tourism in africa statistics

International tourism, number of arrivals - Sub-Saharan Africa

Selected Countries and Economies

Sub-saharan africa.

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A Ticket to Recovery: Reinventing Africa’s Tourism Industry

• COVID-19 triggered an unprecedented crisis in Africa’s tourism industry.
• Still, a growing middle class and young population bode well for travel businesses.
• Tapping domestic tourism demand will be key to rejuvenating the sector.

By Olivier Monnier

Months into the COVID-19 pandemic in 2020, Kenya’s normally manicured beaches were carpeted three-feet deep in parts with thick layers of seaweed.

The Indian Ocean had seemingly taken advantage of the shuttered hotels and absence of tourists to reclaim the white sands in normally bustling Diani, Watamu, Malindi, and other favoured places along Kenya’s coastline.

The story was similar across much of Africa: pandemic-induced lockdowns and grounded flights devastated the continent’s tourism industry, forcing many operators to the brink of bankruptcy—or to cease operations.

During the height of the pandemic in West Africa, the Azalaï Hotel Group took the difficult decision to close completely. The Group has since reopened most of its hotels in the region, but more than half its rooms remain empty.

"I think 2021 is going to be another tough year for the sector," said Mossadeck Bally, founder and Chief Executive Officer of the hotel group. "The vaccination rollout will give travellers some confidence, but I don’t think people will travel much this year. The recovery will really start in 2022."

Unprecedented Crisis

Over the past 20 years, tourism has become vital to African economies. In 2019, the industry accounted for about seven percent of Africa’s GDP and contributed $169 billion to its economy—about the size of Côte d’Ivoire’s and Kenya’s combined GDP.

“The impact has been very strong,” said Bally, who refused a salary himself for more than a year. “Our industry was devastated because all of a sudden, we’ve been asked to just stop operating. We are a front-line sector so we are suffering first before it reaches the other industries.”

Aside from its Grand Hotel in Bamako, Mali’s capital, Azalai’s locations have resumed operations but with fewer staff, pay cuts of up to 40 percent and a hiring freeze, Bally said. Occupancy rates range from five percent in Guinea Bissau to 40 percent in Côte d’Ivoire, still well below normal levels.

Dependence on Foreign Travelers

Africa’s tourism sector has persevered largely without the financial relief provided by governments in wealthier, more developed regions, with the continent’s smaller businesses in the sector most affected.

The crisis has also exposed Africa’s dependence on foreign travelers. This is especially true for countries in Eastern and Southern Africa, which have developed significant leisure and safari-oriented facilities that appeal to European, American, Asian, and other visitors.

In December 2020, an IFC and Dalberg Advisors survey of selected tourism companies in Tanzania, Uganda, and Zambia revealed that the companies would lose two thirds of their revenue from international tourism receipts in the 2020-2021 season.

Some experts believe that Africa might take longer to recover than other regions due in part to a lack of domestic and intraregional demand and the sector’s weaker supply chain.

According to the WTTC, domestic tourism accounted for 55 percent of travel and tourism spending in Africa in 2019, below the contribution of local tourism in North America (83 percent), Europe (64 percent) and Asia-Pacific (74 percent). Domestic tourism accounted for 73 percent of the total global tourism spending in 2017 .

“Much of the world has had the advantage of relying on captive domestic and regional audiences. But in Africa, domestic tourism has been overlooked for a long time,” said Hermione Nevill, an IFC Senior Tourism Specialist in Johannesburg. “The sector needs to be oriented towards more diversified markets so that there is greater resilience in future.”

But all is not lost for Africa’s hard-pressed tourism sector—and some countries have already acted to entice domestic tourists.

Reinventing the Industry

While Africa’s domestic tourism industry is growing—by 2050, Nigeria will have the world’s third largest population, for example—it remains largely untapped and burdened by challenges.

Connectivity is an issue. Traveling around the continent can be complicated and expensive, in part because countries restrict their markets to protect their state-owned air carriers. Although 44 African countries adopted the Yamoussoukro decision to liberalize the aviation market in 1999, implementation has fallen short.

There’s also a need for more and better infrastructure beyond capital cities, which are now generally well served with hotels and other amenities, said Olivier Baric, Africa Aviation Director at Egis, a French multinational company involved in infrastructure and transport.

Tourism experts believe domestic tourists could be enticed if operators invest in the economy and mid-scale market, develop smaller, more authentic, and greener resorts, and introduce more products aimed at middle-class African families and millennials, while marketing more directly to these groups.

Finally, there is the question—and problem—of ownership. The long-term strength and sustainability of Africa’s tourism industry will in part depend on the number of Africans building businesses and supporting and encouraging others on the continent to do so.

Despite the many challenges ahead, Azalai’s Bally says he sees the crisis as an opportunity—but one that can only be grasped through hard work and with fresh thinking:

“I am not worried, but I am perfectly aware that we have to reinvent ourselves to deal with the new situation,” he added. “Those who can reinvent themselves will survive.”

An aerial view of Zaina Lodge, a luxury safari hotel in northern Ghana. Photo: Courtesy of Zaina Lodge.

South Africa, which welcomed 10 million international tourists in 2019, made local tourism in 2020 a focus of its recovery plan . Rwanda, with advisory support from IFC, is developing a recovery strategy that includes developing local and regional markets. Meanwhile in Kenya, entry fees to all game parks and reserves have been cut for one year to attract more local tourists.

“Where we've seen some resilience is when there's domestic travel,” Wayne Godwin, senior vice-president of JLL Hotels & Hospitality Group for Sub-Saharan Africa, said at a virtual IFC event on the future of the tourism sector in Africa and the Middle-East.

Young Travellers and Free Trade

Africa’s growing middle class, its soaring population of young travellers hungry for adventure, and the recently launched African Continental Free Trade Area (AfCFTA), the world’s largest free trade area by the number of participating countries, are among the pillars seen supporting the future growth of domestic and regional tourism in the continent.

“The free-trade agreement is an absolute game changer for travel,” Godwin said. “If 97 percent of commodities and goods are tariff-free, that's going to do a lot for regional trade. And when there's regional trade, travel will follow. It just will happen.”

With its abundant wildlife and varied landscapes, Kenya is a leader in Africa in promoting local tourism.

The country’s beaches have been busy again following COVID’s initial shock, though another month-long lockdown announced for parts of the country in April 2021 frayed nerves among the country’s tourism operators.

Even before COVID-19, Kenya enjoyed a 55 percent rise in bed night occupancies by domestic tourists between 2014 to 2018, according to official data . The growth has been credited to digital campaigns, growing disposable income among Kenyans, and efforts to promote affordable alternatives to five-star resorts.

“International bookings are a higher value in terms of revenue but the domestic market is more resilient,” said Muthuri Kinyamu, cofounder of Kenyan tour operator Turnup.Travel . “Clients take multiple trips with you, and they come back.”

Kinyamu’s company has held up well during the pandemic, even adding staff. It benefited from a strong digital presence, developed new packages and partnered with low-cost airline Jambojet, a unit of Kenya Airways, to create content to reassure travelers and boost domestic bookings, Kinyamu said.

“Of course, our growth trajectory has been hampered by COVID-19 but when we look at our 2020 numbers, the revenues have evened out,” Kinyamu said. “With the restrictions, we had to adapt but we never had to lay off our staff as our business has diverse sources of incomes.”

Across the continent in West Africa, Zaina Lodge , a luxury safari hotel in Ghana, enjoyed its second-best month ever in December 2020—thanks to the power of domestic tourism.

“We established ourselves as a local brand from day one,” said company cofounder Andy Murphy. “The long-term growth in the continent is going to have to come from domestic tourism. If you're a business in tourism in Africa, you need to seriously think about how you build a domestic client base to match or even exceed your international base,” he said.

Published in May 2021

Abbas Africa

Tourism in Africa: Overview

Tourism in Africa is a captivating journey that offers a blend of cultural diversity, breathtaking landscapes, and unparalleled wildlife encounters. With its rich heritage and abundant natural wonders, Africa has emerged as a prime destination for travelers seeking experiences and adventures. This overview explores the current state of tourism in Africa, shedding light on the number of annual visitors and the significant revenue generated by this sector. Additionally, we will delve into the factors that make Africa an attractive tourism hub, including its vibrant music, art, and culinary scene. We will also discuss the role of technology in shaping African tourism and examine the historical context and prospects of this thriving industry. Join us as we embark on an exploration of the wonders of tourism in Africa.

