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National Health Insurance

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The National Health Insurance (NHI), for which membership will be compulsory, is a funding scheme that aims to address healthcare inequity in South Africa. The scheme will do this by creating a fund that the government will use to buy healthcare services at set fees from accredited public and private health providers. The NHI Bill was passed in the National Assembly in June 2023. It has to go to the National Council of Provinces for approval.

HomeArticlesRefugees ripped off at state hospitals

Refugees ripped off at state hospitals

Poor people who have fled their countries are expected to pay steep rates for treatment at government hospitals in Gauteng.

It is lunchtime in the bustling neighbourhood of Malvern in downtown Johannesburg. On a main street lined with shops a man stops in his tracks. He picks several lollipops from a make-shift stall in front of one of the shops and gives the money to the vendor, a tired-looking woman who moves slowly, dragging her feet with every step. 

“I’m sick,” says Yvette Mbayo-Ndaya. “I have high blood pressure. I have diabetes. I have kidney failure.”

After serving the customer, she sits down on a chair that is placed in the centre of the small space that is the inside of her shop.  

“I get my high blood and diabetes treatment from Johannesburg hospital [Charlotte Maxeke]. But for the kidney they never give me medication. They said ‘there is no medication for foreigners’.”

Mbayo-Ndaya, who is from the Democratic Republic of Congo, reaches for a small bucket, places it on the floor in front of her and puts her feet up, first the left then the right, on top of the bucket.  

“I have to go and buy the kidney medication myself. But I don’t have money to pay for it; it is very expensive,” she says. “Now both my legs are swollen. Sometimes my whole body swells up.”  

A month’s supply of the medication Mbayo-Ndaya needs for her kidneys costs nearly R700. 

[WATCH] Close to death, but ‘no medication for foreigners

Many refugees flee their own war-torn countries to find safety in South Africa. But the country is not the safe haven they think it will be.

Denied access to treatment

Refugees and asylum seekers like Mbayo-Ndaya are often denied treatment in government clinics and hospitals, says Marceline Sangara, a home-based care worker for the Johannesburg branch of Jesuit Refugee Services (JRS), an international charity organisation that helps refugees and asylum seekers to gain access to healthcare.  

“Even if they are granted access to treatment, refugees get it at a high cost. Sometimes when patients have to collect their medication from the pharmacy, they are told that the medicine is out of stock even if it is not,” she says. 

“It is as if there are some diseases that refugees don’t have the right to be treated for, like kidney failure. It is very difficult for a refugee to get dialysis or an organ transplant. Some hospitals don’t even give refugees chemotherapy.

“They are xenophobic,” says Sangara.  

A 2014 study in the journal Globalization and Health found that an increasing number of refugees in developing countries are diagnosed with noncommunicable diseases. Diabetes and hypertension are among the most common of these diseases. The study found that “the provision of care for refugees suffering from chronic illnesses and requiring specialised consultations, expensive medications, health education and preventive health services is not adequate”.

Marceline Sangara from the Jesuit Refugee Services says that some South African hospitals refuse refugees treatment. (Troy Enekvist)

Healthcare for refugees, asylum seekers and undocumented migrants

JRS is part of a coalition of civil society organisations called the Johannesburg Migrant Health Forum, which includes the International Organisation for Migration as well as the advocacy organisation Section27. The group is “concerned about the inability of [refugees, asylum seekers and undocumented migrants] to access health care services” in Gauteng province. 

“Refugees and asylum seekers have the same rights as citizens in terms of access to healthcare in South Africa,” says the organisation’s Samson Ogunyemi. 

Various laws in South Africa provide for pregnant and breastfeeding women, and children younger than six years who are not on a medical aid to have access to free primary healthcare at government clinics and community health centres. It is against the law to deny a person emergency medical treatment. 

“However, the situation on the ground is different. These patients continue to face discrimination and exclusion from health facilities,” he says. 

A 2015 study by the University of South Africa published in the Southern African Journal of Demography found that “access to formal healthcare services remains a challenge for refugees in Southern Africa”, partly because of “limitations in the availability of resources”. 

According to a 2011 study by the Centre for the Study of Violence, “whilst both South African citizens and forced migrants in Johannesburg experience challenges in accessing public healthcare … migrants experience specific challenges associated with their status as non-nationals”.

  • A foreign mom’s neglect turns fatal. Read our story here.

Patients die because they can’t get treatment

Janine Kakusheta, also a home-based care worker at the organisation, says she deals with many cases of patients who die because they were refused treatment.

“In 2010 I lost a patient because they were denied chemotherapy at a hospital in Johannesburg.”
The day before our interview one of her patients had died.

“He was suffering from kidney failure caused by high blood pressure and needed a kidney transplant. But because he was a refugee they refused. They said ‘you don’t have a green identity document; you don’t qualify’. He was in a coma for three days before he passed away.”

Kakusheta says previous attempts by the organisation to address this problem with the individual facilities failed because the hospitals always denied turning patients away. 

Janine Kakusheta from the JRS says that many refugee patients die because they are refused treatment. (Troy Enekvist)

According to Gauteng health spokesperson Steve Mabona, “non-South African women and children touring and visitors are expected to pay.  They are classified as private patients. Refugees and asylum seekers receive treatment free on presentation of official documentation as per home affairs policy.”

Kakusheta argues that it is unfair to expect refugees to pay the same fees as private patients or those on medical aid when so many of her patients cannot even afford the taxi fare to the hospital.

“Asylum seekers and refugees with valid documents are classified by means test and are subject to payment. [These patients are entitled to] free health services, like South Africans, [for specific conditions] such as pregnancy and children under six years,” says Mabona.  

No document, no doctor

Recently Sangara and Kakusheta came across the case of a six-year-old boy who is an orphan and lives with his grandparents. When he fell ill his grandmother took him to two different clinics in Johannesburg. She says both clinics refused to treat him because he did not have any documentation. 

Unable to produce any identity document needed for her grandson to get treatment, the grandmother, a refugee from the Democratic Republic of Congo, turned to the organisation for help. 

The law provides for a person with no identity document at all to get emergency medical treatment, but the patient must “bring correct documentation at their next visit”, according to Mabona.

“When we saw how sick the child was, we took him to Nazareth House — a hospice that we work closely with. The doctor there was so shocked to see the condition he was in; he was at death’s door,” says Sangara. 

The boy was referred to Charlotte Maxeke hospital where he tested positive for HIV and tuberculosis and was started on treatment. Today he is doing well and is still on antiretroviral therapy.

But Kakusheta is infuriated that so many refugees and asylum seekers do not have someone to travel with them to health facilities and fight for them to get the treatment they deserves.  

“To make sure that patients get their medicine JRS pays. Sometimes we will even take out money from our own pockets,” she says.

“This is discrimination. It’s xenophobic. They don’t refuse treatment for citizens.”

This is the third and final article in the series on the difficulties refugees face when trying to get healthcare in South Africa. Read the first part here and the second part here.

Ina Skosana was a health reporter at Bhekisisa.