Maverick Citizen

RIGHT TO HEALTHCARE

No cash, no care – Gauteng hospitals turn away undocumented children and pregnant women

No cash, no care – Gauteng hospitals turn away undocumented children and pregnant women
Pregnant women and children under six who are undocumented or stateless are encountering barriers to accessing healthcare in public hospitals in Gauteng, according to SECTION27 and Doctors Without Borders. (Photo: Denvor De Wee)

Pregnant women and children younger than six are prioritised when it comes to accessing free healthcare under South Africa’s health legislation. However, those who are undocumented, stateless or seeking asylum are often required to pay ‘exorbitant’ fees for healthcare services at hospitals in Gauteng, says SECTION27.

When Julian* travelled from Maratane Refugee Camp in Mozambique to South Africa in March 2021, he was driven by the hope of accessing a better standard of living for his young daughter. Crossing the border undocumented is no one’s first choice, but for Julian the risk was warranted.

His daughter, now three and a half years old, had been born prematurely after his wife suffered a physical assault in the camp. In the months after her birth, she showed signs of developmental delays and health complications, and was eventually diagnosed with cerebral palsy.

Concerned that her treatment in Mozambique was worsening her condition, Julian brought his family to South Africa and took up residence in Soshanguve, Gauteng.

However, instead of help, he found only barriers.

“Being a non-South African, it is hard to access medical care as they always ask for a South African ID – which I don’t have – or you pay full amount as a private patient,” explained Julian.

With no steady income, Julian has been unable to pay the around R40,000 bill he faces for his daughter’s care at a public hospital.

“I am still struggling … to get her the medical care she needs. She’s classified as a private patient … I am not working, neither is my wife. We are also traumatised by the situation,” he said.

According to a publication launched by SECTION27 and partner organisations on 14 November – Free healthcare services in South Africa: A case for all mothers and children – pregnant women and children under six are identified as priority groups for accessing free healthcare in terms of South Africa’s health legislation. 

Under the National Health Act 61 of 2003, pregnant and lactating women and children below the age of six, who are not members or beneficiaries of medical aid schemes, must be provided with free health services.

Despite this, SECTION27 has noted a rise in the number of cases of migrant people from these groups being required to pay “exorbitant amounts of money” when accessing healthcare services at hospitals in Gauteng, according to Sibusisiwe Ndlela, an attorney at SECTION27.

Speaking at the launch of the SECTION27 publication, Ndlela said the rise in such cases was identified in May 2020, through requests for assistance from members of the public at the organisation’s advice office.

“On 11 May 2020, the Gauteng Department of Health issued the Policy Implementation Guidelines on Patient Administration and Revenue Management,” according to the SECTION27 publication.

“The 2020 policy is fraught with internal contradictions, and has enabled hospitals to interpret its provisions to deny pregnant women and children access to free services if they are asylum seekers, undocumented persons or persons affected by statelessness. 

“Only pregnant women and children under six who are refugees and have valid documents are permitted to access free health services.”

The policy lists pregnant and lactating women and children under six as “exempted patients”, eligible for free healthcare services. However, it also places non-South African people in the “full-paying patients” category.

Migrants from several African countries camp outside the offices of the United Nations High Commissioner for Refugees. (Photo: Gallo Images / Alet Pretorius)


Visit Daily Maverick’s home page for more news, analysis and investigations


Court challenge

In June, SECTION27 initiated proceedings in the Johannesburg High Court against the MEC of health in Gauteng, the head of the Gauteng health department, the national minister of health, the director general for health and Charlotte Maxeke Johannesburg Academic Hospital. 

The case is intended to “confirm access to free healthcare services for all pregnant and lactating women and children under six, including persons seeking asylum, undocumented persons and persons affected by statelessness”, stated the SECTION27 publication.

According to the notice of motion filed by SECTION27, one outcome the organisation is seeking is an order to amend the 2020 Gauteng Policy Implementation Guidelines on Patient Administration and Revenue Management so that all pregnant and lactating women and children under six can obtain free health services at any public health facility, irrespective of nationality or documentation status.

Motalatale Modiba, head of communication for the Gauteng Department of Health, said the matter of the court case had been referred to the state attorney and counsel had been appointed.

“A notice to oppose was filed and the [Gauteng health department] is awaiting a consultation with the National Department of Health on the draft answering affidavit. This is a process led by the national department with all provinces being respondents,” he said.

