Pregnant women and non-South Africans are often denied free healthcare services, and the numbers are rising. This is according to SECTION27’s latest online publication, ‘ Free healthcare services in South Africa: A case for all mothers and children. 

This lack of access is a leading cause of maternal mortality and morbidity in the country. Access is also largely based on the nationalities of individuals seeking care. In light of this growing problem, the report aims to provide available facts about who has access and also differentiate categories of migrants and their rights.

Negative impact

“When women with high-risk pregnancies cannot access necessary health services at the hospital level, they are unable to monitor the progress of their pregnancy or identify and manage risk factors appropriately. Some women end up not accessing antenatal care consistently during their pregnancy,” stated the publication.

“This results in the loss of an opportunity to make early interventions to manage and treat underlying problems. By the time pregnant women present at hospitals, they are often already in labour and cannot be denied healthcare services. The birth process can lead to complications that could put both the pregnant women and the foetus or the newborn in danger.”

According to Dr Tasanya Nomaliso Chisamy of Doctors Without Borders (MSF) in South Africa, denial of healthcare services is mostly happening at secondary and tertiary levels in South African healthcare services.

A failing public healthcare system fails us all. Download a free copy of our publication and learn what the law says about who has access to free healthcare services in south Africa.

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— SECTION27 (@SECTION27news) November 15, 2022

Improving access

“We have found that the issues were largely at secondary and tertiary levels. So we have joined SECTION27 on this journey to try and improve access to maternal and child healthcare. We found that the consequences are not just medical. When we look at the health of someone, we look at them as an individual considering all aspects. This includes the biological, medical, psychological and social aspects of their health,” said Chisamy.

Chisamy also explained how being denied healthcare services affects one psychologically.

“When we look at the psychological effects, obviously, it causes a lot of stress, anxiety, and mental health strain on patients. It is also a cycle of patients having a worsening medical condition given their anxiety,” she said.

Chisamy was speaking during the official virtual launch of the SECTION27 publication.

Financial strain

“On a social level, patients experience a lot of financial strain. These patients already don’t have much and must pay hospital fees, medication and transport if repeated visits are needed. This increases when they are turned away and have to return. Often, they have to borrow money to seek care elsewhere, which can be inappropriate or not good for them,” said Chisamy.

She further explained that there are also documentation issues where parents of babies are not provided with proof of birth. This carries long-term consequences regarding access to healthcare and other essential services. 

SECTION27(1)(a) of the constitution provides that “Everyone has the right to access healthcare services, including reproductive healthcare”. This means that everyone who resides within the borders of SA should benefit from this right, whether documented or otherwise.

In June this year, SECTION27 and three affected persons launched court proceedings against several health authorities, including the MEC for health in Gauteng. The purpose of the case is to confirm access to free healthcare services for all pregnant and lactating women and children under six. Those seeking asylum, undocumented persons and persons affected by statelessness are also included.  

Children’s rights to healthcare services

Liesl Muller, from the Centre for Child Law, said that every child has a right to healthcare services, regardless of their nationality.

“Undocumented children are not only foreigners. The rights in the constitution where it says everybody has the right to something, it means everybody within the borders of South Africa, regardless of their emigration status,” said Muller.

According to Muller, it is very important in terms of our constitution as well as international law that the survival and development of children are taken very seriously.

“Healthcare, particularly in the first six years of life, is incredibly important. Our constitution and the international law protect the rights of the child to have access to the best available healthcare,” added Muller. 

Medical xenophobia

The publication includes the prevailing conditions of medical xenophobia in Gauteng. It uses a case study to illustrate how new provincial laws and policies are discriminatory in practice and contradict the National Health Act. 

“On 11 May 2020, the Gauteng Department of Health issued the Policy implementation Guidelines on Patient Administration and Revenue Management. But the 2020 policy is fraught with internal contradictions and has enabled hospitals to interpret its provisions. Only pregnant women and children under six who are refugees and have valid documents may access free health services,” reads the publication. – Health-e News