Global Health Ltd (NSE: MEDANTA) Q1 2026 Earnings Call dated Aug. 08, 2025
Corporate Participants:
Unidentified Speaker
Naresh Kumar Trehan — Chairman and Managing Director
Naresh Trehan — Chairman & Managing Director
Pankaj Sahni — Group Chief Executive Officer & Director
Yogesh Gupta — Group Chief Financial Officer
Analysts:
Unidentified Participant
Amey Chalke — Analyst
Tushar Manudhane — Analyst
Bino Pathiparampil — Analyst
Damayanti Kerai — Analyst
Harith Mohammed — Analyst
Anshul Agrawal — Analyst
Presentation:
operator
It. Sam it. It. Sa it it Sam. Ladies and gentlemen, you’re connected to Global Health Limited Q1 FY26 earnings conference call. The conference call will begin shortly. Please stay connected. Ladies and gentlemen, you’re connected to Global Health Limited Q1FY26 earnings conference call. The conference call will begin shortly. Please stay connected. It. It. Ladies and gentlemen, good day and welcome to Global Health Limited QN FY26 earnings conference call hosted by GM Financial Institutional securities Limited. As a reminder, all participant lines will be in the listen only mode and there will be an opportunity for you to ask questions after the presentation concludes. Should you need assistance during this conference call, please signal an operator by pressing Star then zero on a Touchstone phone. Please note that this conference has been recorded. I now hand the conference over to Mr. Amer Chalke from GM Financial. Thank you. And over to you sir.
Amey Chalke — Analyst
Thank you, Aviraj. Good afternoon and a warm welcome to all the participants on Global Health Limited Wednesday FY26 earnings call hosted by GM Financial. Joining with us today from the management side we have Dr. Naresh Prehan, Chairman and Managing Director, Mr. Pankat Thahani, Group CEO and Director, Mr. Yogesh Kumar Gupta, Chief Financial Officer and Mr. Ravi Gopal, Head of Investor Relations. I will now hand over the call to Dr. Preha for his opening remarks. Thank you. And over to you, doctor.
Naresh Kumar Trehan — Chairman and Managing Director
Thank you. Good afternoon to everybody. Thanks for joining us today for Medanta’s Q1 FY26 earnings conference call. I hope all of you have had the chance to review the results and presentations that were released yesterday. At Medanta, we continue to build on our vision of delivering world class, patient centric and compassionate care. Clinical excellence remains the cornerstone of our identity and during the quarter we remain focused on strengthening that foundation through consistent and disciplined execution. During the quarter we have had onboarded over 150 doctors including 30 senior clinicians across specialties. This strengthens our medical department and the depths with which we are able to deliver complex and multidisciplinary care.
I am also pleased to share that we have expanded our presence in Banchi by operationalizing a new 110 bedded hospital in July 25th under long term lease agreement with the. This additional unit enhances our ability to serve the underserved region. Furthermore, we look forward to commissioning of our 550 bed Vedanta Noida facility which is poised to commence operation in the coming weeks. This landmark addition to our network will significantly enhance our capacity, strengthen our presence in the national capital region and and further our mission of delivering world class healthcare to a broader community. As a result of our focus on delivering highest standard of quality care, we have been able to deliver strong financials and operational performances during this quarter.
With that, I will now hand over the call to Mr. Ankar Sani, our Group CEO who will walk you through the quarterly performance. Thank you.
Pankaj Sahni — Group Chief Executive Officer & Director
Pankaj thank you. Dr. Chen, good afternoon and thank you for joining us today. I’m happy to share that Medanta had a strong start to the fiscal year. In Q1FY26. We have delivered our highest ever quarterly total income and EBITDA while maintaining healthy margins and driving operational efficiencies. Our performance reflects the strength of our integrated care model, disciplined execution and the growing trust of our patients. Let me begin with the key financial performance highlights for Q1FY26. During the quarter, Medanta delivered total income of rupees 10,513 million compared to rupees 8,830 million same quarter last year registering a strong growth of 19% year on year.
EBITDA for the quarter was rupees 2,553 million, an increase of 23% year on year with an improved EBITDA margin of 24.3% year on year. Please note that EBITDA is before non cash esop expenses of rupees 79 million. Profit after tax for the period was rupees 15. 90 million. Year on year growth of 50% PAT margins for the quarter improved to 15.1% compared to 12% in the same quarter last year. In Q1FY26, profit after tax is higher due to a non recurring exceptional income of rupees 196 million arising due to reversal of earlier accrued interest liability on EPCG imports in the Lucknow unit following the transfer of the EPCG licenses to GHL pursuant to its merger that was announced last quarter.
