Understaffing, poor management, inadequate resources and Covid-19 backlog — not pressure from foreign migrants — make it difficult to provide health services, said doctors in the public health system and researchers in the field this week.
Limpopo MEC for health Dr Phophi Ramathuba's widely publicised attack on a Zimbabwean woman in a Musina clinic for “killing my health system” this week provoked widespread condemnation as “a xenophobic tirade”, which Ramathuba has denied.
Wits professor Jo Vearey, director of the African Centre for Migration and Society, said there is no evidence that foreigners and migrants are putting the public health system under strain.
Vearey said: “Their numbers are not (routinely) captured and no data exists on this. When people make these claims of high numbers, they are anecdotal. This is the same as going to Yeoville to count the number of Congolese people and saying it's representative of their numbers in the country.”
On Friday the health ministry confirmed it has “no records or stats on the number of foreign nationals using the public healthcare system”.
Asked about the effect of migrant patients on the health system, Foster Mohale, spokesperson for health minister Joe Phaahla, said on Friday: “Some of the challenge, resulting from the unpredictably rising number of undocumented people seeking healthcare services in public health facilities, include medical stock-outs, difficulties to reduce the backlogs especially for elective surgeries, long waiting times, shortages of beds, and so on.”
There are no records or stats on the number of foreign nationals using the public healthcare system
— Foster Mohale, spokesperson for health minister Joe Phaahla
Blaming inadequate healthcare services on foreigners is rubbish and this is not the first time, said Wits professor of medicine Francois Venter this week.
In 2015, then-health minister Aaron Motsoaledi, then-Gauteng health MEC Qedani Mahlangu and then-mayor Herman Mashaba “talked frank rubbish on how foreigners were jamming up Gauteng hospitals when I was doing ward rounds on the same day in the same hospitals”, he said.
“They were barely a problem. What was a problem was the lack of management support for the tottering health system. Our politicians are so quick to steal, so quick to blame Zimbabweans,” Venter said.
Dr Ndiviwe Mphothulo, who works in clinics in Johannesburg and informal settlements in Gauteng, said poverty was so high — including among migrants from Zimbabwe, Mozambique or Lesotho — that it can be difficult for patients to get medication and attend follow-up appointments.
“We are overworked and under-resourced, serving a large population,” said Mphothulo, who has also worked in clinics in rural North West.
“We see a number of migrants who are legal, or illegal, but to us they are patients. As a clinician I see a patient. I do not see their race or nationality. That is for the administrators who open the files,” said the doctor, who is on the Southern African HIV Clinicians Society board of directors.
Vinayak Bhardwaj, regional migration adviser to Medecins Sans Frontieres in SA, said they had observed that health professionals in public health — with whom it has partnered for 22 years — faced wide-ranging challenges.
Treating them is the ethical, legal, moral and right thing to do
— Dr Ndiviwe Mphothula, HIV Clinicians Society of Southern Africa
“In rural Eshowe challenges arise from the under-resourcing of the rural healthcare sector.
“In urban areas, a big challenge is managing the knock-on effects of the Covid-19 pandemic. This resulted in large numbers of people being unable to access care for many months and thus missed cancer treatment, chronic disease treatment and surgical interventions which compounded the existing backlogs and resourcing gaps from before.”
Bhardwaj said migration was among innumerable factors that influenced the health system, as were demographic changes.
“Certainly migration — both internal migration and cross-border migration — has implications for the health system. Migration and the dynamics that drive it will not disappear.”
The organisation supports universal health coverage, free from user fees, as the most effective system “to reduce mortality and morbidity rates around the world”.
Mphothula said that South Africans benefited by treating anybody, irrespective of nationality, who had HIV/Aids and/or TB. “If you delay medical attention, that person can infect other people and it can become expensive if they come to hospital as emergencies.
“Treating them is the ethical, legal, moral and right thing to do for infection control,” he said.
Vearey said that SA and Zimbabwe needed to engage over cost-sharing mechanisms, for example, for health services between Beitbridge and Musina.
Ramathuba should be working to ensure more money is allocated to health in Limpopo, rather than blaming patients, she said.
“Last year we saw that Motsoaledi was incredibly xenophobic and now he is in Home Affairs, and has tweeted his support for her.
“We are in a tinderbox about violence against foreigners and this is another nail in that ... this constant scapegoating — that we have got no services because of foreign migrants — is a symptom of something much bigger.”
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