Ladies and gentlemen, good day and welcome to Q4 and FY 2026 earnings conference call of Nephrocare Health Services Limited hosted by ICICI Securities. This conference call may contain forward-looking statement about the company which are based on the beliefs, opinions, and expectation of the company as on date of this call. These statement are not the guarantee of future performance and involve risk and uncertainties that are difficult to predict. As a reminder, all participant line will be in the listen-only mode, and there will be an opportunity for you to ask question after the presentation concludes. Should you need assistance during the conference call, please signal an operator by pressing star then zero on your touch-tone phone. Please note that this conference is being recorded. I now hand the conference over to Mr. Abdul from ICICI Securities. Thank you, over to you, sir.
Yeah, thank you. Good afternoon, everyone. On behalf of ICICI Securities, I welcome you all to the Q4 and fiscal 2026 earnings conference call of Nephrocare Health Services Limited. We are pleased to have with us the management team of Nephrocare, represented by Mr. Vikram Vuppala, Chairman and Managing Director, Mr. Kamal Shah, Co-founder, Mr. Rohit Singh, Group Chief Executive Officer, and Mr. Prashant Goenka, Group Chief Financial Officer. We'll have the opening remarks from the management, followed by a Q&A session. Thank you. Over to you, Vikram, sir.
Thank you, Abdul. Thanks to everyone joining our first full year earnings call, which is for FY 2026. As this is only our second earnings call, I would want to spend some time upfront on talking about the dialysis at a macro level and then talk about NephroPlus platform play and our key growth drivers. Later, our senior leadership team will share more details on FY 2026 operational and financial highlights. Post that, we'll open the floor for a Q&A session. Now, dialysis is required when both the kidneys of a human being stop functioning. The only other alternative when both kidneys fail is a kidney transplant, which is a cumbersome and a rare procedure. The underlying diseases which cause chronic kidney disease, also called CKD, are well-known diabetes and hypertension.
As we are all aware, unfortunately, the disease burden of both diabetes and hypertension is increasing not only in India but all across the world. If a person develops chronic kidney disease, and if it is not managed well, over time, it leads to kidney failure, which is the last stage of a kidney disease patient. Now, once the kidneys fail, it's either dialysis or transplant that will enable a patient to survive. Dialysis is nothing but just replicates kidney function. It removes excess fluids and toxins from the bloodstream. Now, dialysis business is unique and, hence, we need to understand its nuances well rather than grouping it among other healthcare services. There are five distinct characteristics of this business which I wanted to highlight. Firstly, dialysis is a chronic life-sustaining treatment that our guests need three times a week in order to survive.
Secondly, each dialysis session lasts roughly about 4.5 hours and, hence, dialysis clinics can only offer three sessions per day: a morning cycle, afternoon cycle, and an evening cycle. Hence, it's a fixed capacity business, almost like airlines, which have fixed capacity. The only major way to grow this business is to keep adding capacity, if possible in existing clinics or add new capacity, which is new clinics, and that is how all global dialysis networks have grown across the world. As real estate in any dialysis clinic is limited, the only major lever to increase capacity is to add new clinics. Third, unlike other single-specialty businesses, dialysis is a monoline business. For everyone with kidney failure, it is a standardized single line of treatment that lends itself to scaling in a distributed network model.
Here, paramedical staff, like nurses and technicians, are the ones who actually deliver dialysis treatment, which is prescribed by the nephrologist. This lends itself to scaling to Tier 2, Tier 3, Tier 4 markets where nephrologist availability is very limited. Globally, dialysis is a reimbursed business as it's a very expensive chronic treatment modality. Three times a week in India roughly translates to INR 2.5 lakhs per year, excluding other costs. India operates at the lowest price point in the world, while middle-income markets operate at 5x-7x India price and developed world operates at 10x-12x India price. Across the world, dialysis treatment is reimbursed by either insurance or some form of government payment. Any dialysis provider requires two important things to achieve sustainable margins in this business: massive scale and 100% operational focus.
All firms that have scaled up sustainably in dialysis business are large pure-play dialysis networks. At small scale, no one can make decent margins regardless of price, as it is a high fixed cost-laden business. Without 100% focus, there are numerous leakage points in the business which will significantly erode the margins and make it unsustainable. Coming to NephroPlus. NephroPlus was founded 16 years ago by Kamal Shah and I to redefine dialysis care in India. Kamal has been on dialysis himself for 28+ years now, we believe we understand patients' needs, wants, and wishes better than any other network in the world. We started with few standalone clinics in Hyderabad, pivoted to a captive that is shop-in-shop model in hospitals across India, where we partnered with private hospitals to run their dialysis departments very efficiently.
In 2012, we started our first PPP dialysis project with Andhra Pradesh, and then we expanded to three other states, Bihar, Uttarakhand, and Karnataka as well. During this time, we also built our home dialysis capabilities across home hemodialysis and peritoneal dialysis as well. That gives us an ability to run standalone captive private hospital units, PPP units, home dialysis capabilities, end-to-end spectrum capabilities in the dialysis world. Came international expansion in 2020. After scaling up significantly across all major regions in India, we believe that the platform we created in India at the lowest price point can be significantly leveraged across other global markets. Globally, dialysis is a $80+ billion market. We explored Southeast Asia and found Philippines as a starting point, and we entered it with a small acquisition of a RCDC network.
After understanding the market for a couple of years, we kept on growing for the last 4 years. Today, we are the third-largest dialysis network there with 44 clinics. In 2022, we won a large dialysis PPP project in Uzbekistan, which has been a good ROE accretive project for us. Two years ago, we created a joint venture in Saudi Arabia to set up our operations there. Currently, it is in an investment phase, but looks promising over the next few years. With higher realizations in these international markets, we have substantially increased our RPT while maintaining margins and ROCE due to our India platform play. Today, we run a global network of 524 dialysis clinics in 335 cities spread across five countries. We are India's and Asia's largest dialysis network and also world's fifth-largest dialysis network by volume.
We are quite clear that we'll continue to be 100% focused on dialysis market without any distractions, and we'll continue to expand in existing geographies while also exploring newer geographies to expand our global presence. Very important to understand that at NephroPlus, our growth specifically comes from three levers. Lever 1, existing clinics ramp up on volume and little price increase, which is fairly predictable in nature. Lever 2, roll-ups of clinics in existing countries, lumpy due to business development nature, but is reasonably predictable on an annual basis. Lever 3, foray into new countries or large acquisitions or PPP projects, which are major needle movers but cannot be predicted at all on an annual basis. While I mentioned this in the last earnings call too, I want to repeat it here again.
