To catch a glimpse of what the future of healthcare could look like, Meitra, in Calicut, India, is a good place to look. It is here the first phase of an ultra-modern 500-bed facility was delivered in 18 months – versus the industry standard of four years – at a fraction of the cost, using prefabricated technology and robotics assistance.
The pilot project is by KEF Holdings, a Dubai-based social enterprise that operates in infrastructure, healthcare, agriculture, education, investment, and metal businesses. Its founder and chairman Faizal Kottikollon tells Arabian Business why he looked to innovate in this sector.
“Healthcare is the most complex industry to build, because you’re treating patients,” he says. “The build cost of a hospital in the Middle East is normally AED10,000 ($2,722) per square metre, on average. Using prefab techniques in India, we’ve done it to the same quality specifications at one-third of the price.”
Kottikollon describes the approach as being “like a catalogue”, in which standardised modular designs, complying with standards set by Joint Commission International, an international healthcare accreditation service, eliminate the time and cost of repeat designs.
Hospitals in the catalogue range from small 15-bed to 500-bed facilities, with the number of pre-designed modules changing based on customer requirements. The finished project in India – which is expected to break even in “an unheard of” nine months – can be easily replicated in other markets, it is claimed. The industry standard break-even point, Kottikollon notes, is five years, and even that is considered “a great achievement”.
“Imagine if this is replicated everywhere, in Mexico to Africa to India to the GCC,” Kottikollon says of his intention to scale the approach, while adding he has no active plans for the Gulf at present. “Building a hospital at one third of the cost will make healthcare accessible to everyone. That’s what we want to roll out, not only to the region, but to the world.”
While Meitra took 18 months to complete, future hospital projects are being offered on the market at 15 months, end-to-end. “This is probably the first hospital in the world to be built using offsite technology, so there was a lot to learn. Now that we’ve already done it, we don’t have to repeat the same learnings,” he said. “The idea is that the more and more we build, the more efficient we will become.”
In Kottikollon’s eyes, success can be measured just as much by patient outcomes and satisfaction as it can by cost and time. Just a month after Meitra’s opening, occupancy rates are hovering at between 50 and 60 percent.
“It’s not just the physical infrastructure,” he says of his unorthodox approach. “It’s the IT system, everything is integrated. It’s like a hotel in that everything is totally turnkey [ready for use], and turned around in 15 months. It means many people will get into the healthcare industry, without the fear of waiting five years to get their money back.”
While KEF Holdings is involved in traditional heavy industries, Kottikollon says that he prefers to consider it as a technology company, “changing the lives of people for the greater good”, while at the same time drumming up new business. The Meitra project, he notes, has led KEF to receive “a lot” of business interest from other parties seeking to build medical facilities quickly at a less expensive cost.
A model for others to follow
Kottikollon’s journey into the worlds of construction and healthcare had solid foundations – he hails from a wealthy industrialist family in Kerala, India. But in 1997, the now 53-year-old started a Sharjah-based foundry, Emirates Techno Casting, which used technology to manufacture valves for the oil and gas industry. In 2012, the expanded facility was sold to Tyco International for $400m. Kottikollon used this capital to found KEF Holdings.
“When we moved into prefab, the concept came from the oil and gas industry. Time is money. We became well known in that industry mainly by using technology to compress time using lean manufacturing,” he says. “That’s where we created success, and that’s where we are following with the prefab now.”
For Kottikollon, the Meitra facility is the latest example of how the industry of the future could work. This extends beyond the use of prefab buildings, which have been around for decades in different forms, to also using robotics and artificial intelligence (AI). “The construction industry is outdated. It’s mainly about manual labour and people working in very unsafe conditions. You also see project overruns everywhere, and that costs a lot of money,” he says. “The new concept is to bring efficiency using technology, cutting the time to produce quality products. That’s where we at KEF Infra (a subsidiary of KEF Holdings) decided to move in. We’re probably the first early mover in the industry.”
