Medical Xenophobia and the South African State
By Femi Olugbile
It is generally believed that, despite its many imperfections, South Africa has the most accessible, and possibly the best, healthcare system in sub-Saharan Africa. Basic health services in public health facilities are essentially free, and can be accessed by all resident of the country. Vulnerable groups such as pregnant women and children under six years of age are given special cover. Also covered would be anyone irrespective of status who is in a life-threatening emergency.
Health Insurance, which would enable citizens to access healthcare of their choice without the need for out-of-pocket payment, is a growing area, but the coverage is still relatively low. In 2023, only about 16% of the population, or approximately 10 million residents, had active private medical aid schemes of various sorts.
Private healthcare facilities provide services for about 20% of the population of the country. It is a robust industry with some of the most advanced services in the world, and it has a proud history of contribution to cutting edge innovation and Quality Improvement. It is responsible for 50% of healthcare spending in South Africa However, access for the generality of the population, especially the majority black population and the large number of immigrants, is limited by high cost, with many having to pay out of pocket.
In its broad aspiration to Universal Health Coverage, South Africa, the second largest economy in Africa, may be biting off more than it can chew, as it does not have quite the human and material resources to cope, according to some authorities. The evidence for this conclusion is that health facilities, processes and procedures are in an ‘advanced state of disrepair’ in some parts of the country.
Incidentally there are many Nigerian medical professionals providing service in the highest reaches of the South African system, private and public.
This background merely serves as preamble to a consideration of the increasing spate of brazen efforts by some activists to prevent people who are not citizens of South Africa from accessing the public healthcare system. It is a movement that has been gathering momentum over the past few years and is known by the quaint title of ‘Medical Xenophobia’.
A viral video in the social media shows a group of young South Africans ‘invading’ a hospital in KwaZulu Natal and going to different function areas of the hospital to address patients and staff.
‘If you know you are not a South African citizen…please leave our hospital….Go and seek medical attention from a private facility…not here anymore…’
They confront a patient who claims he is a refugee from Congo. It almost turns into a fist fight as he is walked out.
‘…We have started here to activate our hospitals…We don’t want foreign nationals – documents or no documents…’
They warn the Minister of Health and other officials to ‘stop threatening us with prison’ and claim they have support all over the nation.
‘…Good morning my good doctors…Anyone who is not a South African…please stabilise them…and discharge them…Those people have too many privileges in our country…’
When Medical Xenophobia first reared its head in 2022, after ‘Operation Dudula’ activists blocked immigrants’ access to a Johannesburg hospital, President Ramaphosa warned the activists to desist.
Like other displays of xenophobia, the movement has simply grown stronger since. The response of officialdom at different levels appears mealy-mouthed, even ambivalent.
The social psychology of South African xenophobia is complex and cannot simply be addressed with angry petulance, as is the common reaction of other Africans. It is possible to argue that the fact that other Africans paid a heavy price for South African liberation does not necessarily entitle them to the riches of post-Apartheid South Africa as spoils of war. Afterall, Africans supported Black Liberation because it was the right thing to do, not because they expected to be rewarded.
It is curious, but not unusual in human psychology, that the oppressed black man of yore is now finding common cause with his erstwhile oppressor in his social attitudes, including a disdain for other Africans. He is, in some respects, being assimilated into the values of his former enemy, instead of graciously assimilating the other into his own values, as he set out to do.
Poverty and the persisting gulf between the rich – mostly white, but including a growing number of black billionaires and millionaires, and the vast underclass in the townships requires a scapegoat for the projection of hate and the venting of frustrated hope. The foreigner from Mozambique, Zimbabwe, Zambia, even Nigeria, is a convenient target.
But the truth, beyond all the righteous passion, is that anti-immigrant sentiment is rife all over the world. It is time for people, especially Africans, to begin to put their own homes in order.
South Africa has a problem with long porous borders, and it has a right to decide who comes in and who stays out. Going in droves from Mozambique to benefit from free dialysis in KwaZulu Natal may be seen as a freewheeling act of ‘Medical Tourism’, transferring the burden of healthcare from a poor but potentially rich Mozambique to an increasingly overburdened South African economy.
Having worked for long years in a system where a Nigerian state tried to provide cutting edge, subsidised healthcare in public facilities, only to have them swamped by hordes of patients from surrounding states with extreme needs and empty pockets, it is not too difficult to envisage the possibility that ‘Free Health’ may crash down the line in South Africa, if the issues of who is entitled, and Healthcare Financing generally, are not successfully addressed.
But Dudula paranoia and bands of young hooligans harassing and scaring off sick fellow Africans from the healthcare they need is not the way to solve the problem. The leadership and the people of South Africa are letting themselves down. And if they think they can mouth platitudes and let such criminality go with a nod and a wink, they need to think again.
