The Gauteng Health Department has amended its policy – but only after the pressure of a court order – to clarify that all pregnant and breast-feeding mothers, and all children under six, whether South African or not, are entitled to free healthcare at public hospitals and clinics.
The department reported its amendment to the Gauteng Patient Administration and Revenue Management Policy at the Gauteng High Court (Johannesburg) last Monday, after an April court order by Gauteng Deputy Judge President Roland Sutherland.
The court had ordered that the province’s policy must “expressly provide” that all pregnant and lactating women and children under six are entitled to free healthcare, “irrespective of their nationality and documentation status”, reports TimesLIVE.
The exceptions are people with medical aid and those who have come to South Africa specifically to obtain healthcare. The amendments had to be made by 16 October, the court ordered.
It was also declared in the order that any policies or circulars issued by the Gauteng Government, or the national government, that required pregnant or breastfeeding women or children under six – unless they fell under the exceptions – to go through a classification and fee determination process, would be invalid.
The court order comes on the heels of litigation by SECTION27, which went to court on 22 May arguing that the Gauteng policies and guidelines in this area contained “a shocking lack of clarity”.
While the National Health Act provides for free healthcare services at government facilities for all pregnant and breastfeeding women and children under six, SECTION27 said the relevant regulations and policy guidelines in Gauteng were unclear on whether fees could be charged to some non-South Africans – particularly asylum seekers who had not yet been granted refugee status.
In its application, SECTION27’s Umunyana Rugege said migrant women had been “routinely denied access” to services at hospitals and clinics. If not “denied per se”, they were pressurised into signing acknowledgments of debt and undertakings to pay.
In one case, this discrimination led to the death of two-year-old Sibusiso Ncube, a Zimbabwean national. The child was taken to Charlotte Maxeke Hospital, on referral from the Hillbrow Community Health Centre, after swallowing rat poison. But the hospital said it would not accept him without a birth certificate or R5 000.
“According to relevant medical protocols he should have been admitted immediately for observation and treatment, but he did not receive the care he required. Instead, his mom had to call family to take her and Sibusiso home to get his birth certificate,” said Rugege.
By the time they got home, his condition had deteriorated. They then drove him to Rahima Moosa Hospital, where he had been born, because he would still have a file there, but he died en-route.
Last Wednesday, SECTION27 welcomed the implementation of the court order, but said it had only been partially complied with. This was because the court also ordered that posters informing women and children of these rights be put up in all clinics and hospitals in the country, but that this had not been done at all institutions.
Chris Hani Baragwanath Hospital, Steve Biko Hospital and Bertha Gxowa Hospital “claim to have put up posters”, but according to the organisation’s own monitoring, “those posters were not visible as of 18 October 2023”.
Spokesperson Pearl Nicodemus said some of those without posters include Charlotte Maxeke, the Hillbrow Community Health Centre, Helen Joseph Hospital, South Rand Hospital, Kalafong Hospital and Thelle Mogoerane Hospital.
The court had given the MEC and department until 6 November to report on affidavit that it had fully complied, said Section27. Should compliance not be complete, “Judge Sutherland will personally attend at the relevant hospitals to monitor compliance on 20 November 2023”.
Ironically, on the same day the department reported its compliance to court, a Zimbabwean woman was apparently refused assistance at the Enyadeni Clinic in Ekurhuleni, reports News24.
Lindiwe Mahlangu of the Positive Women’s Network said she had to intervene when a nurse allegedly refused to assist the woman because she did not have the right documents.
“I heard the nurse refuse to help the woman, who had come to collect antiretrovirals.”
When Mahlangu questioned the nurse, she was told the young patient had asylum papers which had “already been used by three other people”.
“However, I told her that no one should leave the clinic without being helped.
“Immigrants end up telling lies because of how they are treated in public healthcare facilities.”
See more from MedicalBrief archives:
Foreigners still being denied healthcare in Gauteng, activists say
Nurses demand bribes before babies can be taken home, foreign mothers say
Gauteng clinics still denying treatment for pregnant migrants