We will want to maintain a revenue CAGR guidance of 15%-20% over a period of 3-4 years. We'll not be giving any annual guidance. We have invested and built a good business development team over the last 2 years to expand into new countries. There will be an investment phase when we explore various geographies, and once we zone in on a country, there will be an investment phase while we set up operations in that identified country. At any point of time, we'll be working on exploration of three to five countries and also setting up operations in one to two countries. Financial returns from these new countries operations will come post this investment phase as can be expected when we start delivering dialysis treatments on the ground. Now, one area we have identified to continue to invest is also in technology.
While we have made good progress over the last year on digitization across various functions, we need to invest more in advanced technologies to truly differentiate us from other large global dialysis networks. We fundamentally believe that investing in technology is the only sustainable way to grow a large, widely distributed healthcare network. We are happy to state that we are the first global dialysis network to effectively use AI in its core operations. Our team at NephroPlus has created Reform.ai application to effectively monitor numerous core operational elements across a distributed dialysis network. This has already been implemented successfully in 50 clinics at NephroPlus as of today, and of course, we'll be expanding this to our entire network over a period of time. This will immensely help us improve our clinical outcomes as well.
Looking ahead, we remain firmly committed with singular focus to our vision of enabling people on dialysis worldwide lead long, happy, and fulfilling lives. Based on our track record, we believe that we are in good shape to make immense impact on people living with kidney disease while creating value for all our stakeholders. I now request our Co-Founder, Kamal Shah, to share his remarks. Over to you, Kamal.
Thanks, Vikram. Like Vikram mentioned, I've been on dialysis for more than 28 years now. I lead a fairly normal life despite this. I swim every morning, work full time, travel, and have fun. At NephroPlus, we believe that anybody on dialysis can lead this kind of a normal life, provided they get good quality dialysis and are treated in a more empathetic and humane manner. Unfortunately, dialysis around the world has become very mechanical, where patients are treated like an assembly line. Vikram and I started NephroPlus to change this. At NephroPlus, we call patients guests to remove the negativity that is associated with the word patient. We wanted to bring in an element of cheer into our clinics by treating all our patients as guests. They say in Indian culture, right?
We have introduced several initiatives that reinforce this message that dialysis patients can lead a normal life, like the Dialysis Olympiad, an Olympic-style games event for dialysis patients, and a holiday dialysis program, immensely successful, where hundreds of patients have gone on a nice holiday with their family or friends, and we took care of their dialysis requirement. Through these initiatives, we hope to enable our guests get their life back despite being on dialysis. I now will hand it over to our Group CEO, Rohit Singh, to take this forward.
Thank you, Kamal. Good evening again, welcome to NephroPlus earnings call. I will focus on three aspects: how the year's closed, how the business is built, how we are thinking about the period ahead. On FY 2026 performance, for the full year, revenue grew 32% to INR 998.8 crores. Adjusted EBITDA grew 37% to INR 238.2 crores. Adjusted PAT grew 75%, well ahead of the revenue, reflecting the model's operating leverage. Guests, our term for active patients, grew by 12% to 37,000. Total treatments grew by 17% to 38.4 lakhs. For quarter four specifically, revenue was INR 265.6 crores, up 21% year-on-year, with treatments up 15%. These outcomes are consistent with the framework we shared last quarter.
Growth came from steady same-clinic growth, a disciplined rollout of new clinics in India and overseas, and a continued shift in the mix towards our international operations. Now progressing on the industry and the opportunity. Since this is only our second call, a short reminder on the fundamentals may be useful here. In India, CKD affects close to 12.4 crore people. Only about 7% are diagnosed, and only 3 lakh of the 42 lakh ESRD patients in 2024 were on dialysis. The dialysis population is projected to grow from 3 lakh to 5.2 lakh by 2029, a CAGR of 13%, which would be served by 5,500 clinics that are unevenly distributed. The gap between need and access is wide and persistent. Globally, dialysis is an $80 billion market.
In developed markets, dialysis migrated from hospitals to standalone clinics decades ago. Today, over 65% of the new patients are treated in standalone settings, and small number of organized players run most of that capacity. India is at the earliest stage of the same shift. As insurance penetration deepens, government-funded schemes expand, we expect organized players to consolidate their share. NephroPlus, with approximately 50% of the organized dialysis market in India, is well-positioned for this transition. How do we build the business? Dialysis is a non-discretionary and recurring service. A patient typically needs three sessions a week, every week for life. That makes our revenue base unusually predictable for a healthcare business. The two numbers to watch are guest, our installed patient base, and the treatments, the sessions actually delivered.
Treatments growth tends to outpace guest growth as patients move to higher frequency protocols and utilization improves. We operate in three models: captive clinics inside private hospitals on a revenue share basis, standalone clinics, and public-private partnership clinics with government hospitals. Each carries a different operating strategy, we choose between them based on the market. Across all three, the operating model is the same: standardized clinical protocols, standardized guest experience, and standardized operating processes. This codified operating system is what makes the clinic from opening predictable to performance, we are now extending it into new geographies. As a clinic service delivery company, we build our protocols to scale. Our structure ensures close oversight of outcomes. We are amongst the very few in our industry to publish clinical data.
In FY 2026, we published two papers, one in the International Urology and Nephrology and one in the Indian Journal of Nephrology, along with eight abstracts at various scientific conferences. We have also adopted a medical advisory board concept where every country, once it reaches a certain scale, sets up its own medical board to ensure local compliances and clinical rigor. We have gone one step further to embed our guest care comes first culture through a manual we call the Blue Book. It gives everyone across our network, right down to the last mile, a clear way to put empathy into practice, covering not just clinical care, but the environment around our guests and smaller needs that often go unnoticed. We believe this will become our deepest moat. Clinical standards can probably be matched. A culture that is deeply embedded cannot be.
How we grew. Our growth is driven by three levers, the framework that Vikram briefly touched upon. I will probably talk at length on them. First is the same clinic growth. Every operating clinic adds patients through nephrologist referral, walk-ins, awareness, and existing patients move to higher frequency protocols as their conditions progress. Because treatments are weekly and non-discretionary, we have month-on-month visibility into this layer. FY 2026 illustrated the pattern. Treatments grew by 17%, while guests grew by 12%. Second, new clinic rollout into existing geographies. In India, we expanded through brownfield takeovers of existing clinics, which carry an established patient base, faster breakeven, and through selective greenfield setups in underserved geographies. Overseas, we have continued to densify. In Philippines, we are now the second-largest provider.
