'Xenophobic tendencies must be rejected': Healthcare groups say migrants have right to treatment in SA

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Limpopo Health MEC Phophi Ramathuba.
Limpopo Health MEC Phophi Ramathuba.
Sandile Ndlovu, Gallo Images, Sowetan
  • Government data on the user profile of foreign nationals, including undocumented immigrants, accessing South Africa's public healthcare system is hard to confirm. 
  • This according to Health Minister Joe Phaahla who was recently quizzed about it in Parliament.
  • Phophi Ramathuba has come under heavy criticism for showing disdain to foreign nationals after she berated a patient from Zimbabwe at a hospital in Bela Bela in Limpopo. 

The government does not require health facilities to keep statistics on foreign nationals accessing public healthcare.

This makes it difficult for the Department of Health to determine the number of undocumented immigrants using public health services and their impact on the system.

Despite this, at least two politicians have accused foreign nationals of burdening the country's already stretched public health system.  

Earlier this year, City of Johannesburg Health and Social Development MMC Ashley Sauls claimed, after speaking to hospital staff he said, undocumented immigrants burdened the Rahima Moosa Mother and Child Hospital.

READ | 'This is not political': Ramathuba says foreigners not budgeted for as she doubles down on comments

This week, Limpopo Health MEC Phophi Ramathuba was caught on camera telling a patient, who she identified as Zimbabwean only because she spoke Shona, the province did not have a budget for foreigners.

She said foreigners were putting a "huge strain" on the province's health system.

Ramathuba has come under fire for her comments, with political parties calling for her to be axed.

The Constitution states everyone has the right to have access to healthcare services.

Foreign nationals can get free primary healthcare in public hospitals and if they need more than basic healthcare, they have to pay.

In addition, Southern African Development Community agreements allow foreign nationals from member states to receive the same care as South Africans, meaning payment is based on a means test, with people paying what they can afford.

Doctors Without Borders (MSF), which has anecdotal evidence of the experience of patients in South Africa, said it had been unable to get independent data about the healthcare user profile at South African public healthcare facilities.

On Thursday, MSF board member Bhelekazi Mdlalose added South Africa's public healthcare system was crumbling due to a variety of issues and not merely because non-citizens were accessing it:

MSF does not possess independent data about the healthcare user profile at South African public healthcare facilities.

"Through our work on access to healthcare for vulnerable and migrant populations in South Africa and internationally, we have witnessed the real-life impacts of policy, procedural and practical barriers ordinary people are confronted with daily." 

Mdlalose said since 2009, MSF had worked on projects in Musina, Tshwane, Durban and Johannesburg that focused on supporting access to public healthcare for migrants, asylum seekers, refugees and undocumented migrants.

"What our staff hear from patients is their daily struggles in getting care that is afforded to them under the South African Constitution.

"What our staff most often witness is a health system struggling to cope, even at the best of times, due to a variety of issues that include planning and management - not merely the number of non-South Africans accessing care."

She said migrants were met with varying attitudes from healthcare workers. 

"Over time, our patients have told us on many occasions about their experiences at the hands of health staff, who hold xenophobic attitudes, but also of dedicated health staff who prioritise the delivery of impartial medical care that is ethical and free of politicisation."

Mdlalose encouraged healthcare workers and leaders to take a principled stance that ensured all who needed treatment got the care they deserved.

She said MSF did not track anti-migrant sentiment in the healthcare sector, but sometimes there were "flare-ups".
While we don't track sentiments directly, we have witnessed occasional flare-ups, like the recent events in Atteridgeville, where patients were being denied access to healthcare by protesters outside Kalafong Hospital, based on appearance and accent, which indicates emboldened xenophobic tendencies. This is worrying and must be rejected by healthcare workers and leaders in order to uphold their oath to and medical ethics.

The health department is also seemingly not in the know about how many undocumented immigrants have accessed the country's public healthcare facilities for services.

"The statistics on the total number of babies who were born to illegal and/or undocumented migrants at public health facilities in each province in the past three years is not available as our health facilities do not keep statistics on foreign nationals," Health Minister Joe Phaahla said in answers to parliamentary questions in June.

"With regards to the number of illegal and/or undocumented immigrants who are making use of health facilities for other medical services other than giving birth in each province, due to community integration of migrants, the Department of Health is not able to determine the number of undocumented immigrants as this is not a policy requirement," he added.

On Friday, Ramathuba's spokesperson, Neil Shikwambane, said they were trying to collate data on foreigners using the system.

He added the data would be available on Friday afternoon but stopped answering News24's calls and messages.

His comments will be added when he responds.

On Friday, News24 published a fact-check article which pointed to poor management being the real cause for some of the problems in the Limpopo public health system.

FACT CHECK | No, MEC Ramathuba, poor management is killing Limpopo hospitals - not immigrants

In a statement following the video, the Progressive Health Forum (PHF) labelled Ramathuba's comments as offensive and showing disdain for foreign nationals. 

"This is deeply offensive on many levels, not least in her conduct as a health professional sworn to uphold her oath. The MEC appears to also wrongly believe that her oath of political office trumps her ethical undertaking.

"The MEC's reprehensible utterances are now filtering through to other facilities, where there are reports of undocumented foreigners being denied urgent care, which is unconstitutional, and contradicts ethical norms.

"Unlike politicians, health professionals may not make a discriminatory distinction, based on a person's origin, circumstances or behaviour."

The PHF said it was understandable why Zimbabwean nationals used the local health system.  

"The reason there are undocumented foreigners entering the country to seek healthcare is easy to understand. Collapsed public health facilities in Zimbabwe and an utterly dysfunctional immigration infrastructure in SA make the influx of migrants a certainty."

It accused Ramathuba of scapegoating Zimbabweans.  

"The MEC also conveniently ignores the uncomfortable truth that up to half of the health budget is stolen or otherwise misappropriated on her watch.

"There is much, therefore, for the government to account for and fix before scapegoating migrants for its shortcomings. The Limpopo health MEC has brought the medical profession into disrepute and scandalised millions for whom national life is rooted in human rights."

The National Education, Health and Allied Workers Union echoed the same sentiments, saying problems the Limpopo public health system faced could not be blamed on Zimbabweans seeking treatment.

The union's provincial secretary, Moses Maubane, said: "We can't attach the challenges to the people of Zimbabwe. Let's rather say the system needs to be overhauled. We need to change the system. They [Zimbabweans] do have the right to be taken care of when sick."

He added the department needed to deal with staff shortages in the province. 

Maubane said a lack of staff also led to negligence in state facilities.


The PHF has called on the SA Human Rights Commission and Health Professions Council of South Africa to take action against Ramathuba.

On Thursday, the provincial government said it would not be disciplining her for the comments.

The ANC in the province said it backed her.

The national health department has instructed officials to gather information on the incident. 

News24 tried to get a comment from the Zimbabwean consulate, without success.

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