MAKING HEALTH AND WELLNESS TOURISM A REALITY IN THE CARIBBEAN

April 15, 2008

SUMMARY AND CONCLUSIONS

Exporting Services to Canada SeminarCaribbean Health and Wellness Tourism

Strategy Meeting

March 31 – April 2, 2008Accra Beach Hotel & Resort, Barbados

Top: Philip Williams, Caribbean Export Development Agency at Opening Plenary Session;Middle from left to right: Minister of Tourism, the Honourable Richard Sealy, Mr. John Stinson, Choice Medical Services Canada; Minister of Health, the Honourable David Estwick; Canadian High Commissioner, the Honourable David Marshall with Minister Estwick.Bottom: Panel discussion led by Mr. Philip Kelly, TFO Canada; Dr. Jacob Thomas, Subang Jaya Medical Centre, Malaysia; Diane Girard, TFO Canada presentation on the Canadian marketplace.

INTRODUCTION

More that eighty (80) representatives from the Health and Wellness Sector from thirteen (13) of the fifteen member states of CARIFORUM, gathered at the Accra Beach Hotel and Resort in Barbados from March 31 - April 2, to provide their perspectives on keys to the successful building of the health and wellness tourism industry. The "Exporting to Canada Seminar/Health and Wellness Tourism Strategy Meeting" was jointly organized by the Caribbean Export Development Agency (Caribbean Export) and Trade Facilitation Office Canada (TFO Canada). The seminar was supported by development experts from Canada, Cuba, Malaysia and the United Kingdom.

Two Ministers of Government in Barbados, the Honourable Richard Sealy, Minister of Tourism and Dr. the Honourable David Estwick, Minister of Health, National Insurance and Social Security, were the featured speakers at the three day event. According to Mr. Sealy, "Health and Wellness tourism is growing at a higher rate than that of global tourism which is the fastest growing industry in the world. So we need to add that niche to our other offerings - conference tourism, sports tourism, heritage tourism and weddings." Dr. Estwick in his keynote address stated that "In pursuing a health tourism strategy, government policy will place attention on improving quality across all institutions as well as giving consideration to the types of services to be delivered."

Mr. Philip Williams, Executive Director, Caribbean Export, in a statement issued at the end of the event noted that there are significant opportunities for the region in the export of services generally, but there also are a number of challenges. “We were guided in this project by a study commissioned by the Commonwealth Secretariat in 2006. In addition to the findings in this study, we are also aware that regional service suppliers need to be export ready. For the development of the sector, high quality customer service is critical and firms can improve by benchmarking their performance. Companies must take a business approach, develop marketable packages and promote their offer and regulation and control will be important to assure quality and maintain brand image. As well, in every country there needs to be a lead agency, for example, in Malaysia, the Ministry of Health, undertook the coordination role. There are also other key actors like the Ministry of Tourism, Trade Promotion Organizations and sector associations who need to play a key role.

During the conference, in addition to presentations from international experts from Canada and Malaysia, 11 of the CARICOM countries had the opportunity to present the status of the Health and Wellness Tourism sector in their countries. Presentations were coordinated by public sector country representatives and included success stories from the private sector with a wide range of services being offered: medical emergency procedures, dialysis treatment, rehabilitation, medical spa treatments, and indigenous wellness products to name a few.

In order to enable more in-depth discussion amongst the participants, three workgroup sessions were organized to delve more deeply into opportunities, challenges and recommendations for the way forward. The reports of the groups are contained in this report under the headings “Public Sector, Medical Professionals, and Marketing and Branding.”

As a follow up to this event, it is proposed that a mission of Canadian businesses active in the health and wellness tourism sector will visit two or three countries in the region during October, to meet with services providers and future business partners. According to Philip Kelly of TFO Canada, “high on the agenda is the forging of collaborative partnerships and the strategic development of the sector.”

In the months to come, Caribbean Export and TFO Canada will continue to collaborate on identifying potential opportunities to make Health and Wellness Tourism a reality in the Caribbean. For more information, contact Veona Maloney, vmaloney@carib-export.com or Diane Girard of TFO Canada, dgirard@ican.net.

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SUMMARY

1. There are significant opportunities for the region in the export of services but there are a number of challenges to be overcome.

2. Mode 2 (consumption abroad) is most practiced mode in the Caribbean however mode 4 (movement of natural persons) is the most widely recognized.