In Uzbekistan, we opened two small new clinics in Karakalpakstan region during the year, building on the trust that we have gained with Ministry of Health. Visibility on this lever is good annually and less precise quarterly, since clinical operation depend on regulatory clearances, infrastructure readiness, and staffing. Third, new geography, large acquisition or a sizable PPPs. These are steps, events, highly unpredictable as their timing depends on approvals, due diligence, and tendering process beyond our control. Country selection is a disciplined one. We assess depth of demand, reimbursement and policy viability, political and regulatory stability, and clarity on cash repatriation. Once we commit to a market, our track record in Nepal, Philippines and Uzbekistan gives us confidence in our ability to integrate and scale. Levers 1 and 2 are compounding base of the business. Lever 3 is an additional capacity we are working on.
There will always be investment phases as we expand in new geographies. A case in point is continued to be our investment in Saudi Arabia. After forming a JV 2 years ago, we built a strong country team to participate effectively in a tender expected to be issued in Saudi Arabia. A NUPCO tender came out a year ago, in which we participated and came out strong. NUPCO was not the end user of the service, hence it has not translated into business yet. This takes time. The good news is the large Ministry of Health and Ministry of Defense dialysis tender has recently been issued with clear visibility of patient volume. Right now it is on the EOI stage, but it will soon move to the RFP stage in couple of quarters.
Our first clinic in Saudi Arabia at Riyadh Hospital is all set to be launched within two months to showcase our clinical excellence. Overall, we are optimist about creating a large dialysis business in Saudi Arabia, but we need to be patient as things sometimes do not move as fast as we expect. Given our current capacity, patient pool and treatment trajectory, we march into FY 2027 with a reasonable confidence. As the network grows, revenue and profitability will improve. Clinical quality and guest experience remains the foundation of everything we do. They also enable the operating model to be replicated. With that, I hand over to Prashant, our Group CFO, who will take you through the financial performance.
Thank you, Rohit. A very warm welcome to everyone joining us today. I will now take you through our performance and the progress we have made over the years, reflected through some of our key operational and financial metrics. Starting with operational metrics. For any dialysis business globally, the most important metric to track is patient volumes and treatments. Dialysis is fundamentally a scale-driven business, where higher volume leads to better operating leverage, stronger asset utilization, and improved return on capital employed. Patient volumes or guests, as we call them at NephroPlus, remain the single most important driver of our business. As of March 2026, our active guest counts stood at 36,981 compared to 33,076 as of March 2025, representing a healthy growth of 11.8%.
Moving to treatment volumes, which represents the total number of dialysis sessions performed during the period. For FY 2026, treatment volumes reached 38 lakh 44,658 sessions compared to 32 lakh 97,447 sessions in FY 2025, registering a growth of 16.6%. This consistent growth in treatments reflect both network expansion as well as improved utilization across our clinics. Coming to revenue per treatment or RPT. For FY 2026, RPT stood at INR 2,598 compared to INR 2,292 in FY 2025, registering a growth of 13.3%. RPT improvement was primarily driven by three factors. First, international mix going from 32% to 42%. As you know, our price point in India is the lowest at $22 versus internationally, Philippines is at $111 and Uzbek is at $60.
This higher price point in international translates into a better RPT because of a higher international mix. Second factor is favorable exchange rate movements. Philippine peso moved favorably by 5%. Uzbek currency moved favorably by 7%, helping our RPT. Also, our Philippine price increased by 58% in October 2024, and in FY 2026, we saw a full year impact of that. Speaking of our financial performance, we continue to demonstrate healthy financial performance. Currently, the business is at a scale where levers for us are playing out well. With continued ramp-up of existing clinics, addition of new clinic across geographies, improving utilization levels, and a disciplined focus on operational efficiency, we delivered another year of steady revenue growth along with healthy improvement in profitability.
Starting with the full year performance, revenue for FY 2026 stood at INR 998.8 crore compared to INR 755.8 crore in FY 2025, reflecting a healthy year-on-year growth of 32.2%. The growth was driven by a combination of higher treatment volumes, improved clinic utilization, and increase in revenue per treatment, particularly supported by the growing contribution from the international market. Favorable forex movement also supported revenue growth. On the profitability front, adjusted EBITDA excluding ESOP and Saudi-related expenses stood at INR 238.1 crore for FY 2026 compared to INR 173 crore in FY 2025, registering a growth of 37.6%. Importantly, this growth also translated into margin expansion.
Adjusted EBITDA margins improved by 100 basis points from 22.8% in FY 2025 to 23.8% in FY 2026, led by platform capabilities in international geographies. Adjusted PAT for the year stood at INR 128.3 crores compared to INR 73.5 crores in the previous year, reflecting a strong growth of 74.6%. PAT margin also improved by 310 basis points from 9.7% to 12.8%. Coming to the quarterly performance. Revenue for Q4 FY 2026 stood at INR 265.6 crore, growing 21.2% over quarter four FY 2025. Adjusted EBITDA for the quarter stood at INR 55.4 crore compared to INR 54 crore in the same period last year.
One thing to note, margins reduced from 24.6% to 20.9% due to a one-time ECL provision of INR 10 crore. Excluding this one-time provision, margin would be at 25%, which is marginally higher than our historical margins. Despite these factors, profitability remained healthy, supported by strong operational performance and continued scale benefit. Adjusted PAT for Q4 FY 2026 stood at INR 35 crore compared to INR 27.6 crore in Q4 FY 2025, registering a growth of 27.4%. We believe our performance reflects the strength of India platform, both in India and international geographies in a margin and ROCE accretive manner. Another important highlight during the year was the continued improvement in capital efficiency. We have been very disciplined in our capital allocation.
Our capital allocation was INR 165 crores in FY 2026 compared to INR 113 crores in FY 2025. Despite almost 50% increase in capital allocation, our annual pre-tax ROCE improved from 22.8% compared to 19.9% in the previous year, reflecting the strength of India Platform and our ability to realize the benefits of India Platform both in India as well as international market through disciplined execution at scale. Equally noteworthy is our working capital and receivables performance. Dialysis as an industry carries a structurally higher working capital requirement given the nature of institutional billing and reimbursement cycle. We have been consciously focused on improving this. Working capital days improved from 92 days to 83 days. AR days has come down from 130 to 116 days, a 14-day reduction with particularly strong improvement in the Philippines.
Cash is a very important daily focus area for us. In FY 2026, we generated INR 233 crore of operating cash flow and despite deploying a capital of INR 165 crore in growing the business, we still generated INR 68 crore of free cash flow. Currently, we hold INR 500 crores of cash, and we will remain disciplined in deploying capital in a ROCE accretive manner. Going forward, our growth strategy continues to be driven by the three key levers as mentioned earlier by Vikram and Rohit. Based on these levers, we continue to maintain our medium-term guidance of delivering 15%-20% CAGR growth over the next 3-4 years. Overall, FY 2026 has been a healthy year for NephroPlus across operational, financial and strategic parameters.
We have continued to scale our network, strengthen profitability, improve capital efficiency, and deepen our presence across key markets while staying focused on delivering high quality patient care. With this, we open the floor for questions.
