healthcare tourism in india - tehran university of medical...

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Healthcare Tourism In India

3.1 HEALTHCARE SCENARIO IN INDIA

3.1.1 OverviewIndia’s health system can be categorized into three distinctphases31:

a) In the initial phase of 1947-1983, health policy was assumedto be based on two broad principles: (i) that none should bedenied healthcare for want of ability to pay, and (ii) that it wasthe responsibility of the state to provide healthcare to the people.This phase saw moderate achievements.

b) In the second phase of 1983-2000, a National Health Policywas announced for the first time in 1983, which articulatedthe need to encourage private initiative in healthcare servicedelivery and encouraged the private sector to invest inhealthcare infrastructure through subsidies. The policy alsoenhanced the access to publicly funded primary healthcare,facilitating expansion of health facilities in rural areas throughNational Health Programmes (NHPs).

c) The third phase, post-2000, is witnessing a further shift andbroadening of focus; the current phase addresses key issuessuch as public-private partnership, liberalization of insurancesector, and the government as a financier.

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31 Report of the National Commission on Macroeconomics and Health, Ministryof Health and Family Welfare, Government of India, August 2005

Healthcare Tourism: Opportunities for India

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The National Health Policy, 200232 outlines improvement in thehealth status of the population as one of the major thrust areas insocial development programme. It focuses on the need forenhanced funding and an organizational restructuring of the nationalpublic health initiatives in order to facilitate more equitable accessto the health facilities. The National Common Minimum Programmeidentifies health as an important thrust area. The Government isin the process of raising the public spending on health with focuson primary healthcare.

As a result of various initiatives, India has registered significantprogress in improving life expectancy at birth, reducing mortalitydue to Malaria, as well as reducing infant and maternal mortalityover the last few decades. The rural primary public healthinfrastructure has increased and now India has around 145,000Sub-health Centres, over 23,000 Primary Health Centres andaround 4000 Community Health Centres, catering to a populationof 5,000, 30,000 and 1,00,000 respectively33. However, only about20% of healthcare services are being provided by public sector,with the remaining being provided by the private sector. It is alsoestimated that about 10% of population is covered by any form ofhealth insurance. Private healthcare is expected to continue asthe largest component (Rs. 156,000 crores) of healthcare spendingin 2012, and could reach Rs. 195,000 crores with broader coverageof health insurance34.

According to a study by KSA Technopak, private sector playsa major role in servicing the Indian healthcare market; more than90% of it is being served by the urorganised sector. However,transition is expected to happen in the healthcare industry, withmore and more corporate players are entering the business in anorganized way. It is also estimated that increase in income levels,

32 Ministry of Health and Family Welfare, Government of India; http://mohfw.nic.in/np2002.htm

33 Annual Report 2006-07, Ministry of Health and Family Welfare, Governmentof India

34 Healthcare in India: The Road Ahead, CII-Mc Kinsey & Co.; October 2002.


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increase in share of population with lifestyle diseases, increasingpenetration of insurance market, especially the health insurancesegment are important reasons for more number of organizedplayers entering in the market. Exhibit –14 depicts increasing shareof private sector in India’s healthcare market over the years. Tables6 and 7 illustrates the healthcare profile of India, and the densityof health workers in India, respectively.

Source: Ten Industry Trends: 2007, Healthcare Outlook, KSA Technopak,Volume – 1, February 2007.

3.1.1.1 Healthcare Education and ResearchThe Government has set up regulatory bodies with the objectivesof monitoring the standard of medical education, and promotingtraining and research activities in the country. The overall objectiveis to sustain the production of medical and para-medical humanresources to meet the requirement of healthcare delivery systemin India. Regulation of medical education and profession in India isgiven in Exhibit - 15.

Exhibit 14:Increasing Share of Private Sector in India’s Healthcare

Market


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Table 6:Healthcare Profile of India

Sl. No Description Data

1 Total Expenditure on Health as % of GDP (2003) 4.8%2 Government Expenditure on Health as % of Total

Expenditure on Health (2003) 24.8%3 Private Expenditure on Health as % of

Total Expenditure on Health (2003) 75.2%4 Government Expenditure on Health as % of

Total Expenditure (2003) 3.9%5 External Resources for Health as % of

Total Expenditure on Health (2003) 1.6%6 Social Security Expenditure on Health as % of

General Government Expenditure on Health (2003) 4.2%7 Out of Pocket Expenditure as % of Private

Expenditure on Health (2003) 97.0%8 Private Prepaid Plans as % of Private

Expenditure on Health (2003) 0.9%9 Per capita Total Expenditure on Health at

Average Exchange Rates (US $) – 2003 27.010 Per capita Government Expenditure on Health

on Average Exchange Rates (US $) - 2003 7.0

Source: Working Together for Health, World Health Report, 2006; WorldHealth Organisation, 2006.

Table 7:Density of Health Workers in India

Categories Year Number Density per 1000

Physicians 2005 645285 0.60Nurses 2004 865135 0.80Midwives 2004 506924 0.47Dentists 2004 61424 0.06Pharmacists 2003 592577 0.56Public and Environmental 1991 325263 0.38 Health WorkersCommunity Health Workers 2004 50393 0.05Lab Technicians 1991 15886 0.02Other Health Workers 2005 818301 0.76

Source: Working Together for Health, World Health Report, 2006; WorldHealth Organisation, 2006.


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Further, Indian Council of Medical Research (ICMR) has beenset up as an apex body for planning, organization, implementationand coordination of medical research in the country. In addition,there are plethora of institutions for education and research in thehealthcare sector.

3.1.2 Role of Private Sector in HealthcareIndia is encouraging investment in healthcare sector; over the years,the private sector in India has gained a significant presence in allthe sub-segments of medical education and training, medicaltechnology and diagnostics, pharmaceutical manufacture and sale,hospital construction and ancillary services, as also the provisioningof medical care. Over 75% of the human resources and advancedmedical technology, 68% of an estimated 15,097 hospitals and37% of 623,819 total beds in the country are in the private sector35.The composition of private sector in India is diverse with largenumber of sole practitioners or small nursing homes having bedcapacities of less than 20. There are also several corporate entities,including pharmaceutical firms, and non-resident Indians (NRIs),

35 Report of the National Commission on Macroeconomics and Health, Ministryof Health and Family Welfare, Government of India, August 2005

Exhibit 15:Framework for Medical Education / Regulation in India


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who have invested in the Indian healthcare sector and are providingworld-class care at a fraction of the cost compared to manydeveloped countries. In addition, there are also traditional healthcareproviders, such as Ayurveda and Yoga, who have set up facilities.It is reported that there are 1369 hospitals with a bed capacity ofover 53000 in India catering to the needs of traditional Indianhealthcare; about 726,000 registered practitioners are workingunder the traditional healthcare system36. Indian hotels are alsoentering the wellness services market offering Spas and Ayurvedicmassages, tying up with professional organizations in a range ofwellness fields.

3.1.3 Health InsuranceAccording to Insurance Regulatory and Development Authority(IRDA), health Insurance is one of the fastest growing portfolios ofgeneral insurance business37. In order to give a special focus tothis area, the IRDA is in the process of setting up a separateHealth Insurance department. IRDA is also planning to bring outseparate regulations/guidelines for health insurance.

Penetration of health insurance in India is low; health insuranceis estimated at around 10% of total population. However, majorityof the health insured in India are covered under social healthinsurance or community-based health insurance, and thepenetration of commercial insurance may be around 1% only. Thereasons for low penetration of commercial health insurance is dueto low level of innovation in health insurance products, exclusionsand administrative procedures governing the policies, and chancesof co-variate risks, such as epidemics, which keeps the premiumshigh.

