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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
³A 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.

)908/07/2010 ARAVIND RAJAN

Enrol. No: A0102209104
MBA- Marketing & Sales (2009-2011)
-)49Noida Amity Business School
Amity University
Noida, UP

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I hereby certify that   " students of Masters of Business Administration at
Amity Business School, Amity University Uttar Pradesh has completed Summer Internship
on ³A 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



 4* 5-0+
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‘

First off all I would like to present this piece of work to our guiding light 3Æ):)!
Æ
1))1), 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 3))++), 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 ma¶am for providing
me with assistance and guidance throughout the project.

I would like to extend my gratitude to 3 ): , Head of Cryobanks Trivandrum, Kerala
and 3 , 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 3 )
:)!)
 )
-)-,
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

-

 Æ

Declaration

Certificate from Industry Guide

Certificate from Faculty Guide

Acknowledgement

Sl. No. CHAPTER NAME PAGE NO.

1 INDUSTRY PROFILE 7
2 LITERATURE REVIEW 12
3 COMPANY PROFILE 17
4 RESEARCH OBJECTIVES 23
& SCOPE
5 RESEARCH DESIGN & 25
METHODOLOGY
6 DATA ANALYSIS & 28
INTERPRETATION
7 FINDINGS, 37
SUGGESTIONS,
CONLUSION

References

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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 body¶s 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.

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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;  
    

   
  
  . 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
therapy3 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 Parkinson¶s disease and 5 million
with Alzheimer¶s disease in India are µpotential beneficiaries¶ of stem cell therapy. First-
generation 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.
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Source: Wikipedia.org

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Cord blood is the blood that remains in the baby¶s 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.

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A cord blood bank is place that stores umbilical cord blood for future use. Cord blood
banking basically involves three steps:  

  

 
  . 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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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.

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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.

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The major players of cord blood banking in India are &
 
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&., 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 world¶s 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
& . 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.‘
‘ ! ;)*)
)-0
) 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 à 
which is Reliance Life Sciences Stem Cell
Banking services has established south Asia¶s 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.

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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-year-
old 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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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. Kerala¶s 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 µKerala 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. Kerala¶s 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.

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Sl. No. Health Indicators Kerala India
1 Birth rate (µ000 14.7 23.1
population)
2 Death rate (µ000 6.8 7.4
population)
3 Infant mortality rate 13 55
(µ000population)
4 Child mortality rate 3 17
(µ000 population)
5 Maternal mortality 110 301
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 71.3 62.3
Life at birth Female 76.3 63.9
TOTAL 73.8 63.1
Source: Directorate of Health Service (DHS)

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Sl. No. Population Morbidity Expense for Percapita % of total

Group Rate one time Treatment family
Expenditure expense
1 Extremely 85.1 701.9 1552.9 31.7%
Poor
2 Poor 82.1 613.5 1309.7 18.1%
3 Lower 78.1 886.9 1801.0 13.0%
Middle Class
4 Upper 73.9 1686.1 3238.5 10.4%
Middle Class
Total 79.2 830.7 1722 13.9%
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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Sl. No. Item Extremely Poor Lower Upper Total

Poor Middle Middle
Class Class
1 Medicines 714.5 527.4 578.8 1196.4 622.5
2 Hospital 192.0 172.7 164.6 252.9 175.3
Fee
3 Lab 76.8 128.6 160.6 717.3 181.5
4 Others 569.6 481.0 897.0 1071.9 742.7
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.

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Sl. No. Income Group Government Private Self/Others

1 Extremely Poor 50.8 44.6 4.3
2 Poor 38.3 59.0 2.4
3 Lower Middle 23.0 73.6 3.0
Class
4 Upper Middle 9.2 84.9 3.3
Class
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 sector²
farming, household manufacturing, and services²provides 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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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)

Group¶s 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 group¶s 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 ³best of
class´ facilities in stem cell industry in India. Cryobanks India follows the ³Closed 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. ³This
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.

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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.‘

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1

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.

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‘ Cryobanks International India is the first ³ 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.

‘ ³Closed 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.

‘ 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.

‘ 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

83'3 4

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:-

83'3$3   +
)
  4: 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.

83'3%3 ( --4

9 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

Ô
   
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.

83'383  --4
  49 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.

83'3'3 Æ

+ 2  0 - 0: 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 customer¶s behalf. The courier collects and safely
transports the cord blood to the lab .

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 83'363 4
+2 0- 09 As soon as Cryobank receives the cord blood, they¶ll
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.

83'3?3  
+   -9 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.

83'3A3Æ )+ 2 4 0;- 0Æ
 --9 If the cord blood is found fit for storage after
processing, they¶ll 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
‘

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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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‘ 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.

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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

'383ÆÆ

Æ4 9The 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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4)4: 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-year-
old 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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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.

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a.‘ Primary data:

The tools used for collection of primary data were Questionnaire. The
questionnaire was provided by Cryobank for the collection of data3 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

‘ Internet
‘ Brochures

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The units chosen for the study as sample generally speaking are the Gynecology and
Obstetrics out patients at various hospitals who are expectant mother. 

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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.


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

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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.


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

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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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 ‘ 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:

‘ 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

636‘ Æ

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.
‘ 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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Sl. No. Reason for selection No. Of Respondents Percentage (%)

of Clinic
1 Proximity to home 75 36%
2 Affordability 35 17%
3 Experience & Good 98 46%
Nature of Doctor
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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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Sl. No. Reasons for selection No. Of Respondents Percentage (%)

of clinic
1 Proximity to home & 45 39%
Experience and Good
Nature of Doctor
2 Proximity, 16 14%
Experience of Doctor
& Affordability
3 Affordability & 17 15%
Experience of Doctor
4 Proximity & 6 5%
Affordability
5 Experience and Good 21 18%
Nature of Doctor
6 Family Doctor 3 3%
7 Proximity to home 7 6%
8 Affordability 0 0%

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Sl. No. Awareness on stem No. Of Respondents Percentage (%)

cell banking
1 Yes, Aware 21 18%
2 No, Not Aware 94 82%

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Sl. No. Like to know more No of Respondents Percentage (%)

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1 Yes, I wish to know 30 26%
2 No, I don¶t wish to 85 74%
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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 (³futuristic´ 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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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 doesn¶t show
any interest in it. People normally have a belief that the need for cord blood is not great and
their child²or other children²will 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.

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‘ 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 Rs10,000-
Rs25,000 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 (³futuristic´ 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,

[A
   
 though devastating for the family and the patient, are very rare in incidence in the
society at large. Hence the disinterest is somewhat justified.
‘ 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
doesn¶t show any interest in it. People normally have a belief that the need for cord
blood is not great and their child²or other children²will 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.

A3%Æ

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

[
   
 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 people¶s
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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A38Æ

Despite medical expertise India¶s 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 well-
educated 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.


   
 Æ

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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