Aster DM Healthcare Limited (ASTERDM) Earnings Call Transcript & Summary

[Audio Gap] general meeting of Aster DM Healthcare Limited. I invite our Chairman, Dr. Azad Moopen, to welcome the shareholders to begin the proceedings of the 13th Annual General the Meeting. Over to you, sir.

Thank you, Puja. Dear shareholders, good morning to you all. I'm Dr. Azad Moopen, Chairman and Managing Director of Aster DM Healthcare Limited. I'm attending this meeting from my home office in Dubai. I welcome you all to the 13th Annual General Body Meeting of your company. In view of the COVID-19 pandemic and the social distancing norms to be followed, this AGM is being held through video conference in accordance with the circulars issued by the Ministry of Corporate Affairs and SEBI. In the current circumstances, the company has taken all feasible steps to enable the members to participate through video conference and cast their votes on the items being considered at the AGM. A live streaming of this meeting is also being webcast under webcast of NBCL -- NSDL. Before we begin the proceedings of the meeting, I request my colleagues on the video conference to introduce themselves. Alisha?

Good morning, dear shareholders. I'm Alisha Moopen, the Deputy Managing Director of Aster DM Healthcare, and I'm also the Chairperson for the Risk Management Committee. I confirm that I'm attending the AGM from my residence in Dubai. Mr. Wilson?

Good morning. I'm Wilson, T.J. Wilson, attending this AGM from my office -- from my home in Dubai. Thank you all. Welcome to this AGM.

Good morning. I'm Anoop Moopen, a Director of Aster DM Healthcare. I'm attending the meeting from my home office in Dubai.

Daniel? Daniel?

Good morning, everyone. I'm Daniel Mintz, Director of the company. I'm attending the AGM from my home office in New York, U.S.A. Thank you.

Shamsudheen? We are not able to hear you. Are you on mute?

Good morning, everyone. I'm Shamsudheen Bin Mohideen Mammu Haji, Director of the company. I'm attending this meeting from my home office. Thank you.

Mr. Suresh Kumar?

I'm Suresh Kumar, Independent Director, joining the meeting from my residence in Dubai. I'm also Chairman of the Audit Committee, and the Stakeholders Relationship Committee. Thank you.

Professor Biju?

Good morning, everyone. I'm Professor Biju Varkkey, Independent Director of the company. I'm also the Chairperson of the Nomination and Remuneration Committee. I'm attending this meeting from my office and I am on Dubai campus. Thank you.

Dr. Layla?

I'm Dr. Layla Marzooqi, Independent Director. I'm attending the AGM meeting from my home residence in Dubai, UAE. Thank you.

Mr. James Mathew?

Good morning, everyone. I'm James Mathew. I'm one of the Independent Directors of the company. I'm attending this meeting from my home office in Dubai, UAE. Thank you.

Mr. Sridar Iyengar? Sir, you're on mute.

Hi, I'm Sridar Iyengar. I am an Independent Director of the company. I'm attending this Annual General Meeting of the company from my home office in California, U.S.

Thank you very much. Thanks a lot, all the directors, except one of the directors, Mr. C.J. George, who couldn't attend today's meeting. All the others are present, and thank you very much for the full quorum. I also request Group CFO, CEO India and Company Secretary to introduce themselves. Mr. Sreenath?

Good morning, everyone. I'm Sreenath Reddy, Group CFO, attending this meeting from corporate office in Dubai.

Yes. Mr. Harish Pillai, India CEO?

Good morning, everyone. I am Dr. Harish Pillai, India CEO, attending the meeting from Aster Medcity City, Kochi.

Ms. Puja Aggarwal?

Good morning, everyone. I'm Puja Aggarwal, Company Secretary and Compliance Officer of the company. I'm attending the meeting from the registered office of the company in Bangalore. Thank you.

Thank you, everyone. Thanks a lot. And we also have Mr. [J.D.], partner of Messrs. Deloitte Haskins & Sells chartered accountants, the statutory auditors attending the meeting from Bangalore and Mr. Rajiv, Senior Partner of Messrs. Damodaran & Associates LLP, company secretaries, the secretarial auditors of the company attending this meeting from Chennai. We have the prerequisite quorum present through video conference to conduct the proceedings of this meeting. Participation of the members through video conferences is being checked for the purpose of quorum as per the circular issued by the Ministry of Corporate Affairs and the Section 103 of Companies Act 2013. The quorum being present, I call this meeting to order. I now request the team to play a short corporate video on the journey Astra DM Healthcare after which I shall continue my speech. [Presentation]

