Summer Internship Report

A MARKET STUDY ON THE AWARENESS OF STEM CELL BANKING TECHNOLOGY IN KERALA FOR CRYOBANKS INTERNATIONAL INDIA PVT LTD

By

ARAVIND RAJAN A0102209104 MBA- Marketing & Sales (2009-2011)

Under the Supervision of

Ms.TEENA BAGGA
Senior Lecture Department of Information Technology

In Partial Fulfilment of Award of Master of Business Administration

AMITY BUSINESS SCHOOL AMITY UNIVERSITY UTTAR PRADESH SECTOR 125, NOIDA - 201303, UTTAR PRADESH, INDIA 2010

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AMITY UNIVERSITY UTTAR PRADESH

AMITY BUSINESS SCHOOL

DECLARATION I, Aravind Rajan student of Masters of Business Administration from Amity Business School, Amity University Uttar Pradesh hereby declare that I have completed Summer Internship on A MARKET STUDY ON THE AWARENESS OF STEM CELL BANKING TECHNOLOGY IN KERALA FOR CRYOBANKS INTERNATIONAL INDIA PVT LTD as part of the course requirement.

I further declare that the information presented in this project is true and original to the best of my knowledge.

Date: 08/07/2010

Place: Noida

ARAVIND RAJAN Enrol. No: A0102209104 MBA- Marketing & Sales (2009-2011) Amity Business School Amity University Noida, UP
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Attach certificate from the organization.

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AMITY UNIVERSITY UTTAR PRADESH

AMITY BUSINESS SCHOOL

CERTIFICATE

I hereby certify that ARAVIND RAJAN students of Masters of Business Administration at Amity Business School, Amity University Uttar Pradesh has completed Summer Internship on A MARKET STUDY ON THE AWARENESS OF STEM CELL BANKING TECHNOLOGY IN KERALA FOR CRYOBANKS INTERNATIONAL INDIA PVT LTD, under my guidance.

Ms. TEENA BAGGA Senior Lecturer Department of Information Technology Date: Amity Business School, Amity University Noida, UP

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Acknowledgement
First off all I would like to present this piece of work to our guiding light Dr.Sanjay Srivastava, Head and Additional Director General, Amity Business School, who has been inspiration to me throughout the academic year. The successful completion of this project would not have been possible without help and assistance that was received from various directions. I would like to thank Ms.Teena Bagga, Senior Lecturer, Department of IT, Amity Business School who has directed me to choose such an interesting topic to do research upon and also for letting me submit a project on the same. I would also like to thank maam for providing me with assistance and guidance throughout the project. I would like to extend my gratitude to Mr. Rajesh, Head of Cryobanks Trivandrum, Kerala and Mr.Arun, Regional Manager, Cryobanks International India Pvt Ltd, Kerala and other employees of all departments at CRYOBANKS INTERNATIONAL INDIA PVT Ltd who provided me with all facilities without which the compilation of the entire project would have been impossible. I would be failing in my duty if I do not thank Dr.Vaijayanthi Manilal, HOD Gynecology and Obstetrics, SK Hospital, Trivandrum, Kerala and my parents who provided me with enough facilities to do research on the topic for hours at an end. They have unfailingly supported my efforts at completion of the project.

ARAVIND RAJAN Enrollment No: A0102209104 MBA-Marketing & Sales (2009-2011) Amity Business School, Noida, UP

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CONTENTS

Declaration Certificate from Industry Guide Certificate from Faculty Guide Acknowledgement Sl. No. 1 2 3 4 5 6 7 CHAPTER NAME INDUSTRY PROFILE LITERATURE REVIEW COMPANY PROFILE RESEARCH OBJECTIVES & SCOPE RESEARCH DESIGN & METHODOLOGY DATA ANALYSIS & INTERPRETATION FINDINGS, SUGGESTIONS, CONLUSION PAGE NO. 7 12 17 23 25 28 37

References

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CHAPTER 1

INDUSTRY PROFILE
Cord Blood Banking in India-An Overview
Cord Blood i.e the blood that remains in the umbilical cord after a baby is born-represents a new and the richest source of stem cells-which is the origin of the bodys immune & blood system. With rising interest in stem cell based therapy, the scope of cord blood bank is becoming more of a cell pharmac. In order to understand the importance and potential of Cord Blood Banking, it is imperative to explore further the emerging applications of stem cells.

1.1 Stem Cells-Emerging Applications Stem cells are basically the primal cells found in the multi cellular organisms. It has the remarkable potential to develop into many different cell types in the body, serving as a sort of repair system for the body. They are actually master cells because they give rise to all tissues, organs and system in the body. The stem cells ability to differentiate or change into other types of cells in the body is a new discovery that holds tremendous potential for treating and curing some of the most common diseases such as heart diseases, cancer etc.(Wikipedia.org) There are basically three sources of stem cells; bone marrow, embryonic cells and cord blood. A bone marrow based surgical treatment is mostly stringent and is a difficult process as it requires accurate and correct match which is often too tedious. On the other hand the treatment based on embryonic cells involves a lot of controversies as it requires the culture of embryo or waste fetus. The third and the richest source of stem cells is the cord blood. Umbilical cord blood contains inexhaustible, non-controversial sources of stem cells for therapy. Stem cell therapy in the coming decades may provide solutions to incurable ailments and severe injuries. Diseases like leukemia, metabolic disorders and immune deficiencies etc have been successfully treated with umbilical cord blood transplantation. Further stem cell breakthrough is expected to promote effective low cost treatment for diseases like diabetes, stroke, spinal cord damage etc. The Indian Council of Medical Research has estimated that some 50 million patients with heart disease, 5 million with Parkinsons disease and 5 million with Alzheimers disease in India are potential beneficiaries of stem cell therapy. Firstgeneration therapy is already being offered in South Korea for spinal injuries .Some of the
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current and emerging applications of cord blood based stem cells have been listed in Table-1, below. Table 1-Applications of Stem Cells Current Applications of Stem Cells/Cord blood Acute Leukemias Chronic Leukemias Thalassemia Fanconis Anemia Sickle Cell Anemia Hodgkins Lymphoma Non-Hodgkins Lymphoma Multiple Myeloma Others Source: Wikipedia.org Emerging Stem Cell /Cord blood Applications Cardiac Disease Diabetes Multiple Sclerosis Muscular Dystrophy Parkinson's Disease Spinal Cord Injury Stroke Alzheimer's Disease Lupus,Rheumatoid Arthritis

