Queues of people wait to be treated at Chris Hani Academic Baragwanath Hospital, Soweto. Picture: Dumisani Sibeko
After a second provincial circular instructing health facilities to charge non-citizens in full for services came to light this week, the National Department of Health (NDoH) vehemently denied it was fuelling xenophobic sentiments.

“The Health Minister (Aaron Motsoaledi) never said that anyone should be attacked To say we are xenophobic is going too far,” deputy director-general for National Health Insurance (NHI) and the NDoH, Dr Anban Pillay said.

Earlier this week, Pillay said no other provincial health department other than Gauteng, acted on a bogus directive issued by a junior official from the NDoH almost two months ago.

But a second circular came to light later in the week, this time from KwaZulu-Natal, instructing non-citizens to pay for services including “emergency treatments”, which many have pointed out is unconstitutional.

“Whilst the NDoH claims that this circular was released in error, such actions have serious ramifications including furthering anti-foreigner sentiments within, and beyond, the public health-care system,” said Professor Jo Vearey of the African Centre for Migration and Society at Wits University.

Towards the end of last year, Motsoaledi came under fire for comments he made regarding the burden foreign nationals were placing on the health system.

According to Vearey, non-citizens make up only between 5% and 8% of provincial populations and are not the root cause of the crippling of the health system.

“The NDoH has a worrying track record of scapegoating foreign nationals for the poor performance of the national health-care system. Denying access to foreign nationals is a public health disaster, with negative public health implications for all in South Africa and the SADC (Southern African Development Community) region,” said Vearey.

Section 27’s Sasha Stevenson said the KwaZulu-Natal circular was withdrawn as of Thursday night, five weeks after it was sent.

Writing in public health magazine Spotlight, Stevenson asked how a junior official in the department would have come up with the content contained in the national communiqué sent in mid-January in the first place.

“The sentiment didn’t come from nowhere.” According to Stevenson, the Constitution and the National Health Act gave everyone, regardless of documentation, the right to free primary health care, antenatal care and HIV and tuberculosis treatment.

Neither could anyone be denied access to emergency care.

Stevenson said this “move to exclude foreign nationals from the health system is not without precedent”, and that the “NHI Bill envisages drastic reductions in access to care for foreign nationals, and so the war is far from won when it comes to unconstitutional regression in access to care”. 

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