Following the enactment of IRDA Act, 1999, Third PartyAdministrators (TPAs) are facilitating the healthcare insurancepenetration. The prime role of TPAs is to provide the back office

36 Department of AYUSH, Ministry of Health and Family Welfare, Governmentof India; http://indianmedicine.nic.in/summary-of-infrastructure.asp

37 Annual Report 2005-06, Insurance Regulatory Development Authority,December 2006.


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administrative set-up to insurance companies – such as issue ofidentity cards, processing of claims and settlement of bills.Performance of TPAs in terms of claims settled in India is givenin Table – 8. However, TPAs have also helped in facilitating a largenumber of policy holders in getting cashless medical treatment inhospitals. Some TPAs are enhancing their role to provider networksto service other needs of the insured. With such enhanced role,the insured are getting a feel of ‘managed care’, relieving thepatients from the psychological stress of filling various forms andmobilizing resources at short notice. Thus, in the long run, therole of TPAs is likely to bring down the cost of medical treatmentin the country.

There are, at present, over 25 TPAs (Box – 9), and majorityof the general insurance companies that are transacting healthinsurance business have empanelled them for servicing theirpolicies. The list of hospitals empanelling TPAs is also expanding,showing greater confidence reposed by both the hospitals as alsothe insurance companies.

Table 8:Third Party Administrators – Claims Data in India

ClaimsReceived Claims Settled(Number) (Number)

Within Within Within More than Claims1 month 1-3 months 3-6 months 6 months outstanding

1126895 730269 291766 36051 10597 104740

(64.80) (25.89) (3.20) (0.94) (9.29)

NB: Figures in brackets indicate the ratio (in per cent) of claims settled tothe total claims received

Source: Annual Report 2005-06, Insurance Regulatory Authority of India,December 2006


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Box 9:List of Third Party Administrators Licensed in India as of

2006-07

Sl No TPAs Sl No TPAs

1 Dawn Services Pvt. Ltd 15 East West Assist Pvt Ltd2 Parekh Health Management 16 Med Save Healthcare

Pvt Ltd3 Medi Assist India Pvt. Ltd 17 Genins India Ltd4 MD India Healthcare 18 Alankit Healthcare Ltd

Services Pvt. Ltd5 Paramount Health Services 19 Health India TPA Services

Pvt Ltd Pvt Ltd6 E Meditek Solutions Ltd 20 Good Health Plan Ltd7 Heritage Health Services 21 Vipul Med Corp. Pvt. Ltd

Pvt Ltd8 Universal Medi- Aid 22 Park Mediclaim Consultants

Services Ltd Pvt. Ltd9 Focus Healthcare Pvt Ltd 23 Safeway Mediclaim Services10 Medicare TPA Services 24 Anmol Medicare Ltd

Pvt Ltd11 Family Health Plan Ltd 25 Dedicated Healthcare

Services (India) Pvt. Ltd12 Raksha TPA Pvt Ltd 26 Grand Healthcare Services

(India) Pvt. Ltd13 TTK Healthcare Services 27 Rothshield Healthcare

Pvt Ltd (TPA) Services Ltd14 Anyuta Medinet Healthcare

Pvt Ltd

Source: Insurance Regulatory Authority of India; http://www.irdaindia.org;

3.1.4 Accreditation of Healthcare Service ProvidersAccreditation of healthcare service providers is a voluntary processby which an authorised agency or organisation evaluates andaccredits health services according to a set of standards describingthe structures and processes that contribute to desirable patientoutcomes. Accreditation can thus be understood as an indicatorof professional achievement and quality of care. Health servicesare increasingly coming under independent evaluation byaccreditation agencies in many countries.


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India made an attempt to have a voluntary accreditation systemsince late 1980s when the Bureau of Indian Standards laid downstandards for 30, 100 and 250 bed hospitals. In addition, theNational Institute of Health and Family Welfare had specified rulesfor hospitals with more than 50-beds. Several state governmentshave also attempted to set standards, since health is a statesubject. In order to have a united and single system to monitorthe functioning of hospitals in India, an Inter-Ministerial Task Forcewas set-up in 1991; the recommendations of the Task Force ledto the setting up of Quality Council of India (QCI) in 1997 as anautonomous body. Under the national accreditation structure ofQCI, a National Accreditation Board for Hospitals and HealthcareProviders (NABH) has been set-up to establish and operateaccreditation programme for healthcare service providers. TheBoard of NABH is having representation from stakeholders includinggovernment, consumers, and healthcare industry. NABH is aninstitutional member of International Society for Quality in Healthcare(ISQua).

NABH standards for hospitals provide a framework for qualityassurance and quality improvement in hospitals, focussing onpatient safety and quality of care. The standards call for continuousmonitoring of sentinel events and comprehensive corrective actionplan leading to building of quality culture at all levels and acrossall the functions. The standards are equally applicable to hospitalsand nursing homes in the government as well as in the privatesector.

NABH also has plans to draw up separate standards forAyurvedic Centres in the country, in addition to formulating ofstandards for ambulance services, blood banks, dental centresand stand-alone clinics.

Over 30 applications from various hospitals / healthcare centreshave been received by NABH for accreditation. Few hospitals havebeen already granted accreditation by NABH. NABH estimates thatabout 250 hospitals in secondary / tertiary level will be able tocomply with the NABH standards (Box – 10) in the next couple ofyears.


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Box 10:Outline of NABH Standards

� Access, Assessment and Continuity of Care� Patient Rights and Education� Care of Patient� Management of Medication� Hospital Infection Control� Continuous Quality Improvement� Responsibility of Management� Facility Management and Safety� Human Resources Management� Information Management System

Source: National Accreditation Board for Hospitals and Healthcare Providers;http://www.qcin.org/html/nabh/nabh_stand.php

In addition, Indian hospitals are also increasingly turning tointernational accreditation agencies to standardise their protocolsand project their international quality of healthcare delivery. As ofOctober 31, 2007, there are eight hospitals in India accredited toJCI. These are given in Table – 9. India is ninth largest country inthe world with six JCI accredited hospitals. In addition, severalIndian hospitals are in the process of getting accreditation. Acomparison of countries with number of JCI accredited hospitalsis given in Exhibit - 16. List of JCI accredited organisations in theworld (as of December 31, 2007) is given at Annexure – 2.

3.1.5 Accreditation of Clinical LaboratoriesIndian healthcare centers including stand-alone clinical laboratoriesare going for national and international accreditation. In India,National Accreditation Board for Laboratories (NABL) provideslaboratory accreditation services in accordance with ISO15189:2003 standards. NABL also satisfies the requirements ofAsia Pacific Laboratory Accreditation Cooperation (APLAC) andInternational Laboratory Accreditation Cooperation (ILAC) mutualrecognition agreements. Several pathological clinics in India havebeen accredited by NABL.

Some hospitals and stand-alone clinical laboratories are alsogoing for international accreditation, especially from the College of


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Table 9:List of JCI Accredited Hospitals in India

Sl. No Name and Place Accredited on

1 Indraprasta Apollo Hospital, New Delhi June 18, 2005

2 Wockhardt Hospital, Mumbai August 25, 2005

3 Apollo Hospitals, Chennai January 29, 2006

Disease- or Condition-Specific Care (DCSC)Certification for AcuteStroke: 29 April 2006

4 Shroff Eye Hospital, Mumbai February 18, 2006

5 Apollo Hospitals, Hyderabad April 28, 2006

6 Asian Heart Institute, Mumbai October 20, 2006

7 Satguru Pratap Singh Apollo Hospital, February 3, 2007Punjab

8 Fortis Hospital, Mohali June 15, 2007

Source: Joint Commission International;http://www.jointcommissioninternational.com/23218/iortiz/, 2007

Source: Joint Commission International;http://www.jointcommissioninternational.com/23218/iortiz/,2007

Exhibit 16:Country-wise JCI Accredited Hospitals in the World


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American Pathologists (CAP) Laboratory Accreditation (List givenin Table 10). Such accreditation helps the hospitals / laboratoriesin achieving the highest standards of excellence in order topositively impact patient care.