Key Takeaways

• Africa offers unique attractions and experiences for tourists, including natural beauty and cultural heritage.
• The tourism industry in Africa is rebounding from the impact of the pandemic, with international arrivals reaching 85% of pre-pandemic levels in the first quarter of 2023.
• Africa’s Travel and tourism sector has more than doubled in value in the past two decades, contributing 5.9% to Africa’s GDP and generating approximately 168 billion U.S. dollars in tourism receipts in 2022.
• Tourism in Africa has significant economic benefits, including revenue generation, job creation, infrastructure development, and poverty reduction.

What Is Tourism?

Tourism is a form of travel that involves visiting different places for leisure, pleasure, or business purposes, typically for a limited duration. In the context of Africa, tourism has become an increasingly important industry, with each country offering unique attractions and experiences.

From the iconic pyramids of Egypt to the vast savannahs of Kenya, Africa is a continent rich in natural beauty and cultural heritage. The diverse landscapes, wildlife, and historical sites make it a popular destination for tourists from around the world.

Countries such as South Africa, Kenya, Tanzania, and Morocco have emerged as top tourist destinations, attracting visitors with their stunning landscapes, wildlife safaris, and vibrant cultures. However, other countries in Africa also have their hidden gems waiting to be explored.

As we delve into the current state of tourism in Africa, it is important to understand the vast potential and challenges facing this industry.

What Is the Current State of Tourism in Africa?

The current state of tourism in Africa is rebounding from the pandemic, but it’s not quite back to pre-pandemic levels yet, with cautious optimism for 2024. Here’s a summary of the current state:

Recovery and Growth:

• International arrivals reached about 80% of pre-pandemic levels in the first quarter of 2023 according to UNWTO.
• According to the announcement of Forward Keys, the leading travel intelligence firm and Knowledge Partner of the World Travel and Tourism Council (WTTC) at the Global Summit in Rwanda in the full 2023-year results showed by their latest air ticketing data, many African destinations entering a growth phase in the last quarter of 2023, with Cameroon (+27% international arrivals compared with 2019), Rwanda (+15%), Tanzania (+15%) and Namibia (+10%) leading the way and boasting double-digit growth.
• In July 2022, the number of tourists that arrived in Africa from overseas was around 5.1 million, which was significantly higher than the number in the same period in 2020 and 2021, due to the effects of the COVID-19 pandemic on the tourism industry according to Statista.
• By 2030, consumer spending on tourism, hospitality, and recreation in Africa is projected to reach about $261.77 billion, $137.87 billion more than in 2015. From 1998 to 2015, service exports, including “industries without smokestacks” such as tourism, have grown about six times faster than merchandise exports in Africa.
• According to the WTTC, Africa’s Travel and tourism sector has witnessed an extraordinary transformation, more than doubling in value in just two decades and contributing significantly to the continent’s economy.
• Africa recovered 92% of pre-crisis visitors in these nine months according to UNWTO.
• International tourism is expected to reach close to 90% of pre-pandemic levels by the end of 2023.

However, full recovery is still on the horizon, as the industry grapples with ongoing challenges like infrastructure limitations, geopolitical instability, and the lingering impact of the pandemic.

Challenges Remain:

• The industry is still facing challenges like infrastructure limitations and security concerns in some regions.
• The global economic slowdown could also impact tourism growth in Africa in the coming year.

There are still challenges to overcome, such as the ongoing effects of the COVID-19 pandemic, infrastructure development, and security concerns. To fully tap Africa’s tourism potential, both public and private sectors need to work together and implement effective policies and strategies. Overall, African tourism is on a positive trajectory. The industry is adapting to evolving preferences and capitalizing on its unique offerings to attract travelers. Continued focus on sustainability, responsible tourism practices, and diversified experiences will be key to sustaining this growth in the future.

How Many Visitors Does Africa Receive Annually?

Africa receives a significant number of visitors annually, both domestically and internationally. To understand the scale of tourism in Africa, it is important to consider the major tourists in terms of domestic and international arrivals. Here are some annual arrivals to the continent in different years:

According to the Africa Tourism Monitor, African international tourism arrivals increased slightly to 62.9 million in 2016 – a 0.64% increase.

Africa received 63.3 million international arrivals in 2017, marking a record high and representing an 8% growth compared to the previous year according to the World Tourism Organization (UNWTO).

According to the World Tourism Organization (UNWTO), Africa received a total of 68.2 million international tourist arrivals in 2018.

In 2019, Africa received 69.9 million international tourist arrivals (excluding Egypt and Libya), representing a 2.4% increase from 2018 according to the World Tourism Organization (UNWTO).

According to the World Bank, Sub-Saharan Africa alone received 43 million international arrivals in 2021, still significantly lower than the 56 million in 2019.

Who Are the Major Tourists in Africa?

With an annual influx of visitors from both within and outside the continent, Africa attracts a diverse range of tourists. The continent’s rich cultural heritage, breathtaking landscapes, and unique wildlife make it a captivating destination for travelers.

In terms of domestic tourism, Africans themselves contribute significantly to the tourism industry. Many Africans travel within their continent to explore different countries, experience different cultures, and enjoy the beauty of their neighboring nations.

When it comes to international tourism, Africa welcomes visitors from all over the world. European countries such as France, Germany, and the United Kingdom are among the major sources of international tourists. Additionally, countries like China, the United States, and India also contribute to the growing number of visitors to Africa.

This intercontinental mix of tourists adds to the vibrant tapestry of Africa’s tourism industry.

How Much Revenue Does Tourism Generate for Africa?

Tourism in Africa is a significant contributor to the continent’s economy. According to Statista, travel and tourism contributed 5.9 percent to Africa’s Gross Domestic Product (GDP), with total tourism receipts amounting to approximately 168 billion U.S. dollars in 2022. This upward trend indicates the potential for further growth in the industry.

With consumer spending projected to reach $261.77 billion by 2030, tourism will continue to play a crucial role in Africa’s economic development.

What Makes Africa a Prime Tourism Destination?

Africa’s rich cultural heritage and diverse traditions make it an appealing destination for tourists. From ancient civilizations to vibrant festivals, visitors can immerse themselves in the unique customs and rituals of different African countries.

Additionally, Africa’s natural wonders, such as the majestic Victoria Falls and the vast Serengeti plains, offer breathtaking experiences that attract travelers from around the world.

How Does Africa’s Rich Cultural Heritage Contribute to Its Appeal as a Tourist Destination?

Africa’s rich cultural heritage is a major factor in its appeal as a prime tourism destination.

Tourists can encounter unique cultural experiences such as traditional music and dance, vibrant festivals, and authentic local cuisine.

These cultural encounters provide visitors with a deeper understanding and appreciation of Africa’s diverse traditions and customs, making their travel experiences richer and more memorable.

What Are Some Unique Cultural Experiences that Tourists Can Encounter in Africa?

Tourists visiting Africa can immerse themselves in a myriad of unique cultural experiences. Africa’s diverse and vibrant cultural heritage makes it a prime tourism destination.

From exploring the ancient ruins of Egypt to witnessing the traditional Maasai tribes in Kenya, there is something for everyone.

Tourists can also indulge in the rich music, dance, and art scenes across the continent. Whether it’s visiting the bustling markets of Marrakech or experiencing the vibrant festivals of Ghana, Africa offers an array of cultural experiences that are sure to leave a lasting impression.

What Are the Must-See Natural Wonders in Africa?

Africa’s remarkable natural wonders and diverse landscapes make it a prime tourism destination.

Africa is home to numerous natural wonders that showcase the continent’s diverse landscapes and ecosystems. Some of the must-see natural wonders in Africa include: Victoria Falls, Zambia/Zimbabwe: One of the most famous waterfalls in the world, Victoria Falls is located on the mighty Zambezi River between Zambia and Zimbabwe.

Mount Kilimanjaro, Tanzania: At 19,341 feet (5,895 meters) above sea level, Mount Kilimanjaro is Africa’s highest mountain and the highest free-standing mountain in the world.

