The holistic approach of ayurveda based wellness tourism in kerala

INTERNATIONAL JOURNAL OF ADVANCED RESEARCH
International Journal of Advanced Research in Management (IJARM), ISSN 0976 – 6324
IN MANAGEMENT (IJARM)
(Print), ISSN 0976 – 6332 (Online), Volume 3, Issue 2, July-December (2012)

ISSN 0976 - 6324 (Print)
ISSN 0976 - 6332 (Online)
Volume 3, Issue 2, July-December (2012), pp. 29- 39
IJARM
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Journal Impact Factor (2012): 2.8021 (Calculated by GISI)
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THE HOLISTIC APPROACH OF AYURVEDA BASED WELLNESS
TOURISM IN KERALA

RAMESH U*, KURIAN JOSEPH**
* Research Scholar, Faculty of Management, NIMS University, Jaipur, Rajasthan.
e-mail: rameshtrivandrum@rediffmail.com

** Research Guide, NIMS University, Jaipur Rajasthan & Associate Professor, St.Dominics
College, Kanjirappally, Kerala

ABSTRACT

The striking feature of healthcare industry in India is its potential to grow at a much faster rate in
the foreseeable future. In this prevailing situation, Health Tourism has emerged as a separate
industry with incredible potential. Health/Wellness tourism refers to trips that are taken by
tourists with the principal purpose being to improve their health and/or wellbeing. Today, once
again, promoting the healthful and health-care benefits of a destination is gaining popularity
because tourism marketers need ways to differentiate their products. Kerala can tap this trend by
highlighting its unique health care products. The State, almost synonymous with the word
'Ayurveda', is now all set to reap the benefits of the same through Wellness tourism. Kerala has
the advantage of worldwide recognition, as it has been included in the list of the ten must-see
destinations by the National Geographic Traveler. Wellness, in general, is used to mean a healthy
balance of the mind, body and spirit that results in an overall feeling of well-being. The concept
of health holiday, now better known as Wellness holiday, is based on the principles of Ayurveda,
meditation, yoga, physical exercises and a balanced diet. It is like rejuvenation and clean up
process on all levels - physical, mental and emotional. Ayurveda deals elaborately with measures
for healthful living during the entire span of life and its various phases. Besides, dealing with
principles for maintenance of health, it has also developed a wide range of therapeutic measures
to combat illness. In order to cope with the growing demand for wellness, resorts, hospitals,
medical practitioners and Government have taken ample measures to promote alternative health
care in Kerala. Along with the projects already underway, there is a need to draw up plans for
promotions in future. The present paper investigates the reasons why Kerala is now pioneering as
an alternative healthcare destination and the main objective is to analyze the reason as to why
Kerala is being chosen as a preferred destination for Wellness Tourism. An attempt is made to

29


study the market potential and strategies adopted for Kerala to emerge as the most sought after
Wellness tourism destination in the Globe.

Keywords : Ayurveda, Destination, Health tourism, Wellness.

OBJECTIVES AND METHODOLOGY

The present study enquires into the current infrastructure and the market potential of Ayurveda
based wellness tourism offered at Kerala in attracting International medical tourists. A set of
questions were employed to interview the Ayurvedic medical practitioners who were working in
reputed wellness resorts. A total of 60 respondents were chosen as the survey sample from
among the 250 wellness providers (both certified and non-certified) in the State. The districts
chosen were Thiruvananthapuram, Kollam, Alappuzha, Kottayam and Idukki. Of these, 17
questionnaires were incomplete as the doctors were not willing to share their real and sincere
comments and hence were discarded. Thus, 43 usable questionnaires were finally entered into
the research analysis and interpretation stage. Earlier studies carried out in the field were
analyzed and it reveals that a striking gap exists in the field of research in this highly potential
but understudied area. Related data were collected from the Directorate of Tourism, Govt. of
Kerala, Kerala Tourism Development Corporation, Govt. Ayurveda College
Thiruvananthapuram, Directorate of Indian Systems of Medicine, reputed and classified wellness
resorts in the private sector as well as from the published research reports on health tourism.
Simple random sampling has been adopted in interviewing the wellness providers from the
selected locations.