Table 10:List of Indian Clinical Laboratories with CAP Laboratory

Accreditation

Sl. No Name and Place

1. BAAP Diagnostics Ltd., Ahmedabad

2. Clinigene Clinical Laboratory, Bangalore

3. Dr. Lal’s Pathological Labs (P) Ltd., New Delhi

4. Dr. Lal’s Pathological Labs (P) Ltd., Mehruali-Gurgaon

5. Ehrlich Laboratory (P) Ltd., Chennai

6. Igate Clinical Research International (P) Ltd., Mumbai

7. Lambda Therapeutic Research Ltd., Ahmedabad

8. Manipal Acunova Limited, Bangalore

9. Manipal Acunova Limited, Manipal

10. Metropolis Health Services (India) Ltd., Mumbai

11. P D Hinduja National Hospital & Medical Research

12. Reliance Clinical Research Services Ltd., Navi Mumbai

13. SRL Ranbaxy Ltd., Mumbai

14. Supratech Micropath Lab & Research Institute,Ahmedabad

15 Thyrocare Technologies Limited, Navi Mumbai

Source: College of American Pathologists, USA;http://www.cap.org/apps/cap.portal?_nfpb=true&portlet

3.1.6 Traditional Healthcare Systems in IndiaIn India, in addition to existence of modern medicine, indigenousor traditional medical practitioners continue to practice throughoutthe country. Popular indigenous healthcare traditions includeAyurveda, Siddha, Unani, Homeopathy, Naturopathy, and Yoga.

The Ayurveda (meaning science of life) system deals withcauses, symptoms, diagnoses, and treatment based on all aspectsof well-being (mental, physical, and spiritual). These professionals,


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traditionally, have been inheriting the skills from their ancestors.However, with the advent of education, a variety of institutions offertraining in indigenous medical practice.

The Siddha system defines disease as the condition in whichthe normal equilibrium of the five elements in human beings islost resulting in different forms of discomfort. The diagnosticmethods in Siddha medical system are based more on the clinicalacumen of the physician after observation of the patient, pulseand diagnosis and clinical history.

Box 11:About CAP Laboratory Accreditation Programme

The goal of the CAP Laboratory Accreditation Programme isto improve patient safety by advancing the quality of pathologyand laboratory services through education, standard setting,and ensuring laboratories to meet the regulatory requirements.

The CAP Laboratory Accreditation Programme meets theneeds of a variety of laboratory settings from complexuniversity medical centers to physician office laboratories.The programme also covers a complete array of disciplinesand testing procedures. The comprehensive nature of CAPaccreditation helps in achieving consistently high level ofservice throughout an institution or healthcare system.

CAP Laboratory Accreditation Programme has recognition ofthe Centers for Medicare and Medicaid Services (CMS), USAand the Joint Commission on Accreditation of HealthcareOrganizations (JCAHO), USA, and thus can be used to meetmany certification requirements.

There are over 6,000 laboratories worldwide that have metthe standards of excellence required under CAP LaboratoryAccreditation Programme.

Source: College of American Pathologists, USA.:http://www.cap.org/apps cap.portal?_nfpb=true&portlet_3_1_actionOverride


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Yoga is a science as well an art of healthy living physically,mentally, morally and spiritually. Yoga is believed to be founded bysaints and sages of India several thousand years ago. Yoga hasits origin in the Vedas, and its philosophy is an art and science ofliving in tune with the universe. Yogis gave rational interpretationof their experiences about Yoga and brought a practically soundand scientifically prepared method within every one’s reach.

Naturopathy has several references in the Vedas and otherancient texts, which indicate that these methods were widelypractised in ancient India. Naturopathy believes that all the diseasesarise due to accumulation of morbid matter in the body and ifscope is given for its removal, it provides cure or relief. It alsobelieves that the human body possesses inherent self-constructingand self-healing powers. Naturopathy differs slightly with othersystems of medicine, as it does not believe in the specific causeof disease and its specific treatment but takes into account thetotality of factors responsible for diseases such as one’s un-naturalhabits in living, thinking, working, sleeping, or relaxation, and theenvironmental factors that disturbs the normal functioning of thebody.

Unani system of medicine believes that the body is made upof four basic elements viz., earth, air, water and fire, which havedifferent temperaments i.e. cold, hot, wet and dry. After mixing andinteraction of four elements a new compound having newtemperament comes into existence i.e. hot-wet, hot-dry, cold-wetand cold-dry. The body has simple and compound organs, whichgot their nourishment through four humours, viz. blood, phlegm,yellow bile, black bile. Unani system of medicine believes inpromotion of health, prevention of diseases and cure.

All these traditional healthcare systems are attracting nationaland international patients, and generate tourism flows. In additionto such healthcare systems, there are also faith / spiritual healers,who are largely present in rural parts of India. Some spiritual leadersuse one or more of the traditional therapies, viz, Ayurveda, Yogaor Naturopathy as one of the healing modes to cure their clients.Such spiritual leaders are attracting large gathering, especiallyinternational travelers from various countries.


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Both the Government of India and state governments haverealized the potential of attracting tourism leveraging traditionalwellness systems of India. Some state governments have beenprojecting their states as center for traditional wellness systems(e.g. Kerala as Ayurveda hub and UP as Yoga hub). Some stategovernments have announced tourism policy leveraging thepotential of traditional healthcare systems. The attempts by thestate Governments to attract tourists are not restricted to traditionalmedical systems, but also through leveraging spiritual tourism /faith healing. For example, Andhra Pradesh has drawn up an actionplan to promote spiritual tourism, especially to attract Germantourists, combining visits to famous temples along with Yoga,meditation and Vedanta. Similarly, Uttar Pradesh is promoting thestate as Yoga hub, leveraging the presence of religious circuitsand being a land of Sadhus.

3.1.7 AromatherapyAromatherapy is one of the holistic forms of treatment. It is a formof therapy using essential oils extracted from products of aromaticplants, shrubs and trees. Aromatherapy is used for treatment ofboth physical and psychological well-being of the patients.Aromatherapy has been practiced for a long time, with risingpopularity, of-late. Scientific research continues in the efficacy ofessential oils and associated aromatherapy into the physical andpsychological well-being of an individual.

The objective of Aromatherapy is to treat the disease as awhole rather than the symptoms alone. The approach adopted byan Aroma therapist has the following benefits:

� It can help patients to assess their own lifestyles, their statesof mind, and the mental and physical demands that influencestheir health;

� It enables the therapist to look more closely at the wellness ofpatient and identify the root causes of the symptoms of anydisease; and

� It promotes a state of balance within mind and body, whichwill enable the individual to cope better with illness.


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Box 12:Ayurveda – India’s Traditional Wellness System

The system of Ayurvedic medicine has evolved overthousands of years through a process of experience,observation, experimentation and intuition. Ayurveda providesa complete system of preventive medicine and healthcare,which has been proven as its effectiveness over a longperiod in India. The sages of the time, who were physiciansand surgeons as well saw health as an integral part ofspiritual life. The Vedic Brahmanas were not only priestsperforming religious rites and ceremonies but also physicianspracticing Ayurveda (Vaidyas). It is said that thy received theirtraining in Ayurveda through direct cognition during meditation.In other words, the knowledge of the use of various methodsof healing, prevention, longevity and surgery came throughDivine revelation. These revelations were transcribed fromthe oral tradition into book form, interspersed with the otheraspects of life and spirituality.

The science of Ayurveda is based on the knowledge of thehuman constitution. If every individual knows his or her ownconstitution, they can understand what constitutes a gooddiet and lifestyle for themselves. The five great elements,viz., ether, air, fire, water and earth are manifested into thethree Doshas or biological organizations known as Vata, Pittaand Kapha. These biological organizations are used by anindividual to gain a full understanding of all aspects of bodilyfunctions, in order to establish the harmonious balancerequired for a healthy existence. In due course, Ayurveda,which started as a magico-religious practice, matured into afully developed medical science with eight branches that haveparallels in the western system of medicine. However, unlikemodern medicine system, Ayurveda is based on naturalherbs, which gives distinct advantage.

Source: Exporting Indian Healthcare; Export-Import Bank of India; QuestPublications; October 2002.