Ngorongoro Crater, Tanzania: Known for its unique ecosystem and the world’s densest population of lions, Ngorongoro Crater is an impressive natural wonder.

Okavango Delta, Botswana: The Okavango Delta is a seasonally flooded marshland that acts like a massive oasis in the middle of the desert, offering a unique and serene experience.

Table Mountain, South Africa: Table Mountain is a prominent landmark in Cape Town, South Africa, offering stunning views and a popular hiking destination.

Serengeti Migration, Kenya/Tanzania: The Serengeti Migration is an incredible natural phenomenon where millions of animals, including wildebeest, zebra, and gazelle, move across the Serengeti Plains in search of water and food.

Fish River Canyon, Namibia: The Fish River Canyon is an enormous ravine and canyon stretching 100 miles (160 km) in length and reaching a width of 16.7 miles (27 km). These natural wonders offer visitors a glimpse into Africa’s diverse landscapes, from powerful waterfalls and towering mountains to unique ecosystems and breathtaking landscapes.

How Does Africa’s Diverse Landscapes and Natural Wonders Attract Tourists?

Africa’s diverse landscapes and natural wonders attract tourists for several reasons. Firstly, Africa is home to some of the world’s most iconic and breathtaking landscapes, such as the Serengeti National Park in Tanzania, the Sahara Desert, the Okavango Delta in Botswana, and the Victoria Falls in Zambia and Zimbabwe. These stunning natural wonders offer unique and unforgettable experiences for visitors.

Secondly, Africa’s diverse wildlife is a major draw for tourists. The continent is renowned for its incredible array of wildlife, including the “Big Five” game animals (elephant, lion, leopard, buffalo, and rhinoceros), as well as gorillas, chimpanzees, zebras, giraffes, and many more. Safari tours and wildlife viewing opportunities allow visitors to witness these majestic creatures in their natural habitats, making it a dream destination for nature enthusiasts and wildlife photographers.

Moreover, Africa’s natural wonders offer a range of activities for adventure seekers. From hiking Mount Kilimanjaro in Tanzania, the highest peak in Africa, to exploring the stunning underwater world of the Red Sea in Egypt or scuba diving with whale sharks in Mozambique, there are countless opportunities for thrilling adventures across the continent.

Additionally, Africa’s cultural heritage and historical sites attract tourists interested in learning about the rich history and diverse cultures of the continent. From the ancient pyramids of Egypt and the rock-hewn churches of Lalibela in Ethiopia to the vibrant markets of Marrakech in Morocco and the Swahili culture along the East African coast, Africa offers a wealth of cultural experiences.

Lastly, Africa’s conservation efforts and commitment to sustainable tourism have also contributed to its appeal. Many countries and organizations are working tirelessly to protect and preserve Africa’s natural wonders and wildlife, making it an attractive destination for conscious travelers who want to support responsible tourism.

What to Know Before Traveling to Africa?

As a traveler, there are things to know before traveling to Africa , it is important to research and understand the cultural norms and customs of the specific countries you plan to visit, as these can vary widely across the continent. It is also essential to check the visa requirements and ensure you have all necessary vaccinations before your trip. Additionally, it is advisable to pack appropriate clothing for the climate and to be prepared for potential language barriers by learning a few basic phrases in the local languages. Last but not least, obtain reliable travel insurance and carry fresh U.S. dollars, which are broadly accepted across many parts of the continent.

What Are the Key Trends Driving Tourism Growth in Africa?

There are several key trends driving tourism growth in Africa. Here are some of the most significant ones:

Economic growth: Africa has experienced significant economic growth in recent years, leading to an increase in disposable incomes and a growing middle class. This has resulted in more people having the financial means to travel and explore their continent.

Improved infrastructure: Many African countries have invested in improving their infrastructure, including airports, roads, and hotels. This has made it easier for tourists to access and explore different destinations within Africa, attracting more visitors to the continent.

Political stability: Several African countries have achieved political stability in recent years, which has enhanced their reputation as safe and attractive tourist destinations. This stability has also led to increased investment in the tourism sector, further driving growth.

Diversification of tourism offerings: African countries are increasingly diversifying their tourism offerings beyond traditional wildlife safaris. They are promoting cultural tourism, adventure tourism, eco-tourism, and beach tourism, among others. This allows them to attract a wider range of tourists with different interests and preferences.

Digital connectivity: The rapid expansion of mobile phone and internet penetration in Africa has opened up new opportunities for tourism growth. It has made it easier for tourists to research and book their trips, as well as share their experiences on social media, which in turn promotes the destination to a wider audience.

Sustainable tourism: There is a growing focus on sustainable tourism in Africa, with many countries and organizations implementing measures to protect the environment and support local communities. This not only appeals to environmentally conscious travelers but also helps preserve the natural and cultural heritage of the continent for future generations.

Collaborative efforts: African countries are increasingly working together to promote tourism in the region. This includes joint marketing campaigns, visa facilitation agreements, and the creation of regional tourism organizations. These collaborative efforts help showcase Africa as a diverse and accessible destination, attracting more tourists to the continent.

These key trends are contributing to the growth of tourism in Africa, making it an increasingly popular and sought-after destination for travelers from around the world.

What Is the Overall Importance of Tourism for Africa?

The importance of tourism in Africa cannot be overstated. Tourism in Africa plays a significant role in the continent’s economic and social development. It has the potential to drive economic growth, create employment opportunities, and promote cultural exchange.

Africa is known for its rich history, diverse wildlife, and breathtaking landscapes, making it a desirable destination for tourists from around the world. The revenue generated from tourism contributes to infrastructure development, conservation efforts, and poverty reduction.

Furthermore, tourism promotes cultural understanding and fosters a sense of belonging among communities, as it encourages interaction between locals and visitors. By showcasing Africa’s unique heritage and natural wonders, tourism helps to raise awareness and appreciation for the continent’s rich cultural and environmental assets.

With these benefits in mind, it is crucial to explore the key potential benefits of tourism for Africa.

What Are the Key Potential Benefits of Tourism for Africa?

Tourism in Africa brings forth numerous potential benefits, including economic growth, job creation, and cultural exchange. By harnessing its tourism potential, Africa can experience significant economic growth.

The tourism industry contributes to foreign exchange earnings, stimulates investment in infrastructure, and boosts income generation for local communities. Moreover, tourism creates a wide range of employment opportunities, from tour guides and hotel staff to artisans and entrepreneurs. This not only reduces unemployment rates but also empowers individuals and communities.

Additionally, tourism promotes cultural exchange, allowing visitors to immerse themselves in African traditions, customs, and cuisine, fostering understanding and appreciation.

What Are the Key Challenges Facing African Tourism?

One major obstacle facing African tourism is the lack of adequate infrastructure. This includes transportation networks, accommodation facilities, and communication systems. Without proper infrastructure, it becomes difficult for tourists to navigate and access various African tourism destinations.

The absence of reliable transportation links and quality accommodations hinders the growth of the tourism sector. Additionally, the lack of effective communication systems makes it challenging for tourists to obtain information about African travel destinations. This deficiency in infrastructure also affects the promotion of African tourism through brochures and other marketing materials.

However, despite these tourism challenges in Africa , the continent’s tourism sector has immense untapped potential. By addressing the infrastructure gaps and investing in modernization, Africa can attract more tourists and fully capitalize on its natural beauty, cultural heritage, and diverse attractions.

What Are the Untapped Potentials in Africa’s Tourism Sector?

Africa’s tourism sector holds tremendous untapped potential, waiting to be explored and harnessed for economic growth and development. Despite being blessed with diverse landscapes, rich cultural heritage, and abundant wildlife, Africa is still yet to fully capitalize on its tourism resources.

According to African tourism statistics, the continent receives only a fraction of the global tourist arrivals. This presents a significant opportunity for African countries to tap into the untapped potential in their tourism sector.

By investing in infrastructure development, promoting sustainable practices, and enhancing marketing strategies, African countries can attract more tourists and generate increased revenue. Moreover, the development of niche markets such as eco-tourism, adventure tourism, and cultural tourism can further unlock the untapped potential in Africa’s tourism sector.

