Pretoria — South Africa’s provincial health departments have no mechanism to recover unpaid treatment costs from the countries of origin of undocumented migrants, despite growing public and political pressure over the strain on the public healthcare system.
This was revealed by Health Minister Aaron Motsoaledi in a written response to parliamentary questions from EFF MP Nqobile Mhlongo about expenditure on emergency and triage care for undocumented migrants during the 2024/25 financial year.
“Currently there is no mechanism for the provincial departments of health to recover the costs from the countries of origins for all immigrants if their accounts remain unpaid,” Motsoaledi said.
No Distinction Between Documented and Undocumented Patients
Motsoaledi confirmed that provincial health departments do not separate data for documented and undocumented migrants. However, the department is finalising its Integrated Disease Surveillance and Response Strategy to improve data collection on patient nationality — regardless of legal status.
He cited Section 27(1) of the Constitution and the National Health Insurance Act, which guarantee access to healthcare for all within available state resources and prohibit refusal of emergency medical treatment based on nationality or documentation status.
Political Pressure Over Lack of Tracking
His remarks come amid criticism from ActionSA, which says the department’s failure to track nationalities or verify patient status prevents accurate budgeting and policy planning.
ActionSA MP Kgosi Letlape argued that in a health system already facing overcrowding, staff shortages, and medicine stockouts, the lack of oversight was “reckless and unsustainable.”
“Without tracking, verification or appropriate data collection, the department is unable to account for the full scope of service delivery liabilities,” Letlape said.
Operation Dudula’s Confrontations at Hospitals
The debate comes against the backdrop of Operation Dudula activists attempting to turn away foreign nationals from public hospitals — actions condemned by rights groups and health authorities.
Motsoaledi stressed that healthcare access is determined by clinical need, not nationality. He also confirmed that only the Department of Home Affairs has the authority to determine a person’s legal status, and hospitals do not refer patients for immigration checks.
“Provincial Departments of Health and health facilities have reported a high number of undocumented patients accessing health services. However, we do not legally know the nationalities of such undocumented patients,” he said.
Root Causes of the Healthcare Crisis
Responding to EFF MP Chumani Matiwane, Motsoaledi said the ongoing healthcare crisis is driven by multiple factors — including budget cuts, infrastructure challenges, and human resource shortages — not solely by the treatment of foreign nationals.