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Box 13:YOGA – A Fitness System of Indian Origin

Yoga represents a process through which one can learn howto live in a most integrated way. The science of Yoga andits techniques have been reoriented to suit modernsociological needs and lifestyles. Today, there are hundredsof Yoga styles practiced; however, the popular styles includeBhathi Yoga, Karma Yoga, Gnana Yoga, Raja Yoga, MantraYoga, Laya Yoga, Tantra Yoga, Hatha Yoga, Kundilini Yogaand Kriya Yoga.

Rishikesh is called the Yoga capital of the world. There area large number of institutions and Yoga professionals in India.Since there is no recognized apex organisation, where theinstitutions have to register, the exact number cannot bestated, though it is estimated to run in to several thousands.In India, the awareness regarding Yoga and its applicationsis on the increase and today a lot of people are comingahead and taking up Yoga courses.

Advantage India

India is in an advantageous position to tap the globalopportunities in this sector. The tradition of Yoga was bornin India several thousand years ago. Its founders were greatsaints and yogis. Yoga has its origins in Vedas, the oldestrecord of India culture. We have the history of expertise inimparting the Yoga training since the ancient time. The greatIndian sage, Patanjali, systematized the Yoga practice in hisYoga Sutra. Although this work was followed by many otherimportant texts on Yoga, his book is the most significant oneas it has touched almost all aspects of human life. Most ofthe popular Yoga institutions in the world have their parentinstitutes or governing bodies in India, and thus placing Indiain an advantageous position to tap the global opportunities.

Source: Exim Research


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Box 14:Yoga and its Health Benefits

Yoga, the art and science of maintaining physical and mentalwell-being, has its origin in India. Yoga is one of the mostancient, yet vibrant, traditions that is getting increasinglypopular today. A potent stress-buster, Yoga is an instrumentto self evolvment and enlightenment, through physical andmental well-being. Broadly, Yoga, when performed withperseverance, precision, patience and ‘shraddha’, yield highlyrewarding results. They promote health and consequentlybeauty. But to derive maximum benefit, one has to embarkon this daily practice or rather pilgrimage, with passion andcommitment.Yogasanas keep the spinal column supple, strong andhealthy. This results in a steady erect posture, boosting selfconfidence. During Yogasanas, the alternate stretching andrelaxation of muscles facilitates blood circulation and supplyof oxygen, rejuvenating every cell of the body. Various Yogicpostures gently massage internal vital organs, keeping themin perfect condition. Cholesterol levels are kept in check andthe blood pressure is normalized. This internal harmonycleanses and detoxifies the body and boosts the immunesystem.Yogasanas make the body toned, strong and flexible. Standingasanas like the Tadasana and Trikonasana result in perfectlytoned and shapely legs and ankles. Certain inverted postures- like the Sarvangasana – results in free flow of blood to theneck, face and hair. Facial skin becomes taut and wrinklefree, attaining a radiant glow. The hair becomes thick andglossy, and the eyes acquire a natural shine.Yogasanas speed up metabolism, resulting in a slim figure.There is no accumulation of fat anywhere in the body.Forward-bending exercises result in flab-free abdomen. Thisnatural pampering of the body by Yogasanas result inslowing down of the ageing process, both physical andmental. This in turn leads to positivism in our thoughts,actions and relationships.

Source: Geetika Jain, www.spirituality.indiatimes.com/articleshow/2376027.cms


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Box 15:Spiritual / Faith Healing in India

Spiritual / faith healing is defined by different people differently.In the context of our study, we may define spiritual / faithhealing as a mode to achieve wellness of a person. Theprinciple behind any spiritual healing is to instigate anincrease in the subtle basic ‘sattva’ component in the personalong with a concomitant decrease in the subtle basic ‘tama’component38. Thus, spiritual healing is about diagnosis andremoval of the spiritual root cause of a physical or mentalproblem. This could be done either through self-healing orthrough the help of spiritual healers.

India is being perceived as the land of diverse cultures andbeliefs with inherent spirituality. Many travelers / writers whohave visited India from abroad, since many centuries, havescripted about many legendary worship sites and pilgrimcenters which are meant for wellness and healing. Manydomestic travelers have traveled scouting for inner-peace tovarious places, be it religious centers or persons whoperform faith healing. India has many lavishly built religiousmonuments that are famous in attracting national andinternational travelers. To name a few, religious places likeAmritsar, Dwaraka, Ajmer, Vaishno Devi and Tirupathi havebeen serving as spiritual as well as tourism centers. Somepeople visit some of the spiritual centers such asGunaseelam and Chotanikkara, seeking mental healing.

India is also having motivating speakers and proponents ofspirituality like Swami Baba Ramdev, Sri Sri Ravishankar,Mata Amritanandmayi, who are attracting large number of,both national and international, tourists. Such spiritual leaderspromote brand India as Yog-Bhoomi through discourses,seminars and other outreaching measures. While the numberof persons visiting spiritual centers or spiritual leaders forhealing is increasing, it is yet to be proven scientifically theefficacy of spiritual healing.

Source: Exim Research

38 Spiritual Science Research Foundation; www.spiritualresearchfoundation.org;


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The main method adopted in aromatherapy is through massagewith the application of essential oils. While the whole body isprovided with massage using suitable essential / herbal oils, greaterattention is provided to specific areas to derive extra benefit for agiven problem.

Aromatherapy also plays an important role during pregnancyhelping the mother-to-be to cope with the pregnancy relatedproblems, especially for the pain relief and relaxation. However,experts suggest that some essential oils are to be completelyavoided during pregnancy due to diverse reasons, as some ofthem are considered as abortifacients. Aromatherapy is also usedon babies for the benefit of relaxation and skin development.However, experts opine that not all essential oils are to be usedon babies, but with either almond oil or olive oil. Wider variety ofoil may be used on children once they grow up.

Aromatherapy has been used in Vedic India. Floral and otherherbal essences have been in continuous use by the Indianindigenous medical systems, such as Ayurveda, for a very longperiod. Ayurveda embraced herbs and aromatics as an importantpart of the philosophy of healing, using fresh herbs, dried herbssuch as tea, or herbs compounded into powder and often handrolled into pills using fresh plant juices. In Ayurvedic massages,herbal essences are used to provide mental and physical well-being of the individuals.

India has rich bio-diversity and is housed with large number ofmedicinal plants and spices. India is the largest producer,consumer and exporter of spices, with a 45 per cent share byvolume and 23 per cent share by value, in the world market. TheIndian spice export basket consists of around 50 spices in wholeform and more than 80 products in value added form. India issecond largest exporter of medicinal plants in the world. Most ofthe medicinal plants and spices grown in India have aromaticcharacteristic. These medicinal plants and spices are still valuedin international markets for their aromatic properties. Some of thespices produced in India and their important flavour compoundsare given in Table - 11.

India is also playing significant role in the production andprocessing of essential oils. India’s rich bio-diversity, coupled with


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competent scientific force, and favourable processing conditionsmake the country as the natural choice to become a foremostleader in aroma business. Some of the culinary effects of essentialoils are:

� Angelica essential oil – used to treat digestive and respiratoryailments;

� Bay laurel oil – used to treat problems associated with theluymphatic system;

� Basil oil – strengthens and supports nervous system

� Bergamot oil – relieves depression and has calming properties

� Pepper oil – improves digestion and stimulates circulation

3.2 INTERNATIONAL TOURISM IN INDIATourism is one of the important components in the India’s servicessector, which has exhibited considerable dynamism in recentyears. Tourism in India contributes to around 6.11% of GDP, ascompared to over 10% of GDP generated in the world. The sectorgenerates employment for over 40 million persons, a share ofnearly 9% of total employment generated in the country.

Share of India in world international tourist arrivals has beengrowing at a moderate level; from a level of 0.39% in 1995, India’sshare has gone to 0.52% in 2006 (Table – 12). In terms of absolutenumbers, India received 4.40 million international tourists in 2006.Foreign exchange generated through the arrival of internationaltourists in India amounted to an equivalent of over Rs. 30,000crores. It may be mentioned that foreign exchange earnings byIndia has been growing greater than the growth in tourist arrivals.The trend in international tourist arrivals and foreign exchangeearnings in India is depicted in Exhibit – 17.