Harnessing these potentials will not only contribute to the economic growth and development of African countries but also showcase Africa’s unique and diverse offerings to the world.

How Does Tourism Contribute to the Economic Growth and Development of African Countries?

The industry of Tourism in Africa generates revenue, creates job opportunities, and stimulates investment in infrastructure development.

With Africa’s diverse natural and cultural resources, the potential for tourism development is high, and it can catalyze sustainable economic growth and poverty reduction in the region.

How Is the Tourism Development Going in Africa?

The growth and development of tourism in Africa have significantly contributed to the economic progress of the continent. Africa is home to some of the best tourist places in the world, attracting millions of visitors each year.

The top tourist places in Africa, such as the Serengeti National Park in Tanzania, the Pyramids of Giza in Egypt, and the Victoria Falls in Zambia and Zimbabwe, have played a crucial role in driving economic growth and development in their respective countries. These popular destinations have not only created employment opportunities for local communities but also generated revenue through tourism-related activities, such as accommodation, transportation, and souvenir sales.

Additionally, tourism has stimulated investments in infrastructure development, such as airports, roads, and hotels, further boosting economic growth.

However, while tourism has brought significant economic benefits, it has also had cultural and environmental impacts, which will be discussed in the subsequent section.

What Are the Cultural and Environmental Impacts of Tourism in Africa?

The cultural and environmental impacts of tourism in Africa can be significant. As the continent experiences an increase in tourist activities, it is important to consider the effects on both the local communities and the environment.

One positive impact is the promotion and preservation of cultural heritage. Tourism provides opportunities for local communities to showcase their traditions, customs, and arts, fostering a sense of pride and belonging.

Additionally, ecotourism in Africa has gained popularity, leading to the conservation of natural resources and wildlife habitats.

However, there are also negative impacts to be aware of Over-tourism can lead to cultural commodification and loss of authenticity, while improper waste management and infrastructure development can harm fragile ecosystems.

Stakeholders must implement sustainable practices and regulations to mitigate these impacts and ensure a harmonious coexistence between tourism and culture, as well as the environment.

What Are Some of the Main Types of Tourism in Africa?

Some of the main types of tourism in Africa include: Ecotourism: Africa offers diverse and unique ecosystems, making it an ideal destination for ecotourism. Countries such as South Africa, Kenya, Namibia, Rwanda, and Zambia are known for their ecotourism initiatives.

Historical Sites and Monuments Tourism: Africa is rich in history and is home to numerous historical sites and monuments that attract tourists interested in cultural and historical experiences. Tea Tourism: Some African countries, such as Rwanda, are known for tea tourism, offering unique experiences related to the tea industry.

Safari Tourism: African safari tourism is a significant draw for visitors, generating over $29 billion annually. Countries such as Kenya, Tanzania, South Africa, Botswana, and Namibia are popular safari destinations. These types of tourism cater to a wide range of interests, including nature and wildlife, history and culture, and wellness and medical services, making Africa a diverse and appealing tourism destination.

How Popular Are Safari Tours in Africa?

Safari tours in Africa are incredibly popular, attracting millions of tourists each year. The continent’s diverse wildlife and stunning landscapes make it a top destination for wildlife enthusiasts and nature lovers.

From the vast savannahs of East Africa to the dense rainforests of Central Africa, safari tours offer a unique and unforgettable experience that is worth every penny.

Is African Wildlife Tourism Worth to Experience It?

Absolutely.

African wildlife tourism offers a unique and captivating experience that showcases the continent’s rich biodiversity and natural wonders.

Safari tours, in particular, are incredibly popular among tourists, providing an up-close encounter with majestic animals such as lions, elephants, and giraffes in their natural habitats.

The thrill of witnessing these magnificent creatures in the wild is unmatched, making African wildlife tourism a truly unforgettable adventure.

What Are Some of the Top Tourist Destinations in Africa?

Africa is a vast and diverse continent with numerous top tourist destinations. Here are some of the most popular top tourist destinations in Africa : Mount Kilimanjaro, Tanzania – Known as the highest peak in Africa, Kilimanjaro offers breathtaking views and attracts adventure enthusiasts from around the world for its challenging hiking routes.

Kruger National Park, South Africa – A world-renowned safari destination, Kruger National Park is home to an array of wildlife, including the Big Five (lion, leopard, elephant, rhino, and buffalo). Visitors can embark on thrilling game drives to witness these majestic creatures in their natural habitat.

Victoria Falls – Located on the border of Zambia and Zimbabwe, Victoria Falls is one of the world’s largest waterfalls. The sheer power and beauty of the falls make it a must-visit destination, offering activities like white-water rafting, bungee jumping, and scenic helicopter rides.

Abu Simbel Temples, Egypt – These ancient temples, carved into the mountainside, are a UNESCO World Heritage site. The colossal statues and intricate hieroglyphics make Abu Simbel a remarkable historical and cultural attraction.

Boulders Beach, South Africa – Situated near Cape Town, Boulders Beach is famous for its colony of African penguins. Visitors can get up close and personal with these adorable creatures while enjoying the picturesque surroundings of granite boulders and pristine beaches.

When planning a trip to Africa, it’s important to consider the best times to visit the top tourist destinations. The timing can greatly impact your experience and the activities available to you.

What Are the Best Times to Visit African Destinations?

To determine the ideal times to visit African destinations, it is important to consider the region’s climate and seasonal variations. Africa is a vast continent with diverse landscapes, offering a wide range of tourist spots throughout the year. Each destination has its unique charm and attractions, making it difficult to pinpoint the absolute best time to visit.

However, there are general guidelines that can help travelers plan their trips. For example, if you are interested in wildlife safaris, the dry season (from May to October) is usually recommended, as it offers better opportunities for spotting animals. On the other hand, coastal destinations like Cape Town in South Africa or Zanzibar in Tanzania are popular during their summer months (December to February).

Ultimately, the best time to visit African destinations depends on your preferences and the specific activities you wish to partake in.

Now, let’s explore which African countries are the top choices for tourism.

Which Are the Top African Countries for Tourism?

Below are some of the top African countries for tourism : South Africa: Known for its diverse landscapes, wildlife safaris, and vibrant cities like Cape Town and Johannesburg.

Morocco: Famous for its rich history, ancient cities like Marrakech and Fez, and beautiful landscapes including the Atlas Mountains and Sahara Desert.

Tanzania: Home to the iconic Serengeti National Park, Mount Kilimanjaro, and the stunning Zanzibar archipelago, offering a wide range of wildlife, nature, and beach experiences.

Kenya: Renowned for its world-class safari destinations such as Maasai Mara and Amboseli National Park, as well as its beautiful coastline and cultural experiences.

Egypt: Boasting ancient wonders like the Pyramids of Giza and the Nile River, as well as vibrant cities like Cairo and Luxor, offering a blend of history, culture, and adventure.

Ghana: Known for its rich cultural heritage, historic sites like Cape Coast Castle, and beautiful beaches along the Gulf of Guinea, making it a great destination for history and beach lovers. When considering the top African countries for tourism, one important aspect to discuss is the safety of traveling for tourists. Safety is a major concern for travelers, and it plays a significant role in their decision-making process.

Therefore, it is crucial to examine the safety measures and precautions taken by African countries to ensure a secure and enjoyable experience for tourists.

How Safe is Traveling for Tourists in African Countries?

Safety is a significant concern for travelers, and it is essential to understand the safety measures in place in various African countries. While some regions in Africa may have security challenges, many countries like Ghana, Rwanda, and Namibia among others have taken significant steps to ensure the safety of tourists. It is crucial for tourists to research and plan their trips, including choosing reliable tour operators and staying informed about any travel advisories.

Despite safety concerns, Africa offers a plethora of incredible tourist sites, making it a popular destination for travelers. From the iconic landscapes of South Africa to the wildlife-rich plains of Kenya and Tanzania, and the historical wonders of Egypt, Africa is home to numerous popular tourist destinations that offer unique experiences for visitors.

Are There Specialized Travel Agencies for African Tourism?

Yes, there are specialized travel agencies for African tourism. These agencies offer tailor-made tours and travel experiences throughout the continent, catering to a wide range of interests and budgets. Some of the specialized travel agencies for African tourism include: Africa Travel: Africa Travel is a specialist luxury tour operator that hand-crafts authentic African holiday itineraries and exclusive travel experiences throughout the entire continent.

