Good morning, everyone. My name is Saurabh Paliwal, and I welcome you to Aster DM Healthcare's Earnings Conference Call for the first quarter of financial year 2023. The company declared the Q1 FY23 results last evening. I hope you got a chance to review them along with other materials which were posted on the stock exchanges and also on the company website. Today, to discuss the quarterly business performance and future business outlook, we have the senior management at Aster DM Healthcare available with us, includes Dr. Azad Moopen, Chairman and Managing Director, Ms. Alisha Moopen, Deputy Managing Director, Mr. T. J. Wilson, Non-Executive Director, Mr. Sreenath Reddy, Group Chief Financial Officer, Mr. Amitabh Johri, the Chief Financial Officer for the GCC, and Mr. Sunil Kumar, Head of Finance for India.
I would also like to remind everyone about how we will conduct this call. All external attendees will be in the listen-only mode for the duration of the entire call. We will start the call with the opening remarks by management, followed by an interactive Q&A session. During the Q&A session, you will get a chance to ask the question by raising your hand by clicking on the Raise Hand icon in the Zoom application at the bottom of the window. We will call out your name, after which your line will be unmuted, and you'll be able to ask question. We'll request to please limit your questions to two, but not more than three per participant at a time. Post the completion of your query being answered, we will lower your hand. Finally, before we get started, safe harbor related to this earnings conference call.
Certain statements that may be discussed in this meeting that are not historical facts may be forward-looking statements. Such forward-looking statements are subject to certain risks and uncertainties like government actions, local, political or economic developments, technological risks, and many other factors that could cause actual results to differ materially from those contemplated by relevant forward-looking statements. Aster DM Healthcare Limited will not be in any way responsible for any action taken based on such statements and undertakes no obligation to publicly update these forward-looking statements to reflect subsequent events or circumstances. With this, I will ask Dr. Moopen to start with his opening remarks. Over to you, sir.
The mic is on mute, I think.
Dr. Azad, if you could unmute yourself, please.
Yeah. Sorry about that. Am I audible now?
Yes, you are.
Can you hear?
Yeah.
Yeah.
Yes.
Sorry about that. There was some technical issue. Good morning, everyone. Thank you all for joining us for the earnings call for the first quarter of financial year 2023. I hope and pray that all is well with you and your families. As the summer vacations conclude in India and other parts of the world, I hope most of you were able to take a break this summer. The world has now reached a stage where COVID cases continue to be there, but we now consider it to be a part and parcel of our lives, exercising necessary safety precautions.
The Ukraine conflict continues, and along with it, high energy prices and Taiwan standoff between USA and China, all this together, continue to battle high inflation with global central banks responding by increasing interest rates, thereby dampening growth prospects. However, we are happy that the scenario in our key markets in India and Dubai seems to be much better with strong growth prospects. GCC, from where we derive majority of our revenue, has the benefit of spiraling oil costs, which will have an impact indirectly in all businesses there, whereas this is actually a damper for India. Let me discuss the financial performance of Aster for quarter one financial year 23. At a consolidated level, we posted a revenue of INR 2,662 crores, which is an increase of 12% when compared with the same period last financial year.
EBITDA grew only 4% to INR 292 crores when compared to INR 281 crores in financial year 2022. EBITDA growth was impacted due to losses of INR 20 crores from commissioning of new hospitals in GCC and India. Profit after tax post NCI stands at INR 69 crores when compared to 44 crores in quarter one financial year 2022, a growth of 54%. Profit after tax post NCI, excluding impact of commissioning of new hospitals and one-time other income, is INR 77 crores, a healthy growth of 74%. With respect to the GCC business, revenue grew 10% year-on-year to INR 2,011 crores with EBITDA of INR 208 crores as compared to INR 210 crores in the same period last financial year.
The Aster India business is growing well, with revenues growing 18% to INR 615.1 crore and EBITDA increasing by 18% to INR 84 crore. Profit after tax post NCI stood at 19 crore as compared to loss of INR 1 crore in quarter one financial year 2022. This shows that we can sweat the assets well in India, increasing revenue and profits. I also want to mention that regarding the GCC, as you all know, this is relatively a weak quarter or half when you look at the first half of the year. That is part of the reflection of that. Of course, along with that, the starting of the new hospitals, which were mainly happening in GCC. Moving to the operational updates of the quarter.
In India, during quarter one we started operations management of the 140-bed Aster Mother Hospital in Areekode in Kerala, kick-starting our planned brownfield low CapEx initiatives, which gives a much better ROE and improves our efficiencies. This addition takes our bed count in India to 4,033 capacity beds. As stated earlier, we are looking at more of such opportunities in various parts of India, and we hope to announce some of this in the coming quarters. We have submitted revised plans for an integrated advanced healthcare facility in Trivandrum, capital of Kerala, named as Aster Capital. Where the hospital is planned to be a 150-bed facility ultimately, the first phase shall be a capacity of 350 beds and is expected to be operational by FY26.
We have bought 6.5 acres of land five years back, and the project was kept on hold due to COVID. We see a huge demand-supply gap in Trivandrum and expect an early break-even of this project in about a year after inauguration, like what we did at Kannur. Aster Labs, which has its presence in both Karnataka and Kerala, has now also entered four other states, Maharashtra, Tamil Nadu, Andhra Pradesh, and Telangana. As of 30th June 2022, there were two reference labs, 15 satellite labs, 109 patient experience centers. The B2C business in Aster Labs is yet to pick up to the levels we wanted due to many factors, including tough competition. However, we have started realizing the benefit of having the labs as an integral part of the ecosystem to create an omni channel.
We have already, we have recently launched Aster Labs on WhatsApp. This customer-centric approach should help us service our customers even better. With respect to the Aster Pharmacy branded retail stores operated by Alfaone Retail Pharmacies Private Limited or ARPPL, as of thirtieth June two thousand twenty-two, there are 176 pharmacies, 89 in Karnataka, 45 in Kerala and 42 in Telangana. As part of its service proposition, which provides facilities like prescription refill reminder, customer-centric promotions, and free home delivery, Aster Pharmacy in India plans to launch its e-commerce operations in the second half of financial year 2023. In the GCC region, the 101-bed Aster Hospital Sharjah had a soft launch during the quarter. There has been some delay in launch of the 145-bed Aster Royal Hospital in Muscat, Oman, due to authority approvals.
We have now got the permissions, and we hope to inaugurate this soon. These two hospitals will increase our capacity bed count in GCC to 1,431. I just want to touch upon the Saudi business. Over the past few quarters, the Saudi business has seen an improvement in performance. As a result of this turnaround, we are now looking to get a minority investor on board instead of selling off the whole business. The first quarter EBITDA of Saudi business, despite the challenges of Ramadan, et cetera, was in the single digits. We are looking to actively enter the retail pharmacy business in Saudi and discussions are going on. The status of restructuring. The process is going on.
The board of directors provided their approval for appointment of the bankers to explore potential restructuring options, which present an opportunity to unlock value for the company and its shareholders and provide further update to the board in relation to further steps to be taken in this regard. Appropriate announcements and public disclosures in accordance with the listing regulations and other applicable laws will be made as and when required in this regard. I now request the Deputy Managing Director, Alisha Moopen, to elaborate on the GCC business, the digital transformation, and other strategic initiatives undertaken by Aster. Thank you very much.
