Health minister Aaron Motsoaledi. Picture: TREVOR SAMSON
Health minister Aaron Motsoaledi. Picture: TREVOR SAMSON

There is no question that SA’s public healthcare services are under pressure. We daily hear of patients confronting long queues, medicine shortages and harried staff stretched to their limit. The problem with the health system is years of under-investment, poor planning, and corruption. It is not foreigners.

The world over, governments scapegoat immigrants to deflect attention from their own failings. And nowhere is this truer than in SA.

Last November, health minister Aaron Motsoaledi told a nursing summit convened by the labour union Nehawu that more hospitals and clinics were needed to accommodate all the local and foreign patients, and that SA needed to re-consider its immigration policies to control the number of undocumented and illegal immigrants. He went on to say that when immigrants “get admitted in large numbers, they cause overcrowding, infection control starts failing”.

The minister presented not a shred of evidence to back up his xenophobic claims, made even more insidious by the fact that he was speaking to an audience comprising largely of frontline staff who daily make life-changing decisions about the patients before them.

The little data there is suggests that foreigners comprise only about 5% of SA’s population, hardly the kind of numbers to overwhelm public services.

Even in Gauteng, where over half the population hails from somewhere else, 44% of its residents were born in other provinces in SA, and a mere 8% of its population  are foreign nationals, according to the African Centre for Migration and Society at Wits. Moreover, contrary to popular belief, migrants are generally healthier than the population they join — they travel in search of jobs, not to get hip replacements.

For evidence of the kind of damage Motsoaledi’s rhetoric wreaks look no further than the despicable action of the Gauteng health department, which last month issued an instruction to hospitals to charge all foreign patients the maximum rate for services, regardless of their financial status.

Current government policy levels fees on a sliding scale, based on a means test: the poorest patients get free care, while those from households with an annual income above R350,000, or on medical aid, pay in full. While public health facility fees are much lower than those charged in the private sector, they can nevertheless be significant. In a nutshell, Gauteng health’s directive had the potential to deprive foreign patients of services if they could not afford to pay for them.

Gauteng health says it was simply following instructions, spelt out in a circular issued by an official in the national health department in mid-January. Once the issue blew up in the media and the national health department rescinded the order on Saturday, it swiftly back-pedalled.

The fact that Gauteng was the only province that moved with such alacrity to implement a directive that was clearly extra-legal is telling and indicates the barely concealed anti-foreigner sentiment simmering in its ranks. The law on migrants’ access to healthcare is clear: section 27 of the constitution says that everyone has the right to access to healthcare services, and no one may be refused emergency services.

The National Health Act goes on to say that everyone, except people on medical schemes or covered by a compensation fund, is entitled to free primary health services and that pregnant, breast-feeding women and children under the age of six get free healthcare. The Refugees Act provides for access to basic healthcare services, and by implication to asylum seekers too. And the Southern African Development Community (SADC) protocol binds member states to treat citizens of other SADC nations like those of their own.

Thus it is patently obvious that an instruction to charge full fees to all non-South African patients regardless of their financial position, or the nature of the care required, is at odds with the legislation.

Motsoaledi has helped create a toxic environment so hostile to foreigners that officials in both his department and Gauteng felt confident in issuing discriminatory instructions that left vulnerable patients high and dry.

It is now up to him to take responsibility and publicly assure eligible foreigners that they too have a right to healthcare services in SA.