The Africa Specialists: The Africa Specialists is a small, specialist tour operator that tailor-made luxury African safari itineraries to the countries of East and Southern Africa.

African Budget Safaris: African Budget Safaris offers affordable safari tours and travel experiences throughout Africa, catering to budget-conscious travelers.

Wild Frontiers: Wild Frontiers offers adventure travel experiences throughout Africa, including safaris, cultural tours, and trekking expeditions. These specialized travel agencies have extensive knowledge and experience in African tourism, offering personalized services and unique travel experiences to their clients. When planning a trip to Africa, many tourists may wonder if there are specialized travel agencies that cater specifically to African tourism.

Finding reputable travel agencies in Africa can be a crucial step in ensuring a smooth and enjoyable travel experience.

In this section, we will explore how tourists can locate and choose reliable travel agencies that specialize in African tourism.

How Can Tourists Find Reputable Travel Agencies in Africa?

Finding reputable travel agencies for African tourism can be achieved through various methods.

One way is to search online for African travel agencies or African tour operators. Many reputable agencies have websites that provide detailed information about their services, itineraries, and customer reviews.

Another method is to seek recommendations from friends, family, or colleagues who have traveled to Africa before. They can provide valuable insights and suggest reliable travel agencies they have personally used and had a positive experience with.

Additionally, travel forums and review websites can help identify reputable agencies, as they often feature discussions and ratings from fellow travelers.

By utilizing these methods, tourists can ensure they are choosing trustworthy and reliable travel agencies for their African adventures.

Now, let’s move on to the next section to explore the availability of travel insurance companies in Africa.

Are There any Travel Insurance Companies in Africa?

Yes, there are travel insurance companies in Africa , as well as companies that offer insurance coverage for travelers visiting the continent from other countries. These companies provide coverage for tourists visiting the continent, offering peace of mind and protection against potential risks and expenses. Some of these companies include: World Nomads: World Nomads is a popular travel insurance provider that offers coverage for travelers visiting Africa, including medical emergencies, trip cancellations, and more.

Insubuy: Insubuy is another platform that allows travelers to compare and purchase travel insurance or travel medical insurance for their trips to African countries.

First Allied: First Allied is a travel insurance company that covers dangerous countries in Africa, offering coverage for various risks such as health issues, infectious diseases, accidents, injuries, assaults, muggings, and trip delays and cancellations.

Just Travel Cover: Just Travel Cover offers travel insurance policies that include COVID-19 coverage for destinations such as Mauritius, Morocco, South Africa, and Seychelles. These travel insurance companies provide coverage for various risks and emergencies, ensuring that travelers have peace of mind and protection while visiting African countries.

For travelers seeking reputable travel agencies in Africa, it is essential to consider the availability of travel insurance as part of their planning process. By obtaining travel insurance, tourists can ensure that they are adequately covered in case of medical emergencies, trip cancellations, lost baggage, or any unforeseen circumstances that may disrupt their travel plans.

Africa tour operators and African travel resources often work closely with these insurance companies to provide comprehensive travel packages that include insurance coverage. It is advisable for tourists to research and compare different insurance options to find the most suitable coverage for their specific travel needs.

What Visa and Travel Requirements Should Tourists Know About When Visiting Africa?

When visiting Africa, tourists should be aware of the visa and travel requirements for their specific destination. Here are some key points to consider: Visa Procurement: Visa and entry requirements for African countries are subject to change. While the majority of visas in Africa can be obtained at the border, it is essential to check with the consulate or a reputable visa-handling company for the most up-to-date visa information before traveling.

Passport Validity: Tourists should ensure that their passport is valid for at least 6 months from their planned date of entry into the country.

Visa Exemptions: Some African countries offer visa exemptions for certain nationalities. For example, New Zealand and South African passport holders do not require a visa to visit Botswana for up to 90 days, and most nationalities, including UK, USA, Canadian, Australian, New Zealand, and South African passport holders, do not require a visa to visit Namibia and South Africa for up to 90 days.

Special Requirements: Some countries have special requirements, such as South Africa, which has specific requirements for traveling with children. It is important to obtain the correct documentation to avoid any entry issues.

Health and Safety: In addition to visa requirements, tourists should also be aware of health and safety protocols, especially in the context of the COVID-19 pandemic. Many African countries have implemented strict health and safety measures, including temperature checks, social distancing, and the wearing of masks. It is advisable for tourists to research and confirm the specific visa and travel requirements for their intended African destination well in advance of their trip to ensure a smooth and enjoyable travel experience.

Now, let’s move on to the next section on how to plan your trip to Africa.

How to Plan Your Trip to Africa?

When planning your trip to Africa , it is essential to consider various factors to ensure a smooth and enjoyable experience. With its diverse landscapes, rich cultural heritage, and abundant wildlife, Africa offers a wide range of tourist destinations for every kind of traveler. Planning a trip to Africa can be an exciting and rewarding experience. Here are some steps to help you plan your trip:

• Determine your interests
• Choose your destination
• Research visa and travel requirements
• Book your flight
• Arrange accommodations
• Plan your itinerary
• Consider using a tour operator
• Get travel insurance
• Pack appropriate clothing
• Research local customs and culture

By following these steps, you can plan a memorable and enjoyable trip to Africa. Now, let’s explore some interesting facts and statistics about tourism in Africa.

What Are Some Interesting Facts and Statistics About Tourism in Africa?

Africa’s tourism industry has experienced significant growth in recent years, attracting millions of visitors from around the world. Here are some interesting facts and statistics about tourism in Africa : Tourism Growth: The number of international tourist arrivals in Africa doubled from 24 million in 1995-1998 to 56 million in 2011-2014.

Tourism Revenue: By 2030, consumer spending on tourism, hospitality, and recreation in Africa is projected to reach about $261.77 billion, which is $137.87 billion more than in 2015.

Tourist Arrivals: In 2018, Africa saw an increase of 2.4% in international tourist arrivals, with 69.9 million visitors (excluding Egypt and Libya). This growth rate was slightly lower than the global average growth rate of 6%. In 2021, inbound visitor numbers to Africa increased by nearly 15% over the previous year.

Tourism Share: Africa held a 4.4 percent share in worldwide tourism arrivals and accounted for a 2.3 percent share of worldwide tourism receipts in 2015.

Popular Tourist Countries: In 2015, Morocco was the only African country to surpass 10 million international tourist arrivals. Other popular countries for international tourists in Africa include Egypt, South Africa, Tunisia, Zimbabwe, Kenya, Uganda, Namibia, and Senegal.

Tourist Origins: Tourists in Africa mostly come from Europe and the US, with France being the number one source, followed by the UK and the US. These facts and statistics highlight the significant growth and potential of the tourism industry in Africa, as well as the diverse range of countries and attractions that the continent has to offer to international visitors.

How Does Africa’s Tourism Industry Compare to Other Continents?

The comparative strength of Africa’s tourism industry can be seen through its remarkable growth, diverse offerings, and significant economic impact.

While Africa may not rank as high as other continents in terms of tourist arrivals, it has been steadily climbing the ranks in recent years. While Africa’s tourism industry is still developing, it holds significant potential and demonstrates promising growth trends:

Growth Rate: Africa boasts the second-fastest growing tourism industry globally, trailing only Asia-Pacific.

Economic Impact: Tourism contributes a substantial 5.9% to Africa’s GDP in 2022 and employs around 13.1 million people in 2012 according to the World Bank.

Global Share: Although Africa held a 4.4 percent share in worldwide tourism arrivals and accounted for a 2.3 percent share of worldwide tourism receipts in 2015 according to UNCTAD, this number is steadily increasing.

Emerging Markets: Within Africa, domestic tourism is flourishing, with African tourists themselves becoming a driving force in the industry.

What’s the Role of Technology in Shaping African Tourism?

Technology plays a significant role in shaping the tourism industry in Africa. With the advent of the digital age, African countries have embraced technology to showcase their unique attractions and experiences to a global audience.

