DECLARATION

I TOUSIF AHEMAD. H. TADAWALGA hereby declare that the project report entitled
A Study On Emerging Markets For Narayana Health In Africa/Asia Regions has
been prepared by me during academic the year 2015-2016 at NARAYANA HEALTH
CITY, BANGLORE under the guidance of Prof: SUSHANTH JOSHI dean, JAIN
COLLEGE OF MCA AND MBA for the partial fulfillment of the award of Master of
Business Administration (MBA).
I also hereby declare that this project has not been submitted at any time to any other
university or institution for the award of any degree or diploma.

Reg No: MB141850

Place: Belagavi
Date: 10-02-2016

TOUSIF AHEMAD. TADAWALGA

ACKNOWLEDGEMENT
It is a great privilege to extend the words of thanks to people who helped, guided and
encouraged me in completing this project successfully.
Fore mostly I would like to thank Prof. Uday Chandra, Director, Jain College of MCA &
MBA, Prof. Sushant Joshi, Dean, JCMM, and Prof. Sandeep Nair Dean, JCMM
Belgaum, for permitting me to undertake this project as part of my curriculum.
I express my deep sense of gratitude to my external guide Mr. Guru Prasad, International
Group Head, for giving an opportunity to undertake internship at Narayana Health and
for his continuous support throughout the project.
I am heart fully grateful to my internal guide Prof: Sushant Joshi, Dean, JCMM, and all
the staff members of our college for helping me throughout the project.
My special thanks to Mr.Suvankar, International Operations Head, Ms. Yasha Angadi,
Senior Executive International Operations, Mr. Manish, Executive International business
analytic and branding, Ms. Varsha Patel, Senior Executive International Operations, Mr.
Syed Abrar, Senior Executive International Operations, Mr. Prashanth, Ms. Reeta and all
the colleagues for providing me the necessary help and encouragement whenever needed.
Without their guidelines it would not be possible for me to complete this project in its
present form.
I would also wish to thank my family and my friends for their constant support.

Tousif Ahemad. H. Tadawalga

MBA 4th Semester
Jain College of MCA and MBA, Belagavi

LIST OF ABREVATIONS

NH- Narayana Health

IPS- International Patient Service
MMA- Maldives Monetary Authority
PWC- Price Water Housecoopers
PHC- Primary Healthcare Centers
FDI- Foreign Direct Investment
CAGR-Compounded Annual Growth Rate
IHHC-India Home Health Care
NCI-National Cancer Institute
TRIPS- Trade Related Aspects of Intellectual Property Rights
SADC-Southern African Development Community
WTO- World Trade Organization
ISRO-Indian Space & Research Organization

EXECUTIVE SYMMARY

It was a wonderful experience to have close review of Narayana Health City, Bangalore.
The health care industry, or medical industry, is an aggregation of sectors within
the economic

system that

provides

goods

and

services

to

treat

patients

with curative, preventive, rehabilitative, and palliative care.

The modern health care industry is divided into many sectors and depends
on interdisciplinary teams of trained professionals and paraprofessionals to meet health
needs of individuals and populations.
The health care industry is one of the world's largest and fastest-growing
industries. Consuming over 10 percent of gross domestic product (GDP) of most
developed nations, health care can form an enormous part of a country's economy.
Thus I selected my topic as A Study on Emerging markets for Narayana Health in
Africa/Asia Regions with the help of my external and internal guides, which will act as
a data for Narayana Health to capture the untapped market in Africa/Asia regions.
This report will give the detail information about political, economic, environment,
education, health/health care system, major diseases, list of hospital, and list of insurance
companies, of the countries like Zambia, Botswana, Zimbabwe, Congo, Myanmar, Sri
Lanka, Pakistan and best medium to advertise services offered by the Narayana Health
which will help NH to gain the attention of these countries and provide them with the
best quality service to the International patients which will indeed increase the revenue of
the Hospital.

CHAPTER 1
INTRODUCTION

1.1 Background of the study

India is a huge magnet for attracting foreign patients for medical treatments. With general
tourism on the rise, it is estimated that the volume of medical tourists worldwide could
reach up to 5 million by 2016, attracting additional visitors to the country.
1) Medical tourism market is estimated to be valued at $ 4 billion. Health care
tourism has been a key growth sector for more than a decade. Growing insurance market,
strong pharmaceutical industry, cheap international travel, and quality health care are
increasingly making India a preferred tourist destination. India hosts about 1.27 million
tourists from countries such as the US, UK, and Canada in addition to visitors from
neighboring countries like Bangladesh, Sri Lanka, and China.
This market includes secondary players from the tourism industry who greatly benefit
from visitors to India. The government estimates that the growth of health-related
services will be more than 5 percent for the next 10 years and that should further attract
more such visitors. Major corporations such as Tata, Fortis, Max, Wockhardt, and Apollo
Hospitals have made significant investments in setting up modern hospitals and tourismrelated services to cater to the new brand of visitors from abroad.
2) Tourists come to India for economic reasons and market attractiveness. Clearly,
there are economic advantages for choosing English-speaking India for certain
procedures. For example, a heart bypass procedure costs roughly $140,000 without any
insurance in the US. The same procedure, however, costs only around $7,000 or Rs 3
lakh at one of Indias leading surgery centers. Procedures such as hip and knee
replacement, face lift, and gastric bypass are far more affordable in India, including the
cost of travel and accommodation, compared to the US. Moreover, these cosmetic
procedures are not covered by most insurance providers in Western countries. India has
many top-notch centers for open-heart surgery and pediatric heart surgeries which are
equipped with the latest equipment that are on par with these Western countries. India is
also acutely aware of the quality perceptions of its visitors; many Indian hospitals that
cater to foreign tourists meet the requirements of US health standards like Food and Drug
Administration and Joint Commission Accreditation for hospitals, hoping to fight this
notion.
India is also home to a number of alternative medicine techniques such as Ayurveda,
Sidha, Unani, Yoga, Acupuncture and Homeopathy which are very popular among
foreigners. Such treatment opportunities give India the edge over its competitors like
Thailand, Singapore, Malaysia, South Korea, and UAE.
3) Infrastructure and better health-related investments will decide the future. While
all trends point towards an increasing demand for medical services in India, some key

factors will determine whether medical tourism becomes Indias next crown jewel, like
our Information Technology industry. Heres a list of some factors:
Infrastructure investment by the government: The health industry as a whole has seen
meagre growth as far as infrastructure is concerned. This has been primarily due to
investments coming from the private players in the market. The government needs to
step in and provide basic infrastructure services which will improve basic access to
high quality centres.
Reducing barriers for visiting India for medical purposes: Currently, foreigners need
the M-Visa to come to India for medical purposes. Obtaining the visa is a huge
barrier for medical tourists wanting to come here. India should consider offering visaon-arrival type of services and partner with medical and tourism providers to
streamline administrative processes.
Raise quality standards to meet Western providers: Such partnerships will give
confidence to foreign tourists to choose India over competitors like Malaysia and
Singapore.
Market health tourism in Western countries: With the ever-growing need for cheaper
health care and complex health insurance offerings in the US and UK, Indian
hospitals could target the neglected populations of those countries and draw them
here to provide a cheaper alternative. This could be a boon for both the Western
economies and Indias.

1.2 Statement of the problem

A study on emerging markets for Narayana Health in Asia/Africa regions
Healthcare in developing countries is undergoing rapid changes. The healthcare systems
in those countries are facing challenges such as the burden of rising and aging
populations and with it the delivery of adequate healthcare to the masses.
Rising populations in these countries will lead to increased demand for medical devices
and diagnostic equipment in the near future. For instance, between 2006 and 2011,
pharmaceutical sales doubled in emerging markets.
The study is conducted to know the factors attract the various patients from Asia/Africa
regions and to know which influenced them to select Narayana Health hospital for
medical treatment.
Political unrest
Political risk is rapidly increasing for countries in East Africa and the Middle East.
Pointing to growing unrest and political violence, global analytics firm Maplecroft
paints a grim picture in its 2014 Political Risk Atlas. The sixth annual report
evaluates 197 countries on a number of factors -- such as terrorism, conflict, regime
stability and resource nationalism -- in order to categorize the nations on a risk
scale from "low" to "extreme."
In all, the company classified 71 countries as having an "extreme" or "high" risk of
social unrest and politically driven conflict. Since 2010, 10 percent of nations have
seen significant increases in their political risk.
Certain countries on the top of the list, such as Somalia and Syria, may come as no
surprise, given the ongoing conflicts there. Since the Arab Spring, Syria has rapidly
climbed the list -- from 44th out of 197 countries in 2010, to second place in the
latest atlas.
Though Libya dropped a few spots on the list from last year's ranking, the African
state remained among the top 10 countries with the greatest political risk.
Given the current state of affairs in Syria, Libya and Egypt, Maplecroft expects the
three countries will remain at an extreme or high level of political risk for the
foreseeable future.

Economic situatio
Economic growth in Africa is expected to accelerate to 4.7% this year and 5% in
2015, but the advance is failing to translate into job creation and the broad-based
development needed to reduce high poverty and rising inequality rates in many
countries.
Although its world economic situation and prospects 2014 report is generally
upbeat about the continent, it warns that a global economic slowdown is likely to
have a significant negative impact on Africa's performance. And like the World
Bank, the UN is worried about the risks associated with a possible bumpy exit from
quantitative easing programmes by the US Federal Reserve that have pumped
money into the global economy.
The main worry is that a tapering or phasing out of quantitative easing could lead to
a global surge in long-term interest rates, a fall in stock markets and a sharp decline
in capital inflows to emerging economies.
The report notes that Africa's recent growth has been driven by commodity
production and exports, but remains far below the continent's potential. Meaningful
job creation is weak and growth is not tackling high poverty and rising inequality in
many countries.
Political unrest continues to pose a significant threat to economic activity in several
countries including Central African Republic, the Democratic Republic of the
Congo, Somalia and South Sudan. Meanwhile, the reliance on agriculture leaves
many countries prone to weather-related shocks.
Brain drain
The number of skilled people and professionals our continent has lost over the
decades is truly frightening. Since 1990, Africa lost 20,000 academic professionals
who left their countries [and] 10 percent of highly skilled information technology
and finance professionals have also left the continent in recent years, Mbeki said
in an address to an interactive gathering held by the Homecoming Revolution in
Sandton, Johannesburg.
Mbeki said with regard to the health profession, especially the public health sector,
research had also shown that out of 57 worldwide with poor health systems, 36 of
them were in Sub-Saharan Africa, yet southern African countries export nurses and
other health professionals to Europe.

This loss of qualified health professionals indicated the need for skilled medical
professionals trained in these countries to remain and make a contribution to
strengthening their local health systems.
Road ahead
The overall Indian healthcare market today is worth US$ 100 billion and is
expected to grow to US$ 280 billion by 2020, a compound annual growth rate
(CAGR) of 22.9 per cent. Healthcare delivery, which includes hospitals, nursing
homes and diagnostics centers, and pharmaceuticals, constitutes 65 per cent of the
overall market.
India's competitive advantage lies in its large pool of well-trained medical
professionals. India is also cost competitive compared to its peers in Asia and
Western countries. The cost of surgery in India is about one-tenth of that in the US
or Western Europe.
There is a significant scope for enhancing healthcare services considering that
healthcare spending as a percentage of Gross Domestic Product (GDP) is rising.
Rural India, which accounts for over 70 per cent of the population, is set to emerge
as a potential demand source.

1.3 Objectives of the study

The overall objectives is to identify the potential markets for Narayana Health,
particularly in Asia and Africa regions, and identifying the most suitable marketing
strategies to promote the health care services offered by the Narayana Health. The
research seeks to achieve these objectives by engaging in the following:
To study the health care services of Asia/Africa regions.
To study the gaps and challenges of health care industry in Asia/Africa countries.
To study the comparison of Narayana Health with respect to Countries in
Asia/Africa.
To identify the potential markets for Narayana Health as well as retaining the
exiting market.
To understand the benefits offered by the competitors.
To study the complimentary benefits offered by Narayana Health
To study the cost advantage with respect to Narayana Health.

1.4 Need of the study

The study will bring in more information and guides the Indian health care industry
and Narayana Health in broader spectrum.
The study will also help in organizing the existing systems and designing new
systems to provide more treatment options in efficient manner.
Healthcare has become one of Indias largest sectors - both in terms of revenue and
employment. Healthcare comprises hospitals, medical devices, clinical trials,
outsourcing, telemedicine, medical tourism, health insurance and medical
equipment. The Indian healthcare sector is growing at a brisk pace due to its
strengthening coverage, services and increasing expenditure by public as well
private players.
The Indian medical tourism industry is pegged at US$ 3 billion per annum, with
tourist arrivals estimated at 230,000. The Indian medical tourism industry is
expected to reach US$ 6 billion by 2018, with the number of people arriving in the
country for medical treatment set to double over the next four years. With greater
number of hospitals getting accredited and receiving recognition, and greater
awareness on the need to develop their quality to meet international standards,
Kerala aims to become India's healthcare hub in five years.
India is a land full of opportunities for players in the medical devices industry. The
country has also become one of the leading destinations for high-end diagnostic
services with tremendous capital investment for advanced diagnostic facilities, thus
catering to a greater proportion of population. Besides, Indian medical service
consumers have become more conscious towards their healthcare upkeep.
India requires 600,000 to 700,000 additional beds over the next five to six years,
indicative of an investment opportunity of US$ 25-30 billion. Given this demand
for capital, the number of transactions in the healthcare space is expected to witness
an increase in near future. The average investment size by private equity funds in
healthcare chains has already increased to US$ 20-30 million from US$ 5-15
million, as per PriceWaterHouseCoopers.

CHAPTER 2
LITERATURE REVIEW

Literature review
Dakshi Mohanty and T Phani Madhav (2008) opines that the Indian health care
industry began to emerge as a prime destination for medical tourists by upgrading its
technology, gaining greater familiarity with western medical practices and improving its
image in terms of quality and cost. They classified medical tourists in to four major
geographical groups who traveled for distinctly different reasons. First group consists of
medical tourists from America who came for cosmetic surgery, as no insurance cover is
available for cosmetic surgery in USA. Second group include of medical tourists from
UK come for medical treatment because of long waiting lists- could not wait for
treatment by the National Health Service and they cannot afford costs of private
hospitals. Third group consists of medical tourists from West Asia who come for medical
treatment because medical services unavailable or short in supply in the country. Fourth
group consists of medical tourists from underdeveloped nations like Nigeria, Bangladesh
etc, who come for medical treatment because of poor medical facilities in these nations.
They also pinpoint certain weakness of Indian medical tourism such as lack of
standardization and accreditation, charging of different prices in different hospitals for the
same procedure.
Kavitha Bajeli- Datt (2009) gives a picture of medical tourism in India. The private
sector has already rolled out the red carpet. The makeover is striking and hospital floors
are squeaky clean and interiors compete with those of five star hospitals. Many hospitals
have prayer rooms, translators, and visa extension and currency exchange services. Some
hospitals are also tying up with travel agents and insurance agencies. She also mentions
the difference in pricing of same treatment in various cities in India. A heart surgery costs
in Mumbai up to Rs.4lakhs and at Kochi it costs up to Rs.1.5 lakh and it would cost a
lakh more in Chennai and up to Rs.2 lakh in Delhi.
Leigh Turner (2007) concludes that with globalization, increasing number of patients are
leaving their home communities in search of orthopedic surgery, ophthalmologic care,
dental surgery, cardiac surgery and other medical interventions. Reductions in health
benefits offered by states and employers will likely increase the number of individuals
looking for affordable medical care in a global market of privatized, commercial health
care delivery.
Devon Herick (2007) notes that global competition in health care is allowing more
patients from developed countries to travel for medical reasons to regions once
characterized as third world. Many of these medical tourists are not wealthy, but are
seeking high quality medical care at affordable prices.

