healthcare taking place within. Each tower contains no more than 30 single rooms per floor, providing 745 beds in total, all featuring large windows and ample natural light. In addition to providing enhanced patient environments, the ICME entire facility is designed ICME is a specialized management consulting firm, and for long-term efficiency, healthcare is one of our major areas of experience and project references. ICME offers public and private clients sustainability and maximum full service advisory and turn-key project management energy savings, with rooftop solutions for healthcare development projects. gardens and the latest energy As ICME we have been involved in development projects conservation devices. and planned and designed hospitals, specialised centers Readers familiar with and rehabilitative care facilities in the range of 300-1100 construction in North beds, both regionally and globally. America will be aware www.icme.com of LEED—Leadership in
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SEHA Energy and Environmental Underlying all work is the demand to achieve at least Design—which is driving up standards in sustainable two pearls on the Estidama scale. design and construction, particularly among public “We design and supervise Number of doctors, buildings with silver, gold the construction through nurses, ancillary care and sp e c ia l i s e d proje c t and platinum grades. In the administrative personnel UAE, the system is known managers and consultants,” as Estidama, which awards he continues. “We adopt a up to five pearls for the highest standards. teamwork policy with all project partners, “SEHA works to recognised international helping them to do good work for SEHA standards,” confirms Al Hameli. with the focus and aim of providing the best “Engineering is carried out by specialised healthcare services for our patients.” engineers and then independently reviewed Both facilities have been designed by the project managers’ team before using environmentally friendly and being submitted to different governmental energy efficient design elements and will departments for peer review and approval. be constructed under the most stringent
16,500
Using the latest medical equipment
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sustainable principles available. Wastewater will be recycled, and electrical consumption minimised through the use of low-voltage LED fibre optic interior sun lighting powered by solar panels. Passive cooling and shading will minimise the need for air conditioning, although in 50-degree summer heat, nothing will fully replace it. “To make sure there is continuity of these critical services and a comfortable
environment for patients, contractors are obliged to use only the highest quality equipment for both electrical and mechanical works, including providing electrical back-up generators and additional chillers to make sure that the services are provided continuously,” says Al Hameli. “SEHA also contracts with private specialised maintenance contractors to maintain the equipment and the facilities
“contractors are obliged to use only the highest quality equipment for both electrical and mechanical works”
Continually improving customer care to recognised international standards
68 | Healthcare
SEHA
A new benchmark for health services in the Middle East
to a high standard.” Finding one’s way around the vast building is aided by the incorporation of elegant sculptural elements into the building’s fabric and memorable water features that orient visitors to the patient towers’ elevator lobbies. Local cultural sensitivities have been catered for, with a separate tower and entrance dedicated to speciality services for mothers and children. One of the problems all hospital designers face is ensuring that in the time between when plans are first laid to the day doors open for patients, technological advances haven’t overtaken the builders and the facilities are saddled with equipment that is already outdated. By consulting with all sectors of the community—medical
and engineering—the hospitals are being designed to accommodate all known equipment; but there has to be a flexibility to live with last minute changes. “We at SEHA adopted a policy to procure the medical equipment only as the end of the project approaches, to make sure that the facility is provided with the most up-todate and recent medical equipment and technologies,” says Al Hameli. When the new hospitals open in 2013 and 2014, they will provide a new benchmark for health services in the Middle East. For more information about SEHA visit: www.seha.ae
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Where care matters most
Following its recent expansion, the American Hospital Dubai has consolidated its position as the foremost facility of its kind in the Middle East. Thomas John Murray, CEO, talks to Jayne Alverca
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American Hospital Dubai
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Pavillion
American Hospital Dubai
T
he American Hospital Dubai was created with a simple mission: the overriding aim of its founders, a private Emirate family, was to introduce the highest standards of American healthcare to a region which had traditionally offered poor or indifferent levels of medical care, usually compelling the sick to travel overseas for treatment. Years of committed work and dedication led to the American Hospital becoming the first healthcare facility in the Middle East to be accredited by the Joint Commission International (JCI) in 2000. This body sets rigorous international quality standards that focus on the areas which most directly affect patients. Accreditation demonstrates that the hospital has been evaluated for its access to care, assessment of patients, infection control, patient and family rights, and education. Other standards addressed include facility management and safety, staff qualifications, quality improvement, hospital leadership and information management. In another first, the hospital’s medical laboratory was also the first private laboratory in the Middle East to become accredited by the College of American Pathologists (CAP). This is the United States’ largest association for American Board-certified laboratory pathologists and
the recognised world leader in laboratory quality assurance. “From a professional perspective, these accreditations, which are reviewed every three years, show how committed we are to achieving and preserving the highest international standards in the services we offer. These are very stringent benchmarks which we take seriously,” states CEO Thomas Murray. Since the original hospital was built, it has undergone several major expansions, most notably the addition of a new patient out-care facility in 2006. Attention is now focused on the latest development—the largest in the hospital’s history— which is a 240-bed inpatient bed tower. The new sevenstorey tower creates an additional 50,000 square metres of space and has been designed by international architects Ellerbe Becket, with the building work executed by Dhafir Construction. Both companies have an extensive international track record on complex projects of this type. “A very important feature we continue to serve our patients is that all of these new rooms are private,” Murray explains. “We strongly believe that offering privacy is a better way to care for patients and their families. Family is a very important concept here and we wanted to create an environment as
“Our rooms are all at least 30 per cent bigger than the norm”
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American Hospital Dubai
All physicians are board-certified in either Western Europe or the US
comfortable and appealing as possible.” sunlight which we think is very important As one of the world’s leading to the healing process.” healthcare designers, Ellerbe Becket was Another facet of the hospital’s current commissioned to plan and design the expansion phase includes the addition tower’s state-of-the-art facilities. Their of facilities related to the oncology approach is inspired by the belief that departments. In November 2011 the the design of healthcare environments hospital opened its new Radiation Therapy can impact on clinical outcomes as well (RT) unit, with a team of six specialist as the overall experience of patients, their staff. Based on the most advanced RT technology available (RapidArc® linear families and care givers. “We wanted to create an environment accelerator), the new radiation oncology service is designed for of light and space,” Murray continues. “Some of our patients requiring curative rooms are actually suites and palliative radiotherapy and all are at least 30 as part of their cancer per cent bigger than the treatment. “The linear accelerator will greatly norm. Great care has been taken over details such as enhance the treatment we Addition of a new patient the view from rooms and can offer to cancer patients; out-care facility the availability of natural and we are also in the
2006
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process of upgrading our breast imaging centre for early detection,” he explains. Murray is also very proud of the hospital’s pioneering Joint Replacement Programme. The newly designed and refurbished Total Joint Replacement Regional Center of Excellence was the first unit to be relocated to the fifth floor of the new building. It features 44 inpatient rooms, as well as medical/surgical units and supporting areas. “People travel from neighbouring countries specifically for this service which has a track record of achieving exceptional results,” states Murray. “Our Cochlear Implant Programme is also set to expand and this again is another area where we can point to outstanding results.” The Total Joint Replacement Center at the hospital is unique in the Middle East and is one of only four in the world, along with similar centres in Holland, Spain and the UK. Dr. Samih Tarabichi, the Center’s medical director, has performed over 4,000 joint replacements and is ranked as one of world’s leading experts in this field. “All of our physicians are outstanding and Board-certified in either Western Europe or the US, which is a standard we will always preserve. We have very fine primary care physicians through
to outstanding cardiac and open heart surgery experts,” Murray states. For example, Professor Dr Uwe Klima, who is based at the Heart Center within the hospital, has pioneered a new and highly promising surgical technique. In October 2010 he became the first surgeon in the world to perform a new technique in coronary artery bypass graft surgery (CABG). The surgical procedure is based
“We have very fine primary care physicians through to outstanding cardiac and open heart surgery experts” 76 | Healthcare
American Hospital Dubai
Some rooms are actually suites
on a medical device called an external saphenous vein stent (eSVS), which dramatically reduces the high failure rate of traditional grafts—50 per cent of which will have failed after 10 years. Dr Klima holds exclusive rights for the medical device and treatment in the Middle East. Another recent breakthrough has seen Professor Michael Weber, director of the Center for Limb Lengthening and Limb Reconstruction, receive exclusive rights in the UAE to the Fitbone limb lengthening procedure. This is the latest technology related to limb strengthening and involves using a motorised ‘nail’ which is surgically inserted inside the bone. The aim is to facilitate new bone growth through a minimally invasive technique.