On behalf of the Board of Astra DM Healthcare Limited, it gives me great pleasure to welcome you to the 13th Annual General Body Meeting of your company. I thank all members, colleagues on the board, the auditors and the management team for joining the meeting through video conferencing and for your support and goodwill. I consider it a privilege to address you all today to give an insight into the performance of your company for the financial year 2021. 2020, and even now has been a black swan period in the history of mankind. We are going through one of the most challenging years in the lifetime of all of us as we are hit by the only pandemic in the last 100 years. As on date, it has affected 205 million people worldwide with 4.33 million succumbing to the sinister monster. Being a health care provider, we are in the middle of the battle and our colleagues are in the front line as soldiers in the battle. I thank and applaud the soldiers, the thousands of doctors, nurses and paramedic staff who work tirelessly, risking their lives to save and serve millions of patients. In fact, in spite of the pandemic, we have served over 15 million patients across 17 countries, adding 7 countries last year. That's a huge number, and we all should salute the people who have made this possible. Our first and foremost effort when WHO announced the corona infection as a pandemic on the 12th March 2020, was to make sure that the front line staff are protected so that they can take care of our patients. In spite of this precaution that we took, 8,000 of our staff were infected and sadly, 4 of them died during the pandemic. So this is a reality with the health care professionals, and we know that many of the doctors and paramedics have died. But this is like a war and soldiers die in war. But we salute those who suffered contracting the disease and pay homage to the families of those who lost their lives in the battle. We have announced a 10-year salary support for families of employees who die of COVID-19. This is applicable to all employees of Aster in India and GCC, who lost their lives due to COVID-19, or those who may succumb God forbid to the disease in future. So this we thought is a small gesture from our side. And this has really helped in improving the morale of the staff. We have to continuously rethink, reevaluate and redesign our strategies in order to meet the changing condition due to the pandemic. The great German philosopher Friedrich Nietzsche said that, "that which does not kill us makes us stronger." So we are proceeding. The testing times proved the resilience of our team and the sustainability of our business model. Though we had some impact on our financials, we are on a much stronger footing now. On the business side, our primary focus was to ensure continuity of operations so that we could ensure best possible health care for our patients and return to the -- returns to the shareholders. We took multiple steps in that direction and adopted best practices and developed protocols and policies to ensure this. One of the greatest research due to COVID was the use of virtual platform for running our business, both clinical and business efficiency. Apart from the rolling out of the telemedicine, we introduced many unique measures, including the e-ICU for remotely monitoring the patients using the resource of critical care doctors in our hospitals in certain locations. There has been severe impact due to COVID in the first quarter of financial year in GCC, as the wave started in GCC first. Patient footfalls came down significantly and the revenues came down also. By the end of the first quarter, our businesses in GCC region stabilized a bit, and we say -- saw a noticeable change with more people approaching the hospitals for elective procedures. There was also significant revenue that was generated through PCR test. While the hospitals picked up, the clinics and the pharmacy sector took time to come out of the impact and is still lagging behind. Overall, towards the end of the financial year, revenues picked up, and we saw a positive momentum in our collections. With the advent of the second wave in the last quarter of -- last quarter, the GCC operations faced again some disruptions with lockdowns and travel restrictions, but we are coming out of that also. So overall, when you look at, even though we had a huge impact to begin with, we could sustain that, and we are slowly coming out of that without too much of an impact on life as well as on the financial performance. The positive news is that the vaccination drive in UAE is proceeding at a very rapid pace. Although it does not remove the possibility of infection, vaccination provides significant protection to a wider population and meets our future prospects better. I'm happy to announce that we have fully vaccinated about 84% of our employees in the GCC and the numbers are going up in India also. In terms of our performance in India, the patient footfall is reduced and medical tourism sector stalled affecting the overall revenue when the first wave hit there. Notwithstanding the uncertainties we continue to serve the population and ramped up our initiative to address the clinical complexities created by COVID-19. Two of our laboratories in Bangalore and Calicut were accredited by ICMR for doing RT-PCR test. The telehealth vertical provide consultations in departments like general medicine, gastroenterology, neurology, cardiology, et cetera, to the people who are not able to come to the doctors for getting consultations. The Aster home initiative, again, performed very well in regions like Kerala and Bangalore and generated and provided support to homebound patients during this very difficult period. The impact of COVID-19 on the -- to control the impact of COVID-19, we implemented conservative financial management to enhance our cost efficiencies, while staying true to our service levels. We critically analyzed overheads and expenditure and filtered all nonessential expenditure. In order to reduce cost, we made constant effort to negotiate for best possible terms with vendors and secured part rent payment deferment for our leased facilities, both in GCC and in India. We also had some delayering exercises and undertook some reduction in payroll costs for both GCC and India during this period. This really helped us to be sustainable. Speaking in terms of financial numbers, I'm happy to report that in the financial year, last financial year, in spite of the COVID impact, our revenues from operations declined only by 1% to INR 8,608 crores compared to INR 8,652 crores in financial year '19. However, due to the increased cost on consumables and many other additional expenses, the profits came down significantly. Our PAT post NCI stood at INR 148 crores during the year under review. Our GCC operations continue to be major contributors to the overall business, accounting for 81% of the total revenue. Looking ahead, I believe Aster DM Healthcare is poised to embark on an exciting journey. We have taken a conscious decision to focus on our India business in future. This shall be achieved through spreading the present assets and adding more beds to it. We shall also focus on Aster labs and the franchised Aster pharmacies in India, along with Aster Homecare, and connect all these through a virtual platform to have seamless connectivity with our hospitals and produce an ecosystem. Outside of India, with the new hospital in Caribbean, we are expanding into Western Hemisphere and unfolding a new chapter in Aster's history. We have signed a concession agreement with Cayman Island government to build the Aster Cayman Medcity with a 150-bed multi-specialty hospital over the next 3 years. This shall be followed by assisted living facility and a medical university in the long term. The project would cater to the under Caribbean region, America and Canada and introduce the world to Aster's world-class tertiary and quaternary care, bolstered by the -- our clinical and service excellence. This is likely to add to our reputation and business significantly in the future years. On the domestic front, we remain dedicated to our expansion in India and see a strong potential for growth. In order to broaden our health care offerings in our -- to our patient base, we are proactively developing Aster labs and pharmacy distribution network in India, which shall be a force multiplier for our ecosystem. In alignment with the strategy of expanding presence through an asset-light model, we also started the Aster Whitefield Hospital, which is a boutique women and children facility in Bangalore, which caters to the unique health care needs of the children and women. I just want to tell you that it has been shown -- a lot of it has been shown in the video, so I don't want to go deeper. I want to say that we believe, as an organization, in giving back, and this is being done through Aster Volunteers. Aster Volunteers has become, in fact, the face of Aster in many places where we are present, and we are extremely happy that we are able to provide support to people in need, especially during this pandemic. To all our stakeholders, I would like to express our gratitude for being with us through these testing times, supporting us throughout and believing in us. This has helped us to overcome the challenges and come out from the difficult times without too much of an impact. Even as the second wave of COVID-19 continues and is causing disruptions, at Aster, we are confident to emerge out stronger, backed by resilience and agility to guide us to a better tomorrow. To close, before I close, I want to just take note that we are celebrating the 75th anniversary of independence of India on 15th of August. I take this opportunity to wish you all a glorious Independence Day celebration, along with prosperous and peaceful year ahead. [Foreign Language] I now request Ms. Alisha Moopen, Deputy Managing Director, to address the shareholders.