Thank you. Ladies and gentlemen, we will now begin with the question- and- answer session. Anyone who wishes to ask a question may press star and one on their touchtone telephone. If you wish to remove yourself from the question queue, you may press star and two. Participants are requested to use handsets while asking a question. Ladies and gentlemen, we'll wait for a moment while the question queue assembles. The first question come from the line of Akshay Thakur from Hillhouse Capital. Please go ahead.
Hi, sir. Thanks for taking my question. My question, first question is on the INR 10 crore expected credit loss you mentioned. Can you throw some light on the nature of this and like what happened there? Can you just share more information on it?
Thanks, Akshay. Good question. I think a lot of people will have same question on their mind. In NephroPlus, we run a very structured ECL model, which is also ratified by our auditor, stat auditor, KPMG. In this ECL model, we basically break all our accounts AR at an account level, at the aging level. Based on this model, we basically understand the loss rate at the different aging bucket. We conduct this exercise every year. At the end of the year, we identified two accounts where we wanted to take a one-time provision out of abundant caution. These two accounts still we believe the money will come, from an ECL model point of view, we took a provision just to prevent the likelihood of a future profit surprise.
These ECL provision of INR 10 crores are predominantly coming from a one-time provision on two accounts, which are, both of these accounts are from four or five years back.
Okay, sir. Can on those accounts, like, what type, as in can you share more on it? Like how What was the nature of the transaction or what was the background of it?
No. I think we will not want to go into the specific details of it. I think as I mentioned, we deal with a lot of private hospitals. We deal with, lot of institutions and AR in dialysis business has some structural nuances. From time to time, there will be one or two accounts that will age, and there will be some difficulty in recovering this money.
Okay. Sir, thank you. My second question is, you mentioned the growth lever. The first one was, as you mentioned, growth lever would be the volume that the sessions conducted per clinic. If I look at your number, the sessions per clinic would be in India, would be around 7,000 per year. Currently the market is placed as in people are going to hospitals, but in future, maybe that hospital would be affiliated with you, the volume would be same. How are we seeing this number increase? When can we expect this number to go to around 10,000? Around what year?
Hi, Akshay. This is Rohit here. I'll take this question. I think the number that we mentioned of the active guests is 37,000 right now in our network. We are already operating at a 37,000 guest network, which is spread across four geographies, namely India, Nepal, Philippines, and Uzbekistan. India is the biggest of the lot, and we are running the large ones here, the biggest geography for us. Now this India has been constantly growing at a constant pace. We've been adding 40-50 clinics on year-on-year basis in India, and we kinda expect and we continue to do so, we expect to do that similarly. Also in Philippines, we are looking at adding 12-15 clinics in this year and the years to come. With these expansion, we can expect a healthy growth rate in the patient count, which will translate to a healthy growth rate in session count.
My question, I'll elaborate a little. My question was pertaining to sessions per clinic. The expansions would be the growth through adding new clinics. How we plan to increase this 7,000 number per clinic, as in 7,000 sessions per clinic. If I take your India number of sessions in India divided by your 255 clinics in India, it comes around 7,000. I was asking about the per clinic sessions, then how to increase the volume of the?
Yeah.
people who are coming in. Yeah, that was the question. Yeah.
Understood, Akshay. This is Vikram. As we mentioned in the opening remarks, right, dialysis is a fixed capacity business. If you have, let's say, in India, on an average, 10 - 11 machines exist in a clinic, each machine can only do three cycles per day, morning, afternoon, and evening. Once the utilization of the clinic is super high, the only way to increase the number of sessions is by adding new machines in that real estate. Now, as you know, most of the hospitals in India are super crunched on real estate, and hence, once the utilization is optimized, the only way is to add a new clinic nearby. Let's say a clinic starts with 10 machines, then we add little bit of space and then add another two machines. It will still get maxed out at 12 machines.
The only way to add new treatment there is to open a new clinic nearby. It's like a retail model. It's a fixed capacity business, unlike a pathology business, where the analyzer can take 1,000 more samples, 2,000 more samples. Here, there is a capacity, fixed capacity of three cycles per day per machine. Hence, all the networks, dialysis networks in the world, they only grow by adding capacity, which is adding new clinics with network. Hope this answers your question.
Yes, sir. That was useful. Thank you. That was from my side. Yeah.
Thank you. Ladies and gentlemen, in order to ensure that the management will be able to address all the questions from the participant, we request you to kindly limit your question to two or three question per participant. If you have a follow-up question, please rejoin the queue. Our next question comes from the line of Payal Shah from Billion Securities. Please go ahead.
Yes. Thank you so much for the opportunity. Am I audible?
Yes.
Yeah. Sir, I have two questions. First is, what are the criteria for us to select new geographies for expansion? My second question is, are you looking to expand into adjacencies of dialysis like CKD management or pre-dialysis in India or abroad? Those are my two questions.
Okay, fine. Thanks for the question, Payal. Let me first take the second question first, the previous, that As Vikram had also mentioned that we will stay focused on dialysis services delivery, so we are not looking at exploring any of the adjacencies right now, and we would stay 100% focused on dialysis delivery and expanding our footprint. To take your first part of the question, which is that how do we look at doing selection of the country, I mentioned that in my script that we look at the depth of the demand. When we're looking at a country, we look at the depth of the demand. We look at the reimbursement and policy viability, that what are the reimbursement rates, how congenial is the policies there of healthcare policies, political and regulatory stability, and clarity on cash repatriation.
These are the four broad areas that we look at and for us to qualify any country for us to explore that, these four has to be in comfort.
Yeah, just to add to what Rohit said on, question number 2, we will be focused, absolutely on the dialysis space going forward as well. In the dialysis or the kidney disease space, Kamal and I are very keen to invest in a CKD prevention platform, which is in the early stage of kidney disease, Stage 1, Stage 2, Stage 3, Stage 4. Stage 5 is the failure, as I mentioned. We want to figure out a way to add value to these kidney, CKD patients in the early stage of kidney disease, so that either the onset of dialysis can be delayed. It creates a very good funnel for our dialysis clinics as well, and it helps make immense impact on the prevention, aspect as well. We'll remain firmly focused, as Rohit said, on the kidney disease space, dialysis plus CKD management.
Okay. That's it. That's it from my side. Thank you so much for the answers.
Thank you.
Thank you. Our next question come from the line of Pranav Chawla from Ambit Asset Management. Please go ahead.
Hi, good morning, sir. Congratulations on the good year. Sir, I have one question from my end. This pertains to our PPP business. In our RHP, we had highlighted certain renewal/expiry dates for our Andhra tender. Can you just share some more color on the contract that will come for renewal in calendar year 2026?
