Migrants must be included in NHI, and retain basic healthcare access: activists

Migrant health experts have criticised the National Health Insurance Bill (NHI) in its current form, saying it is unconstitutional because it excludes asylum seekers and other migrants from a raft of basic services.

In June the National Assembly approved a law meant to pave the way for the introduction of universal health insurance. The health financing system is designed to pool funds to provide access to quality affordable healthcare for all South Africans. 

The bill asserts that asylum seekers and undocumented people are only entitled to access emergency medical services and care for notifiable conditions.

Jo Vearey, an associate professor with the African Centre for Migration & Society at Wits, said: “It’s important to think about the language that's used around safe, orderly, and regular migration. It's important to acknowledge how the wording here presents a very particular sort of framing of migration that we need to be cautious of. But equally it provides for actions that we can hold the state responsible for in terms of health.” 

Vearey advocated for an approach to thinking about the ways in which the collection of data, the use of data, health systems and health information systems can be improved and “at the same time ensure that we're protecting individuals who might otherwise be at risk, for example, those without valid currently valid and permits or currently undocumented”.

Sibusiswe Ndlela, an attorney at Section 27 focusing on migrant health, called for migrants to be able to retain access to the services currently available to them.  “For that to happen, certain provisions of the bill need to be amended.” 

The constitution states that everyone in the country is entitled to primary healthcare services, including foreigners. Regulations allow for access to free healthcare for all pregnant and lactating women, children under six and basic healthcare at clinics. Payment is required for more advanced care.

Ndlela said the NHI as set out does not seem to be consistent with the right to equality and the right to human dignity, and based on that, an argument could be mounted that it could constitute unfair discrimination based on documentation status and nationality.

“It constitutes a significant limitation of the healthcare services available to asylum seekers and undocumented people, because it clearly moves away from these free healthcare services that are provided.”

It also moves away from HIV care, she said, which is in effect based on a national department of health circular that allows all categories of people irrespective of their documentation status to access treatment.

“We're all well aware of the fact that HIV is a prevalent condition in this country. And clearly, to make sure that HIV isn't transmitted, we need to make sure that every single person is afforded access to HIV care,” said Ndlela.

The view of the bill being a regression was echoed by Sam Waterhouse from the Health Justice Initiative, who said there was a need for a push towards the inclusion of the excluded group.

“It's much broader than just the HIV/Aids, the bill is actually taking us back from the right position that has been in place since 2007 for documented and undocumented asylum seekers,” she said.

Waterhouse said detailed submissions talking to why the bill should include asylum seekers seem to have been ignored.

“From a cost perspective, it makes a lot more sense to address medical cases when they are less serious.

“When it gets to that emergency level, it's not a lot more costly on the state. We should want best practice.”

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