One of the key ways technology has facilitated this is through the rise of African travel bloggers and travel blogs. These platforms have become a powerful tool for promoting African destinations, as they offer firsthand insights, recommendations, and personal experiences that resonate with travelers seeking authentic and immersive experiences.

African travel bloggers have harnessed the power of social media and online platforms to reach a wider audience, showcasing the diverse landscapes, rich cultures, and vibrant communities that make Africa a must-visit destination.

Through technology, African tourism is being shaped by these influential voices, creating a sense of belonging for travelers seeking to explore the continent.

How Does the Vibrant Africa’s Music, Art, and Culinary Scene Enhance the Overall Tourism Experience?

The vibrant music, art, and culinary scene in Africa enriches the overall tourism experience, offering visitors an authentic immersion into the continent’s cultural heritage.

Africa’s diverse and vibrant music traditions, ranging from traditional drumming and dance rituals to modern genres like Afrobeats, captivate tourists with their infectious rhythms and soulful melodies.

Art enthusiasts are drawn to Africa’s thriving art scene, which showcases a rich tapestry of styles and techniques, reflecting the continent’s history, traditions, and contemporary issues.

The culinary scene in Africa is equally enticing, with a wide array of flavors, spices, and techniques that vary from region to region. From the aromatic spices of North African cuisine to the fiery flavors of West African dishes, visitors can embark on a gastronomic journey that tantalizes their taste buds.

The African Tourism Association and Travel Africa Magazine are valuable resources for travelers seeking information and recommendations on the best music, art, and culinary experiences across the continent.

What Is the History of Tourism in Africa?

Tourism in Africa has witnessed steady growth, driven by increasing global interest in exploring the continent’s diverse landscapes and rich cultural heritage.

The history of tourism in Africa can be traced back to the colonial era when Europeans began to explore the continent for its vast resources and exotic wildlife. However, it was not until the mid-20th century that tourism started to gain momentum in Africa.

The establishment of national parks and protected areas, such as the Serengeti National Park in Tanzania and Kruger National Park in South Africa, played a significant role in attracting tourists.

In 1975, the African Travel Association was formed to promote tourism in the region and showcase the unique African tourist spots.

Today, Africa is known for its iconic landmarks like the Pyramids of Egypt and Victoria Falls, drawing visitors from all over the world.

As we delve into the prospects and trends for tourism in Africa, it is evident that the continent’s abundant natural beauty and cultural heritage will continue to attract travelers seeking authentic experiences and a sense of belonging.

What Are the Future Prospects and Trends for Tourism in Africa?

Moving forward from the history of tourism in Africa, we now turn our attention to the prospects and emerging trends in the industry on the continent.

Africa has immense potential to become one of the most sought-after tour destinations in the world. With its rich cultural heritage, diverse landscapes, and unique wildlife, Africa offers a captivating experience for travelers.

The African Travel and Tourism Association (ATTA) plays a crucial role in promoting and developing tourism in the region. It works closely with governments, tour operators, and local communities to ensure sustainable and responsible tourism practices.

The future of tourism in Africa looks promising, with an increasing number of international tourists showing interest in exploring the continent. As infrastructure and connectivity improve, Africa is poised to attract more visitors, generating economic growth and creating opportunities for local communities.

In conclusion, tourism in Africa has experienced significant growth and has become a prime destination for travelers worldwide. The continent attracts a large number of visitors annually, generating substantial revenue.

The vibrant music, art, and culinary scene in Africa further enhance the tourism experience. These cultural expressions provide unique and immersive opportunities for tourists to engage with the local communities and experience the rich diversity of African cultures.

With the role of technology shaping the industry, tourism in Africa is set to benefit from advancements in digital platforms and online booking systems. This will make it easier for travelers to access information, plan their trips, and connect with local tour operators.

Furthermore, the rich history of tourism in Africa adds to its appeal. From the ancient pyramids of Egypt to the historic sites of South Africa, the continent offers a wealth of archaeological and cultural landmarks that attract history enthusiasts from around the world.

Considering these factors, the prospects and trends for tourism in Africa are promising. As infrastructure continues to improve, accessibility increases and sustainability practices are prioritized, the continent has the potential to become an even more popular and sought-after travel destination.

Like a blooming flower in a vast garden, Africa’s tourism industry is poised to flourish and continue captivating travelers with its natural beauty, cultural richness, and warm hospitality.

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7 most visited African countries by international tourists, according to latest available stats

• Business Insider Africa presents 7 African countries with the highest international tourist arrivals.
• This list is courtesy of statistics made available by the United Nations World Tourism Organisation.

Tourism is quite the revenue driver for many African countries. However, the sector has taken a major hit over the past two years, no thanks to the Coronavirus pandemic.

Recommended articles

At the height of the global health scare in 2020 and even through to 2021, virtually all African countries were forced to shut down their land and sea borders as part of a global restrictions on travel aimed at curtailing the spread of virus. Unfortunately, this measure had inevitably shut down global tourism. And billions of dollars were lost in the process.

READ: 5 conflict hotspots in Africa and how their economies have been affected

To show just how severe the pandemic's impact on Africa's tourism sector was, we obtained statistics from the UN World Tourism Organisation which show that international tourism receipts (i.e., expenditures by international visitors in Africa) dropped significantly by 62.7% from $39 billion in 2019 to $14 billion in 2020.

But there is some good news. According to the UNWTO's tourism recovery tracker, international tourist arrivals in Africa stood at 69% as of January 2022. Travel restrictions across the continent have also dropped to 9.43% from a high of 84.91% in June 2020.

READ: 5 oldest hotels in Africa and current booking prices

This is not to say that everything is back to normal. As a matter of fact, the number of international tourist arrivals in Africa is still very abysmal compared to pre-pandemic levels.

Based on available data from the UNWTO, a total of 18.5 million international tourists visited Africa in 2021 compared to 68.2 million in 2019. This is indicative of a 72.9% decline year on year.

READ: Top 10 hottest countries in Africa in 2022

Based on the 2021 stats, below are the seven African countries with the highest international tourist arrivals. Now, it is important to bear in mind that the UNWTO emphasized that its ranking is subject to change, as time lapses and more updates become available.

• South Africa: A total of 2.3 million international tourists arrived this country in 2021.
• Tanzania: A total of 900, 000 international tourists arrived this country in 2021.
• Ethiopia: A total of 500,000 international tourists arrived this country in 2021.
• Reunion: A total of 300, 000 international tourists arrived this country in 2021.
• Eswatini: A total of 200, 000 international tourists arrived this country in 2021.
• Seychelles: A total of 200, 000 international tourists arrived this country in 2021.
• Mauritius: A total of 200, 000 international tourists arrived this country in 2021.

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Role, structure and effects of medical tourism in Africa: a systematic scoping review protocol

John jo mogaka.

Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa

Joyce M Tsoka-Gwegweni

Lucia m mupara, tivani mashamba-thompson, associated data.

bmjopen-2016-013021supp001.pdf

Introduction

Some patients travel out of, while others come into Africa for medical care through a growing global phenomenon referred to as medical tourism (MT): the travel in search of medical care that is either unavailable, unaffordable or proscribed at home healthcare systems. While some castigate MT as promoting healthcare inequity, others endorse it as a revenue generator, promising local healthcare system strengthening. Currently, however, the understanding of this component of healthcare in Africa is inadequate. This study seeks to determine the level of knowledge on the role, structure and effect of MT in Africa as it relates to healthcare systems in the region.

Conduct a systematic scoping review to outline the role, structure and effect of MT in Africa. Databases: Academic Search Complete, Business Source Complete. Studies mapped in two stages: (1) mapping the studies based on the relevance of their titles and subject descriptors; (2) applying further inclusion criteria on studies from stage 1. Two reviewers will independently assess study quality and abstract data. Both quantitative and qualitative data analysis will be performed, using STATA V.13 and NVIVO, respectively.

Ethics and dissemination

The study results will be disseminated by publication in peer-reviewed journals and findings presented at academic and industry conferences related to MT, public health, health systems strengthening and tourism.

MT spurs cutting-edge medical technologies, techniques and best practices in healthcare delivery. The two-tier healthcare landscape in Africa, however, presents an exceptionally unique context in which to situate this study. Much has been written about MT globally, but not much is known about the phenomenon in Africa; hence the appropriateness of this scientific assessment of MT in the region. By elucidating the role, structure and effect of this phenomenon, this study hopes to contribute to health systems strengthening in Africa.