Hi, Pranav. I'll take this, please. In this calendar year, we have two contracts that we are expecting to come for renewal. One is a small contract for just two clinics in Uttarakhand. That's in the process. Later part of the year, we should get Andhra Pradesh, one of the phases for renewal. We have already had two renewals in Uttarakhand in past. We will be hopeful that we are able to do something there. Again, there is no 100% certainty of any contract to be renewed. Net-net, we will obviously be observing growth in our business. If by chance there is any contract that we gets lost, we are actively exploring other contracts or PPPs as well. To me, net-net, the PPP will grow in the network level, and there'll be growth there.
Andhra Pradesh is still few months away. We will be addressing that at the right time.
Got it. Sir, on the clinic expansion side, we've invested more in our Nepal subsidiary as well as we're investing in other markets. How should we build our CapEx for the next couple of years that we are in a rapid expansion phase at this point of time?
Hi, Pranav. This is Prashant. I'll answer this question. Nepal, we have about six centers currently. I think the dynamics of Nepal are very similar to India. I think in terms of modeling or in terms of sort of baking it into the model, you can assume the same dynamics as there are in India. In fact, the Nepal business was previously classified as an India branch. We have now opened a subsidiary in Nepal. Now the same centers are now rolled up under the subsidiary. It's not an incremental centers that we have. It's just the reclassification of the center from a branch to a subsidiary. The economics will remain the same.
Got it, sir. Thank you. This was very useful. Thank you so much, sir. I'll get back later.
Thank you. Our next question come from the line of Dhvani Shah from DSP. Please go ahead.
Yeah. Hi. Thank you for the opportunity. Sir, we wanted to understand a little more about the India business. On a total of 468 clinics that we have this year versus 447 last year, how many would have been captive additions?
Dhvani, I'll take this. If I got it, your voice was little meek, so if I got your question right, that in the new clinic additions in India in this financial year, how many were captive, right?
Correct. Yeah. Yeah, that's correct.
We had majority of them captive, while there were 5- 6 standalone greenfield units that we started, but majority of them were captive units only. We did not sign any large PPP project last year.
Understood. The plan going forward is you mentioned 40-50 clinics addition per annum. With respect to that, most of them would be CapEx as mentioned in the DRHP, right? We do see some clinic shutdowns happening. Is this a net number or a gross number that you're thinking about?
This is a gross number that we are talking about, because center shutdowns at times is very hard to predict whether it'll be, how the number would be. It is a gross number that we are talking about. 40-50 is a gross number.
Just to add to what Rohit is saying, Dhvani, typically, when we open a new center, it adds up to a treatment volume. When we shut down a center, typically the volume moves to a nearby center. The right metric to look at from a modeling perspective will be the treatment volume. As you can see, the treatment volume has grown by 17% year-on-year. That's the metric that you should look at because the center has too much variability, both in terms of the number of beds and the dynamics of opening and closing.
Understood. That's helpful. Thank you.
Thank you. Our next question comes from the line of Kushal Chovatia from Nomura. Please go ahead.
Yeah. Thank you for taking my question. The first question is, week ago you had acquired a center in Philippines. What would be the size of this particular dialysis clinic? How many beds or machines?
Kushal, since it was a mandatory requirement, we had made an announcement. This acquisition of centers like this is a business as usual in Philippines. We keep rolling up. As I said, we would be looking at doing anything between 12- 15 roll-ups in the Philippines in the coming year as well. This center was a midsize center, basically, in the range of 600- 800 sessions.
600-800 sessions. In terms of beds? In terms of number of beds in the system.
Beds in the center.
Going ahead also the acquisitions which you would be doing in Philippines would be of a similar scale or how to think of it?
Kushal, again, Philippines is a 900 dialysis center market with 250 if you take out whichever the organized there. It has a long tail of unorganized, 550, 600. In that long tail, there is a high variability. It's hard for us to predict that all will be on the same size or not. Give and take, the range would be on the similar range.
Okay, fine. With respect to your Saudi business, this quarter, there's a INR 3 crore loss in the JV. Going ahead also, at least for the next two or three quarters, would the trend be similar?
The Saudi, as we mentioned, we are on the investment phase, and there is just recently a new contract or new tender which has been just released, and it's at the EOI stage, which will take a couple of quarters to take shape. Our same phase will continue in Saudi for near future.
Okay. Next, it will take at least a year, I'm assuming.
Could be less-
And-
We have to still see how it pans out. government will issue more details. Once we get more details, probably we'll get a firmer view on that.
Okay. Just one last question. On other income, this quarter was significantly high. Anything to read into it?
Hi. Hi, Kushal. Other income. If you're talking about this quarter, the other income has predominantly moved by the ECL provision of INR 10 crore that I previously mentioned. That was the primary driver of the other expense movement this quarter. If you're talking about other expense movement on a yearly basis, there were three primary driver. One was the ECL provision. The other is we continue to build our platform. We are investing money in IT. We are growing our Philippines support areas like supply chain management, business development. We are also adding people in international geography to drive more international business development. The third factor was previously the repair and maintenance was considered as a capitalized expense. This year we have changed the accounting treatment to flow it through the operating expense.
That also created a temporary shift. Those are the three factors that drove the other expenses on a yearly basis. On a quarterly basis, it was predominantly the ECL.
Okay. Yeah. Thank you. That's all.
Thank you. Our next question come from the line of Naman Bagrecha from IIFL Capital. Please go ahead.
Hello. Thanks for the opportunity. Just few clarifications. One to highlight.
Naman, we can't hear you clearly.
Okay. Can you hear me now?
Yeah, much better. Thank you.
Okay. Okay. A few clarifications. You highlighted that, the PPP contract of Uttarakhand is not yet renewed. Is my understanding correct?
No. PPP contract in Uttarakhand right now is at the renewal stage where the tendering is happening. It is not renewed at the moment. We'll get clarity in that in some days, few days.
We do not really book any I mean, so, is it under our operations or?
It is under our operation as we speak, it is under our operation right now. That's not a concern. As I said, the way to look at it is the net-net. We are experiencing growth in other existing PPP projects, like in Karnataka. We have also experienced significant growth in Bihar with government giving us newer centers. Net-net, this segment has experienced dynamic growth, and we are confident of the same in the future to come.
Okay. Okay. I mean, just for our knowledge, I mean, how much time does it really, I mean, typically take for this renewal process? I mean, this entire process, I mean, 5 months, 6 months? Any timeline as such?
It's a factor of government process. Many a times it gets extended, many a times there is fast movement. If it goes with the normal pace, we could expect the tender to be kind of reaching a conclusion in a 2-4 months time period. If it gets postponed due to any reason, then there could be extensions that one can expect.