1.2 Cord Blood-the richest source of Stem Cells Cord blood is the blood that remains in the babys umbilical cord after it has been cut and is a rich source of stem cells. Earlier treated as a waste to be discarded after birth, cord blood is now considered a precious resource. Although the first cord blood transplant was performed by Gluckman in 1988, the concept of banking cord blood was pioneered by Dr. Pablo Rubinstein , who was awarded grant by the National Institute of Health to set up the first National Cord Blood Banking Program at the New York Blood Centre.(National Institute of Health, USA). Back home in India, umbilical cord research started in 1990 at Cancer Research Institute, Mumbai, but did not receive any support from the government to set up a stem cell bank. The first private stem cell bank in India, however, was set up in 2002.

1.3 Cord Blood Banking- the Process A cord blood bank is place that stores umbilical cord blood for future use. Cord blood banking basically involves three steps: collection, processing and storage. Cord blood collection is a simple, safe and painless procedure that usually takes less than 5 minutes and can be performed just after child birth in which the cord is clamped and cut and the blood is drawn from the umbilical cord in a specialized bar coded bag. These collections are further harvested for stem cells, which are then stored in cryo-vials at -196 degrees celsius in liquid nitrogen.
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1.4 Public Vs. Private Cord Blood Banking Cord blood banks can be primarily divided into public and private banks. While public banks accept eligible donations to be used for anyone in need; private banks allow families to preserve their blood for their own use for a fee ($800-$2000). The basic differences between a public and a private cord blood bank have been enumerated in Table-2. Table 2- Types of cord blood banks Public banks Use not restricted. No remuneration collected Usage subject to availability Private banks For use of the family Facility paid for by the family Availability guaranteed

The medical community strongly supports public cord blood banking as it widens the compass of beneficiaries from medical advances. However, since the estimated probability of a need for cord blood stem cells within a family is 1/1500, private cord blood banking is generally not recommended. Globally, out of 100 cord blood stem cell banks, 75 are public banks.

1.5 Major Players in Cord blood Banking in India The major players of cord blood banking in India are Relicord,Lifecell,Cryobanks International Ltd and Histostem.
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Histostem Co. Ltd., is a South Korean, US based Biotechnology Company that is developing the latest human cell based therapy. It is a pioneer in cell based therapy. The main divisions of Histostem are cell therapy research, public cord blood bank for transplantation, and family cord blood bank. It is in the process of investing $20milion to establish the worlds largest cord blood bank ,providing stem cells for transplant surgeons globally.( The Hindu, July 12, 2005)

The leading Indian player in cord blood banking and cell research is Chennai based LifeCell. Establish with initial investment of Rs. 140 million, LifeCell has a lab and state of art storage facility near Chennai. The world class infrastructure, which has
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accreditation from American Association of Blood Banks, help LifeCell provide seamless service from the collection of cord blood to harvesting, testing and finally storage. With 20 regional centers LifeCell has been able to harvest 10,000 units of stem cells.
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Cryobanks International India a JV between Cryobanks International USA and RJ Corp founded in 2006. Cryobanks International is a leader in the collection, processing and banking of umbilical cord blood stem cells. Cryobanks India has set up 28,000 square feet, state-of-the-art stem cell processing and banking facility in Gurgaon Haryana. Cryobanks India with an initial investment of 25 crore has stored more than 15000 samples of stem cells till date .

Another important player is Relicord- which is Reliance Life Sciences Stem Cell Banking services has established south Asias first most advanced and completely automated stem cell enriched umbilical cord blood repository. This is the first cord blood repository in the world to be accorded a license by an official regulatory authority, Food and Drug Administration (FDA), Government of India.

1.6 Cord Blood Banking in India the road ahead High birth rate and lack of any stringent government regulations are the factors favoring the development of cord blood banking in India. With approximately 72000 births daily, resulting in discarding of 72000 umbilical cords a day-the storage of stem cell rich blood derived from these umbilical cords can prove to be the best possible insurance against life threatening diseases. The Ministry of Health has approved a Grant of Rs.5 crores to upgrade its stem cell research at the Mumbai based National Institute for Research in Reproductive Health under the Indian Council of Medical Research (ICMR). New private cord blood banks are being established all over India in an attempt to use their knowledge, research and storage facility to benefit the Indian population. What seemed like a dream few years back is now becoming a reality. The use of umbilical stem cells for therapeutic purposes can ensure lower treatment costs and longer lives. India is poised to be the largest source for umbilical cord blood in the world. It's no surprise then that leading stem cell banking companies are keenly eyeing India. The investments are considerable and mostly run into millions of dollars. Analysts estimate that Indian stem cell banks, which are currently at Rs 100 crore, would generate Rs 2,700 crore in revenues by 2012, accounting for 17 per cent of the world market.