Our overall performance was driven by sustained growth in patient volumes across units and improved realizations, especially in Gurugram. Our inpatient volumes during the quarter increased by 14% and the outpatient volumes increased by 13% year on year. Our average occupied bed days for the quarter increased by 13% year on year with occupancy of approximately 63% on increased bed capacity. Average revenue per occupied bed for the quarter was rupees 66,584 compared to rupees 64,035 in the same quarter last year, an increase of 4% year on year. This increase was largely driven by an increase in realizations in the Gurugram unit and change in specialty mix during the quarter.
Revenue from international patients was rupees 636 million, an increase of 34% year on year coming to the matured hospital performance during the quarter. Total income from our matured hospitals was Rupees 7,006 million compared to Rupees 6,328 million in Q1 FY25 registering a year on year growth of 11%. The EBITDA of mature hospitals stood at Rupees16.40 million reflecting a growth of 7% year on year with a margin of 23.4%. Inpatient volume growth was 6% year on year. ALOs declined by approximately 4% year on year. These two combined factors resulted in an average occupied bed days increasing by 1% representing an occupancy of 62%.
RPOP grew by 9% to Rupees 73,256 in Q1FY26 primarily driven by increase in realization in Gulgaram and change in specialty mix. Now when it comes to our developing hospitals, developing hospitals comprises Lucknow and Patnam. To note, Noida Hospital which is yet to commence business operations has now been included in the developing hospital categorization. Noida expenses of approximately Rupees 30 million of which 50% are attributable towards employee cost and the remaining towards other expenses have been included in Q1 FY26 numbers. Our Lucknow and Patna hospitals continue to show strong momentum as they move towards operational maturity.
Total income during the quarter was 3,219 million compared to 2,369 million in the same quarter last year registering strong growth of 36% year on year. EBITDA was 942 million compared to 589 million in the same quarter of last year registering a robust growth of 60% with margins remaining strong at 29.3%. Average occupied bed days increased by 39% year over year representing an occupancy of 64% on increased bed capacity. Lucknow RPOps declined by 11% year on year due to an increase in ALOs by 17% year on year driven by an increase in share of scheme patients.
Patna Hospital saw an improvement in RPOps of 8% year on year driven by a 7% reduction in ALOs as part of our ongoing operational efficiency. The combination of these factors resulted in developing hospital RPOP declining by 3% to rupees 56,704 during the quarter. 20 beds were added on the 9th floor of Tower A at Medanthapatna Hospital marking the Completion of Tower A there. Moving on to our projects. Update. We are excited about the upcoming launch of our 550 bed Vedanta Noida facility which is expected to be operational in the coming weeks. We have already onboarded over 230 employees, all of whom are undergoing a comprehensive training program.
In July 2025, we successfully operationalized our 110 bed hospital in Ranchi, further deepening our presence in the eastern region of India and enabling access to high quality health care in an underserved market. Interior fit out and commissioning for Tower B and Patna and two floors in Lucknow is in progress which will add additional capacity in these locations. Our broader expansion pipeline now includes 2,000 beds over the course of three to four years. These projects are in various stages from design to execution and are aligned with our strategy to scale in high demand markets. Over the near term, we aim to add 1000 beds supported by the development of advanced medical technology and expansion of clinical teams.
This forms the foundation for sustained long term growth across our network. With this, I request the operator to open the line for questions. Thank you.
Questions and Answers:
operator
Thank you very much. We will now begin the question and answer session. Anyone who wishes to ask a question may press star and one on the Touchstone telephone. If you wish to remove yourself from the question queue, you may press star and two participants are requested to use handsets while asking a question. Ladies and gentlemen, we’ll wait for a moment while the question queue assembles. The first question is from the line of Tusharmanudane. Please go ahead.
Tushar Manudhane
Hi, am I audible? Just on the operational cost first with you know, additional.
operator
Ladies and gentlemen, since there is no response from the current participant, we’ll move on to the next one. The next question is from the line of Vishnu, an individual investor. Please go ahead.
Tushar Manudhane
Hello. Hello.
operator
Yes, please go ahead. Hello. Thank you. Thank you. The next question is from the line of Tushar Manitani from Motila Loswell Financial Services. Please go ahead.
Tushar Manudhane
Am I audible now?
operator
Yes.
Tushar Manudhane
So just with respect to the additional operational cost of Noida and Rachi, if you could call out how much to sort of factor. Operational cost for Noida and Ranchi. The new hospital.