Dear shareholders, thank you, Chairman, it gives me immense pleasure to address all of you today. The last 1 year has been a phenomenal trajectory in the history of Aster DM. It has been one of the toughest years in the history of the organization, and yet it has been a turning point in our journey to build a sustainable future in our organization. The year was a difficult one personally and professionally for everyone around the globe. As countries in which we operate went into lockdown, we spent the initial weeks addressing and adapting to the rapidly changing local circumstances. Our primary focus was to switch over to telemedicine, reduce mortality and morbidity, sustain our revenue streams and ensure a robust liquidity in the system. We believe that the digital expertise is the future of health care and wellness and are committed to creating solutions that go beyond the literal meaning of health care. Because our patient care outreach is currently limited to hospitals, clinics, labs and pharmacies, we're always looking for methods to break down these barriers and establish a unique model of clicks and bricks. With resilience, we have shifted a large part of our back-office work to a shared service center in India and took proactive measures towards creation of various digital assets. On the technology front, we have initiated key innovative projects, which are aimed at supporting people and their families with the necessary knowledge and assistance to deal with the pandemic. For example, we recently invested in a new app called One Aster, which will serve as our coordinated way of engagement with our patient base for their wellness. It will have teleconsult, e-pharmacy, chronic disease management and various other teams to support the patient care. Our attempt to help people adjust to the new normal living through our new microsite called Our New Earth has also emerged as one of the one-stop couture solutions for people for seeking -- for people seeking practical and yet medically verified guidance on topics ranging from ways to safeguard against COVID in everyday routines, assisting children and high-risk groups to providing guidance for COVID-19 recovered patients to adjust back to normal routine. It has acquired a lot of traction in the GCC, in India and neighboring countries such as Sri Lanka, Bangladesh, Pakistan, Nepal, Iraq. We have had almost 450,000 website visitors and 20% plus return visitors in a span of just 10 months. Even amidst the pandemic, we continue to drive and maintain our clinical excellence, achieving some significant milestones, which requires a special mention. We have made huge strides in transplant services and neurosciences. All our 7 global centers of excellence have been virtually connected, and now, our entire clinical team can come together to leverage on their collective strength and dreams to be the global best. As part of our inorganic expansion strategy, we have entered into a partnership with Roche Middle East, the world leader in biotechnology, as a strategic partner for us across the UAE, Qatar, Saudi, Oman and Bahrain. This collaboration will really empower Aster hospitals, clinics and laboratories across the region to adopt the latest diagnostic innovation and solutions, which will help support our doctors in providing the most optimal treatment solutions for our patients. We've also taken another giant step towards global excellence by inking the agreement to establish our clinical excellence hub in the Western Hemisphere, as Chairman mentioned, at Cayman Islands in the Caribbean region. In tough times like these, it is unquestionably necessary to not only unify our teams to the shared goal of tending towards our patients, but also to let them know that they are our heroes for serving the people in the need of the hour. To that end, we had -- we started the program called Aster Salutes Everyday Heroes program, which is a group-wide initiative that highlights the outstanding work that has been done by the Asterians across geographies. Being constantly motivated by our promise of We'll Treat You Well, we have also continued to provide quality services across the communities we serve across the world. From contribution to the Kerala Chief Minister's Disaster Relief Fund, the distribution of free masks to spread awareness regarding COVID-19, and bolstering the connect with the UAE by bringing 88 of the ICU nurses from India to UAE to catering for the emergency evacuation of critically ill patients from Yemen, there have been numerous acts of valor that we are all supremely proud of. In conclusion, I want to again convey my deepest appreciation to each and every Asterian for the commitment and passion with which they have stepped up and gone beyond the call of duty in this challenging year. And thank our shareholders for standing by us over this tough year. Thank you so much.