Okay. Okay. Okay. Actually my line was bad. In Philippines acquisition that we recently did you highlight 600, 800 sessions, and what were the number of beds?
It's at 600-800 sessions per month, and number of beds are somewhere around 15. That number we can review, but it's around 15.
Okay. third, on the share of profit loss from this JV, this INR 3 crore number, the Is it more, let's say, a contract based till the time we operationalize in the next few months, on a I mean, so INR 3 crore per quarter once we build in and then gradually over the next, you know, one, kind of break in profits from this JV? Or how should one look at it?
Hi, Naman. Prashant here. I'll take that question. Currently we have a 51%/49% JV, where we have the 51% and the JV partner has 49%. As part of the contract that we have with them, the JV partner has participative rights in the running of the business. Because of that, our stat auditor has taken a view that the line-by-line consolidation is not possible. Any income will be shown as a single line item as a share of profit or loss. And that will remain as long as the participation rights remain. In the future, we will consult with the Big Four, and we will figure out if there is any methodology through which we can do line-by-line consolidation. That discussion is going in parallel, but I think we will probably learn more about it in the coming year or two.
Okay. Now, I mean more on a broader, let's say, I mean, question in terms of the TAM of the opportunity. We've seen, you know, GLP-1 picking up, which also kind of slows progression of the disease. Any, any comments in terms of whether this improves our existing TAM or reduces our TAM? I mean, more on a longer term, kind of an opportunity or longer term impact because of GLP-1s.
Naman, this is Vikram. I think it's a very good question, pertinent question at this time. GLP-1 drugs are making a small minor impact in the developed world markets like the U.S. and Western Europe. When I talk to the nephrologists in the U.S. and U.K. and, let's say European countries, they are talking about a 0.25% drop in new patient additions because GLP-1s are managing the CKD early stage more effectively, and hence the delay of onset of dialysis happening. The way to look at the developed world 0.25% drop versus where everyone who needs dialysis is getting access to dialysis. Whereas in the emerging markets, majority of the patients don't even have access to dialysis who need it.
This GLP-1 drug is not relevant to the emerging markets in the next 10, 15 years. In the developed world markets, there is a small, tiny drop. If the developed world markets is growing, let's say, at a 2.5%, maybe they'll grow at 2.25%. The emerging markets, if you pool them together, they'll be growing at double-d igits. That will continue to grow. At a macro level, I do not see any effect on NephroPlus TAM opportunity going forward.
Mm-hmm. I mean, let's say I'm thinking more in terms of like, can there be a positive impact? Because ultimately, while it slows the progression, but ultimately the patient will, you know, come to let's say Stage 4, Stage 5, and their longevity or let's say, I mean, their life expectancy will also improve. Is this something to wish about or is it just a far-fetched thesis?
Not really, Naman, because without GLP-1 drugs, let's say in the U.S., the patient incidence, which means new patients coming onto dialysis, will be faster because they're getting onto the end-stage or kidney failure stage faster, right? With GLP-1 drugs, there is a slight delay. They will come to the dialysis front, but with a delay. I don't see how it will benefit with more dialysis patients. It's just that it's causing a time lag. It's just one single time lag.
Okay. Okay. Okay. No, that was really helpful. Lastly, just on some repeating questions. What could be your CapEx for 2027 if you could highlight?
Yeah. Hi. Hi, Naman. This is Prashant. I'll take that question. I think in terms of CapEx, in FY 2026 we had a CapEx of INR 165 crore compared to INR 116 crore the year before. Our CapEx almost grew by 50% in FY 2026 compared to FY 2025. We are currently sitting on INR 500 crore of cash. From a planning point of view, we are actively looking at opportunities, both India and internationally. We want to strengthen our India platform. We want to take the India platform benefits to market where we can create ROCE accretive opportunities. At the end of the day, we have a very disciplined capital allocation approach.
Any opportunity that comes has to filter through the ROCE criteria and also the other criteria that Rohit mentioned in his during his opening remark. From a guidance point of view, we are not giving any guidance on the CapEx amount. Suffice to say that we have, we have the and we have a approach in place, and we will follow that.
Thank you. Our next question come from the line of Akshay Thakur from Hillhouse Capital. Please go ahead.
Hi, sir. Thanks for taking my question, sir. My question is, the clinics model which work in, say, Philippines or Saudi, work on primarily for standalone clinics. In India, we have certain regulatory restrictions or insurance empanelment issues. How do you see this environment changing in future, government opening this up for the Indian markets? Can you throw some light on that? Any new developments there?
Hi, Akshay. Good question. See, I had briefly touched upon that in the developed market, this model of dialysis has gravitated towards standalone aside from the captive units, and we have observed that when we go to Philippines and other markets as well. India will follow the same model because real estate will become a constraint in tertiary and quaternary hospitals. As they grow, the real estate will be of constraint, dialysis would be carved outside out of the hospitals. As a chronic therapy, it makes logical sense to be closer to the home of the patients as well, right? Both these factors will influence this move.
Again, this is a factor of availability of clinicians, nephrologists, the right policies, the payer mechanism has to be in place, insurance mechanism has to be. We are seeing that shift. To me, this might take 2 to 5 years' time to really build more momentum, but the shift has started.
Thank you, sir. One more question on, compared to our peers like DaVita and Fresenius, how are we placed in terms of talent acquisition? Do we have an advantage in terms of costs for employee, like for technicians in our clinics in Philippines and the upcoming ones in Saudi? How are we placed as compared to the global benchmark?
Great question again, Akshay. I'll kind of answer that in two folds. When we were kind of doing India, and focusing on India, our strength was getting into details of consumables and getting that cost to the best level possible. When we go overseas, we realize that the manpower is the area that we have to focus and develop on. While we have already developed Enpidia, which are training academies in India, and we operate close to eight, nine of them, we have replicated that model in Philippines as well. Now, given that we are operating in India and in Philippines with a comfortable scale, a large scale, I think that puts us in a good competitive edge over our other global peers. Because globally, India and Philippines are the suppliers for nurses and the paramedic staff. Mm-hmm.
We have a strong hold in both these geographies. To me, I think this is a very strategic advantage that NephroPlus carries as compared to its other global peers. When we go look towards developed markets, this presence and this understanding of the market and the hold that we have will come in play and will make us have a competitive advantage.
Thank you, sir. Thank you. Very elaborately explained. Thanks for the opportunity. Thank you. Good luck to you, sir.
Thank you.
Thank you. Our next question come from the line of Devang Patel from Sameeksha Capital. Please go ahead.
Sir, I wanted to understand what will be the cost of new clinics that we set up. In FY 2026, we set up about 24 clinics, which cost us about INR 5 crores per clinic. Is that a good standard to go by?