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Companies with foreign funding are entering the market and are planning to capture at least 21 per cent of the total market. As of now, there are more than six players in this five-yearold market. Most of these cord blood banking companies are having an overseas parent company which is responsible for the initial investment.

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CHAPTER 2

LITERATURE REVIEW

The Indian State of Kerala with a per capita income of around 1% of that of the wealthiest countries, has achieved good health comparable to theirs. Kerala is having the highest number of health care institutions as per the 1991 census. About 26% of total health care institutions in India are located in Kerala. Mortality indicators show that health status of Kerala is far advanced and higher than the all India average and is even comparable with developed countries. This outstanding progress of health status is achieved through widespread growth of the three systems of medicine in public, private, co-operative sectors combined with people's health awareness. The basic health indicators of Kerala and India are given in Table below. For example the infant mortality rate for Kerala in 2000 was 14/1000 live births compared with 23/1000 for India. Life expectancy at birth was 76 years for women and 71 for men in Kerala; for India these figures were 64 and 63 respectively. The most important reasons for this good health in Kerala are probably the following: its high level of female literacy (87%); access to health care (e.g. 97% institutional deliveries); a good public distribution system (PDS), which provides essential food items at subsidized rates (the system covers 96% of the population); political commitment (40% of the state budget went to the social sector till recently 15% to health, and 25% to education); good communication and transport (newspapers, telephones, rural roads); land reforms (land distributed to the poorest and the landless) which helped reducing inequality in land and income; and Christian missionaries who started schools and hospitals, mostly in rural areas. Overall, the achievements of Kerala seem to result from a relatively fair distribution of wealth and resources across nearly the entire population of the state. The urgent need for public delivery of health care services is increasingly being recognized and has drawn considerable attention in recent years. Keralas remarkable achievements in health care were to a large extent based on its vast network of public health institutions which enabled her to earn the fame of Kerala Model of Health worth emulating even by advanced countries. The hall mark of this model was the low cost of health care, universal accessibility and availability to the poor sections of the society. This health model was made possible by

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many socio-economic conditions, important among which was the high female literacy rate in the state. Apart from these, the extensive network of medical care institutions in modern medicine, homeopathy and ISM has also made this possible. Despite all these, Kerala faces some major problems in the health sector at the beginning of the 21st century. Difficult access to
health care owing to high out of pocket health care expenditure has resulted in the impoverishment of a sizeable segment of the population. Keralas total health care system spread across villages and communities consists of institutions in Government sector, co-operative sector, and in private sector with systems of treatment in allopathy, ayurveda, homeopathy, sidha, unani and naturopathy.

Table 3-Basic Health Indicators Kerala & India Sl. No. 1 Health Indicators Birth rate Kerala India 23.1

(000 14.7

population) 2 Death rate (000 6.8 7.4

population) 3 Infant mortality rate 13 (000population) 4 Child mortality rate 3 (000 population) 5 Maternal mortality 110 301 17 55

rate (per lakh live birth) 6 Total fertility rate 1.7 2.9

(children per women) 7 Couple protection 48.28 (2009) 46.6 (2005)

rate (in percent) 8 Life at birth Male Life at birth Female TOTAL Source: Directorate of Health Service (DHS) 71.3 76.3 73.8 62.3 63.9 63.1

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Table 4- Treatment Expenditure in Kerala (in Rs) Sl. No. Population Group Morbidity Rate Expense for Percapita one time Treatment Expenditure 1 Extremely Poor 2 3 Poor Lower Middle Class 4 Upper Middle Class Total 79.2 830.7 1722 13.9% 73.9 1686.1 3238.5 10.4% 82.1 78.1 613.5 886.9 1309.7 1801.0 18.1% 13.0% 85.1 701.9 1552.9 % of total

family expense 31.7%

Source: Kerala Padanam, Kerala Sasthra Sahithya Parishad, 2004

Morbidity rate has decreased from 85.1 in 1000 in extremely poor group to 73.9 in upper middle class. Though it shows that morbidity rate has decreased, treatment expenditure has increased. Percapita treatment expenditure has increased from Rs89 in 1987 to Rs1722 in 2004. This can be treated has a huge increase while taking inflation into consideration. The changes in technology and treatment methods, increased use of laboratory tests and scans, and rise in price of medicines could be some of the reasons for this. There has been not much change in the first three income groups. Whereas treatment expenditure for the fourth group of people stands high when compared with other three showing that advanced technology and methods of treatment can be availed only by people of high income.

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Table 5- Treatment Expense Percapita in Kerala (in Rs)

Sl. No.

Item

Extremely Poor

Poor

Lower Middle Class

Upper Middle Class 1196.4 252.9

Total

1 2

Medicines Hospital Fee

714.5 192.0

527.4 172.7

578.8 164.6

622.5 175.3

3 4

Lab Others

76.8 569.6

128.6 481.0

160.6 897.0

717.3 1071.9

181.5 742.7

Source: Kerala Padanam, Kerala Sasthra Sahithya Parishad, 2004

Treatment expenditure and other expenditures like medicines are an important factor. There is a greater difference between people belonging to different income group. While people belonging to upper middle class avail routine check-ups and conducts tests & scans unnecessarily, people belonging to lower income are not even able to avail necessary tests.

Table 6- Treatment Area (in %)

Sl. No. 1 2 3

Income Group Extremely Poor Poor Lower Class

Government 50.8 38.3

Private 44.6 59.0 73.6

Self/Others 4.3 2.4 3.0

Middle 23.0

Upper Class

Middle 9.2

84.9

3.3

Total

31.6

64.4

4.1

Source: Kerala Padanam, Kerala Sasthra Sahithya Parishad, 2004

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More than 80% of people belonging to upper middle class depend solely on Private hospitals for treatments and only half of the extremely poor category of people depends on Government hospitals and PHCs for treatment. The perceived quality of care seems to play an important role in the choice of the provider, irrespective of household income. As the quality of public service is perceived to be poor, people increasingly seek private care. The cost implications of this are serious, with the poorer segments of the population devoting a sizable proportion of their income to health care.