Thank you, Chairman. Good morning, everyone. Just like Chairman mentioned, we are in a stage where COVID has now become a part and parcel of our lives, with normal life and business moving in full swing, and so is Aster. As Chairman mentioned again, we have two of our new hospitals, which we had put on hold during COVID, now we have begun the commissioning. The Aster Hospital, Sharjah, which is a 101-bed hospital, has opened up with a soft launch during Q1, and Aster Royal Al Raffah Hospital in Oman with 145 beds is expected to have the soft launch end of this month since we just got the regulatory approval. We are excited to get them operational in Q2 of this year as we expand the footprint in the GCC. Revenues at GCC saw a return towards normalcy.
This period of Q1 marked by both the Ramadan break as well as Eid holidays, and there was also the sad demise of the ruler of UAE, which had some extended mourning period as well. The combination of all of that, we've seen a little bit of a soft quarter which anyways is quite typical of Q1 and Q2 in GCC. The hospital revenues yet, quarter-on-quarter grew by 8%. The retail business saw a strong comeback, with the increase in revenue of 30%, while the core revenue of clinic business, which is excluding the PCR revenue, saw an increase of 26%.
The GCC business would have seen a much better EBITDA but for the operational losses of the new hospitals which has been commissioned, which resulted in a loss of almost 15 crore in the GCC. As chairman briefed on the Saudi business, which really was a concern for a long time, it has witnessed a positive turnaround. We've seen a very sustained revenue and EBITDA numbers despite the summer as well as Ramadan. Some of this is emanating from certain systemic changes which we've made in the business, and we believe they are likely to maintain as business trends. We truly believe that Saudi has huge potentials, and for our GCC strategy, we cannot ignore this. We have recently signed a preliminary MoU with one of the largest retail and entertainment group to launch our pharmacies in Saudi.
These will be low CapEx, but will help us harness the healthcare ecosystem better. On the digital initiatives, our expansion, we are continuing to tread along the planned lines. We've done a successful launch of our digital app in Dubai. Currently, we're live with both the tele consultations as well as the online pharmacy in the UAE, which we have seen a positive response to. With pretty much no marketing, we've had more than 100,000 users who since the launch in June and this was the numbers up till end of July. We actually aim for marketing to be driven from the end of August and expect the numbers to scale quite significantly. At this moment, we're running live load tests and refining the system responses to ensure that the platform remains stable at higher loads, which we expect post-marketing.
For India, the teams are engaged in solving the specificities of the technology and the workflows, and we expect the India business to be enabled on the digital platform soon, which will complement both our pharmacies as well as the labs which are growing in scale. For the Aster Innovation and Research Center, which is the innovation hub of Aster DM, we have collaborated with Intel Corporation and CARPL to announce a state-of-the-art secure federated learning platform. This will enable the development of AI-enabled health tech solution where data can securely reside where it is generated. This collaboration will boost innovation in areas such as drug discovery, diagnosis, genomics, predictive healthcare. It will also help clinical trials to access the relevant data sets in a very secure and distributed manner.
I will now request our Group CFO, Srinath Reddy, to take you through the details of the financial and segmental performance of the quarter. Thank you.
Thank you, Alisha. Good morning, everyone. On a consolidated basis, our revenue from operations for the quarter has increased by 12% to INR 2,662 crore year-on-year. India revenues have increased to INR 651 crore, up 18% year-on-year from INR 550 crore. The revenue growth excluding COVID vaccination in India was 26%. Revenue from our GCC operations was INR 2,011 crore, an increase of 10% year-on-year, whereas the revenue growth excluding COVID testing was 18% year-on-year. Consolidated EBITDA for the quarter was at INR 292 crore, an increase of 4% year-on-year.
However, if you exclude the losses of new hospitals not present in your FY22, quarter one, namely Aster Hospital, Sharjah, Aster Hospital, Sonapur, and Aster Mother Hospital, Areekode, the EBITDA growth will be 11%. EBITDA from India operations was INR 84 crores, a growth of 18% year-on-year. EBITDA from GCC operations stands at INR 208 crores, a decrease of 1% year-on-year. Excluding losses of new hospitals in GCC amounting to INR 16 crores, the EBITDA growth will be 6.7%. An important point to mention is that we are now going back to the pre-COVID scenario, wherein the EBITDA for the first half of the year, as per the historical trends, will be in the range of 40% of the full year numbers.
Consolidated PAT post NCI is at INR 69 crore as compared to INR 44 crore in Q1 FY22. Excluding losses of INR 32 crore from new hospitals and one-time other income, the PAT stands at INR 77 crore, a growth of 34% year-on-year. Coming to the segmental performance for the quarter, GCC hospital revenue was at INR 930 crore, an increase of 8% year-on-year, and the EBITDA stands at INR 133 crore, compared to INR 130 crore in FY22 Q1. Our hospital in Saudi has performed well during the quarter. The EBITDA from the business has nearly doubled with high single-digit margins. GCC clinics revenue stands at INR 538 crore, a decrease of 2% year-on-year.
Excluding revenue from COVID testing, the business registered a growth of 26%, which is a sign of a core business normalizing. EBITDA decreased by 9% year-over-year to INR 91 crore, and EBITDA margin stands at 17%. GCC pharmacies revenue increased 30% year-over-year from INR 508 crore to INR 660 crore. EBITDA increased from INR 44 crore to INR 58 crore, an increase of 32%. EBITDA margin for this segment is at 8.8%. India hospitals and clinic segment has grown to INR 627 crore when compared to INR 549 crore, an increase of 14% year-over-year. EBITDA has increased from INR 84 crore to INR 99 crore, an increase of 18%.
Consolidated net debt as at 30th June 2022 stands at INR 1,847 crores, compared to INR 1,806 crores as at 31st March 2022. India net debt stands at INR 359 crores compared to INR 390 crores as at 31st March 2022. GCC net debt has reduced to $189 million from $197 million as at 31st March 2022. Capital expenditure during the quarter was INR 142 crores. On that note, I conclude my remarks. We will be happy to answer any questions that you may have. I now request Saurabh to open the Q&A session. Thank you.
Thank you, Sreenath. Anybody who wants to ask a question, please use the raise hand icon at the bottom of the Zoom application. We'll wait a moment for the line to assemble, and then take your questions one by one. The first question is from Nikhil Chandak. You may please unmute your line and ask your question.
Yeah. Hi, good morning. You know, my question was on the proposed restructuring. You know, if you could share some more elaborate thoughts on what exactly is the, you know, the plan of action. Because, frankly, every con call we hear that, "Yeah, this is under consideration," but, you know, it's been a long time, and there is no, you know, visible progress at least to the investors on, you know, what really is happening, what is the thought process. Even on the Saudi hospital, as you mentioned, there's a change in plan where you're not exiting or you're getting an investor there. So what exactly is the plan? You know, do we eventually see two separate entities, one India and one non-India? You know, some plan and timeline would help.
