Are foreigners truly burdening South Africa's healthcare system?

For the past decade, Rungani Baloyi, a 55 year-old Zimbabwean peasant farmer, has frequented South Africa for no other purpose than to remain alive. The father of six has a renal condition that has troubled him for many years, but with the Zimbabwe's health system in shambles, Baloyi owes his life to the frequent trips he makes to neighbouring South Africa, where he has received medical attention unimaginable back home either free of charge or at minimal cost.

"These trips are a matter of life and death for me," Baloyi told FairPlanet in his hometown of Chiredzi in the southeastern part of Zimbabwe, close to the South African border. "From the time my son, who works in South Africa, took me there for medical attention after my condition got worse, I have always made it a point that I go down there whenever in am not feeling well."

Baloyi is one of the tens of thousands of people from several African countries who rely on South Africa for their medical needs because the services are either unaffordable or simply unavailable back home.

To these people, reports that South African government officials and politicians are increasingly hissing over the growing financial costs these medical excursions are having on their budget, are a real source of anxiety. 

‘Our Hospitals Are Full Of Foreigners’

For a country that regularly suffers bouts of xenophobic violence, the influx of foreign patients into South African hospitals has always been sure to be an emotive issue among stakeholders.

"The weight that foreign nationals are bringing to the country has got nothing to do with xenophobia… it’s a reality," Aaron Motsoaledi, South Africa’s former Health Minister, stated at a nurses gathering in 2018. "Our hospitals are full, we can’t control them."

Motsoaledi, who is now Home Affairs Minister, reiterated this stance in January 2022 when he claimed that over 70 percent of births in hospitals in the Gauteng and Limpopo provinces (close to the borders with Zimbabwe and Mozambique) were foreign.

"If you go to Musina Hospital now, and to the labour ward, and I challenge you to do so, you will find that 70 percent of the women who are delivering there are from Zimbabwe - nobody stops them."

"bill foreign embassies" 

Even those in the opposition share Motsoaledi’s sentiments. A recent video of pregnant women sleeping on bare floors in a hospital because of the shortage of beds infuriated many, with members of country’s main opposition Democratic Alliance (DA) blaming this sorry state of affairs on the influx of foreigners seeking medical treatment. 

"The proportion of foreign births at some Gauteng hospitals is more than 25 percent of total births, so it’s a significant burden on our public health system," said DA party’s Gauteng health spokesperson, Jack Bloom. 

Bloom, a member of the Gauteng Provincial Legislature, said the only solution to this problem would be to bill the embassies of the countries from which those treated come from, an idea that was mooted in the past.

"This is a practical way to deal with the issue of foreign patients overburdening Gauteng hospitals that has recently been highlighted by a video of pregnant women sleeping on the floor at the Rahima Moosa Mother and Child Hospital in Johannesburg," said Bloom, adding that he will be taking up this issue.

"Some years ago, the Gauteng health department claimed that they were going to bill foreign embassies but nothing seems to have come from this."

rising hospital fees for FOREIGNERS

While the debate rages own, reports from South Africa suggested that some public hospitals had already started charging foreign patients full fees. 

"For a bed only, one now has to fork out over R2 300 ($153) a day and R8 542 ($569) for a normal delivery," the report said, citing new fees at The Steve Biko Academic Hospital in Pretoria. "If it is a Caesarean delivery, the fee is now a whooping R11 603 ($773)."

These are fees that most foreigners like Baloyi, who frequents South Africa for medical reasons, cannot afford.

A Self-defeating move?

Loren Landau, a Research Professor at the African Centre for Migration & Society at the University of Witwatersrand in South Africa, told FairPlanet that the move to make foreign patients pay full fees might have negative side effects on South Africa's healthcare system.

"Access to adequate healthcare is in our personal and collective interest," Professor Landau wrote to FairPlanet. “It is for this reason that the South African Constitution explicitly bans restrictions on life saving care, regardless of patients’ immigration status or ability to pay. This has never been universal in its implementation, but the principle remains."

Landau who is also a Professor of Migration and Development at University of Oxford, pointed out that while it is legal to ask foreigners to pay additional fees for health services in public hospitals, it is important for the health and the welfare of South African citizens that all residents in the country access the care they need. 

"Therefore, additional upfront fees intended to discourage people from seeking care are not only punitive, but also ultimately self-defeating."

"The South African Constitution explicitly bans restrictions on life saving care, regardless of patients’ immigration status or ability to pay."

CLINICIANS aren't immigration officers 

The South Africa Medical Association (SAMA) also does not agree with the idea of discriminating against foreign nationals who seek medical attention. SAMA's chairperson, Dr Mvuyisi Mzukwa, said that hospitals in South Africa couldn’t be expected to treat patients based on their nationalities.

"[The] Government cannot expect clinicians to be chasing away foreign nationals. It is not our domain. All we do as clinicians, if we see a patient who needs medical attention in a hospital premises, we just offer that service without asking any questions. We are not the Department of Home Affairs," Mzukwa said.

"We do not deal with immigration or whatever. We do not even want to know whether a patient is an asylum-seeker [...] Once you are in hospital premises and you are sick, all we do is to give you medical attention." 

Mzukwa further stated that the issues of immigration and the influx of undocumented immigrants clogging the system at public health facilities is not for hospitals to fix; rather, Mzukwa maintains, the government should engage the nations from where these people are coming.

Move Previously Resisted

This is not the first time the government of South Africa has tried to make foreigners pay their medical bills in full. In January 2019, a South African national health department circular instructed clinics and hospitals in the country to begin billing foreign nationals the full rate for public health services.

However, only the Gauteng provincial health department tried to implement this directive, which specified that all non-South Africans, other than documented refugees, should be charged full fees for all services including emergency treatment, maternity care and "basic health services." 

Section 27, a South African public interest law organisation representing the Treat Action Campaign (TAC) – a local HIV/AIDS activist organization - called the Gauteng Health Department to order, pointing out that the move was unlawful in that it had the potential to withhold previously available services from patients, which contravenes the country’s National Health Act and could lead to a violation of people’s rights.

The organisation also pointed out that the move threatened to derail progress in the fight against HIV/AIDS.

"Section 27 of the Constitution says that everyone has a right to have access to health care services, including reproductive health care services and that no one may be denied emergency medical treatment," the social justice organisation stated.

In South Africa, the law has always been that refugees, asylum seekers and undocumented migrants from the Southern African Development Community (SADC) states - especially those from Lesotho, Mozambique and Zimbabwe - who need hospital care, should be treated like South African citizens. That meant they only had to be subjected to the standard means test given to South Africans to determine how much they had to pay for hospital care.

Hopeless Situation Back Home

In Zimbabwe, where the bulk of those seeking medical treatment in South Africa come from, nurses and doctors who are almost always striking for better pay and improved working conditions complain that the hospitals are poorly equipped, with drugs and other consumables being critically in short supply.

Some of the patients come from countries further north, as far as Zambia, Malawi and the Democratic Republic of Congo (DRC),  countries that - like Zimbabwe and Mozambique - also have threadbare healthcare systems.

Hospitals in these countries are poorly equipped, under-staffed and hardly have any drugs, save for those that are donated by international agencies. Corruption and patient extortion are also rife in most of these countries, with drugs from public hospitals frequently finding their way to backyard and private drugstores. 

Image by Hush Naidoo