The Gauteng Department of Health is mandated to provide healthcare services in compliance with section 27 of the South African Constitution, which provides that everyone has the right to have access to healthcare services, including reproductive healthcare, and that no one may be refused emergency medical treatment, according to Modiba.

“To this end, the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of each of these rights,” he said.

“Pregnant women and children under six years receive free service, and the category of refugees with valid documentation is also included in this. All patients irrespective of nationality when accessing hospitals are categorised for fees determination.”

According to Tshepo Shawa, spokesperson for the MEC for health and wellness in Gauteng, the department has a policy called the Uniform Patient Fees Schedule which determines what fees should be paid by non-South African citizens at hospitals.

“Services at primary health care facilities – clinics and community health centres – are free of charge. It is the higher level of care at hospitals that is being charged, mainly due to the specialist nature of the services,” he said.

Migrants from several African countries outside the offices of the United Nations High Commissioner for Refugees. (Photo: Gallo Images / Alet Pretorius)

Equitable access to care

Dr Tasanya Chinsamy, medical activity manager at the MSF (Doctors Without Borders) Tshwane Migrant Project, told Maverick Citizen that the problem of accessing healthcare for undocumented people arises mainly at a secondary and tertiary level, rather than in primary healthcare clinics and centres.

“At [primary healthcare] level, it’s understood that everyone should have access to free care,” said Chinsamy. 

“The issue is more at secondary or tertiary level, where particularly at the tertiary Gauteng hospitals, there’s an actual policy in place that says that if you are not South African, and you don’t have the appropriate refugee documentation, then … they charge people as private patients, which obviously most patients really cannot afford.”

The 2020 Policy Implementation Guidelines on Patient Administration and Revenue Management is not uniformly applied in Gauteng hospitals, but rather subject to the interpretation of each facility, she continued.

“There are hospitals in Gauteng where we have not had issues with [undocumented] patients – even when it’s not an emergency, they still see patients. But there are other hospitals that really double down on the policy and interpret it in such a way that they can only provide emergency care to undocumented people.”

Means testing is currently used to determine how much South Africans or those with proper documentation should pay for care at public hospitals, according to Chinsamy. People without documentation, however, are automatically charged high rates.

“Means testing must be extended to people without documentation, so that vulnerable people are not denied care if they do not have the means to pay,” she said.

“As MSF, we understand that equitable access to free healthcare poses a challenge, and that many people – including South African women and children – are being asked to pay for care. For as long as universal free care is unattainable, we’re asking for equitable access to care.”

As pregnant women and children have been identified as priority groups when it comes to healthcare, “access safeguards” should be extended to those of them who are undocumented, asylum seekers or people affected by statelessness, said Chinsamy.

“No one should be denied care because they cannot pay.” DM/MC

*Julian is a fake name used to maintain anonymity of a source for their safety.

Gallery

Comments - Please in order to comment.

  • Jane Crankshaw says:

    I’m not sure how to respond to the article. Unfortunately there are too many people and too few taxpayers who are already stretch to capacity to deal with a situation like this.
    Apart from the graft and theft of the public purse, there also doesn’t appear to be much heed paid to the Hippocratic Oath nor to the spirit of a Ubuntu!

  • Ahmed M says:

    We cannot continue to service individuals who have entered the country illegally. They willingly left there own countries and assuming access to South African state services is not a guarantee when you enter illegally is not a right. We seem to have many humanitarian groups who seem to forget that an open borders policy does not exist globally and think that rights should be given willy nilly to any who enter our country.

Please peer review 3 community comments before your comment can be posted

X

This article is free to read.

Sign up for free or sign in to continue reading.

Unlike our competitors, we don’t force you to pay to read the news but we do need your email address to make your experience better.


Nearly there! Create a password to finish signing up with us:

Please enter your password or get a sign in link if you’ve forgotten

Open Sesame! Thanks for signing up.

We would like our readers to start paying for Daily Maverick...

…but we are not going to force you to. Over 10 million users come to us each month for the news. We have not put it behind a paywall because the truth should not be a luxury.

Instead we ask our readers who can afford to contribute, even a small amount each month, to do so.

If you appreciate it and want to see us keep going then please consider contributing whatever you can.

Support Daily Maverick→
Payment options

Become a Maverick Insider

This could have been a paywall

On another site this would have been a paywall. Maverick Insider keeps our content free for all.

Become an Insider

Every seed of hope will one day sprout.

South African citizens throughout the country are standing up for our human rights. Stay informed, connected and inspired by our weekly FREE Maverick Citizen newsletter.