Thank you very much. Thanks a lot. The first part I'll answer, then Alisha will answer about the Saudi. Regarding the restructuring, I assure you that it's going forward in the direction which we wanted, where we wanted the two businesses, one in GCC and one in India. In the GCC, now it's very clear. Earlier there was a lot of, I mean, talk about that, but now we are looking at the GCC business and looking for somebody to come into the GCC business. There is a vendor DD happening in GCC which is in progress. Once the vendor DD happens, and that is over, that's the time when we hope that we'll have more of clarity on that.
Answering your question, there is more of clarity and this is going the direction where there'll be a segregation between the two businesses. Once we have a clarity on what are the bids and after the vendor DD happens, then we will get back to you as well as to, as per, you know, the requirements we will inform the stock exchange. That's the first part. Regarding Saudi, Alisha, if you can just enlighten him, you know.
Thanks, Nikhil. Thanks for the question. Earlier when we were looking at a potential exit from Saudi, it was because the Saudi market requires quite significant, probably capital allocation for us to grow in a market like that. We thought maybe if we are continuing as a global entity with the GCC business, we would rather allocate the capital into India rather than in some of the other GCC markets. Now with this potential restructure, what we have realized is a lot of the investors who have expressed interest to come into the Aster GCC business thinks of Saudi as a core business and a core geography that they would want to pursue.
At that point in time, we do not feel comfortable exiting from a market at this point in the restructuring process. We felt it would be better for us to stay until we have clarity on the partner who's coming on board. If they wanted to pursue the Saudi business, we thought it would be a bit premature for us to exit from it, especially as we mentioned earlier, the business seems to have been doing well. Most of the Saudi business are turning around, and there seems to be a very positive traction there. One on its own accord, it's standing strong. Two, as part of the restructure also, we believe that Saudi is a important element to get the right investor attention and demand. I hope that clarifies.
Perfect. Yeah, thank you. The last question was, you know, on capital allocation in the interim till the restructuring doesn't come into effect. You know, how do you see capital allocation between India and non-India? Even within India, you know, in the competitive diagnostics space, where do you think, you know, the focus would lie?
Yeah. See, we have a clear plan now, and we are following that, in spite of, the restructuring process happening. The only change is that, we would like to hear from the investors regarding the GCC, what their, requirement is. As to a great extent, whatever we have announced regarding the India GCC, the split between the, capital allocation will happen this year, because we are almost halfway through. Regarding the allocation of the capital, see the capital required for, very low CapEx business, like the hospitals as well, I mean, the lab as well as pharmacy is, not very high when compared to a hospital.
What we have allocated now is a large part is going towards the major projects like, you know, the hospital in Trivandrum, as well as the one which we announced for Kasaragod. The hospital projects will be the one which will be attracting the largest capital. The others will be there, but the numbers will be high when you look at the total number of establishments. The capital requirement for these businesses are much lower when compared to the hospital business. Answering your question, there is no change from what we discussed earlier between GCC and India for the capital. Second, in India, the focus will be on the hospital business. Even that, as we have mentioned, there is a change now.
We want to make it low CapEx, and that's why this brownfield projects like the mother hospital, we are looking at many opportunities and we hope that we'll be able to have significant number of beds added to that, where the CapEx allocation that is required is very minimal.
Great. Thank you so much.
Thank you.
Thank you, Nikhil. The next question is from Amrish. You can unmute yourself and ask the question.
Hi. Thanks for the opportunity and congratulations on a solid set of numbers, despite the loss of COVID revenues. Thank you very much also for increased transparency in the clinics and pharmacy data in India. First question I had was on the operational performance in India. Is there something more you could shed on what's happening in Andhra and Telangana in terms of financial operational metrics? Everything seems much weaker than the rest of India.
Yeah. I'll ask Sunil to add on to whatever I say. Sunil is our India CFO. The business in Andhra and Telangana when compared to our businesses in Kerala and Karnataka has been weaker. Part of it is because we had very high business last year because of COVID. The COVID revenue was very high. In spite of that, we had put some budgets, but they have not reached those budgets. The reason for that is mainly because the hospitals in Andhra and Telangana have come out of the schemes, the Aarogyasri and such schemes which are there, because they wanted to cater to more of a cash and insurance business. This we think that is something which we should be looking at because that is reducing the occupancy.
We are now in a process of attracting, I mean, going into talks that will ramp up the occupancy and which will help us to have better occupancy and also to sweat the assets better. That's what more about the Andhra and Telangana. We hope that with this, whatever strategies that have been adopted, that should do better, and if not to the speed of the other two clusters should be doing better. Sunil, do you want to add something onto that?
Sure, chairman. Thank you. Thanks, Amrish, for the question. Just to add to what chairman said is that, as you know that, you know, just to put numbers to it, last year, same time, we had the wave two going on. Andhra and Telangana is where we have the smaller format hospitals which really did good, wherein the COVID revenue went up to 50% of the total revenue. Because of this, what happened is that the EBITDA margins were very high, you know, upwards of 20%, 30% and all. Now, you know, you know that, right? It is H2 last year. Then, you know, COVID numbers have completely come down. Now we are trying to depend on more of the non-COVID numbers. This is a scenario across the hospitals, across the clusters.
We have seen that Karnataka and Kerala did very well to bring back the non-COVID revenue. They are even better than the pre-COVID numbers, what we see. That is not the case in Andhra and Telangana. Similar other hospitals also facing that issue. Currently the occupancy is, you know, sub 50%. As chairman said, you know, we are also looking at how to increase the numbers by bringing in the schemes. Because, considering scheme patients are quite high in Andhra and Telangana cluster, we cannot work without, schemes, but we will try to see how to get in through, see that we don't, you know, dilute the ARPOB, neither the, you know, EBITDA margins. Whatever you see is just a one-time thing. We're just trying to recover. Future quarters are going to look, you know, quite better on this aspect.
Thank you. I suppose it's better to look at it from a longer term and assume the FY22 numbers are a little bit of a blip as well. That's helpful. Thank you. A couple of just strategic comments/questions. On slide 18 on Aster Labs, there is a mention of Delhi being added as a potential location. Is this a planned activity or is this an error, or just because it's getting very competitive, and is this where we want to go?
Yeah. Thank you for that question. This is something which we also internally reviewed. In the overall plan, north was very minimal, but Delhi, because maybe even that, our CEO for the hospital sector was earlier in the north. He had huge hope, and he wanted a presence in the state capital as well as in some other major metros. We have now thought that we will look at the next few quarters, how the business is doing in the south, then only we will go into the north. Whatever you have seen there is not going to happen immediately. We have said that we'll go to the north only after stabilizing the south.
Thank you. That makes sense. Just a quick one on the restructuring as well. Through the process, I'm assuming that we don't lose the benefit of the synergies that we have both ways. I assume that's already been considered, but if you could just give some comfort on that, because we benefit from, say, the digitalization activities in GCC, patients this way, and of course, from India, we can send doctors and so on.
Yeah. No, no, that's a very, very important thing which we have deep in our mind. One of the things which is going to remain as it is is that we are going to be there on both sides. Whatever restructuring happens, as promoters, we'll be there on both sides. The synergies which are there, which are beneficial for the company, will be continuing. Like for example, the movement of employees, the movement of patients and the things like what you mentioned about the digital. Those things will continue wherever there is a benefit to both sides and at arm's length, we'll be doing that.