Hi, Devang. This is Prashant here. If I understood your question correctly, you're talking about the CapEx in FY 2026, correct?
Yes.
I think as I indicated, our CapEx in FY 2026 was INR 165 crore. This was split evenly between India and Philippines and a little bit in Uzbek as well. We continue to, as Rohit mentioned in his opening remarks, we continue to aspire to do 40- 50 clinics in India. We try to do 10- 15 in Philippines. The CapEx per bed in India is about INR 10-INR 11 lakhs, with a payback period of about 3.5-4 years. Philippines it is INR 40 lakh-INR 45 lakhs, with a payback period of 1-1.5 years. Uzbek it is INR 18-INR 20 lakhs with a payback of 1-1.5 years. That's the broader math on it.
Although this is CapEx per bed, while we are giving only the total clinic count.
Yeah, I think it's correct. I'm giving the broader clinic count, but the best way to look at our business is the treatment volume and the guest count and RPT.
Okay.
So I think-
Good.
Yeah.
The second part to that was what is the visibility we have on clinic expansions for the coming year? Like 40, 50 would be your broad target. Are you on track for that? Or that overall CapEx would include some lumpy PPP contracts also in that 40, 50 guidance.
Devang, good question again. As I said that we in India, we are fairly confident of delivering a 40-50 range of gross new clinics and Philippines of 12-15 range. These do not include any large, big PPP project or any good acquisition factored in. The three models that we spoke about, you know, the in-center organic, center roll-offs and the large M&A PPP of leading geography. When we look at any predictions or our AOPs, we do not factor the third lever. We factor the first and the second lever only. Based on that, our forecast is kind of created. In this case, right now, there's no acquisition or PPP baked in this number.
Okay. Our average revenue per treatment was higher 1% QOQ. The growth has kind of flattened out. For the next one year, do we expect any price increases or we'd have a flattened revenue per treatment for next year?
Devang, to look at dialysis businesses that this, in this business, since it's chronic service, price does not increase on a yearly basis, and this is a sponsored therapy world over. When I say sponsored therapy, what do I mean? Typically, this will be paid through by the government or any other scheme or via an insurance, because for out-of-pocket it's very expensive and it's chronic, right? The price increase also in this case does not happen on a year-on-year basis, but it happens in a stepwise manner. Whenever it happens, it is on a lumpy side of it. We experienced a price increase in the CGHS in India in October last year, October. That was a 35% increase, but that came after 11 years. Mm-hmm.
Similarly, when we observed a price increase in the PhilHealth, which is a national insurer in the Philippines, that also happened in September/October time period in 2024. That price increase was a 40%, close to 40% after close to a decade. We, it's safe to assume that any meaningful price increase will happen only after a certain time period. In this coming year, we are not expecting any large price increase, but RPT change will be a factor of geography mix. If our international geography, as we keep expanding, that would translate to the net RPT increase at the platform level.
Got it. Just one last question. When you mentioned the clinics to be expanded next year, you did not mention anything about Saudi Arabia. Over the next 1, 2 year, could you indicate how many clinics you're looking at in that geography?
As I mentioned, Saudi Arabia is a tender market. We have been committed to the market for 2 years, and we are right now in the investment phase. A new tender has recently come out of probably just 1 month ago, which is at the EOI stage. Till the time, and it will take us one or two more quarters to understand how this tender and the terms that the government is expecting is laying out. It is very hard to right now predict that what would be the center count in Saudi Arabia coming forward. I think we should have some visibility in few quarters from now, and whenever it translates, it should be comfortable, a good-sized business.
Thank you so much.
Thank you. Our next question comes from the line of Nilanjan from TCG AMC. Please go ahead.
Hi, sir. Thank you for the opportunity. I hope I'm audible.
Yes, you are, Nilanjan.
Yeah. I have several sets of questions, but I'll limit to only a few, and I'll probably email the rest to you. The first one is, you know, increasingly we are going more foreign, and the understanding is it is more profitable. The way for me to understand is to basically do a difference between console and standard. In addition, what I heard in the CNBC interview that there's some amount of corporate expense which is sitting in the India offer, which is the standalone business. The delta, when you do it, ideally the margin should be increasing, the EBITDA margin in the delta. It is actually going the other way around. Would you want to comment exactly what is happening or if I'm missing something?
Hi, Nilanjan. This is Prashant. I'll take that question. See, I think NephroPlus, I think as Vikram and Rohit talked about, it's a platform play. We operated in a country like India where the price point was $22, and because we were operating at $22, it actually took us 10 years to become EBITDA positive, 13 years to become PAT positive, because it takes critical scale and a refined operating model to generate profit. Once we have done that, we are now taking the India platform to international geographies which are at higher price point. Because of the India platform capabilities, we are able to generate higher margins, higher ROCE compared to the competition.
As we are scaling up this platform, as a country gets started, slowly those costs gets transferred to the country, but there is a ramp-up phase where those costs are sitting in India. We are building IT platforms, we are building business development capabilities, we are building other areas of the company that will help us not only grow the markets which are existing, but also help us grow the markets which we want to open in the future. That's where the whole platform piece has to be understood, and therefore the best way to look at NephroPlus will be at a console level. The standalone level will be full of noise in terms of the data, the best way to look at it is the console level.
That's true, sir. Maybe I should say offline because I kind of bought, for the lack of another word, you know, kind of agree to it because I thought it should be more, you know, a bit profitable, at least on the differential side, which is basically the entire foreign operations. Leave that aside. The second question sort of dovetails into the same one. If you look at revenue per treatment, which is let's say about INR 2,600. This was I think about INR 2,200 at the end of FY 2024, right? If you look at the overall, India is about, let's say, $2,700 for a treatment per patient basis, and this comes from your IPO document. The same numbers for Philippines and Uzbekistan is at least 3x more.
I am not able to tally how INR 2,200 goes to INR 2,600, while revenues from my foreign operations went up from, I think 13% to almost 42% today. I'm not doubting this, but it will help us if we can get a broad split of patients or treatments that you are doing on a per country basis. Secondly, it is also a little harder for us to figure this out because we are also acquiring more units abroad. That sort of is one of my request to you is if you can put a patient pool understanding in terms of opening patients that you have lost, patients that you have missed because they have gone for some other treatment, newer acquisitions, so on and so forth. That will help us, you know, sort of build out a good understanding of the foreign market.
Nilanjan, I'll break this into two, three quick parts. One is the RPT. The RPT went from INR 2,292 to INR 2,598, which is about 13.3% increase. As I mentioned in my opening remarks, there are three key drivers. One is obviously the international mix going from 32% to 42%, with the higher price point internationally that's driving the higher RPT. The second factor was the Forex. The Philippine peso moved favorably by 5%. Uzbek currency moved favorably by 7%, that also contributed to higher RPTs. The third factor was in Philippines, the dialysis price. There is a universal standard dialysis price in Philippines for every single center. That price went up by 58% in October 2024. In FY 2026 we saw the full year impact of that, whereas in FY 2025 it was a partial year impact.