Low mortality, high morbidity, and high utilization of private care summarize the story of health care in Kerala. The use of private care, with the associated out-of-pocket expenditure, is a heavy burden on the poorer segments of the population. As in the other states of India, only a small proportion of Kerala's population is gainfully employed in the organized sector with some financial protection against the cost of ill health. The large unorganized sector farming, household manufacturing, and servicesprovides no financial protection against the cost of illness, leading to high levels of financial distress and dragging down productive investment and income generation. Furthermore, the lack of access to health care belies Kerala's image of providing good health at low cost.

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CHAPTER 3

COMPANY PROFILE
Cryobanks International India a JV between Cryobanks International USA and RJ Corp founded in 2006. Cryobanks International is a leader in the collection, processing and banking of umbilical cord blood stem cells. Cryobanks International provides a Private Cord Blood Storage Program for expecting families that wish to privately store their baby's precious stem cells and a Public Cord Blood Donation Program for those who prefer to donate. Founded in 1993, Cryobanks International, Inc., a pioneer in the collection, isolation, and storage technologies for cord blood stem cells, is located in Altamonte Springs, Florida, a suburb of Orlando. The company is focused on providing high-quality umbilical cord blood stem cell processing, and storage for both private family use and public donation purposes. Other facilities of the group are in Greece, India and Thailand. RJ Corp is a well diversified Indian MNC, with business interests in soft beverages, breweries, real estate, hospitality, healthcare, education, dairy, food service and retail, with an annual turnover of over 15 billion rupees. The first signs of economic liberalization signalled the entry of Pepsi into India in 1991 and with it started the journey of partnering Pepsi in their beverages business in India. In 1993 Devyani Beverages Ltd was set up to take the Pepsi bottling operations forward. Currently there are 9 bottling plants operating across the country. The current capacity is 35 million cases per annum during the peak season. In 1995 Varun Beverages was created and Devyani Beverages was merged with it in October 2004. Devyani International Limited is the food service/retail arm of the group and is uniquely placed with a portfolio of 3 international brands in the quick service restaurant space. (Pizza Hut, Costa Coffee, KFC) Groups foray into the healthcare business started in 2005 with a tie up with Cryobanks in the US for the storage of stem cells. The business has mushroomed and is on the verge of explosive growth. The year 1992 heralded our appearance in the ice cream industry with Gaylord. After being a key supplier to HLL in India for many years, in 2003 we launched Cream bell ice creams with Candida of France in 2003. With a manufacturing facility in Baddi to start with, we are now on threshold of starting another unit in Panda district in Goa.

Group has been associated with education. It strongly believes that investment in quality care and education for young minds is essential for the future growth and development of our
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country. The groups foray into Secondary & pre-school education is in line with educational projects of the group. The Group has entered into a joint venture partnership with Modern Montessori International (MMI) Singapore, to open pre-school educational institutions across the country and franchise agreement with DPS at Gurgaon and Jaipur. Under the able guidance of Dr. Naresh Trehan, one of the country's best-known cardiac surgeons, this joint venture has set up the first modern, state-of-the-art cord blood stem cell bank in India at Gurgaon. It aims to become one of the largest cord blood stem cell bank and a highly specialized training centre in the field of cord blood banking. Cryobanks India will have special focus on research of stem cell therapies as a potential treatment for cardiac diseases and diabetes. Cryobanks India has set up 28,000 square feet, state-of-the-art stem cell processing and banking facility in Gurgaon Haryana. Cryobanks India with an initial investment of 25 crore has stored more than 15000 samples of stem cells till date .The company is working towards national and international collaborations to provide the best of class facilities in stem cell industry in India. Cryobanks India follows the Closed bag collection method for harvesting cord blood stem cells which greatly reduces the possibility of contamination of cord blood. The company provides a facility of collection from all major cities in India. Cryobanks has a team of medical professionals who have been extensively trained, certified and educated in cord blood processing and Quality Assurance processes at Cryobanks International, Inc., U.S.A. Cryobank has a bank in Gurgaon with a network of 200 thalassaemia patients and nearly 3,000 medical practitioners. The company is setting up cord blood banks in Chennai, Mumbai, Bangalore, Kolkata and Hyderabad. It is also setting up collection and counselling facilities in cities like Coimbatore, Erode, Madurai, Vellore and Pondicherry. Cryobank also provides a public banking facility, which means that parents can place the umbilical cord of a newborn for public use. There are 2.5 million registered deliveries in India every year. This means potentially, these many donors every year, Nerikar said. Once the sample is HLA typed, it is in a registry. It can be accessed by anyone who needs the cord cell type and can revolutionise thalassaemia and leukaemia therapy.

3.1. Vision

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To excel in everything we touch and handle - is visible in their many charitable and pioneering initiatives, under the supervision of Mrs. Dhara Jaipuria. All to meet the genuine needs of the community and society.

3.2. Objective

To be the largest inventory holder of cord blood stem cells in India for both family storage & public donation Have a total of seven cord blood banks all over India to have stem cell inventory, covering maximum ethnicities in India. Be part of stem cell research initiative of India by becoming major source of all types of stem cells to various research institutions with in the country.

3.3. Cryobank advantage over other banking companies

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Cryobanks International India is the first State of the Art cord blood stem cell bank to be set up in India.

They have set up a 14,000 square feet, state-of-the-art stem cell processing and banking facility in Gurgaon, Haryana.

