The City of Joburg’s Health Department is struggling to cope with an increasing number of undocumented patients who visit its public health facilities.
In December 2018, the City’s health department began compiling a report on the number of documented and undocumented persons accessing primary healthcare services across all seven regions of the City’s clinics.
Secondary data analysis extracted from the electronic health records system on 66 of the 81 city clinics found that 15-39% of the patients accessing health care services across the various regions are undocumented. These include both South African and foreign national patients.
Data extracted from the electronic health system shows that the number of undocumented patients has increased from 32 092 to 82 923 between 2016 and 2018. The number of asylum seekers and those holding foreign passports patients have remained constant.
While South African patients might not disclose their identification due to various health reasons in order to protect their perceived position in society or family structures, illegal immigrants will also opt to conceal their identity to avoid potential deportation.
Indeed, the fear of deportation also causes some undocumented immigrants to stay away from seeking healthcare till the last possible minute. Often, placing themselves in danger.
I am troubled by the number of pregnant undocumented persons who reportedly present themselves at the City’s clinics at the eleventh hour. Our clinics are not meant to deal with emergency deliveries, and these are some of the difficulties we deal with on a daily basis.
The Constitution guarantees healthcare to all, however we have limited resources and our systems are under severe strain. We need the national government and Home Affairs to assist so as to properly budget for services which need to be provided arising from this Constitutional responsibility.
The City receives budgetary resources from provincial and national government based on census related data which does not take undocumented patients into account. As such, City resources are ill equipped to address the growing number of undocumented person seeking assistance. This is of particular concern for Johannesburg which is a hub for both cross-border and domestic migrants.
I continue to welcome all immigrants into our City and the City will continue to provide healthcare to those in need, within our severely limited resources. However, it remains my duty to raise concerns that have a direct bearing on service delivery.
Failure to implement controls on undocumented patients will result in expenditure not initially budgeted in this respect.
The Department of Home Affairs has a constitutional obligation in terms of the Immigration Act and the Refugee Act to address the issue of undocumented migrants, but to date the Department is failing at their constitutional mandate. I have even sought legal advice to explore legal options available to compel the Department of Home Affairs to address the issue.
The concerns raised by the City are seemingly also echoed by the Minister of Health, Dr Aaron Motsoaledi, when he is reported as stating that the national health system was not coping with the increase in the numbers of undocumented immigrants accessing health services in public hospitals.
He is reported to have added that South Africa had to “re-look at its immigration policies to control the number of undocumented and illegal immigrants in the country.”
What is also of concern to us are patients whom are allegedly engaging in “medical shopping”. With no documentation, persons can move from one health facility to the next collecting medication.
Through the eHealth system, the City is attempting to clamp down on this practice which allegedly results in some medication making it into markets outside the country while others use medication to enhance the illicit drug trade.
We need to openly talk about undocumented persons and how we respond as a government to the growing needs of service delivery.
The National Department of Health and Home Affairs should act with speed before further inaction results in the collapse of the public health system.
Cllr Herman Mashaba
Executive Mayor
City of Joburg
Media enquiries:
Luyanda Mfeka
Director: Mayoral Communications
Office of the Executive Mayor
Cell: 076 171 5978
Email: luyandam@joburg.org.za