Annette Arellano (2009) observes that trade in health care services therefore now
includes countries promising first-class services at third-world prices.
Sandhya Anvekar (2012) concludes that in the international market scenario, India
comparatively attracts lesser medical tourists than its counterparts like Thailand. Most of
those arriving in India come from poor countries. Developed countries like the USA,
Britain and Canada have costliest, overloaded health systems, producing long waiting
lists that create high market potential for Indian service provider. Though India is wellqualified, certified and cheap in every aspect of health care, from new-drug discovery and
testing to surgery, it is still not considered as a very attractive medical tourism destination
William Bies and Lefteris Zacharia (2007) opined that a trend emerging in recent years
has been travel from industrialized nations to developing countries such as India and
Thailand for purposes of undergoing medical procedures, a phenomenon called medical
tourism. Medical tourism offers the prospect of greatly reduced expenses for healthcare
as well as other advantages such as reduced waiting times, but there are risks associated
with seeking healthcare overseas. The researchers find that self selected medical tourism
is preferred over employer or government sponsored programmes and over the status
quo.
S.Rajagopalan (2006) opined that the health tourism market has three segments-1,
Surgeries like orthopedic surgery, by-pass surgery, cancer therapy, eye surgery, organ
transplantation.2, Plastic surgery or cosmetic surgery and 3,health spas, weight loss
exercise centers, hot springs and holistic treatment including wellness therapies. He
identified that inadequacy of healthcare provision in relation to need is the major push
factor for people in developed countries to seek treatment abroad. He identified certain
risks in health tourism like commercializing doctors profession, issue of recuperation
after treatment, insurance cover will available only if when the standard of services is the
same as the patients home country, recourse to legal action is difficult in countries that
have weak malpractice laws or not feasible if the legal process is slow.
Swathi Soni and Markarand Upadhaya (2006) opined that medical tourism has risen
from the rapid growth of an industry where people from all around the world are
travelling to other countries to obtain medical, dental and surgical care while at the same
time touring, vacationing and fully experiencing the attractions of the countries that they
are visiting. They list out factors such as exorbitant costs of healthcare in industrialized
nations, ease and affordability of international travel, favorable currency exchange rates
in the global economy, rapidly improving technology and standards of care in many
countries of the world and most importantly the proven safety of healthcare in select
foreign nations etc lead to the recent increase in popularity of medical tourism.

CHAPTER 3
RESEARCH METHODOLOGY

3.1 Research Design

To do the situational analysis, a descriptive study was designed. Only secondary data
were used in this study.

3.2 Data sources

The secondary data included the healthcare scenario and scope of medical tourism in
the country, factors influencing this industry stream, cost of various procedures in other
developed and developing countries. Various sources like internet, WHO reports Journals,
Magazines, News papers have been used to collect.

3.3 Scope of the study

The study focuses on the existing market (i.e. Bangladesh, Oman, Iran, Maldives,
Ethiopia, Kenya, Tanzania, and Nigeria.) and the potential market (i.e. Congo,
Zimbabwe, Zambia, Sri Lanka, Botswana, Myanmar and Pakistan.) of Narayana
Health, Bangalore. The healthcare system and the major deceases in the above countries
is studied and analyzed with respect to Narayana Health. And the marketing strategies for
the same are formulated.

3.4 Limitation of the study

As the research is based on secondary data analysis the data collected is up to the year
2015 but may vary due to further research conducted.

Secondary data can be general and vague

The information and data may not be accurate

The data maybe old and out of date.

The sample used to generate the secondary data may be small.

CHAPTER 4
COMPANY PROFILE

4.1 Profile of Narayana Health

Narayana Health formerly known as Narayana Hrudyalaya. NH is one of the most
respected hospital groups in India and has been instrumental in revolutionizing the
healthcare system in India. NH has head office in Bangalore and is spread in 30acrs of
land. The campus has Worlds largest Cardiac and Cancer hospital besides separate
Orthopaedic and Eye hospitals.
Narayana Health, one of India's largest and World's most economical healthcare service
providers is set to emerge as a global industry model for its ability to reconcile quality,
affordability, scale, transparency, credibility and sustainable profitability. Equipped with
all super-specialty and tertiary care facilities that the medical world has to offer, it is now
a one-stop destination for any healthcare requirement a common man needs.
It may be noted that the affluent come here for the world's best healthcare and the poor
come here for the focused attention they can get from a private hospital. No one is
refused treatment due to lack of funds. From a humble beginning of a 300 beds hospital
in 2001, Narayana Health has grown to a 6900 beds healthcare conglomerate in 2014
with 29 hospitals present in 17 locations within the country. The group has already
established its presence in Bangalore, Kolkata, Ahmadabad, Hyderabad, Jaipur, Raipur,
Jamshedpur, Guwahati, Mysore, Dharwad, Kolar, Shimoga and Davangere. With 120
major surgeries performed everyday and 80,000 OPD patients attended per month.
Narayana Health offers super-specialty tertiary care facilities across areas of
specialization including cardiac surgery, cardiology, gastroenterology, vascular,
endovascular services, nephrology, urology, neurology, neurosurgery, paediatrics,
obstetrics & gynaecology, psychiatry, diabetes, endocrinology, cosmetic surgery and
rehabilitation, solid organ transplants for kidney, liver, heart and bone marrow transplant
as well as general medicine. They also have oncology services for most types of cancer
including head, neck, breast, cervical, lungs and gastro intestinal.
Famous for its cost-cutting approach in many ingenious ways, NH has been ranked 36th
among "WORLD'S 50 MOST INNOVATIVE COMPANIES" by Fast Companies in
2012. We have also been a proud recipient of Frost & Sullivan India Healthcare
Excellence Awards 2012 in the category Healthcare Service Provider Company of the
Year and FICCI Health Care Excellence Award 2012 for "Addressing Industry Issues".
In India, where accessibility to good healthcare facility still depends on one's economic
status Dr Devi Shetty decided to bring about a revolution in the health sector. The journey
from 6000 to 30,000 beds has just begun.

Narayana Health is also a renowned centre for telemedicine, the services rendered are
free of cost. It is now amongst the largest telemedicine networks in the world.
The story of NH is a case study at Harvard business school and various news agencies
like BBC/CNN/Discovery/Al-Jazeera etc have done exclusive documentaries on NH.

4.2 Vision of NH Hospital

Our vision is to provide high quality healthcare, with care and compassion, at an
affordable cost, on a large scale.

4.3 Values
Narayana Healths Core Values are defined by I CARE.
Innovation and efficiency to continuously reduce cost of delivery of high quality health
care and improve reach
Compassionate Care in providing accessible care that makes a difference to our patients
Accountability to honour our commitments with integrity and transparency to our
patients, employees and investors
Respect for all recognize the contribution of every employee and respect rights and
dignity of every patient and employee
Excellence create a culture of individually excelling to collectively ensuring highest
quality of consistent, reliable service to our patients and sustainable value to all our
stakeholders

4.4 Narayana Health as brand

NARAYANA in Sanskrit means the preserver of the universe which matches with the NH
ethos of being committed to the health of every life
Colour: BLUE is the colour of calm, peace and cure. Leaf is a symbol of life
NH: NH does not have any gaps in between as there is no space for discrimination while
catering to the health needs of every individual
Three Leaves: The THREE LEAVES three core values of NH Compassion, Quality,
Affordability
Sunrise: The SUNRISE behind the letters NH marks a new dawn in healthcare that
Narayana Health is trying to bring about

4.5 Departments in NH hospital

Cardiology
Cardiac surgery
Neurosciences
Gastroenterology
Nephrology
Urology
Cancer
Organ transplant
Orthopedics
Women & child
Ophthalmology
Critical care
Cosmetic surgery
General surgery

4.6 Typical Day at NH Hospital

450 Inpatient admissions
150 Surgeries all together
42 Cardiac surgeries
4200 Outpatient on an average
250 Cardiac procedures
420 Dialysis procedures
10 Neuro surgeries

 1 Kidney transplant/day
Narayana health is recognized for transplants and cochlear implants
Bone marrow transplant
Stem cell transplant
Renal (kidney) transplant
Paediatric liver transplant
What makes NH hospital difference from others ?
More than 90,000 cardiac surgeries
Amongst the largest telemedicine networks in the world
80 bed dedicated post-op paediatric cardiac ICU at NH Health City, Bangalore
the largest in the world
Patients from 76 countries
One of the largest dialysis unit in India with 217 dedicated beds & 130000
procedures per year.

4.7 Alliance partners of NH hospital

Aetna Global Benefits (Middle East) LLC
Axa Insurance (Gulf) B.S.C
Cigna Global Health benefits (CGHB)
Europ Assistance Indian private limited
Vanbreda International NV
International SOS
Star Well Destination
Alliance Global Assistance USA

 Mondial Assistance USA

4.8 Services provided to international patients

Query response within 24 hours
Visa assistance
Complimentary airport pickup and drop
Assistance in accommodation within the vicinity of the hospital
Hand held patient from the immigration counter to the hospital
Dedicated relationship manager
In house 24/7 translator services
In house Forex services / travel assistance
Availability of international channels
Preference to international patient in OPD and diagnostics
Dedicated person for visa registration /extension process
Executive deluxe rooms with luxurious amenities

4.9 Specialties Offered In NH Hospital

Super specialties
Cardiac Surgery
Cardiology
Diabetes and Endocrinology
Gastroenterology
General Surgery
Maxillo Facial Surgery
Nephrology
Neurosciences
Obstetrics and Gynaecology
Oncology
Orthopaedics
Paediatrics
Transplant
Urology
Vascular Surgery

Other specialties
Dental
Dermatology
Emergency Medicine
ENT
Family Medicine
General Medicine / Internal Medicine
Genetics
Geriatrics
IVF (Assisted Reproduction)
Ophthalmology
Plastic surgery
Psychiatry
Pulmonology
Rheumatology

4.10 Unique Health City Model Of NH Hospital

Telemedicine
Outreach to rural people through telemedicine in collaboration with Indian Space &
Research Organisation (ISRO). This program helps millions of Indians who live in
villages to get health advice. This is one of the largest telemedicine centres in the world
and extends to 19 countries. Benefits here are:
Leveraging technology to reach out to masses
Till date NH has treated over 70,000 heart patients in remote locations of India
Has helped millions who live in villages to get timely attention
Yeshaswini
The micro insurance scheme called "Yeshaswini" conceptualised by Dr. Devi Shetty was
launched in 2002 in association with the Karnataka state government. The huge success
of this scheme in Karnataka has led other state governments in the country to adopt a
similar scheme. Initiatives has also been taken to develop similar schemes for teachers
and other groups in the State of Karnataka. Experience with micro insurance has shown
that poor families are now more likely to seek low cost treatments which they had
previously forsaken because of ability and reluctance to pay for conditions that did not
appear life threatening. The government infrastructure like post offices are used to collect
monthly premiums, track payments and issue health insurance cards.
Low Cost Surgical Hospital Model
Indias first low cost hospital has been built in Mysore. Narayana Health has done this
pilot project with 300 surgical beds. It is a super speciality hospital providing tertiary care
in cardiac surgery, neuro surgery, orthopaedic surgery, general surgery, urology and
gynaecology. While the industry average per bed cost is Rs 40- 50 lakhs, through this
model the costs drastically reduce to Rs 15 lakhs. Thus bringing down charges to patients
drastically. Some of the special features of such environment friendly projects are:
Built on pre fabricated structure with minimal RCC construction
Limited to a ground floor structure thereby further reducing construction costs
Maximum use of natural daylight in order to reduce consumption of electricity

Increasing life span of medical equipment

With Trimedex Indias support, NH has doubled the life of medical equipment thereby,
reducing the need to replace expensive machines with new ones. In India, cost of
maintenance is high due to which the hospitals are forced to buy new ones. Trimedx India
services medical equipment for NH in a lower cost therefore doubling the machine life.
Daily Profit and Loss tracking
All doctors and administrators are given a daily P and L calculation. Updates are sent
electronically and on mobiles. This helps us stay above our competitors. More
importantly if there is a course correction required it can be done immediately.
Cloud ERP system
We have a robust ERP system that integrates all the units of Narayana Health. This ERP
system is deployed on Cloud, making us the first hospital chain in India to do so. This
allows real time access to data across the Group. The advantage with this system is pay
per use concept resulting in no investment and maintenance costs. It also makes the entire
hospital management system efficient, thereby positively impacting the bottom line.
Staff and Patient feedback system
PEARLS - Patient & Employee Resolution and Learning System is unique initiative that
is a customer friendly complaint redressal recourse. The primary features of PEARLS are

That employees/ patients need to dial a single number. An executive logs the
complaint and sends request to the concerned department for addressing the issue.

Each department is expected to attend to the problem and update the status on the
system. There has to be a favourable resolution.

If the complainant is not satisfied then the executive will refuse closure and
resend to service department.
Till date 99% of complaints registered have been satisfactorily resolved.

Scholarship for Medical studies

In West Bengal, Narayana Health in collaboration with Asian Heart Foundation has
initiated a scholarship scheme Udayer Pathey for underprivileged children.

Those students who are in the 7th standard and plan to pursue medical studies to become
doctors/surgeons are given Rs 6000 annually. This works as an incentive for parents and
their wards.
To augment healthcare professionals in remote areas and villages. Given that India has an
acute shortage of practicing doctors and poor patient to doctor ratio exists in villages, this
scheme allows meritorious students to pursue further studies by providing them access to
education loans from banks.
These loans make government medical colleges financially viable.
Investment towards training and development
Narayana Health believes that investment into training, skilling and education are the
pillars on which the healthcare delivery rests. These increase efficiency and productivity.
Post graduate programmes for doctors conducted by National Board, New Delhi.
Training for technicians, paramedics and staff are conducted round the year. Nursing
Institute affiliated to Indian Nursing Council and Rajiv Gandhi University have regular
skilling programmes for nurses.
Asset Light Strategy
Narayana Healths strategy of keeping an asset light model has worked in its favour by
keeping operating costs low. We have invested in greenfield projects where land and
buildings belong to the Group. We have further explored other models of partnership eg
running a speciality department in an existing hospital. We have also entered into
agreements with existing hospitals which own the land and buildings but Narayana
Health manages the entire facility ie equipment, manpower belong to the Group. Other
parameters that contribute to a healthy bottom line are manageable sizes of hospitals and
number of beds which differ with locations and ensure a much lower capex spends than
the industry norm through innovative planning and construction.

4.11 Marketing channels used by Narayana Health Hospital

Free medical camps in other countries.
Free checkups.
Advertising in news papers.

4.12 Few of the highlights of NH hospital

Worlds largest cardiac hospital, conducting 42 cardiac surgeries every day
Worlds largest 80 bedded dedicated pediatric cardiac ICU.
More than 60 interventional procedures conducted by cardiologist every day
The most experience hospital in valve repair and ross procedure
Having expertise in endovascular intervention for aneurysms and radio frequency
ablation
Expertise in pulmonary endarterectomy for chronic pulmonary embolism and
aneurysm surgery
East Asias largest kidney transplant unit at Kolkata, doing more than 25
transplants every month
Largest dialysis unit in India
Pioneer in Indian of combined kidney and pancreas transplant
Expertise in liver transplant on babies less then 10kg with 95% success rate
Indians largest bone marrow transplant centre
First hospital in India to have implant 3G artificial heart device
Worlds largest cancer hospital offering wide range of cancer unit
Pioneers in concept of tele-medicines and having already treated more than 70000
patients via telemedicine
Having 24/7tele-radiology,connected to various parts in India and abroad
Treating patients from over 76 countries
Dedicated team to handle international patients

Past 2 years non Indian patients visit ratio in Narayana Health Hospital
The non Indian patients visiting ratio in Narayana Health Hospital
40% from Bangladesh
30% from Middle East countries
20% from African countries
10% from other countries

CHAPTER 5
DATA ANALYSIS

EXISTING MARKETS

BANGLADESH
Bangladesh officially the People's Republic of Bangladesh , is a country in South Asia,
bordered by India and Myanmar, at the apex of the Bay of Bengal. It is separated from
Nepal and Bhutan by the narrow Siliguri Corridor. It is the world's eighth most populous
country and the ninety-second largest country by area, making it one of the most densely
populated nations on Earth. The majority of the population are Muslims, followed by
Hindus, with diverse Buddhist and Christian communities. The official language is
Bengali, which is also spoken in the neighboring Indian states of West Bengal and
Tripura. Dominated by the fertile Bengal delta, Bangladesh is rich in biodiversity and is
home to the world's largest mangrove forest, a mountainous east and a 600 km (370 mi)
coastline that has one of the world's longest beaches.

Health
Health and education levels remain relatively low, although they have improved recently
as poverty (26% at 2012) levels have decreased. In the rural areas, village doctors with
little or no formal training constitute 62% of the healthcare providers practicing modern
medicine and the formally trained providers are occupying a mere 4% of the total health
workforce. A survey conducted by Future Health Systems revealed significant
deficiencies in treatment practices of village doctors, with a wide prevalence of harmful
and inappropriate drug prescriptions. There are market incentives for accessing health
care through informal providers and it is important to understand these markets in order
to facilitate collaboration across actors and institutions in order to provide incentives for
better performance.

