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South Dakota-based Sanford Health is launching new clinic and research ventures in Costa Rica, Ireland, New Zealand, South Africa and Vietnam as it expands its global presence.

The new operations rolled out Tuesday mean that the Sanford World Clinic division will now have operations in nine countries with more than 30 locations.

In November, Sanford Health announced its first international hospital investment by acquiring a minority stake in a medical center in Germany.

“This is not something we are pursuing for financial gain, but we believe this type of collaboration will help further our mission of health and healing,” said Sanford Health CEO Kelby Krabbenhoft in a statement.

Sanford Health did not disclose financial terms for any of the partnerships.

The health system is one of the larger operators of medical centers in the Upper Midwest, with 44 hospitals and nearly 300 clinics in nine states. For the fiscal year ending June 30, Sanford posted operating income of $151 million on $4.4 billion in revenue.

In Costa Rica, Sanford said it will provide strategic and operational support to the country’s growing Hospital Metropolitano health system. The country has an emerging middle class that wants better access to care, since the state-run Costa Rican health system is struggling to keep up with demand, said Dr. Dan Blue, the executive vice president of Sanford World Clinic.

Blue said there’s a similar dynamic in Vietnam, where Sanford is collaborating with Victoria Healthcare on clinical and education programs.

“I do think across the globe we are seeing an emerging middle class,” Blue said in an interview. “And we’re seeing an interest or a desire among people to invest in health, whether that’s through insurance or a private health care system.”

Sanford is not alone in sizing up the health care market in Latin America. In December, Minnetonka-based UnitedHealth Group announced a $2.8 billion deal to acquire a health plan and health care company operating in Chile, Colombia and Peru.

In New Zealand, Sanford is opening a general practice clinic in February in conjunction with a local health care provider. In Ireland, the South Dakota health system is working with a local clinic to create a clinical research office for work on oncology services.

In South America, Sanford is supporting the ongoing development of a research program in fetal alcohol spectrum disorders. The health system also announced on Tuesday extensions for its operations in China and Ghana.

“We want to go where we can be impactful and create partnerships that will stand the test of time,” Blue said in a statement.

Christopher Snowbeck • 612-673-4744 Twitter: @chrissnowbeck