Thank you, Alisha. Since this being the AGM held through video conferencing, I request Ms. Puja Aggarwal, Company Secretary, to take you through certain instructions for participation -- participating in the meeting. Puja?

Thank you, Chairman. Good afternoon, everyone. Members may note that the meeting is being held through video conference in accordance with the Company's Act and circulars issued by the Ministry of Corporate Affairs and SEBI. The facility of participation in the AGM through video conferencing facility is being made available to all the members, and the procedure has been detailed in the AGM notice. Members are requested to refer to the instructions in the notice of the AGM for uninterrupted and seamless participation. In case any members are facing any difficulty, they may reach out to the helpline numbers. All the members have been -- have joined the meeting, and they have been placed on the mute mode to avoid any disturbances arising from the background noise. The company has received requests from a few members who have registered themselves to speak at the meeting. Accordingly, the floor will be open for these members to ask questions. The moderator will facilitate this session once the Chairman opens the floor for questions and answers. The register of members, register of directors and KLP, the register of contracts or arrangements in which directors are interested, certificate from the statutory auditors in terms of Regulation 13 of the SEBI Share-based Employee Benefit Regulations of 2014, statutory auditor's report and secretary and auditor's report have been made available electronically for inspection by the members during the each year. Members seeking to inspect such documents can send their requests to [email protected]. As the meeting is being held through video conference, the facility for appointment of proxies by member is not available, and hence, the proxy register is not available for inspection. The company has provided the facility to cast votes electronically on all the resolutions set forth in the notice. Members who have not yet cast their votes and who are participating during this meeting will have the opportunity to cast their votes through the e-voting system provided by NSDL. Members can click on the Voting tab on the video conference screen to avail this facility. Those shareholders who have cast their votes through remote e-voting prior to the AGM can attend the AGM but shall not be entitled to cast their votes again. Thank you. I now request Chairman to conduct the proceedings of the meeting.

Thank you, Puja. The notice dated 27 -- 22nd June 2021, convening the meeting, the statement of profit and loss for the year ended 31st March 2021, and the balance sheet dated 31st March 2021, together with the report of the Board of Directors and the auditors have been circulated to you. With your permission, I would like to take the notice as read. I further confirm that there are no qualifications, observations or comments mentioned in the auditor's report on the financial transactions or matters which have any adverse effect on the functioning of the company, and it does not call for reading of the auditor's report. The shareholders may also note that considering that e-voting on all the items of the agenda has been made available to the shareholders, there shall be no voting by show of hands. We shall now proceed to deal with the various business in the order as set out in the notice of the meeting. After this, we will open the floor for any questions by shareholders. Item #1 of the agenda. I would now take up all agenda items given in the notice of the 13th Annual General Meeting. The first item of the agenda is to receive, consider and adopt the audited standalone financial statements of the company for the financial year ended 31st March 2021, along with the auditor's report and the report of the Board of Directors thereon. This item forms a part of the ordinary business, and it is proposed to be passed as an ordinary resolution. Item #2 of the agenda. The second item of the agenda is to receive, consider and adopt the consolidated audited financial statement of the company for financial year ended 31st March 2021, along with the auditor's report thereon. This item forms a part of the ordinary business and it is proposed to be passed as an ordinary resolution. Item #3. The item #3 of the agenda is to appoint a Director in the place of Mr. T.J. Wilson, who retires by rotation and being eligible offers himself for reappointment. This item forms a part of the ordinary business, and it is proposed to be passed as an ordinary resolution. Item #4 of the agenda. the fourth item of the agenda is to secure ratification for remuneration payable to the cost auditors for the financial year 2021/2022 as proposed in the notice. This item forms a part of the special business, and it is proposed to be passed as an ordinary resolution. Item #5 of the agenda, the fifth item of the agenda is to secure approval for reappointing Mr. Suresh Muthukrishna Kumar as a Non-executive Independent Director of the company for a second term of 1 year. This item forms a part of the special business, and it is proposed to be passed as a special resolution. Item #6. The sixth item of the agenda is to secure approval for the contribution of bona fide charitable fund trust. This item forms a part of the special business and it is proposed to be passed as an ordinary resolution. Item #7 of the agenda. The seventh item of agenda is to secure approval for remuneration of Ms. Alisha Moopen, Deputy Managing Director of the company. This item forms a part of the special business, and it is proposed to be passed as an ordinary resolution. Now we will take questions from the shareholders. To avoid repetition, the answers to all questions shall be provided towards the end. Members may also note that the company reserves the right to limit the number of members asking questions depending upon the availability of time. The company secretary will now invite the speaker shareholders one by one to ask their questions.