Another important feature of international tourism in India isthe foreign exchange earnings per international tourist arrived inIndia. Foreign exchange earning per international tourist arrived inIndia is over US $ 2000 as compared to the world average of US$ 873 in 2006 (Exhibit – 18). This is higher than many othercompetitor countries in the region such as China (683), Sri Lanka(984), Malaysia (548), Thailand (892), Singapore (934), and


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Table 11:Important Flavour Compounds of Select Spices

Spice Important Flavour Compounds

Allspice Eugenol, β<-caryophylleneAnise (E)-anethole, methyl chavicolBlack pepper Piperine,S-3-Carene, β-caryophylleneCaraway d-carvone,carone derivativesCardamom a-terpinyl acetate, 1-8-cineole, linaloolCinnamon, cassia Cinnamaldehyde,eugenolChilli Capsaicin,dihydro capsaicinClove Eugenol, eugeneyl acetateCoriander d-linalool, C10-C14-2-alkenalsCumin Cuminaldehyde, p-l,3-mentha-dienalDill d-carvonFennel (E)-anethole, fenchoneGinger Gingerol,Shogaol, neral,geranialMace a-pinene,sabinene, 1-terpenin-4-ol.Mustard Ally isothiocynateNutmeg Sabinine,a-pinene, myristicinParsley ApiolSaffron SafranolTurmeric Turmerone,Zingeberene, 1,8-cineoleVanilla Vanillin, p-OH-benzyl-methyl etherBasil, Sweet Methylchavicol,linalool, methyl eugenolBay laurel 1,8-cineoleMarjoram e- and t-sabinene hydrates, terpinen-4-olOregano Carvacrol,thymolOriganum Thymol, carvacrolRosemary Verbenone,1-8-cineole, camphor, linanoolSage, Clary Salvial-4(14)-en-l-one, linaloolSage, Dalmation Thujone,1,8-cineole, camphorSage, Spanish e- and t-sabinylacetate, 1,8-cineole, camphorSavory CarvacrolTarragon Methyl chavicol,anetholeThyme Thymol, carvacrolPeppermint 1-menthol, menthone,menthfuranSpear mint 1-carvone,carvone derivatives

Source: Spices Board, Government of India; www.indianspices.com;


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Source: World Tourism Organisation; India Tourism in 2005, Incredible India,Ministry of Tourism, Government of India, August 2006.

Table 12:International Tourist Arrivals in World vis-à-vis India

(Million Persons)

Year International Tourist International Tourist Share ofArrivals in the World Arrivals in India India (%)

1995 544.9 2.12 0.39

1996 575.3 2.29 0.38

1997 597.8 2.37 0.38

1998 617.4 2.36 0.38

1999 641.1 2.48 0.38

2000 685.5 2.65 0.39

2001 683.8 2.54 0.37

2002 702.8 2.38 0.34

2003 690.9 2.73 0.39

2004 766.0 3.46 0.45

2005 808.0 3.92 0.49

2006 842.0 4.40 0.52

Source: World Tourism Organisation; India Tourism in 2005, Incredible IndiaMinistry of Tourism, Government of India, August 2006.

Exhibit 17:Trends in International Tourist Arrivals and

Foreign Exchange Earnings in India


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Indonesia (897). Such high spent in India may be attributed to morenumber of days spent by a foreign tourist in India compared toother countries besides the visit of high-end tourist to India.According to a foreign tourist survey conducted by Ministry ofTourism (MOT), Government of India, a foreign tourist from thetop 15 international markets for India spend in the range of 7 to18 days in India, the overall average being 16 days.

Nearly two-third of international tourist arrivals in India arecatered by UK and USA (Exhibit – 19). Other major source marketsfor India include Canada, France, Sri Lanka, Germany, Japan,Malaysia, Australia and Singapore. These ten countries cumulativelyaccount for around 57% of international tourist arrivals in India.Nearly 50% of international tourists have stayed in budget hotels,as compared to 20% that have stayed in starred hotels. Nearly50% of tourists are repeat visitors; about 10% of total internationalvisitors to India have visited more than five times39.

Source: India Tourism in 2005, Incredible India, Ministry of Tourism,Government of India, August 2006.

39 International Passenger Survey - 2003; Incredible India, Ministry of Tourism,February 2006, New Delhi.

Exhibit 18:Per Tourist Foreign Exchange Earnings by India and

Select Countries (2006)


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3.2.1 Tourism Promotion in IndiaThe Approach Paper40 to the Eleventh Five Year Plan hashighlighted the importance of tourism sector in terms of itscontribution to GDP and employment generation, and proposed tofocus on creation of adequate tourism infrastructure likemodernisation and expansion of airports, increase inaccommodation facilities under star and budget category andimproved road connectivity to tourist destinations. In addition, theApproach Paper has sought to ensure the upkeep and preservationof historical sites and other tourist places, as one of the strategiesto attract international tourists. Other strategies proposed by theApproach Paper include enhancing India’s competitiveness throughreduction in various taxes, provision of hassle-free inter-statemovement of passenger vehicles, and conduction of skilldevelopment programmes in hotel and catering managementstreams.

Source: Tourism Statistics 2006 at a Glance, Incredible India, Ministry ofTourism, Government of India, September 2006, New Delhi.

40 Towards Faster and More Inclusive Growth, An Approach to the 11th FiveYear Plan (2007-2012, Planning Commission, Government of India, December2006.

Exhibit 19:International Tourist Arrivals by Countries - 2006


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A National Policy on Tourism highlighting the importance of thesector in economic development of India was announced in 1982.The policy was formulated at a time much before the economicreforms in India. Thus the policy did not emphasize much on therole of private sector and foreign investment.

With the objective of providing thrust on private sectorpartnership in tourism development, the Ministry of Tourism,Government of India has announced a New National Tourism Policy,in 2002. The key areas identified to provide the requisite thrust tothe tourism industry include ‘Swagat’ – welcome; ‘Soochana’ –information; ‘Suvidha’ – facilitation; ‘Suraksha’ – safety; ‘Sahyog’ –coopration; Samrachana’ – infrastructure development; and ‘Safai’– cleanliness.

3.2.2 Exclusiveness of India in Tourism41

India has many tourist attractions that have healing abilities andare capable of providing rewarding experiences of life. India hasthe Himalayan ranges in the north, a long coastline surrounded byseas in the south. In addition, India is rich in varied landscapes,enchanting historical sites and royal cities, clean beaches, serenemountain retreats, rich cultures and festivities to enjoy andrejuvenate.

In any part of the year, India can offer a wide selection ofdestinations and experiences. In summer, there are lovely retreatsamidst the heady beauty in the Himalayas or the lush-heights ofthe western Ghats with cool trekking trails, tall peaks, or stretchesof white water for the adventure seekers. In the cool Indian winter,cities come alive with cultural feasts of music and dance. Thesun-clad beaches are ideal locations for rejuvenation in the winter.The wild-life sanctuaries with their abundance of flora and faunaprovide delights to the mind and rejuvenation to the body. Varioustourism themes are being promoted in India, which are describedbelow:

41 This section is written using information from literature / publications /promotional materials of the Department of Tourism, Government of India.


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Adventure Tourism: The country offers a wide range ofadventure sports for tourists. Trekking and skiing in the Himalayas;white water rafting on the rivers such as Ganges and Beas; cameland jeep safaris in the deserts of Rajasthan, paragliding in HimachalPradesh, water-sports in Goa; Scuba diving in Andaman andLakshadweep islands are some of the options available to adventureseeking tourists. Lakshadweep islands also offer excellent windsurfing and snorkelling in the crystal clear waters of the lagoons.

Sun and Sand – Coastal Tourism: India’s coastal states suchas Gujarat, Masharashtra, Goa, Karnataka, Kerala, Tamil Nadu,Andhra Pradesh, West Bengal and Orissa have a choice ofbeaches. Many breathtaking beaches promise perfect escape totranquility. While some of them are for quite beaches (like Chorwad,Ahmedpur and Mandvi in Gujarat; Gopalpur in Orissa), the beachesin Goa are popular for wind-surfing and yatching.

