In recent years, some African nations have witnessed an increase in the numbers of tourists that visit their countries for the purpose of receiving health care. Medical tourism is a growing industry in Africa as more people around the world search for affordable, faster, or improved healthcare services. Countries in Africa that are benefiting from the boom in this tourism subsector include Egypt, South Africa and Tunisia. This CAI paper discusses how the medical tourism sector in Africa is being impacted by North to South medical tourism. It also highlights the impact of South to South medical tourism. Lastly, it notes that the growth and development of medical tourism in African destinations has generally been a positive development.

What is medical tourism?

Medical tourism, or health tourism, occurs when patients travel to a foreign country in order to receive medical treatment.⁽²⁾ This type of tourism is increasingly being referred to as ‘global healthcare’. ‘Medical tourism’ generally implies a packaged tour organised by an agent that specialises in arranging health-related travel, whilst ‘health tourism’ implies travel across borders in order to receive health rejuvenation. The latter term has also been used to imply wellness travel, such as visiting hot springs that emphasises spirituality or rejuvenation.⁽³⁾ Medical tourism will be used for the purposes of this paper to refer to those seeking medical procedures either through an organised tour or individually.

Patients travel to another country in order to receive faster, cheaper or better medical services than they would receive in their home countries. This can include a wide array of procedures ranging from elective and preventative procedures to urgent care. The most popular elective medical procedures include joint replacements (hip and knee), cardiac surgery and cosmetic surgeries (liposuction, breast augmentation and facelifts).⁽⁴⁾

Medical tourism packages often offer a consultation, treatment (surgery), a physical therapist and personal assistant, and recovery in a spa.⁽⁵⁾ Medical tourism therefore offers the patient a chance to receive medical treatment and recover in a vacation-like setting. Oftentimes patients recuperate at medical tourism hotels that resemble five-star hotels.⁽⁶⁾ They can also opt to partake in tourism activities in the host country prior to departing from it.

When the medical tourism industry began to be established as its own industry, it was conceived as the movement of patients from the Global North to the Global South in search of faster and more affordable healthcare.⁽⁷⁾ Medical tourism in Africa emerged as an industry in response to visitors from the Global North increasingly travelling to destinations such as India or Thailand to receive treatment. Visitors from countries such as Japan, the UK and the United States (US) were uninsured or underinsured. They could not afford the high medical costs in their own countries and were opting for cheaper locations. Many others from these countries wanted to have a procedure done without being wait-listed. Medical tourism therefore filled a niche need for these tourists. Countries in the Global South offered tourists from the Global North a profit-driven, low-cost alternative to receiving quality healthcare.

Medical tourism from African nations in the Global South has always been present but it is under-researched. Medical tourism takes two forms here: Africans who visit the Global North to receive treatment, and Africans that visit countries in the Global South for treatment.⁽⁸⁾ New research is providing more insight on the travel patterns of African medical tourists. African medical tourists are usually middle-class, wealthy Africans seeking treatment abroad. Overall, the number of Africans contributing to medical tourism is increasing drastically.

The global medical tourism industry

Nearly 7 million patients travel abroad for healthcare every year. The global medical tourism market is an industry valued at US$ 20 billion a year.⁽⁹⁾ In 2011 alone, medical tourism contributed to 9% of the world’s gross domestic product (GDP) of US$ 6 trillion.⁽¹⁰⁾ The global industry also accounted for an estimated 255 million jobs in 2011.⁽¹¹⁾

There are several destinations in the industry across four continents that are vying for the medical tourism business. India leads the market among the Asian destinations. It is one of the pioneer countries in the industry and has remained a popular destination overall. Other medical tourism destinations in Asia include Israel, Jordan, Malaysia, Philippines, Singapore, Thailand and Vietnam. Singapore and Thailand in particular have government-supported medical tourism industries and actively recruit medical tourists. Hungary is the leader in the European market. Other popular destinations in Eastern Europe include Croatia, Cyprus, Czech Republic, Latvia, Lithuania and Poland. West European country, Costa Rica, leads the Latin American market. Other popular destinations in Latin America include Argentina, Bermuda, Chile, Colombia, Cuba, Mexico, Panama and Venezuela. South Africa is the leader in the African market. Other medical tourism destinations in Africa include Egypt and Tunisia.