Pankaj Sahni
Noida operational cost right now only includes about 3 crores of cost in Q1 as a EBITDA expenses. Basically there’s no revenue there as we move forward, Tushar, it really depends on how we scale up the unit. Ranchi, on the other hand, will be mostly supported by the existing unit as far as the administrative and overhead costs go. So most of the cost in the new Unit at Ranchi will only really be for the clinical nursing teams. But exact numbers I can’t tell you because I don’t know what it will lay out in the future. But as we scale up, as the doctors come on board, there will of course be some amount of cost which we may incur as and when the doctors and the nurses and everybody comes on board.
But exact numbers right now I can’t project out into the future. In any case, we don’t really give the future projection, so I’m not sure, but I don’t see any real difference. Why? There would be a very significant change in the cost or performance profile of the Noida unit versus any other unit. Except of course for the initial startup kind of costs.
Tushar Manudhane
Got it, sir. And this 150 plus doctors onboarded. So broad breakdown at reason. This is largely for Rachi and Moida or correct me if I’m wrong. And this sort of help us understand where all these.
Pankaj Sahni
Yeah, so I would say that the majority of the 150 doctors is actually for our existing units. That includes almost all the units, Gurgaon, Lucknow, Patna, even some additions in Indore and Ranchi. The addition for the new unit in Ranchi will be very negligible. And in Lucknow it will be hardly about 15 to 20 doctors. Sorry, in Noida it will be hardly about 15 to 20 doctors. So most of the 150 doctors that you see are actually all for the existing units. So we should be expecting reasonably more number of doctors getting onboarded in the coming quarters for Noida and new unit of Rachel. Right? Yes. So if you recall Pushar, we have been consistently mentioning over the last several quarters that we actually still have quite a bit of growth to add in to the Lucknow and Patna unit, both in terms of the bed build out as well as in terms of the clinical hiring over there. So just to give you an example, we are currently building out in Patna our mother and child floor in Tower B. And there will of course be a complete hiring of the department there. So it’s not like the hiring is only for Noida, it is very much for the other units.
We also hired in units in Gurgaon. So to give you an example, we have a complete new depart team for ophthalmology which we’ve hired into our Gurgaon unit. We’ve hired oncologists into our Gurgaon unit, we’ve hired nephrologists, we hired cardiac surgeons. So the hiring which you see is very much part of our agreed and announced strategy. I Believe we called it on focusing on the core and we will continue to do that in the coming quarters as well. And of course there will be a complete hiring for Noida.
Tushar Manudhane
So just lastly on matured hospital there’s been reasonably good increase in rpob, maybe year over year, quarter, quarter, but at least sequentially the. And despite occupancy remaining stable, we’ve seen reduction in the margins. So any particular reason to call out here?
Pankaj Sahni
So I think that the margin reduction is largely the impact of the salary increments for this which come in typically in quarter one. So when you look at it on a sequential quarter basis or even if you look compared to last year, large percentage of this is employee costs which then gets kind of across the year gets managed out. And we saw that last year as well. Your second question was RPOP if I’m not mistaken, right?
Tushar Manudhane
Yeah, yeah.
Pankaj Sahni
So RPOPs have seen actually a good amount of growth. What we’ve seen is that across many of the specialties in Gurgaon, we’ve seen some amount of realization growth. And then of course as with the country and the industry as a whole lot of work moving towards oncology in terms of the sales mix. So that has a natural growth towards rpop. Also certain efforts have been made on a loss management which we continue to do. So if you see our average length of stay, it’s quite low for complexity of this size at about three days. So you know, really have, you know those impacts of low ARP, low ALOs actually also impacts the RPAP growth.
Tushar Manudhane
Just on your comment of RPAP realization across therapy. So this is like more of a price hike which we have taken in Gurgaon. Is that the same?
Pankaj Sahni
And so no, actually when we look at it internally, yes, we have given some amount of price hike and some of it also plays out with respect to at least maybe with respect to quarter last year because last year we took some insurance renegotiations. So that may not be reflected in Q1 25. I think that impact probably came in Q2, Q3 and onwards. So that may be a little bit of it. But I would say that Yogesh, correct me if I’m wrong, that would be less than 5% of the impact would be tariff. Most of it is just complexity and realization.
Daycare procedures increasing in many cases sales mix across because you’re looking at it consolidated but realization increase is largely linked to within the specialty. Also we’ve seen realizations increase and some of that is just linked to more complex work happening. So I think we had mentioned this last time also, if you do say robotic versus non robotic, there’s a change in the ARPP in some cases in neuro and cardiac, we’ve seen some changes. So those are the kinds of things.
