THE head of health in South Africa’s Limpopo province, Dr Phophi Ramathuba, says the failure by the Southern African Development Community (Sadc) to tackle the migration crisis in the region is straining the country’s health delivery system, whose resources are insufficient to cater for undocumented foreigners.
The province, which borders Zimbabwe, is burdened with undocumented migrants seeking free medical treatment.
In a Twitter Spaces discussion hosted by journalist Hopewell Chin’ono on Thursday night, Ramathuba said the migration crisis in the region was straining the country’s health budget, hence the need for the intervention of Sadc governments.
“How I wish that governments would be able to come on board and be able to assist in making sure their citizens are catered for. If they cannot, but would like South Africa to assist, we should formalise it and give the bill which Zimbabwe, Mozambique and others should be able to pay . . . we are not going back on this.
“There was a time the Member of the Executive Council (MEC) for Gauteng … was our deputy minister. They also sent bills to different government embassies. We have not received the joy of getting such support,” she said. Zimbabweans have been flocking to South Africa for better health services following the deterioration of the health sector, with Limpopo province being the nearest port of call.
“People of Zimbabwe should also work with their government to deal and resolve these problems. If the citizens do not take interest and say we have an alternative … South Africa’s health system will also crumble and we will not have anywhere to go,” she said.
It is estimated that over 70% of women giving birth Limpopo are foreigners, mostly Zimbabweans. One of the participants in the Twitter Space session said Zimbabweans’ migration to South Africa for medication has been worsened by President Emmerson Mnangagwa’s appointment of Vice-President Constantino Chiwenga as minister of Health.
“The minister of Health is a soldier. He has flown overseas for medication, yet he is denying better healthcare to his wife, and these are the people Mnangagwa is hiring to manage the healthcare of over 16 million people,” said a participant.
Ramathuba said other South African provinces have also been receiving foreign patients who have not been paying hospital bills, thereby incurring unbudgeted expenditure. She said the lack of documentation by immigrants and leniency of the South African health delivery system is worsening debt-recovery from migrants flocking to her province for medication.
“Some of the people (migrants) do not even bring national identification documents. We do assist, but cannot bill or classify them which has its own repercussions because when the Auditor-General comes, we say we can collect this revenue, but have to explain why the patient cannot pay. “When you ask Treasury to write off, they want to know proof of unemployment and health status,” she said.
“Undocumented migrants will give false information. Government has appointed a team to help collect the debt . . . they were sharing that only 10% could be traced, 5% they have already traced and that the remaining must be written off,” she said.
The country’s health system has two categories: primary and secondary, which have allowed for immigrants among other groups to be allowed access to medical services.
“We have primary healthcare, where you go to the clinics, get immunisation and vaccines. You do not pay anything at that level as everything is funded by the government. Then, when you go to the hospital, you must pay because you are now entering a secondary and tertiary level,” she said.
The province has been doing “means tests” on patients to allow for universal healthcare for people who cannot afford secondary education, but this has made it difficult for the health department to make follow-ups on money owed by patients, she said.
“When I arrive at a hospital, I am classified H3. This means I earn over R75 000 per annum, or I have medical insurance. This means I have to cover full insurance.
“When you earn above R35 000, but below R75 000, you are classed H2, where you ought to pay a discounted fee. But when you are H0, this is where the problem is. You have to prove that you are unemployed,” she said.
Ramathuba said illegal immigrants have constituted the bulk of patients in the H0 class, and their lack of documentation has been making it difficult for her as head of Health to track down money owed by patients.
She said the Sadc countries ought to make formal agreements with South Africa to foot bills that are incurred by their citizens who have been accessing medical services in the country. An estimated three million Zimbabweans are resident in South Africa — many of them undocumented. The South African health department says the migration crisis is compromising service delivery.
“We acknowledge that the public healthcare system is struggling in some areas to meet the healthcare needs of the citizens and reduce the backlogs due to unpredictably high number of undocumented migrants from neighbouring countries seeking healthcare services in the country, other than the asylum-seekers and refugees,” the department said in statement after Ramathuba’s initial remarks in a video that went viral online.
The revelations by Ramathuba amplify the frosty relations between South Africa and Zimbabwe. During the Robert Mugabe era that ended in 2017, South African leaders would dare not challenge the late Zanu PF leader directly as they regarded him a statesman.