IPASJ International Journal of Management (IIJM) Web Site: http://www.ipasj.org/IIJM/IIJM.htm Email: editoriijm@ipasj.org ISSN 2321-645X A Publisher for Research Motivation........ Volume 2, Issue 11, November 2014 An Analysis of the Economic Impact of Medical Tourism in Zimbabwe Maphosa Thembinkosi1 and Dr. Marunda Edmond2 1 Scholar, Department of Tourism, Leisure and Hospitality Studies, University of Zimbabwe 2 Lecturer, Department of Tourism, Leisure and Hospitality Studies, University of Zimbabwe ABSTRACT This article explores the potential impact of medical tourism on Zimbabwe’s economy. The Tourism Act articulates that tourism authorities must take advantage of thriving macro-economic sectors such as education, sport, health and medical so as to boost tourist arrivals and stimulate economic growth. The study’s objectives were grounded on finding out whether medical tourism would have a positive significance towards economic growth in Zimbabwe. Literature reviewed synchronized Zimbabwe’s ‘three tier health system’ with the systems theory approach. The focus of the study investigated the economic impact of medical tourism in Zimbabwe. Both qualitative and quantitative research methodologies were used. Data analysis and interpretation was based on information derived from 45 respondents comprised of 15 medical doctors, 15 traditional healers and 15 apostolic faith healers who were interviewed or responded to the questionnaires. A key finding was that notwithstanding the risks involved, medical tourism can create employment, increase foreign currency and income, improve the standard of living and pressurise destinations to upgrade infrastructure and technology. Keywords:- Medical tourism, economic growth, tourism promotion 1. INTRODUCTION Zimbabwe is a landlocked nation situated in the southern region of Africa. It has plenty to offer including tourist attraction sites, hospitals, traditional healers’ shrines and churches welcoming people from all over the world to attractions customarily in Harare, Victoria Falls, Hwange and Lake Kariba. Medical Tourism is an economic activity that entails trade in services and represents the linking of the sectors, ‘Medical’ and ‘Tourism’ (Bookman et al, 2007: 14). This combination of Medical and Tourism seems to be a relatively new and promising type of niche tourism (Caballero et al, 2006). Machinga (2003) finds the Zimbabwe medical industry to be unique as it follows a ‘three-tier health system’ involving western styled hospitals, traditional healers and apostolic faith healers. The systems approach or theory tells us that an activity of any one part of an organization affects activities of every other parts, communication with other departments and other functional units is very important (Stoner 1982: 52). Today, traditional healers are consulted by the people for advice and healing of many illnesses. Sometimes traditional healers refer their patients to western medical practitioners and hospitals such as Parirenyatwa in case of emergency or illness they cannot cure with the help of their healing spirit (www.wikipedia.org./wiki/nyanga: 31.03.2014). This reflects that the Zimbabwean health system is a replica of the systems theory or approach. Upon receiving treatment from any one or combined principals of the three-tier health system the patient and his accomplices have the opportunity to tour and enjoy Zimbabwe’s tourism product. 1.1 Background of the study Although traditionally medical tourists travel from less developed countries for medical treatment unavailable in their own communities, the advocated Zimbabwean scenario calls for a reversal situation where tourists are coming from more developed countries (www.wikipedia.org/wiki/medical-tourism.com 03.02.2014). This kind of crusade from decidedly industrialized homelands to less affluent nation states for medical attention is motivated by the appeal to find treatment at a lower cost with less waiting times. Medical tourists from developed countries also seek treatment including various medical procedures in other developed countries. Canada provides medical treatment to many Americans (Gatell, 2007). Developing countries such as South Africa, Egypt, India, Costa Rica, Malaysia, and Thailand have benefited economically through medical tourism (www.health-traveler.com 03.02.2014). Health tourism generated some US$40 million per year in revenues in Cuba and some US$27, 6 million in Malaysia in 2004. Each year people from Latin America spend up to