Thank you, Chairman. Dear shareholders, thank you for joining our AGM and for taking the time to participate in it. Before we begin with the question-and-answer session, we have a few points to be noted for your convenience. The name of the shareholders who have registered to speak at the AGM shall be announced in turn. The shareholder will be unmuted by the host. Shareholders are requested to turn on their video and audio to participate at the meeting. Those shareholders who are unable to join through audio/video mode can join through the audio mode. Shareholders are requested to mention their name, folio number and location from where they are connecting before asking your question. Each shareholder will be given 3 minutes for their questions. To avoid repetition, the Board of Directors shall respond to all the questions at the end. In case there is a connectivity problem with any shareholder, then the next shareholder will be asked to join. Once the connectivity improves, the shareholders will be called again. Once you have asked your question, you can log off and continue to watch the AGM. If the members are facing any technical issue, then the members may reach out to the helpline numbers mentioned in the notice of the AGM. Please note that we have received requests from 3 shareholders to speak at the AGM and the moderator shall unmute each shareholder in turns. The first shareholder is Mr. [Bajeesh]. I request the moderator to please unmute Mr. [Bajeesh].

4002342497. Sir, my question is what are our plans to increase the footprint in India? Thank you.

Thank you, Mr. [Bajeesh]. The second shareholder is Mr. [Janish]. Moderator, request you to please unmute Mr. [Janish].

Good afternoon, everyone. My name is [Janish]. My client ID is IN30023915668108. My question is, what is the impact of COVID in your overall performance? Thank you.

Thank you, Mr. [Janish]. And the last request is received from Mr. [Veneet]. I would request moderator to please unmute, Mr. [Veneet].

Hello. And my question is, what is the status of company's Cayman project? And when are we likely to start the operations? Thank you.

Thank you, Mr. [Veneet]. Thank you. Over to you, Chairman. Sir, you're on mute. Request you to please unmute.

Sorry about that. So I will answer the first question and maybe part of the second question. And then ask Alisha to answer the other questions. So the question was on the footprint increase in India. This is a very, very important, I mean, strategic direction in which the company is moving. As I mentioned in my speech, we see India as the growth opportunity for Aster as we go forward. You might have noticed that the India business has increased from just 10% 10 years back to nearly over 20% now, and it's going up. So -- and India has a huge potential. So what we are planning to do is multiple things. One, the existing business, it has to spread and it has to produce more revenue, which will be without investment, we are going to have that benefit, and that will increase our EBITDA, our ROCEs, all the metrics, it will increase. So that is something which we are on that journey. But apart from that, the footprint increase can happen through 2 ways. One, by starting more of hospitals. And that, as you know, is very capital heavy. So when you go into a capital-heavy situation, that will have an impact on your return on capital, and that will have an impact on your share pricing and which, in fact, even now, I'll also mention about that, even though that has not been asked, I should mention that. The share price has not gone to a level what the shareholders wanted over the last 4 years since we got listed. So we don't want to have too much of a struggle with capital, more of capital, more of debt and all. So we are looking at asset-light models to increase our footprint in India. So that's why we are starting the laboratory as a major area for focus. Along with that, we have now started the franchised chain of pharmacies and home care. So in areas where we have presented the South Indian states where we want to focus, there will be the concentration of the pharmacies, the labs as well as the home care. And along with that, we will also have as part of digital transformation, we will also have the virtual consultation happening. So this will provide a good ecosystem where patients can come for primary care, and they can get all that is required at their homes or closer to them. And in case they require any advanced treatment, they can come to the hospital. This is the model which we have in GCC. So we hope that this will help a lot in spreading our presence in the areas where we already are and also to go a little away from that. Apart from this, we have identified some areas in the country where we want to establish large hospitals, so that will happen. So if you look at next 5 years, what we are looking at, there will be some hospitals coming up in large areas, I mean, in large cities in South India. Along with that, this network of the laboratories, along with the pharmacies and virtual consultation and the home care will be the way in which we'll be seen much more in South India, especially, and that is the plan for expansion of the footprint. And that, I think, will have a significant impact on our visibility, our revenues as well as our profitability. Now I mentioned that I just wanted to mention about the stock price. I get many calls or many people ask me about it, so I just want to tell that. So this is something where a value has to be identified by the investors. The company is doing very well in the last 4 years or even last 15 years, if you look at, company has been doing very well. And we have been proving that we have the capability to increase our revenues and profit even during the COVID times. But this has not reflected in the stock price. There is nothing to worry about that. It is only a matter of time. We are sure that the market will discover the value of Aster because large part of our business is in the GCC and only a small part is visible to the investors in India. We know that there are some challenges, and we are looking at ways in which we could actually make it visible to the investors in India as well as to show that we are having an excellent business in GCC also, which has to be reflected in the Indian prices. So to make it short, I just want to tell that there is an expansion plan in India. And along with that, there is also what Alisha mentioned in her speech, the digital transformation which is happening, which will take the company to a next level. So I hope that we will be able to live up to your expectations in the future. Thank you. So the next question is the impact of COVID on the performance. So we have Dr. Harish Pillai here who is the India head who can speak on that, as well as Alisha also can speak about the GCC. So Dr. Harish?