India for treatment

An increasing number of Bangladeshis are seeking medical treatment abroad. Unlike
when medical tourism first reared its head a decade ago, it is no longer limited to the
most affluent members of society. Today, many people use their savings to go to
neighbouring countries in the hope of getting quality healthcare.
Nearly 500,000 Bangladeshis visit India every year. Of them, 25 percent people
travel for treatment purposes.
The experts said medical specialities such as high-tech medical infrastructure and
doctors professional expertise of the developed countries attract rich patients.
A recent study shows the patients mostly travel to India, Singapore, Thailand and
Malaysia for better treatment.

State Minister for Health Mozibur Rahman Fakir said the government hospitals
have comparatively better facilities but those remain fully packed with middle class
and poor patients.
However, we have some private-sector hospitals which provide world-class
treatment but their costs are excessively high, he told daily sun.
Hospitals like Apollo, United or Square take about Tk 600,000 to Tk 700,000 for an
open-heart surgery, but the same costs only Tk 300,000 in Bangalore, India, he
said.
In terms of price, our neighbour is hard to beat. South India and Kolkata are extremely
popular destinations for all kinds of medical treatment, not only because they are nearby
but also because of some renowned institutions.
For eye related treatments, Shankar Netralaya, which originated in Chennai but now also
has a branch in Kolkata, is deemed one of the best places to go. National Institute of
Mental Health and Neuroscieneces (NIMHANS) in Bangalore has the best treatment for
neurological and mental health problems.
Visitors claim that both these places are quite reasonable because they started as charity
hospitals and still maintain some subsidised rates. For cardiac treatments, cardiologist Dr
Shetty's hospital in Bangalore is a top pick. Doctors in Kolkata are also popular because
they are closer to Bangladesh distance-wise. Many Bangladeshis go to Tata Memorial
Hospital in Kolkata

OMAN
Oman, officially the Sultanate of Oman, is an Arab country in the southeastern
coast of the Arabian Peninsula. Holding a strategically important position at the
mouth of the Persian Gulf, the nation is bordered by the United Arab Emirates to
the northwest, Saudi Arabia to the west, and Yemen to the southwest, and shares
marine borders with Iran and Pakistan. The coast is formed by the Arabian Sea on
the southeast and the Gulf of Oman on the northeast. The Madha and Musandam
exclaves are surrounded by the UAE on their land borders, with the Strait of
Hormuz (which it shares with Iran) and Gulf of Oman forming Musandam's coastal
boundaries.
From the late 17th century, the Omani Sultanate was a powerful empire, vying with
Portugal and Britain for influence in the Persian Gulf and Indian Ocean. At its peak
in the 19th century, Omani influence or control extended across the Strait of
Hormuz to modern-day Iran and Pakistan, and as far south as Zanzibar (today part
of Tanzania, also former capital). As its power declined in the 20th century, the
sultanate came under the influence of the United Kingdom. Historically, Muscat
was the principal trading port of the Persian Gulf region. Muscat was also among
the most important trading ports of the Indian Ocean. Oman's official religion is
Islam.

Health
Life expectancy at birth in Oman was estimated to be 76.1 years in 2010.As of 2010, there were
an estimated 2.1 physicians and 2.1 hospital beds per 1,000 people. In 1993, 89% of the
population had access to health care services. In 2000, 99% of the population had access to health
care services. During the last three decades, the Oman health care system has demonstrated and
reported great achievements in health care services and preventive and curative medicine. In
2001, Oman was ranked number 8 by the World Health Organization.

India for treatement

Advantages for medical treatment in India for Oman patients include reduced costs, the
availability of latest medical technologies, and a growing compliance on international
quality standards, as well as the fact that foreigners are less likely to face a language
barrier in India. The Indian government is taking steps to address infrastructure issues
that hinder the countrys growth in medical tourism.
The government has removed visa restrictions on tourist visas that required a two-month
gap between consecutive visits for people from Gulf countries which is likely to boost
medical tourism. A visa-on-arrival scheme for tourists from select countries has been

instituted which allows foreign nationals to stay in India for 30 days for medical reasons.
At Medical & Wellness Services we understand that Oman peoples seeking medical
treatment in India. We specialize in helping you find the best hospitals and doctors in
India at affordable prices.
Superb healthcare facilities, great infrastructure and low treatment costs are
attracting more medical tourists from Oman and the gulf region. The country is
becoming most favored medical care destination for Omanis and people from GCC.
According to a report, from January to August, more than 60,000 patients from
Oman have traveled to India in order to avail quality medical treatment.
India has become one of the top three medical tourism destinations in the continent.
Every year most of the Omanis visit Indian states like Tamil Nadu, Kerala,
Maharashtra, Andhra Pradesh, and New Delhi for medical treatment. Direct air
connectivity, proximity, and cultural connectivity have helped people from Gulf to
feel comfortable during their medical tour.

IRAN
Iran, also known as Persia officially the Islamic Republic of Iran is a sovereign
state in Western Asia. It is bordered to the northwest by Armenia, the NagornoKarabakh Republic, and Azerbaijan; to the north by Kazakhstan and Russia across
the Caspian Sea; to the northeast by Turkmenistan; to the east by Afghanistan and
Pakistan; to the south by the Persian Gulf and the Gulf of Oman; and to the west by
Turkey and Iraq. Comprising a land area of 1,648,195 km2 (636,372 sq mi), it is the
second-largest country in the Middle East and the 18th-largest in the world. With
78.4 million inhabitants, Iran is the world's 17th-most-populous country. It is the
only country that has both a Caspian Sea and an Indian Ocean coastline. Iran has
long been of geostrategic importance because of its central location in Eurasia and
Western Asia, and its proximity to the Strait of Hormuz

Health
There are noticeable health inequalities within the country; for instance, the
difference between life expectancy between different provinces reaches 24 years.
The same is through for almost all indicators excluding the vaccine coverage and
access to primary health care which are above 90% nationwide.
While the major burden of disease in the country as a whole and specially in the
large metropolitans is non communicable diseases (NCDs) including cardiovascular
disease (CVD), cancer and injuries, the country is still faced with the problem of
infectious diseases which in many instances are somehow related to its neighbor
countries. In the both recent epidemics of the Cholera which occurred in Iran in
2005 and 2007 through fingerprinting of the bacteria it was clearly shown that
organisms was imported from Pakistan and Iraq respectively.
Cremean Congo fever previously not known in Iran is now a real health hazard
with up to 250 cases each year affected with a fatality rate of 25%. All these
reported cases were related to smuggled poultry from neighbor countries. Two out
of four countries which could not still eradicate poliomyelitis are neighbors of Iran.
Despite of these challenges, it is now 12 years that Iran has obtained the certificate
of polio eradication and sustained this success. Malaria although previously
endemic in Iran is now confined to three south eastern provinces which its majority
of falciparum cases being foreigners who entered the country illegally.

India for treatment

During the Pharmexcil visit to Tehran in December, the Iranian government agreed to
bypass production registration requirements, and the delegates met with Iranian buyers to
discuss procedures for sales. After the visit, the Iranian government let the Indians have a
list of products that are urgently needed, such as Amiodarone Hydrochloride,
Amphotericin, Cefotaxime, Gadopentetate Dimeglumine, Iopromide, Mesalazine,
Nicotinic Acid, Thiabendazole, Thioguanine, and Valganciclovir.
If Indian pharma supplies the medicines on the list turned over by the Iranians to the
Indian government on December 26, this would be the largest export of Indian drugs to
date.
Indian pharmaceutical firms have done well in 2012. The BSE Healthcare Index rose by
40%, far more than the market in general. This rise is largely due to the opportunities
posed by the US generics market. As medicines lose their patents in the US, Indian firms
have been well poised to seize those medicines and market them at the low prices that
they now earn producers. This will be a regular revenue stream for some of the bigger
players among the Indian producers.
Some firms, such as Sun Pharmaceuticals, have cleverly used their US profits to buy up
assets in the US market and elsewhere. But others have begun to look elsewhere, toward
Malaysia into the market of the Association of Southeast Asian Nations for instance, or
else to Iran.
The cache of Indian rupees held by Iran in the Indian banks and the eager Iranian market
make this an attractive opportunity for the Indian pharmaceutical firms. The problem will
be how to balance the interest in US generics and Iranian needs. The US "standing
authorization" on drug sales provides an indication that Indian pharmaceuticals need not
worry about its competing interests for the present.

MALDIVES
Maldives, officially the Republic of Maldives , is an island country and archipelago
in the Indian Ocean. It lies southwest of India and Sri Lanka in the Laccadive Sea.
The chain of twenty six atolls stretches from Ihavandhippolhu Atoll to the Addu
Atoll. The capital and largest city is Mal, traditionally called the "King's Island."
The Maldives is a tropical nation in the Indian Ocean composed of 26 coral atolls, which
are made up of hundreds of islands. Its known for its beaches, blue lagoons and
extensive reefs. The capital, Mal, has a busy fish market, restaurants and shops on
Majeedhee Magu and 17th-century Hukuru Miskiy (also known as Old Friday Mosque)
made of coral stone.

Health
It is difficult to quantify the major health scourges from which the Maldivians
suffer because of the scattered nature of their settlements and their conservative
attitudes to health and hygiene-related matters. Projects to improve the quality of
the health and disease data have been instituted by the World Health Organization
(WHO) and the Maldivian Ministry of Health. The paper analyses information that
has since become available on three major ill-health conditions in the Maldives,
namely infant deaths, malaria and leprosy.

India for treatment

Some 57 percent of Maldivians travel overseas for medical purposes while 32
percent travel for vacation, according to the Maldives Monetary Authoritys
(MMA) Maldivians Traveling Abroad Survey.
The most popular destinations for Maldivians during 2014 were India and Sri
Lanka, with 41 percent and 38 percent, respectively, the survey found.
Return airfare to India and Sri Lanka costs US$307 and US$205 per person,
respectively, while the cost of a return ticket to Malaysia was about US$414. The
cost of airfare to Thailand and Singapore was US$512 and US$720, respectively.
India was the most popular destination for medical travellers (61 percent), followed
by Sri Lanka (34 percent),Thailand (two percent), Malaysia (one percent), and
Singapore (one percent).
The average duration of a visit to India for medical purposes was 16 days while the
average expenditure for such trips was US$737 per person. A trip to Sri Lanka to

seek medical treatment costs about US$716 per person with an average duration of
stay of around 13 days.
The most popular holiday destination for Maldivians was Sri Lanka with 48 percent
of holidaymakers visiting the neighbouring country and spending 11 days on
average.
India was the destination of choice for 14 percent of holidaymakers who returned
during the survey period. Vacationers spent about 15 days in India and spent
US$690 per person during the trip.
The MMA noted that the survey addresses the need for collecting accurate
statistics required for the compilation of travel expenses of the balance of payments
statistics.
The information gathered for the survey has several limitations, the central bank
cautioned, as the survey period coincided with the school holidays, during which
the proportion of Maldivians traveling for medical purposes and vacation tends to
be higher than the rest.

ETHIOPIA
Ethiopia, officially known as the Federal Democratic Republic of Ethiopia, is a
sovereign state located in the Horn of Africa. It is bordered by Eritrea to the north
and northeast, Djibouti and Somalia to the east, Sudan and South Sudan to the west,
and Kenya to the south. With over 100 million inhabitants, Ethiopia is the most
populous landlocked country in the world, as well as the second-most populous
nation on the African continent after Nigeria. It occupies a total area of 1,100,000
square kilometres (420,000 sq mi), and its capital and largest city is Addis Ababa.
Some of the oldest evidence for anatomically modern humans has been found in
Ethiopia, which is widely considered the region from which Homo sapiens first set
out for the Middle East and points beyond.
According to linguists, the first Afroasiatic-speaking populations settled in the
Horn region during the ensuing Neolithic era. Tracing its roots to the 2nd
millennium BC, Ethiopia was a monarchy for most of its history. During the first
centuries AD the Kingdom of Aksum maintained a unified civilization in the
region. followed by Abyssinia circa 1137.

Health
According to the head of the World Bank's Global HIV/AIDS Program, Ethiopia
has only 1 medical doctor per 100,000 people. However, the World Health
Organization's 2006 World Health Report gives a figure of 1,936 physicians (for
2003), which comes to about 2.6 per 100,000. Globalization is said to affect the
country, with many educated professionals leaving Ethiopia for better economic
opportunities in the West.
Ethiopia's main health problems are said to be communicable (contagious) diseases
worsened by poor sanitation and malnutrition. Over 44m people (more than half the
population) do not have access to clean water. These problems are exacerbated by
the shortage of trained doctors and nurses and health facilities.
The state of public health is considerably better in the cities. Birth rates, infant
mortality rates, and death rates are lower in cities than in rural areas owing to better
access to education, medicines and hospitals. Life expectancy is higher at 53,
compared to 48 in rural areas. Despite sanitation being a problem, use of improved
water sources is also on the rise; 81% in cities compared to 11% in rural areas. As
in other parts of Africa, there has been a steady migration of people towards the
cities in hopes of better living conditions.

There are 119 hospitals (12 in Addis Ababa alone) and 412 health centers in
Ethiopia. Ethiopia has a relatively low average life expectancy of 58 years. Infant
mortality rates are relatively very high, as over 8% of infants die during or shortly
after childbirth, (although this is a dramatic decrease from 16% in 1965) while
birth-related complications such as obstetric fistula affect many of the nation's
women.

India for treatment

Ethiopia is the second most populated country in the Africa continent. It is known
as a land of history, beauty, and wildlife. It is rich in natural resources and it offers
everything from nature and home to millions of inhabitants. Earlier, the country
was not able to provide quality care to its citizens as it lacked in adequate
professional and medical facility providers.
Patients of the East African countries, especially cancer patients have been
travelling to countries like Bangkok to avail cancer treatment. According to a
report, more than 90 percent of African citizens travel outside the continent for
quality medical care. Most of the Ethiopians are travelling to India, Central Europe
and South East Asian Medical tourism destinations for treatment. This also includes
European medical care, which is very expensive and unaffordable for many people.
They have to rely on the low quality medical care in Ethiopia.

KENYA
Kenya is a country in East Africa with coastline on the Indian Ocean. It encompasses
savannah, lakelands, the dramatic Great Rift Valley, mountain highlands and abundant
wildlife such as lions, elephants and rhinos. From Nairobi, the capital, safaris visit the
Maasai Mara reserve, known for its annual wildebeest migrations, and Amboseli National
Park, offering views of Tanzania's 5,895m Mt. Kilimanjaro.
Kenya has a warm and humid tropical climate on its Indian Ocean coastline. The climate
is cooler in the savannah grasslands around the capital city, Nairobi, and especially closer
to Mount Kenya, which has snow permanently on its peaks. Further inland, in
the Nyanza region, there is a hot and dry climate which becomes humid around Lake
Victoria, the largest tropical fresh-water lake in the world. This gives way to temperate
and forested hilly areas in the neighboring western region. The north-eastern regions
along the border with Somalia and Ethiopia are arid and semi-arid areas with neardesert landscapes. Kenya is known for its safaris, diverse climate and geography, and
expansive wildlife reserves and national parks such as the East and West Tsavo National
Park, the Maasai Mara, Lake Nakuru National Park, and Aberdares National Park. Kenya
has several world heritage sites such as Lamuand numerous beaches, including
in Diani, Bamburi and Kilifi, where international yachting competitions are held every
year.

Health
Nurses treat 80% of the population who visit dispensaries, health centres and
private clinics in rural and under-served urban areas. Complicated cases are
referred to clinical officers, medical officers and medical practitioners. According
to the Kenya National Bureau of Statistics, in 2011 there were 65,000 qualified
nurses registered in the country; 8,600 clinical officers and 7,000 doctors for the
population of 43 million people (These figures from official registers include those
who have died or left the profession hence the actual number of these workers may
be lower).
Despite major achievements in the health sector, Kenya still faces many challenges.
The life expectancy estimate has dropped to approximately 55 years in 2009 five
years below 1990 levels. The infant mortality rate is high at approximately 44
deaths per 1,000 children in 2012. The WHO estimated in 2011 that only 42% of
births were attended by a skilled health professional.

