The provincial health departments lack a mechanism to reclaim unpaid costs incurred for treating migrants in the public health facilities from their countries of origin.

This was revealed by Health minister Aaron Motsoaledi in response to parliamentary questions posed by EFF MP Nqobile Mhlongo.

Mhlongo asked about the expenditure by provincial health departments on emergency and/or triage healthcare for undocumented migrants in the 2024/25 financial year.

“Currently there is no mechanism for the provincial departments of health to recover the costs from the countries of origins for all immigrants if their accounts remain unpaid,” Motsoaledi said.

Motsoaledi also said the departments do not segregate any data related to documented and undocumented migrants.

“The department is working on finalising the Integrated Disease Surveillance and Response Strategy, which aims at strengthening surveillance systems including improvements on collection of data about nationality, irrespective of the legal status of clients in the country,” he said when asked about the number of public health facilities that exceeded capacity due to migrant patient volumes.

Motsoaledi explained that the National Health Insurance Act provides that nobody may be refused emergency medical treatment in line with the Constitution.

“Section 27(1) of the Constitution provides that everyone has the right to have access to health care services within the state’s available resources. Section 4 of the NHIA mandates who will be required to pay for elements of their health care. It does not exclude anyone from accessing healthcare,” he said.

Motsoaledi’s response comes amid ActionSA slamming the department for not keeping track of nationalities of patients treated in public healthcare facilities.

Activists from Operation Dudula have until recently attempted to turn away foreign nationals seeking treatment at public health facilities.   

Responding to ActionSA MP Kgosi Letlape, the minister cited the Constitution which provides that everyone has the right to access healthcare services, including reproductive healthcare, and that no one may be refused emergency medical treatment.

“Health care is provided based on clinical need, not on nationality or documentation status,” he said.

However, Letlape said in the absence of tracking, verification or appropriate data collection, the department was unable to account for the full scope of service delivery liabilities.

“We believe that this is particularly concerning given that millions of foreign nationals, many of whom are undocumented or lack any form of medical insurance, reasonably make use of taxpayer-funded public healthcare services.

“In a public health system already buckling under pressure, with overcrowded hospitals, long queues, understaffing and medicine shortages, this lack of oversight is reckless and unsustainable.”

Letlape also said the absence of patient categorisation severely compromises effective planning, budgeting, and policy formulation.

“This is further compounded by the lack of any identification or status verification mechanism, which means patients are not required to present identification, preventing healthcare providers from verifying legal status or maintaining accurate and continuous patient records,” he said.

Motsoaledi clarified that the country’s health system was under pressure due to several factors that included but were not limited to budget cuts, infrastructure challenges and human resources constraints.

The clarification was a response to EFF MP Chumani Matiwane who asked whether he has found that the ongoing crisis in the public healthcare system stemmed primarily from structural under-investment, maladministration and systemic weaknesses, rather than the treatment of foreign nationals.

He was also asked about steps his department has taken to ensure that healthcare access remained non-discriminatory amid the increasing public pressure and demonstrations targeting foreign nationals in public healthcare facilities.

Motsoaledi stated that it was only the Department of Home Affairs, which has the ability to know whether a person is legal or not in the country.

“However, we do not refer patients to Home Affairs, but we can report that provincial Departments of Health and health facilities have reported a high number of undocumented patients accessing health services. As we have stated above, we do not legally know the nationalities of such undocumented patients.”

Motsoaledi also said his department and all their health facilities never stopped anybody from entering facilities and accessing healthcare services.

mayibongwe.maqhina@inl.co.za

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