3. There are opportunities for the region in Canada in many services areas, including Health and Wellness and Medical Tourism – baby bombers are looking for up-market services

Aging population in Canada – 13.5% - (12.6% - USA approx 30 million)- linked to the growth potential of the health and wellness sector

Over 155 sub-sectors of services that can be exported 1 in 10 global employees are employed in tourism The countries in Caribbean can leverage their services capacity among each

other. 5.4% growth of services in the Canadian market

4. Regional service suppliers need to be export ready

Barbados Coalition of Service Industries will offer ITC C-Step export preparation programme

Need to research and document the supply capacity

5. Absence of services statistical data This is an old problem to be addressed – might form a committee, but similar

initiatives in the past need to be researched first Must not let the absence of statistics prevent us from getting out there and doing

business

6. Need to take advantage of strategic partnerships or linkages

Importance of the diaspora – reaching out to this sector for export of services Need to leverage on strengths of other trade promotion organizations Need to piggy back on contacts from other successful regional/national sectors

e.g. energy sector in Trinidad & Tobago, or financial services sector in Barbados

7. There needs to be a lead agency – e.g. coordination role of the Ministry of Health in Malaysia, and other actors also have an important role to play e.g. Ministry of Tourism, Trade Promotion Organizations, Investment Authorities, sector associations e.g. Spa and Herbal Associations

8. Governments need to talk to other governments

Need to facilitate the cross border delivery of services e.g. through the upcoming Canada/CARICOM negotiations

9. Importance of customer service

Delight your patient or customer Invest in your people: train your staff Provide a turnkey service – customs express, logistics management, etc…

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10. Benchmark your performance

There is almost always someone around from whom you can learn, e.g. the experience of the last 3 days needs to be replicated and deepened

Aim for international best practice

11. Accreditation, regulation and control are important to assure quality and maintain brand image

Basis for services is establishing credibility Need for a good legislative framework – public and private sector must work

together on this Systems of accreditation and recognized standards will need to be introduced in

order to ensure customer confidence

12. Evaluate capacity Work to capacity with growth as an outcome of working to capacity Manage expectations, don’t over-anticipate, best to grow incrementally

13. Take advantage of technology

Technology creates an enabling environment for the development of new business opportunities, delivery of services, and most importantly communicating key messages

14. Take a business approach

Adopt and execute a customized strategy e.g. through formation of private/public policy committee

Pay attention to training and skills development Access to finance will be important – many of the services providers cannot

provide the collateral required by the financial institutions. Need for disaster contingency planning Need for National/Regional Branding

15. Need to package and promote this offer

This wonderful and very varied mix of services across the region needs to be packaged

It needs to be promoted professionally

16. DON’T WAIT – do something – start a pilot project.

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WORKGROUP PRESENTATIONS

Workgroup 1: Public Sector – How can the Public Sector facilitate Health and Wellness Tourism?

Workgroup moderator: Mr. John Stinson Workgroup rapporteur: Ms. Sharon McIntosh

OPPORTUNITIES

POLICY:

1. Collaboration between key government agencies and Ministries (Ministry of Health, Ministry of Tourism, Ministry of Trade, Ministry of Finance, National Coalitions of Services Industries etc.)

2. Establishing policy, legislation and incentives for the development of Medical Tourism3. Establishing standards, certification and licensing through the public sector's collaboration with

sector experts4. Development of infrastructural policy to support development policy (e.g. land use and

environmental policies)5. Preservation of the environment (environmental standards, certifications and policies)

CAPACITY

1. Mapping what currently exists in the sector (facilities, human resources, existing standards)2. Rationalization across the region of “who does what”. Following on the idea that each island has

something to offer, building on those strengths and allocating a level of responsibility to their self development

3. Complimentary infrastructural development (e.g. wellness spa in an eco-lodge)4. Capacity building through technology knowledge transfer 5. Tele-medicining - increases the technical capacity of the medical professionals

MARKETING AND COMMUNICATIONS

1. Connect with the diaspora in Canada as patients as well as a source of medical expertise2. Promotion of medical Tourism at a national level through tourism agencies, investment companies,

local overseas missions (embassies and high commissions)3. National and subsequent regional branding programs to develop health and wellness professionals

CHALLENGES

POLICY

1. Lack of research and statistics2. State, federal, provincial health benefit to the Caribbean3. Immigration issues

MARKETING

1. Small markets2. Unsophisticated communication systems

CAPACITY

1. Infrastructure: Facilities, communications, airlines2. Competitiveness and productivity compared to North America3. Human resources constraints: brain drain as well as decreasing numbers of school leavers

entering the medical field (existing trainable stock)4. Attracting Investment5. Funding6. Limited product availability 7. Inconsistent quality8. Culture of not “saying no”9. Natural disasters (hurricanes)

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SHORT-TERM ACTIONS (60-90 DAYS)

1. Identify champions in key leadership roles to drive the development of health and wellness tourism2. Undertake an assessment of the existing capacity: Identify what is being done; what needs to be

done; where do you want to be3. Ask leaders from the public sector (identified above) to liaise with the private sector

MEDIUM TO LONG-TERM ACTIONS (90-180 DAYS)