US$6 billion on medical care outside their countries. It is estimated that India earned as much as US$2.2 billion per year from medical tourism in 2012 (Bookman et al, 2007: 16). In comparison to South Africa, Zimbabwe’s neighbour, medical tourism in 2012 amplified its contribution towards the country’s Gross Domestic Product (G.D.P) when the country increased the number of its state of the art hospitals from 161 in the year 2010 to 247 hospitals in 2012. (www.mtsaj.co.za: 20.12.2013). Medical Tourism is an economic booster (Cannell, 2011). Volume 2, Issue 11, November 2014 Page 3 IPASJ International Journal of Management (IIJM) A Publisher for Research Motivation........ Volume 2, Issue 11, November 2014 Web Site: http://www.ipasj.org/IIJM/IIJM.htm Email: editoriijm@ipasj.org ISSN 2321-645X Even before the 1990s, South Africa had begun practicing medical tourism (www.mtsaj.co.za: 20.12.2013). On 3 December 1967, Doctor Christian Barnard and his team made history with the world’s first successful heart transplant at Groote Schuur Hospital in Cape Town. Since this successful operation South Africa has been receiving large numbers of medical tourists. Kanyenze (2012) wrote that Zimbabwe, for the period 2000-2008 experienced hyperinflation, deterioration of health standards and shortages of pills or drugs. As of 2011 to date the Zimbabwe Medical Association (2011) notes that hospitals such as Parirenyatwa in Harare have the best Intensive Care Unit (I.C.U) in Zimbabwe and are equally competitive in the Southern African region. They believe Harare hospital has the best Children’s Rehabilitation Unit, whilst Chitungwiza Hospital boasts quality kidney dialysis services and Marondera hospital offers the best training for rehabilitation technicians. Zimbabwe’s traditional healers are registered under the Zimbabwe National Traditional Healers Association (ZINATHA). According to Machinga (2013) ZINATHA has more than 45 000 traditional healers. Shoko (2014) adds Traditional healers in Zimbabwe claim that they are able to heal illnesses categorized as conflicting with nature, are unnatural and those dogged by spiritual possession such as HIV/AIDS, cancer, barrenness and other complex diseases. According to Shoko (2014) the World Health Organization (W.H.O) cannot rule out cultural medicine or complimentary medicine. Again Zimbabwe just like Nigeria and Ghana is blessed with spiritually filled Pastors and Apostolic faith healers. A Prophet of the United Family International church (U.F.I) and another Prophet of the Prophetic Healing and Deliverance church (P.H.D) all are well known prophetic healers regionally. A heart valve operation that might cost US$100 000 in the United States of America could be priced well under US$10 000 in India (www.medical-tourism.org/India: 12.02.2013). The same can be said about popular medical tourist destinations like Brazil, Costa Rica and Mexico (www.patientswithoutborders.com: 13.12.2013). Receiving treatment in a less developed country would be cheaper, even after one factors in airfare, hotel accommodation, and travel insurance, car rentals, shopping, and dinning. Many medical vacations are substantially more affordable than domestic health care. Against this background Zimbabwe is no exception on being ranked amongst the best medical destinations in the world. It’s a country graced with hospitals such as Parirenyatwa medical school for University of Zimbabwe (U.Z), Mpilo (medical school for National University of Science and Technology (N.U.S.T), Avenues, Baines, more than 45 000 registered Traditional healers and Apostolic Faith Healers. York (2008) adds, as medical tourism becomes prevalent, education, credentialing and certification of services may be required to help assure patient safety. 1.2 Statement of the problem Developing economies such as South Africa, Nigeria, India, Cuba and Thailand are earning a lot from medical tourism ventures. Zimbabwe is making minimal or no promotion of medical tourism. It’s a country graced with state-of-the art hospitals such as Parirenyatwa Hospital, the medical school for the University of Zimbabwe and Mpilo Hospital, the medical school for the National University of Science and Technology, as well as more than 45 000 registered Traditional and Apostolic Faith Healers. 1.3 Objectives of the study The objectives of this study are: To find out whether medical tourism would have a positive significance towards economic growth in Zimbabwe. To determine the extent to which medical tourism can be used as one of the strategies for economic development in Zimbabwe. 