Although there are several destinations for medical tourism around the globe, six popular hubs have been identified.⁽¹²⁾ The three major hubs for medical tourists from the Global North are India, Singapore and Thailand. India has maintained a competitive advantage by offering low cost surgical services.⁽¹³⁾ Thailand has remained competitive for its elective procedures such as plastic surgery and routine check-ups.⁽¹⁴⁾ Singapore competes by providing skilled healthcare providers and advanced technology.⁽¹⁵⁾ The three minor hubs that have been identified include Costa Rica, Hungary and South Africa. Hungary competes by providing a rich cultural experience in addition to dental or cosmetic treatments. Costa Rica has remained competitive by offering highly skilled specialists in plastic surgery and dentistry.⁽¹⁶⁾ Competitively, South Africa provides world-class healthcare, expertise and professionalism at reduced costs, primarily for cosmetic procedures and dental surgeries.

Medical tourism destinations in Africa

Although South Africa has been identified as an important hub for medical tourism in Africa, other destinations on the continent have also become prime destinations for medical tourism. Egypt has had a robust tourism industry for several years and is becoming a popular destination for medical tourists from Europe and the Middle East. A number of tour operators in Egypt now offer medical tourism packages in Egypt. Popular services in Egypt’s medical tourism industry include cosmetic surgery and dental work, in part due to the country’s flourishing film industry and celebrity aesthetics.⁽¹⁷⁾ Further, medical tourism allows visitors to visit many of Egypt’s historic sites.

Tunisia is also emerging as a tourist destination on the continent and is known for providing procedures for cardiology, urology and gynaecological complications.⁽¹⁸⁾ Similar to Egypt, Tunisia is a particularly attractive destination for European travellers seeking plastic surgery or dental work; in part due to its proximity to Europe. Tunisia also offers patients a chance to visit the country’s sandy beaches and enjoy the Mediterranean climate. Tunisia’s market is not as large as Egypt’s, but both destinations serve an increasing number of tourists. Nevertheless, South Africa has emerged as the top medical tourism destination in Africa.

South Africa: Top medical tourism destination in Africa

South Africa has emerged as the clear leader in medical tourism destinations in Africa,⁽¹⁹⁾ in part because the country has built a reputation for providing cutting edge procedures. In 1967, Dr Christiaan Barnard made history by performing the world's first successful heart transplant in Cape Town. Since then, South Africa has continued to be a player known for quality medical research and treatments world-wide. Popular procedures for medical tourists to South Africa include dental procedures, cosmetic surgeries, fertility procedures and rehabilitation. South Africa has been able to offer these world-class services at reasonable costs.

Surgery in South Africa costs roughly a third of surgeries performed the United Kingdom (UK). For example, a facelift in Britain costs about GBP 9,000 (US$ 13,953), while the same services in South Africa costs about ZAR 53,276 (US$ 5,428).⁽²⁰⁾ In South Africa luxury hotel fees and tourist activities, such as a post-op safari, are included in the price.⁽²¹⁾ Other procedures, such as botox injections, that would usually cost about GBP 200 (US$ 310) in the UK would cost about ZAR 685 (US$ 70) in South Africa.⁽²²⁾ Included in South Africa’s package is stellar service that is meant to differentiate South Africa from its competition. Therefore, South Africa also competes based on its level of professionalism and competency in comprehensive tour packages.

The Medical Tourism Association (MTA) of South Africa promotes the industry and represents its value chain.⁽²³⁾ This helps ensure that services in the industry are consistent, standardised, and integrated.⁽²⁴⁾ Surgeon and Safari is a Cape Town-based provider of medical tourism tours in South Africa. They offer ‘Surgery and Safari’ tours to nearly 20 visitors a month from the Global North, mostly the UK.⁽²⁵⁾ Visitors to their facilities benefit from their top-class services. Medical tourists to this destination also take advantage of Cape Town’s beaches, vineyards, mountains, golf courses, restaurants, shopping centres and good weather.⁽²⁶⁾ Therefore Cape Town and South Africa in general remain popular medical tourism destinations for many visitors from the Global North.

In 2009, South Africa received 500,000 visitors, an increase from 327,000 in 2006.⁽²⁷⁾ Although the recession affected the number of tourists able to travel, during the period 2006-2010, the Global North generated 281,000 medical travellers to South Africa.⁽²⁸⁾ However, the majority of visitors to South Africa during this period were not from the Global North. Africans comprised 2,196,000 medical visitors to South Africa. They constituted nearly 80% of all medical tourists to South Africa.⁽²⁹⁾ These visitors tended to be middle-class or wealthy Africans who were likely to spend more days in South Africa and spend more money in the country than visitors from the Global North.

Much of the early literature conceptualised medical tourism as the movement of patients from the Global North to the Global South. However, recent studies suggest that the majority of medical tourism to South Africa comes from the Global South, including neighbouring countries such as Lesotho, Mozambique, Swaziland and Zimbabwe.