Tushar Manudhane
All right, thanks. Thanks.
operator
Thank you. The next question is from the line of binopathy, Parma Pil from Elara Capital. Please go ahead.
Bino Pathiparampil
Hi, good evening. Congratulations on a great set of numbers. Couple of quick clarifications. One, I see that the depreciation and. Amortization cost has come down this quarter. Compared to last few quarters. Why is that?
Yogesh Gupta
There are certain estimates which are have completed their life like computers, et cetera. When they complete their life, don’t count zero. And plus building life, which was already taken as a 30 years as we realized now in the industry center, 60 years. But that impact is very minimal. Okay. So for existing assets, this will be the new level at which there will be DNA and then as you add assets, it will pick up.
Bino Pathiparampil
Okay. And second, any update on the indoor. ONM that you were planning. On? Which one, Sorry, indoor.
Yogesh Gupta
There was a planned hospital. Right. Any update on that? We had announced, I think maybe one or two quarters ago that that had gone into the back burner and that that we were not very confident that that would come back. So as on date, no update on that. So that was. That was basically a legal case going on between the previous owners and that was not moving. So we had said that we may not. We are not very sure of the progress on that. So we putting it into kind of get the clarity. We were not very sure about projecting.
Bino Pathiparampil
Got it. Thank you. Thank you.
operator
Thank you. Before we take the next question, we would like to remind participants that you may press star in one to ask a question. The next question is from the line of Tamyanti K. Rai from hsbc. Please go ahead.
Damayanti Kerai
Hi, thank you for the opportunity. My question is again on Noida Hospital, so you mentioned you have hired around 15 to 20 doctors for the unit and initially you’ll start with 300 beds. So just want to understand say how do you open a bed so up to 300 in initial two to three months, how many will be actually operational and then at what occupancy level you generally open up further beds. If you can walk us through this.
Pankaj Sahni
Yeah. So just to clarify, we have released, we have currently as on today, the number which I mentioned, 15 to 20 doctors are currently on roles and working for the company, some of them actually sitting in our clinic in Defence Colony as well. Of course offers are out for a far greater number of that, upwards of 100. So they will be coming on board in the next days and weeks actually. Now to go to your question as to how do you start? So for operationalizing any hospital you need basically three, four of the key areas to be operational.
Of course we need the ward beds, we need the ICU beds, but more importantly than that we need the operation theaters and the cath labs and the basic support systems beyond beds to be operational. So we are currently planning to operationalize with approximately five OTs in the next few days and then two cath labs and then as and when we get Almost all our ICUs are actually complete and then the ward clause we keep adding in. So we had mentioned that we would start out with 300 beds. I don’t think we will wait again in the previous earnings call I had mentioned that since it’s a single tower property, we would not wait for the build out for the remaining floors.
So we will continue to build that out over next month. There will be no pause in the construction build out. So we will continue to move to 500 beds. And in this particular case unlike Lucknow and Patna, we don’t need to actually put in fresh services or build out a second tower. It’s a single tower building. So we just continue the build out over the next few months and hopefully complete it as soon as possible. And then it will really depend on how the occupancy grows as and when we continue to fill out the beds.
Damayanti Kerai
Sure. So day one itself, 300 beds across these different categories will be available. And as in when you scale up maybe you’ll, your operations will pick up accordingly.
Pankaj Sahni
Yes.
Damayanti Kerai
Okay, that’s helpful. And very broadly right now, 15, 20 doctors which you mentioned, how many like further offers has been rolled out? Like what are the plan on the clinical team size for this unit?
Pankaj Sahni
So we have more than 100 offers out in the market across various departments and across various levels. I can’t tell you exactly how many doctors will finally be working in the hospital. But just to give you some context, if you look at Medanta Burgaon, which is a 1500 bed hospital, we have almost 1000 doctors who work here. And out of those thousand doctors I would say that probably about 500 to 600 maybe bit more are what we would consider as the senior category doctors, what we call associate consultants and above. So you can apply similar ratios for the 500 beds in Noida.
Damayanti Kerai
Sure. And on the non clinical side your presentation mentioned already, you have admin and nurses etc who have been onboarded. And then are the costs for those non clinical staff reflecting in one Q or some like only some parties right now visible to it.
Pankaj Sahni
So some parties, whoever, obviously whoever is on roles before June 30, their cost is reflected. The total cost in Q1 for Noida is about 3 crores only. And then as and when people come on board of course their cost is getting added. So you will see obviously a scale up in costs in Q2.
Damayanti Kerai
Sure. And if you can explain, sorry I missed out in the developing hospital segment, why did we see a decline in rpob?