AYURVEDA BASED WELLNESS TOURISM IN KERALA

Tourism is an important economic activity and continues to be the fastest growing sector and
hence is typically included among the top three industries in the country. Although India has
progressed a lot since the fifties with respect to tourism, the country is still way behind the
developed or even the developing countries. India earns one seventh of China, one fourth of
Indonesia and less than half of Philippines from tourism in comparison. Kerala is the foremost
state in India that realized the potential of Ayurvedic health tourism and has widely marketed it
throughout the state. About 10-12 years back, Kerala started with the task of promoting
Ayurveda on a larger scale. It is estimated that about 30% of the foreigners coming to Kerala
avail themselves to Ayurvedic care and about 40% of the State’s tourism revenue is generated
from the same. Table 1 indicates the top 10 States/Union Territories in India regarding foreign
tourist’s arrivals from 2006 to 2009

30


Table 1: Foreign Tourist Arrivals to India- Top 10 States/UT

Sl No State 2006 2007 2008 2009
1 Delhi 1974836 1995123 2339287 1958272
2 Maharashtra 1712302 1762005 2056913 1969992
3 Uttar Pradesh 1328974 1396932 1610089 1532573
4 Tamil Nadu 1319501 1338521 1594680 1534787
5 Rajasthan 1220164 1250056 12677646 1073414
6 West Bengal 998029 1024220 1133671 1080418
7 Andhra Pradesh 669617 69732 789180 795173
8 Karnataka 505524 555798 571846 614316
9 Kerala 428534 468480 598929 609880
10 Goa 380414 416355 433375 444576
Source: India Tourism Statistics – 2009

Kerala – The mesmerizing land located in the south of India enjoys geographical features that are
unique and rich. This state is also the only place in India which practices Ayurveda in its purest
form. Ayurveda is the traditional Indian system of medicine that has brought true health,
happiness and wellbeing to millions of individuals throughout the ages. This ancient art of
healing has been in practice for over 5000years, and was also the mainstream medicine in the
ancient times. Derived from its ancient Sanskrit roots – ‘ayus’ (life) and ‘ved’ (knowledge) – and
offering a rich, comprehensive outlook to a healthy life, it is the only medical science in this
universe which is useful even when one is not ill. Ayurveda is a complete science of health that
is being applicable in all stages of life starting from birth, neonates, infants, childhood, youth, old
age and even life before and after death. For many people, the image of Ayurveda is limited to
the use of herbal or home/kitchen remedies and a traditional way of treatment. But in reality,
Ayurveda is a much serious medical science, which strongly emphasizes on the diagnosis,
examination, analysis of the disease, diet, medicinal properties, dose, frequency of the medicine
and the medium with which it should be consumed. The Medicare in Ayurveda has broadly two
parts: one is preservation of health and prevention of diseases and the second, diseases and their
treatment. In Ayurvedic terminology, the first is “Swasthavritha” and the later is “Athuravritha”.
Ayurveda follows a totally different way of treating diseases known as “Panchakarma”, which
means literally “Five Therapies” which are the subtly harmonizing purification procedures that
dissolve metabolic waste products and toxins generated from the environmental ill effects, in a
gentle and effective way from the tissues and eliminate them from the body. This treatment is
advisable to the diseased as well as the healthy. Ayurveda also has a comprehensive system of
massages and body treatments that gives relief from a wide range of illnesses, from migraine and
sinus to arthritis and paralysis; that detoxify and cleans the body through controlled emesis,
purgation, making the individual sweat; and that makes the body receptive to further treatment.
These therapies are more effective in Kerala due to the almost year around humid climate of the
state. Ayurveda extends excellent treatments for ailments like Osteo-Arthritis, Rheumatic
Arthritis, Tennis Elbow and Carpel Tunnel Syndrome, Spondylosis, Intervertibular disc prolapse,
Frozen Shoulder, Insomnia, Migraine, Skin Diseases and of course Weight management. From
the past two decades, the necessity for a holistic approach in the treatment of diseases had been
an active topic for discussion among the scholars of modern medical sciences. As a system of
medicine that completely eliminates the disease from the body without causing any side effects,

31


and which ultimately promotes the basic health, Ayurveda stands atop the alternative systems of
treatments recognized by the World Health Organization. Many foreign countries have already
started Kerala Ayurveda treatment centers and the export of Ayurvedic medicines to
international market is increasing in a faster pace day by day. But, to the surprise, foreign tourists
are often just as keen to visit the origin of the practice to avail treatments and body purification
processes. The basic principles emerging from a holistic outlook, the peculiar and unique
techniques of treatments, and the health promoting and non reactive herbal drugs used are the
main elements which differentiate Ayurveda from the other prevailing medical systems.