“The combination of our range of facilities and some of the finest doctors in the world means that we can offer a very comprehensive range of services,” asserts Murray. “We are extremely proud of this institution and its achievements. The services we offer are second to none as a result of the dedication of an exceptional team of people. For a number of years we have had a leadership position in this part of the world and we are determined to preserve and build upon this reputation,” he concludes. For more information about American Hospital Dubai visit: www.ahdubai.com
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Lancet Laboratories
The key to diagnostic excellence Lancet Laboratories is already one of the leading pathology services operating throughout Africa. Moving into Nigeria will be a step change for the 60-year old partnership
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Laboratories that analyse samples are the backbone of the system
Lancet Laboratories
B
ecause they are a support activity, active behind the scenes of primary and secondary healthcare, diagnostics tend to go unnoticed. From the patient’s point of view, any medical procedure is seen in terms of the outcome and how smoothly it is reached. To get there, doctors need to orchestrate a whole range of specialist services and one of the most important of these, whether in an acute or chronic case, is pathology. From diagnosis, through treatment, to long term post-treatment monitoring, the laboratories that analyse the samples sent to them by physicians are the backbone of the system. The patients have no contact with these labs and even the doctors rarely visit them, so it comes as a surprise to find the extent and depth of this activity. Lancet Laboratories is one of the largest providers of diagnostic services in South Africa after the National Health Laboratory Service (NHLS). Lancet is not in competition with NHLS though, as marketing director Peter de Wet explains. “We deal principally with private clients, though on occasion we do work for the NHLS when they have a backlog of cases or if a machine were to go down, for example.” Lancet started as one of the first private pathology laboratories in South Africa almost 60 years ago in the heart of Johannesburg. In 1996 the main laboratory moved out of the central business district to Richmond, strategically placed to service the whole of the Gauteng region. Today it is the hub of Lancet’s 250-strong network of laboratories large and small: some standalone facilities,
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“We are constantly looking at how we can upgrade our processes” others located in hospitals. “The Richmond lab is a three storey building of 4,500 square metres, and to support a 24-hour service we have a total of 200 technologists working there,” says de Wet. The partnership has grown continuously since it was founded. An early goal was to provide coverage throughout South Africa, and strategic acquisitions were made to achieve this. A merger with Pillay MacIntosh and Partners extended coverage to KwaZulu Natal in 2000 and
Lancet’s 450 couriers are a key part of the operation
subsequently Lancet merged with the Dyson and Niehaus laboratories in Pretoria and the Independent Pathology Services in Alberton, Johannesburg. Lancet now has an effective presence in five of South Africa’s nine provinces; Supercare however, organic growth Supercare is a leading South African cleaning company has been just as important, with expertise in a wide range of environments including and more recently the group industrial, corporate, retail, education and healthcare. has extended its operations Services offered include contract and specialised cleaning, into other African countries. hygiene, pest management and labour outsourcing. The group structure Supercare personnel are trained to fit seamlessly into the is the same as a legal client’s environment and to maintain high standards of quality. Electronic reporting systems allow Supercare to partnership. Shares are react fast, while the Centre of Excellence programme keeps held by 23 partners, the the company continually improving systems. board of directors and the Supercare’s commitment to excellence has been recognised chairman. There is healthy by a string of training, safety and service awards, the most competition from the two recent of which was being named Cleaning Company of the other significant players Year for 2010. in South Africa as well as www.supercare.co.za numerous local laboratories;
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Lancet Laboratories the provider that can Siemens Healthcare Diagnostics deliver the best service Siemens Healthcare Diagnostics is the largest clinical diagnostics company in the world, serving a critical role in is the one the physicians the health care continuum. We offer products and services will choose. “We focus on designed for efficient delivery of patient test results used improving our efficiency for diagnosing medical conditions, monitoring patient and effectiveness and therapy and providing quality health care. providing our doctors Siemens Healthcare Diagnostics offers comprehensive with a good turnaround solutions designed to improve clinical outcomes, streamline time,” says de Wet. “They workflow and enhance the operational efficiency of expect a good quality, clinical laboratories. www.siemens.co.za accredited result a s quickly as possible. We are constantly looking at how we can upgrade our processes internally.” The business depends on the reliable collection of samples, transporting them to the laboratory and returning the printed report promptly, so Lancet’s 450 couriers are a key part of the operation, he continues. “In South Africa the courier handles two types of specimens: the routine work and the urgent.” The bulk of samples are taken by couriers on a regular ‘bus route’ that calls on the clinics at set times each day. In the cities this can be as often as four times a day. In a crisis—say where a heart attack is suspected—the doctor may have sent the patient to the hospital but needs cardiac enzyme analyses performed as a matter of The business depends on the urgency. In such a case, a special courier reliable collection of samples
“We focus on improving our efficiency and effectiveness and providing our doctors with a good turnaround time” Healthcare | 85
would be dispatched. “We are in the process of setting up a call centre for urgent work that comes in from outside the hospital. When the doctor practice calls in, the operator liaises with Logistics and they dispatch a courier to collect the sample there and then, rather than waiting for the scheduled collection.” The entire system is replicated in the other countries that Lancet operates in but with the benefit of local expertise. “When we go into another country we generally tend to look for a local partner with an established business who is looking for growth in their practice. We send them a team to establish the infrastructure in terms of IT, communications, and all the compliance checking that needs to be done and to up-skill the local staff. Eighty per cent of the tests ordered in Swaziland, Botswana, Zimbabwe, Zambia, Mozambique, Ghana, Uganda or Kenya are performed in the local laboratories. Some are already SANAS [the South African National Accreditation System] accredited to an international ISO standard so the result you get in Nairobi or Accra is going to be of similar quality to what you’d get out of Richmond in South Africa.” Some highly specialised tests do have to be sent back to South Africa, and that
too happens seamlessly, he says. “It is a fundamental part of our infrastructure to make sure we have a good IT feed into every country we work in. All the pathologists are linked electronically so if a doctor in Nigeria, Ghana or Uganda wants to consult with one of ours, that pathologist can view the results in-country, online, using our intranet.”
“We are in the process of setting up a call centre for urgent work that comes in from outside the hospital” 86 | Healthcare
Lancet Laboratories
Lancet is committed to using cutting-edge equipment
Every year a team of external auditors comes in and audits each lab, which is a rigorous process, says de Wet. “To audit a relatively small lab will take two or three auditors a whole day. When you audit our main Richmond laboratory they can send in up to 18 or 20 auditors, and they can be there for two days!” Lancet is now in the process of setting up in Nigeria and aiming to go live with its service in early 2012. Just one more country, but a huge step, since Nigeria has three times the population of South Africa. This will certainly help achieve its modest goal of maintaining ten per cent annual growth over the coming years.