Medical tourists from Africa

The number of medical tourists from Africa to the Global North and South is increasing. This increase has been spurred by the growth of African economies, the growing spending power of Africans, and the growth of the middle-class on the continent. In the past, it was common to see Africans travel to Europe or the US to receive medical treatment. Now, these travellers are increasingly visiting other Global South destinations such as Egypt, India, Ghana and South Africa. Nigerian medical tourists travel to Dubai, Germany, India, UK and the US. Currently, the UK issues about 40,000 medical visas to Nigerians yearly. This is comparable to the 35,000 medical visas issued by India for Nigerians. Asia has now become the top destination for African medical tourists, most of who visit India.⁽³⁰⁾ Nearly 50,000 Kenyans travel to India annually to receive healthcare.⁽³¹⁾

African medical tourists are coveted for the business they bring to the host countries.⁽³²⁾ They tend to pay higher out-of-pocket rates than local patients.⁽³³⁾ They also spend money on lodging, dinin, and entertainment for themselves and their families. Nigeria estimates that it generates about 5,000 medical tourists per month.⁽³⁴⁾ According to the Nigerian MTA, in 2012 India generated over N 40.94 billion (US$ 260 million) from Nigeria’s medical tourists alone.⁽³⁵⁾ Each medical tourist spends between US$ 20,000 and US$ 40,000 per trip. The economic implications of the tourism sector are too large to be ignored.

Although this is a positive development for India and other nations that host these tourists, it drains the economies of the home nations. Nigeria’s medical tourists contribute to a loss of over N 78 billion (US$ 500 million) to Nigeria’s economy.⁽³⁶⁾ In light of this type of capital flight, some African governments are hoping to capture some of the business. They are trying to retain local patients and attract new medical tourists.

A home-grown medical tourism market

Due to the numbers of African visitors leaving the continent in order to receive medical treatment, a few African countries are hoping to attract some of these tourists. Many Rwandans currently travel to South Africa and India to receive treatments that are not available in their own country, but Rwanda has been investing in its healthcare infrastructure in order to become a hub for African tourists. The state-owned Faisal hospital has been laying the foundation for Rwanda to offer top quality healthcare services through rapid expansion and purchasing of top quality equipment.⁽³⁷⁾ Furthermore, private investors such as Indian Dr. Agarwal recently opened an eye hospital in Rwanda.

While Rwanda attempts to become a leader in medical tourism in East Africa, the Nigerian Government is monitoring the medical tourism patterns within its borders and on the continent. They are hoping to transform Nigeria into a medical tourism destination. Some private hospitals are in the process of upgrading their equipment and technology in order to attract more local patients.⁽³⁸⁾ The Nigerian Tourism Development Corporation (NTDC) has entered into partnership with the MTA to check on the prevalence of medical tourists to the US.⁽³⁹⁾ They are also monitoring local medical tourism. According the Egyptian embassy, 3,500 of 12,000 visas issued for Nigerians last year were granted for medical reasons.⁽⁴⁰⁾ Although Nigeria is committed to growing its industry, Ghana seems to be making greater strides towards being recognised as the leader for medical tourism in West Africa. Ghana’s medical tourism is developing fast and specialises in cosmetic and other surgery, hydrotherapy and beauty treatments.⁽⁴¹⁾

The benefits of growing Africa’s medical tourism market

Critics of medical tourism facilities on the continent have questioned the ethics of building world-class facilities that cater to foreigners and the elite in countries where the healthcare available to citizens is poor. Therefore, if medical tourism is to continue to grow without opposition from the general populace, the medical tourism and healthcare industry must start to generate benefits for entire populations.

Nevertheless, the growth of medical tourism brings several advantages to African nations. Besides providing access to healthcare, it is also an important source of revenue and employment for many healthcare workers. Medical tourism hubs on the continent require less travel time and less complicated visa restrictions than similar hubs in the Global North. African medical tourism hubs help to keep Africa’s healthcare money on the African continent. It also generates income and foreign exchange from outside the continent. Importantly, it forces many governments to invest in their healthcare industries and healthcare professionals.

If African countries are able to create medical tourism hubs in each region of the continent, this would benefit healthcare services across the entire continent. If countries such as Ghana, Nigeria and Rwanda are successful in their endeavours to be recognised as medical tourism leaders in their respective regions, East and West Africans will not need to travel North and South to receive medical services. Each region on the African continent would have a viable medical tourism destination in proximity.

Conclusion

African nations are increasing their market share in a lucrative market. Although South Africa is a clear leader in the medical tourism field, Egypt and Tunisia are also competitive tourist destinations. Currently, there is space for new entrants, such as Nigeria and Rwanda, to become competitive in this market. The African medical tourism industry offers a new dimension to tourism on the continent, which is bound to benefit its people in a myriad of ways. Continued growth of the African medical tourism must therefore be carefully monitored and managed to ensure its growth embraces the needs of all African citizens.