Diseases
of
poverty directly
correlate
with
a
country's economic
performance and wealth distribution: Half of Kenyans live below the poverty level.
Preventable diseases like malaria, HIV/AIDS, pneumonia, diarrhoea and
malnutrition are the biggest burden, major child-killers, and responsible for much
morbidity; weak policies, corruption, inadequate health workers, weak management
and poor leadership in the public health sector are largely to blame. According to
2009 estimates, HIV prevalence is about 6.3% of the adult population. However,
the 2011 UNAIDS Report suggests that the HIV epidemic may be improving in
Kenya, as HIV prevalence is declining among young people (ages 1524) and
pregnant women. Kenya had an estimated 15 million cases of malaria in 2006.
The total fertility rate in Kenya is estimated to be 4.49 children per woman in 2012.
According to a 200809 survey by the Kenyan government, the total fertility rate
was 4.6% and the contraception usage rate among married women was 46%
Maternal mortality is high, partly because of female genital mutilation,[85] with
about 27% of women having undergone it. This practice is however on the decline
as the country becomes more modernised and the practice was also banned in the
country in 2011.

India for treatment

Medical tourism from Africa, Specifically from Kenya and Tanzania, to Indian
hospitals particularly in the city of Mumbai. It also comments on the growing
relationship emerging between private healthcare providers in India and East
Africa, as well as Indian government support for health initiatives. We can
understand this evolving industry in the current context of globalisation and
liberalisation, which has impacted on all the sectors of the Indian economy.
India is emerging as a global healthcare provider because of its ability to offer
world-class expertise at developing world costs. There has been a proliferation of
new healthcare facilities at private centres of medical excellence in Mumbai
specifically. High class medical infrastructure facilities, coupled with improved and
cheaper air connections and easy access to visa facilities, are some of the factors
that have contributed to the emerging scenario.

TANZANIA
Tanzania is an East African country known for its vast wilderness areas. They include the
plains of Serengeti National Park, a safari mecca populated by the big five game
(elephant, lion, leopard, buffalo, rhino), and Kilimanjaro National Park, home to Africas
highest mountain. Offshore lie the tropical islands of Zanzibar and Mafia Marine Park,
where whale sharks swim through reefs.
Tanzania is one of the poorest countries in the world. Tanzania's population of 51.82
million is diverse, composed of several ethnic, linguistic, and religious groups. Tanzania
is a presidential constitutional republic, and since 1996, its official capital has
been Dodoma, where the President's Office, the National Assembly, and some
government ministries are located. Dares Salaam, the former capital, retains most
government offices and is the country's largest city, principal port, and leading
commercial centre.

Health
Health care in Tanzania is available depending on one's income and accessibility. People
in urban areas have better access to private and public medical facilities. Insurance has
only in recent years been introduced where as pension schemes have been around longer
but the limitations of either are vast and not attending to the needs of majority of
Tanzanians.
Current data shows in Tanzania there has been an increase in health budget over the
years: Total Health Expenditure (THE) increased from US$734 million in 2002/2003 to
US$1.75 billion in 2009/2010 as indicated in the National Health Accounts 2010 report.
However donors have been the main financier of health, despite the decrease in their
share of health expenditure from 44 percent in 2005/2006 to 40 percent in 2009/2010.
(Table1). Overall, the government allocation to health spending has remained almost
constant at about 7 percent since 2002/2003, far away from reaching the Abuja
declaration target of 15% of total government expenditure. The increase in donor funding

is attributed to the commencement of financing for HIV and AIDS by the Global Fund in
2001 and the commencement of health financing through Sector wide Approach (Swap)
in early 2000.

India for treatment

A lot of Medical Tourism is taking place between Tanzania and India. Many
Tanzanians come to India for Medical Treatment, more than to any other foreign
country until such time when Tanzania develops adequate capacity of its own
internal Medical Facilities.
Tanzania is endowed with many natural and cultural resources that have become a
global attraction for Tourists from different tourist market segments. The country is
home to an estimated 20 per cent of Africas large mammals, with 25% of the
countrys area set aside for conservation purposes. Tanzania is also home to
attractions like Mount Kilimanjaro and Mount Meru (the highest and fifth-highest
peaks in Africa), the Spice Islands of Zanzibar, the beautiful sea beaches along
the Indian Ocean Coast, Serengeti National Park (arguably the best known wildlife
sanctuary in the world), Ngorongoro Crater (the largest unbroken caldera in the
world) and many other attractions.

People are getting to know that India offers world class medical treatment and facilities at
extremely low rates as compared to developed countries. Proof of this increasing
awareness is the fact that where earlier most people who came to India seeking medical
treatment, came from neighboring countries, today Indian hospitals attract patients from
across the globe, including the U.S. and Britain.

NIGERIA
Nigeria, an African country on the Gulf of Guinea, is known for its natural landmarks and
wildlife reserves. Safari destinations such as Cross River National Park and Yankari
National Park showcase waterfalls, dense rainforest, savanna and rare primate habitats.
One of its most recognizable sites is Zuma Rock, a 725m-tall monolith outside the capital
of Abuja thats pictured on the national currency
Modern-day Nigeria has been the site of numerous kingdoms and tribal states over the
millennia. The modern state originated from British colonial rule beginning in the 19th
century, and the merging of the Southern Nigeria Protectorate and Northern Nigeria
Protectorate in 1914. The British set up administrative and legal structures whilst
practicing indirect rule through traditional chiefdoms. Nigeria became a formally
independent federation in 1960, and plunged into a civil war from 1967 to 1970. It has
since alternated between democratically-elected civilian governments and military
dictatorships, until it achieved a stable democracy in 1999, with its 2011 presidential
elections being viewed as the first to be conducted reasonably freely and fairly.

Health
Health care delivery in Nigeria is a concurrent responsibility of the
three tiers of government in the country, and the private sector. Nigeria has been
reorganizing its health system since the Bamako Initiative of 1987, which formally
promoted community-based methods of increasing accessibility of drugs and health care
services to the population, in part by implementing user fees. The new strategy
dramatically increased accessibility through community-based healthcare reform,
resulting in more efficient and equitable provision of services. A comprehensive approach
strategy was extended to all areas of health care, with subsequent improvement in the
health care indicators and improvement in health care efficiency and cost.
Nigeria was the only country in Africa to have never eradicated polio, which it
periodically exported to other African countries; Polio was cut 98% between 2009 and
2010. However, a major breakthrough came in December 2014, when it was reported that
Nigeria hadn't recorded a polio case in 6 months, and on its way to be declared Polio
free. In 2012, a new bone marrow donor program was launched by the University of
Nigeria to help people with leukaemia, lymphoma, or sickle cell disease to find a
compatible donor for a life-saving bone marrow transplant, which cures them of their
conditions. Nigeria became the second African country to have successfully carried out
this surgery. In the 2014 Ebola outbreak, Nigeria was the first country to effectively
contain and eliminate the Ebola threat that was ravaging three other countries in the West
African region, the Nigerian unique method of contact tracing employed by Nigeria

became an effective method later used by countries, such as the United States, when
Ebola threats were discovered.

India for treatment

India has among the finest licensed professionals in every single medical discipline,
which fact has been recognized all over the world. On the subject of the Medical
Facilities, India has world class Medical Facilities with outstanding
infrastructure and the most qualified physicians. With most competitive prices India
today is quite a rewarding destination for patients needing medical treatment of specific
medical issues. World Class Medical Facilities, similar with the western countries are
offered by India. India has state of the art the finest licensed physicians and Hospitals.
With the greatest infrastructure, the greatest facilities that are Medical, accompanied with
the most competitive costs, you will get the treatment done at the lowest costs in India.
Nigerian Citizens have become sensitive towards their well-being conditions.
Patients would rather travel abroad for medical direction, since the medical
infrastructure isnt so highly developed in Nigeria. Its been the situation in past
additionally when just the wealthy travelled to Europe and USA for health care.
Medicare Medical Travels has now become the favoured Health Care and Service
Provider for Nigerian Patients and has been at the vanguard in executing the needs,
for the following reasons

EMERGING MARKETS

SRI LANKA
A diverse and multicultural country, Sri Lanka is home to many religions, ethnic groups,
and languages. In addition to the majority Sinhalese, it is home to large groups of Sri
Lankan and Indian Tamils, Moors, Burghers, Malays, Kaffirs and the aboriginal Vedda.
Sri Lanka has a rich Buddhist heritage, and the first known Buddhist writings of Sri
Lanka,
Sri Lanka is a republic and a unitary state governed by a Semi-presidential system. The
legislative capital, Sri Jayawardenepura Kotte, is a suburb of the commercial capital and
largest city, Colombo. An important producer of tea, coffee, gemstones, coconuts, rubber,
and the native cinnamon, the island contains tropical forests and diverse landscapes with
much biodiversity.
Sri Lanka is a founding member of the Non-Aligned Movement (NAM). While ensuring
that it maintains its independence, Sri Lanka has cultivated relations with India. Sri
Lanka became a member of the United Nations in 1955. Today, it is also a member of the
Commonwealth, the SAARC, the World Bank, the International Monetary Fund, the
Asian Development Bank, and the Colombo Plan.

1. Politics and Government

Sri Lanka is a democratic republic and a unitary state which is governed by a semipresidential system, with a mixture of a presidential system and a parliamentary system.
Most provisions of the constitution can be amended by a two-thirds majority in
parliament. However, the amendment of certain basic features such as the clauses on
language, religion, and reference to Sri Lanka as a unitary state require both a two-thirds
majority and approval in a nationwide referendum.
Current politics in Sri Lanka is a contest between two rival coalitions led by the
centre-leftist and progressivist United People's Freedom Alliance (UPFA), an
offspring of Sri Lanka Freedom Party (SLFP), and the comparatively right-wing
and pro-capitalist United National Party (UNP). Sri Lanka is essentially a multiparty democracy with many smaller Buddhist, socialist and Tamil nationalist
political parties. As of July 2011, the number of registered political parties in the
country is 67.

2. Economic Situation

Expenditure on healthcare has grown steadily. In the period 200510 Sri Lanka's total
expenditure on health is estimated to have grown at a compound annual rate of around
11%, according to a local government think-tank, the Institute for Policy Studies. Private
sector spending grew by 12% a year, while government spending increased by 10% a
year in that period. Total spending on healthcare per head has risen from US$49 in 2005
to US$89 in 2012, according to the World Bank.
Healthcare spending is likely to increase owing to changes in lifestyles and
demographics. The share of the population aged 65 years or older rose to around
14% from around 8% in 2013. As the population ages, the demand for healthcare
will increase and it will require changes to the current system, which is heavily
geared to improving maternal and child health and fighting infectious diseases.
According to the International Monetary Fund, Sri Lanka's GDP in terms of
purchasing power parity is second only to the Maldives in the South Asian region
in terms of per capita income. Sri Lanka recorded a GDP growth of 8.3% in 2011.
While the production and export of tea, rubber, coffee, sugar and other
commodities remain important, industrialisation has increased the importance of
food processing, textiles, telecommunications and finance. The country's main
economic sectors are tourism, tea export, clothing, rice production and other
agricultural products. In addition to these economic sectors, overseas employment,
especially in the Middle East, contributes substantially in foreign exchange.
A large number of private hospitals have appeared in Sri Lanka, due to the rising
income of people and demand for private healthcare services. They provide much
more luxurious service than government hospitals, but they are mostly limited to
Colombo and its suburbs and also have high prices.

3. Environment
The island consists mostly of flat to rolling coastal plains, with mountains rising
only in the south-central part. The highest point is Pidurutalagala, reaching 2,524
metres (8,281 ft) above sea level. The climate is tropical and warm, due to the
moderating effects of ocean winds. Mean temperatures range from 17 C (62.6 F)
in the central highlands, where frost may occur for several days in the winter, to a
maximum of 33 C (91.4 F) in other low-altitude areas. Average yearly
temperatures range from 28 C (82.4 F) to nearly 31 C (87.8 F). Day and night
temperatures may vary by 14 C (25.2 F) to 18 C (32.4 F).

Rainfall pattern is influenced by monsoon winds from the Indian Ocean and Bay of
Bengal. The "wet zone" and some of the windward slopes of the central highlands
receive up to 2,500 millimetres (98.4 in) of rain each month, but the leeward slopes
in the east and northeast receive little rain. Most of the east, southeast, and northern
parts of the country comprise the "dry zone", which receives between 1,200 and
1,900 mm (47 and 75 in) of rain annually. The arid northwest and southeast coasts
receive the least amount of rain at 800 to 1,200 mm (31 to 47 in) per year. Periodic
squalls occur and sometimes tropical cyclones bring overcast skies and rains to the
southwest, northeast, and eastern parts of the island. Humidity is typically higher in
the southwest and mountainous areas and depends on the seasonal patterns of
rainfall.
An increase in average rainfall coupled with heavier rainfall events has resulted in
recurrent flooding and related damages to infrastructure, utility supply and the
urban economy.

4. Education
With a literacy rate of 92.5%, Sri Lanka has one of the most literate populations
amongst developing nations. Its youth literacy rate stands at 98%, computer literacy
rate at 35%, and primary school enrolment rate at over 99%. An education system
which dictates 9 years of compulsory schooling for every child is in place. The free
education system established in 1945 is a result of the initiative of C. W. W.
Kannangara and A. Ratnayake. It is one of the few countries in the world that
provide universal free education from primary to tertiary stage.

5. Health
Sri Lanka has a unique healthcare system where one can go directly to the hospital
(government or private), to the family GP or directly see a specialist with no
reference from a 3rd party, something most of you may have not been aware of up
until now. It scores higher than the regional average in healthcare having high Life
expectancy and a lower Maternal and Infant deaths than its neighbors. It is known
for having one of the worlds earliest known Healthcare systems and has its own
Ayurvedic Medicine.
Despite low expenditure on healthcare, the island's health indicators are similar to
more developed countries in the region. The government provides universal
healthcare to its citizens, although there is a long wait for specialist care and
advanced procedures in the public sector. The private sector plays a role in
addressing this gap but requires payment up front. The ageing population and rise
in non-communicable diseases (NCDs) will increase the burden on the healthcare

system, but rising incomes are likely to increase opportunities for the private sector
and demand for medical equipment and pharmaceuticals.
The growth in both public and private healthcare, moreover, will increase the
opportunities to export medical equipment and pharmaceuticals to the island. For
example, US firms exported around US$15m worth of pharmaceuticals and
medical equipment to Sri Lanka in 2013. The opportunities for exporting medical
equipment are likely be greater because the government imposes prices controls on
all imported medicines. Although the island's changing demographics and income
growth are likely to allow for the expansion of private healthcare, the government
will face growing challenges to continue to provide universal low-cost healthcare to
the population.

6. Diseases
Diarrhoea remains the most common complaint amongst tourists visiting Sri Lanka. It
can have many causes, including serious diseases like typhoid or cholera, but in the vast
majority of cases diarrhoea is a result of contaminated food or drink and will pass
naturally in a few days. Such diarrhoea is also often accompanied by cramps, nausea and
vomiting, and fever in more severe cases.
The incidence of malaria in Sri Lanka has fallen dramatically in recent years from over
200,000 reported cases in 2000 to just 736 in 2010 although of course its always
possible that the incidence of the disease may rise again in the future.
More widespread than malaria, and equally serious, is the mosquito-borne disease
dengue fever, regular outbreaks of which continue to plague the island, causing
numerous fatalities. Dengue is a predominantly urban disease Colombo is particularly
at risk.
A third mosquito-borne disease is Japanese encephalitis (JE), a virus transmitted by
mosquitoes which bite at night. Its particularly associated with rural areas, as the virus
lives in wading birds, pigs and flooded rice fields. JE is most prevalent following periods
of heavy rainfall resulting in large areas of stagnant water.
Other diseases
Hepatitis is an inflammation of the liver. The disease exists in various forms, though with
a shared range of symptoms, typically jaundiced skin, yellowing of the whites of the eyes

and a general range of flu-like symptoms. Hepatitis A and hepatitis E are spread by
contaminated food and water.
Typhoid is a gut infection caused by contaminated water or food, and which leads to a
high fever and diarrhoea. Oral and injected vaccines are available and usually
recommended
Sri Lanka has experienced occasional outbreaks of cholera, although this typically occurs
in epidemics in areas of poor sanitation, and almost never affects tourists.
Symptoms of tetanus (lockjaw) can be discomfort in swallowing and stiffness in the
jaw and neck, followed by convulsions potentially fatal.
Typhus is spread by the bites of ticks, lice and mites. Symptoms include fever, headache
and muscle pains, followed after a few days by a rash, while the bite itself often develops
into a painful sore.
Chikungunya fever is another mosquito-borne disease, outbreaks of which are
sometimes reported in various parts of the country. Symptoms include fever, joint pains,
muscle aches, severe headaches and a rash, usually lasting around a week sometimes
much longer.
The increase in NCDs will also stress the existing system and will challenge the
government's continued ability to deliver universal low-cost healthcare. NCDs such as
heart disease, diabetes, cancers and asthma are becoming more frequent as the population
ages, incomes rise, urbanisation becomes more prevalent and lifestyles become more
sedentary. There has also been a rise in obesity, smoking and alcoholism, which increase
the risk of NCDs developing. Over the past 50 years, the share of deaths from
cardiovascular disease has increased from 3% to 24% in 2013, according to the World
Bank. The current public healthcare system is ill-equipped to provide the long-term care
associated with the treatment of NCDs, and it is unclear to what extent the government
can meet the growing costs of treating them. A shortage of skilled medical professionals
is another constraining factor faced by the healthcare sector in Sri Lanka. In 2012
Saman Rathnapriya, a health sector union leader, claimed that Sri Lanka needed an
additional 14,000 doctors and 25,000 nurses to bring it to international standards.