Another major contributor will be Lancet’s commitment to cutting-edge equipment. In March 2010, Lancet opened its P3 TB lab—a facility which de Wet says is a major technological achievement. “We are talking about a state-of-the-art TB diagnostics centre which not only enables us to diagnose TB within 24 hours as compared to the weeks it used to take but also gives our people a clean and sterile environment to work in,” he concludes. For more information about Lancet Laboratories visit: www.lancet.co.za
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New Natalspruit Hospital
A new dawn in healthcare South Africa is putting great effort into improving living standards for its more disadvantaged citizens, as Alan Swaby discovers
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The New Natalspruit Hospital will be a flagship hospital within the South African medical system
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New Natalspruit Hospital
N
o doubt the World Cup in South Africa made a huge difference to the country as a whole in terms of roads, railway stations and airports; but that is little comfort to those citizens whose local medical centres had a poor reputation. No wonder that politicians in Gauteng felt the hot wind of public opinion on their necks when the populace felt funds were being diverted from promised new hospital wards to sports arenas. The New Natalspruit Hospital currently being built in Vosloorus, some 40 kilometres east of Johannesburg, will be a flagship hospital within the South African medical system. Where the average hospital has around 400 beds, the new one—at a cost of R1.5 billion—will have 760. Its construction has been an odd mix of rush and stop-start ever since the plan was first mooted back in 2004. The project managers, on behalf of two Gauteng government departments (Health and Infrastructure Development), is a joint venture between the companies MOA and BKS. Gideon Grobler of BKS Johannesburg is the resident engineer and one of the project managers. “A project of this size,” he says, “would normally need about 12 months to design and plan before going out to tender but for a whole series of reasons, not least of which is the need to replace the physically precarious existing hospital, we had to do that in just five months.” Throughout the development there has been disagreement between the various interested parties and at times,
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New Natalspruit Hospital
The new hospital comprises two parallel banks of four buildings connected together either side of a public-friendly pedestrian ‘High Street’
the budgeted funds have not always been be modified at any stage. To get general forthcoming. As such, following periods contractor Basil Read off the ground, of reduced activity, the pressure has been we developed a kit of parts that enabled even greater to complete quickly. Despite the superstructure to accommodate all everything, construction is currently on possibilities.” Justifiably, both Grobler and Van Onselen are pleased that the track for commissioning in 2012. Lead architects on the project are original designs have been proved Osmond Lange Architects 90 per cent accurate. & Planners; and Deon With so much uncertainty Van Onselen explains the over exactly what goes design strategy behind the where, the whole structure hospital. “Compressing the has been built with a strong development phase in this service rationale. “Each level way meant that we had of the building,” explain Van no option but to go for a Onselen and Grobler, “has Cost of the New 1.5 metres of space above totally modular approach Natalspruit Hospital the ceiling. Together with where space usage could
R1.5 Billion
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major vertical ducts and defined horizontal and vertical service zones, this means that we have been able to install all the services for the building without disruption and minimal clashes.” The hospital is being built on the site of a previous sports ground which first had to be relocated before the hospital proper could begin. Unlike the hospital it is replacing, the new building has the advantage of solid bedrock rather than dolomite. In terms of shape, the 70,000 square metre complex comprises two parallel banks of four buildings connected together either side of a public-friendly pedestrian ‘High Street’, with the two banks linked by elevated walkways and link bridges. Although not governed by any formulised guidelines, the structure has been designed with a greenish pen. Natural light and ventilation play an important role in giving the hospital a light and airy feel. In order to test the various colours, materials and fittings which will be ultimately used, a test ward has been set up so that all interested parties can inspect and comment before committing. The lower ground floor will be for the exclusive use of staff offices, kitchen and workshops while the ground floor,
first, second and third levels will house consulting and treatment rooms as well as hospital wards. The centre will cater for a wide spectrum of general medicine with the usual array of diagnostic equipment found in all modern hospitals. The nature of the region which the hospital serves has put particular emphasis on certain activities. As well as an extensive maternity wing, there is sadly the need for a dedicated burns
“Basil Read has put together mixed teams in terms of expertise, where experienced tradesmen pass on their knowledge while on the job” 94 | Healthcare
New Natalspruit Hospital
The hospital is being built on the site of a previous sports ground
department. “This area has a mix of middle class and much poorer residents,” says Van Onselen, “many of whom are living in rural areas and relying on open fires for cooking and heating. Not surprisingly, there are a lot of accidents involving burns.” As well as the main buildings, the contract includes the construction of a series of outbuildings, one of which— the Family Medicine Centre—will act as a gateway to the hospital, with triage medical staff deciding how best to treat incoming patients. As is often the case in South Africa, there is a political hook attached to this project. A condition of the contract is that 60 per cent of labour comes from the immediate vicinity. In other words, as
Natural light and ventilation play an important role in giving the hospital a light and airy feel
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Construction is on track for commissioning in 2012
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New Natalspruit Hospital well as a much needed health facility, the hospital is also a gigantic work creation project and skills training programme. “There are over seven million bricks to be laid in this building,” says Grobler, “and many of them will be the work of newly trained bricklayers. Basil Read has put together mixed teams in terms of expertise, where experienced tradesmen pass on their knowledge while on the job. At the same time, though, Basil Read has to carry the financial risk of wasted materials and guaranteed quality levels.” The hospital is expected to serve the community for many years, with materials and fittings being selected accordingly. The north-facing solar control screens, for example, are all galvanised to make them maintenance-free, while a curved roofline has been chosen in preference to flat in order to minimise leakage problems. South Africa’s national and provincial governments are drawing up plans for a new round of hospital developments that could outspend the money which went into the World Cup. Not all of this will be public money and PPP initiatives will play a major role in upgrading medical facilities. The lessons learnt from the New Natalspruit Hospital will find their way into new developments, delivering value for money coupled with new hope for a better life for local inhabitants. For more information about New Natalspruit Hospital visit: www.bks.co.za
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Penn Pharma
Penn pals
Even the largest names in pharmaceuticals need some help from their friends from time to time. Penn Pharma is a friend to all, as Alan Swaby learns from finance director Lee Mainwaring
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The recent investment in Xcelodose equipment will enable the efficient processing of small amounts of active pharmaceutical ingredient
Penn Pharma
A
career in pharmaceutical East Wales has a good pool of skilled R&D is not for those with a workers and the universities of Cardiff, short attention span. Perhaps Swansea and Bristol are in close proximity growing bonsai needs more when it comes to recruiting highly qualified patience; but the painstaking staff, especially forensic and analytical search for new drugs can’t be far behind. science graduates. Even when an exciting breakthrough “The sheer variety of work we do,” is made in the form of a promising new says Mainwaring, “gives young scientists molecule, the hard grind has barely begun. accelerated experience. The average But this all bodes well for Penn Pharma. length of service with Penn is six years Its raison d’être is to take over the D in R&D. and then staff are ready to move on and In the business for over 30 years, it’s now one up the career ladder which may be into of the longest established pharmaceutical our internal project management group services companies around. From its or move externally. This we don’t mind UK facilities in Tredegar, because it is good for all organisations to be South Wales, it works with members of the international refreshed with new blood.” hea lthca re industr y, Interestingly, at board providing pharmaceutical level, Penn Pharmaceuticals companies of all sizes with has done just that. Over drug development, clinical the years it has transferred t r ia l supply a nd ownership via management Management buy-out manufacturing services. buyouts on three occasions— in 2007 “It’s a hackneyed cliché, the most recent was a £67 I know,” says finance million purchase in 2007. director Lee Mainwaring, “but we actually With backing from LDC Private Equity, the do provide the proverbial one-stop service. new management team found the funds and Not only that, but we have something to the strategic intent to finance a £12 million offer everyone, from the entrepreneurial development programme, with assistance sole scientist who has discovered a also from the Welsh Assembly Government. promising molecule to multinational Since then the analytical and microbiology household names.” laboratories have been refurbished In case you’re wondering, Penn is not and expanded, as have the secondary named after the founder of the business packing rooms. A new high containment but the village in Buckinghamshire where manufacturing facility was opened in it started in 1979. In 1986 it was attracted to January 2008 and an additional 75,000 Wales by the Welsh Development Agency sq.ft temperature controlled warehouse was and has flourished there ever since. South added in April of the same year.
