NHI Bill’s fatal f law
Foreigners and asylum seekers marginalised, with consequences for health care in SA
SINCE the National Health Insurance (NHI) Bill was introduced to Parliament on August 8, the debate about the plan, which promises to fundamentally change health care in South Africa, has heated up.
The latest version of the bill proposes only limited access to healthcare services for population groups such as asylum seekers and undocumented migrants.
Currently, refugees, asylum seekers and undocumented migrants from SADC states legally enjoy the same health benefits as South Africans, including being means tested to determine the level of state subsidisation of the cost of their health-care services.
This is, however, not always true in reality, as can be seen from a growing number of reported cases of migrants allegedly being refused access to health-care services on the basis of their citizenship.
Recently, a Zimbabwean was allegedly refused care at Mamelodi Hospital and consequently lost her child at birth. A similar incident was reported to have occurred at the same hospital in January. Over the years, civil society organisations such as Section27 and Lawyers for Human Rights have helped a number of migrants who were denied access to health-care services in public hospitals to receive care as required by law.
Section 27 of the Constitution guarantees everyone the right to access health-care services, including reproductive health-care services.
According to the NHI Bill, however, asylum seekers and undocumented migrants will only be entitled to emergency medical care and services for notifiable medical conditions such as tuberculosis and malaria, among others.
This is in contrast with the previous version of the bill released last year, which entitled asylum seekers, refugees and undocumented migrants to access emergency and primary health-care services, maternal health services and services for notifiable conditions of public health concern. The proposed package of care afforded to asylum seekers and undocumented migrants has, therefore, drastically decreased, both from the current entitlements and when compared with the bill released just last year.
It is of concern that the current bill excludes critical services such as sexual and reproductive health-related services.
Not having access to contraception and antenatal care services for certain population groups would have a detrimental effect on their health and on the country’s health profile.
The infant and maternal mortality rate has declined from 189 per 100000 live births in 2009 to 134 per 100 000 in 2016. The decline is due mainly to the expansion of the antiretroviral treatment programme for HIV-positive pregnant women. Since maternal mortality is a general indicator of the overall health of a population, any reverses in this area would be a major setback for the country.
Moreover, South Africa has the highest HIV prevalence in the world – with around 13% of the population living with HIV. Migrants form part of the population that is heavily burdened by HIV. HIV is not a notifiable medical condition and its treatment would not fall under emergency medical services. This means that under the current bill, HIV care would not be available to asylum seekers and undocumented migrants.
It is in the best interest of the country to treat everyone who is living with the virus, to prevent its spread. This is particularly important in settings where South Africans are in sexual relationships with foreigners who may not be documented. This limitation has the potential to delay the country’s progress against HIV.
Children born to asylum seekers and undocumented migrants will be entitled to basic health-care services as enshrined in section 28 of the Constitution.
However, there is no definition of what the basic health-care services package includes, and therefore we do not know what these children are entitled to.
While South Africa is joining the rest of the world in moving towards universal health coverage, the current NHI Bill would divert us from that goal. Universal means everyone, and that includes undocumented migrants and asylum seekers.