7. Hospitals

Government Hospitals: 593

Private Hospitals:197

Qualified Doctors: 17,129 (a doctor per 1,187 persons)

Qualified Nurses: 29,871 (a nurse per 683 persons)

Average Life Expectancy: 75 years

Infant Mortality: 9.5 per 1000 births (a regional low)

As of 2014 the public sector accounted for 73% of the hospitals and 93% of the
available bed capacity in Sri Lanka, while handling over 90% of the total patient
admissions and outpatient visits to hospitals.In the private sector, the top five
players the Dr Neville Fernando Teaching Hospital (NFTH), Asiri, Nawaloka
Hospitals PLC (Nawaloka), Durdans Hospitals (Durdans) and The Lanka Hospitals
accounted for nearly 45% of the private-sector bed capacity , with NFTH the
market leader with 1,002 beds.

8. Insurance companies
1. Sri Lanka Insurance Corporation Ltd.
2. Ceylinco Insurance Co. Ltd.
3. ABC Insurance Company Ltd.
4. Sanasa Insurance Company
5. Co-operative Insurance Company Ltd
6. Eagle Insurance
7. Allianz Insurance Co Lanka Ltd.

BOTSWANA
Botswana, officially the Republic of Botswana, is a landlocked country located in
Southern Africa. Botswana is topographically flat, with up to 70 percent of its territory
being the Kalahari Desert. It is bordered by South Africa to the south and southeast,
Namibia to the west and north, and Zimbabwe to the northeast. Its border with Zambia to
the north near Kazungula is poorly defined but at most is a few hundred meters long.
A mid-sized country of just over 2 million people, Botswana is one of the most sparsely
populated nations in the world. Around 10 percent of the population lives in the capital
and largest city, Gaborone. Formerly one of the poorest countries in the worldwith a
GDP per capita of about US$70 per year in the late 1960sBotswana has since
transformed itself into one of the fastest-growing economies in the world, now boasting a
GDP (purchasing power parity) per capita of about $18,825 per year as of 2015, which is
one of the highest in Africa. Its high gross national income (by some estimates the fourthlargest in Africa) gives the country a modest standard of living and the highest Human
Development Index of continental Sub-Saharan Africa.
Botswana is a member of the African Union, the Southern African Development
Community, the Commonwealth of Nations, and the United Nations. Despite its political
stability and relative socioeconomic prosperity, the country is among the hardest hit by
the HIV/AIDS epidemic, with around a quarter of the population estimated to be infected.

1. Politics and Government

The Constitution of Botswana is the rule of law which protects the citizens of Botswana
and represents their rights. The politics of Botswana take place in a framework of a
representative democratic republic, whereby the President of Botswana is both head of
state and head of government, and of a multi-party system. Executive power is exercised
by the government. Legislative power is vested in both the government and the
Parliament of Botswana. The most recent election, its eleventh, was held on 24 October
2014.
Since independence was declared, the party system has been dominated by the Botswana
Democratic Party. The judiciary is independent of the executive and the legislature.
Botswana ranks 30th out of 167 states in the 2012 Democracy Index. According to
Transparency International, Botswana is the least corrupt country in Africa and ranks
close to Portugal and South Korea.

2. Economic Situation

Botswanas economy has recovered from the global economic crisis. Real GDP registered
robust growth in 2013, underpinned by buoyant activity in the mining sector, particularly
diamond production, in spite of bottlenecks in the power and water sectors. According to
our estimates, the economy, however, slowed down in 2014, reflecting modest overall
growth in nonmining activities, mainly the water and electricity sector which contracted
sharply.
Botswanas growth prospects look broadly favourable. Real GDP growth is projected to
moderate slightly during 2015-16. Growth will primarily be driven by the non-mining
sectors including trade and tourism, as well as financial and government services.
Medium-term growth prospects also depend crucially on the expansion in diamond
cutting and polishing activities and the commissioning of a steel manufacturing plant and
a horticultural processing plant in 2015. However, the uncertain external environment,
particularly the potential slowdown in emerging markets, exposes Botswanas narrow
export base to significant downside risks.

3. Environment
Botswana faces two major environmental problems: drought and desertification.
The desertification problems predominantly stem from the severe times of drought
in the country. Three quarters of the country's human and animal populations
depend on groundwater due to drought. Groundwater use through deep borehole
drilling has somewhat eased the effects of drought. Surface water is scarce in
Botswana and less than 5% of the agriculture in the country is sustainable by
rainfall. In the remaining 95% of the country, raising livestock is the primary
source of rural income. Approximately 71% of the country's land is used for
communal grazing, which has been a major cause of the desertification and the
accelerating soil erosion of the country.

4. Education
Botswana has made great strides in educational development since independence in 1966.
At that time there were very few graduates in the country and only a very small
percentage of the population attended secondary school. Botswana increased its adult
literacy rate from 69% in 1991 to 83% in 2008.
The quantitative gains have not always been matched by qualitative ones. Primary
schools in particular still lack resources and the teachers are less well paid than their
secondary school colleagues. The Botswana Ministry of Education is working to establish

libraries in primary schools in partnership with the African Library Project. The
Government of Botswana hopes that by investing a large part of national income in
education, the country will become less dependent on diamonds for its economic
survival, and less dependent on expatriates for its skilled workers.
In January 2006, Botswana announced the reintroduction of school fees after two decades
of free state education though the government still provides full scholarships with living
expenses to any Botswana citizen in university, either at the University of Botswana or if
the student wishes to pursue an education in any field not offered locally, such as
medicine, they are provided with a full scholarship to study abroad.

5. Health
The Ministry of Health in Botswana is responsible for overseeing the quality and
distribution of healthcare throughout the country. Life expectancy at birth was 55 in 2009
according to the World Bank, having previously fallen from a peak of 64.1 in 1990 to a
low of 49 in 2002.
Healthcare services are provided by a network of clinics in villages and towns across
Botswana, as well as by referral to large state hospitals, such as those in Gaborone and
Francistown.
High-quality medical care is available in Gaborone, the capital and largest city of
Botswana. Gaborone has hospitals with adequately-equipped emergency rooms and
trained physicians. There are also private medical facilities in Gaborone, adequate for
simple medical problems.
Outside of Gaborone medical care is rudimentary. Professional private rescue services
operate air and ground ambulances throughout the country, but care is only rendered after
a patient's ability to pay has been established, and response times are slow in lightly
populated areas.
In 2004, there were an estimated 241 nurses, 29 physicians and 2 dentists per 100,000
people. In 1995, 70% of the population had access to safe water and 55% of the
population had access to sanitation. Public health teams conduct tuberculosis and malaria
control campaigns.
Botswana has been badly affected by the HIV/AIDS epidemic; a quarter of adults (15-49
years) are infected and over 90,000 children have lost at least one parent.
Potential reasons for Botswana's high HIV prevalence include concurrent sexual
partnerships, transactional sex, cross-generational sex, and a significant number of people

who travel outside of their local communities in pursuit of work. The polyamorous nature
of many sexual relationships further impacts the health situation.

6. Diseases
Botswanas dry climate and lack of surface water limit cases of tropical diseases
such as malaria and sleeping sickness. The most common illnesses are intestinal
(diarrheal and digestive diseases) and respiratory (pneumonia and tuberculosis).
Trypanosomiasis
Trypanosomiasis is also an important public health problem in Chobe and Ngami
districts. However, there have been no recent cases since a control programme
based on treatment of infected people was successfully implemented between 1985
and 1993, when the prevalence reduced from 28.7% to 6.7%. Since then,
notification has been relaxed.
Leprosy
In a survey carried out in 1991 on 8235 school children and 799 contacts of 127
index cases of leprosy, a point prevalence of registered leprosy cases on multidrug
therapy in five districts in northern Botswana was 0.18 per 1000. Forty-four cases
of active leprosy were identified and 32% of those were newly identified during the
survey. The majority of leprosy cases were found in Ngami and Chobe districts.
Cholera
Fifteen cases were reported in Francistown, a city bordering Zimbabwe, in 2008. It
was well contained in that area and it is therefore considered to be a low-risk
potential public health problem, even though it should be monitored.
Diarrhoeal
Outbreaks of diarrhoea do occur, especially during heavy rain falls and where water
supply and sanitation facilities are poor. The last diarrhoeal outbreak was in 2006
and the causative parasite was Cryptosporidium spp., which is transmitted through
ingestion of contaminated food.
Public education on prevention of food and water contamination and vigilance,
especially during heavy rains, is continuing. Cases of fatalities can occur, especially
with delayed diagnosis and in malnourished and HIV-positive children. Diarrhoea
is a notifiable disease in Botswana.

Other
Thirty three cases of influenza A H1N1 were reported in 2009.
One case of polio was confirmed in Ngami district in 2005.

7. Hospitals
1. Gaborone Private Hospital
Bag BR 130 Broadhurst, Gaborone
Plot 8448 Mica Way
Telephone: (+267) 368-5766 OR Fax: (+267) 390-1998
2. Princess Marina Hospital - Gaborone
Telephone: (+267) 395-3221
3. Nyangabgwe Hospital - Francistown
Telephone: (+267) 241-1000
4. Good Hope Hospital - Good Hope
Telephone: (+267) 548-6236
5. Bobonong Hospital - Bobonong
Telephone: (+267) 261-9233
6. Seventh Day Adventist Hospital - Kanye
Telephone: (+267) 544-0333
7. Athlone Hospital - Lobatse
Telephone: (+267) 533-0333
8. Mahalapye Hospital - Mahalapye
Telephone: (+267) 471-0333
9. Maun Hospital - Maun
Telephone: (+267) 686-0444

10. Mochudi Hospital - Mochudi

Telephone: (+267) 577-7333
11. Molepolole Hospital - Molepolole
Telephone: (+267) 592-0333
12. Palapye Hospital- Palapye
Telephone: (+267) 4920333
13. Selebi Phikwe Hospital- Selebi Phikwe
Telephone: (+267) 261-0333
14. Serowe Hospital - Serowe
Telephone: (+267) 463-033

8. Insurance compa
1. Botswana Insurance Company
2. Botswana Life
3. FirstLife Assurance (Pty) Ltd
4. General Insurance Botswana (Pty) Ltd (GIB)
5. Hollard Insurance Botswana
6. Letshego Guard Insurance Company Ltd
7. Letshego Life Insurance Limited
8. Liberty Botswana (Pty) Ltd t/a Liberty Life Botswana
9. Metropolitan Life of Botswana Ltd
10. Mutual & Federal Insurance Company of Botswana Limited

11. Prefsure (Botswana) Ltd

12. Regent Insurance Botswana
13. Sesiro Insurance Company (Pty) Ltd
14. Zurich Insurance Company Botswana Limited

CONGO (DEMOCRATIC REPUBLIC OF THE CONGO)

The Democratic Republic of the Congo, also known as DR Congo, DRC, DROC,
RDC, Congo-Kinshasa, or simply Congo is a country located in Central Africa. The
DRC borders the Republic of the Congo, the Central African Republic, and South
Sudan to the north; Uganda, Rwanda, Burundi and Tanzania to the east; Zambia
and Angola to the south; and the Atlantic Ocean to the west. It is the second largest
country in Africa by area, the largest in Subsaharan Africa, and the eleventh largest
in the world. With a population of over 75 million, the Democratic Republic of the
Congo is the most populated officially Francophone country, the fourth most
populated nation in Africa and the nineteenth most populated country in the world.
The Democratic Republic of Congo is extremely rich in natural resources, but
political instability, a lack of infrastructure, deep rooted corruption, and centuries of
both commercial and colonial extraction and exploitation have limited holistic
development. Besides the capital, Kinshasa, the other major cities, Lubumbashi and
Mbuji-Mayi, are both mining communities. DR Congo's largest export is raw
minerals, with China accepting over 50% of DRC's exports in 2012. As of 2013,
according to the Human Development Index (HDI), DR Congo has a low level of
human development, ranking 176 out of 187 countries.

1. Politics and Government

The Democratic Republic of the Congo is governed under the constitution of 2006 as
amended. The president, who is the head of state, is popularly elected and may serve two
five-year terms. There is a bicameral legislature. The National Assembly has 500
members, who serve five-year terms; the majority (439) of the members are elected
proportionally, the rest directly. The prime minister is chosen from the party or coalition
that controls the assembly. The Senate has 108 indirectly elected members, who also
serve for five years. Administratively, the country is divided into ten provinces
(Bandundu, Bas-Congo, quateur, Kasai-Occidental, Kasai-Oriental, Katanga, Maniema,
Nord-Kivu, Orientale, and Sud-Kivu) and the federal district (which includes Kinshasa).
Each province also has an elected assembly.

2. Economic Situation
The economy of the Republic of the Congo is a mixture of subsistence hunting and
agriculture, an industrial sector based largely on petroleum extraction and support
services, and a government spending, characterized by budget problems and
overstaffing. Petroleum has supplanted forestry as the mainstay of the economy,
providing a major share of government revenues and exports. Nowadays the

country is increasingly converting natural gas to electricity rather than burning it,
greatly improving energy prospects.
Around 55% of people live below the poverty line, living on less than a dollar each
day. Areas with the greatest number of poor are particularly in the east of the
country, where conflict continues. Fighting and the lack of roads make it difficult
for aid and help to be provided to certain regions.
With families struggling to survive and the high number of orphans created by war
and disease (an estimated 4 million), there are many street children in the DR
Congo. The capital, Kinshasa, contains around 20-25,000 children who sleep rough
and survive by begging.
Lack of investment in the healthcare system results in a lack of infrastructure and
properly trained medical staff throughout the country. While medical needs are
enormous, people are left struggling to access the most basic level of healthcare
services.

3. Environment
The Democratic Republic of Congo (DR Congo) has the greatest extent of tropical
rainforests in Africa, covering more than 100 million hectares. The forests in the eastern
sector are amazingly diverse as one of the few forest areas in Africa to have survived the
ice age. About 45 percent of DR Congo is covered by primary forest which provides a
refuge for several large mammal species driven to extinction in other African countries.
Overall, the country is known to have more than 11,000 species of plants, 450 mammals,
1,150 birds, 300 reptiles, and 200 amphibians.
Despite this richness, over the past ten years DR Congo's forests have been the site of
terrible violence and immense human suffering, which spilled over from Rwanda and
neighboring African countries.

4. Education
In 2014 the literacy rate for the population between the ages of 15 and 49 was
estimated to be 75.9% (88.1% male and 63.8% female) according to a DHS
nationwide survey. The education system in the Democratic Republic of the Congo
is governed by three government ministries: the Ministry of Assignment Primary,
Secondary of Professional (MEPSP), the Ministry of Assignment Superior et
Universities (MESU) and the Ministry of Affaires Socials (MAS). Primary
education in the Democratic Republic of the Congo is not free or compulsory, even

though the Congolese constitution says it should be (Article 43 of the 2005

Congolese Constitution).
As a result of the 6-year civil war in the late 1990s-early 2000s, over 5.2 million
children in the country did not receive any education. Since the end of the civil war,
the situation has improved tremendously, with the number of children enrolled in
primary schools rising from 5.5 million in 2002 to 12 million in 2012, and the
number of children enrolled in secondary schools rising from 2.8 million in 2007 to
3.9 million in 2012 according to UNESCO.
Actual school attendance has also improved greatly in recent years, with primary
school net attendance estimated to be 82.4% in 2014 (82.4% of children ages 611
attended school; 83.4% for boys, 80.6% for girls).