£67 MilLion
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Penn has all the requirements needed to
“One part of the service which has attracted considerable attention,” says Mainwaring, “is our ability to work with small, highly potent compounds which need much more careful handling.” Furthermore the recent investment in Xcelodose equipment will enable the efficient processing of the small amounts of active pharmaceutical ingredient that is required to be dispensed. This is very important for potent drugs. Penn also has all the requirements needed to turn molecules into medicines: mixers, driers and tablet presses that can supply the full gamut of bottling, sealing and packaging equipment to make compounds ready for the market. Penn has over 150 clients on its books
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Penn Pharma
o turn molecules into medicines
Speed of delivery is attractive to the multinational majors
made up from SMEs which have precious little in the way of facilities and which rely on Penn for virtually all their development work, through to the multinational majors. With the former, the recession and availability of development funds from financial institutions held work back for a time, but after a relatively flat period, activity is once again picking up. For the latter, it’s not so much the facilities
that are attractive as the speed at which the work is progressed. “Our Fast Track service, for example,” says Mainwaring, “is proving beneficial for pharma companies involved with clinical trials. It’s a logistical service getting product in the specified manner to clinical researchers who are conducting the clinical trials. We prepare, package and distribute the drug under investigation along with placebo which can include
“The sheer variety of work we do gives young scientists accelerated experience” Healthcare | 103
complex double blinded trials much quicker than would normally be the case. Dedicated teams can prepare, pack and despatch product through in days, rather than the weeks it would normally take.” Penn also finds that it is a popular portal for drug companies from outside the EU wishing to enter the European market. Legislation determines that someone designated a Qualified Person and usually
trained to PhD level must supervise any such approach. US and Japanese pharmaceutical companies often call on Penn, which currently has five QPs on staff. At the other end of the spectrum is the work Penn does for the NHS on what are known as ‘specials’—unlicensed medicines. Ironically, manufacturers need to hold a licence to manufacture unlicensed products in MHRA approved facilities. These
“rather than producing ‘just in time’, we try to ensure adequate stocks are always on hand ‘just in case’”
Analytical and microbiology laboratories have been refurbished and expanded
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Penn Pharma
An additional 75,000 sq.ft. temperature controlled warehouse was added in April 2008
medicines are made from active ingredients bought from GMP sources and subjected to full analytical testing before use in just the same way licensed drugs are made. They might involve a different formulation—a liquid, for example, where tablets can’t be swallowed—but they can only be supplied against bona fide orders from registered wholesalers, pharmacies, dispensing doctors and hospitals to satisfy named patient prescriptions. On the production side, Penn has borrowed from the wider manufacturing world and has an online portal through which clients can see the status of inventories being held,
or the progress of a new batch of medicines being prepared. “But rather than producing ‘just in time’,” says Mainwaring, “we try to ensure adequate stocks are always on hand ‘just in case’.” After all, the one area where patients would be in short supply is when a sick person can’t get access to the medicines needed. Penn is ultimately here to serve its clients and improve the quality of life for all who require medicinal products. For more information about Penn Pharma visit: www.pennpharm.co.uk
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The new buzz in the pharmaceutical industry is how best to capitalise on the rapid demand from newly affluent emerging markets. As Jeff Daniels learns, Biocon is already well ensconced
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biocon
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biocon
T
here’s nothing very conventional Today, Biocon is a fully integrated about the way the Indian healthcare company that delivers innovative biopharmaceutical company biopharmaceutical solutions. Through Biocon has developed. Even separate subsidiary businesses that have its original structure—a joint been created to specialise on specific roles, venture in 1978 between the Indian Biocon’s business structure enables it to entrepreneur, Ms Kiran Mazumdar-Shaw, span the entire drug value chain, from prebarely out of university at the time—and clinical discovery to clinical development the Irish Biocon Biochemicals company is and then on to commercialisation. Together, hardly textbook. But it did mark the start these interests provide multiple revenue of a bio-revolution in India with Biocon streams which balance risk, encourage evolving over the years from an enzyme- innovation and deliver products with manufacturing company into a fully accelerated growth. integrated biopharmaceutical enterprise. Biocon capitalises on India’s globally competitive cost base The full impact that coupled with its own Biocon was to have on India exceptional scientific had to wait for some time. people resources, pushing In the meantime, ownership through its own in-house of Biocon Biochemicals R&D programmes, while in Ireland, first passed to also providing custom Unilever, where for a while and clinical research it was incorporated into Biocon value in 2004 services to international Quest International. Later pha r maceut ica l a nd still, in 1998, when Unilever sold a package of businesses in its specialty biotechnology majors. chemicals division—including Quest—to Biocon has rapidly developed a robust ICI, an agreement was made for Unilever drug pipeline, led by monoclonal antibodies to sell its shareholding in Biocon to Indian and several other molecules at exciting promoters, thus bringing Biocon home as stages in the biopharmaceutical value chain. an independent entity. With the successful commercial launch After six years of private ownership, of its first anti-cancer drug and several Biocon created a storm in the stock market other promising discovery partnerships when it floated a third of the stock in March in progress, Biocon strongly advocates the 2004. On day one of its hugely oversubscribed development of affordable medicines. launch, markets closed valuing Biocon Syngene is Biocon’s custom research at $1.11 billion—only the second time in organisation, responsible for pre-clinical history that an Indian company crossed the discoveries of new pharmaceutical products. It aims to provide high value $1 billion mark on the first day of trading.
$1.11
Billion
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biocon development services, from Agilent Technologies Inc. target identification and Agilent Technologies Inc. (NYSE: A) is the world’s premier validation to small molecule measurement company and a technology leader in life and library synthesis. With sciences and chemical analysis. Agilent has developed its reputation for meticulous innovative analytical solutions for laboratory-dependent protection of intellectual organizations in the form of UHPLCs, HPLCs, GCs, columns property, it provides and chemistry products, dissolution baths, UV-VIS spectrophotometers, mass spectrometry systems (LCMS, customised solutions in GCMS, GCQQQ, ICPMS), FTIR, NMR, MRI, lab automation the areas of synthetic solutions, qPCR, microarrays, lab informatics & data chemistry and molecular systems, and comprehensive service programs to enable biology to pharmaceutical scientists, manufacturers, researchers and regulatory and biotechnology majors agencies working in pharmaceutical, chemical, food worldwide. testing, environmental, forensics, genomics, clinical and Clinigene covers the contract research & life science research/academia to work more effectively. Agilent solutions provide measurement middle ground, specialising capabilities making our world a safer, healthy, productive in phase I-IV clinical trials and more enjoyable place. and studies, using wellwww.agilent.com/chem characterised clinical databases in diabetes, oncology, lipidemia and cardiovascular diseases at Biocon’s state-ofthe-art Bioavailability and Bioequivalence Centre—accredited by both the College of American Pathologists and NABL (National Accreditation Board for Testing and Calibration Laboratories). Biocon handles the commercialisation of products, for which it has gained a solid reputation with a formidable portfolio of biopharmaceuticals, led by Biocon’s cholesterol lowering star Statins. The ability to commercialise insulin, immunosuppressants and a range of biogenerics demonstrates highly advanced process development and manufacturing expertise. In recent years, Biocon has spread its wings internationally, starting in 2007 Kiran Mazumdar-Shaw
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biocon
Biocon advocates the development of affordable medicines
with a joint venture with Abu Dhabi-based brought significant cost savings to German pharmaceutical company Neopharma health providers and patients in the underto manufacture and market a range patent pharmaceuticals market, as well of biopharmaceuticals specifically for as in the off-patent market. Through the countries in the Gulf Cooperation Council. AxiCorp acquisition, Biocon has access to In 2008, Biocon acquired a 78 per a wide range of pharmaceuticals including cent stake in German generics, biosimilars, pharmaceutical company biologics and innovative AxiCorp at a cost of pharmaceutical products in €30 million. AxiCorp Germany and Europe. markets parallel-distributed At other times, Biocon EU pharmaceuticals as has elected to enter strategic well as its own generic partnerships, both with high Stake in AxiCorp aquired brand ‘Axcount’ in a unique tech ‘start-up’ companies or by Biocon in 2008 business approach which has long established names in
78%
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biocon order to exploit potentially rewarding new products. The list is far too long to itemise here but the following selection will provide a flavour of the variety of interests Biocon is developing. Biocon’s relationship with Amylin Pharmaceuticals, for example, is to jointly develop, commercialize and manufacture a novel peptide therapeutic for the treatment of diabetes. Sapient Discovery is an established leader in structure-guided drug discovery with a number of proprietary algorithms and capabilities for efficient protein structure based drug discovery. Sapient is working with Biocon and using its proprietary Genes-to-Leads, Fragments-to-Leads and X-ray crystallography technologies which are claimed to provide dramatic reductions in the time and costs associated with compound synthesis and screening. Sometimes these partnerships are created to better exploit generic drugs while at others, as is the case with US start-up company Iatrica, the collaboration is to co-develop an
