Special Reports:

National Health Insurance

< Back to special reports

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.

HomeArticlesAre foreigners stealing your jobs and healthcare? Find out

Are foreigners stealing your jobs and healthcare? Find out

A ‘foreign threat’ makes for a convenient boogeyman in an election season but buyer beware, write activists.


Last week, Health Minister Aaron Motsoaledi claimed in a speech at the National Education, Health and Allied Workers’ Union’s (Nehawu) Nurses’ Summit that undocumented immigrants are flooding South Africa and overburdening clinics and hospitals. When immigrants “get admitted in large numbers, they cause overcrowding, infection control starts failing”, he said.

In his speech, Motsoaledi argued that South Africa must re-evaluate its immigration policy in order to prevent illegal immigrants from entering the country. But he offered no data or evidence to substantiate his claims about immigrants being such a burden on the public healthcare system.

How many immigrants are in South Africa? 

According to the most recent census, there were 2.2-million foreign-born people living in South Africa in 2011. This figure includes both documented and undocumented immigrants.

Statistics South Africa estimates that one-million people immigrated between 2011 and 2016. Add that to the census’ total, subtracting the almost 400 000 foreigners that the  2017 White Paper on International Migration says home affairs deported during roughly the same time, then about 2.8-million immigrants called South Africa home in 2016.

What does that mean? 

Immigrants comprised about 5% of the country’s total population of 55.9-million. 

Reliable data clearly shows that the country is not overwhelmed with immigrants. That clearly hasn’t stopped claims by politicians and Motsoaledi is not alone.

In 2015, former Gauteng health MEC Qedani Mahlangu told Eyewitness News that often “nine out of 10” patients in provincial health facilities were immigrants and blamed them for putting strain on the healthcare system. She was unable to substantiate that claim.

Then, like today, there was no evidence that foreigners were flooding clinics and hospitals.

Francois Venter from the Reproductive Health and HIV Institute at Wits University responded to Mahlangu’s claims, telling Health-e News Service that “blaming foreigners for the failure to organise the public health services properly is the worst kind of xenophobia”.

“I’ve worked in the public sector for over 10 years [as a doctor], and the problems we see [at the hospital] are largely due to poor human resource and supply line management, and the disease burden related to the local failure of poverty relief programmes and poor organisation of services — not a handful of foreigners who are here for jobs, not for healthcare,” he said.

When it comes to the public healthcare sector, it is true that the clinics and hospitals are stretched to the limit. But this is not because of immigrants; the crisis in the healthcare sector is due to years of mismanagement, understaffing, poor planning and corruption.

The failure to deliver basic services and quality care to millions of South Africans who cannot buy private healthcare is why Motsoaledi is blaming powerless and voiceless foreigners.

As Nelson Mandela University researcher Savo Heleta recently wrote on the online media outlet Africa is a Country: “Why would politicians choose to face the rightful anger of millions of poor and hopeless South Africans when they can revert to anti-immigrant rhetoric and shift blame to those who have no voice?”

Meanwhile, the government and the department of home affairs have already developed and approved antipoor and anti-African immigration plans as part of the  2017 White Paper on International Migration, which proposes building detention centres for African migrants and asylum-seekers in South Africa.

Building walls and using arrest, detention and deportation as tools to manage migration will force people to go underground and into situations in which undocumented people may shun healthcare services for fear of being reported. This will make it impossible to ensure comprehensive screening and treatment, which are critical for the eradication of communicable diseases such as TB.

Motsoaledi’s anti-immigrant rhetoric is in line with similar recent bigoted and baseless claims by some of his colleagues in government as well as many opposition politicians.

Earlier this year, News24 reported that Democratic Alliance leader Mmusi Maimane blamed immigrants for high crime rates in the country, claiming that securing border posts would reduce crime in South Africa.

Congress of the People leader Mosiuoa Lekota took his turn deriding foreigners, accusing them of robbing South Africans of housing and job opportunities in Johannesburg, News24 also reported. Lekota vowed that if in power, an opposition coalition government would confine refugees to camps within the country. Deputy police minister Bongani Mkongi also accused foreigners of over-running South Africa’s cities in 2017, prompting widespread condemnation, including by the human rights commission.

None of this anti-immigrant rhetoric is based on evidence.

2018 study done by the World Bank shows that between 1996 and 2011, every immigrant worker generated two jobs for South Africans, mostly because their diverse skill sets led to productivity gains and multiplier effects.

Immigrants also contribute to the national fiscus through payment of VAT and purchase goods and services, such as rent, from South Africans.

There is also no evidence that foreigners are responsible for high levels of crime. In 2017, the country’s prison inmate population stood at 161 054, according to the department of correctional services’ 2016-2017 annual report. Minister of Justice and Correctional Services Michael Masutha told Parliament that foreign prisoners comprised about 12 000 or less than 8% of the total incarcerated population in July 2017.

Through blatant xenophobic lies, othering and scaremongering, foreigners are blamed for many of South Africa’s social ills.

This will only get uglier as we get closer to the 2019 national elections. We will continue to hear the politicians put the blame on foreign migrants, asylum-seekers and refugees for many of the hardships experienced by the majority of South Africans.

South Africans need to see this for what it is: scapegoating of immigrants in order to hide government’s massive failure to improve the lives of millions of destitute South Africans.

Savo Heleta is a researcher at Nelson Mandela University writing in his own capacity. Follow him on Twitter @Savo_Heleta. Sharon Ekambaram is the manager of the refugee and migrant rights programme at Lawyers for Human Rights. Sibongile Tshabalala is the national general secretary of the Treatment Action Campaign. Follow her on Twitter @SibongileTsha14.

Savo Heleta is a researcher at Nelson Mandela University writing in his own capacity. Follow him on Twitter @Savo_Heleta.

Sharon Ekambaram is the manager of the refugee and migrant rights programme at Lawyers for Human Rights.

Sibongile Tshabalala is the national general secretary of the Treatment Action Campaign. Follow her on Twitter @SibongileTsha14.