Thank you. I'll come back into the queue. Thank you.
Thank you.
Thank you. The next question will be from Spark Capital, Harith Ahamed. You can unmute your line.
Hi, good morning. Thanks for the opportunity. My first question is on Sanad. So you mentioned that there's a fair bit of improvement there. Can you give an indication of the EBITDA margins there currently? Are we at a high single digit margin level there, or have we touched a double digit margin there? Some sense would be helpful. One more follow-up on Sanad.
Yeah, sure.
Would be that, you know, you talked about, you know, bringing in a minority shareholder there. Can you elaborate a bit more on the rationale for this? What exactly will the fund be used for? Because the way I see it, the expansions that we've talked about so far at Sanad, you know, we should be able to finance it through our own balance sheet.
Yeah. Dr. Harith, Alisha will come on the second part. On the first part, in terms of the margins at Aster Sanad Hospital. See, historically, if you look at quarter one and quarter two, for us in the GCC, it's a lean period, mainly because of the summer holidays. Quarter three and quarter four are strong period. Now, if you look at Aster Sanad Saudi, quarter one will be the weakest. But however, if you look in the current year, in spite of the you know holidays and the festivals, quarter one, we are at 9% EBITDA margin at Aster Sanad Hospital. These margins will get into double digits, getting into quarter three.
Therefore, there is hope that the turnaround has happened, and this performance will lead to stronger margins in the coming quarters. Alisha, on the minority interest.
Sure. Thanks, Harith. On the minority interest, there is an expansion of the hospital. We have 60 beds, which again, we had put on hold. Right now we are running at almost 85% occupancy. Like you said, the internal accruals should take care of us expanding that bed capacity. This was more looking at a more strategic partner for Saudi. We were thinking of using this funds from the potential minority partner coming in for the expansion of the pharmacies. We would use it for the pharmacies and also the base on the digital that we are setting up in UAE. We would like to quickly mobilize the same in Saudi. That would again go towards some of that in Saudi. That was the plan towards Saudi.
Thanks. That's helpful. My next one is on GCC Pharmacies. I see that revenues have increased. I know we generally don't look at the GCC business on a quarter-on-quarter basis, but still, you know, looking at the GCC Pharmacy segment, the revenue increase quarter on quarter has been almost 10%, but the EBITDA has almost halved. Struggling to understand why, you know, with revenues growing, there's this such a high impact on or such a high decline in EBITDA.
Amitabh, you would like to take that up?
Sure. Thank you for the question. I think you're looking at a sequential number between quarter four of FY twenty-
Yeah.
Yeah. Typically, this is impacted by two factors. One, of course, is the factor that quarter four is the highest quarter that we have in a year. It's a seasonality factor that is there. Which is a reflection that you if you look at the quarter one of the year, because of, as Alisha called out, that the Ramadan holidays and the summer period, there is a natural reduction in the volumes that are sitting over there. It's also the factor on EBITDA that comes in, wherein, in the as we close the financial year, there are typically procurement benefits that come in, which we do not know till for the whole year, they only come towards the end of the year in our knowledge.
Which is why you would notice that the margins for the quarter four for pharmacies are relatively higher than the other balance of the year. However, if you were to compare the year-on-year basis performance of pharmacies, I think that data is more representative because we've seen between the quarter one of FY 2022 and quarter one of FY 2023, a 30% increase in the top line of pharmacy and a bottom-line increase of 32%. I think that is a more relevant data to look at because it's representative of the business change that we have observed.
All right. Srinath, this unallocated and eliminations item that we have both at revenue and EBITDA level, there's been a sharp increase. It's almost INR 1.20 crore at the revenue level and INR 80 crore at EBITDA level. This is an increase from INR 60 crore in the last couple of quarters. What exactly is the nature of these items here? Can you explain the increase as well?
Yes. This, if you look at Dr. Harith, the pharmacy business has increased during the quarter, right? The pharmacy business also provides their services to our other verticals. That is where this unallocated will be a higher number.
Okay.
Yeah.
Thanks for that. That's all from my side. Thanks.
Thank you, Harith. The next question will be from Manoj Bagaria. You can go ahead and mute your line. Manoj? I guess he's gone. Next question will be from Manish Mandhana.
Hi. Can you hear me clearly?
Yes, yes. Please go ahead.
Yeah. Hi, good morning. I have two questions. One is regarding the medical tourism, which ideally the southern hospitals should have benefited. Are we seeing some recovery in the medical tourism which would ideally lead to a potential improvement in the operating utilizations of the hospitals in South?
Yeah. Definitely there is an increase. This had gone down significantly in the COVID period. This year-
Dr. Azad Moopen, your line is muted by mistake.
Okay, sorry about that. There is some issue, technical issue. Are you able to hear now?
Yeah, I can hear you.
Yeah. I was telling that there is definitely an increase in the MVT revenue which is coming from mostly GCC as well as from other regions. To give you some numbers, Sunil, can you give some numbers, indications in the first quarter performance?
Yes, Chairman. Manish, thanks for the question. Now if you see pre-COVID, when we look at MVT revenue, we were clocking 5% of the total India revenue and 10% across 8%-10% within the hospitals where we used to do MVT revenue. That had dropped to almost, you know, 1% during the COVID period. That is between FY21 and FY22. Now what we see is that the percentage is now in Q1 already back to around 7%-8%. When I look at only the units which do what do you call, the core MVT revenue. At the India level, with again the 1% which was down, now it has moved to almost 4%.
You know, to you know put it in a very simple manner, yes, COVID revenue is almost back to pre-COVID levels, almost 80%-90% you can say. We are seeing the good numbers already coming in July itself. We should be able to do very good in FY23.
My second question is regarding the pricing pressure in GCC. Are we at the bottom of the cycle in terms of the pricing pressure or do you think there's any more pricing pressure left, from where we are standing today?
Alisha, you would like to answer that, Alisha?
Yeah. I mean, when you are working in an insured market, there is always some pricing pressure that comes in. Over the last couple of quarters, internally, our focus has also been on shifting a bit of our portfolio from insured business to non-insurance. We've actually seen an upswing on medical tourism. We've had more than INR 200 crore of revenue in the last sort of nine months, just to our Medcare facilities. We are increased our focus on cosmetic, aesthetic business as well as the non-pharma piece, which is all cash. We ourselves are trying to get more than close to 20% of our business coming in from the cash element.
Separately, there has been a lot of discussions with the regulators to add the increase with the inflationary pressure to do a tariff revision upwards. This is a constant dialogue that happens between the payers and the providers. We believe that will keep continuing to happen. There seems to be a lot more upward increase as far as premiums are concerned, and we're just making sure that we get it passed on to the providers as well.
Would this strategy be implemented in India also, looking at the success what you are trying to find in Middle East?
Sorry, on what, Manish?
I mean to say the non insured portion, the cash payment portion, would you just implement this strategy in India also?