Biocon Biopharmaceuticals facility at Biocon Park
exclusive new class of immune-conjugates for targeted immunotherapy of cancers and infectious diseases. Iatrica is based in Baltimore and uses technology developed at Johns Hopkins University. Alternatively, Biocon has chosen to use licensed technology to further its product portfolio as was the case when Biocon acquired Millipore the rights to manufacture Millipore is a Life Science leader providing cutting-edge Abra xis BioScience’s technologies, tools and services for bioscience research Abraxane approach to the and biopharmaceutical manufacturing. As a strategic treatment of breast cancer. partner, we collaborate with customers to confront the world’s challenging human health issues. From research Under the terms of the to development to production, our scientific expertise agreement, Biocon will and innovative solutions help customers tackle their have the right to market most complex problems and achieve their goals. Millipore the drug throughout the Corporation is an S&P 500 company with more than 6,000 Gulf States and the Indian employees worldwide. sub-continent. www.millipore.com To demonstrate its
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biocon versatility and flexibility, Leadership, Innovation and you need look no further Change at the ISB, and helps than the partnership it organisations find answers has with DuPont, which is to questions such as the working with Syngene on gaps in a company’s ability Ranked global the development of new to innovate, assessing the biotechnology company required understanding to crop protection products. manage and mitigate risks Biocon also works closely with a number of universities. For associated with innovation and how to example, in conjunction with the Indian produce high value, high quality, strategic School of Business (ISB) the Biocon Cell for innovation at low cost. Innovation Management has been launched To capitalise on the interest in to promote innovation in business. The biotechnology and biosciences research at Cell, set up at the cost of 10 million rupees, the Deakin University of Australia, Biocon operates under the aegis of the Centre for has helped establish the Deakin Research
Top 20
Biocon works closely with a number of universities
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biocon Institute in Bangalore Waters and a joint development One purification solution provides endless possibilities of a mammalian cell biofor your lab. Whether you want a greener purification processing facility at laboratory or more choices in instrumentation and Geelong in the Australian capabilities, Waters now has the most comprehensive state of Victoria. purification solutions on the market. No matter your In an industry dominated challenges, Waters has the purification system you need. Waters is the laboratory technology leader that first brought by American and European mass directed auto purification system to the commercial g iants, Biocon has market and is first to bring a single-vendor solution that nevertheless carved out a encompasses the entire purification range. significant role for itself, Waters’ robust solutions are flexible and scalable, from ranking among the top high-throughput fraction collection of hundreds of samples 20 global biotechnology to simple systems for purification of just a handful of companies—making it, samples. From HPLC to the newest Supercritical Fluid Chromatography (SFC) innovations, Waters systems are at one stage, the seventh designed to adapt to your needs. largest biotech employer in www.waters.com the world. Biocon’s workforce presently totals around 5,000, of which, at the last analysis, 84 per cent were university graduates and more than half of these held postgraduate degrees or PhDs. With the average age of employees at just 29, the company is alive with energy and youthful enthusiasm. We started this profile of Biocon by remarking on its unconventionality. Perhaps the most striking example of this is the founder of the business herself. Born and educated in Bangalore—still the home of Biocon—Kiran Mazumdar-Shaw graduated in 1973 and studied beer brewing at the Ballarat Institute of Advanced Education in Australia before joining Carlton & United Beverages, originators of the famous Fosters brand. In 1978, Mazumdar-Shaw moved to Ireland and joined Biocon Biochemicals Biocon campus
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biocon
Biocon is now the biggest biopharmaceutical firm in India
as a trainee manager. Within a year she issue was over-subscribed by over 30 had persuaded the Irish management to times! Mazumdar-Shaw held onto 40 help her establish Biocon in India with the per cent of the stock, making her one of initial goal of extracting an enzyme from India’s richest women. papaya. At that time, biotechnology was Over the years, her inspirational a completely unheard of science in India leadership has won her countless awards and and not surprisingly, her first application accolades. Barely four years after the start for finance was turned of her business career, she won Gold for Best Woman down by banks. Entrepreneur, awarded by Nevertheless, over the the Institute of Marketing years, the company grew Management. Since then under her stewardship and is today the biggest she has been showered with biopharmaceutical firm in honorary degrees from Amount of stock held by universities, leadership India. When the business Kiran Mazumdar-Shaw awards from business was floated in 2004, the
40%
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biocon publications and numerous Chemetall recognitions from various Chemetall is a global company committed to specialty august business institutions. chemistry and the world’s leading supplier of a broad Despite the enormous range of Lithium compounds. Following to our expertise workload of her role as in this field of chemistry we also supply other chairman and managing organometallic compounds like Grignard reagents, director, the open door Amides and Alkoxides. Besides our high quality products we offer technical and chemical solutions for lab, pilot policy of Mazumdar-Shaw and commercial applications. still remains—whether www.chemetalllithium.com for the key management team that surrounds her or for the most recent campus recruit—a highly refreshing attitude. A commitment to continuous training programmes for internees and permanent staff alike brings out the best in her people from the very beginning of their employment at Biocon. And headaches aplenty there certainly have been in recent years for the chairman. As Mazumdar-Shaw reported at the annual general meeting, 2010 was a very challenging year for the global pharmaceutical industry. Sales declined, research productivity fell off while development costs spiralled at the same time that pricing pressures from national healthcare systems squeezed margins. Clinigene at Semicon Park But when markets experience churn,
Thermo Fisher Scientific
Thermo Fisher Scientific is a Biocon partner for providing various products and services for research applications, manufacturing cell culture based products, laboratory consumables and analytical equipments that help Biocon in new drug discovery. Thermo Fisher Scientific works closely with Biocon from R&D, bench top to large-scale cGMP operations and remains a world leader in serving science. www.thermoscientific.com
“when markets experience churn, new opportunities often emerge” Healthcare | 123
new opportunities often emerge. To take advantage of unfolding possibilities, companies need to have in place business strategies that are open to change. In this regard, Biocon has demonstrated it has developed a business model that is both flexible and risk balanced. Mazumdar-Shaw believes that the dependence on blockbuster drugs in niche developed markets is “suboptimal, expensive and economically unsustainable.” Instead she considers that the industry’s next growth story will come from emerging markets, through synergistic alliances and a diversified portfolio weighted towards generics and biosimilars. Nevertheless, innovation is expected to continue delivering exciting, new opportunities. She advocates risk sharing models based on co-development of novel drugs. She argues that research services capable of spanning discovery, preclinical and clinical development will win out thanks to their ability to contain R&D costs. If this is the case, Biocon is uniquely positioned to capitalise on its superior technology base, proven research teams and highly productive manufacturing. Biocon has identified four strong and differentiated growth drivers. Firstly, it
expects demand for its portfolio of biosimilar insulin and insulin analogs and the basket of biosimilar monoclonal antibodies to continue strongly, thanks to the prevailing health of the Western world and the way it is being copied in the East. It also sees considerable opportunities for customised research services as delivered by Syngene and the high productivity clinical research delivered by Clinigene. With escalating R&D
“Biocon is uniquely positioned to capitalise on its superior technology base, proven research teams and highly productive manufacturing” 124 | Healthcare
biocon
Syngene facility at Biocon Park
costs and the long path to new medicine, Biocon considers that many companies will be forced to view outsourcing or contract services as a means of achieving the advances they need. As the complexity and scope of Biocon’s own R&D increases, this will be the perfect foil for the other divisions, delivering meaningful synergies. Finally, Mazumdar-Shaw predicts rewards from a strong market development focus on India and emerging markets. And there is no shortage of emerging markets. As well as India itself, countries such as China, Brazil, Mexico, South Korea, Turkey and Russia are all home to a growing middle class with rising disposable income and with that, the seemingly irresistible onset of ‘affluent’ diseases. These markets
are increasingly investing in healthcare and health insurance. Together, these nations will generate exponential growth for biopharmaceutical sales in years to come. Whether wanting to revive the research base, bolster the product pipeline or make inroads into new markets, biopharmaceutical companies such as Biocon are increasingly recognising the strength of, and need for, partnerships. Through licensing of advanced discovery programmes, marketing alliances and strategic research collaborations, it is possible to share the risks and costs associated with drug development by leveraging complementary skills and combining capabilities along the drug value chain. In Biocon’s opinion, collaboration is proving to be the most prudent and effective