This brand new facility provides complete, in-house processing and storage technology, licensed by Cryobanks International, Inc., USA.

Closed bag collection method for harvesting cord blood stem cells greatly reduces the possibility of contamination of cord blood.

National coverage - Facility of collection is being provided from all major cities in India.

Certified team of medical professionals have been extensively trained and educated in cord blood processing and Quality Assurance at Cryobanks International, Inc., U.S.A.

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The storage facility is an earth quake resistant building i.e. it is a concrete structure. All equipment is backed up for 24 hours with UPS and Generators, in case of a power failure.

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Adequate fire fighting measures such as automatic sprinklers and alarm systems are present throughout the building.

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Laboratory operating 24 x 7. Flexible payment plans that offer hope for your family The facility is been fitted with a Central Monitoring system which monitors the temperature, humidity and pressure, 24*7 to ensure a controlled environment as required for Current Good Manufacturing Practices and Current Good Laboratory Practices

3.4. Processes

The company has an established sales force wherein trained medical representatives who visit the prospective client's home and explain the concept, collection and processing, and provide confidence on the storage facilities.

Cryobank follows Processes in accordance with international standards and has ensured that thye follow the best practices in every step of the way. Cryobank gives presentation to clients interested in stem cell banking at any time of their convenience. The following are the various processes involved:-

3.4.1. The Registration Process: Simple procedure where one is required to complete and sign an enrollment form that includes mother-to-be's health history form and a client agreement form. Once the paperwork and payments are done, Cryobank send a cord blood collection kit that is be used to collect the umbilical cord blood after the delivery of your baby. 3.4.2. Pre-Collection: The registered client will get a specialized cord blood collection kit which contains everything their doctor needs, including instructions, to collect the cord blood. Most doctors do not have a problem performing this simple procedure. However, it is essential that the client discuss their decision to bank their baby's cord
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blood and check with the doctor prior to collection whether they will perform the procedure. All that the client need to do after this is to make a call to let Cryobank know that the client is about to deliver the baby. They will immediately dispatch a courier to the hospital who will then pick up the cord blood once it is collected, packed and ready to be shipped. 3.4.3. Collection Process: The doctor in charge performs the collection process. The collection of the cord blood is done immediately after the baby is born when the umbilical cord is clamped and cut to stop the outflow of the blood present in the cord. As collection can be performed in-utero or ex-utero, this choice is left to the doctor who is the best judge of the situation. Depending on whether the birth is a vaginal delivery or a caesarean section, the doctor can make a decision on collecting before or after the delivery of the placenta. The collection of the cord blood is a simple and short procedure that does not take more than 10 minutes. After the baby is born, the doctor will clean and sterilize the umbilical cord with the iodine and alcohol swabs provided in our kit. Once cleaned, the sterile needle, with one end attached to the blood collection bag, is inserted into the maternal side of the cord. The blood is allowed to flow by gravity into the bag. This usually takes 3-5 minutes and when there is no more blood left, the needle is taken out and reinserted into the umbilical cord, closer to the placenta. This allows some remaining blood to be collected, thus increasing the total volume of blood collected. After collection of the blood, the needle and connecting tube is cut and removed, and the tubing emerging from the bag is stripped, clamped and knotted twice. The blood bag is carefully placed in a plastic bag and the bag sealed. The cord blood bag is packed in between the two gel packs which are placed on either side of the bag to maintain the temperature. The bag is then sealed in the box provided in the kit and a customer information card is filled out and placed along with the box in a kit container, which is then handed over to the courier. 3.4.4. Shipping of Cord Blood: When the client register with Cryobank, the help in arranging for a suitable courier who will transport the cord blood to them, safely. The best suitable logistics plan is offered to the customers and Cryobank bear the courier charges. Once customer leaves for the hospital, they should call Cryobank so that they are able contact the courier on customers behalf. The courier collects and safely transports the cord blood to the lab .

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3.4.5. Processing Of Cord Blood: As soon as Cryobank receives the cord blood, theyll inform parents of the safe arrival of the sample. The maternal and cord blood sample is tested for bacterial and viral infections when it arrives at the Cryobank India lab. This testing is necessary to check the status of the sample and to see if any infection is present in the blood. This is a mandatory requirement as per the cord blood banking regulations. 3.4.6. Reporting Test Results: All the results of tests performed on maternal and cord blood are documented and a report is prepared and sent to all our customers. If samples test positive for any transfusion transmissible infections (TTIs), the parents are duly informed. The cord blood may either have to be quarantined or discarded. In such cases we discuss the issue with parents before any further steps are taken. 3.4.7. Storage of cord blood Stem Cells: If the cord blood is found fit for storage after processing, theyll store the cord blood in Cryo-bags by controlled rate freezers, cooled by Liquid Nitrogen (which takes the temperature of the cord blood from 40 Celsius to 196 Baby's cord blood sample is stored in a set that constitutes a 20ml main

3.5. EMI Payment schemes The cost of harvesting, processing and storing stem cells is about Rs 35,000 ($850) but this is too expensive for the common man. That is why stem cell bank Cryobank International offers a first payment option of Rs 8,500 ($200) to store cord cells. The remainder is collected as EMIs of Rs 3,000 ($75) and the EMI period can be stretched to 11 months or even 21 years. Such schemes have made it possible for people from low-income groups to access the path-breaking technology. Those families that cannot raise the money at the time of birth can bank the cord blood in the public domain and then arrange for it to be transferred for exclusive use. Cryobank believes that very parent should have the right to bank, provided they believe in it.

