Zimbabwean women told GroundUp they dreaded going to local clinics such as Jeppe Clinic and Hilbrow Clinic because they were asked for money up front. A woman said she had to send her five-year-old daughter with epilepsy to Zimbabwe late last year because she was struggling to get treatment for her in Johannesburg. (Photo: Kimberly Mutandiro)
- Public Law Centers say policy changes made last year by the Gauteng Health Department are unconstitutional and regressive.
- Asylum seekers, people whose permits have expired and undocumented immigrants are effectively excluded from access to most public health services.
- To get health care, they are first asked to pay an upfront fee that they cannot afford.
Human rights organizations are concerned about policy changes affecting immigrants since the Gauteng Health Department published it in the Official Gazette in June last year and issued a circular in May 2020.
According to the organizations, medical care is denied to asylum seekers and refugees if they are undocumented or have expired permits, unless they can pay an upfront fee.
Hlengiwe Mtshatsha of Lawyers for Human Rights (LHR) said, âThe new fee structure is very high and foreign nationals end up being at the highest level and have to pay up front.
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âPeople with expired or undocumented documents have complained about being charged the highest fees or being turned down. They are expected to pay as if they were in private hospitals, even if they are in public hospitals.
âWithout documents, they can’t even enter into a payment plan and they also have to report their income, which is difficult in most cases.
âAsylum seekers and refugees are also affected, especially those with expired papers. All of our efforts to build relationships with the department have been unsuccessful.
Sibusisiwe Ndlela, a lawyer for SECTION27, a public interest legal center, said that since March 2020, the organization has received nearly 70 requests from immigrants trying to access health services. She said this influx of customers came after the flyer.
Ndlela said there are regulations and policies containing incriminated provisions that “must be put aside.”
SECTION27 and LHR say immigrants in need of medical care, sometimes urgently, are turned away at Hillbrow Community Health Center, Yeoville Clinic, Charlotte Maxeke Hospital, Jeppe Clinic, Wits University Hospital and at Kalafong Hospital (Pretoria).
Immigrants also complain of being treated disrespectfully and insulted by hospital staff, simply because they are not South Africans.
This is not the first time that the Gauteng department has been accused of wanting to exclude immigrants. A circular published in January 2019 was withdrawn and heavily criticized for being not only a problem for immigrants, but a threat to public health in general.
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Ndlela says: âThis circular is an attempt to introduce the same position as the one adopted in the circular which was withdrawn.
The organization wrote to hospitals on a case-by-case basis.
She said Gauteng’s guidelines on patient administration and revenue management are both illegal and unconstitutional. It ignores the provisions of the Refugee Law, which stipulates that refugees and asylum seekers have the constitutional rights to dignity and equality, and to access to health care.
According to Ndlela, this also violates the national health law, which obliges the state to provide free primary health services, and it is unconstitutional because it discriminates unfairly on the basis of nationality and the status of documentation.
SECTION27 is considering litigation because it believes the state has created a policy to exclude immigrants, despite their clear legal right to health care.
Woman, who lives in Johannesburg and is undocumented, says she sits with a R35,000 bill after her four-year-old spent eight months (June 2020 to January 2021) at Johannesburg General Hospital for burns. She says her child has been released from the hospital but still needs follow-up medical attention, so she avoids going back to the hospital due to payment demands.
Earlier this year, she went to the Helen Joseph Hospital to seek treatment on her own, but was initially asked to pay a consultation fee of R350. She stopped going.
âI begged on the streets at traffic lights and looked for money to buy medicine from the local pharmacy. Even now I am not healed, âshe said.
Another woman from Zimbabwe, who has been in South Africa for 10 years, says she was denied maternal care at the Jeppe Clinic when she was pregnant because she is undocumented. She gave birth in October.
âThey kept pushing me back, giving the excuse that I didn’t have any papers and I didn’t have any money. I was worried because my time was approachingâ¦ When I went to the Hillbrow clinic at seven months, they only gave me one card, but didn’t even book me, told me never to come back, “she said.
She said that when she started labor she went to the clinic. She said she was insulted by staff, but they eventually called an ambulance. The delivery was complicated and she had to do a cesarean.
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Ndlela says that in addition to removing policies that exclude immigrants from accessing health care, the department must have an “awareness program” to tackle xenophobic attitudes.
Foster Mohale, spokesperson for the Gauteng Department of Health, sent us mostly one-line responses to our questions.
He said: “We hear ad hoc reports all the time, but we don’t get enough information or evidence to allow us to investigate.”
He said the ministry treats immigrants and their children “the same as everyone else.”
But, says Ndlela, the Uniform Patient Fee Schedule, which defines applicable patient classifications and fees for hospitals, provides for full payment for patients and subsidized patients. (Patients who pay in full are responsible for full payment of hospital costs and fees; subsidized patients are eligible for partial or full state subsidy).
The fees are means tested, she explained. South African citizens are generally subsidized. Under the uniform fee schedule for patients, SADC citizens, even undocumented migrants, are subsidized, in the same way as South African citizens. But under the controversial circular “only documented refugees are treated the same as South African citizens”.
Ndlela said this means the circular excludes asylum seekers and undocumented SADC citizens from grants.