2.LITERATURE REVIEW 2.1 What is Medical Tourism? A tourist is a visitor who spends at least one night in the place visited and whose journey is for any one or more of the following purposes, a holiday, recreation, health/ medical, study, religion, sport, business, meetings, visiting friends or relatives, or work that is not remunerated from within the host country (Zimbabwe Tourism Authority, 2012). Medical Tourism is the act of travelling to another country to obtain medical, dental or cosmetic care (www.health-traveler.com 03.02.2014). Besides receiving treatment, the medical tourists may tour or visit the country’s recreational and tourist attractions. Bookman et al (2007: 14) adds that medical tourism is an economic activity that entails trade in services and represents the merging of at least two sectors: Medical and Tourism. Roy (2012) also defines medical tourism as medical travel, health tourism or global healthcare. Medical tourism is the movement of patients from highly developed nations to other areas of the world for medical care usually to access treatment at a lower cost and with less waiting time. Scholars of medical tourism argue that, from a theoretical point of view, medical tourists are motivated to travel abroad by a number of factors, including the affordability of care abroad, access to treatment not available at home, and the long waiting times for care at home. Destinations must implement unique marketing strategies so as to attract medical tourists. Countries such as the United States have not been very successful in attracting medical tourism business. Alyssa Morrison (December 20:2003). Volume 2, Issue 11, November 2014 Page 4 IPASJ International Journal of Management (IIJM) A Publisher for Research Motivation........ Volume 2, Issue 11, November 2014 Web Site: http://www.ipasj.org/IIJM/IIJM.htm Email: editoriijm@ipasj.org ISSN 2321-645X 2.2 Medical tourism is a process Medical tourism is a process. It takes an economy like Zimbabwe at least seven stages to implement medical tourism. Figure 1 Medical Tourism Process. Source: Public Health Ethics. (2012) Roy (2012) wrote that countries who have followed and implemented the process have enjoyed rapid economic growth. In India as an example, medical tourism is expected to contribute about 30% towards its gross domestic product. According to Bookman et al (2007:16) Thailand receives 400 000 foreign medical tourists every year, of which 50 000 are Americans going to a single hospital, the Bumrungrad. Cuba in 1995-1996 treated some 25 000 foreigners. In 2004 150 000 foreign patients travelled to India for treatment, while the year before, some 50 000 British medical tourists travelled to Thailand, South Africa, India and Cuba. Zimbabwe, because of its Traditional healers, Herbalists, Doctors, and Apostolic faith healers should be able to attract a fairly large number of medical tourists. These foreign patients would generate more revenue for the country that hosts them. South Africa is set to experience an annual growth rate of about 25%. According to (www.medicaltourism.com/southafrica: 12.01.2014) South Africa as a medical tourist destination has gone from strength to strength. Starting on 03 December 1967, with Doctor Christiaan Bernard and his team making history by conducting the world’s first successful open heart transplant at Groote Schuur Hospital in Cape Town. Now the Groote Schuur Hospital serves people from all over the world, who do not have access to such facilities in their own countries. Also Groote Schuur Hospital still excels in all branches with its many departments dedicated to world class training and research. 2.2 Systems approach Stoner (1982: 52) highlights that the systems theory is made up of three major concepts which are subsystems, synergy and open and closed systems. Parts that make up the whole system are ‘subsystems’. Subsystems that make up medical tourism are the medicine and tourism industry. Within the Zimbabwean medicine industry there are three major principles namely: doctors, traditional healers and apostolic faith healers. The tourism industry is made up of subsystems such as tourism attractions, hospitality and leisure features. These subsystems must synergize (Stoner 1982: 52). Synergy means that the whole is greater than the sum of its parts. Separate departments within an organization must cooperate and interact so that they become more productive than if each acts in isolation. For example, it is more efficient for the doctors, traditional healers and apostolic faith healers to continue to work together than to work in isolation. Zimbabwe has a three-tiered health system, where Zimbabweans visit the Traditional healers, the apostolic faith healers from “churches of the spirit”, and Western styled hospitals and clinics for health and healing (Machinga, 2013). A system is considered open if it interacts with its environment; it is considered closed if it does not (Stoner 1982: 52). The Zimbabwean medical and tourism industry have an open system, they interact with their environment. 