Yeah. There is a fair I mean, in India anyways our, It's largely cash for us. I think we're talking about 70%-80% of our business in India is cash. But, as the insurance penetration is increasing here, and as our focus on our flagship facilities, whether it is in Medcity, whether it's in CMI as well as Aster MIMS, there is a focus on MVT. In fact, we were just with the Medcity teams. There is a focus on a lot of the cash elements, like we spoke about. We're building a rehab center, 80 beds over there in Medcity, which will again be international patients, which will happen in the next one year. There is a focus on cosmetics and similar models.
We are trying to extend some of these strategies which make sense for India, of course.
Thank you.
Thank you.
Thank you, Manish. The next question is from Mehul Sheth from Axis Capital. You can go ahead.
Yeah, yeah. Am I audible?
Yeah, yeah.
Yeah. Yes, sir.
We can hear you.
Some question related to your margin guidance. Like what are your expectation towards segmental margins, like, in GCC as well as in the India hospital side? We have seen that Q1 was bit on a lower side for both hospital business in GCC and India, as well as clinic was expected to be on a lower side, but even pharmacy has declined. What is your overall outlook as per the segment in terms of margins?
Yeah.
Srinath Reddy, would you like to answer that, Srinath Reddy?
Yeah. Thank you. In terms of margins, hospital margins, if you look at it, especially in the GCC, has been more or less the same, mainly because of the new hospitals, new facilities that have come in. But for the new facilities, the margins, existing hospitals margins have improved. From 15.4%, the improvement is to 16.3% on the existing hospital. That improvement should continue in the coming quarters, and we expect somewhere around existing hospitals, almost close to 17%-18% is what we expect existing hospitals to do in the GCC.
Now, on the clinic side, we had indicated earlier itself because with the RT-PCR testing going away, definitely, that will have an impact on our margins compared to the previous year. We expect anywhere around 150-200 basis points of impact, which is playing out. In the coming quarters, we should do better even on the clinic side, because the core business on the clinics has come back and our dependence on the RT-PCR testing is now very minimal. Pharmacies, the revenues have gone up. However, the margins continue to remain the same.
On a full year basis, the margins will go up to around 11.5%, because once we get the various purchase benefits, the volume rebates and other things, so these margins will go up over the subsequent quarters, mainly in quarter three and quarter four. Coming to the India hospitals. India hospitals, we are seeing an improvement in the existing hospitals. There has been a slight drop because of the new hospital, Areekode, which has made some losses.
In spite of that, the margins have improved to 15.7% from the earlier 15.2% during the same period last year. In India, we expect these margins in the current year, in quarter three and quarter four, to be somewhere around 18%.
Thank you, sir. One more question on your pharmacy business itself in the GCC. What's your expectation in terms of sustaining this kind of a momentum in sales for at least FY23?
Okay.
Alisha, you would like to answer that, Alisha?
Mehul, we are actually quite bullish about the growth on the pharmacy. We have been working quite a lot with aggregators, we have been seeing a real uptake on the home delivery business. Once our digital platform push happens, as I mentioned earlier, we do believe we will have a very sustained and very strong year coming forward for Aster Retail. In general, when you look at Dubai, the retail business has been soaring. We have also been focusing on shifting from the pharma to the non-pharma, building up the cash component there. The margins should look better, like what Sreenath was saying, and we believe the growth will be better as their digital platform takes off.
Yeah. Yeah. Thank you. Thank you.
Thank you.
These are the questions from my side. Thank you.
Thank you, Mehul. The next question is from Shyam Srinivasan from Goldman Sachs. Please go ahead.
Yeah, thanks. Thanks for taking my question, and good morning, team. I joined a little late, so if some of my questions are repeating, my bad. The first one is on the cluster-wise India hospital and clinics data that you're sharing. Just noticed that, you know, the Andhra Telangana cluster, after a good growth fiscal 2022, right, I think 30% plus growth, we have seen some like decline. Just trying to understand what's happening there. Even some of the metrics around occupancy. If I look at capacity beds is also down. Just your initial thoughts on this one.
Yeah. Thank you, Shyam. In fact, like what you mentioned, we had this question earlier and this was answered, but, for the benefit of you as well as others who might not be there. Sunil, if you can just give those details, you know, the numbers which you mentioned about the Andhra Telangana cluster.
Sure, Shyam. Thanks for the question. Now, I'd put across that, you know, H1 or specifically Q1 in the Andhra and Telangana cluster, we have smaller format hospitals, you know, 150 beds. There the revenue was almost double during the COVID period, and the EBITDA margins were higher than 25%. You know that, right, that weathered out in the H2. Considering we don't do any schemes, right, only we depend on the cash and insurance patients. The recovery what we are seeing in the Kerala and Karnataka cluster, the recovery is not the same. In the Kerala and Karnataka cluster, the recovery is better than pre-COVID levels. We are not able to recover the same way in the Andhra and Telangana cluster because we have limited ourselves to only walk-in patients.
Considering considerably in this particular region, there is more scheme patients also. That is all of the reason why you can see the revenue drop per se, and that is indirectly affecting my EBITDA margins also. So you know, saying that this is just a one-off thing because we are seeing a you know, improvement in numbers happening in the Q2. I think this should be taken just as a one-off, not for the full long term, for the full year. We see the trends the way it improved in Karnataka and Kerala, it's going to improve in the going forward in the Q2 end or Q3, Q4 period.
Got it. Helpful. Just again, sorry if it's a repeat, but just noticed Q1 over Q1, even occupancy in Kerala and Karnataka / Maharashtra is also down, more so Maharashtra. Was that covered? Sorry.
Sorry. Yeah. Shyam, the thing was that, occupancy you are referring to Q2, you know, the wave two, wherein everything was 70% plus occupancy. Even India as a whole, we did almost 70%. Now we are at 63%. You can see the ALOS also, right? ALOS is very high at 4.5 in the Q1, FY 2022. Now we are at 3.5, 3.6. It's purely the COVID numbers which is what. If you look at the sequential Q4, we are at 60% occupancy margin. From there it is improved to 63% India. On a occupancy level, Kerala is above 75%. Karnataka, Maharashtra is between 55%-60%.
Andhra, as I said, because of the occupancy being lower, sub 50% is what it is there.
Yeah. What's the outlook for the remainder of the year? How should we look at occupancies for the India hospitals?
Yeah. It will be better than.
Yeah.
Yes, Shyam Srinivasan.
Yeah, please go ahead, Sunil.
No. Shyam, it will be better than that because, you know, Q1 is the year, you know, quarter which we start, and Q2 is the best quarter in India, right?
Mm-hmm.
Q4. Q3 is what we have festivals and all. Usually you can see a decline. Q2, as I said, the indications already in July is 70%. That shows that, you know, we will do better than occupancy in Q2 and Q4, better than what we have seen the numbers in Q1.
Fair enough. Yeah, very helpful. Last question is on the ARPOP dynamics. I think some question asked on GCC pricing pressure, but even in India this quarter, we have about 20% ARPOP growth. So, maybe you know, if you could get a overall sense of how we should look at ARPOP for the fiscal 2023.
