Limpopo Health MEC Phophi Ramathuba has acknowledged that leaders could do more to prevent hospitals from becoming overburdened.
In a virtual interview with Zimbabwean journalist Hopewell Chin'ono on Thursday, Chin'ono asked her if she accepted that leaders had failed concerning ensuring the stability of the South African health system, reports News24.
Ramathuba responded: “At risk of limiting my career, we as leadership – voted in by citizens – have not done much to prevent this (the collapse of the public healthcare system). We can do more.”
This followed her interaction with a patient in a Bela-Bela hospital on 23 August, which went viral on Twitter, showing her berating a Zimbabwean woman for “using up” the healthcare budget and “crowding” hospitals – despite evidence pointing to other reasons relating to poor governance as to why the Limpopo health budget is in distress.
The MEC has been accused of xenophobia, with even Health Minister Joe Phaahla stepping in and saying no one should be turned away from hospitals, reports TimesLIVE.
Audit reports and official statistics showed “no indications of any significant adverse impact of foreign nationals on the healthcare system in the province, but enough evidence of poor management and weak financial controls contributing to a system in distress”.
Ramathuba said that as her jurisdiction shared a border with Zimbabwe, the immigrants received at Limpopo public hospitals were mostly Zimbabwean.
However, she said her ire was not directed at Zimbabweans or that country’s President personally.
“The failure of our governments to deal with the border crisis is resulting in the working classes fighting against each other. We are creating a situation where there is a divide between foreigners and South Africans. We who created this must do something about it.”
She said she viewed pregnancy as a medical emergency and could understand why women would want to give birth in South Africa. Her issue, she said, was with undocumented immigrants who had elective surgery at hospitals. The MEC said only 14% of the country had access to private healthcare while the rest relied on public healthcare.
In Limpopo, 91% of the 5.7m people relied on public health, she said. The influx of foreign patients overburdened public hospitals, “which are underfunded and under-resourced but have to care for this huge population”.
“Undocumented patients must be taken care of, but they often do not pay for the services. As they are undocumented, we cannot find them when it comes time to pay for their care.” The result, she said, was that R450m of the R500m owed to hospitals by patients in Limpopo couldn’t be reimbursed. Since her tenure, she has had to ask Treasury to write off R1bn in monies owed.
“We need Treasury to wipe the R450m debt off the books but they want proof that the patients (who they cannot trace) cannot pay for the service.”
However, her diatribe against the patient had set off a chain reaction, with Operation Dudula members then stationing themselves at various public hospitals in Gauteng, preventing immigrants from accessing healthcare. The group has been widely criticised for promoting xenophobic sentiments and vigilantism.
They had also been holding protests outside the Kalafong Provincial Tertiary Hospital, Pretoria, blocking the entrance and turning away patients they believed to be undocumented foreign nationals, based on the colour of their skin and the language they spoke.
On 26 August, the Gauteng MEC for Health obtained a court interdict from the Gauteng High Court (Pretoria) prohibiting the group from “threatening and denying” patients and employees access to the hospital.
The interdict was pinned to a noticeboard outside the hospital. But Dudula was undeterred and on 29 August, the group resumed protests, demanding to see people’s ID documents, TimesLIVE reported.
On Thursday, a violent scuffle broke out outside the hospital between the Operation Dudula group and members of the EFF, and Dudula supporters violently removed the political party’s supporters from outside the hospital.
Police used stun grenades to disperse them, reports News24, and EFF Gauteng spokesperson Philip Makwala accused police of “sleeping in the same bed” as Dudula members.
“They (the government) have obtained a court interdict from the High Court, but they are still questioning whether it is legitimate or legal.
“The SA Police (Service) is promoting black-on-black violence, so we need to fight with these people because they are just here to watch us (and) not bringing order or dispersing the group of protesters as instructed by the court interdict.”
After a meeting with Phaahla later that day, the group eventually agreed to stop its protests and to end its barring of entrance to foreign patients.
“These activities are a violation of the Constitution and deprive people of their fundamental rights, and are consequently illegal,” Phaahla said.
His meeting with the Dudula leadership had been “fruitful” and the group had said it would engage in further consultations with the government over its grievances, reports Daily Maverick. He said some of the concerns raised by Dudula included “pressure on the hospital”, “long queues” and “allegations of people stealing medicine and corruption”, which Dudula blames on foreign nationals.
“We have agreed these are matters are very important but that we can address them without picketing and demonstrations. We have agreed on … engagement locally with Kalafong management, but also at a provincial level with the leadership of Gauteng Health,” said Phaahla.
“We accept that our services are under pressure and if this demand from our neighbours keeps increasing, you will reach a stage where it is not sustainable.
“But it is not up to ordinary citizens of the country to think they can help the state. That is not the correct approach.”
He said the Constitution was “very clear” regarding the rights of people who lived in the country to be assisted with the best possible healthcare, reports News24.
“As the government, we are obliged by the Constitution and the law to make sure our population has access to healthcare services and that no one may be refused emergency medical treatment.”
However, he added, the national health department was considering charging neighbouring countries for immigrants who access health services in SA, and was consulting with governments from those countries to see how they could contribute to the medical bills of immigrants in SA.
He added that matters raised by the MEC relating to the high demand and pressure on health services beyond what was planned for “put additional pressure on a system already fragile for many reasons known to many”.
These included “reduced funding, inefficiency, maladministration, corruption and poor management”.
“This can be solved through leadership and political intervention, and we are ready to be held accountable in the improvement of quality of health services for the South African population,” he said.
Phaahla also conceded they needed to work more closely with embassies to address specific issues faced by hospital staff.
He said the department was looking at organising for governments from neighbouring countries to sign agreements whereby, if there is a need for SA to be refunded for providing health services to immigrants, there could be some compensation, reports TimesLIVE.
“Every government has a responsibility to its citizens so we need to hold them accountable for their responsibility.
“If South Africans go to Namibia to seek help, the Namibian Government must hold us accountable. If, for instance, we are unable to provide renal dialysis and people are flocking to Namibia to get renal dialysis, they must hold us accountable and say: ‘We’ve got your people here who need dialysis. We can provide it but what are you going to do to compensate?’ These are the things we need to put into regulation.”
Minister in the Presidency Mondli Gungubele cautioned that preventing access to the health system and the country’s citizens could have dire consequences for patients.
“We understand the public health system is overburdened. However, doctors and healthcare workers have an obligation to provide healthcare to those in need.
“The Hippocratic Oath guides the actions of doctors, which includes them not withholding services because of religion, nationality, race, politics or social standing. Government is hard at work to improve our healthcare system and deal with challenges,” he said.
Meanwhile, reports Sunday World, the South African Medical and Dental Practitioners (SAMDP) body has thrown its full weight behind the embattled Ramathuba.
While the EFF labelled her a “morally bankrupt”, “cynical” and “arrogant” politician and asked Limpopo Premier Stan Mathabatha to remove her from his Cabinet, and the DA reported her to the South African Human Rights Commission, the SAMPD, an association representing previously disadvantaged practitioners who predominantly work in public health and previously disadvantaged areas, is siding with Ramathuba.
SAMDP spokesperson Tshepiso Seopa said she ought to be supported for raising an important public issue, “and commended … Her fortitude and frank approach on the subject are good because these have brought sharp focus on the matter”.
See more from MedicalBrief archives:
Foreign patients: a burden on the system, or scapegoats for poor management?
Limpopo MEC under fire over migrants comments
The rights of foreign nationals in accessing SA healthcare