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biocon
“Collaboration is proving to be the most prudent and effective way to boost productivity, cut time to market and sustain growth” way to boost productivity, cut time to market and sustain growth. Biocon is among those farsighted biopharmaceutical companies that have been mindful of change, agile to adapt and intuitive about opportunities for growth. Its strategic location in the heart of a ‘pharmerging’ market (industry jargon for an emerging pharmaceutical market) has enabled it to fully capitalise on its low cost base. Long before it became a widely held strategic need, Biocon has advocated affordable innovation. It invested in world class research outsourcing capabilities, US FDA compliant bio-manufacturing facilities and a self-financed R&D pipeline while the global industry was still grappling with strategies to mitigate escalating drug development costs. A forward looking biosimilar strategy was already in place prior to the industry realising its potential to sustain expensive discovery and become a powerful source of revenue. So today, as the industry restructures to seize opportunities, Biocon could perhaps lead the way as a model, risk balanced company well positioned to harness the biopharmaceutical emergence. Patents for first generation biological products will begin to expire from 2014
onwards, opening the door for biosimiliars which have been estimated to be worth $19 billion. With products such as Insugen Basalog and BioMAb, Biocon has already demonstrated it has the technical and operational expertise necessary to take innovative and affordable insulin and MAb products to the market. Biocon has also taken a number of steps closer to its ambitious global aspirations. In September 2011 Biocon announced project commencement for its first highend biopharmaceutical manufacturing and research and development facility in Malaysia. In October the company launched INSUPen, a convenient and affordable reusable insulin delivery device. And in December Clinigene International Limited, a subsidiary of Biocon, announced a collaborative agreement with Pacific Biomarkers Inc. a Seattle, Washington-based company to address the specialty biomarker and high-end clinical trial laboratory needs of the global pharmaceutical and biotechnology industry. For more information about Biocon visit: www.biocon.com
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New vistas of growth Mumbai-based Hikal Ltd is determined that achieving innovation and growth in a competitive environment should not come at the price of environmental sustainability
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Hikal Ltd
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Hikal Ltd
A
reliable source of quality fine with a strong commitment to intellectual chemicals, pharmaceutical property rights (IPR). Hikal has made APIs (active pharmaceutical significant investments in intellectual i n g r e d i e n t s) a n d capital, research and development agrochemicals, Mumbai- (R&D) and state-of-the-art manufacturing based Hikal Ltd is continuously evaluating plants. There has also been a large its operations to ensure incremental investment in IT. growth while minimising its impact on With five manufacturing facilities in India the environment. The company believes at Maharashtra (Taloja and Mahad), Gujarat that growth must be sustainable and that (Panoli) and Bangalore (Jigani), including the interests of all constituents need to an R&D centre and a dedicated contract be protected. research facility—Acoris Research—in Pune, With annual revenues of £72 million, Hikal the Indian company has started construction is a technology driven company. What sets of a new multipurpose, multiproduct API plant, which will be it apart is its commitment to operational by June 2012. clean, safe technologies and The flexible plant will be its ability to establish itself able to manufacture four as a dependable partner for high quality fine chemicals, APIs simultaneously under safety and environmental GMP (good manufacturing protection. practices) and enable backward integration, Vice chairman and Annual revenues in addition to meeting managing director Jai demand for products and Hiremath is the driving force behind Hikal. He has a clear vision— containing rising input costs. to innovate and sustain high levels of Hikal undertakes custom manufacturing growth in today’s competitive and difficult projects in intermediates and APIs for environment, and to position Hikal as a multinational companies. The company company of choice both as a preferred has expertise in custom synthesis and contract research, with capabilities supplier and as an employer. Hiremath believes by enhancing scaling up from gram to kilo and ton capacities, improving operating efficiencies level of production. Acoris also provides and infusing long-term capital, the cutting-edge research for global innovator company will become more internationally mid-size and biotech companies. competitive. Though Hikal has firmly Even as Hikal continues to generate its positioned itself as a leader in the contract own intellectual property through process research and manufacturing (CRAM) space, patents, the company plans to increase its it is one of the few Indian companies therein Drug Master Filing every year. Acoris is
£72 Million
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Hikal Ltd A partner for all seasons
A partner for all seasons COLLABORATION gaining a customer’s trust is a tough piece
COLLABORATION of work. “Don’t give up” is the Gaining a customer’s trust is a tough piece word. The cooperation between of work. “Don’t give up” is the word. The Endress+Hauser India and the cooperation between Endress+Hauser India chemical group Hikal Ltd. shows and the chemical group Hikal Ltd. shows that that perseverance pays. perseverance pays. “Winning Hikal asas a customer wasaatrue true “Winning Hikal a customer was challenge,” recalls Sajiv Managing challenge,” recalls SajivNath, Nath, Managing Director of Endress+Hauser India. Hikal Director of Endress+Hauser India. Hikal has managed to establish itself in the has managed to establish itself in the pharmaceutical and agrochemical business pharmaceutical and agrochemical business in that short time,” he continues. The only in that short time,” he continues. The only question was: How shall we start business question was: How shall we start business and and be a preferred partner with Hikal?” be a preferred partner with Hikal?” Hikal relied mainly on instruments made by competitors. When iton came to invitations Hikal relied mainly instruments made byfor tenders, Endress+Hauser India – in those competitors. When it came to invitations for days tenders, also a young business – were usually Endress+Hauser India – in those days further runners. But the–sales colleagues also a young business were usually further in India stayed on the ball and kept on runners. But the sales colleagues in India submitting their offers. The breakthrough stayed on the ball and kept on submitting their contract came in 2003 - and with a bang, offers. The breakthrough contract came in not a whimper. “Hikal bought three magnetic 2003 - and with a bang, not a whimper. “Hikal flowmeters from us,” says Sajiv Nath. “Now bought three magnetic flowmeters from us,” that was no big deal, but the snag was that says Sajiv Nath. “Now that was no big deal, the instruments had to be delivered within but the snag was that the instrumentsand had to three days.” With much commitment be to delivered within three With much thanks the help from thedays.” colleagues at the commitment and thanks to the help from the Flowtec production site in Aurangabad, the at the Flowtec site in Salescolleagues Center completed theproduction job. Managing Director Sajiv Nath is certain: contract Aurangabad, the Sales Center“This completed the was the stoneSajiv for Nath the ongoing job. foundation Managing Director is certain: partnership”. “This contract was the foundation stone for the ongoing partnership”.
The success story continues Another milestone followed in 2006 when Hikal invited bids for seven projects at
The success story continues Another milestone followed in 2006 when
the same time. The complete measuring instrumentation, they specified, should the same time. The complete measuring be sourced from a single supplier. instrumentation, they specified, should Endress+Hauser India used the opportunity be sourced from a single supplier. and offered Hikal a fixed-rate contract. A Endress+Hauser India used the opportunity clever move, since Endress+Hauser was and Hikal a fixed-rate contract. clever notoffered only awarded the contract forA all seven move, since Endress+Hauser was not only projects, but also became Hikal’s Main awarded the contractVendor for all seven projects, Instrumentation for measuring but also became Hikal’s Main Instrumentation instrumentation. “It’s factors such asinstrumentation. meeting expectations and Vendor for measuring keeping promises which make Endress+Hauser “It’s factors such as meeting expectations and a trusted vendor,” says Falgun Shukla, longkeeping promises which make Endress+Hauser serving Hikal Senior General Manager IT a trusted vendor,” says Falgun Shukla, longinstrumentation. He continues. We trust the serving Hikal Senior General Manager IT quality of their products and we’re grateful for instrumentation. He continues. trust the their support. We’re lookingWe forward to many quality of theirofproducts and we’re grateful for more years cooperation.” Hikal invited bids for seven projects at
their support. We’re looking forward to many more of cooperation.” Newyears milestones ahead
Today, Hikal is one of Endress+Hauser India’s most loyal customers. And there is more Today, Hikal is one of Endress+Hauser India’s to it: “With Hikal, we’re now aiming for a most loyal customers. And there is more to it: partnership in the fields of energy monitoring, “With Hikal, we’re now aiming for a partnership life cycle management and added value in the fields of energy monitoring, life cycle services”, explains Managing Director Sajiv management valueto services”, Nath. “To doand so,added we need intensify Hikal’s explains Managing Director Sajiv Nath. “Toachieve trust and confidence in us. We can do so,only we need to intensify Hikal’s trust this by showing that we’re notand only confidence in us. We can achieve this only familiar with Endress+Hauser instruments, by that instruments we’re not only made familiarby with butshowing also with third party vendors”.instruments, These plans Endress+Hauser but demonstrate also with that mutual trust instruments made byand thirdunderstanding party vendors”. create a genuine win-win relationship. A great These plans demonstrate that mutual trust gain for all stakeholders. and understanding create a genuine win-win New milestones ahead
relationship. A great gain for all stakeholders.
