Destination Management of Health Tourism based on Forest Medicine Programs - Nataša Milić, Milica Ilinčić & Tamara Gađanski

Destination Management of Health Tourism based on
             Forest Medicine Programs

              Nataša Milić, Milica Ilinčić & Tamara Gađanski
                       MSc in Tourism Management

This paper is based on the extended case study of Serbia that was presented at the Conference in Budapest on the topic of Wellbeing
Traditions and Health Tourism combined with conceptual model of destination competitiveness developed by previous researchers
(Crouch and Richie, Dwyer and Kim). Medical tourism is in its infancy, local residents seem to be using spas less than their parents and
grandparents, and very few foreign tourists visit Serbian spas at present, therefore it is important also to consider other forms of healing
and health tourism in Serbia, such as authentic Serbian wellness programme and forest bathing therapy.

The multiplicity of players involved in the supply and delivery of tourism services make destination management more complex
compared to the management of simple products by single firm, therefore destination competitiveness theory has been the focus of past
research in the tourism field (Crouch, 2007). Crouch and Richie began to study the nature and structure of destination competitiveness
in 1992, and based on that Dwyer, Mellor, Livaic, Edwards and Kim (2004) also undertook to contribute to the development of a general
model of destination competitiveness (figure 1).

                                            Figure 1. Model of Destination Competitiveness

                                                                                    Dwyer et al (2004)

The primary elements of the model include resources comprising endowed resources, both ‘natural’ (e.g., mountains, coasts, lakes, and
general scenic features) and ‘heritage’ (e.g., handicrafts, language, cuisine, customs, etc.) resources; created resources (such as tourism
infrastructure, special events, shopping, etc.); and supporting resources (such as general infrastructure, accessibility, service quality,
etc.). Destination management is the second core component of their model comprising government and industry. Their model then
shows resources and destination management interacting with tourism demand and situational conditions to influence destination
competitiveness and socio-economic prosperity (Crouch, 2007, 2).

SWOT Analysis of Forest Medicine Programs in Serbia based on Model of Destination Competitiveness
 Strengths                                                Weaknesses
Existing natural and heritage resources                           Weak created and supporting resources

•        Region of Serbia represents an important European        •       With a growing trend of healthier eating, Serbian nutrition has
biodiversity centre and a global centre of plant diversity.       been greatly criticized for its reliance on large quantities of oil and fat
Forests occupy 29% of Serbian territory and a number of           and excessive consumption of meat and meat products (Dulović, 2013).
endemic species found in them is quite high (Ministry of          Thus cuisine has very slowly started to adapt to these trends and some
Environment and Spatial Planning, 2011).                          are looking for healthier variations of the traditional meals.
•        Water-based traditions in Serbia are based on the        •       As already stated there are over 50 thermal and climatic health
thermo-mineral springs, traditional healing and rehabilitation    resorts in Serbia with variety of mineral water springs, natural mineral
programs which are the base for today’s potential                 gasses, medicinal mud and so on. Unfortunately, only around 5% of
development of “Medical Spa” and “Mineral Springs Spa”            these capacities are used. Many Serbian spas lack investments for
tourism products which are defined in the tourism strategy of     improvement of their services and infrastructure. Thus, their full
the Republic of Serbia (2005). There are over 50 health           capacities remain unused and Serbian spa tourism stays undeveloped.
institutions and spas in Serbia, and the quality of the thermal   •       Traditionally, spas are considered as places where elderly and        Deleted: older
water was known throughout history and was used for               people with poor health condition would go to treat their illnesses and       Deleted: s
treating many diseases (Serbian Spa Association, 2014)            find relief. However, modern way of life and contemporary trends seek
•        Ethno villages and farms (salaš) are oases of peace in   for modernisation of these traditional spa centres and treatments and are
which people are able to relax and enjoy the local food, drinks   putting more accents on prevention, healthy lifestyles and wellness           Deleted: to
and the music of local musicians. All the food that is offered    programmes. Only a number of Serbian spas have managed to follow
to the guests is fresh and naturally grown and recipes are        these trends and bring innovation to their offer, while others are still
traditional and unique. Food preparation certainly occupies       facing many difficulties in achieving this and filling their capacities.
an important part of the Serbian family tradition (Popović,       Main reasons for this are relatively little or no investment in maintenance
Timotijević, & Ristović, 2011). Ethno villages and farms          of spa resorts and construction of complementary guests’ infrastructure
offer a number of activities such as picking fruits, vegetables   and lack of product innovation (Berber, Gajić and Đordević, 2010;
and medicinal herbs, mowing, donkey and horse racing,             Isailović, 2010).
colourful festivals and traditional events, mountain biking,      •       Weak quality of supporting infrastructure (accessibility)
tractor races, culinary courses, making bread in a traditional
way, folklore classes, and ancient customs and handicrafts        Demand and situational conditions
workshops.
•        Looking at the Serbian traditional medicine its          •        In modern culture in Serbia with emphasis on an aesthetic and
greatest application can be found in nutrition and prevention     attractive look (forever young and slim) cosmetic surgery (e.g.
of illnesses with healing through domestic ingredients, such      liposuction) is a quick way to correct consequences of the wrong way of
as food, herbs and mineral waters. It also includes non-          living. Furthermore, using cosmetic surgery individuals are trying to
invasive healing techniques, such as massages, healing with       hide the natural process of aging and unhealthy lifestyle. Although
hands as well as prayers and visitation of holy places            wellness and fitness movements are not supportive to instant corrections,
(Republika Srbija, Ministarstvo zdravlja, 2009).                  some wellness centres have ordinations of plastic surgery so they could