PROSPERO registration number

CRD42016039745.

Strengths and limitations of this study

• This study offers the ‘big picture’ analysis of medical tourism (MT) in Africa by synthesising vast amounts of literature on the subject.
• The scoping review approach offers an ideal platform for synthesising literature on MT in Africa whose methodological approaches, settings, study populations and behaviours are wide ranging.
• This approach of synthesising literature, however, presents a limitation in that a detailed analysis of case-specific interventions and quality assessment of individual studies is not applicable.
• As the study will only include literature published in English, studies published in other languages will be omitted. However, research shows that almost 70%–90% of published works are in English. This fact invariably minimises the adverse effects of searching publications written only in English.
• To our knowledge, there is paucity of scientific study on MT in Africa. While this may be a possible limitation in terms of the amount of data for this scoping review, it may be an important finding of this study and a basis for calling for more research in the area.

Africa is concurrently a source and destination of patients who form part of a global phenomenon referred to as health tourism or medical tourism (MT), 1–4 the practice of travelling abroad to consume healthcare that is either too delayed, unavailable, unaffordable or proscribed at own home countries. 1 5

MT challenges the role played by traditional, nation–state-bound healthcare delivery systems. Public health core functions of assessment, policy development and assurance with regard to the health of citizens within the nation-state are fundamentally affected by developments and expansion of MT. 6 7

On the one hand, MT affords patients individual solution to what is traditionally considered a government concern, health for its citizens, 8 thereby, arguably, creating more equitable healthcare options for individuals. The wealthy middle class in Africa, for instance, regularly seek advanced medical care abroad. 9

Conversely however, MT can indicate a breakdown of service delivery at home health systems. Patients may lack confidence in the ability of home health systems to meet their medical needs and move abroad in relatively large numbers. 6 10

Whereas MT may pose potentially attractive economic benefits to most governments, especially in Africa, it may particularly prove challenging to local health systems, whose officials may be tasked with both its regulation domestically and promotion internationally, while at the same time grappling with risks such endeavours pose to the national health system. 8

Specialised medical services and procedures offered to medical tourists include elective, non-elective and diagnostic as depicted in figure 1 .

However, current availability, pricing and geodistribution of these procedures and services in Africa is not sufficiently known.

Principally, MT entails highly trained and experienced physicians, high-tech medical equipments and specialised ultra-modern medical facilities. Some African countries are said to have invested in or attracted ample pool of specialist physicians in quality private hospitals whose medical facilities are similar to the ones in developed countries. 9 Costs associated with these MT infrastructure are substantial. 11 Similarly, MT is said to cause competition for best local resources including qualified medical professionals 11 12 and transplant organs. The accrued benefits to the local host population, in turn, is however, not well-known.

Many arguments have been advanced for and against MT in most LMICs, including Africa. 11 figure 2 summarises these advantages and disadvantages.

Advantages and disadvantages of medical tourism in Africa. (Source: adapted from Bookman and Bookman). 11

The extent and dimension of these pros and cons in as far as healthcare systems in Africa are concerned, however, is inexact. 2 5 8 11 13–16

The role and effects of MT in Africa need to be investigated and documented in the face of Africa’s two-tier healthcare systems, with a relatively efficient private, juxtaposed with a relatively overburdened public medical care sector.

MT services are primarily provided by the private sector and payments are mostly out of pocket. Whereas private healthcare providers have little incentive to consider population-wide and -based services, the public at large must be served through public health interventions focused on the health needs of the entire population or population groups. Individual healthcare, population health and public policy decisions must, therefore, be premised on best available evidence to avoid poor and inappropriate interventions. 3 14 16–19 However, for MT in Africa, this is clearly difficult because of paucity of scientific evidence on the subject. Moreover, even with the available evidence, the information generated from individual studies may be biased, methodologically flawed, time and context constrained, resulting in conflicting conclusions. This does not allow MT in Africa to be understood well. 20 Hence, the necessity and justification for this scoping review, whose purpose is to assess current level of knowledge on MT in Africa with specific reference to Africa’s healthcare systems; by systematically reviewing available literature on the subject. The study will focus on MT flows out of, into and within Africa.

In this study, we take Africa geoscheme approach used by the African Union and United Nations in dividing the region directionally 21 :

• North Africa lies north of the Sahara and runs along the Mediterranean coast.
• West Africa excludes Northern Africa and the Maghreb and includes the large portions of the Sahara Desert and the Adamawa Mountains.
• East Africa stretches from the Horn of Africa to Mozambique, including Madagascar, Seychelles and Mauritius.
• Central Africa is the large mass at the centre of Africa which either does not fall squarely into any other region or only partially does so.
• Southern Africa consists of the portion generally south of −10° latitude and the great rainforests of Congo.

The main aim of this study is to outline the role, structure and effect of MT in Africa as it relates to Africa’s healthcare systems by answering the following specific questions:

• What is published about Africa’s MT infrastructure: the availability, pricing and geodistribution of specialised medical procedures and services offered to medical tourists in Africa?
• Who are the main MT actors in Africa, as identified in the literature?
• What are the identified effects of MT on healthcare systems in Africa?
• What are the identified ethical issues associated with MT in Africa?

The study will employ Arksey and O’Malley scoping review framework as well as incorporate recent scoping review suggestions by Levac et al . 22 23

Identification of relevant studies

Multiple terms are used to refer to MT in literature. Evidence indicate that while literature on MT is generally growing, it is mostly focused either on individual case studies or specific aspects of MT. 10 Therefore, an extensive list of primary and secondary search terms will be developed. Search terms will include: MT, stem cell tourism, fertility tourism, dental tourism, health tourism and transplant tourism, among other terms with Africa as the bounding parameter. The university librarian will help in finalising the keyword and search strategy in this study. Attempt will be made to obtain relevant documents that are not readily available through concerned authors or publishers.

Academic databases : Academic Search Complete, Business Source Complete, PsycARTICLES (EBSCO), PsycINFO (EBSCO), Health Source—Consumer Edition, Health Source—Nursing/Academic Edition and Sabinet.

Search engines : Google and Google Scholar.

Relevant MT industry associations, Organisation for Economic Co-operation and Development, WHO, World Bank and other multilateral organisations’ websites will be used to search for government reports, practice guidelines and industry reports.

Relevant research dissertations will be searched through WorldCat via Online Computer Library center(OCLC) and reference list scanning of included studies.

Search strategy

The databases selected will cover a broad range of disciplines to ensure sensitivity. Search queries will be tailored to specific requirements for each database. For academic databases, keywords will be combined using Boolean operators (AND, OR, NOT). A snowball technique will be used to find related works.

However, since this will be an iterative process, the detailed search strategy will be documented in the analysis and write up of the full review.

Researchers will keep an updated record on dates and the numbers of publications identified during each session of literature search using a search records table 24 as shown in table 1 .

Electronic search record (source: adapted from Mashamba-Thompson et al ) 24

Study selection (screening)

A two-stage screening process will be used to assess the relevance of studies identified in the search. Two reviewers will independently evaluate and apply the identified selection criteria to candidate literature titles and abstracts. Titles and abstracts will be screened as ‘include’, ‘exclude’ or ‘uncertain’. Full text of articles screened as ‘uncertain’ will be reviewed by the third reviewer for verification against the inclusion criteria. During the first stage, only the title and abstract of citations will be reviewed to preclude articles that do not meet the minimum inclusion criteria. A title and abstract relevance screening form will be developed and pretested on a convenience sample of 10 academic citations to evaluate reviewer agreement. A kappa calculation will be done based on the results of this pretest. This will in turn be used to show the reviewers’ inter-rater agreement level. Generally, a kappa score over 0.8 is considered a high level of agreement. 25 In accordance with recommendations by Levac et al , 23 after reviewing every batch of 20 to 30 publications, the reviewers will meet to resolve any conflicts and ensure consistency with the research question and purpose.

Executive summaries in grey literature will be treated as abstracts. Relevant titles whose abstracts are not available will be taken to screening stage 2 for full review. During screening stage 2, reviewers will independently screen the rest of the search results using the predefined inclusion–exclusion criteria. Any ensuing discrepancies will be resolved by discussion or the involvement of the third reviewer.