The Kerala government realizes that it is of vital importance to offer assurance to its wellness
seeking guests and visitors to the state that safety, hygiene, service quality and quality assurance
are top priorities. This is to be achieved through the introduction of quality standards,
registration, certification and regulation, and legislation. The comprehensive plan also includes
guidelines and measures to ensure fair pricing. Beyond a competitive pricing strategy, achieving
quality is another key to Kerala's competitiveness. The ability to attain international standards
and consistently deliver high quality products and services are critical success factors in the
promotion of Kerala products on the global market. Kerala, as part of its marketing strategy,
continuously organizes road shows all around the world for the promotion of Ayurveda along
with modern medicine. It is vitally important to create confidence in the products Kerala offers.
There is much greater awareness and operators have come to realize that delivering quality
translates into greater business efficiency, lower operating costs and increased profits.

RESEARCH ANALYSIS

The first part of the questionnaire dealt with the location of the Wellness centre, qualification of
the respective medical practitioner employed and whether the centre possessed any certifications.
The percentage distribution of the sample according to selected variables is shown in the table 2
below.

Table 2: Percentage distribution of the sample according to selected variables
Count Percent
Qualification BAMS 37 86.0
of Doctor MD 6 14.0
Nil 17 39.5
Certification Govt. Approved 7 16.3
possessed by Green leaf 8 18.6
the centre Olive leaf 9 20.9
ISO 2 4.7
Alappuzha 4 9.3
Idukki 12 27.9
District Kollam 7 16.3
Kottayam 4 9.3
Thriruvananathapuram 16 37.2

32


• Among the 46 wellness centers, 37 employed Doctors with BAMS as their qualification
and 6 centers had Doctors with Post Graduation.
• Among the 46 wellness centers 9 were certified with olive leaf, 8 with Green leaf, 7
centers were Government approved and 2 possessed ISO certification while 17 lacked
any certifications.
• The district wise distribution was:-Thiruvananthapuram – 16, Idukki – 12, Kollam – 7,
Kottayam and Alappuzha with 4 each.
Certification by competent authorities were considered as the bench mark deciding factor for the
respective Wellness centers and various aspects were analyzed using statistical tools to check
the reliability, significance and validity.

Destination
The destinations chosen for the study were located either in a Beach or River/Lake/Wetland,
Forest/Rain forest or Mountain. The comparison of destinations in which the selected Ayurvedic
resorts are situated is shown in the table 3 below.

Table 3: Comparison of destination based on certification

No Yes Total
Destination p#
Count Percent Count Percent Count Percent
Beach 6 35.3 21 80.8 27 62.8 p<0.01
River, lake, wetland 3 17.6 5 19.2 8 18.6 p>0.05
Forest/rainforest 3 17.6 0 0.0 3 7.0 p>0.05
Mountain 6 35.3 3 11.5 9 20.9 p>0.05

The statistical test employed was Fishers Exact Test and the comparison is shown in the above
table. It indicates that 62.8 % among the wellness centres were located in destinations near
beaches, 20.9% in destinations near Mountains, 18.6% in destinations near river/lake/wetland
and 3% in destinations near forests. 80.8% of wellness centres located in beaches possessed
certifications by competent authorities. The results displayed in the table prove that certification
is a significant factor only for Ayurvedic wellness centres located near Beaches.

