Politicisation of health care could do more harm than good by discouraging migrants from seeking healthcare services while their ailments are still manageable and affordable, only to show up at healthcare centres much later when complications arise and it’s too expensive to treat.
That’s a warning from Scalabrini, a Cape Town-based advocacy and legal centre that provides welfare services to migrants, refugees and displaced communities.
This week the centre’s head of advocacy and legal adviser, James Chapman, cautioned that inflammatory statements by politicians could discourage undocumented migrants from taking part in population census, which not only counts everybody within SA but helps provinces get the appropriate distribution of funds from the national purse.
“The more such statements that these are your foreigners ... You don’t belong here and you should go back to Zimbabwe, the greater the chances are that people will stand back and not come forward because of the fear of the repercussions of doing so.”
He was responding to the debate that has ensued in the country after Limpopo health MEC Phophi Ramathuba’s comments, which sparked controversy after a video showing her telling a woman that migrants from Zimbabwe were a “huge strain” on the provincial healthcare system.
In the widely circulated video, Ramathuba is heard telling a patient Zimbabweans are abusing SA’s healthcare system despite not being catered for in the provincial budget.
“To effectively address public health, you need to address and assist everybody. The best way to target the disease is to address it when it’s first starting ... when it’s cheap and affordable to address,” Chapman said.
He said statements such as Ramathuba’s would make undocumented migrants not trust authorities and to be even more scared to seek health care for fear of arrests and deportation.
“They would only go into facilities when they’re very ill ... when they need a hospital bed and it’s too expensive to treat them. That’s not favourable to government either, as the state is required to treat those sick patients.”
Chapman said Ramathuba was not only wrong when she said illegal Zimbabweans are not counted. Instead her rhetoric could cause further damage as illegal immigrants could decide not to take part in future censuses.
“She is not so accurate because the census done by Stats SA included both the documented and undocumented ... as long as you are within the borders of SA.”
The right to have access to healthcare services is a basic human right guaranteed by section 27 of the constitution, including reproductive healthcare services and no-one may be refused emergency medical treatment.
— Mark van der Heever, Western Cape health department spokesperson
“Her comments actually worsen the situation because they result in people who are undocumented having increased vulnerability and not coming forward to be counted. And if you don’t come forward to be counted for the census, it’s quite hard to be aware of numbers and make policy and budget accordingly.” He said the budget allocated to provinces was not only based on the number of South Africans but on population size.
Just as SA dealt with Covid-19 by attempting to vaccinate everyone in the country to limit the spread of the virus, Chapman said government should do the same even with other health services, as it is the only rational way to control diseases, especially infectious epidemics.
When it came to public healthcare provision Chapman said the approach should be in accordance with the Hippocratic Oath of doing no harm “and treat everybody who comes through the doors of healthcare centres irrespective of the country of origin”.
A means assessment test should be used to determine who could afford to pay for medical costs, while the department of home affairs, which is mandated to deal with immigration issues, should be left to do its job of ensuring everyone in SA is documented.
Western Cape health department said while the primary-level health care is free for everyone, when it comes to hospital services it charged foreigners the same way it charged South Africans by using means test to check affordability.
But identity requirements are a prerequisite for those needing hospital services, and for those who don’t have documents, support letters are required.
“The right to have access to healthcare services is a basic human right guaranteed by section 27 of the constitution, including reproductive healthcare services and no-one may be refused emergency medical treatment,” said department spokesperson Mark van der Heever.
He said foreign nationals with invalid documents are billed using the means test if they are assisted by lobby groups and refugee rights organisations. Those without valid documents are charged the maximum tariffs.
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