Written by Sitinga Kachipande ⁽¹⁾

NOTES:

(1) Sitinga Kachipande is a scholar and professional in Pan-African Studies and Business Administration with a focus on international development, nation-branding and the political economy. Contact Sitinga through Consultancy Africa Intelligence's Optimistic Africa Unit ( optimistic.africa@consultancyafrica.com). Edited by Kate Morgan.
(2) Discover Medical Tourism website, http://www.discovermedicaltourism.com.
(3) Crush, J.R., Chikanda, A. and Maswika, B., 2012. Patients without borders: Medical tourism and medical migration in Southern Africa. Southern African Migration Programme: Cape Town; Discover Medical Tourism website, http://www.discovermedicaltourism.com.
(4) Ibid.
(5) Marshall, S., ‘South Africa leads the way in medical tourism’, Ethical Traveler, 1 April 2012, http://www.ethicaltraveler.org.
(6) Discover Medical Tourism website, http://www.discovermedicaltourism.com.
(7) Crush, J.R., Chikanda, A. and Maswika, B., 2012. Patients without borders: Medical tourism and medical migration in Southern Africa. Southern African Research Center: Cape Town.
(8) Ibid.
(9) Ajobe, A.T., et al., ‘Nigeria: How Nigerians spend billions on medical tourism’, The Daily Trust, 5 January 2013.
(10) Grout, P., ‘Medical tourism: A global stampede for affordable care’, CNN, 22 March 2013, http://travel.cnn.com.
(11) Ibid.
(12) Crush, J.R., Chikanda, A. and Maswika, B., 2012. Patients without borders: Medical tourism and medical migration in Southern Africa. Southern African Research Center: Cape Town.
(13) Marshall, S., ‘South Africa leads the way in medical tourism’, Ethical Traveler, 1 April 2012, http://www.ethicaltraveler.org.
(14) Ibid.
(15) Ibid.
(16) Discover Medical Tourism website, www.discovermedicaltourism.com.
(17) Ibid.
(18) Medical Tourism website, http://medicaltourism.com; Discover Medical Tourism website, http://www.discovermedicaltourism.com.
(19) Marshall, S., ‘South Africa leads the way in medical tourism’, Ethical Traveler, 1 April 2012, http://www.ethicaltraveler.org.
(20) Surgeon and Safari website, http://www.surgeon-and-safari.co.za.
(21) Ibid.
(22) Ross, J., ‘Sun, sea, sand and scalpel’, BBC, 6 January 2002, http://news.bbc.co.uk.
(23) The Medical Tourism Association of South Africa website, http://www.medicaltourismassociation.org.za.
(24) Ibid.
(25) Ross, J., ‘Sun, sea, sand and scalpel’, BBC, 6 January 2002, http://news.bbc.co.uk.
(26) Ibid.
(27) Crush, J., ‘South Africa top destination for medical tourists’, The New Age, N.D., http://www.thenewage.co.za.
(28) Ibid.
(29) Ibid.
(30) Kalagho, K., ‘Medical tourism up’, East African Business Week, 3 September 2012, http://allafrica.com.
(31) ‘50,000 medical tourists expected to visit India in 2011’, AALA Times, 26 March 2011, http://www.aalatimes.com.
(32) Kalagho, K., ‘Medical tourism up’, East African Business Week, 3 September 2012, http://allafrica.com.
(33) Ntangungira, G., ‘Rwanda targets medical tourism’, The Independent, 22 April 2013, http://www.independent.co.ug.
(34) Pollard, K., ‘Medical tourism destinations. Today, Nigeria..., next stop... Mars?’, IMTJ Blog, 2013, http://www.imtj.com.
(35) Ibid.
(36) Ajobe, A.T., et al., ‘Nigeria: How Nigerians spend billions on medical tourism’, The Daily Trust, 5 January 2013.
(37) Ntangungira, G., ‘Rwanda targets medical tourism’, The Independent, 22 April 2013, http://www.independent.co.ug.
(38) Ajobe, A.T., et al., ‘Nigeria: How Nigerians spend billions on medical tourism’, The Daily Trust, 5 January 2013.
(39) ‘Nigeria partners with MTA to check medical services’, Business Day Nigeria, 1 July 2013, http://businessdaynigeria.com.
(40) Ajobe, A.T., et al., ‘Nigeria: How Nigerians spend billions on medical tourism’, The Daily Trust, 5 January 2013.
(41) Greenwod, L., ‘Ghana targets health tourism boost’, BBC News, 30 October 2009, http://news.bbc.co.uk.