2.3 Zimbabwe Medical Association (ZIMA) The first subsystem to be recognized would be the Zimbabwe Medical Association (ZIMA). ZIMA is the sole representative association for all doctors in Zimbabwe, irrespective of their area of specialty. It is a membership-based association whose objectives among others, is to protect and advance the interests of the medical profession in Volume 2, Issue 11, November 2014 Page 5 IPASJ International Journal of Management (IIJM) A Publisher for Research Motivation........ Volume 2, Issue 11, November 2014 Web Site: http://www.ipasj.org/IIJM/IIJM.htm Email: editoriijm@ipasj.org ISSN 2321-645X Zimbabwe. It is comprised of a membership of over 1 000 doctors across the country consisting of different specialist disciplines. ZIMA’s activities focus on the professional and business aspects of medical practices (www.thestandard.co.zw/12/08/2012/ab). 2.4 Zimbabwe National Traditional Healers Association (ZINATHA) Zimbabwe National Traditional Healers Association (ZINATHA) just like ZIMA above is the sole representative of traditional healers. It is an association comprised of over 45 000 traditional healers spread all over Zimbabwe. Its aim is to provide professional health care services to all walks of life. It is a voluntary and an independent body. Morris (2010: 45) argued that Lithuania is popular with medical tourists for its services of cosmetic surgery and eye surgery. Hence, this paper suggests that Zimbabwe must also be popular with medical tourists because of its unique medical service, traditional and herbal medical services. 3.METHODOLOGY The researcher employed the descriptive survey design involving gathering data from a sample comprising 15 doctors at Parirenyatwa hospital, 15 Traditional Healers and 15 apostolic faith healers all from the Harare province. The researcher’s instrument for conducting the survey was mainly personal interviews. In addition the researcher observed patients (mainly foreigners) checking in and out at Parirenyatwa hospital and at some traditional healers shrines including attending a mega prayer and healing session. The research under study used personal interviews aided with a questionnaire. According to Kent (1993) Personal interviews refer to a survey that gathers information through face-toface interaction with respondents. The researcher favoured personal interviews because they allowed checking and ensuring respondents eligibility, for instance, when interviewing respondents the researcher made sure that the respondent identified him or herself as either a doctor or traditional healer. Interviews had a higher response rate than other instruments. 4.RESULTS 4.1 Gender category Table 1 below illustrates the gender categories of doctors, traditional healers and apostolic faith healers. Table 1: Gender categories of Parirenyatwa doctors, traditional healers and apostolic faith healers. Gender Parirenyatwa Traditional Apostolic Faith Row Total Row Category Doctors Healers Healers Percentage % Male 9 9 10 28 62.3 Female 6 6 5 17 37.7 Column 15 15 15 45 100 Total Graph 1: Gender category Table 1 and Graph 1 above show that 62.3% of the population there were males compared to 37.7% females. The table illustrates that of those interviewed there were more males than females in the Zimbabwean three tier health system. The table allows one to appreciate that the health industry is comprised of female doctors, traditional healers and apostolic faith healers. 4.2 Professional qualifications Table 2 below shows the professional qualifications of doctors, traditional healers and apostolic faith healers so as to reveal the potential exposure to the medical tourism concept and its impact on economic growth. As they have learnt Volume 2, Issue 11, November 2014 Page 6 IPASJ International Journal of Management (IIJM) A Publisher for Research Motivation........ Volume 2, Issue 11, November 2014 Web Site: http://www.ipasj.org/IIJM/IIJM.htm Email: editoriijm@ipasj.org ISSN 2321-645X and experienced in their medical field, a professional qualification reveals the potential ability to cure and provide quality patient care to a medical tourist. Table 2: Professional qualifications of doctors, traditional healers and apostolic faith healers. Professional Parirenyatwa Traditional Apostolic Faith Row Row Qualification Doctors Healers Healers Total Percentage % Higher degree 1 0 0 1 2.2 (PhDs) Masters 1 0 2 3 6.7 Bachelors 13 0 3 16 35.5 Diploma 0 3 4 7 15.5 Other 0 12 6 18 40 Total 15 15 15 45 100 Table 2 above shows 2.2% of the total population are doctorate (PhD) degree holders. 6.7% are master’s degree holders, 35.6% are bachelor’s degree holders, 15.5% are diploma holders and 40% mostly traditional healers possess other qualifications. The research study found out that the majority of traditional healers fall into the “Other” category, possessing certificates, Advanced level certificates, Ordinary level certificates, Standard 6 and Standard 3 certificates. The results revealed that the doctors had the required medical qualifications. However, the qualifications of the doctors, traditional healers and apostolic faith healers happen to be the basic requirements to stimulate an effective medical tourism service in Zimbabwe. 4.3 Experience Table 3 below shows the period of service served by Parirenyatwa doctors, traditional healers and apostolic faith healers in the health industry. The period of service shows depth of knowledge and experience pertaining to medical tourism and medical services. Table 3: Experience of Parirenyatwa doctors, traditional healers and apostolic faith healers. Experience Parirenyatwa Traditional Apostolic Faith Row Total Row (Years) Doctors healers Healers Percentage % 1-5 13 1 2 16 35.5 6-10 0 5 7 12 26.6 11-15 1 0 2 3 6.6 16-20 1 4 4 9 20 21- above 0 5 0 5 11.1 Total 15 15 15 15 100 Results exposed on Table 3, display that 35.5% of the population possess 1-5 years working experience in the health industry. The majority of doctors are clustered in the 1-5 years working experience. The doctor’s experience is an equal representation of age as 26.6% of the total population falls in the 6-10 years working experience. 6.6% in the 11-15 years, 20% in the 16-20 years and 11.1% in the 21 and above working experience. Traditional healers’ experience is also an equal representation of age. Thus maturity is apparent. Sheen (1998) argued that mature employees are better able to understand clientele needs and execute work more professionally. 4.4 Medical services rendered to local Zimbabwean patients The pie chart below shows the responses made by Parirenyatwa doctors, traditional healers, and apostolic faith healers to the question whether or not they render services to the local Zimbabwean patients. DOCTORS TRADITIONAL HEALERS APOSTOLIC FAITH HEALERS - Pie chart 1: Medical services rendered to local Zimbabwean patients. Volume 2, Issue 11, November 2014 Page 7 IPASJ International Journal of Management (IIJM) Web Site: http://www.ipasj.org/IIJM/IIJM.htm Email: editoriijm@ipasj.org ISSN 2321-645X A Publisher for Research Motivation........ Volume 2, Issue 11, November 2014 Pie chart 1 indicates that 100% of the doctors, traditional healers and apostolic faith healers agreed that they render medical services to local Zimbabwean patients. Evidently, if Zimbabwean doctors, traditional healers and apostolic faith healers are satisfactorily rendering services to locals then, this must pave way in rendering services to foreign patients. 4.5 Medical services offered to foreigners Table 4 below shows the responses of Parirenyatwa doctors, traditional healers and apostolic faith healers to the question whether they offer any medical services to foreigners. Table 4: Medical services rendered to foreign patients Services rendered to Doctors Traditiona foreigners l healers Strongly Agree 7 10 Agree 7 4 Neutral 1 1 Disagree 0 0 Strongly disagree 0 0 Column Total 15 15 Apostolic faith healers 5 8 0 1 1 15 Row Total 22 19 2 1 1 45 Row Percentage % 48.8 42.2 4.4 2.2 2.2 100 The table shows that 48.8% of the population strongly agreed that they had received and treated foreign patients. 42.2% agreed to having rendered medical services to foreign patients. 2.2% disagreed to having rendered medical services to foreign patients. 2.2% strongly disagreed to having received and treated foreign patients. 