www.in.endress.com
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Hikal Ltd also expanding its services Orbit Fine Chem and manpower. Hiremath Promoters of Orbit Fine Chem have been engaged in believes the R&D unit will international and local trade for the last three decades. be the centre of innovation Our main activity is the distribution of bulk actives / for the company and intermediates to various pharmaceuticals, food and its customers. chemical industries, multinationals and conglomerates all Hikal is the only throughout India and across the world. In our endeavour to serve the nation and industry in company in the world a better way, we have always been in search of new which ma nufact ures technology and new concepts. In doing so, we have for the Thiabendazole (TBZ) at first time introduced the shot blasting system of Blastrac its plant in Tajola, which USA for industrial, road and airport runway, and concrete/ has been set up with the asphalt cleaning purposes. Now we have introduced technical support of Merck state-of-the-art products from Ultra Tech International & Co Inc, which in turn of the USA, which provides compliance solutions for spill containment, storm water management, construction has a 100 per cent longcompliance, facility protection and oil spill containments. term buy-back agreement. www.orbitfinechem.com TBZ is an important postharvest fungicide used for vegetables and fruits. The Indian firm is also in talks for joint ventures with drug and agrochemical multinationals, where the technology for new molecules would be transferred to the venture by the multinational in exchange for equity. The company also recently signed an agreement with a US-based pharmaceutical company to supply Gabapentin, a $2 billion anti-depressant that is going off-patent. It has also entered into a long-term supply
“Hikal is poised to be a part of India’s growth story”
Hikal is a leader in contract research and manufacturing (CRAM)
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agreement with a leading crop protection company in the US for the supply of new generation agrochemicals. Though Hikal recently signed a longterm contract with a leading European pharmaceutical company for the manufacture of APIs, the financial year 2010 to 2011 was a challenging year. Overall sales revenues declined by eight per cent due to costs and the rupee appreciation against the dollar; the pharmaceuticals business slid 10 per cent due to the regulatory issues faced by a major customer; and crop protection business was down three per cent for the year. Despite the setbacks, Hikal is clearly intent on leveraging clean technologies and process innovation for environmentallyfriendly operations across the value chain. Hiremath himself is focused on achieving sustainable growth: speaking to shareholders recently, he said reducing carbon footprint and utilising new technologies such as enzymatic processes to manufacture products efficiently without harming the environment would be a key driver towards this. The company currently recycles all the water at its factories, and has a solvent recovery operation in place. Recently, it added an annexure to its solvent recovery unit to make its products more competitive.
This improves the recovery of solvents and re-utilises key starting materials that reduce the load on the effluent treatment plant. Hikal was awarded the ISO-1400 certification and also the Four Stars award by the British Safety Council for adhering to world-class health, safety and environmental standards at its Taloja plant. The company
“Though Hikal recently signed a long-term contract with a leading European pharmaceutical company, the financial year has been challenging� 136 | Healthcare
Hikal Ltd
Hikal has won awards for its world-class health, safety and environmental standards
has also bagged the 1999 to 2000 Top Award for productivity, quality innovation and management from the Indian Chemical Manufacturers Association. This year, the company has plans to increase its R&D manpower and introduce more products and technologies. The move is set to further strengthen Hikal’s position as a key supplier to the global CRAM market. Hikal has established itself as a leading supplier to innovator, generic pharma and biotech companies and is well positioned to capitalise on new opportunities and build on existing ones. With its advanced infrastructure inspected and approved by globally
recognised bodies such as the USFDA, Hikal is poised to be a part of India’s growth story. Dealing in spheres as intricate as crop protection, industrial chemicals and healthcare, the company is clear on making its mark, providing a strong bridge in the research to marketing value chain through its excellence in development and manufacturing. The road ahead is full of opportunities and Hikal is keen to take the next step ahead. For more information about Hikal Ltd visit: www.hikal.com
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Mechanisms of life India is rapidly becoming the world hub for biotechnology research, with the quality of its scientists, doctors and pharmacology researchers regarded as second to none
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Life Technologies: Invitrogen
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Life Technologies can supply a wide range of instruments
Life Technologies: Invitrogen
L
ife Technologies declares that it is Asia, in November 2010. Devashish Ohri, a company dedicated to improving who joined the company from one of its the human condition, and it would major private sector customers Eli Lilly, was be hard to argue that this is not the appointed in April 2010 to lead the regional case. In less than 40 years since business, based in Bangalore—previously, RNA and DNA sequencing became possible he says, Invitrogen operated as a separate through the work of Frederick Sanger and entity in India, while Applied Biosystems Walter Gilbert, these techniques have did its business through a dealer. become fundamental tools for advancing The strategy in India and across Asia medical diagnostics, organ transplantation, will be to focus on creating a one-stop-shop agricultural and environmental research, for biotechnology customers whether in and forensics. government laboratories, pharmaceuticals Invitrogen, founded at Carlsbad, or clinical research organisations, says California, in 1987, rapidly became the Ohri. “Our competitors can typically leading global supplier of provide either instruments the high grade reagents, or certain consumables, media and consumables but we have the capability that support this activity. of supplying from under In 2008 it acquired Applied one roof a wider spectrum Biosystems, the company of instruments, nearly Invitrogen founded in that provided most of 65,000 consumables, Carlsbad, California the equipment used in and software relevant to the Human Genome biotechnology research Project. In doing so, it and bioinformatics.” added to its portfolio a global supplier of For the moment, India will remain the machines and materials used by academic main focus for Life Technologies, where and pharmaceutical industry research it has increased its number of offices from laboratories. Today, the combined one to five and its staff level to 200— company—renamed Life Technologies— though Ohri expects this to go up to 300 has an annual turnover of more than $3.3 by the end of this year. “We increased our billion, and demonstrates convincingly that distribution capability fivefold; we also improving the human condition also makes support markets in neighbouring South Asian countries including Pakistan, Sri for a sound business proposition. The last two years have been a period Lanka and Bangladesh. Biotech activity of integration between the two companies has started growing as these economies under the Life Technologies brand, a stabilise.” process that was completed with the The largest customer sector for Life establishment of Life Technologies, South Technologies, South Asia consists of
1987
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Customers can expect lead times in India comparable to those in Europe or the US
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government-funded research labs, hospitals and universities. “It’s like anywhere else in the world in that they are looking for cures for any number of common diseases, insulin regeneration ability for diabetes and the like. But there is a different emphasis in a developing economy like India’s in terms of: how do we find the root cause of infectious diseases and manage them, either in screening or treatment?” If the public sector accounts for 60 per cent of the company’s business, 30 per cent comes from pharmaceutical research, one of the fastest-growing sectors in India, driven by the generic drugs industry. “A lot of biosimilars are made in India, where the chemical structure of proprietary medicines is reached through a different process.” Biosimilars or follow-on biologics are developed once the original patent has expired: they bring the price down, but are sensitive to manufacturing changes, so it is important to the generic drug companies to be able to say they are using the same reagents, culture media and serums that the original producers used. As a global market leader in these consumables, Invitrogen stands to capture a generous share of this market, which is growing at something approaching 40 per cent per annum. Ohri estimates that in the coming two years around $80 billion worth of drugs will come off patent. This offers a twofold opportunity to Life Technologies, since it stimulates both generic manufacturing and outsourced clinical research. “On the one hand biosimilar companies in India are ramping up production; on the other,
Life Technologies: Invitrogen
Biomek laboratory automation workstation
big pharma companies are rushing to India to get their clinical research done more cheaply. Furthermore, work performed by clinical research organisations has trebled in the last two years.” While Invitrogen retains some manufacturing capacity in Bangalore, producing specific reagents such as monoclonal antibodies, these are all exported back into the global organisation. As long as this output can be loaded into the global supply chain so that customers can expect lead times in India comparable to those in Europe or the US, there will be
no real necessity for local manufacturing in order to serve customers in South Asia efficiently, he says. It’s important to realise that life sciences research scientists are an international community. “They are also keen to avail of the latest products and technologies just like their Western counterparts. In India we have had very significant penetration into the nextgeneration sequencing market, in which we have become market leaders.” Last year, Life Technologies launched a new, highly accurate, flexible and userfriendly next-generation sequencing
“Whatever instrument is launched worldwide, we have access to it right away because our customers keep in touch” Healthcare | 143
platform for genomic analysis, called the SOLiD PI system. Next-generation sequencing (NGS) is about decoding the DNA structure of the gene profile, and within India, Life Technologies already has greater market share than any competitor. “Whatever instrument is launched worldwide, we have access to it right away because our customers keep in touch with their international colleagues through