•        Practising sports was always part of the Serbian         adapt to all demand needs (Isailović, & Matić, 2006, 12). There are many
tradition which is connected with national events, contests,      beauty salons in Serbia and it is common for women to regularly go to
games and activities of the community. Rounds are played in       different treatments in beauty salons therefore demand for this type of
the squares or streets when celebrating a holiday or slava        tourism is weak. Spending time in forests in not very popular among
(traditional Serbian family celebration).                         Serbian population compared to other Balkan countries as shown in the
                                                                  Balkan Wellbeing research.
Opportunities                                                     Threats
•        Serbia has a great potential for development of forest   •        Increased competitiveness in the surrounding countries with
spa and wellness programs, given the unspoiled quality of its     better accessibility (flight connections, road infrastructure) and quality
forests.                                                          of life
•        Demand increase in the long term period. Nowadays,       •        Afeja Association started the development of health tourism as a
workshops and courses on spirituality have been on the rise.      product after it was defined as a tourism product and one of the tourism
Even spa hotels and resorts have been organizing “special         priorities by the Serbian Law in Tourism in 2009. Afeja created an Afeja
weeks” over the past few years. Those weeks are organized         Club which has linked medical institutions, travel agents and law firms
by professionals and devoted to particular themes such as         on a contractual basis in order to provide quality health and tourism
yoga, dealing with stress, nicotine withdrawal, etc. These        services. Their experience is that foreigners are coming to Serbia in
events are also known as “spa retreats” (Isailović and Matić,     search of cheaper medical services, well-qualified staff and high-quality
2010). A great example of the spiritual dimension of Serbian      private health facilities. All medical services that can be found in Serbia
wellness is a meditation while lying on hay which gently          are presented on the Serbian Medical and Health tourism website               Deleted: a hay
massages the body.                                                (Serbian Medical and Health tourism, 2014). Some of the most popular
•        Good prospect for further development of alternative     medical services for tourists mostly coming from the United Kingdom,
tourism activities, as wellness concept has developed in          USA, Italy and Switzerland are dental surgeries, eye treatments and
Serbia over the last decade first in mountain and spa resorts,    cosmetic plastic surgeries (Todorović, 2010). Therefore recognizing
but also in cities with numerous day city spa and wellness        Serbia as a health tourism destination with developed Forest hamam
centres. Nowadays wellness programs are offered in many           programs and not cheap medical services might be a challenge.
hotels and beauty centres.
•        Alternative healing methods officially recognized by
the Serbian Ministry of Health in 2005 are: ayurveda,
acupuncture, quant medicine, traditional Chinese medicine,
macrobiotics, applied Kinesiology, reflexology, sectional
therapy, Su Jok, tuina, phytotherapy, homeopathy, shiatsu
and traditional domestic medicine (Republika Srbija,
Ministarstvo zdravlja, 2009)

Conclusion

It is recommended for Serbia to rely on its unspoiled nature, its biodiversity and its unique culture and traditions in developing new and
alternative spa tourism products. Forest hamam programs have already been developed by MSPAAS which invite people to explore
Serbian rich forest environments in order to improve their overall health condition. Moreover, from 2003, High Medical College of
Professional Studies in Belgrade has included education of future wellness and spa professionals in their study program. Students of this
College with the support of Medical SPA association of Serbia (MSPAAS) experts have developed a unique concept called Authentic
Serbian Wellness. Serbian Wellness concept has been greatly promoted through promo video broadcasted on National Television and
through various publications and conference/meeting proceedings presenting its benefits both for guests and suppliers. The concept has
been included in tourist offer of some of the Serbian ethno and rural households, but importance of standardization has been outlined
with MSPAAS scientific team as a leading consulting subject. From 2012 R&D team of MSPAAS has been also developing programs
of Serbian outdoor wellness and medical SPA programs through the Forest hammam project inspired by Prof Dr Mufit Zeki Karagule.
The term forest bathing emerged in Japan in the ‘80s and represents quiet walking and discovering with all the senses open to forest
sounds, smells, colours and its vibrant biodiversity (Spafinder, 2015). In comparison to Japan where forests are thick and dark, Balkan
forests are much lighter with sun beams passing through treetops just like sun lightens hararet in traditional hammams through its roof
openings. That is why Prof Karagule was inspired to name Forest baths in Balkan – Forest hammams. In recent years MISPAAS has
organised numerous programs with a goal to investigate, measure and present effects of the authentic outdoor medical SPA programs
such as “Shumadian Forest hammam”, “Cigota Cross SPA golden pine forest hammam” and “Tara hammam as 75+, ageing well
program” that combine phytoncides, heliotherapy, mineral springs water, zero distance food, tradition and heritage of the Serbian people,
on participants’ health. These pilot investigations showed that there is measurable positive effect of authentic forest hammam medical
SPA programs on the holistic health of the attendants. Currently there is an initiative of founding a Centre for development of health
tourism based on forest bathing programs whose main role would be to establish educational, R&D, promotional and other programs
with the aim of popularizing forest tourism. These programmes can be combined with accommodation in authentic ethno-villages and
farm settlements. In fact some of the ethno Serbian households already offer raspberry massages and other services of authentic Serbian
wellness concept. It is important that these alternative spa programs do not require much investment and promote carbon neutral tourism
and sustainable development while also educating tourist on natural and cultural beauties of Serbia and their preservation. However,
greater support of official institutions in Serbia as well as greater management and marketing of such products is needed for them to
achieve wider acceptance.