These three things together drove the RPT to go up. It was a combination of these three factors. Coming to your second question about giving the details at the country level and patient level. You know, we can discuss it offline, it is a platform play. We have taken a call that the best way to understand this company will be at the consolidated level. If you look at some of our global competition, Fresenius, for example, is in 46 countries. DaVita is in 16 countries. Trying to break things at the country level will not help because the cost will be sort of mixed up between the countries and the platform.
The best way to look at this company and model out this company will be at the consolidated level, and therefore we have decided not to give the country level detail. Happy to SGA or IR firm, happy to take your questions on model front offline.
Sure. Just one additional point to this. If you can, instead of giving, let's say the number of patients at the end of the quarter, if you can do a, you know, sort of a monthly average or daily average for the quarter and maybe the same number for the whole year. That will give us at least some understanding of the, how the patient volumes is moving at least.
Yeah.
On an overall basis.
I think maybe we'll take this offline.
Sure.
Your questions better and do what is possible.
Sure. Sure. Thank you so much.
Thank you. Our next question comes from the line of Harsh Shah from Avener Investment Wealth Management. Please go ahead.
Am I audible?
Yes, you are.
Thanks for taking my question. I had a question on the Philippines market. As we see, the prices were substantially lower in FY 2025, right? We have followed an acquisition-based strategy. I think there would be, you know, single clinic chains who would be willing to sell the assets at a relatively lower valuation. Now, since prices are substantially increased, even those clinics would have turned profitable, and the incentive to sell would have reduced for the existing players. Also considering the prices have now become attractive, there will be, you know, higher competitive intensity by the global players. Your comments on those.
It's a good observation, and I think you're absolutely right that the price has increased and the market probably is more lucrative than it was earlier. Hence we can expect the competition to increase there, which is absolutely fine. NephroPlus has been in the market for the last 6 years. We have developed our complete business development capabilities, and we are covering every corner of the country, not limiting ourselves to only one or two metro cities. We are fairly well-positioned to be catering to the entire country and not only select pockets. I had also briefly mentioned in one of my answers, if you were to do the landscape division market now, given that it has become lucrative, the supply side has also increased.
The dialysis clinics, which were around 800- 850 clinics, my senses would have crossed 900 or would be in that range. There is a supply side that has increased. If you take the large players out, which is NephroPlus and two, three others, it will also come to around 200 approximately. There is an unorganized small center network of say one or two clinics, which will aggregate to anything between 550- 600 clinics. That presents a huge opportunity for long time to come, not just a year or two or something. My sense is, it's a multi-decadal story, wherein this aggregation will come in play. As we go deeper in the country, we will be able to do more underserved markets.
It's not only acquisition mode, we will be starting greenfields as well because we are getting a firmer, better view of the whole landscape. The same way that we have gravitated or also has mastered the PPP model in India, we will also probably be exploring it, partnering with the government. We'll be opening greenfields there. We will be continuing on our acquisitions from a mid to long-term basis. At some point in time, we will explore PPP models. To us, Philippines continues to be a good growth story for a long time to come from now.
Okay, that was helpful. Secondly, I was asking, is there any private Indian player, like one of our peers who is also planning to enter the Philippines market? My last question would be, say, the expected credit loss, could you tell us if it is for which geography?
I'll take that, Harsh. Again, I can't comment on the competition, how they're planning, what they're thinking. I would not have any idea on the approach of that. It's safe to assume that there would be, many, not only from India, probably from others also trying to explore the market. That's a safe assumption to have. As I mentioned, that we are strategically well-positioned to kind of handle that for a long-term basis, but I can't comment on the competition. On the ECL front, I think, Prashant, you may want to share some thoughts.
Yeah. On the ECL front, I mean, like I had mentioned earlier, we don't give geographical split. It is driven by a very standardized ECL model, which is also industry-standard ECL model and fully ratified by our stat auditor, KPMG. We very objectively and, to be honest, we are very conservative in our ECL approach. We try to follow ECL model that allows us healthy provisions to avoid any surprises in the future. We believe we have followed the model very religiously and taken provisions which are in a very conservative and comfortable state.
Okay, thank you. Those are the questions from my side.
Yeah, Harsh, just to add to the previous Philippines point, right? With the long tail of 600 odd clinics, we expect the competition to come in, like the large global networks, because the price point is decent, competition to come in. We expect some players from India also to come in. The players have been trying for the last couple years. It's not that easy. Philippines is a high regulatory complex market, which is very, very different from running operations in India. Even when, let's say, 10 new players come in, because of the 600 odd tail of single location or two location dialysis clinics, right? This offers an opportunity for the next 10, 20 years, because all we are talking about is adding 12- 15 clinics in a year, while the tail is 600 strong, right?
We expect more competition. There will be more competition, but it won't dampen our growth plans by any means.
Okay, sir. Just to follow up on that, can you just qualitatively describe how the Indian dialysis market is very much different versus the Philippines dialysis market?
Yeah. From a regulatory perspective, right? In India, you get a small nursing home license and you can open a standalone dialysis clinic. It's relatively less regulated because the supply side is very, very limited in India, right? While the demand is very high. In Philippines, it's a very, very complex licensing mechanism. First, you need to take a standalone premises on rental. You need to do the interiors, you need to buy the machines, then you need to get the Department of Health license, then you need to get the PhilHealth empanelment. There are another five licenses, LTO and various other licenses that you need to get, and there is annual renewal. When we operated in India, when it was fairly simple versus when we went to Philippines, it took us 2 years to understand the Philippines market.
We did not grow at all in the first two years of Philippines foray. We understood the market. After two years, we started expanding. The bulk of the expansion in Philippines came in the last three years, Harsh. It's not that easy. Even if more players come, there is such a long tail of 600 odd clinics that it won't dampen our growth projections is our hypothesis.
Understood. Yeah, Sir. That was really helpful. Thank you, and all the best.
Thank you. Ladies and gentlemen, that was the last question for today. I would like to hand the conference over to the management for closing remarks. Thank you, and over to you, team.
Yeah, thank you everyone for joining our first full year call and the second earnings call. I think we hope we have been able to address your questions and queries. We'll continue to keep the capital market participants informed of any major updates on NephroPlus. For any further queries, please feel free to reach out to us or to SGA, our investor relations partner. Thanks everyone for joining.
Thank you, sir. Ladies and gentlemen, on behalf of ICICI Securities, that concludes this conference. Thank you for joining us, and you may now disconnect your lines.