Pankaj Sahni
So the developing hospitals are largely Lucknow and Patna. If you look at our two facilities, we found that our Patna facility which I came on first, that actually saw an increase in rpop of about 8% and that is largely driven by a reduction in a loss of about 7%. In Lucknow we saw a decline in rpop by about 11% and much of that is because of the increase in the scheme business which has a longer length of stay typically. So you did find that as the length of stay increases, the RPOP reduces and of course vice versa.
Damayanti Kerai
Okay, so from the current quarter level of around 56,000 5, 6, 57,000, how should we look at the RFOP trend in this developing hospital? Vertical.
Pankaj Sahni
So the way in which we think about RPOps and we mentioned this consistency is that if you look at this on a quarterly basis it has got a lot of variation. In some quarters you have different diseases, in others you have different diseases. So we don’t really study it on a quarterly level. But if you look at this, over the years we’ve consistently maintained that typically we think about RPOP growth in normal times, which is a little bit more than inflation. Of course this is dependent on certain things like alos reduction, etc. So if you notice our alos in our facility in Patna, we found quite a significant amount of difference in the ALOs for our PPP patients.
So as we started working on operational efficiency of bringing down the alos of the PPP patients, it reduced.
Damayanti Kerai
Okay, that’s clear. And my last question is you have taken tariff hiking program unit. That’s what I understood. What about that was last year and any. Okay, so that impact is getting reflected in 1Q number, right?
Pankaj Sahni
You haven’t taken in 1Q in the first quarter. We haven’t taken any impact. Maybe there is some carry forward from the last year, especially when you Compare it to Q1 of 25 and then there may be, you know, some small increases. But even if you consider the tariff increases for I think the whole of last year. It’s fairly negligible on the overall realization increase.
Damayanti Kerai
Okay. Anyway, like it’s smaller part of your RFCB increase, but any plans for any tariff hike during the current fiscal in any hospital?
Pankaj Sahni
Yes, maybe we will possibly look at some amount of tariff hike in Gurgaon as we come into the two years from our last tariff hike. Especially with respect to the insurance companies, etc. Those contracts will need to get renewed. We’ve also never taken a tariff increase in Lakhau or Patna and we may consider a tariff increase there. But these are also maybe not. It is not like it may be blanket. It may be in certain specialties, certain areas. So typically Vedanta has been extremely conservative vis a vis the rest of the industry on tariff increases.
And we broadly would like to maintain that posture as much as possible.
Damayanti Kerai
Okay, thank you. These are very helpful.
Pankaj Sahni
Without tariff increases then no real need to take tariff increases.
Damayanti Kerai
Okay, thanks for your response. I’ll get back in the queue.
operator
Thank you. Before we take the next question, we would like to remind participants that you may press Char in one to ask a question. The next question is from the line of Hareet Ahmed from Evan Des Park. Please go ahead.
Harith Mohammed
Good evening. Thanks for the opportunity. My first question is on the new Ranchi hospital. Is this hospital going to be operated independently from the existing hospital? And if not, then with 110 beds, how should we think about our ability to offer all the specialties in this unit? Wouldn’t we be constrained by the number of beds? Or are we looking to expand this hospital further so that we can have more specialties here?
Pankaj Sahni
Yeah. So I think in one of our earlier investor presentations, we had discussed that this hospital is very near to our existing hospital and we do intend to operate them both as one kind of unified campus. So we will not be looking at them as completely independent. We will operate them as a unified campus. We will also look at which are the specialties which will move to the new hospital, which one will remain in the older hospital. But more importantly, there are certain specialties that we were not able to add in our Ranchi facility because of space constraints as well as because of some of the infrastructure challenges, because the infrastructure is actually quite an old building.
So this new hospital allows us to do two things. One, it allows us to commence the renovations of the old hospital and put some amount of maintenance into that facility, which was challenging while it was running. And the second thing that it allows us to do is expand new specialties. And hire more clinicians and add in certain departments that were missing as well as increase the capacity for very high demand departments. So to give you a very simple example, we are completely full and overflowing with a waiting list for our dialysis work in Ranchi. So adding capacity allows us to shift some care to the new facility and then make more space for dialysis.
So examples like that across the existing specialties would also be affected.
Harith Mohammed
Okay, that’s helpful. My second question is on rpob, both in the mature hospitals cluster as well as the developing hospitals segment in mature hospitals. Not sure if you have addressed this before, but the 9% growth that we saw this quarter is above what we’ve seen in recent quarters where we saw mid single digit RPOC growth in this segment. So what’s driving the higher RPOC growth and how should we think about growth here going forward?