Thank you, doctor. So when you look at the impact of COVID in India specifically, it's been a rolling phenomena. The biggest impact was in quarter 1 last fiscal, which was the first wave when all outpatients across hospital networks were shut down, and we were only allowed to have emergencies and fever clinics. In spite of that, when we came out of the first wave in quarter 2, especially during the phased withdrawal of the lockdown, there has been a big spurt in terms of pent-up demand for non-COVID work. So we were in a phenomenon where in quarter 2, we were able -- because the confidence level of the clinical team dramatically improved over quarter 1 last fiscal on how to really manage the COVID crisis per se. And in quarter 2, we saw that it was almost like a binary mode of managing COVID as well as non-COVID work. In quarter 3, it completely petered out and we could see the non-COVID workload peaked quite a bit, and it reflected back in quarter 4 numbers. When you look at this fiscal quarter 1, yes, we had the second wave, which was impact. But in reflection of the last year, the Aster India units have done extremely well. It's a combination of our management skills, clinical management skills of taking care of COVID patients and also non-COVID patients. And of course, the reflection that most of our health care workers in India were fully vaccinated. So that kind of -- the protective shield of the vaccines have also improved the care paradigm within our network. If you look at what we have done in quarter 1, it is much better than our fiscal performance in the previous years. So the reality is that COVID is perhaps here to stay. We have managed to overcome those kind of challenges whether in terms of skills, competencies or infrastructure. And we are quite sure that the steady state what we have accomplished in quarter 1 will continue and our focus in India is obviously to improve margins. Thank you.

Chairman, you're on mute.

So Alisha, you wanted to highlight some of the important things about COVID in GCC?

Sure. So just to add to what Dr. Harish mentioned, [Janish], thank you for the question. So I think the biggest challenge was, of course, in GCC, where we had almost 2 months where the elective surgeries were stopped, so we couldn't actually do any of the surgeries for almost 2 months in the last financial year. So there was a direct hit as far as our revenue was concerned. But what we try to do as a business is there was a real requirement in terms of COVID care. So whether it's RT-PCR testing, whether it was increasing capacity as far as our ICU/HDU beds, we expanded the capacity within these areas and which is a reason, when we look back at our revenues, we're still only 1% short of what it was in the prior year. So we try to build alternative streams such as home care. Our home care business has really increased over the last 1 year. Even when you look at the telemedicine, we have had almost 1,000 doctors that's been onboarded into our telemedicine network right now. So there's been a significant strength as far as building alternative revenue streams, which has happened. Now on the cost side, there has been a little bit of a challenge because of the increased cost with COVID, whether it is PPE, sanitation, all of these as well as the inflationary cost of health care workers. There's been some cost -- additional cost impact from what we had assumed at the beginning of the year. And hence, a lot of efforts to recalibrate our business model in terms of outsourcing, in terms of shared service center, in terms of digitization and automation to kind of optimize operations further. So we feel that after now 3 quarters of COVID, we have reached a new recalibrated model where we have a much more healthier, leaner, stronger and more resilient system. And more than anything, I think we have become a lot more agile as an organization. So we know that there are a lot of moving parts. We don't know how long COVID is going to stay with us, but we know, as a system and as a unit and as an organization, we have become strong enough to readjust as needed in these ambiguous situation.

Thank you, Alisha. The third question is from Mr. [Veneet], which you again could answer because you are leading this from the front. This is regarding the Cayman project, to which people are not fully aware about. So if you can just give a brief on the Cayman project.

Sure. Thank you, Mr. [Veneet], for the question. This is a very exciting project for us. So we had gone across to the Cayman Islands just before COVID hit, and we really fell in love with the islands. Incredible opportunity that lie there to take Aster's core clinical competence and sort of our focus on service over to the Western Hemisphere. So we have signed, as Chairman mentioned in his opening remarks, a concession agreement with the Cayman government there. We will be setting up, in Phase 1, a 150-bed hospital. We have received a planning approval from the government there just last month. We will be clearing the launch, doing the landfill and hoping to break ground by November this year. And the hope is that the hospital will be commissioned by 2023, end of 2023. So we are looking at our quaternary care facility. It is a multi-specialty hospital with a focus on 2, 3 departments such as orthopedics, oncology, and a big focus on wellness. So the whole philosophy of this hospital is that while it will serve the local Cayman population, we also want it to be a destination for health care for people from the U.S. to come across for better health care, better value for money as well so that we can make our vision of more affordable, accessible health care a reality in the Cayman Islands.