5. Health
Medical facilities are severely limited, and medical materials are in short supply.
An adequate supply of prescription or over-the-counter drugs in local stores or
pharmacies is also generally not available. Payment for any medical services is
expected in cash in the DR Congo, in advance of treatment.
There is only 1 doctor and 5 nurses/midwives for every 10,000 people in the DR
Congo, according to the World Health Organization (WHO), 2000-2010.
Most hospitals and health centers across the DR Congo are poorly staffed and
equipped. This is because the healthcare system collapsed during the years of
conflict.
Health professionals have not received a wage from the government for many
years. This means they have either gone private, emigrated or become an employee
of one of the foreign non-governmental organizations (NGOs) providing healthcare
support.
Decades of conflict and a lack of government investment have made it hard for
people in the Democratic Republic of Congo (DRC) to access basic healthcare.
Epidemics have spread unchecked and treatment of deadly diseases has been
neglected.
The long-running war that is still going on has left the country without proper
health care to address the health needs of these populations, says Dr Omar Khatib
of the Unit of Emergency and Humanitarian Action at WHOs Regional Office for
Africa.

The hospitals in the Democratic Republic of the Congo include the General
Hospital of Kinshasa. DRC has the world's second-highest rate of infant mortality
(after Chad). In April 2011, through aid from Global Alliance for Vaccines, a new
vaccine to prevent pneumococcal disease was introduced around Kinshasa.

6. Diseases
Malaria is the leading cause of illness and death in DRC, and MSF medical teams
continue to treat large numbers of patients in 2013. Malaria treatment represents
one third of consultations at MSF clinics.
However, the greatest threat to health is malaria. In 2009, there were over 6.7
million cases of malaria. Two out of every five deaths among young children are
caused by malaria (WHO).
In 2013, it was estimated that about 1.1% of adults aged 1549 were living with
HIV/AIDS. Malaria is also a problem. Yellow fever also affects DRC.
The major health concern is a cholera epidemic in North Kivu that by 10 December
2008 had affected 10 332 persons and resulted in 201 deaths. According to a WHO
field team evaluation in the cholera treatment centre, 80% of patients in this
province are displaced persons
Other waterborne diseases, such as shigella/dysentery, are also a major concern.
The population is weak and malnourished, especially children aged under five
years, says Kamwa. This makes them easy prey for malaria, which continues to be
the main cause of death of children in the country. Deaths from malaria and
measles are believed to have increased in the last few months of intensified
conflict.
Outbreaks of cholera occur every year and around 3% of those who contract the
disease die because of lack of treatment.
Half of all cases of the neglected and fatal disease Human African trypanosomiasis
also called sleeping sicknessoccur in DRC, particularly in the Haut-Ul and
Bas-Ul districts of Orientale Province in the northeast. Prevalence can reach five
percent in some areas, well beyond the threshold of 0.3 percent needed to consider
it a public health problem.
There have been outbreaks of the Ebola virus, hemorrhagic fever, polio, cholera,
and typhoid. Tuberculosis is an increasingly serious health concern in the DR
Congo.

7. Hospitals

1. Mutombo Dikembe Hospital (private)

2. Nganda Hospital (private)
3. Monkole Mother&Child Hospital (non-profit)
4. Centre Medical de Kinshasa (private)
5. Bondeko Clinic (private)
6. General Hospital (public)
7. Goma Sanru Hospital (non profit/Protestant)
8. Saint Luke Hospital (non profit/diocesan)
9. Kimpese Sanru Hospital (non profit/Protestant)
10. Mutombo Dikembe Hospital (private)
11. Nganda Hospital (private)
12. Monkole Mother&Child Hospital (non-profit)
13. Centre Medical de Kinshasa (private)
14. Bondeko Clinic (private)

8. Insurance companies

1. Mutombo Dikembe Hospital (private)

2. Nganda Hospital (private)
3. Monkole Mother&Child Hospital (non-profit)
4. Centre Medical de Kinshasa (private)
5. Bondeko Clinic (private)

ZAMBIA
The Republic of Zambia is a landlocked country in Southern Africa, neighbouring the
Democratic Republic of the Congo to the north, Tanzania to the north-east, Malawi to the
east, Mozambique, Zimbabwe, Botswana and Namibia to the south, and Angola to the
west. The capital city is Lusaka, in the south-central part of Zambia. The population is
concentrated mainly around Lusaka in the south and the Copperbelt Province to the
northwest.
Originally inhabited by Khoisan peoples, the region was affected by the Bantu expansion
of the thirteenth century. After visits by European explorers in the eighteenth century,
Zambia became the British protectorate of Northern Rhodesia towards the end of the
nineteenth century. For most of the colonial period, Zambia was governed by an
administration appointed from London with the advice of the British South Africa
Company.
In 2010, the World Bank named Zambia one of the world's fastest economically reformed
countries. The Common Market for Eastern and Southern Africa (COMESA) is
headquartered in Lusaka and the country is a member of the United Nations, the
Commonwealth of Nations and the Southern African Development Community (SADC).

1. Politics and Government

Zambia has had a long period of political stability. With strong growth in the last decade
the country has reached lower middle income status. Investor confidence has been high as
evidenced in the successful issue of two Euro bonds.
Politics in Zambia take place in a framework of a presidential representative
democratic republic, whereby the President of Zambia is both head of state and
head of government in a pluriform multi-party system. The government exercises
executive power, while legislative power is vested in both the government and
parliament.
Zambia became a republic immediately upon attaining independence in October
1964. From 2011 to 2014, Zambia's president had been Michael Sata, until Sata
died on 28 October 2014.
After independence in 1964 the foreign relations of Zambia were mostly focused on
supporting liberation movements in other countries in Southern Africa, such as the
African National Congress and SWAPO. During the Cold War Zambia was a
member of the Non-Aligned Movement.

2. Economic Situation
Zambia has had a decade of rapid economic growth. A combination of prudent
macroeconomic management, market liberalization policies, and steep increase in copper
prices helped drive investments in the copper industry and related infrastructure to
achieve an average annual growth of about 6.4% during the last decade. Though the
economy is dependent on copper, the agriculture sector is the major employer (70% of
the population). However, the sectors potential to contribute to the countrys
development remains largely underexploited.
For the first time since 1989 Zambia's economic growth reached the 6%-7% mark (in
2007) needed to reduce poverty significantly. Copper output has increased steadily since
2004, due to higher copper prices and the opening of new mines. The maize harvest was
again good in 2005, helping boost GDP and agricultural exports. Cooperation continues
with international bodies on programs to reduce poverty, including a new lending
arrangement with the IMF in the second quarter of 2004. A tighter monetary policy will
help cut inflation, but Zambia still has a serious problem with high public debt.
Zambia was ranked the 127th safest investment destination in the world in the March
2011 Euromoney Country Risk rankings.
3. Environment
Zambia is one of the most industrialized countries in Africa, and air pollution and
the resulting acid rain are growing problems. The lack of adequate water-treatment
facilities presents substantial health risks to the population.
Wet lands, including floodplains, swamps, and mudflats, make up about 6 percent
of Zambia's area, although none are adequately protected from degradation. Only
about 42.2 percent (1995) of the land is forested, mostly with open woodland.
Deforestation takes place at a rate of about 1 percent per year. Some important
habitats are endangered, such as mountain areas in the northeast.
National forest makes up about 9 percent of the land. In addition, there are 19
national parks that protect about 8 percent of the country's land, although game
management areas and protected forests cover more than 20 percent of the land.
Threats to protected land include brushfires, agricultural encroachment, prospecting
and mining activities, hydroelectric development, habitat destruction due to local
overpopulation of some game species, and poaching, especially of elephant and
rhinoceros.

Zambia has ratified international environmental agreements concerning

biodiversity, climate change, endangered species, hazardous wastes, the ozone
layer, and wetlands. Regionally, the country participates in the African Convention
on the Conservation of Nature and Natural Resources.
4. Education
For many years the Zambia Government has had little money to put towards its
Education Program and, whilst the District Education Boards do their best, they struggle
with a budget that is inadequate to meet the needs of the growing population.
Schools in rural areas suffer from a shortage of classrooms with their existing ones
usually in need of significant refurbishment. Often teaching is done in shifts with some
classes coming in the morning and others in the afternoon but in spite of this many
classes are still overcrowded. Educational resources such as text books and teaching aids
are in short supply and often out of date and it is not unusual for there to be just one text
book for the whole class.
When there is no school close to a community some villages have been able to establish
their own Community Schools. These usually start with just one class being taught in a
thatched shelter by an unqualified volunteer.
As fees are due from Grade 8 onwards many children do not continue with their
schooling after Grade 7 but often families cannot even afford the basics such as uniform,
exercise books and pencils. The situation is worse for orphans as the relatives who care
for them may already be struggling to provide for their own children.
The ages of children in any one grade will vary enormously; sometimes kids start late or
have to miss the odd year or two due to difficult home circumstances. Either reason
results in classes with children of widely differing ages.
What can be said is that each child craves the chance of an education. In spite of often
having to walk long distances and a never-ending round of chores before and after school
they are desperate to learn.

5. Health
The vision of the health reforms in Zambia is to provide equity of access to costeffective, quality health care as close to the family as possible.

Zambia has been implementing health reforms since 1992 under the framework of the
Sector Wide Approach (SWAP), which takes a holistic development view of the sector. In
the SWAP, resources from government and other stakeholders are pooled so as to ensure
efficient utilisation of resources. The mission of the health sector is to significantly
increase life expectancy in Zambia by creating environments and encouraging life styles
that support health. The financing of the basic health care package is a priority to try to
reduce both morbidity and mortality rates and contribute to poverty reduction.
The Zambian health policy stipulates that every able-bodied Zambian with an income
should contribute to the cost of his or her health. However, exemptions exist based on
age (children under 5 and adults over 65), diseases (TB, HIV/AIDS, STDs, Cholera and
dysentery; safe motherhood and family planning services; immunisation; and treatment of
chronic hypertension and diabetes) and other factors. This is aimed at enhancing an
equitable and appropriate delivery of health services to all Zambians, but in practice is
not implemented due to lack of resources.
There is inequitable access to basic health services in Zambia between provinces and
between urban and rural areas. In urban areas, 99 percent of households are within 5
kilometres of a health facility compared to 50 percent in rural areas. In Zambia,
household expenditures on health vary according to location. Poor households spend the
highest proportion of their income on health, which can be up to 10% of total expenditure
when in kind costs are included. Long distances and cost and lack of transport in a large
but sparsely populated country like Zambia is a key determinant of health seeking
behaviour.
A lack of human resources is also present in Zambia impacting the delivery of services.
This problem is due to three factors:

Medical staff leaving abroad mainly to the US and UK

Medical staff leaving the Public Sector for the Private Sector in Zambia

The impact of HIV/AIDS on health workers

The general state of healthcare in Zambia is poor. Although there are adequate private
health facilities in Lusaka, the public health system remains heavily underfunded, and
many expats requiring serious medical attention will find themselves evacuated to
another country, such as South Africa, where there are better medical facilities. Its
essential that expats have a comprehensive health insurance policy before moving to
Zambia.

6. Diseases
Malaria
Malaria has for a long time remained the leading cause of morbidity and mortality in both
the children and adults in Zambia. Malaria is endemic in Zambia, with seasonal and
geographical variations. Whilst malaria affects the whole population, the most vulnerable
are children under the age of 5 years and pregnant mothers.
HIV&AIDS and Sexually Transmitted Infections (STIs)
HIV&AIDS is currently the leading epidemic in Zambia, with significant social and
economic impact on the country. The most recent data estimates indicate that there are
approximately 1 million adults and children living with HIV&AIDS in Zambia (NAC,
2007) . Approximately 800,000 people have died from HIV/AIDS, leaving an estimated
600,000 children orphaned (NAC, 2006 ).
The priority communicable diseases in Zambia include malaria, HIV&AIDS and
TB. The main outcomes of the efforts to fight these diseases are discussed below.
Tuberculosis and other respiratory infections (non-pneumonia)
Tuberculosis (TB) is one of the major non-pneumonia respiratory infections and remains
a major health problem in Zambia, contributing a significant proportion of all hospital
admissions in the country. This is despite the significant achievements made by the
National TB programme. Zambia is among the high TB burdened countries in Africa. The
World Health Organization (WHO) estimated incidence (2007) for all forms of TB cases
was 553/100,000 and for sputum smear positive was 228/100,000, or approximately
67,800 and 28,000 cases per annum, respectively. However, preliminary results from
some studies being conducted in the country suggest that the WHO estimates may even
be on the lower side.
Non-communicable diseases
Zambia is currently experiencing a major increase in the burden of noncommunicable diseases (NCDs). The common NCDs include cardiovascular
diseases, diabetes mellitus (Type II), cancers, chronic respiratory diseases, epilepsy,
mental illnesses, oral health, eye diseases, injuries (mostly due to road traffic
accidents and burns) and sickle anaemia.
Most of these health conditions are associated with lifestyles, such as unhealthy
diets, physical inactivity, alcohol abuse and tobacco use, while some are also
associated with biological risk factors, which run in families.

7. Hospitals
In Zambia, there are hospitals throughout the country which include:
1. Levy Mwanawasa General Hospital,
2. Chipata General Hospital,
3. Kitwe Central Hospital,
4. Konkola Mine Hospital,
5. Lubwe Mission Hospital,
6. Maacha Hospital,
7. Mtendere Mission Hospital,
8. Mukinge Mission Hospital,
9. Mwandi Mission Hospital,
10. Nchanga North Hospital,
11. Chikankata Salvation Army Hospital,
12. Kalene Mission Hospital,
13. St Francis Hospital, and
14. St Luke's Mission Hospital.
The University Teaching Hospital serves as both a hospital and a training site for
future health workers. There are very few hospitals in rural or remote places in
Zambia, where most communities rely on small government-run community health
centres and rural health posts.
9. Insurance companies

1. Goldman Insurance Limited

2. Madison Insurance Company Ltd.
3. Nico Insurance Zambia Ltd.
4. Professional Insurance Corporation
5. Zambia state Insurance Corporation
6. Zambia state Insurance Corporation Gen Insurance Ltd.

ZIMBABWE
Zimbabwe officially the Republic of Zimbabwe, is a landlocked country located in
southern Africa, between the Zambezi and Limpopo Rivers. It borders South Africa to the
south, Botswana to the west, Zambia to the northwest, and Mozambique to the east and
northeast. The capital and largest city is Harare.
Since the 11th century, present-day Zimbabwe has been the site of several organised
states and kingdoms as well as a major route for migration and trade.
An ethnically diverse country of roughly 13 million people, Zimbabwe has 16 official
languages, with English, Shona, and Ndebele the most commonly used. President Robert
Mugabe serves as head of state and government, and as commander-in-chief of the armed
forces. Renowned as a champion for the ant colonial cause, Mugabe also has a reputation
as an authoritarian figure responsible for Zimbabwe's problematic human rights record
and substantial economic decline. He has held power since 1980: as head of government
until 1987, and head of both state and government since then.

1. Politics and Government

Zimbabwe is a republic with a presidential system of government. The semipresidential system was done away with the adoption of a new constitution after a
referendum in March 2013. Under the constitutional changes in 2005, an upper

chamber, the Senate, was reinstated. The House of Assembly is the lower chamber
of Parliament.
President Robert Mugabe's Zimbabwe African National Union Patriotic Front
(commonly abbreviated ZANU-PF) has been the dominant political party in
Zimbabwe since independence. In 1987 then-prime minister Mugabe revised the
constitution, abolishing the ceremonial presidency and the prime ministerial posts
to form an executive president, a Presidential system. His ZANU party has won
every election since independence, in the 1990 election the second-placed party,
Edgar Tekere's Zimbabwe Unity Movement, won only 20% of the vote. During the
1995 parliamentary elections most opposition parties, including the ZUM,
boycotted the voting, resulting in a near-sweep by the ruling party. When the
opposition returned to the polls in 2000, they won 57 seats, only five fewer than
ZANU.

2. Economic Situation
The economy had shown signs of modest improvement under the government of national
unity (GNU) between 2009 and 2013, when President Robert Mugabe and his long-ruling
ZANU-PF party shared power with the opposition Movement for Democratic Change
(MDC). But industry has been performing poorly and company closures have picked up
since ZANU-PF won general elections in July 2013.
Mineral exports, gold, agriculture, and tourism are the main foreign currency
earners of Zimbabwe. The mining sector remains very lucrative, with some of the
world's largest platinum reserves being mined by Anglo American plc and Impala
Platinum. The Marange diamond fields, discovered in 2006, are considered the
biggest diamond find in over a century. They have the potential to improve the
fiscal situation of the country considerably, but almost all revenues from the field
have disappeared into the pockets of army officers and ZANU-PF politicians. In
terms of carats produced, the Marange field is one of the largest diamond producing
projects in the world, estimated to produce 12 million carats in 2014 worth over
$350 million.] Zimbabwe is the biggest trading partner of South Africa on the
continent.
Taxes and tariffs are high for private enterprises, while state enterprises are strongly
subsidised. State regulation is costly to companies; starting or closing a business is
slow and costly. Government spending was predicted to reach 67% of GDP in
2007.