The Backwaters: Kerala is said to have sprung from theocean. All along the coast, these exotic backwaters, canals,lagoons and inlets create an intricate maze that stretches for 1900km. across the land. The serene villages in the backwaters ofKerala are living portrait of Kerala’s rural life.

Eco-Tourism: The Himalayan Range spread across five Indianstates providing widest monotonic geographical variety. Widesweeping valleys and deep gorges give way to thick deciduousforests and alpine meadows, undulating tea gardens and slopes,bar narrow terraces, gently contoured hills, snow draped peakssurrounded by a fluff of clouds, thundering rivers and deeplyfissured glaciers provide excellent locations for eco-tourism. In thesouthern part of India, the south and eastern Ghats, especially theNilgiri Ranges, have its own unique appeal to eco-tourism.

Architectural Treasures: India has rich architecture traditions,which have the beginning as old as 3rd millennium BC. Indianarchitectural tradition is the living vital art of the various dynasties,which ruled over it. The Buddhist stupas (dates back to 230-500AD); Jain’s sculpture at ancient Palitana, Ajanta, Ellora, and MountAbu; the Hindu temples with profuse carvings and Gopurams ofthe South India; arches and domes, filigrees in architecturepromoted by Mughals; presidency towns built by modern rulerslike British, French, Portuguese, are some of the vital arts


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assimilating the influence of various dynasties that ruled over thecountry.

Forts and Palaces: India’s once famous princely kingdoms,which carried feudal traditions, have built forts and palaces, someof which have been converted into hotels now. Jaipur, Jodhpur,Jaisalmer, Bikaner in the state of Rajasthan; Mysore in Karnataka;Mughals’ forts in Northern India are some of the examples ofseveral fascinating forts and palaces.

Hill Delights: A journey through the hill resorts of India promisesa deep and refreshing communion with nature in its varying beauty.Lush river valleys surrounded by snow-caped peaks, fruit-laidenorchards, gurgling streams and dense forests evoke enchantmentand delights of hilly regions. The misty dawn on mountains creatingmagnificent landscapes extend to the entire north-eastern states,whose natural beauty has earned the title ‘seven sisters’. Otherhill states, Himachal Pradesh and Jammu & Kashmir provides abreathtaking variety of the Himalayan splendour. The Nilgiris in theSouth have the picturesque Anantagiri, Udhagamandalam, Madikeriand Munnar. Mount Abu in Rajasthan, Panchgani in MadhyaPradesh and Mahabaleshwar in Maharashtra are other hill regionswith tourist attractions.

The Deserts: The state of Rajasthan has the mystique of thedesert with sand dunes closer to the splendid cities of Jodhpur,Bikaner and Jaisalmer. The royal edifices take the tourists to themagnificence of the bygone era. Turbaned men with proudmoustaches, and village girls in colourful attires and heavy jewelleryswaying in the desert sands to match with the enchanting rhythmand melodies, are other attractions of the deserts of India.

The Jungle: India is a land of wildlife providing delight for thenatural lovers. Total area of India’s protected wildness isapproximately 140,000 sq. km. and constitutes 4 percent of thecentury’s total land area. The country has preserved vast tracts offorests and habitats in its nearly 100 national parks over 400 wildlifesanctuaries. India’s climatic and geographic diversity makes it thehome of over 350 mammals and 1200 bird species, many of whichare unique to the sub-continent.


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The wildlife parks and sanctuaries, filled with varieties of tigersand elephants, the peacocks and the rhinoceros, are fascinatingdiversity of terrain, flora and fauna. In northern India, CorbettNational Park and Dudhwa National Park in Uttar Pradesh, KanhaNational Park and Bandhavgarh National Park in Madhya Pradeshand Rajasthan’s Ranthambore National Park and Sariska TigerReserve, are all the home of the magnificent predator-the tiger.These also have varieties of deers, and a range of lesser cats,mammals and birds.

Island attractions:The Andaman and Nicobar, andLakshadweep islands are enriched with white and sandy beaches,crystal-clear water and picturesque coral reefs. Sun-bathing in theseislands along with snorkelling and scuba-diving are touristattractions.

Pilgrimage: India holds attractions, for pilgrim tourists of diversereligions, where religion is considered more than the act of worship,but a way of life. For the Hindus age-old cities of worship likePrayag (that provide holy confluence of Ganga, Yamuna andSaraswati rivers); Puri (Jagannath temple); Konark (Sun temple);Kanchipuram, Madurai, Tiruchirappalli and Kanniyakumari (SouthernGopurams), provide peace and reverence. In addition, there arealso religious places that are carved with craftsmanship, at Belurand Halebid. In these temples, the interior and exterior walls aredecorated with intricately-carved deities stylized motifs from natureand friezes depicting the life in the reign of the Hoysalas. Thereare also worship places for the Muslims (Delhi - Jumma Masjid),Christians (Churches in Goa and Kerala), Buddhists (Bodhgaya,Saranath, Kushinagar), Sikhs (Golden Temple) and Jains(Sravanabelagola), that have tourist attractions.

North-East Region: Life moves at a serene pace in the north-eastern region of India with the ‘seven sister’ states are generouslyblessed with the natural beauty. The region is enriched withmagnificent landscapes naturally created by verdant valleys,emerald tea gardens, lush forests and tumultuous rivers. A misty-dawn of the mountains, bronze sun-set across the expanse ofthe Brahmaputra, and the clang of prayer bells at monasteries,provide healing to mental and physical well-being of the visitingtourists.


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3.2.3 Select Schemes for Tourism Development in IndiaMOT, Government of India has set out several schemes supportingthe tourism development initiatives of the state governments andprivate corporate sector. The focus of such schemes is to improvethe existing products and developing new tourism products tomatch with other countries. These include:

3.2.3.1 Scheme For Product / Infrastructure And DestinationDevelopment

For infrastructure and product development, MOT, Government ofIndia, has been providing Central Financial Assistance to the StateGovernments with the objective of strengthening the infrastructureand product development all over the country. The destinations forsupport are identified, in consultation with state Governments,based on tourism potential, under an overall Master Plan, withforward and backward linkages, so as to develop them in anintegrated manner.

Eligible activities include: improvement of the surroundings ofthe destinations, illumination, improvement of solid wastemanagement systems and sewerage management, constructionof budget accommodation, procurement of equipments related totourism, signage, tourist centers and refurbishing the monuments.Eligible activities will be fully funded by the MOT. However, thestate Governments will have the responsibility of making the landavailable, implementation of rehabilitation package, provision ofexternal infrastructure (such as roads, power, water supply),maintenance and management of assets.

3.2.3.2 Scheme for Integrated Development of Tourist CircuitsMOT has been extending assistance to state Governments fordevelopment of tourism circuits in order to identify and developtourist circuits to match with international standards. Tourismcircuits are identified in consultation with state Governments, asalso the mode and channelisation of funds. DOT would bear 100%of total capital cost of the project.


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Box 16:New National Tourism Policy (2002)

Broadly, the National Tourism Policy (2002) attempts to:

� Position tourism as a major engine of economic growth;

� Harness the direct and multiplier effects of tourism foremployment generation, economic development andproviding impetus to rural tourism;

� Focus on domestic tourism as a major driver of tourismgrowth;

� Position India as a global brand to take advantage of theburgeoning global travel trade and the vast untappedpotential of India as a destination;

� Acknowledges the critical role of private sector withgovernment working as a pro-active facilitator andcatalyst;

� Create and develop integrated tourism circuits based onIndia’s unique civilization, heritage and culture inpartnership with states, private sector and agencies;

� Ensure that the tourist to India gets physically invigorated,mentally rejuvenated, culturally enriched, spirituallyelevated and ‘feel India from within’.

To achieve the overall vision for the development of tourism,five key strategic objectives need to be achieved. They are:

� Positioning and maintaining tourism development as anational priority activity;

� Enhancing and maintaining the competitiveness of Indiaas a tourism destination;

� Improving India’s existing tourism products and expandingthese to meet new market requirements;

� Creation of world class infrastructure;

� Developing sustained and effective marketing plans andprogrammes.