To capture and present the screening process, the Preferred Reporting Items for Systematic and Meta-Analyses flow diagram in figure 3 will be used.

Preferred Reporting Items for Systematic and Meta-Analyses flow diagram. # stands for number. (Source: adapted from Moher et al ). 47

Inclusion criteria

• Evidence published in English.
• There will be no publication date restrictions up to 06 June 2016.
• Literature with substantial focus on MT in Africa including: peer-reviewed journal articles, systematic reviews, scoping reviews, meta-analysis and rapid reviews, government and non-governmental organisation reports and academic dissertations.
• Research focusing on MT in low-income and middle-income countries and whose conclusions and discussion demonstrate transferable findings to African settings.
• All study designs will be considered including qualitative, quantitative and mixed-methods studies.
• Studies focusing on healthcare provision through specified bilateral or multilateral government agreements in Africa.

Exclusion criteria

• Evidence focusing on MT outside Africa and whose results are non-transferable to African settings.
• Evidence focusing on people forced to seek emergency medical care in conflict or postconflict settings as opposed to organised medical travel in non-conflict settings.
• Evidence with focus on emergency medical care for conventional tourists.
• Evidence where medical care provision to medical tourists is not explicitly differentiated from the day-to-day provision of healthcare offered to the general public.
• Evidence with main focus on wellness tourism.

Charting the evidence (data abstraction)

After title and abstract screening, successful candidate citations will be exported to endnote bibliographic dataset for subsequent full-text review. Endnote library application will be used to discard any duplicates. A data abstraction spreadsheet will be developed collectively by the reviewers to extract predetermined variables and themes. Structuring this spreadsheet database will involve selecting and defining data categories and subcategories, as advised by the MT conceptual framework. 20 It will be secured online so that involved reviewers will have access and can make updates freely.

Bibliographic details, study design, number of participants, intervention(s), comparison(s), study setting, funding source and conclusions for the primary and secondary outcomes of interest will be extracted. This dataset will be populated from each selected paper. This step will be done iteratively as more familiarity of literature is gained and revisions done as appropriate. See online supplementary appendix I for the data extraction form.

Risk of bias (quality) assessment of individual studies

Methodological quality of quantitative, qualitative and mixed-method primary studies will be assessed using the Mixed Methods Appraisal Tool. 26 Studies will not be excluded on account of low-quality scores, but quality scores will be reported and considered in the narrative synthesis of the evidence.

Collating, summarising and reporting the data

The extracted data will be summarised and presented. This is in line with the purpose of a scoping review which is geared towards establishing the scope of the current evidence, summarising the results as presented across articles and not synthesising or distilling specific results. 22 23 27 The data will be analysed accordingly to address the main aim and the four specific study questions. Further to this, the study team will scrutinise the meanings of the findings as they relate to overall purpose of the study, discuss the implications for future research, practice and policy.

Data analysis will employ both quantitative and qualitative methods.

After the coding and validation of the spreadsheet file, the data will be exported into STATA V.13 for analysis. Descriptive statistics will be used to summarise the data. Frequencies and percentages will be used to describe nominal data. A basic statistical account of the amount, type, and distribution of the studies included in the review will be presented.

Also, a thematic analysis and concept map of the results will be presented. Thematic analysis will be carried out using NVIVO research software.

This analysis will generally answer questions like: how large is the literature on MT in Africa (number of papers), when was it published (age), where was the research conducted (geographic distribution), at what scale and by whom (geographic/institution); where, when and by whom research was published; the geographical spread of the research; types of methods used; types of subjects examined; types of variables measured; different disciplines assessing the topic and patterns found in research results. We will use statistical means to produce tables and charts that depict cross-tabulations like: MT in Africa as it relates to study designs used, type of treatments, medical facilities and selected patient characteristics (such as age, sex, geography, ethnicity).

MT is different from medical care administered to conventional tourists in need of emergency medical care. Unlike the latter, the former specifically refers to ‘foreign patients’ who travel abroad for the express purpose of obtaining medical care. 16 MT is defined as a set of socioeconomic activities carried out either by or for medical tourists. 28 The activities carried out by medical tourists correspond to the travel of patients in search of health services outside the jurisdiction of their home health systems, 20 while those carried out for them correspond to attempts on the part of destinations to attract international patients by promoting their healthcare services and facilities. 20 Although there is no standard meaning that is assigned to it, the term ‘tourism’ could refer to the measures taken by destination countries (supply side) to attract and meet the needs of international patients. The term could also refer to the tourism channels the medical tourist uses to get to the destination countries.

In light of the above, therefore, evidence with focus on emergency medical care for conventional tourists will be excluded.

This study will include literature on formal bilateral and multilateral medical care agreements that enable patients to be attended to in other countries, but exclude those papers that focus on ‘forced’ cross-border medical care, especially if public health facilities of destination countries are ‘forced’ to provide the care on humanitarian grounds. Such conditions exist especially in conflict and postconflict zones.

Evidence on MT that is global in outlook will be included in-as-far-as its findings are relevant to Africa and its healthcare systems. Relevance will be informed as progressive familiarity with literature is gained in the study.

Africa presents an exceptionally unique and fascinating context in which to situate this MT study. This is because of the stark contrast in the African healthcare landscape: whereas MT demands highly specialised medics, capable of executing most complicated surgeries, clad in advanced medical technologies and luxury, specialised hospitals; Africa, on the other hand, has a large local population enduring rudimentary health, insufficient clean water and inadequate sanitation.

To our knowledge, this is the first systematic scoping review that attempts to expound on the role, structure and effects of MT as it relates to healthcare systems in Africa. Most MT evidence on Africa is emergent and multidisciplinary in nature, hence the critical necessity of a scoping review to map the range of extant evidence and systematically identify research gaps to more clearly illumine the role, structure and effects of MT in Africa.

It is anticipated that while findings from this study will lead to clearer understanding of MT in Africa, they will also contribute to the resolving of paradoxical healthcare issues in the region. The needs of ‘foreign’ patients may be prioritised over those of locals, especially if economic incentives over weigh public health considerations, thereby unfairly shifting resources towards the development of more expensive clinical interventions that cater for exclusive few, while promoting healthcare inequity. 6 8 29 For instance, reproductive tourism uses expensive and non-routine medical expertise to bring new children into this world, 30 31 yet yearly, malaria, pneumonia and other preventable infections kill millions of under-fives in Africa. 32 33

MT is promoted as a solution to healthcare queues in some parts of the world. 1 9 11 13 15 34 Able-to-pay patients opt to fly to Africa to avoid these long queues to get faster service. But, in sharp contrast, local patients are forced to experience similar long queues in oversubscribed and underfunded local health systems. 9 33 35–38

Some literature suggest that MT has been growing globally. 11 39 40 This growth, however, seems to be based solely on MT advantages to medical tourists, short-term economic rent for destination economies and profits to care providers. Medical tourists benefit from preferential treatment based on their ability to pay for medical services. 20 Destination countries benefit in revenue generation. 11 41 42

Motivated by these benefits, many African countries are competing for the global MT dollar. 43–45 Unfortunately, MT in most of these countries is based on unsustainable, haphazard regulatory frameworks. 46

Given its potential contextual significance, it is imperative that a scientific reconnaissance study be carried out on MT in Africa. This scoping study is, therefore, an attempt to do this by providing more information about MT in Africa to policy makers, healthcare providers, potential patients and future researchers. This study will therefore o contribute to improved healthcare systems in Africa.

Supplementary Material

Acknowledgments.

We would like to thank the College of Health Sciences, University of KwaZulu-Natal for providing support in carrying out this study. Furthermore, we would like to thank Duke Magwaza, UKZN librarian, for his support in database search strategy.

Contributors: JJOM and JMTG conceptualised the study and developed the background. LMM and JJOM prepared the draft of the research proposal. JJOM and TMT designed the study and contributed to developing methods relating to review and synthesis of data. All authors planned the output of the review, reviewed draft versions of the manuscript and approved the final version of the manuscript.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

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Statistics on " Tourism industry in South Africa "

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