Tourism was an important industry for the country, but has been failing in recent
years. The Zimbabwe Conservation Task Force released a report in June 2007,
estimating 60% of Zimbabwe's wildlife has died since 2000 due to poaching and
deforestation. The report warns that the loss of life combined with widespread
deforestation is potentially disastrous for the tourist industry.
The ICT sector of Zimbabwe has been growing at a fast pace. A report by the
mobile internet browser company, Opera, in June/July 2011 has ranked Zimbabwe
as Africa's fastest growing market.
3. Environment
Zimbabwe is a landlocked country in southern Africa, lying between latitudes 15
and 23S, and longitudes 25 and 34E. Most of the country is elevated, consisting
of a central plateau (high veld) stretching from the southwest northwards with
altitudes between 1,000 and 1,600 m. The country's extreme east is mountainous,
this area being known as the Eastern Highlands, with Mount Nyangani as the
highest point at 2,592 m. These highlands are renowned for their great natural
beauty, with famous tourist destinations such as Nyanga, Troutbeck, Chimanimani,
Vumba and Chirinda Forest at Mount Selinda. About 20% of the country consists
of low-lying areas, (the low veld) under 900m. Victoria Falls, one of the world's
biggest and most spectacular waterfalls, is located in the country's extreme
northwest and is part of the Zambezi river. The country has a tropical climate with
many local variations. The southern areas are known for their heat and aridity, parts
of the central plateau receive frost in winter, the Zambezi valley is also known for
its extreme heat and the Eastern Highlands usually experience cool temperatures
and the highest rainfall in the country. In general however, Zimbabwe's rainy
season usually runs from late October to March and the hot climate is moderated by
increasing altitude. Zimbabwe is faced with recurring droughts, the latest one
commencing early in 2015 and ongoing into 2016. Severe storms are rare.
Water pollution
The state of water and its cleanliness in Zimbabwe is at its lowest. The nature of
water and its function as the crucial element of life is known as the opposite for the
people of Zimbabwe. In Zimbabwe, water contains not life but life-threatening
diseases due to contamination from industrial works. One of the major origins of
water pollution is Zimbabwes small industry of mining. By mining for gold,
platinum, and other precious, expensive metal alloys, mining makes up for one
third of the earnings from Zimbabwes exports.

An excessive amount of these metals in water deteriorates the health of humans but
also the lives of animals and plants hence it is dangerous for any type of
organisms to consume. For example, intakes of excessive zinc may cause internal
organ damage and reduce the immune systems function. Although zinc is a major
nutrient supplied with food, an excessive amount of it is harmful.
Other diseases that occur in Zimbabwe due to water pollution are cholera, typhoid,
infectious hepatitis, giardia, salmonella, and cryptosporidium.[29] However, despite
all this, because water is needed and the people of Zimbabwe are becoming more
vulnerable and desperate, they consume this greatly contaminated water hence,
contamination-related health issues and epidemics arises.
Air pollution
Air pollution is also a growing problem in Zimbabwe, due to industries, poor waste
management and transportation. The World Health Organization has set up a limit
for the emission of sulfur dioxide to 20 g/m3 24-hour mean. In Harare, Zimbabwe,
that limit has been exceeded to 200 mg/m3. This is only the beginning of the reality
of the air pollution in Zimbabwe, especially in its capital, Harare. The release of
sulfur dioxide is harmful to the life of humans and other organisms. The inhaling of
sulfur dioxide leads to lung diseases, breathing difficulties, formation of sulfurous
acid along with the moisture of the mucous membranes causing a strong irritation
and prevents the respiratory systems role in defending the body against foreign
particles and bacteria. Hence, it can be concluded that the inhaling of sulfur dioxide
is tremendously detrimental to the life of organisms. Not to mention, as sulfur
dioxide is emitted into the atmosphere, it forms into acid precipitation as it reacts
with water, nitrogen oxides and other sulfur oxides.
4. Education
The state of education in Zimbabwe effects the development of the economy while
the state of the economy can effect access and quality of teachers and education.
Zimbabwe has one of Africa's highest literacy rates at over 90%. The population is
usually better educated than the African average, making the people one of the
greatest assets of the country. The crisis since 2000 has however diminished these
achievements because of general lack of resources and the exodus of teachers to
other countries.
The wealthier portion of the population usually sends their children to independent
schools as opposed to the government-run schools which are attended by the
majority as these are subsidized by the government. School education was made
free in 1980, but since 1988, the government has steadily increased the charges

attached to school enrollment until they now greatly exceed the real value of fees in
1980. The Ministry of Education of Zimbabwe maintains and operates the
government schools but the fees charged by independent schools are regulated by
the cabinet of Zimbabwe.
Zimbabwe's education system consists of 2 years of pre-school, 7 years of primary
and 6 years of secondary schooling before students can enter university in the
country or abroad. The academic year in Zimbabwe runs from January to
December, with three terms, broken up by one month holidays, with a total of 40
weeks of school per year. National examinations are written during the third term in
November, with "O" level and "A" level subjects also offered in June.
Education in Zimbabwe became under threat since the economic changes in 2000
with teachers going on strike because of low pay, students unable to concentrate
because of hunger and the price of uniforms soaring making this standard a luxury.
Teachers were also one of the main targets of Mugabe's attacks because he thought
they were not strong supporters.

5. Health
Zimbabwe's economy is almost non-existent. Bad government policies have
decimated what was once a powerful country. This bad economic management is
killing the nation's health system. Health services in Zimbabwe are extremely poor.
Public hospitals in Harare and other towns are experiencing shortages of staff,
water, power, medicines and equipment. They are unlikely to offer treatment of
certain illnesses or offer assistance in an accident or emergency.
Hygiene is very poor. The few private hospitals in Harare are also suffering from
staff and resources limitations and are likely to require payments of up to US$2000
in cash notes before a patient is admitted.
Medical facilities outside Harare and Bulawayo are limited.Medical supplies
throughout Zimbabwe are very limited and some prescription medicines are not
available (recently insulin) or are very expensive. In the event of a serious accident
or illness, a medical evacuation to South Africa would be necessary, costing up to
$25,000.
Shortage of nurses
Regina Smith, president of the Zimbabwe Nurses Association, told IRIN that public
hospitals were severely understaffed. Hundreds of nurses that have been trained locally

have found it difficult to be employed because government had frozen vacancies in the
public sector, she said.
Shortage of epilepsy drugs in Zimbabwe
Drugs for non-communicable diseases like epilepsy are being hardest hit by funding
shortfalls affecting Zimbabwes public health sector. While the government is struggling
to meet its budget commitments, donors are more focused on communicable diseases like
HIV and TB After a tour of hospitals in Bulawayo, the second largest city, in early June
with her parliamentary committee, Labode said health facilities were keeping expired
drugs and syringes, putting patients health at risk.
Government, which regulates basic admission and consultation costs in both the private
and public sectors, raised consultation fees for private institutions in May. General
practitioners can now charge $30 for consultations, up from the previous $15, while
physicians and pediatricians can charge $70.
At public hospitals, patients only pay $10 for a consultation, but a bed for in-patients
costs $110 per day, an amount few can afford.

6. Diseases
Cholera:
A severe cholera outbreak affected most of Zimbabwe between August 2008 and
July 2009. Cholera deaths have decreased recently, although the disease is still
present and may break out again with little warning.
Mosquitoes:
Malaria is a risk in all areas except Harare and Bulawayo. Other mosquito-borne
diseases (including filariasis) are also prevalent in Zimbabwe.
Water-borne, food-borne and other infectious diseases (including hepatitis,
tuberculosis, measles, typhoid and rabies) are prevalent, with more serious
outbreaks occurring from time to time. Malaria is a major killer across Africa, and
for the price of a $2 mosquito net, it's wise to protect yourself.
AIDS:
The rate of HIV/AIDS infection in Zimbabwe is very high - 15% of the population
has the virus. You should exercise appropriate precautions if engaging in activities
that expose you to risk of infection. Once the jewel of Southern Africa, Zimbabwe
now finds itself in crisis. With the country's economy in tatters, and the devastating
impact of HIV and AIDS.

Few Zimbabweans with HIV receive the treatment they need to survive, and few
hospitals are equipped to provide adequate care. This means that up to 3,500 people
die from AIDS-related illness each week.
Tuberculosis
Zimbabwe is ranked among the 22 countries, where tuberculosis occurs frequently.
In 2000, the incidence rate of tuberculosis reached 726 incidents per 100,000
people, where as in 2011, the number decreased to 603 incidents per 100,000
people. In 2011, the number of incidences of tuberculosis in Zimbabwe was
80 thousand, and the amount of deaths from this disease was 3.4 thousand. Africa is
the top continent where tuberculosis occurs frequently, as it reached an estimated
value of 2.3 million for incidences in 2010 by the World Health Organization.

7. Hospitals
Chatindo Clinic
Address: Nyanga, Nyanga Zim, Zimbabwe, Zimbabwe. See full address and map.
Categories: Hospitals, Medical Centre & Clinics

Chipinge Clinic
Address: Chipinge, Zimbabwe, Zimbabwe. See full address and map.
Categories: Hospitals, Medical Centre & Clinics

Chirawu Medical Chambers (PVT) Ltd

Address: 125 Nelson Mandela Ave, Harare, Zimbabwe, Zimbabwe. See full address and map.
Categories: Hospitals, Medical Centre & Clinics

Medical Centre Norton Multi Specialist Centre

Address: Norton, Zimbabwe, Zimbabwe. See full address and map.
Categories: Hospitals, Medical Centre & Clinics

Kingsmead Clinic

Address: 11 Mbuya Nehanda St, Harare, Zimbabwe, Zimbabwe. See full address and map.
Categories: Hospitals, Medical Centre & Clinics

Nyamutumbu Clinic
Address: Murewa, Zimbabwe, Zimbabwe. See full address and map.
Categories: Hospitals, Medical Centre & Clinics

Ruvimbo Clinic
Address: 26 Rusike Cres, Harare, Zimbabwe, Zimbabwe. See full address and map.
Categories: Hospitals, Medical Centre & Clinics

8. Insurance companies
1. Alliance incurance company Pvt Ltd
2. Altfin insurance company limited
3. First mutual life
4. Gallant insurance company
5. Heritage insurance company
6. Old mutual Zimbabwe
7. RM insurance company
8. Tristar insurance company

MYANMAR
Myanmar, officially the Republic of the Union of Myanmar and also known as Burma, is
a sovereign state in Southeast Asia bordered by Bangladesh, India, China, Laos and
Thailand. One-third of Myanmar's total perimeter of 1,930 km (1,200 miles) forms an
uninterrupted coastline along the Bay of Bengal and the Andaman Sea. The country's
2014 census revealed a much lower population than expected, with 51 million people
recorded. Myanmar is 676,578 square kilometres (261,227 sq mi) in size. Its capital city
is Naypyidaw and its largest city is Yangon (Rangoon).
For most of its independent years, the country has been engrossed in rampant ethnic strife
and Burma's myriad ethnic groups have been involved in one of the world's longestrunning ongoing civil wars. During this time, the United Nations and several other
organisations have reported consistent and systematic human rights violations in the
country. In 2011, the military junta was officially dissolved following a 2010 general
election, and a nominally civilian government was installed. While former military
leaders still wield enormous power in the country, Burmese Military have taken steps
toward relinquishing control of the government. This, along with the release of Aung San
Suu Kyi and political prisoners, has improved the country's human rights record and
foreign relations, and has led to the easing of trade and other economic sanctions. There
is, however, continuing criticism of the government's treatment of the Muslim Rohingya
minority and its poor response to the religious clashes.
Myanmar is a country rich in jade and gems, oil, natural gas and other mineral resources.
In 2013, its GDP (nominal) stood at US$56.7 billion and its GDP (PPP) at US$221.5
billion. The income gap in Myanmar is among the widest in the world, as a large
proportion of the economy is controlled by supporters of the former military government.
As of 2013, according to the Human Development Index (HDI), Myanmar had a low
level of human development, ranking 150 out of 187 countries.

1. Politics and government

The constitution of Myanmar, its third since independence, was drafted by its military
rulers and published in September 2008. The country is governed as a parliamentary
system with a bicameral legislature (with an executive President accountable to the
legislature), with a portion of legislators appointed by the military and others elected in
general elections. The current president, inaugurated on 30 March 2011, is Thein Sein.
Political culture
The major political parties are the National League for Democracy, National Democratic
Force and the two backed by the military: the National Unity Party, and the Union
Solidarity and Development Party.

Myanmar rates as a corrupt nation on the Corruption Perceptions Index with a rank of
157th out of 177 countries worldwide and a rating of 2.1 out of 10 (10 being least corrupt
and 0 being highly corrupt) as of 2012.
2. Economic situation
Myanmar is one of the poorest nations in Southeast Asia, suffering from decades of
stagnation, mismanagement and isolation. The lack of an educated workforce skilled in
modern technology hinders Myanmar's economy, although recent reforms and
developments carried out by the new government, in collaboration with foreign countries
and organisations aim to make this a thing of the past.
Myanmar lacks adequate infrastructure. Goods travel primarily across the Thai border
(where most illegal drugs are exported) and along the Irrawaddy River. Railways are old
and rudimentary, with few repairs since their construction in the late 19th century.
Highways are normally unpaved, except in the major cities. Energy shortages are
common throughout the country including in Yangon and only 25% of the country's
population has electricity.
The military government has the majority stakeholder position in all of the major
industrial corporations of the country (from oil production and consumer goods to
transportation and tourism).
The national currency is Kyat. Inflation averaged 30.1% between 2005 and 2007.
Inflation is a serious problem for the economy.
3. Environment
Much of the country lies between the Tropic of Cancer and the Equator. It lies in the
monsoon region of Asia, with its coastal regions receiving over 5,000 mm (196.9 in) of
rain annually. Annual rainfall in the delta region is approximately 2,500 mm (98.4 in),
while average annual rainfall in the Dry Zone in central Myanmar is less than 1,000 mm
(39.4 in). The Northern regions of Myanmar are the coolest, with average temperatures of
21 C (70 F). Coastal and delta regions have an average maximum temperature of 32 C
(89.6 F).
Wildlife
Myanmar's slow economic growth has contributed to the preservation of much of its
environment and ecosystems. Forests, including dense tropical growth and valuable teak
in lower Myanmar, cover over 49% of the country, including areas of acacia, bamboo,
ironwood and Magnolia champaca. Coconut and betel palm and rubber have been
introduced. In the highlands of the north, oak, pine and various rhododendrons cover
much of the land.

Typical jungle animals, particularly tigers and leopards, occur sparsely in Myanmar. In
upper Myanmar, there are rhinoceros, wild buffalo, wild boars, deer, antelope, and
elephants, which are also tamed or bred in captivity for use as work animals, particularly
in the lumber industry. Smaller mammals are also numerous, ranging from gibbons and
monkeys to flying foxes and tapirs. The abundance of birds is notable with over 800
species, including parrots, peafowl, pheasants, crows, herons, and paddybirds. Among
reptile species there are crocodiles, geckos, cobras, Burmese pythons, and turtles.
Hundreds of species of freshwater fish are wide-ranging, plentiful and are very important
food sources. For a list of protected areas, see List of protected areas of Myanmar.

4. Education
According to the UNESCO Institute of Statistics, Myanmar's official literacy rate as of
2000 was 90%. Historically, Myanmar has had high literacy rates. To qualify for least
developed country status by the UN to receive debt relief, Myanmar lowered its official
literacy rate from 79% to 19% in 1987.
The educational system of Myanmar is operated by the government agency, the Ministry
of Education. The education system is based on the United Kingdom's system due to
nearly a century of British and Christian presences in Myanmar. Nearly all schools are
government-operated, but there has been a recent increase in privately funded English
language schools. Schooling is compulsory until the end of elementary school,
approximately about 9 years old, while the compulsory schooling age is 15 or 16 at
international level.
There are 101 universities, 12 institutes, 9 degree colleges and 24 colleges in Myanmar, a
total of 146 higher education institutions. There are 10 Technical Training Schools, 23
nursing training schools, 1 sport academy and 20 midwifery schools. There are 2047
Basic Education High Schools, 2605 Basic Education Middle Schools, 29944 Basic
Education Primary Schools and 5952 Post Primary Schools. 1692 multimedia classrooms
exist within this system.
There are four international schools acknowledged by WASC and College BoardThe
International School Yangon (ISY), Crane International School Yangon (CISM), Yangon
International School (YIS) and International School of Myanmar (ISM) in Yangon.