Pankaj Sahni
So I did mention earlier, but you know what, much of the growth from the mature hospitals has been driven by increased realizations in Gurgaon as well as some amount of ALOS reduction and operational efficiencies there. As we think about R Corp growth going forward. Again, I wouldn’t like to give you a guess on what would happen in this quarter or the next quarter, but when we look at this on an annualized basis we do see typically anywhere in the range of at least in the Medanta ecosystem, maybe 3 to 7% is our normal. There are times when you find that the increases are a little bit higher either because there’s been operational efficiencies or in the case of what we do see this quarter as well, there has been an increase in the complexity of work.
So as I mentioned earlier that sometimes you go from say non robotic surgery to robotic surgery. So that would increase your realization. You may go in the cardiology arena into some of the more complex procedures like tabi, etc. Those are expensive procedures that increases your realization. Similarly in neurosurgery you may have complicated procedures so that increases your realization. And also as we move into a more precision oncology and immunotherapy type of care in cancer, those drugs tend to be a little bit more expensive, so that also increases your RPOX because you have a higher price on Nivea smaller days day procedure.
Harith Mohammed
Similarly on the developing hospital side we’ve had a few quarters of upon decline and we’ve discussed some of the factors for this like the, you know, allocation of beds for PPP patients etc. Where exactly are we on this? Have we reached the 45% level and when can we expect growth returning in this segment?
Pankaj Sahni
So just to clarify on the ppp first, our PPP business in Patna is somewhere in the range of about 15 to 17% of our total business. So to answer your question, have we reached the maximum of 25%? The answer is no. We continue to work very closely with the government to increase that business actually because we do find that the realizations are good as well as as we mentioned in the past, payment terms are very good. And of course it is our obligation as well to work with the government to do that and that work is on quite aggressively.
The good part of what we’ve been able to do in Patna over the last several months is actually reduce the length of stay of the PPP patients to bring them more in line to the cash and PPA patients for the same specialty. So we do find that there has been an operational efficiency which has been brought in in Patna and that actually has resulted in a pretty good alos reduction of 7% and that gets translated to an RPOP increase of about 8%. So that’s what’s happened in Patna. I would not say that it’s stable because for two reasons.
First of all we have about 100 beds coming on board over the next couple of quarters in Patna as well as we have new specialties coming on board, as I mentioned say, like mother and child. We also would be very happy and keen to have the PPP business get to that 25% number. And so I do see that Lucknow will continue to have growth and therefore some amount of changes across various metrics that we study. As far as Lucknow goes, Lucknow had in Q1 of last year had almost no business from various schemes because if you remember when we had our last year earnings call in either Q4 or Q1, we talked about the fact that we had only really started and signed up for schemes like Ayushman, CGHS, etc.
In FY25. So Q1 would have very, very little of that and therefore the length of stay is significantly optimized because it’s purely cash insurance patients, as you get into STEAM patients, they tend to have a little bit longer length of stay and that results in an ALOS reduction and therefore ALOS increase, sorry, and therefore RPOP reduction. We will work on optimizing that as we move forward. But again Lucknow also has beds to get added. So I would say still various amounts of growth and therefore some amount of changes that may come into the metrics that you look at in Lucknow.
As well.
Harith Mohammed
Thanks. Thanks for this. That’s very helpful.
operator
Thank you. The next question is from the line of Anshula Krapal from NK Global. Please go ahead.
Anshul Agrawal
Hi. Thank you for the opportunity. Hope I’m audible.
operator
Yes.
Anshul Agrawal
Great. So my first question is on the occupancy in developing hospitals. As per your assessment, sir, is there any element of C seasonality here? I believe the occupancy has risen quite sharply and it has even exceeded the same of mature hospitals. So is there any element of seasonality or any onset of monsoons, earlier monsoons, anything that you could share on this?
Pankaj Sahni
So I don’t think, I mean I don’t have exactly the. The impact of things like dengue et cetera off the top of my head. But I don’t think that really has impacted in Q1. Typically we see that kind of impact more in Q2 and Q3. There is definitely a seasonality impact with certain specialties. Like I forget now whether it was FY25 or 24. I think FY24 we had a very significant growth in volumes because of dengue and Lucknow unit. We do get seasonality impact but that’s typically Q2, Q3. So not so much in Q1. So I would assume not much impact of seasonality.