Number of staff employed

The total numbers of staff employed in the wellness centres were classified into three groups:
less than 10, between 10 and 15, and greater than 15. The comparison of the average number of
staff members employed in the selected wellness centres in shown in the table 4 below

Table 4: Comparison of number of staff based on certification
Number of No Yes Total
χ2 p
staff Count Percent Count Percent Count Percent
<10 10 58.8 2 7.7 12 27.9
10 – 15 6 35.3 12 46.2 18 41.9
15.43** 0.000
>15 1 5.9 12 46.2 13 30.2
Mean ± SD 11.1 ± 11.2 16.5 ± 5.2 14.3 ± 8.4

33


41.9% among the total had their respective number of staff between 10 and 15 irrespective of the
possessing of certification. Considering the certified centres, 46.2% had staff numbers between
10 and 15 and equally 46.2% had staff numbers greater than 15. 58.8% of the wellness centres
without any certification had less than 10 numbers of staff. Analyzing the significance, the
number of staff between 10 and 15 only proves to be valid.
Open to all Categories
A question was asked to the respective official to know whether the services provided at the
wellness centre were made available to all categories of tourists. It was noticed that the Ayurveda
dispensaries and hospitals owned by the State Government provides treatment and medicare only
to the Indian nationals. The table 5 below shows the comparison on whether the services are
open to all categories of tourists.

Table 5: Comparison of open to all categories of Tourists based on certification
Whether open to all No Yes Total
p#
categories of Tourists Count Percent Count Percent Count Percent
Yes 15 88.2 15 57.7 30 69.8
p<0.05
No 2 11.8 11 42.3 13 30.2

69.8% among the total wellness centres irrespective of the possessing of certification provides
medicare services to all categories of medical tourists. When analyzed based on certification,
57.7% of the certified centres were open to all categories and 88.2% of the uncertified centres
were open to all categories of tourists. Hence the option ‘Yes’ was found significant.
Patient Accommodations
The total number of patients who could be accommodated in the wellness centre to provide
consultation and treatment were classified into three groups. Less than 10, between 10 and 15,
and greater than 15. Whether the particular centre possessed any certification by the competent
authority was considered as the bases for comparison. The comparison and the respective result
is shown in the table 6 shown below.

Table 6: Comparison of maximum no: of patients accommodated at a time based on certification
Max. no of patients No Yes Total
accommodated at a Count Percent Count Percent Count Percent χ2 p
time
<10 10 58.8 3 11.5 13 30.2
10 - 15 6 35.3 21 80.8 27 62.8
11.04** 0.004
>15 1 5.9 2 7.7 3 7.0
Mean ± SD 12.5 ± 23 11.7 ± 3.6 12 ± 14.5
**: - Significant at 0.01 level

A total of 62.8% of the wellness centres irrespective of the possessing of certification could
accommodate between 10 to 15 patients at a time. When analyzed based on certification, 80.8%
among the centres could accommodate between 10 and 15 number of patients and 58.8 % among
the centres without any certification could accommodate only less than 10 patients at a time. The
number of patients between 10 and 15 was found significant at 0.01 levels.

34


Method of Fixation of Price.
The method of fixation of prices and costs of medicare services is an issue of great concern.
Based on the realities, the same could be classified into two categories. The first one is that the
prices are standard and the patient could know it before his/her arrival and availing of the
services. The second category says that the prices are fixed after the arrival and availing of
services by the patient. The table 7 below shows the comparison and analysis of the same.

Table 7: Comparison of method of fixation of prices based on certification

Method of fixation of No Yes Total
p#
prices Count Percent Count Percent Count Percent
It is standard. Patient
know it before
p<0.05
arrival 8 47.1 21 80.8 29 67.4
It is fixed after arrival 9 52.9 5 19.2 14 32.6
# : Fisher's Exact Test

A total of 67.4% of the resorts fix the prices and costs as standards. The patient who is willing to
avail medicare could know the same well in advance. When the data were compared based on
certifications, 80.8% among the certified wellness centres have standard pricing strategies while
52.9% of the wellness centres without certification fixes the prices and charges after the arrival
and availing of services by the patients. On statistical analysis, the method of standard price
fixation proves to be significant when compared based on certifications.

Implementation of Treatments and Therapies

The design and implementation of therapies at the wellness centres could be grouped into three
categories. Mostly the doctors will diagnose the patient and based on the report he shall design
the therapies and treatment plans. Sometimes, if a patient with ample knowledge on Ayurveda
comes as a patient, he shall inform the doctor in advance regarding his requirements and the
doctors and masseurs just follow the same. The third category is that the doctor and the patient
will discuss and will mutually discuss and arrive at the treatments plan to be implemented. The
comparison of the mode and delivery of treatments based on whether the wellness centre
possesses certification and the respective statistical analysis is shown below in table 8.