Source: National Tourism Policy 2002, Ministry of Tourism, Government ofIndia, New Delhi


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3.2.3.3 Scheme of Assistance for Large Revenue GeneratingProjects

The Government, recognizing the role of private corporate sectorin development of tourism infrastructure in India, supports largerevenue generating projects, under public-private partnership. Largeprojects like Tourist trains, Cruise vessels, Cruise Terminals,Convention Centres and Golf Courses would qualify for suchassistance. A SPV would have to be set up by the implementingprivate agency prior to the consideration of their project under thisscheme. The amount of assistance would be released to SPVthrough the financial institutions. The quantum of subsidy for theprojects will normally be determined through a competitive biddingprocess, with a cap of Rs. 50 crores subject to a maximum of25% of total project cost or 50% of equity contribution of the privatepromoter, whichever is lower.

3.2.3.4 Scheme for Capacity Building for Service ProvidersAssistance under this scheme is extended to eligible implementingagencies to undertake training programmes for select tourismservice providers such as staff of bus / railway air stations, policepersonnel, immigration staff, taxi / coach drivers, staff atmonuments, who come in contact with the tourists. The objectiveis to increase the skill-sets (of service providers), such as etiquette,behavioural and client handling manners, and communication. Inaddition, the programmes may also cover areas such as personalhygiene, cleanliness, basic service techniques, garbage disposaland administering first aid.

3.2.3.5 Scheme for Rural TourismUnder this Scheme, thrust is to promote village tourism as theprimary tourism product to spread tourism and its socio-economicbenefits to rural and its new geographic regions. Key geographicregions are identified for development and promotion of ruraltourism. The implementation is done through a ConvergenceCommittee headed by the District Collector. Activities like improvingthe environment, hygiene and infrastructure are covered forassistance. Apart from providing financial assistance, the focus isto tap the resources available under different schemes ofDepartment of Rural Development, Government of India, state


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Governments and other relevant departments of the Governmentof India.

3.2.3.6 Scheme for Organising Tourism Related Events Under this scheme, MOT provides financial assistance to stategovernments for organizing events such as fair, festival, show,seminar, conclave and convention for promotion of domestic andinternational tourism.

3.2.3.7 Scheme for IT InitiativesUnder this scheme, state tourism departments are encouraged toimplement Information Technology (IT) initiatives for improved touristinformation, facilitation, marketing and publicising of tourist products.Assistance is given up to 50% of IT project cost, such as purchaseof hardware / software, and production of CD / VCD or websites,subject to a defined ceiling.

3.2.3.8 Scheme for Market Development AssistanceMOT is also administering a Market Development Assistance (MDA)scheme, which provides financial support to approved tourismservice providers (such as hoteliers, travel agents, tour operators,tourist transport operators, whose turnover include foreign exchangealso), for undertaking activities such as sales – cum - study tour,participation in fairs and exhibitions, and publicity through printedmaterial.

3.3 HEALTHCARE TOURISM IN INDIAIndia holds competitive advantages in healthcare tourism – be itthe low-cost advantage, availability of healthcare professionals,reputation for treatment in advanced healthcare segments suchas cardio-vascular surgery, organ transplants, and eye surgery,increasing popularity of India’s traditional wellness systems, andstrengths in information technology.

The International Passenger Survey (2003) conducted by theMinistry of Tourism, Government of India estimates that about 2.2%of foreign travelers visited India with the objective of healthcareand treatment (Exhibit – 20). The same share, if extrapolated tothe foreign tourist arrival statistics for the year 2006 (estimated to


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be 4.4 million), would give an estimated number of about 97,000foreigners visiting India with healthcare objectives.

Further, the International Passenger Survey – 2003 hasestimated that about 2 million non-resident Indians visiting Indiaevery year, of which about 10% come with healthcare objective.This works out to about 200,000 NRI patients visiting India toundergo various treatments. All these put together, the visitors toIndia with healthcare objective could be estimated at around300,000 patients.

In addition, there are a large number of international visitors,including non-resident Indians, who come for other purposes, butuse wellness systems, such as Ayurveda / Yoga or SpiritualHealing. Even if we assume that only 5% of foreign travelersundertake such wellness systems in India, the estimated numberof travelers under this category would be 200,000. Thus, it maybe quantified that the healthcare visitors to India would easily bein the range of around 500,000.

Based on the data on international tourist arrivals and foreignexchange earned by India42, it could be estimated that averagespending of international tourists visiting India was of the order ofUS $ 2000 per person. Using this data, the estimated total

Source: International Passenger Survey, 2003, Incredible India, Departmentof Tourism, Government of India, February 2006, New Delhi.

42 India Tourism in 2005, Incredible India, August 2006;

Exhibit 20:Purpose of Visit


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expenditure incurred by foreign healthcare tourists works out toabout US $ 200 million. The International Passenger Survey – 2003,of Ministry of Tourism, Government of India estimates an averageper capita expenditure of Rs. 48,000 for NRIs visiting India. Forthe 200,000 estimated NRIs visiting India, annually, with healthcareobjective, the total expenditure works out to approximately US $240 million.

In addition, we may assume that 10% of the general foreignvisitors may use wellness systems during their travel to India, andspend about 20% of their total expenditure on healthcare; the totalspending on healthcare by these travelers works out toapproximately US $ 150 million. Putting together, the healthcaretourism industry in India generated revenue of over US $ 600 million(or about Rs 2400 crores) in 2006. It may be mentioned that thegiven estimate is considering healthcare in its broader perspective.

3.3.1 Healthcare Tourism – Initiatives in IndiaThe tourist inflow for a wide healthcare service spectrum, fromwellness tourism to surgery and rehabilitation has made allinterested stakeholders to tap the unexplored potential. Both theindustry and Government (central and state governments) areindependently or jointly taking initiatives to project India as an idealhealthcare destination.

3.3.2 Industry InitiativesHealthcare centers are establishing world-class infrastructure (bothmedical as well as patient-handling infrastructure) in order to attractinternational patients. The hospitals are also constantly upgradingtechnology by acquiring state-of-the-art equipments. The playersare setting up comprehensive diagnostic centres, imaging centersand world-class blood banks.

Some hospitals have established special wards for internationalpatients as also special desks to handle international patients. Suchspecial desk will have officials to handle translation, travelrequirements and food and beverages needs. Some hospitals arealso tying up with travel / tour operators to offer healthcare tourismas a single service package.


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Some hospitals project themselves operating in specialty fields,such as cardiology, ophthalmology, dentistry. Some of them haveeven set up specialty centers focusing on areas such astransplantation surgery. Few hospitals are organizing internationalconferences in such specialties, and invite medical fraternities fromvarious countries with the objective of showcasing Indian skills invarious healthcare segments. Such conferences also facilitateinteractions with specialists and help enhance knowledge transfers.

Few hospitals have established international collaborations –both with developed and developing countries. Such collaborationsare with hospitals, healthcare institutions, Government departmentsof health and family welfare, which would facilitate participation inhealthcare delivery, treatment of their patients, and training of theirmedical / paramedical professionals. Such tie-ups have facilitatedflow of patients from select countries to Indian hospitals, thetreatment of which would be covered under the respective country’snational health programmes.

Few hospitals are in the process of continuous innovation ofproducts, services and facilities in order to give better value to thecustomers as also to stand ahead in the competition. While doingso, some hospitals are focussing on cost-effective-customeroriented technology. Quality, standardisation and accreditation areassociated strategies followed by some Indian players. Indianhealthcare institutions are increasingly going for internationalaccreditation of hospitals and clinical laboratories.

Indian healthcare establishments are also adopting marketingand promotional strategies. These are through participation ininternational trade fairs / exhibitions, international medical symposia/ conferences. Internet is being used as an effective media ofcommunication with international healthcare travelers. Thehealthcare industry in India has formed the Indian HealthcareFederation (IHCF) with the objective of collectively promotinghealthcare industry in the country.

A ten point agenda outlined by the Indian Healthcare Federationin order to impart quality, accessibility and affordability of healthcarein India is given at Annexure – 3.