We do have the growth coming in in terms of our occupancy in our Lucknow unit. And so when you look at our Lucknow unit that has seen a significant growth in volumes and therefore a significant growth in occupancy not just on the STEAM business but on all aspects and across the board as well. So if you look at the absolute volume growth in the Lucknow unit also that’s increased pretty significantly and that’s why you’re probably seeing an increase in the occupancy numbers.
Anshul Agrawal
Great. Would you be able to share the scheme patient mix, revenue mix from schemes in Lucknow?
Pankaj Sahni
So we don’t break up the category by each area but if I look at it, it would be reasonably negligible. I mean I would say that across all hospitals across Lucknow, all the scheme business would probably be somewhere around 10% or under range. When you look at our business as a consolidated, I think also it ranges in this area with the PPP business of Patna I think adding into that a little bit. So if you look at our investor presentation, the PPP business is actually categorized in the others category. So that is not shown in the.
Just trying to quickly check which slide it is. But it is not shown in the revenue mix of CGHS, ECHS. I think it’s on slide number 11 you can see about 11% business as a whole of CBHS and then there’s about 3% in others. That includes the PPP business of Patna which is at CGHS tariffs, although realizations are still high.
Anshul Agrawal
Got it. Sir, is it 11 plus 3 for the entire portfolio?
Pankaj Sahni
So not all the 3% is. Some of that includes business from some of our government contracts. But yes, I think at an overall level you can say 11 +3 would be at a non hospital tariff rate.
Anshul Agrawal
Got it? Clear. The second question that I had was what could be peak occupancy levels for generally for our hospitals? I see that in our mature portfolio or Gurgaon Hospital has hit about 70, 71 percentage in the past. Is that like the peak occupancy level? Because I believe midnight occupancies would be higher or you know, we can go higher than that also at current capacity.
Pankaj Sahni
So just to clarify, midnight occupancy is typically lower than peak occupancy during the course of the day because patients get admitted and discharged. And so therefore midnight occupancy is always typically lower than what happened. What the peak occupancy is during the course of the day, not the other way around. Now if you look at the alos which we have for the group, it’s about 3 days, 3.03 days if I’m not mistaken. And if you just increase that alos by half a day or one day, you would find that the occupancy would go upwards of 70 to 75%.
And the reason I mention this is that occupancy on its own is not necessarily a good metric because it means patients are staying in the hospital for a longer period of time. And that doesn’t necessarily make it a good thing. So if you look at our alos, it is amongst the best in the industry and something which we’ve always maintained we work on very aggressively because the objective is to get you home, not to make you stay at night. And so therefore occupancy on a standalone basis would not be the right metric in my opinion.
And the right way to look at this is to see are we seeing inpatient growth, volume growth, which we have seen consistently across the group and across both mature as well as developing hospitals. But to answer your question, what is the peak occupancy? I think depending on the kind of complex work which you do, that would range probably anywhere from 70 to 75%. I think would be what a big system like Vedanta which is doing very complex care would look at. There are systems around the world that operate on higher occupancy, but some of them are far more institutionalized and organized in various ways.
But the system starts to get choked once you cross that at a midnight occupancy level. But again, occupancy on a standalone basis is not necessarily a good thing. The right way to think about it is more around throughput than who stays at night.
Anshul Agrawal
Very clear. Thank you so much for your answers.
operator
Thank you. Participants who wish to ask questions may press char in one at this time. The next question is from the line of amay Chalke from JM Financial Institutional Securities Ltd. Please go ahead.
Amey Chalke
Thank you. I hope I’m audible. Yeah. So first question I have on international patient revenue this quarter, we have seen a good jump of 34% year on year. On revenue side, I believe the contribution largely is coming from Gurgaon. Right. So how much would be the contribution now for the Gurgaon Hospital for the international patient? And is it the reason why the RPOps are also going up?
Pankaj Sahni
So, yes, you’re right. International business is almost exclusively Gurdon. I would not say largely it’s almost exclusively. You know, if you recall, over the last few quarters, there has been some amount of reduction and impact of the international business, and that is driven by three factors. One factor would be the Afghanistan change in leadership there. Second is some of the challenges which we’ve seen in Iraq. And the third one is the challenges which we’ve seen in Bangladesh. So if you look at all of these three things, they have impacted international business over the last several quarters.
Now, a lot of that is one, of course stabilizing with the exception of Afghanistan, but Iraq is definitely stabilizing. Bangladesh still some stabilization to continue. But what we’ve seen is that actually there’s been a growth in international business from other areas. So Africa is one notable area where we’ve seen good amount of growth in the Naganta system and I’m sure across the industry. And the second is the CIS countries. So I guess as we look at some of the challenges, because Bangladesh was definitely one of the largest countries sending medical tourism patients to India, that has been offset to some extent by patients from Africa, CIS and other parts of the world.