Table 8: Comparison of mode and delivery of treatments based on certification

Mode and delivery of No Yes Total
p#
treatments Count Percent Count Percent Count Percent
As per the diagnosis
report the doctor will
schedule 1 5.9 12 46.2 13 30.2 p<0.01
As instructed by the patients 0 0 0 0 0 0
Both 16 94.1 14 53.8 30 69.8
# : Fisher's Exact Test

35


Totally, in around 69.8% of the wellness centres, the treatments are carried out based on the
mutual agreement between the doctors and the patients while in 30.2%, the treatments are strictly
carried out as per the instructions and plans of the doctors alone. When analyzed based on
availability of certifications, 53.8% of the centres implemented the same based on mutual
consultation and 94.1% of the wellness centres without any certification implemented treatments
based on mutual discussions. Fishers Exact test was carried out to measure the significance.

Patient’s knowledge on Ayurveda
Analysis was conducted in order to measure the awareness of the patients availing Ayurveda
treatments in the respective wellness centres prior to their arrival to Kerala. The comparison and
the respective analysis is shown in the table 9 below.

Table 9: Comparison of patients have adequate knowledge about Ayurveda before arrival based on
certification

Patients have No Yes Total
adequate knowledge Count Percent Count Percent Count Percent χ2 p
about Ayurveda
before arrival
NA 3 17.6 0 0.0 3 7.0
Yes 11 64.7 22 84.6 33 76.8 5.21 0.157
No 3 17.6 4 15.4 7 16.3

In total, around 76.8 % of the patients availing medicare in both certified and non certified
wellness centres possessed adequate knowledge about Ayurveda and other alternative wellness
therapies prevailing and practiced at Kerala. When analyzed based on certification, around
84.6% of the patients residing at certified centres possessed prior and adequate knowledge on
Ayurveda and around 64 .7% of the patients at non certified centres too had prior awareness. The
analysis and significance of the answers based on chi square test is displayed in the above table.

FINDINGS AND SUGGESTIONS

Kerala, the state almost synonymous with the word 'Ayurveda', is now all set to reap the benefits
of Ayurveda through health tourism. The reason for this is the popularity of Ayurvedic
treatments and the manner in which Kerala is marketing Ayurveda in medical tourism.
International patients seeking medical services across borders or globally look at more than just
cost comparisons in their search for the right physician and right facility to address their specific
needs. The top priorities include
1. Credentials – recognized international accreditations & certifications.
2. Experience – board certified doctors, training, years of experience.
3. Patient References – patient testimonials, before & after pictures.
4. Specific Treatment Methods – uniqueness of center & procedures offered.
5. Comprehensive Solution – provide complete solution to a treatment.
6. Reputation – locally as well as internationally e.g., publications, research papers.
7. Language – effectively communicate in patient’s preferred language.
8. Geographic Location – local conveniences, transportation services, attractions.

