Medical Travel Today (MTT):  Why you are interested in medical travel as a form of sustainable tourism? Zachary Rozga (ZR):  I am currently engaged with the Inter-American Development Bank (IDB) as a Tourism Expert. The Inter-American Development Bank is like the World Bank, except that its focus is in the Latin-America Caribbean region, and they have a special facility within the Inter-American Development Bank called the multi-lateral investment fund (MIF). The MIF is essentially that:  It is a fund that was created by a number of sovereign countries that basically pooled their economic aid and funding together — and put it in one facility to be able to engage in projects throughout the Latin-American region. Instead of the US government going in and doing a solo project in Honduras, they partnered with the British, the Spanish — and the Chinese just joined.  They put their monies together and then they have larger funds that can implement these projects. This has been going on for more than ten years and the organization has undergone a number of changes.  In the recent past, they had specific areas of emphasis, one of which was sustainable tourism. They financed over 50 projects in the region that were focused on sustainable tourism, covering something like 22 countries.   MTT:  Can you describe what a project looks like? ZR:  They really run the gamut.  Most importantly, they are set up to support small businesses. The target beneficiary of each project is the small and medium size enterprises (SME’s) that sit in those destinations. An example of a project is in the Bahamas that focuses upon sustainable tourism and marketing.  The idea is how to get the small privately held cottages and resorts that are owned by the Bahamians to be more competitive with the larger, corporate-owned properties in their destination.  That’s a typical project. Another project was the establishment of the town of Tequila [in Jalisco, Mexico] as a tourism destination.  Tequila enjoys World Heritage status, but it didn’t really have much in the way of tourism outside of bus tours coming from Guadalajara.  Therefore the project was focused on assisting the community to turn it into more of a tourism destination — helping people start up things like boutique hotels and other tourism services. One important point to note here is that the MIF does not fully finance projects, they only provide counterpart funds.  Typically, there will be an entity that has an idea that they propose to the IDB.  The money from the MIF does not go to public sector entities — it’s only allocated or channeled through non-governmental organizations (NGOs) for these specific project like the ones I mentioned before.   MTT:  How does your personal experience match these projects? ZR:   My experience and personal background are that I’ve been a sort of sustainable tourism expert, if you will, for the past seven years. I earned a master’s degree at George Washington University in Sustainable Tourism Development, and then I moved to Africa and worked there for three years working with governments and international development agents like the International Finance Corporation and the World Bank.  During that time I also had the opportunity to work in Central and South America and Southeast Asia. The IDB has recently asked me to help them look at some new transformational projects.  A lot of the projects that they have worked on in the past, particularly in tourism, have really been national projects or even destination projects – such as the one in the Bahamas or the Tequila project. With the maturation of some of the funds and these types of projects, they really are now looking for more sector level projects, and seeking opportunities where they can have a larger, broader impact. It is a coincidence that some of my industry colleagues actually approached me about medical tourism because it’s one of the areas I’ve been interested in pursuing.  Working in Africa and Southeast Asia, this concept of medical health wellness travel has been prevalent, but unorganized in many destinations.   MTT:  So you are a man before your time. ZR:  I guess so, yes. Although, I think I look at the industry a little bit differently than others do.  I guess I look at it from a more purely academic tourism perspective. The IDB and particularly the gentlemen I am working with have a particular interest – although from a different viewpoint that mirrors my observation:  They are examining the potential negative impacts of medical tourism on the local population. Right now, we are in a scouting investigation phase for the design of a new MIF project focused on Medical/Health Travel. When we look at it from the perspective of having a negative impact, and from what we can find online, it seems to be that all of the literature, all of the marketing, and all of the organizations are client-focused — in this case the clients are also patients. They seem to dwell upon the issues of “How do we get more clients?  How do we tell clients this is safe?  How do we ensure that clients are safe when they go to Panama, Brazil or Bangkok?” Very little — from what we can find — is focused on what is happening in Bangkok or what is happening in Panama City. Through our work in Sustainable Tourism in the region we see some negative impact from medical tourism to local populations in Latin America.   MTT:  I might direct you to some of the hospital management companies that would help you to frame this out.  When I talk to them, they have just the opposite approach.  Their whole purpose is to establish hospitals that will upgrade the level of care for the local communities and only depend upon 15 – 20 percent of the census to be dedicated to medical tourists. ZR:  Thank you, these are the kinds of things we need to uncover. Then we have to figure out how to put a medical tourism program or plan of action through our project in a way so that we can extend it throughout the region in a sort of systemic way.  