What is needed to improve the situation?

As mentioned, the South African public healthcare system is struggling to address the nation’s needs. Many people struggle with access, South African and non-South African alike. Groups of the population, such as people living in rural areas, will face specific challenges. Similarly, there are unique and specific challenges that are faced by non-nationals, which are mostly linked to language and documentation. There are some actions which can assist in clarifying this complex matter:

• There is a deep need for evidence-informed policy processes and frameworks. Despite being a region that witnesses such high levels of migration, these movements are not commonly taken into consideration when developing health responses – including for treatment and prevention of communicable diseases.
• There has been little case-law (legal cases) on the issue of migrants and refugees access to health. The laws, policies and practises around this issue are very unclear. It would be beneficial to receive legal clarification on such issues.
• Governmental planning of healthcare budgets and resource allocation must take into consideration correct predictions of both cross-border and internal migration patterns in South Africa, using current population data.
• The healthcare system needs to be more responsive and reactive to migration: South Africa would benefit from migration-aware and mobility-competent healthcare systems, that facilitate movement within the country (including within cities) and between countries in SADC.
• We advocate for increased awareness about migrants’ health rights – training on migration, mobility, health and development for all levels of staff in the Department of Health, including frontline staff, healthcare providers, facility managers, district and provincial health co-ordinators, and within the national department, would be beneficial. As one expert explains, ’understanding of migration is poor within sectors responsible for developing appropriate [healthcare] responses; negative, unsupported assumptions relating to the prevalence of cross-border migration, the spread of disease, and the burden on receiving health systems prevail.”
• We advocate for the printing and distribution of uniform and correct classification of non-nationals when being means tested for co-payment for healthcare, and the uniform implementation of national monitoring of the correct implementation of existing legislation within health facilities.
• We advocate for those who are denied rightful access to health to lodge the matter with the Office of Health Ombud or to contact one of the organisations below for advice.