South–South medical tourism and the quest for health in Southern Africa
Introduction
Medical tourism is usually associated with the movement of affluent patients from the Global North to access treatment in dedicated private health care facilities in the Global South (Turner, 2010, Johnston et al., 2010, Chuang et al., 2014). Yet, the bulk of the world's medical tourism to destinations in the South is actually intra-regional in nature and often between countries with varying standards of care and levels of access to treatment (Ormond, 2011). India, for example, is one of the world's major medical tourism destinations, yet a large proportion of India's medical tourists are of South Asian origin. Some studies estimate that as many as 85 percent of medical tourists to India are from neighbouring countries (Connell, 2011). In the case of Malaysia, Ormond (2013) shows that nearly three-quarters of all recorded medical tourists are actually from neighbouring Indonesia. The well-known Bumrungrad International Hospital in Thailand draws most of its patients from South East Asia, but the Gulf Region is also one of its most important sources of medical tourists (Connell, 2011). Other emerging South–South medical tourism corridors include China–Taiwan (Pan and Chen, 2014), Myanmar–Thailand (Maung and Walsh, 2014) and Cambodia–Vietnam (Pocock and Phua, 2011).
South–South medical tourism falls into two general categories: first, there are medical tourists from the more affluent upper and middle-classes in many countries in the South who move across borders to access the higher quality private healthcare available in major medical tourism destinations. This appears to mimic “high-end” medical tourism from the North to the South. However, there are several important differences including the motives for travel, the distances travelled and the types of medical procedures accessed. For example, high-end South–South medical tourists are more likely to travel because facilities and forms of treatment are not available in their own countries. Distances travelled tend to be smaller since much of the movement is intra-regional in character. And the cosmetic surgery market that drives a significant portion of the North–South movement is not as important in South–South medical tourism. Secondly, and numerically more noteworthy, South–South medical tourism is characterised by what Roberts and Scheper-Hughes (2011: 2) call “poor and medically disenfranchised persons” who are “desperately seeking life-saving drugs and therapies and corrective surgeries that they cannot get at home.” In this context, South–South medical tourism (from poorer to better resourced countries within the Global South) is not only growing rapidly but challenges conventional North–South models of the phenomenon (Connell, 2011).
Since the end of apartheid, South Africa has emerged as an important secondary hub for global medical tourism. The South African industry regularly positions itself as a cosmetic surgery destination for patients from the North offering a uniquely “African” combination of medical treatment and recuperative tourism experience (such as a wildlife safari) (Maaka, 2006, Stolk, 2009, Nicolaides, 2011, Nwafor, 2012). George (2004: 241, 243), for example, argues that “South Africa has a number of attributes that entice medical tourists. These include a wonderful climate, wildlife, spectacular scenery, a favourable exchange rate and world-class medical care … It is the provision of two desired services, surgery and safari, that prospective patients/tourists are enticed to utilise South Africa for their medical needs.” The main target market for cosmetic procedures is Europe, particularly the UK and Germany. The most popular procedures are rhinoplasty, breast augmentation, liposuction, facelifts and tummy tucks (Maaka, 2006). More recently – and controversially – South Africa has become a destination for kidney and stem cell transplantation (Bass, 2005, Scheper-Hughes, 2011, Mohamed and Slabbert, 2012, Meissner-Roloff and Pepper, 2013) as well as fertility treatment and drug rehabilitation (WeDoRecover, 2011, Currie, 2013).
A recent critical analysis of medical tourism in South Africa focuses on one segment of the medical tourism market (cosmetic surgery) and one company (Surgeon & Safari) (Mazzaschi, 2011). In the context of a two-tier and highly inequitable health system, the critique is certainly prescient but could reinforce the popular impression that this is all there is to medical tourism in the country. As Turner (2007:307) suggests, to equate medical tourism with cosmetic surgery is a serious error. Medical tourism to South Africa is not simply about scalpel safaris and producing “valuable bodies” through cosmetic surgery (Mazzaschi, 2011). It is far more heterogeneous and complex than its popular image as an archetypal “sea, sun, sand, surgery (and safari)” destination for body sculpting might suggest (Connell, 2006, Stolk, 2009). In this paper we argue that cosmetic medical tourism from the North is only one small segment of the industry in South Africa and that the private health care system is only one provider. The evidence presented in this paper suggests that the vast majority of medical tourism to South Africa is not from the North at all, but rather from other African countries. The South African case therefore offers an important opportunity to examine the dynamics of South–South medical tourism and to instate intra-African medical tourism as an important topic worthy of further research and policy attention.
Section snippets
Data sources
Estimates of the number of medical tourists to South Africa vary widely. Published estimates for 2006, for example, vary between 50,000 (Prasad, 2012) and 200,000 (Gilfellan, 2008). Such widely varying figures reflect the fact that there is a paucity of reliable data on the size of the phenomenon in South Africa. South Africa's 2002 Immigration Act provides for the issue of ‘medical permits’ but only to people who intend to stay in South Africa for periods in excess of three months. Since the
Mapping medical tourism to South Africa
Between 2003 and 2008, 5.8 percent of total visitors undertook a medical or health-related activity in South Africa, either as medical tourists or as business or holiday tourists who received medical treatment while in the country (Series A). This amounts to nearly 2.5 million individuals out of just over 43 million visitors. Over the period 2006 to 2012, 4.3 percent of visitors to South Africa indicated that their primary reason for entry was medical (Table 1) (Series B). This figure increased
Conclusions
South Africa has become a significant medical tourism destination since the collapse of apartheid in 1994. Within the global medical tourism industry, the country is represented as a destination which combines medical treatment with more conventional tourist pursuits. This paper argues that this “surgeon and safari” tourism experience is a very small component of overall medical tourism to the country. South Africa's medical tourism experience is largely based on South–South and intra-African
Acknowledgements
The authors would like to thank Belinda Maswikwa and Maria Salamone for their considerable assistance and the IDRC for its support of the Southern African Migration Programme (SAMP).
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