In response to the technological advancements in the fields of robotics and AI that have taken place over the last five years, KEF Infra opened the 42-acre KEF Infra One in December 2016. The world’s largest fully integrated offsite manufacturing park, located in Krishnagiri, Tamil Nadu, includes eight factories, ranging from ones that produce precast products and prefabricated rooms to windows, furniture, aluminium, marble and granite. Using the prefabricated components that the facility churns out, Kottikollon says he is able to construct buildings in “a minimum” of half the time, at 25 percent lower costs.
Already, Kottikollon’s vision seems to have paid off for KEF, with other projects including Embassy 7B, a 10-floor, 1.5m square feet office building in Bangalore; GEMS Kochi, an 130,000 sq ft school and a LuLu mall in Lucknow that will be completed in 21 months, as well as an $8,000 home that can be assembled in only two hours. In Mysuru, KEF Infra is building what will become the world’s tallest freestanding clock tower, which, at 135 metres, will dwarf London’s 96-metre Big Ben at Westminster Palace.
“We’ve built 68 schools now, and the government (of the Indian state of Kerala) will build another 1,000. What we do is create models for others to follow. For example we built a public school in 95 days, and 2,450 girls are studying there. Nobody could really believe it was possible, but now people can touch and feel it. So when 68 schools come up so quickly, it’s not just because of us; it’s people’s confidence. [They see] that a company can do that.”
Unlike the rest of KEF’s projects, the school initiative was a corporate social responsibility (CSR) project done as a partnership between Kerala’s state government and Kottikollon’s charity, the Faizal and Shabana Foundation. While the company says it made a decision not to involve itself in building the government’s 1,000 additional schools – to not mix Kottikollon’s business dealings and his charitable work – they will be based on KEF's models and the company has offered expertise to the state.
According to KEF, the company does not see much competition when bidding for projects, as it is stacking up against companies using traditional building methods, or only partly using offsite construction methods, as opposed to KEF’s end-to-end solution. As an example, Kottikollon noted that KEF was able to offer Meitra hospital at a cost-per-bed of around AED1.2 million ($326,717), as opposed to AED2 million ($544,528) for similar facilities in the UAE.
While KEF has worked on a number of private-public partnerships with state governments in India, Kottikollon says the company is in talks with India’s central government, which has expressed “significant interest” in leveraging KEF’s experience as it works toward fulfilling Prime Minister Narendra Modi’s stated goal of delivering 20 million new homes by 2022. The company has conducted several demonstrations for the prime minister.
The future of infrastructure
The mission, Kottikollon says, is “not about just keeping it to ourselves. We want to give this knowledge to the world, because the world has a long way to go. It’s [not] about being selfish.”
As a symbol of KEF’s commitment to social entrepreneurship, the company announced in August that it successfully constructed 101 canteens and 27 kitchens in Bangalore in 45 days using the offsite technology at KEF Infra One – a feat that Kottikollon says would have been impossible using traditional construction methods.“Every day we are feeding 180,000 people. Everything is completely prefabbed. We produce, on average, four canteens per day,” he says proudly. “The furniture, everything, is precast.”
Looking to the future, Kottikollon believes that the prefab construction methods may have wide-reaching developmental implications for entire countries. “It speeds up growth and allows countries to develop faster. Dubai is a classic case. In the last 25 years, the infrastructure that the government built was mainly built using technology. That’s the success of Dubai. It’s how they grew so rapidly and created a large economy. If you build infrastructure faster, you progress faster.”
Given that all the components of any city – such as its schools, hospitals and homes – can now be prefabricated offsite, Kottikollon believes that it is “only a matter of time until we can manufacture entire smart cities using offsite technology”.
These new cities, he believes, may help alleviate the problems of the world’s overcrowded urban areas and the crumbling infrastructure that often goes with them. Cheaper, faster and safer construction methods have the potential to one day provide a better alternative for millions – or even hundreds of millions – of city dwellers around the globe.
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