Yeah. Shyam, if you're referring to Q1 FY22, as I said, because of the higher ALOS, ARPOP gets diluted. Also you know that, COVID revenue was as high as 25% during that time. Also because of the restrictions what we had in Kerala and Karnataka very specifically, the ARPOPs were, you know, dragged down. Now, what you see, INR 36,000, is because we have also taken certain price increases in majority of the, you know, locations what we have or the clusters what we have. The consolidated number what you're seeing or the, ARPOP what you see at the cluster level, these are the ARPOPs are very stabilized because there is no one-off item, in this quarter, right?
There is nothing as in with respect to the vaccination or the COVID revenue specifically in Kerala and Karnataka. In Andhra, yes, you, if I take scheme patients more, which is not there today, you can expect certain dilution of 10%-20%.
Yes, Sunil. What's the price increase? Like, quantitatively, what have you taken? Is it like same-
It's between 5%- %10. Not across the board. It depends on, you know, certain services we have taken, certain services we've not taken. Overall it ranges between 5%-10%. Yeah.
Got it. The remainder of the question was on the GCC. What's happening to RPOBs there? Thank you.
Yeah. The GCC RPOB, Amitabh, if you could give some color on that.
Sure. Thanks for the question, Shyam. Shyam, if you look at it in the GCC RPOB, while our overall revenue from hospitals increased, there's also increase in the bed capacity. With the Sharjah Hospital coming in, the bed capacity has increased from 1,160 to 1,260 while the hospital is not fully operational. The occupancy between a Q4 and a Q1 also declines, which is around 53% going to 51%, which has resulted in the reduction on the RPOB from $205 thousand to $194 thousand. Those are largely the reasons why we've seen an RPOB reduction between a Q4 and a Q1.
Outlook, Amitabh, sorry.
The outlook is only going to get better from here because this is the lean quarter for us. The Q1 and Q2 are the lean quarters for us. If you look at the last year, you would observe the same trends.
Mm-hmm.
Despite COVID, we saw better RPOBs in the quarter three, quarter four. As we go towards the end of the year, in between the quarter three, quarter four, we expect this RPOB to rise.
Yes. The revenues for Shyam.
Yes, sure.
RPOB definitely because in terms of the revenues, we'll do better in quarter three and quarter four. In terms of RPOB, because more beds are getting added and more the Aster cluster, because this is a mix of Medcare and Aster. Not only Medcare, Aster also, the occupancy is going to go up. However, more beds will come into this segment of Aster, because we have got Oman which is coming up, then we also got the Aster Sharjah, which is more in the Aster brand. You could see somewhere a slight decrease once these beds get occupied. That could be a small decrease in terms of the RPOB.
Got it. Yeah. Thank you, and all the best.
Thank you.
Thank you, Shyam. The next question is from Puneet Maheshwari. You can go ahead and ask your question.
My question is already asked, so it's already answered.
Thank you. Next question is from Nikhil Mathur from HDFC Mutual Fund.
Hi. Good morning. I hope I'm audible.
Yes, yes. We can hear you.
Yeah, sure. Yeah. Good morning, sir. My question is on the Saudi operations. You mentioned that the outlook for that particular country is looking good, at least in FY 2023. Just wanted to understand what exactly is changing there. I believe that there's a lot of macro-driven tailwinds that the region is perhaps seeing. COVID opening, maybe influx of blue collar workers, investments happening. But a lot of this is to do with macros. We never know how the macros could trend, let's say in 2024/2025. If oil prices were to, let's say, take a certain downturn again, things might again go back to where they were.
Isn't this actually a good opportunity for you to continue on the path that you were envisioning two, three quarters before, wherein you were looking to exit these operations and now you are trying to bring in a minority non-controlling investor? I just want to understand, is something tangible in that market because of which you are relooking your stance on that particular facility?
Alisha, you would like to answer that?
Sure. Thanks, Nikhil. There are some intrinsic, inherent issues with our own asset, which we believe that we have rectified. I think I mentioned in the last call that we had a lot of long-term risk contracts with insurance companies, which had kind of affected our pricing significantly. Those are things which we believe will be sustained, because things which we were getting a certain RPOB for, we've reduced our non-pay percentages by more than 30% there. Which all pretty much goes to our bottom line. That's the increasing margin. On the macro level, of course, the government has taken a strong direction towards diversifying away from oil. You're seeing. You have a high Saudization policy over there. You,
We used to have a lot of Saudis working for us, but then they were working in other departments as well, and their contribution and productivity was always a challenge. What's shifted over the last one, two years is they're all expected to sort of be a lot more effective within the system. I think the contribution from the Saudi population who work in the environment is also different. All those activities have also seen kind of a positive. Those we believe are will not change even if some of the other macro conditions that you're talking about will disappear or go adversely. For us, inherently, the business has become better. Our own team has also been restructured, and we're seeing a stronger team on the ground.
We've had to go through a couple of leadership changes before we found a team that's actually working, and we have that confidence that the current team can take things forward. It's been almost close to nine months now, we're seeing that consistent performance as well.
That's helpful. Any particular investments that you're planning in Saudi region in 2023 and 2024? Any CapEx plans for that country?
We haven't confirmed any plans yet. We have. We would like to commission the facility which was put on hold during COVID in Saudi. It was half constructed. We have a 60-bed additional capacity that can be commissioned. We would ideally. There's not a lot of capital that needs to go in to get that in order. We could probably make it go live in another four or five months. That's something which we would like to complete because we are sometimes at choking capacity, and that this is in the summer months. We believe by October, November, there are a lot of tenders from the government which are out there, which we would like to bid for. Those, that's something which we would like to do for this financial year.
For the next financial year, it's more the pharmacy, which is still under consideration. We'll probably have a little bit more information to share in the next quarter. Again, this would be ideally funded through the minority stake that comes in. We believe anyways it's low on CapEx, so it wouldn't be a significant capital outlay.
Got that. One question on India. I understand that there are CapEx plans for the India business from a two- to three-year perspective. Can you give some directional sense on the return on capital employed for that particular business? I think the investments are gonna be there, so would it be safe to assume that the return on capital employed, whatever it was in FY 2022, might remain flat-ish in the next one or two years, and only two, three years out can we expect some bit of improvement on that front?
Yeah. Sreenath, you would like to answer on the ROCE in India, how it is trending and what we are looking at?
Yeah. See, the return on capital employed in India, even though the other business segments, like the labs and pharmacies, the capital outlay over there is very minimal. We are not expanding across India, right? It's more of creating that ecosystem in the geographies where we are present. That is our main strategy of getting into the pharmacy distribution and the labs. The focus is going to be mainly on the hospitals. These hospitals, most of the hospitals are reaching a state of maturity.
That way, the return on capital employed as well, you'll keep seeing an improvement every year by at least 200 basis points from here on, in spite of some of the losses coming from the labs as well as the pharmacy distribution. Because that will be minimal, the return on capital employed will continue to improve and you'll see that increasing trend for the next few years.
Yeah, I think that's quite helpful. Basically, is the understanding correct that there might be some margin dilution as the lab and the pharmacy distribution revenue share goes up? Because pharmacy distribution itself is margin capped, right? I mean, at the distribution and retail end. At the same time, that helps your overall ROCE profile. Would that be a fair assumption that, at the expense of ROCE, the margins might get diluted a bit?
