Foreign nationals scapegoats for poor health system
THE delivery of equal and quality health care is a constitutional obligation in South Africa. Since the advent of democracy, the South African government has introduced several developments, policies, and programmes to improve health care, efficiency, and access for all users.
Despite several ambitious goals set by the government to ensure quality healthcare, reports by the media and the public have consistently revealed services in public health institutions are failing to meet the basic standards of care and patient expectations.
Although South Africa is widely known for having a progressive constitution and being an advocate of human rights and the rights of all citizens to access health care, challenges in delivering quality health care are still persistent, resulting in the public losing trust in the country's healthcare system.
Research has shown the prevailing obstacles facing the healthcare system in SA include unequal distribution of resources, management and leadership crises, corruption and poor implementation of strategies adopted by the government to improve healthcare quality.
Presently, of the estimated population of 60 million, about 84% of South Africans depend on the public health sector for their healthcare needs.
According to the 2023 Global Healthcare Index, SA's healthcare system ranks 49 out of 94 countries. Notwithstanding, the country’s healthcare system remains one of the most unequal in the world. The Covid-19 pandemic put additional strain on the healthcare system and, to an extent, exposed the vulnerabilities of highrisk population groups in accessing healthcare services.
Recently, media reports showed immigrants and refugees denied access to healthcare based on their nationality, known as “medical xenophobia”. Weeks ago, an anti-migrant group Operation Dudula chased away foreign nationals from the Jeppe Clinic in Johannesburg, preventing them from receiving medical treatment.
Correspondingly, last year, the Limpopo Health MEC, Dr Phophi Ramathuba, made xenophobic remarks about immigrants allegedly overcrowding the public health system.
Even research has documented the disturbing experiences of foreign nationals in the public health sector, characterised by inadequate access to essential medical treatment, medical xenophobia, and discrimination.
Critically, no evidence suggests foreign nationals cause an undue burden on the public healthcare system. Instead, available data indicate the number of international migrants in South Africa requiring healthcare is relatively low since they constitute (only) 6.5% of the South African population. In addition, research has shown migrants are often more healthy than non-migrant populations in their host countries, known as the “healthy migrant effect”.
Despite evidently considerable migration within and into SA, its impact on the health system is unclear and controversial.
According to Collective Voices Against Health Xenophobia, foreign nationals have been scapegoats for the public health system crisis and targeted to divert attention from severe challenges facing public health.
The country’s healthcare system is not overburdened because of the provision of services to a small minority of patients born outside South Africa’s borders but because of the poor governance of the public health sector.
The National Health Act and Section 27 of the South African Bill of Rights state everyone (regardless of nationality or immigration status) has a right to healthcare, and no one should be denied emergency medical services.
Likewise, Article 27(g) of the Refugee Act (1998) states refugees in South Africa should be given the same right to healthcare as everyone else in the country.
The accessibility of quality public healthcare also applies to undocumented migrants who are Southern African Development Community citizens.
Furthermore, studies show that maintaining the good health of migrants brings economic benefits to the socio-economic development of both countries of origin and destination.
However, these comprehensive economic and societal benefits of migration and health are often overlooked, particularly in the context of a resource-scarce healthcare system.