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CHAPTER 4

RESEARCH OBJECTIVES AND SCOPE OF RESEARCH PROJECT

4.1. PRIMARY OBJECTIVE

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To conduct a market research on the awareness of stem cell banking technology among the Gynecology and Obstetrics out patients of various hospitals in Trivandrum, Kerala.

4.2. SECONDARY OBJECTIVE

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To collect data on the reason for the selection of clinic among Gynecology and Obstetrics (ObGyn) out patients at various hospitals.

To know the satisfaction level of the Gynecology and Obstetrics out patients on the various services provided by the clinic.

To know the reason for the unawareness of stem cell banking technology among the Gynecology and Obstetrics out patients

4.3. SCOPE AND SIGNIFICANCE

Scope: The study is to understand the awareness of stem cell banking technology among the Gynecology and Obstetrics out patients at hospitals and the various factors that results in the unawareness of the technology. The study thus provides information on the preferences made by the patients in choosing the clinic/hospital. Since stem cell banking technology is considered as an expensive technology, income of the patients is also a critical factor in this. Thus study helps to know which classes of customer choose which type of clinics, their preferences and their awareness level on stem cell banking technology.

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Significance: With more than 80,000 births a day or 26 million births a year, India is poised to be the largest source for umbilical cord blood in the world. It's no surprise then that leading stem cell banking companies are keenly eyeing India. The investments are considerable and mostly run into millions of dollars. Analysts estimate that Indian stem cell banks, which are currently at Rs 100 crore, would generate Rs 2,700 crore in revenues by 2012, accounting for 17 per cent of the world market. As of now, there are more than six players in this five-yearold market. Most of these cord blood banking companies are having an overseas parent company which is responsible for the initial investment.

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CHAPTER 5

RESEARCH METHODOLGY AND LIMITATION

5.1 RESEARCH PLAN

5.1.1 PRELIMINARY INVESTIGATION The study is conducted based on Questionnaire to collect the necessary data; the questionnaire was distributed among the Gynecology and Obstetrics out patients at various hospitals who are expectant mother.

5.1.2 TOOLS OF COLLECTION OF DATA

a. Primary data: The tools used for collection of primary data were Questionnaire. The questionnaire was provided by Cryobank for the collection of data. It was constructed in a manner of getting maximum information from the expectant mother and her family.

b. Secondary data: The Secondary data mainly consists of data and information collected from company records; company profiles offices records and also discussion with employees of the organization
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Internet Brochures

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5.2 SAMPLING PLAN

5.2.1 SAMPLING UNITS The units chosen for the study as sample generally speaking are the Gynecology and Obstetrics out patients at various hospitals who are expectant mother. 5.2.2 SAMPLING TECHNIQUES The technique employed for the sampling in this study is mainly the identification of expectant mothers from the Gynecology and Obstetrics out patients at hospitals to whom the instrument or tool can be distributed to collect the primary data.

5.2.3 RESEARCH INSTRUMENT The research instrument used for the study was an open ended and well structured questionnaire.

5.2.4 CONTACT METHOD Communication with the patients and employees of Cryobank took place frequently. Researchers were given opportunity to interact with the expectant mother and staffs of Cryobank and the doctors of various hospitals where the survey was taken place to discuss and get their responses informally.

5.3 SAMPLE SIZE

A sample of 130 expectant mothers was chosen. Questionnaires were distributed to each out patient, inviting their suggestions.

5.4 DATA COLLECTION INSTRUMENT DEVELOPMENT

While preparing the questionnaire, the key factors that contribute towards the topic have to be considered. This enables the construction of the questionnaire easier. Before delivering the questionnaire, plotting or testing the questionnaire effectively is very important. The reasons for this are:

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y y y y

To test how long it takes to complete To check that the questions are not ambiguous To check that the instructions are clear To allow one to eliminate questions that do not yield usable data

Developing a checklist for the questionnaire can help spot any of the common mistakes that apply to your questionnaire developed. Some of the important things to be kept in mind are:
y y y y y

Avoid all leading questions Make the questions as specific and simple as possible. Make sure all questions are understandable to all the respondents. Applicability of the questions to all the respondents Make sure none of the questions are double-barreled

5.5 RESEARCH LIMITATION

Similar to the case of most research conducted, the research conducted for this project had its own limitations. These limitations may have contributed to results and suggestions which may have been different if some of them could have been avoided.
y

Most of the hospitals were reluctant to give permission to do such a survey as they believed, this could result in violation of medical ethics. Mostly this was due to poor awareness about the underlying issues.

Limited number of patients - the survey was done among 120 out patients. The reason behind this being the unwillingness of patients to take part in the survey

Time time was yet another limitation as such a survey and analysis cannot be done within a short duration of two months

Less Educated people Some of the patients who undergone the survey were less educated. So it was very difficult to make them understand about the scientific details on stem cell and stem cell banking technology.

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CHAPTE

ATA ANAL

INTE PRETATION AND PRE ENTATION

T Sl

l 7- MONTHL INCOME OF THE SAMPLE POPULATION M t l t R R R R R R R t t

Rs.50,000-Rs.80,000 1%

Monthly Income

Rs.80,000 and above 0%

Less than Rs.20,000 37% Rs.20,000-Rs.50,000 62%

l t

ll i t

l it l

it li i ll i i

t l i lt t tt l R

l t i t

t t tl t i i t t R i t i li t it i t M it i i

it t t

t ili l t

li t t

t it i t

i iti l li i / it l

ti it l

i t i

t t

C il i t

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Table 8- SHOWING REASON FOR THE SELECTION OF CLINIC Sl. No. Reason for selection of Clinic 1 2 3 Proximity to home Affordability Experience & Good Nature of Doctor 4 Family Doctor 3 1% 75 35 98 36% 17% 46% No. Of Respondents Percentage (%)