Does that make sense?   MTT:  Yes, and I think you’re on the right track.  What can the industry do to help you progress? ZR:  I guess this is where I am saying that I am coming from the academic perspective and just beginning our process of engaging the industry to formulate a project. Usually a MIF project has between three to five components.  They are all different, but they are all leading towards the same overall project objective or goal. What I am seeing personally from the medical tourism/health tourism sector is that it is very much a wide-open space right now.  There’s no sort of central organized unit.  There’s no set of standards or real criteria as to what is good practice or what is bad.   MTT:  You are absolutely spot-on with that.  ZR:  Sure. I think that there needs to be some sort of baseline study that’s taken to actually identify what is medical tourism and what is this field. From another perspective, I’ve been discussing with some university departments.  One of the issues that they see — and they relate this to medical tourism — is that they have a lot of recent graduates from the medical doctor program who are being “recruited” to go volunteer their expertise in an impoverished area. Some of the people I’ve talked to said it was outright poaching because the “doctors” are made these promises as to what they would get in return for going to a place like Honduras.  In reality, what ends up happening is, because they are going to places that have no primary care, they are getting thrown into situations where they are basically ER doctors with no actual ER experience. Sure, they’ve gone through medical school, but they haven’t actually physically been an ER doctor — and it can be quite traumatizing to some students.   MTT:  What are some of the other key issues that you are reviewing? ZR:  Right now, we are doing some general investigation:  What is going on out there in Medical/Health tourism?  What can we ascertain from a preliminary investigation talking with the industry?  Finally, where can the IDB eventually partner with someone to actually leverage the experience and strength in a project? The IDB is a fairly important political entity within the Latin American Caribbean Region, and we are well positioned to help. With our previous experience within the sustainable tourism industry, the IDB was one of the first entities to work on the Global Sustainable Tourism Council, GSTC that has now been taken over by the UN Foundation. Since then, it’s been a moving entity and it really shaped what we know of as the sustainable tourism industry. Again, I think this is kind of what we’re looking at with the medical tourism industry today.  It is just this wide-open expanse and everybody who is in it has their own belief of what it is and what it can become. So, if you’re on the supply side or if you’re on the demand side, you feel like you have the only right answer and everybody else is wrong. Those sentiments are creating benchmarks, and we are saying, “I think this is someplace where we can play a role in this evolving industry.” Leverage the past experience working with the GSTC in the early days to shape something sustainable and inclusive for medical travel. But I also want to point out we want to make sure we partner with the right people who are active in this industry.  We are really one small cog in the wheel. Part Two of this interview will be featured in Issue 23.   About Zachary Rozga Zachary Rozga is an international sustainable development expert with a focus on sustainable tourism and small business development and is working for the Inter-American Development Bank Multi-lateral Investment Fund. Zachary has been working in tourism for over 10 years and in sustainable development for over five years. Zachary received his Bachelor’s Degree in Business from the University of Colorado at Boulder, majoring in Finance and International Business in 2001. He received his Master’s Degree in Sustainable Development and Tourism from the George Washington University in Washington, DC, in 2005. [email protected] 360-593-4444   About the Multilateral Investment Fund (MIF) The Multilateral Investment Fund/MIF, funded by 39 donors, supports private sector-led development benefitting the poor — their businesses, their farms and their households. The aim is to give low-income populations the tools to boost their incomes: access to markets and the skills to compete in those markets; access to finance; and access to basic services, including green technology. A core MIF mission is to act as a development laboratory – experimenting, pioneering, and taking risks in order to build and support successful micro and SME business models. To make effective use of MIF projects, the MIF is committed to:

1. rigorous results measurement and impact evaluation, and
2. active knowledge-sharing so that the most promising solutions are widely known and can be taken to scale.

The MIF finances about 100 projects per year, with a total finance volume of about US$100 million. MIF project benefits reached over 600,000 individuals and businesses in 2010. The MIF works through technical assistance grants, lending, and equity investments, as well as through combinations of these tools when both capacity building and risk sharing finance are needed for success. It is the largest international technical assistance provider to the private sector in Latin America and the Caribbean and always works with local, mostly private partners to help fund and execute projects – civil society organizations, industry associations, foundations, universities, cooperatives, companies, and financial institutions. Every dollar approved by the MIF leveraged more than US$2 from partners in 2010.