1. Educating, engaging and sensitizing overseas missions and representation agencies2. Initiate work towards the implementation of standards and regulations3. Creation of a public/ private sector policy team to create draft national policy for the health and

wellness tourism sector4. Identify the first pilot project for implementation and begin work

OVERALL RECOMMENDATIONS

1. Start following up on this seminar immediately. Takes steps to move forward2. Use existing statistics to assist on the formulation of an implementation policy. Create a national

strategy for the collection of statistics and data. This may be followed by a regional harmonization in the future

3. Create a national/ regional networking framework of key stakeholders and policy-makers under one umbrella

4. Create a technical agreement regionally

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Workgroup 2: Medical Professionals

– What are the key challenges and possible solutions regarding regulations, standards, certification, credentials, etc…

Workgroup moderator: Dr. Byung Moon Workgroup rapporteur: Dr. Malcolm Grant

OPPORTUNITIES

1. Regional standardization of quality care / efficiency (Professionals/Patient)2. Accreditation (Education and Training)3. Increasing Services/Employment/New Skills 4. Build infra-structure5. Cooperation/collaboration6. Integration of allopathic and Holistic Medicine

CHALLENGES

1. Accreditation / Medical professionals2. Education / awareness (Public/Medical Profession/Government)3. Bureaucracy (Government/Local)4. Institutional strengthening5. Physical Institutions and equipments6. Traveling within region7. Capitalization / finances8. Centralized coordinating body9. Insurance10. Marketing professional profile

SHORT-TERM ACTIONS

1. Form coordinated regional task force (Timeline: 2-3 months)2. Identify what we could provide3. Meet with Ministers of Health and Tourism (Collectively)4. Involve CROSQ5. Bench marking (site visit etc.)

MEDIUM TO LONG-TERM ACTIONS

1. Centre of excellence / regulatory body (Regional/International)2. Improve standard of healthcare3. Training and education (continual)4. Research by professionals to grow in their respective fields

OVERALL RECOMMENDATIONS

1. Continuation of process with time line2. Task force to meet (2-3 months)3. Educate medical and health professionals4. Raise public awareness

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Workgroup 3: Marketing and Branding

What are the key messages and strategies which need to be put into place?

Workgroup moderator: Ms. Diane Girard Workgroup rapporteur: Ms. Kim Martin

OPPORTUNITIES

1. Branding Make the Caribbean the largest spa in the world Come up with a unique Caribbean brand (quality, accessibility)

2. Collaboration Private sector clustering Governments to create an enabling environment Regional Marketing Board (CSME) Build on existing marketing channels, e.g. Market spas to cruise passengers

3. Promote our success Media, word of mouth

CHALLENGES

1. What is the product/service? Need clear understanding of “supply side” No current inventory, no current website (Minister’s suggestion of fully integrated website)

2. How good is the product/service? Quality, standards, credentials Shortage of qualified personnel - retention Requirement for training Customer service “delight”

3. How to market? (Two different market segments) Wellness side - Tour operators, travel agents Medical side – medical clinics and practitioners

SHORT-TERM ACTIONS

1. Establish a Focal Point• Consolidate existing studies and reports• Develop guiding principles• Coordinate short-term activities

2. Identify Champions National Regional Media strategy – public perception

3. Compile an Inventory• By country by type of service• Understand level of readiness

4. Education and Training• H & W Tourism is relatively new• Need further strategizing, sharing of best practices, training

MEDIUM TO LONG-TERM ACTIONS Develop a 3 year Strategic Action Plan

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- Regional Roadmap- Needs of Target Market- Supply side capabilities

- Need to do the ground work, then we can promote the Caribbean as a viable Health and Wellness destination

OVERALL RECOMMENDATIONS

1. Immediately develop a database of service providers, taking into consideration level of readiness and adherence to standards

2. Gain a better understanding of the demand side in Canada in order to respond to market needs3. Develop a short-term marketing plan which will evolve as the industry becomes more viable.

OVERALL CONCLUSIONS

1. There are significant opportunities for the region in the export of services to Canada including the export of health and wellness tourism.

2. The supply capabilities of service providers needs to be strengthened and must include a focus on accreditation, standards, availability of skilled personnel, branding and excellence in customer service. Supply capabilities need to be identified through the development of a database and an integrated web portal.

3. Regional and national strategies need to be put into place to address both short-term and longer-term objectives. Immediate opportunities exist for the development of partnerships between Caribbean and Canadian organizations. These opportunities should be pursued immediately, while a concurrent longer term strategy is being developed.

4. The establishment of an enabling environment is critical to success. A supporting infrastructure is required to ensure direct transportation routes, state-of-the-art hospitals, clinics and related medical equipment. Leadership from government will be instrumental in achieving this enabling environment. Regional collaboration will help to promote a positive brand image of the Caribbean as a prime Health and Wellness destination.

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