Reason for selection of clinic

Family Doctor 1%

Affordability 17

Most people wish to visit clinic that are near to their place of stay. Experience and good nature of doctor is also another reason for the selection of clinic. People with a monthly income of less than 20,000 also take affordability into consideration while choosing the clinic. They depend largely on Government owned hospitals and private hospitals which are not too costly. Proximity and experience of the doctor plays a major role. Thus it shows that if any medical concept has to be rolled out, the doctors have to be taken into the loop. It is better to set up a marketing and sales force structure which is just like a pharma company that gets in touch with the obstetrician, gynaecologist on regular basis and have tie-ups with the hospitals and get pregnant patient population from them. Thus emphasis should be more on doctors and hospitals to make people aware of stem cell banking.
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Experience & Good Nature of the Doctor 46

Proximity to home 36

Table 9- SHOWING REASONS FOR SELECTION OF CLINIC Sl. No. Reasons for selection of clinic 1 Proximity to home & Experience and Good Nature of Doctor 2 Proximity, Experience of Doctor & Affordability 3 Affordability & Experience of Doctor 4 Proximity & Affordability 5 Experience and Good 21 Nature of Doctor 6 7 8 Family Doctor Proximity to home Affordability 3 7 0 3% 6% 0% 18% 6 5% 17 15% 16 14% 45 39% No. Of Respondents Percentage (%)

Pr xi ity & Aff rda ility 5

Aff rda ility & Experience f D ct r 15

Pr xi i ty Experien ce f D ct r & Aff rda i lity 14

Experience and G d Nature f D ct r 18

Pr xi i ty t 6 Fa ily D ct r 3

e Aff rda ility 0

Pr xi ity t e & Experience and G d Nature f D ct r 39

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Table 10- SHOWING AWARENESS ON STEM CELL BANKING Sl. No. Awareness on stem cell banking 1 2 Yes, Aware No, Not Aware 21 94 18% 82% No. Of Respondents Percentage (%)

Awareness on stem cell banking

Yes 18

N 82

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Table 11- SHOWING RESPONDENTS WHO WOULD LIKE TO KNOW MORE ABOUT STEM CELL BANKING Sl. No. Like to know more about stem cell banking 1 2 Yes, I wish to know No, I dont wish to know 30 85 26% 74% No of Respondents Percentage (%)

Like t k

re a ut ste a ki g
Yes 26

cell

Lack of awareness among the people about the benefits that can be gained from the storage of cord blood is a key reason for small customer base in Kerala. The study shows that when it comes to preventive healthcare (futuristic healthcare), there is very little concern among the people. Stem cell banking requires a customer base that has a high concern in preventive healthcare. Technical and scientific nature of the process involved normally creates a disinterest among the clients. They never show interest in such details. Rarity of the diseases that Cord blood banking aspires to cure/treat is crucial. For example, Cancers and other Genetic/Congenital diseases, though devastating for the family and the patient, are very rare in incidence in the society at large. Hence the disinterest is somewhat justified.


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No 74

Table 12- Awareness about stem cell banking

Res o Not aware of stem 24

e ts (%) 21%

to k ow more a o t it 2

Not aware of stem

k ow more a o t it 3

Aware of stem cell

wa t to k ow more a o t it 4

Aware of stem cell

k ow more a o t it

        

cell a ki g

     

        

     

cell a ki g

like

71

62%

o t wa t to

12%

a ki g

o t

14 6 5%

a ki g

like to

   

Sl No

Criteria

No Of.

Perce tage

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Not aware of stem cell a k i g do t wa t to k o w more a o t it 62%

80
70

60
50

40
30

20
10

Though stem cell banking technology is an ultimate preventive, it is considered as a luxury because of high cost barrier. Thus a person who knows about the technology doesnt show any interest in it. People normally have a belief that the need for cord blood is not great and their childor other childrenwill hopefully never need a transplant with this lifesaving blood. They also state that one in 1000 or 10,000 families that bank cord blood actually use the blood at some date. Thus, just like any other insurance policy, the cord blood is there if it is needed.

# ! & % %$

# ! ! ! & % %$

# ! ! ! " ! !

Not aware of stem cell a ki g like to k ow more a o t it

Not aware of Aware of stem Aware of stem stem cell cell a k i g cell a k i g a ki g do t do t wa t to like to k ow wa t to k ow k ow more more a o t it more a o t it a o t it

# ! " ! !

Aware of Aware of stem stem cell cell a ki g a ki g do t wa t to like to k ow k ow more more a o t a o t it it 12% 5%

Not aware of stem cell a ki g like to k ow more a o t it 21%

# ! ! ! " ! !

' $ % % % & % %$

# ! " ! !

# ! " ! !

Series1

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Not aware of stem cell banking & like to know more abo t it- 24
less tha Rs20 000 12%

Rs20 0 00Rs50 0 00 88%

Not aware of stem cell banking & dont want to know more abo t it- 71
Rs50 000 Rs80 000 1%

Rs20 000 Rs50 000 47%

less tha Rs20 000 52%

3 3

2 2

0 0

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Aware of stem cell banking & dont want to know more abo t it -14
less t a n s20 000 21

s20 0 00s50 0 00 79

Aware of stem cell banking & like to know more abo t it -6

less tha Rs20 000 17%

Rs20 000Rs50 000 83%

7 5 6 4 7 6 5 6 5 9 9

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CHAPTER 7

SUGGESTIONS, RECCOMENDATION AND CONCLUSION

7.1 FINDINGS
y

In Kerala, normally people with a monthly income of less than 20,000 or 10,000 depends on Government owned hospitals and health centres for treatment whereas a bit higher income group depends on private clinics which are not too luxurious and costly. When it comes to stem cell banking, on an average Rs70,000 has to be paid by the client for the storage of umbilical cord for 21years. Though companies have come out with EMI schemes of payment, each client has to pay an initial cost of Rs10,000Rs25,000 which is 3 - 5 times higher than the average expenditure for a Childbirth incurred at a Government hospital and twice the charge of a private clinic/hospital.

