Sanford Health announced last week new clinic and research ventures in Costa Rica, Ireland, New Zealand, South Africa and Vietnam as the South Dakota-based health system expands its global presence. The goal is not financial gain, but collaborations that are focused on expanding access to care in some cases and research partnerships in others, says Dr. Dan Blue, executive director of Sanford World Clinic. The latest additions mean the South Dakota-based health system's global division will now have operations in nine countries with more than 30 locations. Sanford Health is one of the larger hospital and clinic operators in the Upper Midwest, with operating income of $151 million on $4.4 billion in revenue for the fiscal year ending in June. Based in Sioux Falls, the health system includes 10 hospitals in Minnesota.

Q: Are there any similarities between health care in the Upper Midwest and the countries where Sanford World Clinic operates?

A: We serve an area that's considered the frontier in the United States — across broad geography and more sparsely populated rural areas. The developing countries and even developed countries, they face challenges in delivering care to their citizens in some of the rural and more remote places. We feel that that's an area where we have focused our energy, and are able to share some things with them.

Q: The newly announced partnerships range from research projects in Ireland and South Africa to clinical care in Costa Rica. What's happening in New Zealand and Vietnam?

A: In Vietnam, we are partnering with Victoria Health System in Ho Chi Minh City. Our approach is around shared learning and making the educational resources of Sanford Health available to physicians, management, nursing and staff. We are working with them to elevate their levels of efficiency, quality, and professional skills and capabilities. … In New Zealand, we are working with our partner Omni Health through a joint venture to open a primary care clinic in downtown Auckland, New Zealand. Through our partnership we have the opportunity to expand primary care across the country.

Q: In terms of clinical care, what does Sanford Health offer these other countries?

A: Being from the Upper Midwest, we tend to have bought into the concept of integrated health care delivery systems. In Minneapolis, you have the same. When we do that [integrated system], we actually have much more coordinated care — eliminating waste, efficiencies that are gained with that.

In many of these systems that are developing in other parts of the world, those are critical things.

Q: How did Sanford World Clinic get started?

A: It was one of several initiatives that were laid out as a result of a major philanthropic gift that we received from Denny Sanford back in 2007. We really wanted to learn how health care was delivered not only in other parts of the United States, but also other places in the world. And tied to that, we wanted to understand firsthand how health care was financed and paid for in different countries. In the United States, we're continuing to evolve and look for solutions to how to deliver health care here in our country.

Q: Any other motivations?

A: The second one was really around brand and reputation. Let's face it, many people don't know where South Dakota is or who Sanford Health is. We frankly feel that we have a story to tell, and that we have something to say and we want to offer that up. We need to get our name out there — it helps expand our reputation and our brand through our actions.

Q: For years, patients from around the world have visited the Mayo Clinic in Rochester for care. Is part of the goal at Sanford Health to attract international patients to the Upper Midwest?

A: We strive to deliver care that's as close to home as possible. … Our goal is not to take from countries.

If there was a third reason, it would be around — we really value building relationships and partnerships. … It's been amazing to see how those relationships open the doors to further opportunities and further projects.

Q: Sanford Health doesn't have an unlimited sum of money to put toward this. Is part of the goal to make sure these programs cover their costs?

A: We do have money that we put in on the front end. But it is one of those requirements that we look at. Our goal is to get these to a sustainable position in a four-year period of time. …

It's a challenge. Like in Ghana, Africa, the average payment for a doctor's visit, the lab and the prescription is around $6 or $8 for a visit. You have to become very creative to figure out how we can deliver quality care and services and fit the financial obligation in that country.

Q: What's next for the world medicine program at Sanford?

A: Our expectation over the next 10 years is that we'll be growing anywhere from three to five relationships per year.