online communities and blogs—they want the latest technology quickly!” says Ohri. And customers appreciate being brought to Life Technologies’ demonstration labs for hands-on experience with machines and systems where other companies can only produce brochures and simulations, he adds. So machines from the SOLiD stable, or the new real-time PCR (polymerase chain reaction) system that will advance
“In India we have had very significant penetration into the next-generation sequencing market, in which we have become market leaders”
Customers want the latest technology quickly
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Life Technologies: Invitrogen
The Indian biotechnology sector is growing at 15 per cent
the understanding of molecular biology in the pharmaceutical discovery and clinical research markets, are vital to the pharmaceutical R&D community as are Invitrogen’s consumables. However as increasing amounts of data are generated, analyzing this data and arriving at meaningful results from it becomes a major bottleneck. Life Technologies’ global teams are developing bioinformatics software to tackle this problem. So far the Indian company’s input has been limited, but Ohri believes that more sophisticated mapping methods for the huge amount of information resulting from genomic and molecular biology experiments will present a real opportunity. “Bioinformatics is an area where we can grow even faster once
we have stabilised the integration.” The Indian economy is growing at nine per cent; the Indian biotechnology sector at 15 per cent. Ohri confidently predicts that Life Technologies will grow by 40 per cent this year, stabilising to an annual rate of 30 per cent. “We still have room to grow because we currently only contribute about 12 per cent of Life Technologies’ global turnover. But the more mature markets will be growing in single digits and we will certainly become one of the bigger markets in the next three or four years.” For more information about Life Technologies visit: www.invitrogen.com
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Fortis Healthcare
Healthy processes Established less than 10 years ago, Fortis Healthcare has become India’s largest private healthcare provider. Managing director Shivinder Mohan Singh explains to Gay Sutton how the company is providing world-class medical care while using economies of scale and improving efficiency to bring costs down
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CT scan
Fortis Healthcare
O
ne of the greatest global Punjab. It was the first of many. Ten years success stories of the last on, the company manages a nation-wide two decades is the rise of footprint of some 54 hospitals, roughly India as an industrialised, one third of which are large purpose-built business-driven nation, and institutions located in state capitals. One its emergence as a global economic force. third came to Fortis through acquisition, Think of the steel industry, software and call and the final third are managed and run by Fortis on behalf of private or state owners. centres—the list is continuously growing. Despite the Indian government’s Today, the company is India’s largest private intentions to create a national health service, healthcare provider and has achieved a healthcare still lags behind in this race for reputation for transparency and clinical the top, however. Although some 70 per excellence. cent of the nation’s health infrastructure “Our vision,” says managing director is owned by the government, only 20 per Shivinder Mohan Singh, who has guided the company through this cent of the money spent is publicly financed. A massive period of dynamic growth, 80 per cent, amounting “is to provide world-class to four per cent of India’s quality healthcare to anyone GDP, is funded by the who needs it in our country. private healthcare sector We fundamentally believe Amount of health we’re in the business to and therefore paid directly infrastructure owned deliver top quality care. through insurance or out of by the government Therefore, our financial the patient’s pocket. That same private sector, viability is a by-product and however, has inherited a dubious reputation. not the end game in our organisation. And Largely unregulated and unlicensed, it that affects everything we do.” consists of a loose congregation of over The company’s operational model is to 50,000 hospitals, 84 per cent of which deliver end-to-end healthcare with a full provide fewer than 30 beds while only range of services, and to provide centres one per cent exceeds 200 beds. Lacking of excellence at each of its hospitals in in transparency, it is often accused of six specialist areas: cardiac, orthopaedics, overcharging, and blatantly making money neurosciences, renal diseases, cancer and out of ill health. mother & child. From the very earliest The last decade has, however, seen a days, considerable attention has been paid breath of fresh air blow through this stagnant to achieving transparency throughout the marketplace. Launched in 2001, Fortis organisation, and to refute the industry’s Healthcare began with the construction profit-oriented image. To begin with, the company publishes a of a large high-tech hospital at Mohali in
70%
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Fortis Healthcare price list for all outpatient B.Braun Medical India Pvt Ltd tests and procedures, and B.Braun Medical, operational for 170 years, has 40,000 ensures those prices are employees in 50 countries, sharing their knowledge of rigorously adhered to; 30,000 innovative products. however, it is with the ‘Hospital Care’ provides solutions in anesthesia, intensive costing for inpatient care care and emergency medicine. ‘Aesculap’ focuses on that Fortis has been truly surgical instruments, suture materials, container & storage systems, and products for cardiology. ‘Out Patient innovative. Where possible, Market’ portfolio includes products for skin/wound care clinical investigations and diabetes. ‘Avitum’ offers treatment systems for acute and tests are done prior dialysis, hemodialysis and therapeutic apheresis. to admission. Meanwhile, Patients and the medical fraternity can enhance their a comprehensive range knowledge through CME programmes under ‘Aesculap of packages has been Academia’ whereas B.Braun Medical Trust Foundation is a developed for the different non-profit organisation providing scholarships to talented postgraduate medical students. conditions and diseases, and www.bbraun.com this is used as an estimate for the final inpatient bill. “We then very closely monitor the estimate to bill ratio. Any final bill that comes to five per cent more than the estimate is examined by the head of the hospital to see if anything has gone wrong. Was the estimate right, for example, or were there too many diagnostics or procedures performed, was the billing correct, and so on,” Singh explains. “In India as a whole, it’s not uncommon for patients to be charged 250 per cent more than the original estimate.
“Our vision is to provide world-class healthcare to all who need it”
Treatment
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inspired Your weekly digest of business news and views www.bus-ex.com
Fortis Healthcare
Reception
I am very happy to say that on average 92 management team to ensure that activities per cent of our bills are within the five per ranging from waiting times for admission cent of the estimate.� and turnaround for tests and investigations, This same rigorous standardisation and through to ambulance response time and verification has been applied to a wide time to discharge, are all performed to the range of operational processes over the last required standard and efficiency. five years, resulting in increased efficiency Having achieved significant benefits and a higher patient satisfaction level. At from FOS, the company has applied the present, 171 patient touching processes same concepts to the development of have been standardised an equivalent Medical across all the hospitals, Operating System (MOS). and are monitored and This monitors a whole host of parameters that managed on a daily, weekly measure the quality of and monthly basis through clinical performance and the Fortis Operating medical outcomes, and System (FOS). Enabled Number of bills within five is being used to improve through a company-wide per cent of the estimate IT system, FOS enables the medical excellence both at
92%
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hospital level and across the group. Both FOS and MOS are playing a key role in continuous improvement at Fortis, helping it to achieve world-class performance and far greater efficiency. But they are also being mobilised to help reduce costs as part of the company’s bid to make healthcare more affordable for the local population. “We won’t compromise on our world-class medical standards, on our talent or on technology. Therefore, to provide quality healthcare at prices that are affordable in India, we need to leverage process efficiency and economies of scale,” Singh says. Everything from consumables and equipment through to technology, IT and the services of consultants and experts, are much more cost effective for the larger organisation. “And this is one reason why we’ve grown at the rate we have.” Fortis has faced many challenges during its 10 years in operation, and one of the biggest has been sourcing skilled staff. The company opened the first Fortis School of Nursing in 2001 at Mohali, Chandigarh, and since then, has opened four more, each providing full nurse training. “We are always adding to the training courses we provide, and always updating our staff,” Singh says. “For example, we run specialist ICU and
critical care nursing programmes. We provide dialysis and paramedic training, and teach a wide range of technical disciplines such as radiology and pathology. We also provide a 17-day induction programme for every new nurse who joins the company.” Looking to the future, Fortis plans to continue developing its clinical excellence, and to cut costs across the organisation. “We are also developing different models
“We want to be clinically comparable to the international institutions and to do it at Indian prices— affordable for all” 154 | Healthcare
Fortis Healthcare
MRI
whereby we can systematise, package and modularise our healthcare expertise, and take it out to the 70 per cent of the population living in semi-urban and rural areas,” Singh comments. “As part of this, we are committed to opening a dozen more hospitals in non-metropolitan areas over the next two years.” Fortis has undoubtedly established its place as the leading private healthcare provider in India. “But what we have done is only a drop in the ocean,” Singh continues. “There are 50,000 hospitals in India of which we have just over 0.1 per cent. Of the two million hospital beds in India, we provide just over 8,500, which is 0.425 per cent. So whichever way you slice it, we’re making a miniscule impact on the country’s
healthcare. And the scale of that challenge is what really haunts us. We want to be clinically comparable to the international institutions and to do it at Indian prices— affordable for all. So we have a long way to go,” he concludes. If the company’s track record is anything to go by—expanding from one hospital to 54 in nine years and building a reliable and repeatable service based on medical excellence, care, quality and efficiency— then Fortis has what it takes to achieve this ambitious goal. For more information about headerHealthcare Fortis folio visit: visit: www.xxxxxxxxxx.com www.fortishealthcare.com
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