Most people wish to visit clinic that are near to their place of stay. Experience and good nature of doctor is also another reason for the selection of clinic. People with a monthly income of less than 20,000 also take affordability into consideration while choosing the clinic. They depend largely on Government owned hospitals and private hospitals which are not too costly. Proximity and experience of the doctor plays a major role.Thus it shows that if any medical concept has to be rolled out, the doctors have to be taken into the loop. It is better to set up a marketing and sales force structure which is just like a pharma company that gets in touch with the obstetrician, gynaecologist on regular basis and have tie-ups with the hospitals and get pregnant patient population from them. Thus emphasis should be more on doctors and hospitals to make people aware of stem cell banking.

Lack of awareness among the people about the benefits that can be gained from the storage of cord blood is a key reason for small customer base in Kerala. The study shows that when it comes to preventive healthcare (futuristic healthcare), there is very little concern among the people. Stem cell banking requires a customer base that has a high concern in preventive healthcare. Technical and scientific nature of the process involved normally creates a disinterest among the clients. They never show interest in such details. Rarity of the diseases that Cord blood banking aspires to cure/treat is crucial. For example, Cancers and other Genetic/Congenital diseases,

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though devastating for the family and the patient, are very rare in incidence in the society at large. Hence the disinterest is somewhat justified.
y

Though stem cell banking technology is an ultimate preventive, it is considered as a luxury because of high cost barrier. Thus a person who knows about the technology doesnt show any interest in it. People normally have a belief that the need for cord blood is not great and their childor other childrenwill hopefully never need a transplant with this lifesaving blood. They also state that one in 1000 or 10,000 families that bank cord blood actually use the blood at some date. Thus, just like any other insurance policy, the cord blood is there if it is needed.

7.2 RECCOMENDATIONS

Cryobanks have already geared up to capitalize on the upcoming potential. The need of the hour is to increase the number of repository of cord blood samples. To achieve this action recommended may include the following:

Building awareness establishing collection centers

Providing training for the specialized & contamination free collection process

Tie up with hospitals engaged in cord blood based treatment: Cryobank at present has tie-ups with selected number of hospitals in Kerala. These hospitals are mainly chosen by people belonging to upper middle class and business class of the society. Rather than concentrating only on a few segments of the society, they should target all classes. This study on awareness of stem cell banking proved that most people visit hospitals mainly because of two reasons: proximity to home and experience & good nature of doctor. So they should target hospitals and doctors also.

Counselling, Meetings, Talks and Awareness Campaigns: Conducting counselling and awareness campaign and talk shows at companies could help to target more customers. IT and business parks like Technopark, Infoparks in Kerala are a great source of young, talented and educated minds. People who get
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benefitted through these talks and campaigns may contact Cryobank in future for banking.

Seminar cum Dinner meetings for doctors.

Diversify into public cord blood banking

The Company needs to find people or specific groups that can really benefit from its services, for example, families with many generations affected by genetic diseases like Thalassemia, Muscular Dystrophies and various kinds of Leukaemias or peoples Welfare initiatives and NGOs like the Multiple Sclerosis Society, or Cancer societies. These can bring the target population closer to the services offered by CryoBank. Persuading people who are directly or indirectly affected by the diseases is much easier and fruitful than persuading people who only have a vague idea of how impactful the disease can be. This is important considering the fact that all the diseases where Cord blood banking has a role are very rare in incidence in the general population.

Considering the special situation in Kerala, where the Government has initiated health insurance/ health card schemes for the people with incurable genetic diseases like haemophilia, thalassemia, sickle cell anaemia etc, the possibility of tie ups with the Government need to be explored. This is especially important when it comes to the Tribal populations that have a greater than average incidence of genetic diseases like Thalassemia, Sickle cell Anaemia etc due to heavy inbreeding.

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7.3 CONCLUSION
Despite medical expertise Indias global share in cord blood based surgical treatment is a meagre 0.25 %.( 20 out of 8000 cord blood transplants). Major break through in stem cell research promising low cost treatment is attracting foreign players in India. While advancement in stem cell therapy would provide solutions to incurable and severe injuries, an established cord blood banking sector in the country would widen the compass of beneficiaries by making these affordable for the masses. There is enormous potential for further growth in the cord blood banking sector in a welleducated society like that of Kerala. However there is a need to devise specific measures for making the concept aware among the public. Right awareness could be the first thing. Cord blood banking when started in India was an expensive proposition. It is still considered that only a particular group of the society can think and avail this technology. This involves a thorough evaluative decision rather than a spontaneous one. There is also a huge shortage of the right kind of people in Kerala. Since stem cell banking is a people-driven business, the concept need to be understood by the people. Non availability of trained man power is also there since the industry is very nascent. The technology requires huge funds. Further more, researches are taking place across the globe. Once this technology gets outdated due to the invention of some other cheap source of stem cells, it affects the entire industry in a bad way.

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REFERENCES

Economic Review, Directorate of Health Services, Govt of Kerala, 2009 Kerala Padanam, Kerala Sasthra Sahithya Parishad, 2004 Cord Blood Banking- Opening New Vistas for Medical Tourism Industry in India, Saboohi Nasim and Kiran K Momaya Websites: www.wikepdia.org www.cryobanksindia.com

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