Prescription medicines are easily accessible from illegal vendors on the streets of Johannesburg as immigrants, who say they are denied healthcare in clinics, turn to the black market for smuggled drugs.
This could, say experts, be contributing to antimicrobial resistance.
The medicines are mostly smuggled from Malawi and, to a lesser extent, Zimbabwe, so there is no oversight by South Africa’s medicines regulator, writes Kimberly Mutandiro for GroundUp.
Melina (not her real name) is originally from Malawi, and is neither a doctor nor a nurse, nor a health worker. But she runs a flourishing informal pharmacy from her home in Johannesburg, where she sells pills for R2 each. She also offers a wholesale price to resellers.
Her products include a range of drugs, and antibiotics like amoxicillin and metronidazole (brand name Flagyl).
She’s not the only one. In Johannesburg, a bustling black market has emerged for pharmaceuticals, including antibiotics, contraceptives and antihistamines. Interviews conducted by GroundUp with store owners suggest the drugs are mostly smuggled from Malawi and Zimbabwe.
Immigrants are major customers, saying they struggle to access healthcare from clinics and hospitals in Johannesburg because of documentation issues.
While immigrants have a constitutional right to access healthcare, in practise they often face barriers, said Asiphe Funde, an attorney with the public interest law firm SECTION27. They are sometimes turned away from health facilities, and at large tertiary hospitals they are often charged high fees.
“The patient administration policy introduced by the Department of Health states that South Africans, refugees and asylum seekers have the right to access healthcare, but are required to pay at tertiary facilities. Patients are then subjected to a means test calculated based on income,” Funde said.
However, the Gauteng Department of Health does not apply this means test to immigrants, and simply charges them the maximum amount, even though they qualify to be means tested. She said SECTION27 has engaged with hospital administrators, but the problem persists.
“In worst case scenarios, undocumented immigrants or those with expired refugee and asylum papers are being denied access to free healthcare,” she added.
Market opportunity
Melina said her customers don’t need a passport or ID, and that she can make a profit of R3 000-R5 000 on each batch of medicine she brings from Malawi.
She orders a large box of different drugs from Malawi every month, with her mother and sister acting as intermediaries. Her mother buys the drugs for her and packs them in a box to give to her sister or a bus driver to bring to South Africa.
Dealers who smuggle the meds into South Africa claim to buy large quantities for next to nothing from hospital “connections” in Malawi.
Recent SAPS raids have made business for these sellers more difficult, however. Some told GroundUp they now sell only to regular customers, fearing arrest from plain-clothed police.
Ethel Musonza from the Zimbabwe Isolated Women in South Africa (ZIWISA) support group said the organisation was aware of people selling medicine on the streets and from their homes.
“People in the migrant community claim the medicine works, but there is a risk of side effects when they buy drugs randomly from the black market without a proper medical examination.”
She confirmed the healthcare crisis with Johannesburg’s immigrants because they are being turned away from clinics and hospitals due to lack of valid documents, while others cannot afford high hospital fees they are now routinely charged.
She said some people were also unable to renew their asylum documents. “Some lost documents during illegal evictions and fires; others are stateless,” she added. “The denial of health access leaves all of them vulnerable.”
She called on the Department of Health to allow immigrants access to healthcare regardless of their documentation status.
Gauteng Department of Health Spokesperson Foster Mohale said everyone is entitled to healthcare.
“The Constitution is clear in terms of who gets access to healthcare and emergency care. In hospitals, people are asked to provide their documents and personal information and they must pay for services. All hospitals charge for access to services and there are universal charges for every patient,” he said.
South African Health Products Regulatory Authority (SAHPRA) spokesperson Madimetja Mashishi said substandard and falsified medicines have become a global concern. He said the World Health Organisation estimates that these drugs now account for at least 10% of all medicines consumed globally and that South Africa is not immune to this challenge.
He said SAHPRA was working with the police and other agencies to root out unauthorised products, and that overuse of antibiotics can promote antimicrobial resistance.
See more from MedicalBrief archives:
Gauteng free healthcare policy amended after court pressure
Gauteng clinics still denying treatment for pregnant migrants
Medical xenophobia and discrimination widespread in Gauteng health care
Xenophobia or unsustainable burden on creaking health system?