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The concept of telemedicine is also being promoted by Indiancorporates while providing healthcare services. Some hospitalsuse the concept of telemedicine to undertake their social obligationsof supporting Rural Health Mission of the Government, and someof them use the concept to provide distance consulting andtreatment advise to the patients abroad.

3.3.3 Government InitiativesThe Ministries of Health and Family Welfare, and Tourism,Government of India are evolving an approach to give a strategicpush to open the Indian healthcare sector to foreign tourists. TheMinistry of Health and Family Welfare has set up a NationalAccreditation Board for Hospitals, under the Quality Council of Indiafor accreditation of hospitals. The policies adopted by othercountries for accreditation of their hospitals are also beingexamined to gain from their experiences in taking this forward inIndia. Government of India has also taken the initiative of

Box 17:Indian Healthcare Federation

Indian Healthcare Federation (IHCF) is an independent non-statutory body, with a membership of around 300 members,comprising non-government hospitals, diagnostic centers,medical equipment manufacturers and pharmaceutical firms.The main objective of IHCF is to promote and encouragehealthcare industry in the country. IHCF seeks to functionas a liaisoning medium between Government, healthproviders, medical equipment manufacturers and othermedical institutions. IHCF also provides a common platformfor its members to discuss and arrive at solutions for variousissues related to healthcare industry and ensure organizedaction wherever necessary. IHCF endeavours for a disease-free India by providing accessible quality healthcare everysingle citizen at affordable cost and transform India into ahealthy and vivacious nation.

Source: Indian Healthcare Federation;www.indianhealthcarefederation.org;


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Box 18:Concept of Telemedicine

The World Health Organization defines Telemedicine as, “Thedelivery of healthcare services, where distance is a criticalfactor, by all healthcare professionals using information andcommunication technologies for the exchange of validinformation for diagnosis, treatment and prevention of diseaseand injuries, research and evaluation, and for the continuingeducation of healthcare providers, all in the interests ofadvancing the health of individuals and their communities”.The concept of telemedicine would thus include:

� Telehealth - use of electronic information andtelecommunications technologies to support long-distanceclinical health care, patient and professional health-relatededucation and training, public health and healthadministration;

� Teleconsultation - use of information and communicationstechnology to enable clinical consultation betweengeographically separated individuals such as health careprofessionals and their patients;

� Telemonitoring - A real time and live interactive monitoring(evaluation) of technique(s) or procedure(s) of anapplicant seeking procedures, or a surgeon seeking tocertify or document his competence in a specifictechnique or procedure(s);

� Teletreatment – advice provided to the patient throughanother doctor using information and communicationstechnology about the course of treatment to be taken;

� Telediagnostics - is the use of information andcommunications technologies to enable the diagnosis ofa patient between geographically separated individuals.

Source: Recommended Guidelines & Standards for Practice ofTelemedicine, Report of the Technical Working Group for TelemedicineStandardisation, Ministry of Communications and InformationTechnology, Government of India, May 2003.


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rationalizing the flow of tourist traffic. Earlier, foreigners coming toIndia with healthcare objective were being granted tourist visa byIndian Missions abroad. As tourist visa is non-convertible, non-extendable and valid only for a period of six months, the healthcarepatients and their accompanying persons faced difficulties inemergencies. To resolve this, Government of India has introduceda new category of visa - “Medical Visa”, which can be given forspecific purpose of medical treatment to foreign tourists comingto India. Further, the Government has facilitated with a fast trackclearance for the healthcare visitors at the airport.

The Ministry of Communications and Information Technology,Government of India has developed a framework for IT Infrastructurefor Healthcare (ITIH) prescribing appropriate standards for eachstakeholder to build an integrated healthcare information networkfor India. This initiative is expected to bring in value and benefitsto all healthcare players as also the users.

At the state level, some state Governments are participatingin healthcare tourism expos abroad. Such activities are being usedas a platform to meet international experts from the medicalfraternity and brief them about the competence of Indian healthcareindustry in general, and the healthcare sector in the state, inparticular. Further, at the state level, several initiatives are takenby the industry in association with the state governments.

Kerala has made concerted efforts to promote healthcaretourism, leveraging Ayurveda, in a big way, which has resulted ina substantial increase of visitor arrivals into the state. KeralaTourism Development Corporation (KTDC), since early 1990s hasbeen promoting Ayurveda under the banner of healthcare tourism,and has started Ayurvedic health centers in its hotels. KTDC hasalso tied up with reputed Ayurveda centers in order to provideauthentic treatment to the international travelers to Kerala. TheDepartment of Tourism, Government of Kerala has classified theAyurvedic centers in two categories - Green Leaf and Olive Leaf– a sort of accreditation or grading of centres. With such initiatives,Kerala and Ayurveda have virtually become synonymous with eachother. The current trends show that Kerala is emerging as amodern healthcare provider with significant collaborations of


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entrepreneurs in the private healthcare sector and the tourismindustry.

In Karnataka, the state is in the process of setting up of aBangalore International Health City Corporation, which will offerpatients a wide variety of health care products and treatments.The Government of Karnataka is also in the process of leveragingthe state’s IT prowess to tap business in the healthcare outsourcingservices. Leveraging IT skills would help enhance Karnataka’sposition in associated services to the growing healthcare sectorsuch as medical billing, disease coding, forms processing andclaims settlement. Karnataka is also bidding high on Telemedicine,a concept by which patients can be treated even when the doctoris geographically placed in another area.

In Maharashtra, the Infrastructure Development and SupportAct (MIDAS) of Maharashtra has granted the tourism activity withan industry status, with the objective of granting all the benefitsand incentives that are given to other industries. This Act wouldalso empower the Maharashtra Tourism Development Council(MTDC) as a Special Planning Authority, to procure and provideland available at various tourism estates without needing approvalfrom the Maharashtra Industrial Development Corporation (MIDC).In Maharashtra, the industry in association with the StateGovernment has set up Medical Tourism Council of Maharashtra.

Gujarat is one of the few states in India to announce a separatepolicy for medical tourism, with the objective of creating integratedmedical tourism circuits based on the location of specialtyhospitals, heritage and culture. In addition, Gujarat is in the processof setting up a Healthcare Tourism Council in association with thehealthcare and tourism industry.

Goa, which has been for long attracting tourists for its beachesand exotic cuisine, has fine-tuned the hospitality skills into an art,and is now attracting healthcare tourists with focus on cosmetictreatments.


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Box 19:Medical Visa in India

Medical visas are issued by the Indian Missions / Postsabroad after scrutinizing the medical documents carefullyand after satisfying the bonafide purpose for which the visaunder medical conditions are sought. The visa officials mayalso satisfy themselves that the applicant has soughtpreliminary medical advice from his country of origin / countryof residence and he has been advised to go for specializedmedical treatment. The illustrative list of ailments that maybe considered primarily would include neuro-surgery,ophthalmic disorders, heart related problems, renealdisorders, organ transplantations, plastic surgery and jointreplacement. Medical visa is being granted if the treatmentis to be undertaken in reputed / recognized specialty hospitals/ treatment centers in India. In case the foreign nationaldesires to undergo treatment under the Indian Systems ofMedicine, such cases may also be considered.

The initial period for issue of such visa may be upto a periodof one year or the period of treatment, whichever is less,which can be extended for a further period of another year,upon the recommendation of the state Governments /Foreigners Regional Registration Office (FRRO), supportedby relevant medical documents. Such visa will be valid for amaximum of three entries in one year. Foreigners comingon medical visas is mandatorily required to get registeredthemselves within a period of 14 days of arrival with theconcerned FRROs.

Attendant / family members of the patient coming to Indiafor medical treatment are also granted visa undermiscellaneous category that would co-terminus with themedical visa of the patient. Such visa is being granted tothe spouse / children or those who have close blood relationswith the patient, but not more than two persons. Such visitorsare also required to get themselves registered with the localFRROs.

Source: Ministry of Tourism, Government of India; http://www.incredibleindia.org/pdf/MedicalVisa.pdf

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