5. Health
The general state of health care in Myanmar is poor. The government spends anywhere
from 0.5% to 3% of the country's GDP on health care, consistently ranking among the
lowest in the world. Although health care is nominally free, in reality, patients have to
pay for medicine and treatment, even in public clinics and hospitals. Public hospitals lack
many of the basic facilities and equipment.

The 2010 maternal mortality rate per 100,000 births for Myanmar is 240. This is
compared with 219.3 in 2008 and 662 in 1990. The under 5 mortality rate, per 1,000
births is 73 and the neonatal mortality as a percentage of under 5's mortality is 47.
Myanmar's government spends the least percentage of its GDP on health care of any
country in the world, and international donor organisations give less to Myanmar, per
capita, than any other country except India. According to the report named "Preventable
Fate", published by Doctors without Borders, 25,000 Burmese AIDS patients died in
2007, deaths that could largely have been prevented by antiretroviral therapy drugs and
proper treatment.
HIV/AIDS, recognised as a disease of concern by the Burmese Ministry of Health, is
most prevalent among sex workers and intravenous drug users. In 2005, the estimated
adult HIV prevalence rate in Myanmar was 1.3% (200,000570,000 people), according to
UNAIDS, and early indicators of any progress against the HIV epidemic are inconsistent.
However, the National AIDS Programme Myanmar found that 32% of sex workers and
43% of intravenous drug users in Myanmar have HIV.

6. Diseases
Cutaneous Larva Margrans
This disease is caused by dog hookworm. The rash starts as a small jump, then slowly
spreads in a linear fashion. It is intensely itchy, especially at night. It is easily treated with
medications and should not be cut out or frozen.
Dengue Fever Myanmar
This mosquito-borne disease is becomingly increasingly problematic throughout
Myanmar. As there is no vaccine available it can only be prevented by avoiding mosquito
bites. The mosquito that carries dengue bites in Myanmar. The mosquito that carries
dengue bites day and night, so use insect-avoidance measures at all times. Symptoms
include high fever, severe headache and body ache (dengue was previously known as
"break bone fever") some people develop a rash and experience diarrhea. There is no
specific treatment; just rest and paracetamol do not take aspirin, as it increases the
likelihood of hemorrhaging. See a doctor to be diagnosed and monitored in Myanmar.

Filariasis
A mosquito-borne disease that is very common in Myanmar local population, yet very
rare in travelers. Mosquito-avoidance measures are the best way to prevent this disease in
Myanmar.

HIV Myanmar
Myanmar is among the list of countries in Asia with the highest rate of HIV infection and
the problem is increasing. Heterosexual sex is now the main method of transmission.
Malaria
For such a serious and potentially deadly disease, there is an enormous amount of
misinformation concerning malaria and malaria medication. You must get expert advice
as to whether the destinations you are going to will put you at risk. For most rural areas,
however, the risk of contracting the disease far out weighs the risk of nay tablets side
effects. Remember that malaria can be fatal. Before you travel, seek medical advice on
the right medication and dosage for you.

7. Hospitals
1. Academy Private Hospital
2. Asia Royal Clinic
3. Australian Embassy Health Clinic
4. Central Woman's Hospital
5. Civil South Bagon Hospital
6. Jivitadana Sangha Hospital
7. Kantaw Nadi Hospital
8. Mandalay General Hospital
9. Minesite Medical Services Minesite Hospital
10. New Yangon General Hospital
11. Pacific Medical Center
12. Pun Hlaing International Hospital
13. Sakura Hospital
14. Sakura Medical Center

15. Shwegondine Specialist Center

16. Shwepadauk Hospital
17. Thingangyun Sanpya Hospital
18. Waibargi North Okkalapa Hospital (Infectious Diseases Hospital)
19. Yangon Children's Hospital

8. Insurance companies
1. Myanma Insurance
2.

First National Insurance

3. Young Global Insurance

4. Capital Life Insurance
5. Grand Guardian Insurance
6. Public Excellent Fortune Insurance
7. Pillar of Truth Insurance
8. Citizens Business Insurance Public

PAKISTAN
Pakistan, officially the Islamic Republic of Pakistan is a country in South Asia. It is the
sixth-most populous country with a population exceeding 199 million people. It is the
36th largest country in the world in terms of area with an area covering 881,913 km2
(340,509 sq mi). Pakistan has a 1,046-kilometre (650 mi) coastline along the Arabian Sea
and the Gulf of Oman in the south and is bordered by India to the east, Afghanistan to the
west, Iran to the southwest and China in the far northeast respectively. It is separated
from Tajikistan by Afghanistan's narrow Wakhan Corridor in the north, and also shares a
maritime border with Oman.
The territory that now constitutes Pakistan was previously home to several ancient
cultures, including the Mehrgarh of the Neolithic and the Bronze Age Indus Valley
Civilisation, and was later home to kingdoms ruled by people of different faiths and
cultures, including Hindus, Indo-Greeks, Muslims, Turco-Mongols, Afghans and Sikhs.
The area has been ruled by numerous empires and dynasties, including the Indian
Mauryan Empire, the Persian Achaemenid Empire, Alexander of Macedonia, the Arab
Umayyad Caliphate, the Mongol Empire, the Mughal Empire, the Durrani Empire, the
Sikh Empire and the British Empire. As a result of the Pakistan Movement led by
Muhammad Ali Jinnah and the subcontinent's struggle for independence, Pakistan was
created in 1947 as an independent nation for Muslims from the regions in the east and
west of the Subcontinent where there was a Muslim majority. Initially a dominion,
Pakistan adopted a new constitution in 1956, becoming an Islamic republic. A civil war in
1971 resulted in the secession of East Pakistan as the new country of Bangladesh.

1. Politics and Government

Pakistan is a democratic parliamentary federal republic with Islam as the state religion.
The first set was adopted in 1956 but suspended by Ayub Khan in 1958 who replaced it
with the second set in 1962. Complete and comprehensive Constitution was adopted in

1973suspended by Zia-ul-Haq in 1977 but reinstated in 1985is the country's most

important document, laying the foundations of the current government. The Pakistani
military establishment has played an influential role in mainstream politics throughout
Pakistan's political history. There were military coups which resulted in imposition of
martial law and military commanders continued governing as de-facto presidents from
19581971, 19771988, and 19992008.
As of now, Pakistan has a multi-party parliamentary system with clear division of powers
and responsibilities between branches of government. The first successful demonstrative
transaction was held in May 2013. Politics in Pakistan is centered and dominated by the
homegrown conceive social philosophy, consisting the ideas of socialism, conservatism,
and the third way. As of the general elections held in 2013, the three main dominated
political parties in the country: the centre-right conservative Pakistan Muslim League-N
(PML-N); the centre-left socialist Pakistan Peoples Party (PPP); and the centrist and
third-way Pakistan Movement for Justice (PTI) led by cricketer Imran Khan.

2. Economic Situation
Economists estimate that Pakistan has been part of the wealthiest region of the world
throughout the first millennium CE having the largest economy by GDP. This advantage
was lost in the 18th century as other regions edged forward such as China and Western
Europe.
In recent years, Pakistan has been a rapidly developing country and is one of the Next
Eleven, the eleven countries that, along with the BRICs, have a high potential to become
the world's largest economies in the 21st century. However, after decades of social
instability, as of 2013, serious deficiencies in macromangament and unbalanced
macroeconomics in basic services such as train transportation and electrical energy
generation had developed.
The economy is semi-industrialized, with centres of growth along the Indus River. The
diversified economies of Karachi and Punjab's urban centres coexist with less developed
areas in other parts of the country.
According to the World Bank, Pakistan has important strategic endowments and
development potential. The increasing proportion of Pakistans youth provides the
country with a potential demographic dividend and a challenge to provide adequate
services and employment. 21.04% of the population live below the international poverty
line of US$1.25 a day. Unemployment rate among aged 15 and over population is 5.5%.
Banking in Pakistan is competitive and profitable. There are 6 full-fledged Islamic banks
and 13 conventional banks offering products and services. Islamic banking and finance in
Pakistan has experienced phenomenal growth. Islamic deposits held by full-fledged

Islamic banks and Islamic windows of conventional banks at present stand at 9.7% of
total bank deposits in the country.

3. Environment
The geography and climate of Pakistan are extremely diverse, and the country is home to
a wide variety of wildlife.] Pakistan covers an area of 796,095 km2 (307,374 sq mi),
approximately equal to the combined land areas of France and the United Kingdom. It is
the 36th largest nation by total area, although this ranking varies depending on how the
disputed territory of Kashmir is counted. Pakistan has a 1,046 km (650 mi) coastline
along the Arabian Sea and the Gulf of Oman in the south and land borders of 6,774 km
(4,209 mi) in total: 2,430 km (1,510 mi) with Afghanistan, 523 km (325 mi) with China,
2,912 km (1,809 mi) with India and 909 km (565 mi) with Iran.
The climate varies from tropical to temperate, with arid conditions in the coastal south.
There is a monsoon season with frequent flooding due to heavy rainfall, and a dry season
with significantly less rainfall or none at all. There are four distinct seasons: a cool, dry
winter from December through February; a hot, dry spring from March through May; the
summer rainy season, or southwest monsoon period, from June through September; and
the retreating monsoon period of October and November. Rainfall varies greatly from
year to year, and patterns of alternate flooding and drought are common.

4. Education
The Constitution of Pakistan requires the state to provide free primary and secondary
education. At the time of establishment of Pakistan as state, the country had only one
university, the Punjab University in Lahore. On immediate basis, the Pakistan
government established public universities in each four provinices including the Sindh
University (1949), Peshawar University (1950), Karachi University (1953), and
Balochistan University (1970). Pakistan has a large network of both public and private
universities; a collaboration of public-private universities to provide research and higher
education in the country, although there is concern about the low quality of teaching in
many of the newer schools.
It is estimated that there are 3193 technical and vocational institutions in Pakistan, and
there are also madrassahs that provide free Islamic education and offer free board and
lodging to students, who come mainly from the poorer strata of society. Strongly
instigated public pressure and popular criticism over the extremists usage of madrassahs
for recruitment, the Pakistan government has made repeated efforts to regulate and
monitor the quality of education in the madrassahs.
Education in Pakistan is divided into six main levels: nursery (preparatory classes);
primary (grades one through five); middle (grades six through eight); matriculation

(grades nine and ten, leading to the secondary certificate); intermediate (grades eleven
and twelve, leading to a higher secondary certificate); and university programmes leading
to graduate and postgraduate programs. Network of Pakistani private schools also operate
a parallel secondary education system based on the curriculum set and administered by
the Cambridge International Examinations of the United Kingdom. Some students choose
to take the O-level and A level exams conducted by the British Council. According to the
International Schools Consultancy, Pakistan has 439 international schools.

5. Health
Expenditure spend on healthcare was ~2.8% of GDP in 2013. Life expectancy at birth
was 67 years for females and 65 years for males in 2013. The private sector accounts for
about 80% of outpatient visits. Approximately 19% of the population and 30% of
children under five are malnourished. Mortality of the under-fives was 86 per 1,000 live
births in 2012.

6. Diseases
According to surveys conducted by government and reviews of statistics, these are the
top 10 deadliest diseases in Pakistan.
1. Acute respiratory infection (51%) is one of the most lethal diseases in Pakistan. Most
victims are children under the age of 5 with weak immune systems. It is caused by
viral infections, pneumonia and Influenza-like illness.
2. Malaria (16%) greatly affects the lower-class people in Pakistan who live in rural
areas or slums. The high incidence of malaria is due to the presence of stagnant
bodies of water and unsanitary conditions where mosquitoes breed.
3. Viral Hepatitis (7.5%) is a major epidemic in our country. Approximately, 12 million
people are infected with either hepatitis B or C.
4. Cholera, infection of the small intestine, is controllable but it is still prevalent,
particularly during the rainy season.
5. Dengue fever is another controllable but highly infectious disease with frequent
epidemics.
6. Tuberculosis is one of the major diseases in Pakistan. It is the fifth TB high-burden
country worldwide. Not only that, globally, it has the fourth highest prevalence
of multidrug-resistant TB (MDR-TB).
7. Breast cancer is the most common cancer in Pakistan. About one in every nine
women in Pakistan suffers from breast cancer. Approximately, 40,000 women die
every year of breast cancer in Pakistan.

8. Cardiovascular diseases kill 200,000 annually in Pakistan. Over the last few years,
obesity has become an health issue in our country that eventually leads to coronary
heart diseases and diabetes.
9. Talking of diabetes, Pakistan has the highest percentage of people in South Asia with
diabetes. Right now, there are 7 million people in Pakistan with diabetes.
10. Lung cancer takes the lives of 100,000 people every year in Pakistan, and almost 90%
of the cases are caused by chain smoking. In South Asia, Pakistan has the highest
consumption of tobacco.

7. Hospitals
1. Civil Hospital, Karachi
2. Pakistan Institute of Medical Sciences, PIMS Hospital, Islamabad
3. Shaukat Khanum Memorial Cancer Hospital, Lahore
4. Jinnah Hospital, Karachi
5. Punjab Institute of Cardiology, Lahore
6. Shifa International Hospital, Islamabad
7. Lady Reading Hospital, Peshawar
8. Childrens Hospital, Quetta
9. Nishtar Hospital, Multan
10. Civil Hospital, Hyderabad

8. Insurance companies
Public sector
1. National Insurance Corporation
2. Pakistan Reinsurance Company Ltd.

3. Postal Life Insurance

4. State Life Insurance Corporation Ltd.
Private sector
a) Incorporated in Pakistan

1. Adamjee Insurance Company Ltd.

2. Agro General Insurance Company Ltd.
3. Allianz EFU Health Insurance Company Ltd.
4. Alpha Insurance Company Ltd.
5. Amercian Life Insurance Company Ltd.
6. Asia Insurance Company Ltd.
7. Beema Insurance Company Ltd.
8. Central Insurance Company Ltd.
9. Delta Insurance Company Ltd.
10. East West Insurance Company Ltd.
11. Gulf Insurance Company Ltd.
12. Indus International Insurance Company Ltd.
13. Metropoliton Life Assurance Company Ltd.
14. Muslim Insurance Company Ltd.
15. Prime Insurance Company Ltd.
16. Reliance Insurance Company Ltd.
17. Universal Insurance Company Ltd.
b) Incorporated abroad
1. ACE Insurance Aid Pacific Ltd.
2. CGU Assurance Company Ltd.
3. New Hampshire Insurance Company Ltd.

4. New Zealand Insurance Company Ltd.

5. Royal & Sun Alliance Assurance plc.

CHAPTER 6
FINDINGS AND CONCLUSION

FINDINGS

The overall Indian healthcare market today is worth US$ 100 billion and is
expected to grow to US$ 280 billion by 2020.

The analysis of various literature and interaction with the patients revealed that
clinical outcomes in India area at par with the worlds best centers as hospitals
here have internationally qualified and experienced doctors.

Political unrest continues to pose a significant threat to economic activity in

several countries including Central African Republic, the Democratic Republic of
the Congo, Somalia and South Sudan. Meanwhile, the reliance on agriculture
leaves many countries prone to weather-related shocks.

The most prominent markets for Narayana health are Bangladesh, Nigeria, Oman,
Iran, Kenya, Maldives and Tanzania

The non Indian patients visiting ratio in Narayana Health Hospital

40% from Bangladesh

30% from Middle East countries

20% from African countries

10% from other countries

CONCLUSION

Future of medical tourism is bright and is considered as mile stone for growing
Indian economy. World class facilities and infrastructure will make India as most
suitable destination in medical tourism in the worldwide. Taking a clue from the
current scenario, it would be apt to conclude that medical tourism has huge
potential in times to come as more and more foreign travelers will be visiting
India specially Delhi, Bangalore, and Chennai for their health needs and keeping
an eye on future will lead to quantitative and qualitative gains for international
and national clients.

Factors that encourage foreign nationals to seek healthcare in India are low-cost,
quality of service, availability of latest technology, and well qualified and skilled
healthcare professionals

Narayana Health City has been a well accomplished center for medical tourism
since the last 4 years. All the associate hospitals of the Health City offer
international standard medical care facility. The Narayana Health proud to be
offering such high quality services to the international patients. Besides offering
medical care, NH provides assistance of interpreters at request for the overseas
patients.