We do expect this to continue and we hope also that Bangladesh will continue to stabilize and then restart the original stream of business from there. The second important point as far as the Melanka ecosystem is concerned is that we do expect that Noida will have international patient base because being part of the NCR Region that is a market which is more likely to attract international patients than say a Lucknow or a Patna. So that’s the second important point then to answer your question, that approximately I would say 11 to 12% of our business in Gurgaon comes from international.
And while we’ve seen about a percentage or percentage and a half uptick in that vis a vis the same quarter last year, I don’t think that that alone has contributed to the bulk of the realization increase. I think our business is very much driven fundamentally on domestic patients with international really more of the icing on the cake. So much of the growth is really coming from, as I said earlier, realization increases on domestic business.
Amey Chalke
Sure. The second question I have on the expansion beyond Noida, is it possible to give any updated timeline for South Delhi, Mumbai and Kitampura?
Pankaj Sahni
Well, I don’t have really any more timelines as far as dates or anything like that. As you see in the investor presentation we mentioned various stages of work. So for example, in our Mumbai project we have received the additional FSI approval that we were seeking and that actually allows us to build the kind of beds and get this kind of scale that we are looking for. We have got the building plans being under preparation in our Pitampura project. We have submitted the building plans for approval and we are under process for all of that. As far as timelines, I would say that the overall level, just like with our Noida project, things typically take in the range of three to four years to get built out.
So I don’t see any very significant shift in the absolute timelines.
Amey Chalke
So any one of these units or. Assets you expect to see in FR 29 or should we assume the FR 30 as a starting to commission these units?
Pankaj Sahni
I would say that, you know, that is a timeline that I don’t want to predict out into the future. You know that can’t get a building up in a day so it takes a certain amount of time. I don’t know whether we should be more confident or less confident of the build out in places like Mumbai and Guwahati than we have been in UP and Bihar. But we’re very happy to get it in 29 if you could.
Amey Chalke
Sure. That comes to the third question basically. So we have good amount of cash on books. The capex requirement looks like still we looks very comfortable to generate good amount of FCF for next two years. So what would be the priority going ahead, the uses for this capital? So would you be like willing to do acquisition to fill up any gap in terms of that addition is these three hospitals going to come, let’s say beyond FY29 or you would still go with the greenfield approach?
Pankaj Sahni
Sure. So we are very much open to acquisitions and I will just qualify that to confirm that acquisitions of every kind of variety, the pure typical M and A, which you may be more used to in the financial world, but also acquisitions in the nature of O and M contracts, asset light models, etc. That we’ve seen gain popularity in this industry. So absolutely looking into the appropriate acquisitions. I think the key word here is appropriate. So it has to be, as I said, it has to be the right, as I said in the past, it has to be the right kind of quality of an asset that fits well with the melanctha ecosystem.
It has to be in a geographical area or a market which we believe is appropriate for us, where melancha can come in, make a difference in the quality of care we provide. And then of course, the valuations and the other financial parameters have to be logical and make sense for us to do so. If all these three parameters are checked, we will absolutely be looking into the acquisition O and M and other kind of associated models. The second use for the cash which we have on hand would be to continue to double down on our investments in the latest technology.
And also let’s not forget, we do still have a good amount of cash to be spent as we think about the build out of the existing four hospitals, that’s two hospitals in Delhi, Mumbai as well as then Guwahati. Although that cash requirement is typically backloaded when we build out hospitals, typically the bulk of the spend happens in the last year of the build up. So you’re right, we have a very, very strong balance sheet, very happy with the current cash position that we have, but lots of sticks in the fire. So no shortage of growth opportunities in our industry and especially with Nidanta.
So we have a lot of exciting growth opportunities in our system to come.
Amey Chalke
So thank you. Thank you so much. I will join then.
operator
Thank you. Participants who wish to ask questions may press CHAR in one at this time. Participants who wish to ask questions may please press star n1 at this time as there are no further questions from the participants. And I hand the conference over to the management for closing comments.
Pankaj Sahni
Thank you everyone for your questions and for joining us today. As we scale, we continue to focus on what is always defined Medanta, clinical excellence, operational discipline and a commitment to delivering outcomes that matter to our patients. We’re happy that you joined us. Please feel free to reach out to our investor relations team in case you have any other questions that remain unanswered. Look forward to meeting you and seeing you also. Thank you.
operator
Thank you on behalf of GM Financial Institutional securities limited that concludes this conference. Thank you for joining us. And you may now disconnect your lines. It.