Margins on a consolidated basis, the margins. The pharmacy is significant. Yes, there could be a dilution because pharmacy business you don't have that kind of margins what the other segments have, which we see in GCC as well. The way we are looking at, like, Waterstone, the pharmacies as well as the labs, it is not that we are on an aggressive spree of expansion. We are creating that ecosystem. Therefore, this will be limited. We'll pause and take a call once things stabilize and once we feel that, yes, it is scalable and the margins are good. For now the focus is more to create that ecosystem.
Considering even the lower margins that we may get from the pharmacy segment, because the business is small, so we don't see that diluting the India margins.
Great. Thanks a lot. These are all my questions.
Thanks, Nikhil. The next question is from Alankar Garude, from Kotak Securities. You may please go ahead.
Yeah. Hi. Thank you for the opportunity. Dr. Azad Moopen, you mentioned about announcing some more CapEx plans, expansion plans in the coming quarters. Were you referring to the 500-700 beds to be added to the O&M model in addition to the 1,300-odd beds which we have announced in India so far?
Yeah, yeah. I was talking not about any new CapEx where we'll be going into new hospitals. I was talking about the, I mean, low CapEx model. No? The brownfield model which we started off, and we hope that there'll be. See, our hope is that this financial year we'll be able to reach around 750-1,000 beds in that category by end of this financial year. It may not require too much of CapEx. It is very minimal CapEx. For example, the 140-bed hospital which we started now, Areekode Hospital, the CapEx requirement was less than INR 15 crore or around that. It's not going to attract too much of a CapEx.
Understood. Basically, and that 700- 1,000 beds number which you mentioned, it doesn't include Aster Mother as well as Whitefield phase 2, right?
No, Whitefield is that's our own hospital where we are spending money and when I mentioned about Trivandrum or Whitefield. No, the second part of Whitefield is happening. It will take another four-five months for us to complete. Where we are investing as a mother hospital, it go to 750-1,000 beds. There are many things in discussion, and we hope that we'll be able to reach that number by end of this year.
Yeah, sorry, sir, I think I lost you in between. Can you just repeat the last two sentences, please?
Yeah. What, there is some echo. If people who are not speaking, if they can put their mic on off mode, please. Yeah. What I was saying is, there are two things. One, there are hospitals of our own where we are investing CapEx. Whitefield Hospital is such a project where we are investing CapEx, and in the next four-five months we'll be able to complete that, and we'll be investing more CapEx into that and whatever has been projected. Now, the project which I mentioned, like the brownfield and low CapEx, is something like the Mother Hospital or Areekode Hospital, 140-bed hospital, where there has been only very small amount which has been spent. Such models we are looking at different places.
For example, we are looking in Kerala again, another project which most probably we'll be able to announce in the next quarter. We are looking one in Andhra Pradesh, where again it is a very low CapEx, same model. There are many hospitals which are being discussed, and we hope that we'll be able to reach about 750-1,000 beds in that category with very minimal CapEx in the next, this financial year.
Sure. That's helpful, Dr. Azad Moopen. Sreenath, one clarification on the margins, the India margins. You mentioned about 18% margin expectation in the second half. Was that for the existing hospitals only, or you're talking about the overall India hospital business?
I was talking about the hospital business in India. That is something, if you look at present, our hospital business is 15.7%, right? We expect Andhra and Telangana to deliver in the next couple of quarters. We are also looking at the Kerala cluster. Some of our hospitals in Kerala cluster are doing extremely well, and even with good EBITDA margins. On a consolidated basis, because there's been a drag in some of the hospitals, we are looking at that improvement, and we expect that the hospitals will go up to 18%. It could even get better.
There is a possibility that it could even get better if our Andhra and Telangana vertical, if that we are able to bring into good margins. Yeah.
Understood. Just to clarify this, I mean, we have the Whitefield Hospital coming in the fourth quarter, and I'm sure there will be some start-up losses from this hospital, considering it's our own hospital. Despite that, you are saying 18%+ EBITDA margins in India in the second half, India hospitals rather, is possible, you see?
That's right. The Aster hospital at Whitefield will be somewhere at the end of quarter four. Despite that, we should be there at that 18%.
Fair enough. Given that we are having this hospital expansion towards the end of this fiscal, is it possible to comment on the trajectory in FY 2024 as well?
Yeah. On the hospital margins?
Yes.
Yeah. What happens is that, if you look at, there are additions to the hospitals which is coming up. The Whitefield is coming up. For at least one year there will be losses from that. Similarly, the 700 beds what chairman was talking about, when we add that, even though it's existing hospitals, those margins could be slightly lower compared to our established hospitals. Therefore, considering all this, we expect the next year, 2024, the hospital margins to improve from that 18%- 20%.
Understood. The other question was on. Yeah. Sorry.
No, I was just adding. We have now, I mean, some of our hospitals, you know, are doing even at the level of 25%-30% EBITDA margin. That's a good thing which we never had. We have gone to that level. The efficiencies have improved, the occupancy has improved, as well as the costs have come down. We hope that there will be many hospitals, especially the larger hospitals, which will be that level of 25%-30%, which will be able to, I mean, absorb the losses or lower margins in other hospitals. That's one thing.
At the same time, when you look at this low CapEx model which I mentioned, where we are going to do it this year as well as in future years, you will find that there is a dilution of the margin because we have to give. This is not owned by us, so this will be somewhere we'll have to give a percentage of the overall profit to the people who are coming in as partners with us. Definitely the margin will be lower when you look at the EBITDA margin of the hospitals. But this is, when you look at the ROC, it will be significant improvement in our ROC. That's the benefit that we are seeing. The ROC will go up significantly, whereas there may be some dilution of the EBITDA margin.
Understood. Thank you, Dr. Moopen. The other question was on the investments in labs and pharmacy. I think just now you mentioned that it's more about creating an ecosystem, and you maintain that you would like to take a pause if required. Just wanted to understand what's the threshold which you are tracking here. Is it more in terms of timelines? Would you want to give the business, say, another year or so before looking at the progress? Or are you tracking certain numbers or to take that call?
Yeah. Regarding this, you know, while we are creating an ecosystem which will be complete only when the digital platform comes into India, that will tie up all this together, the hospitals, the pharmacies, the labs, and the online consultation. Which will take about a year for us to know that how is the impact, even though there may be losses sustained in the pharmacy or in the lab, how is it overall? Also it's a startup, like, you know that there is huge discounting happening in the pharmacies and all. How are we going to sustain without that discounts being offered? We are not going for a discounting model. We are looking at a profit model. How can we do that in the pharmacy as well as in the lab?
You know, how can we have sufficient number of patients coming in spite of the competition? I give about two years for that. I'm not burning cash, but at the same time not going into profit, but at the same time helping the overall ecosystem, including referrals to the hospitals and helping us as a whole.
Understood. One final question from my side. Can you provide a firm timeline on the GCC restructuring as well as the minority stake sale in Saudi?
Yeah. We won't be able to give a definite timeline. One thing which I can tell you is that there are certain firm steps which have been done. One is the appointment of the investment bankers. Two investment bankers have been appointed by the board. The second is regarding this DD, which is happening. You know that anything, you know, if we don't find a proper value or proper price for the GCC, we may not even do that. This all depends on what price we are going to get from whoever is bidding for the GCC business. That will. We hope that there will be a good value which will be discovered, and we will be able to sell. That's our hope, and that's why we are doing this.
