As vulnerable migrants and undocumented people continue to face serious difficulties in accessing maternal and child healthcare in Gauteng hospitals, Doctors Without Borders (MSF) urges the National Department of Health (NDoH) to re-affirm and closely monitor access to free primary and hospital healthcare for all pregnant and lactating women and children under six – irrespective of migration or refugee status – to ensure timely, impartial medical care to save and protect all lives.
MSF also reiterates its call to the Gauteng Provincial Department of Health to clarify its ambiguous payment policies and immediately implement an equitable hospital charging system.
“It is heart-breaking to see so many pregnant women who need hospital-level care due to the complexity of their conditions being sent back home by hospital authorities in Tshwane when they are unable to pay the fees,” said Dr Tasanya Chinsamy, Medical Activity Manager in Tshwane, who added that unlike South African nationals, pregnant migrant women and their families are not being means-tested*, and are instead charged full fees, resulting in medical bills that most cannot afford.
“Until free maternal and child healthcare can be guaranteed for all, we call on all provincial departments to implement an equitable hospital charging system so that no one is denied essential and lifesaving care on the basis that they can’t afford to pay,” says Chinsamy.
MSF has witnessed several incidences in the last year of migrants, asylum seekers, and undocumented people who have struggled to access essential maternal and child healthcare in Gauteng hospitals, either due to their inability to pay high fees or a lack of appropriate documentation. This has left many pregnant mothers and children with high-risk conditions unmonitored and untreated as they are only assisted at the hospital level when they become ill enough to require emergency care.
Safi**, a pregnant migrant woman from Democratic Republic of Congo, visited a clinic in Tshwane and was considered a high-risk patient due to her elevated blood pressure and history of miscarriage. She was referred to a nearby tertiary hospital and was seen by the doctor, who asked her to come back with a payment of R500. She and her husband are unemployed, and being unable to afford the payment Safi did not return for her appointment.
“I was sitting with no money for the procedure. If the baby was going to come, I did not know how. Only God knows. I was just waiting, waiting, waiting,” she said.
By her 38th week of pregnancy, Safi had dangerously high blood pressure. Left untreated, this would have increased the risk of seizures, kidney and liver damage, and other severe complications, which could have cost the lives of both Safi and her baby. With the help of MSF, she was taken to the hospital in an ambulance as an emergency for a caesarean section. She delivered a healthy baby and was discharged after a week. While she wasn’t asked to make any payment at the time she was discharged, she has since received a hefty bill of R37,000. With no means to pay this bill, she is reluctant to seek further medical care for herself or her child again.
“It is their indirect way of telling people like us not to come back,” Safi said.
Gauteng hospitals continue to implement exclusionary and dangerous payment policies, made worse by the Gauteng Department of Health’s “Circular 27 of 2020”, which directly contradicts the National Health Act with ambiguous guidance regarding who should be charged for certain health services. The hospitals in the province are perpetuating a discriminatory approach, using Circular 27 to charge asylum seekers and undocumented people full fees.
We have also observed with concern an increasing trend of infants born to migrant parents being denied proof of birth due to non-payment of medical fees. Withholding birth records undermines the right of all children in South Africa to a name and nationality as safeguarded by birth registration. Denying this right can negatively impact the ability to access essential services including healthcare, education, and social assistance.
MSF is supporting litigation led by SECTION27, launched together with three patients who were denied maternal and child healthcare, against the Gauteng Department of Health in the Johannesburg High Court, which seeks to affirm universal access to free maternal and child healthcare in South Africa.
*A means test is a method for determining whether someone qualifies for financial assistance to obtain a service or good, for instance, essential healthcare services.
**Name changed to protect her identity
Since 2019, MSF has run the Tshwane Migrant Project alongside local partners to provide supportive medical, psychological and social services for vulnerable people irrespective of nationality and immigration status, including providing care to vulnerable South African nationals.
In 2021, MSF teams working in Tshwane and Johannesburg ran migrant health projects that supported COVID-19 vaccination activities for undocumented people at a time when no other access was available.