So thank you, everyone, for the questions and also Alisha and Harish for the answers. Now one thing which we would like to show you is to play a video of the Aster Volunteers. I mentioned about that, about which we are very passionate. So we would like to show you a very short video of Aster Volunteers as we are coming to the end of the program, just to show you that how important it is to us and how we are trying to help people. [Presentation]

Thank you. Thank you very much. So I understand that there are some questions which have come into chat box and would like to take it up. We would like the company secretary to read these questions so that we can provide answers for that. Puja?

Thank you, sir. I will -- we have received 4 questions in the chat box. I will read out all the 4 questions and then the management can answer it. The first question is why our company is not able to perform, whereas health care industry and other competitors like Apollo and Manipal are able to perform well? The second...

Puja, we'll answer one by one, that will be better. So see, I partially answered, in fact, even without asking, I answered this question. It's not that we are not performing. It's not right to say that why we are not performing. Why is that not reflected in the share price of Aster is the right question. We are in a situation where the GCC business, which is 80% of our business, is not actually clearly understood by the India investors, fund managers, the analysts and all. So it's a phase which happens in many countries when they are in a situation where the investors don't understand the company fully. And they will have their own challenges, and it may take time. But there are ways in which we can expedite this. We don't want to now wait for another 2 or 3 years for this to happen. So we are looking at ways how we can do that and get the value. What you said is absolutely right. When you look at the share price or the market cap of companies which you mentioned, we are nowhere near the multiples that we command is much lower when compared to that. It is because of this disconnect. So we hope that we'll be able to bridge that gap and have a reset overall as we go forward. I would like, Sreenath, our CFO, to add to that. Sreenath?

Thank you, Chairman. Yes. So nothing much to add because you've already covered it. It's more of a market which will determine the stock price, and hopefully, that we'll get recognized is a matter of time. But at the same time, from the company's side, we are looking at seeing ways of performing even better than what we are now trying to increase our margins. And last year was a COVID year. During the COVID year, every hospital group had an impact. But on a comparative basis, compared to our peers, even during COVID times we have done fairly well. And even if we look at quarter 1, which we announced the results a day before yesterday, we have fairly done well. The result speaks for itself. Having said that, we will continue to strive. And we will see that our margins improve further, and we are hopeful the market will recognize the price at some point of time. Thank you.

Thank you, Sreenath. Thanks a lot. And so this is -- the second question, Puja.

So the second question is similar to what we have answered right now. Why is Aster DM's stock price so volatile and still below the listed price?

Yes. So actually, it is not volatile. There is not much of volatility for the price. It has remained below the listed price ever since we got listed 3.5 years back, which is most unfortunate, and -- but the volatility is not too much. One good thing is that the volume of trade has gone up significantly, but the price band has not moved up. It is exactly due to what we described or what we said about the previous question. So we are hopeful that there has to be. The most important thing is that the people in India, the investors, who are the -- it is not the retail, I mean, small investors but it's the major investors, they should realize the value of Aster in the GCC. Then only this reset will happen. So we hope that we'll be able to do that. There are certain things which we are doing to make this happen, which definitely you will know as we go forward as shareholders. And we hope that without much delay, at least to a great extent, we'll be able to get this corrected is what we are all hoping for. See, you must also understand like you, the shareholders, we as well as our major investors who are there. We are all the more worried because there's a huge wealth, which is on our side also sitting there. So we are trying very hard how to give that benefit to you by which we also will get that. But the good thing, the best thing is that the company is doing well. The company has been doing well in the last 15 years, if you look at. And even after listing, we have done extremely well. And even during COVID, we have done well. Yes. Puja?

The next question is medical needs with aging is going to be massive. How Aster is planning to be part of this growth opportunity? And serving the humanity as well in the process?

Yes, that's a fantastic question, and this is a reality in some of the geographies that we are like Kerala are with the huge aging population anywhere in the world for that matter. Dr. Harish, if you can just answer that.