We won't be able to definitely give a timeline on that. Regarding the Saudi, like what Alisha said, we are now, I mean, looking at maybe in the next six months, we'll be able to find a minority partner who can take a stake in the hospital. That person probably will also be partner in the pharmacy business. We are looking at strategic partner rather than just the money coming in. In Saudi, what we have understood by our failure in the last seven, eight years is that there has to be a partner who is ready to support on ground and who will be standing in front and will be seen as somebody who is running the business by the Saudi authorities. Only in such a situation you can have a successful business in Saudi.
With 30 million population in Saudi, which is almost, you know, the same, much more than the other GCC countries altogether. That is the future if you have to have a good business in GCC. We hope that we have found a partner like that. There have been a lot of discussions. Now we have somebody who has been identified. With that person who is coming into the hospital as well as into the pharmacy business, we think that we will have a partner who will stand in the front and will be able to drive it forward.
Understood, sir. That's it from my side. Thank you, and all the best.
Thanks.
Thanks, Alankar. The next question is from Harith Ahamed. You may please go ahead.
Hi, thanks for the follow-up opportunity. Alisha, on the GCC clinics business, I think you mentioned that there's been a growth of 26% YOY, excluding the COVID testing revenues. What I'm trying to understand is whether COVID testing is still a significant part of the segment, you know, trying to understand what is a sustainable number. Because this is a segment where we've had some pricing pressure exerted by insurance players. There's been a significant impact during COVID. We've also seen some impact from the economic situation in UAE in the past. What exactly would be a sustainable number is what I'm trying to figure out here.
Sure. Thanks, Harith. I can't remember exactly. I will have to ask Amitabh about what was the exact ratio of COVID, but I do think it's Amitabh, what is it, around 10%?
Alisha, at the same time last year from the clinics revenue perspective, the PCR revenue was almost 33%. Now, that has come to almost 9% in the clinic business. That has dropped down significantly. Which is why, Harith, you are looking at the growth of the business year-over-year basis. It's a 26% growth if you take out the PCR revenue.
Yes.
Got it.
That was on the COVID business. It has come down quite significantly, Harith. On the other part, we've made a kind of conscious strategic call that earlier Aster was also eligible for the lower segment of the population. We had a clinic network which was exposed to all the network. Over the last one year, what we have said is we want to actively disengage from the lowest network. We wanna make sure those people have only access to Access brand of ours. We want to make sure that Aster is able to command a higher pricing and the higher segment, the core middle income segment to be our customers. There has been a reshuffle and a change in the portfolio.
A much stronger focus on that, which we believe will enhance our margins, will enhance the brand and keep it more intact as well. We believe that this is working. Again, it goes back to the whole point. It is with that segment that you can push more of the cash business, you can do more of the dental work, you can do more of the aesthetic work. All of that is much more suitable and well-suited for the middle income population over there. That's the population which is increasing in Dubai. Post this whole COVID, we're seeing that less of the blue collar workers, all that segment is getting more diminished and there is a much more increase in the higher segment and the middle income population.
We said, let's restore Aster brand to be much more of the core middle income brand and avoid the dilution which had happened at some point when we had an overcapacity of clinics, and we said, "Let's try and increase the volume into the business." That's something which we believe is a much more strategic, better initiative for Aster and keep the lower blue collar workers only for our Access brand and referral into our hospitals where we have capacity being built up in Aster.
Thanks. That's helpful. Dr. Azad Moopen, last one from my side. On the new hospital in Kerala, which is in Kozhikode. You know, our strength historically has been in tertiary care and high-end care. When I look at our other assets in Kerala, they're all in the larger cities in the state. This appears to be a bit of a deviation from our strategy in Kerala. I'm also trying to understand if there is a market for such high-end services in a smaller town like Kozhikode.
Yeah. Thank you. There are multiple things why we selected this hospital. One, this was having an excellent infrastructure. This was built over the last 15 years, and that has not been successful. We thought that, no, that has not even been run. We are the first people to operate that. Excellent infrastructure. There is a potential for us to even grow it further because there is land and other, I mean, foundations even laid for a building. From the point of view of the services that we are offering, as this is only 30-35 km from the Aster MIMS Calicut, the ability to provide tertiary care in that hospital is there, and that is something which we have already started doing.
We are providing services like cath lab, neurosurgery and all this, where the doctors from the Aster MIMS Calicut can reach in half an hour. They are going there and providing this treatment. If at all there is a patient who has to be transported, within half an hour that patient can be brought to this hospital. This is a real hub-and-spoke model where basic services like the gynecology, obstetrics, general medicine, pediatric, all are provided. The higher services, the doctors are not employed there, but they are actually going from our main hospital. We also now see, because there is a huge issue on the capacity and the full capacity utilization at our Kannur and Calicut hospitals.
There is an overflow and this we are now able to send to this hospital and take care of them in a hospital like Kozhikode. Answering your question, we have been having this strategy and which has worked out very well. Just to give you some numbers, we have started two months back, and we hope that we'll go into a break even next year, next month. In three months we are going into a break even in the Kozhikode hospital. Just because the HR cost is very minimal because we have taken all the specialist doctors under MIMS Calicut, and they are providing the support. The break even is very low amount, even though it is a large hospital.
We hope that we'll have good EBITDA coming out of it as we go forward, and it will also help to increase our footprint in the areas that we are operating.
Thank you, Doctor. That's all from my side. Thank you for taking my questions.
Thank you. Thank you, Harith.
Thank you, Harith. As we are approaching the close of our call, the last question is from Mehul Sheth from Axis Capital.
Yes, sir. Thank you. Just to confirm a couple of numbers, like, your CapEx plan will remain like more of like a INR 500 crores, means nearly INR 600 crores for this current year, and, of that around INR 300 crores will be towards India expansion.
That's correct.
Is this correct?
That's right.
Okay. You have done something like INR 147 crore kind of CapEx in Q1.
That's right.
Yeah. There is one observation, like, earlier you had a guidance of having an Aster Labs expansion strategy with 38 satellite labs and around 500 centers, collection centers which is now you have reduced to like 35 labs and 300 centers. Is there any major change in expansion plan?
Yeah. Thank you. We have found that there is a very tough competition, like what we told earlier, you know, because of the competition. We thought that unlike the pharmacy, where we have found much more traction, we thought that according to the market, we should look at it and try to change, like what has been told earlier, not to go into north. We are trying to create this ecosystem. Around our hospitals we are focusing. Beyond that, how much we should spend and, I mean, spread and how much we should make it a standalone large lab alone is something which we are looking at. That's why there has been some downgrading of the numbers which has been provided earlier.
Okay, sir. Thank you. That is from my side.
Thank you.
Thank you, Mehul. Ladies and gentlemen, this concludes the earnings call for this quarter for Aster DM Healthcare. I thank you all and the management for joining us today. If you have any further questions or queries, please do get in touch with us. Have a good rest of the day and have a great long weekend.
Thank you.
Thank you.
Thank you.
Thank you.