4.6 Positive or negative contribution of medical tourism on the destination’s Gross Domestic Product Table 5 below shows the respondent’s views on whether medical tourism impacts positively or negatively on Gross Domestic Product levels in Zimbabwe. Table 5 Medical tourism contribution towards Zimbabwe’s Gross Domestic Product (GDP) levels. Row Frequency Parirenyatwa Traditional Apostolic Row Percentage % distribution Doctors Healers Faith Healers Total Strongly Agree 6 1 6 13 28.8 Agree 7 14 6 27 60.0 Neutral 2 0 3 5 11.1 Disagree 0 0 0 0 0 Strongly disagree 0 0 0 0 0 Column Total 15 15 15 45 100 The table 5 illustrates that at least doctors, traditional healers and apostolic faith healers are satisfied that medical tourism can contribute positively towards Zimbabwe’s Gross Domestic Product levels. 28.8% of the population interviewed strongly agreed that medical tourism can contribute positively towards gross domestic product levels. 60% agreed and 11.1% where neutral to whether medical tourism can contribute towards Zimbabwe’s gross domestic product levels. The results show that there was a significant relationship between medical tourism and economic growth in Zimbabwe. What is needed is to find means and ways to implement it, both for Zimbabwe’s domestic and international medical tourists. 4.7 Medical tourism can help the Reserve Bank increase its foreign currency reserves. Table 6 shows an overall analysis of respondents who aired different views pertaining to whether or not medical tourism can help the Reserve bank increase its foreign currency reserves. Volume 2, Issue 11, November 2014 Page 8 IPASJ International Journal of Management (IIJM) Web Site: http://www.ipasj.org/IIJM/IIJM.htm Email: editoriijm@ipasj.org ISSN 2321-645X A Publisher for Research Motivation........ Volume 2, Issue 11, November 2014 Table 6: Medical tourism helping the Reserve bank increase its foreign currency reserves Responses Parirenyatwa Traditional Apostolic Faith Row Total Doctors healers Healers Strongly Agree Agree Neutral Disagree Strongly Disagree Column Total 7 6 1 14 Row Percentage % 31.1 4 4 0 0 7 2 1 0 12 2 0 0 23 8 1 0 51.1 17.7 2.2 0 15 15 15 45 100 4.8 Need to improve infrastructure and technology so to certify Zimbabwe as a medical tourist destination. Graph 2: Graph 2: Need to improve infrastructure and technology Graph 2 above shows 71.1% of the total population strongly agreeing to that there is a need for medical and health facilities improvement. 28.9% agreed to a need for medical and health facilities improvement so as to certify Zimbabwe as a medical tourist destination. Hence, there is a need to upgrade medical facilities and technology so as to certify Zimbabwe as a medical tourist destination. 2. DISCUSSION / ANALYSIS 5.1 Advantages of medical tourism to Zimbabwe The results from the interviews clearly show that medical tourism can boost Zimbabwe’s economy through earning foreign currency, creating employment and contributing positively towards the Gross Domestic Product levels. Medical staff would be motivated to work hard, research more and become more innovative. Tourism staff would be motivated to work hard and market Zimbabwe as a favourable medical tourist destination. Local authorities would be inspired to continuously improve the country’s infrastructure and technology. An example would be for instance a need to renovate and refurbish traditional healers’ stands at Mbare Musika, a need to cut grass around hospitals and ensure adequate water and electricity supply in hospitals, churches, and shrines. Training and better health and tourism education would be provided. Out of concern for the safety of their patients, some doctors, traditional healers and apostolic faith healers said that medical tourism carries some risks such as malaria and HIV/AIDS. Results display that in terms of qualifications all principals have the basic education qualifications. They are all literate. Some apostolic faith healers even possess Master’s degrees from the University of Zimbabwe and Zimbabwe Open University. Traditional healers had the basic educational qualification and a deeper knowledge of herbs, spiritual world and tourism. Parirenyatwa doctors, traditional healers and apostolic faith healers were positive in that they are receiving and treating domestic and foreign patients. At least traditional healers and apostolic faith healers answered that they are receiving and treating regional and international tourists. The research study found out there is a need to lure more domestic, Volume 2, Issue 11, November 2014 Page 9 IPASJ International Journal of Management (IIJM) A Publisher for Research Motivation........ Volume 2, Issue 11, November 2014 Web Site: http://www.ipasj.org/IIJM/IIJM.htm Email: editoriijm@ipasj.org ISSN 2321-645X regional and international medical tourists so that Zimbabwe would realize positive medical tourism contributions towards the economy. The results also showed that medical tourism can contribute positively towards Zimbabwe’s economy but there is need to improve health and medical infrastructure and technology. There is also need to improve on hospital / medical service centres, patients waiting times and planning by Zimbabwe’s tourism and health authorities. Results indicated that apostolic faith healers mostly Pentecostal and traditional healers registered under ZINATHA, have the power to cure diseases including sexually transmitted diseases (STDs) such as Herpes, reduce HIV/AIDS symptoms, cancer, headaches, stomach pains, back pains, barrenness, and high blood pressure. The respondents highlighted that some foreign patients favoured Zimbabwe’s medical service centres because of affordability, good waiting times, powerful strong medicines, qualified, experienced, good customer service, and mature personnel. Shoko (2014) highlighted that the World Health Organization cannot rule out cultural medicine or complimentary medicine. China uses complimentary medicine called Tiyashe. Zimbabwe uses complimentary medicine supplied mostly by traditional healers and herbalists. Shoko (2014) brought out that local doctors have discovered a powerful herb called “Ngudamiti” that reverses the HIV/AIDS symptoms. He adds that some of the powerful herbs used by traditional healers and herbalists are Chafifixe (to fix simple illness), Muringa, Musimboti (immune system), ginger (stomach), Mubvamaropa (Blood pressure and blood system) and Vhuka vhuka (powerful sexual drive). Respondents identified some traditional healthy foods that help boost the immune system as sorghum, millet, rapoko, sweet potatoes, water melons and maheu. 5.2 Marketing Zimbabwe as a medical tourist destination The respondents suggested that for Zimbabwe to be included among the top most medical tourist destinations, it needs to market its services including medical/health services. Both Public and Private Tourism and Health service providers ought to assist in marketing Zimbabwe as a potential medical tourism destination. Elsevier (2013:196) marketing of medical services is through mostly word-of-mouth and viral marketing. Viral marketing refers to marketing techniques that use pre-existing social networking services and other technologies to produce increases in brand awareness. It may take the form of video clips, interactive flash games, eBooks, images, text messages, email messages and web pages (www.wikipedia.org/wiki/viral-marketing: 30.03.2014). Other marketing tools include internet, trade shows, bill boards, newspapers, magazines, Facebook, twitter, WhatsApp, attending expos, trade shows, exhibitions, and the different tourism and medical unions and meetings. 3. CONCLUSION Literature reviewed integrated Zimbabwe’s ‘three tier health system’ with the systems theory / approach. Respondents however, argued that medical tourists are motivated to travel abroad by a number of factors, including the affordability of care abroad, and access to treatment not available at home, together with good waiting times for care at home. Respondents maintained that medical tourism can create employment and boost standards of living. It can aid in improving health infrastructure and technology in hospitals such as Parirenyatwa, Harare hospital, Mpilo and Avenues hospitals. They reiterated that attractive medical and tourism policies and unique marketing strategies need to be put in place in order to attract medical visitors. The study however laments that medical tourism carries security risks as well as legal and ethical issues. REFERENCES [1] Best, J.W. and Kahn, J.V. (1993). Research in Education, New York: Allyn and Bacon. [2] Bookman, M. Z. and K. R. Bookman. (2007). Medical tourism in developing Countries. Palgrave MacMillan: New York.Campbell, R., McConnell. And Stanley, L.B., (2002), Economics. 5th Edition., McGraw-Hill., North America. [3] Cohen, L. and Manion, L. (1994), Research Methods in Education. London. Rutledge. [4] Crossby, M. and Vulliamy, G. 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