OPINION: Despite several ambitious goals set by the government to ensure quality health care, reports by the media and the public have consistently revealed that services in public health institutions are failing to meet the basic standards of care and patient expectations, writes Selemo Nkwe.
By Selemo Nkwe
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 health care, reports by the media and the public have consistently revealed that services in public health institutions are failing to meet the basic standards of care and patient expectations.
Although SA 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 health-care system.
Research has shown that the prevailing obstacles facing the health-care system in SA include unequal distribution of resources, management and leadership crises, corruption and poor implementation of strategies adopted by the government to improve health-care quality.
Presently, of the estimated population of 60 million, about 84% of South Africans depend on the public health sector for their health-care needs. According to the 2023 Global Healthcare Index, SA’s health-care system ranks 49 out of 94 countries. Notwithstanding, the country’s health-care system remains one of the most unequal in the world. The Covid-19 pandemic put additional strain on the health-care system and, to an extent, exposed the vulnerabilities of high-risk population groups in accessing health-care services.
Recently, media reports showed immigrants and refugees denied access to health-care 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 that foreign nationals cause an undue burden on the public healthcare system. Instead, available data indicate that the number of international migrants in SA requiring health care is relatively low since they constitute (only) 6.5% of the South African population. In addition, research has shown that 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.
Chasing people away from accessing medical treatment solely based on nationality or immigration status goes against the country’s constitution. The National Health Act and Section 27 of the South African Bill of Rights clearly state that everyone (regardless of nationality or immigration status) has a right to health care, and no one should be denied emergency medical services. Likewise, Article 27(g) of the Refugee Act (1998) clearly states that refugees in South Africa should be given the same right to health care as everyone else in the country. The accessibility of quality public health care also applies to undocumented migrants who are Southern African Development Community (SADC) 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. A lack of priority has been given to understanding the complex relationship between migration and health at the regional level. Correspondingly, regional coordination in migration and health is still lacking in the SADC, and whilst some policy processes have been initiated, there has been slow progress.
Policy implementation and improved consideration of migration in public health system policy and its application are needed at the SADC, national and local government levels. Likewise, South Africa’s migration policy needs further development to address the significant challenges facing the governance of the public health system rather than just focusing on the costs of migration and blaming foreign nationals for their failures.
* Selemo Nkwe is a Researcher, Institute for Pan-African Thought and Conversation (IPATC).