Yes. Thank you. So it's a reflection, as Dr. Azad mentioned about the demographic transition, notably of the subcontinent, but also the West Asian region. In the Indian context, in the state of Kerala, where Aster is the #1 provider, we are the #1 geriatric state in India with a state population of 35 million. We have roughly about 4.5 million citizens above the age of 60. So from an Aster point of view, we have already designed clinical programs for geriatric care, notably by onboarding the concerned specialists. Our infrastructure, our entire set of network of hospitals are NABH accredited. And we are actually -- we have got unique programs like one of the programs which we are very proud of, it's called Aster seniors, which is totally tailor-made for this specific demography also using technology. Many of -- we find that in certain geographies, you have elderly parents at home, whereas their children are overseas. So through a technology bridge, we are able to connect the children with their aged parents and also give them green channel out of fast, rapid access towards care provisions within our system. Like Alisha Moopen mentioned, one of the big things that we are taking on board is the launch of One Aster, which is our virtual care platform, in which a key component is chronic disease management. As you know that as we advance in age, type 2 diabetes, cardiac issues, especially hypertension, stroke, these are all facts of life. So with this kind of technology and mobilization of resources, we are clearly focused on this growing segment within our population.

Thank you. And I just wanted to also add that there are the innovative programs like the Aster Seniors, which we have started in Kerala, which we are spreading to other areas where there will be exclusive care being provided to the people who are in the older age group. And that is something which we have taken up as one of our missions both in India as well as in GCC. Yes. Next question?

The last question is customized medical needs, bed at home, nursing care are massive growth opportunities. What else do you think are the areas of growth for Aster?

Yes. This is very futuristic question, and this is something. Partially, we actually addressed this when we mentioned about the digital transformation. So our hope is that in the next 5 years, Aster DM Healthcare instead of being just a health care company, will become a digital health care company. So that's our hope. And we will be among the few in the world who will be a digital health care company. So for your information, we are running a program with the very reputed consultants called [Bein] as our -- I mean, the partners to have a road map as well as to handhold us in that journey. So when that happens, there will be tremendous amount of, exponential amount of changes coming into the way in which we run our business now, internally and externally. The way in which patients are accessing us, the way in which they get the report they are able to see from home, they are able to access us from home. They are able to do everything that is required with the hospital at home. Unfortunately, health care is 1 area which has not moved forward in spite of all the other sectors doing that. 50 years back, we used to go to a doctor to get a consultation and then come back -- I mean, get the prescription, go to the pharmacy, come back home, and it used to take half a day. I always tell this, to 1 day many times. Even now that is what is happening in health care. Whereas in other areas like banking or in other areas like retail, where we buy things, just completely transformed. People don't go to the physical facilities. So there is a transformation happening, and you will start seeing this with Aster within the next 1 year. That will be really transformational, somebody who wants a consultation to see a doctor, can sit at home, have the consultation done, the blood drawn at home. And then after that, the results will come and the doctor will write the prescription. The medicine will be delivered from the pharmacy to your house. So sitting at home within 1 hour, you can finish that. So I'm just giving you an example. So there are tremendous possibilities for such omnichannel, which we are going to leverage as we go forward. There are other things that you are asking about other opportunities. Personalized medicine is something which is coming. Where instead of everybody getting the same medicine at the same dose, there will be medicines which will come according to your genetic composition. You will be having a personalized record of what your genetic composition is and how we are going to -- I mean, the doctor is going to prescribe or give you something on the basis of that. So we are in all those areas. It is not that we are just doing the day-to-day care, but we are planning to go into digital as well as new areas like genomics and all to provide a comprehensive advanced care to the patients that we serve. So we will be there and we are extremely happy that you are asking such questions which are very, very futuristic. Thank you.

Thank you, sir. We just received 1 question, 1 additional question. It says none of the AMCs are bothered to include Aster DM in their portfolios. What have we done to influence these AMCs?

So do you want to answer that, Sreenath?

Yes. So Puja, I think you can -- it is in public domain. I mean the investors so that is something which is available. There are foreign institutional investors, there are domestic investors who are invested into the company. So we are having that relationship with and reaching out to various institutions, and we hope that this list will increase further.

Yes. Thank you. Thank you very much. Thanks a lot. So Puja, are we over? Done with the questions?

Thank you, sir. We are done with all the questions, we'd request you to conclude the AGM.

Yes. So I think we have answered all the questions and see if there are any further queries, please e-mail it to us and we will answer them separately. So even the last question, if there has to be any clarification, please send it and we will answer it. Members, please note that the voting from NSDL will be made available for next 30 minutes. Members who have not yet cast their votes can cast their vote through the e-voting system provided by NSDL. Members can click on the Voting tab on the video conference screen to avail this facility. Mr. Rajiv Balakrishnan, practicing company secretary, has been appointed as the scrutinizer for supervising the e-voting process. The scrutinizer's report on voting results will be available on the website of the company, and the same shall be disseminated to the stock exchanges at the earliest. The resolutions, as set forth in the notice, shall be deemed to be passed today subject to the receipt of the requested number of votes. I confirm the participation of 48 members at today's AGM. On behalf of the Board and the management, I thank the shareholders for their active participation in the meeting. I also thank all the Board members, employees, suppliers, bankers and everybody else for the committed and efficient services rendered by them towards the successful operations of the company. I now declare the meeting has concluded. Thank you.

Thank you.

Thank you.

Thank you very much.

Thank you, Puja. Well done.

Thank you.

Thanks, everyone. Thank you.

Thank you.