Bibliography

Berber, N., Gajić, T. and Đordević, M (2010). Management and Development Possibilities for Spa Tourism in Serbia. Journal of
Tourism, 9 (9), pp. 33-39.
Bojanin, S. (2013). Lečenje biljem u srednjovekovnoj Srbiji. Osnovni pregled. Annual of Socail History, pp. 7-34.
Ceperković, Z. (2005). Srpska medicina u srednjem veku. Vrnjačka banja.
Crouch, Geoffrey I. (2007). Modelling destination competitiveness a survey and analysis of the impact of competitiveness

attributes, http://www.sustainabletourismonline.com/awms/Upload/Resource/bookshop/Crouch_modelDestnComp-web.pdf (accessed
24th April, 2016).

Dwyer, L., R. Mellor, Z. Livaic, D. Edwards and C. Kim (2004). Attributes of Destination Competitiveness: A Factor Analysis. Tourism
Analysis 9(1-2), pp. 91-101.

Dulović, V. (2013). Belgrade in Your Hands. Belgrade: Komshe.
Đorđević, T. (1984), Naš narodni život, knjiga 4, pp. 27-34, Beograd: Prosveta.
Hadžić, A. (2013). Welness i seoski turizam u svetlu etnologije i antropologije. Diplomski rad, Univerzitet u Beogradu, Filozofski
Fakultet, Odeljenje za etnologiju i antropologiju.
Isaliović, G. and Matić, B. (2006). Vodič kroz Wellness: Razvoj Wellness-a u Srbiji. Beograd.
Isailović, G. and Matić, B. (2010). Welness u Srbiji. Beograd: Happy Fitness Studio.
Katić, R. (1981). Poreklo srpske srednjovekovne medicine. Beograd: Srpska akademija nauka i umetnosti.
Katić, R. (1989). Hilandarski medicinski kodeks. Beograd: Narodna biblioteka Srbije.
Katić, R. (1990). Medicinski spisi Hodoškog zbornika. Beograd: Narodna biblioteka Srbije.
Marjanović, S., and Popović, D. (2004). Privatni život u srpskm zemljama srednjeg veka. Beograd: Klio.
Medical & Wellness Tourism (2010). Impressive entrance to the industry. News and analysis for the medical & wellness tourism
industry, 4, pp. 4, www.zdravstveniturizam.com/content/media/mwt_eng.pdf (accessed 18th October, 2015).
Ministry of Environment and Spatial Planning (2011). Biodiversity Strategy of the Republic of Serbia for the period 2011 – 2018,
www.cbd.int/doc/world/cs/cs-nbsap-01-en.pdf (accessed 21st October, 2015).
Popović, M., Timotijević, M., and Ristović, M. (2011). Istorija privatnog života u Srba. Beograd: Klio.
Republika Srbija, Ministarstvo zdravlja. (2009). Tradicionalna medicina, www.zdravlje.gov.rs/showpage.php?id=193 (accessed 4th
July 2014).
Republic of Serbia (2005). Tourism Development Strategy, www.dgt.uns.ac.rs/download/ektur04v.pdf (accessed 20th July 2014).
Serbian Medical and Health tourism (2014). About, www.serbia.medicalhealth-tourism.com/about (accessed 10th July 2014).
Spafinder (2015). Forest Bathing, http://content.spafinder.com/forest-bathing (accessed 20th October 2015).
Stupar, D. and Panov, I. (1994). Hilandarski medicinski kodeks - ishodište farmacije u Srba. Arhiv za farmaciju 44 (1-2), pp. 62-63.
Todorović (2010). Stranci dolaze u Srbiju na jeftinije lečenje, www.zdravstveniturizam.com/content/media/iz_blica.pdf (accessed 4th
September 2015).
Trojanović, S. (1896). Starinska srpska jela i pića. Beograd: Srpska kraljevska akademija.

Vizantološki institut. (1986). Vizantijski Izvori Za Istoriju Naroda Jugoslavije VI. Beograd: SANU.
Vujović, M. (2008). Spravljanje prirodnih rakija. Beograd: Zlaja.