Fresenius, which commenced Indian operations in 1996, has managed to corner 12 per cent market share in four years. Analysts say the inability of the largest Large Volume Parenteral ( LVP ) manufacturer to maintain the supply chain and some aggressive marketing strategies have helped Fresenius to attain the number three slot in a short period.

Fresenius India runs two LVP production units at Ranjangaon, near Pune, and at Nashik.

There are 11 LVP manufacturers in India who use form-fill-seal technology. The top five include Wockhardt Life Sciences, Core Parenterals, Fresenius Kabi, Albert David and Alcon.

The company has earmarked foreign direct investment of around US$ 60-70 million to fund acquisitions in India, but is also exploring the possibility of raising resources through Iveon Laboratories, a company acquired in June 1996.

Healthcare is emerging as one of the fastest growing sectors in the state and most investments by NRI medical professionals. There are four medium to large size super specialty hospitals that are coming up in Kerala. One of the larger projects is being set up by Dr. Abdullah Cherayakkar, an endocrinologist who has worked in the Gulf and UK for over 20 years and his associates.

The doctors have invested Rs.60 crore to set up Malabar Institute of Medical Sciences, a 450-bed multi-specialty hospital at Calicut. Work on the project began two years ago and the hospital will be opened in August 2001. The focus areas will include cardiology, gastroenterology, diabetes trauma and urology. August will also see the launch of Kerala Institute of Medical Sciences in Thiruvananthapuram.

The project is promoted by Great India health Care Management, a company that comprises mainly NRI medicos from the Gulf and the UK. In the first phase, the hospital will have 250 beds which will be increased to 350. This hospital is being set up at a cost of Rs.42 crore.

For the cash rich NRIs, the lack of quality healthcare is just one of the reasons to invest in the sector. Quite a few are also planning to attract foreigners. One project in Kochi combines both healthcare and tourism to attract foreigners. Lake Shore Hospital, which is also promoted by doctors, will have a hotel annexe. Dr. Peter John, chairman of the company, is an NRI and is currently with the Arab American Oil Company. The total outlay in the first phase is Rs.40 crore. The 390-bed hospital will be opened in September this year and the 50 room 3-star hotel will also be opened simultaneously. One of the smaller projects in Kochi is being set up by Abad Specialty Hospital, a healthcare company promoted by NRI doctor Dr. Najeeb Zackeria and others. Abad specialty Hospital is investing Rs.12 crore in a 80-bed hospital.

"Kerala is a very unique case. The state is affluent and yet has a paucity of good tertiary healthcare services," says Dr. Vivek Desai, director of Hosmac, a healthcare consultancy. As a result, residents were compelled to travel to Karnatka or Tamil Nadu for healthcare.

There is optimism about the success of these projects. Dr. Ramesh says, healthcare providers in the Gulf are keen on sending their patients to Kerala.

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