36


9. Cost – clear price list, services included in the package, pricing options.
10. Benchmark Data – any comparative information that will convince patients.
The promotion of Ayurveda in health tourism started in 1994 and the Kerala Tourism
Development Corporation (KTDC) started Ayurvedic health centers in its premium properties
like Hotel Samudra, Kovalam, during the same period. KTDC has tied up with the most reputed
Ayurveda treatment providers and hence the authority of doctors and the quality of the medicines
used are not compromised. While all the hotels and resorts in Kerala have now started including
Ayurveda in their services, there are some resorts, which are exclusive for Ayurvedic treatments.
With a view to facilitate the wellness tourism industry to achieve the targets and to give a greater
momentum for this growth, the Ministry of Tourism, Government of Kerala, in association with
the Department of Indian Systems of Medicine (ISM) has identified an urgent need to evaluate
the safety and service standards of the prevailing and newly establishing Ayurveda centers and
classify them accordingly. Standards have been set in terms of Personnel – Qualified physicians
and masseurs having sufficient degree and training from recognized Ayurveda institutions,
Quality of medicines and Health programmes – Prior approval by the advisory committee for
the levels of treatments, clear exhibition of the treatment programmes offered and usage of
medicines manufactured by approved firms with proper labeling, Equipments – Standards are
fixed for the size and make of massage tables, facilities for medicated hot water , sterilization,
electric/ gas stove and the hygiene , Facilities - in terms of number of treatment rooms with
prescribed size , proper ventilation and attached bathrooms, quality and finishing of floors and
walls, consultation room with proper equipments, separate rest rooms, locality , ambience and
the cleanliness of surroundings. Ayurvedic centers fulfilling all the mentioned essential
conditions are awarded a certification named Olive Leaf. Apart from the same, Government has
also set some optional conditions in terms of the construction and architectural features of the
building, adequate parking space, facilities for steam bath, separate hall for yoga and meditation,
herbal garden attached to the center and the picturesque location. The Ayurveda centers also
fulfilling these optional conditions will awarded Green Leaf. The Department of Tourism does
not take responsibility of any centre, which is not classified in either of the above categories.
Table 10 shows the distribution of Government classified Ayurvedic health centers in Kerala.
Table 10: Distribution of Classified Ayurvedic Health Centers in Kerala
District Govt. Approved Ayurvedic Centers
Thiruvananthapuram 24 ( Green Leaf:15, Olive Leaf: 9)
Kollam 9 ( Green Leaf:5, Olive Leaf: 4)
Pathanamthitta 2 ( Green Leaf:0, Olive Leaf: 2)
Allapuzha 6 ( Green Leaf:6, Olive Leaf: 0)
Kottayam 11 ( Green Leaf:9 Olive Leaf: 4)
Idukki 6 ( Green Leaf:5, Olive Leaf: 1)
Ernakulam 19 ( Green Leaf:8, Olive Leaf: 11)
Thrissur 12 ( Green Leaf:5, Olive Leaf: 7)
Palakkad 3 ( Green Leaf:1, Olive Leaf: 2)
Kozhikod 6 ( Green Leaf:5, Olive Leaf: 1)
Wayanad 2 ( Green Leaf:1, Olive Leaf: 1)
Kannur 2 ( Green Leaf:0, Olive Leaf: 2)
Total 104 ( Green Leaf:59, Olive Leaf: 45)
Source : Kerala Tourism Statistics

37


With the destination firmly established as the 'Wellness Capital of Asia', achieving world-class
status is next on the national agenda. Kerala is the foremost state in India that realized the
potential of Ayurvedic health tourism and has widely marketed it throughout the state. About 10-
12 years back, Kerala started with the task of promoting Ayurveda on a larger scale. It is
estimated that about 30% of the foreigners coming to Kerala avail themselves to Ayurvedic care
and about 40% of the State’s tourism revenue is generated from the same. The Kerala
government realizes that it is of vital importance to offer assurance to spa guests and visitors to
the state that safety, hygiene, service quality and quality assurance are top priorities. This is to be
achieved through the introduction of quality standards, registration, certification and regulation,
and legislation. The comprehensive plan also includes guidelines and measures to ensure fair
pricing. Beyond a competitive pricing strategy, achieving quality is another key to Kerala's
competitiveness. The ability to attain international standards and consistently deliver high quality
products and services are critical success factors in the promotion of Kerala products on the
global market. Kerala, as part of its marketing strategy, continuously organizes road shows all
around the world for the promotion of Ayurveda along with modern medicine. It is vitally
important to create confidence in the products Kerala offers. There is much greater awareness
and operators have come to realize that delivering quality translates into greater business
efficiency, lower operating costs and increased profits.

CONCLUSION

The Indian tourism industry has outperformed the global tourism scenario in terms of growth,
revenue and the volume of international tourist visits. A recent trend has shown that people from
developed countries are seeking treatment from the health professionals from developing
countries. The destination in wellness tourism is often an alternative space in which one can
engage in self analysis without the stresses and distractions of home as well as work place. In the
long run, Wellness tourism can become the niche for foreign revenue generation as there is an
increasing trend in the number of visitors to Kerala as wellness seekers. The study reveals that
the most favourable factor for Kerala to emerge as the Global Wellness Hub is its authenticity
and rich Ayurvedic heritage with multifaceted attractions. Marketing Kerala as a safe quality
wellness destination depends on effective distribution channels, hospital-defined market niche
strategies, as well as data collection on the sources of information used to select Kerala as the
preferred medical destination.

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The holistic approach of ayurveda based wellness tourism in kerala

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