Last week, a circular was released by the Gauteng Province Department of Health calling for upfront fee payment – or payment before discharge – by non-nationals, except for documented refugees.
This is an extremely worrying development that has negative public health implications for all in South Africa and the SADC region. The circular suggests practice that is outside of the law, goes against the principles of our constitution, and is contrary to international obligations. It indicates that asylum seekers, undocumented migrants and individuals on visitors visas will need to pay to access services, which include HIV and TB testing and treatment. Not only is this a human rights issue, this is a public health disaster and a return to the situation pre-2007 when non-nationals struggled to continue treatment (if travelling from elsewhere already on treatment), to access testing, and to access treatment in South Africa. The era of Universal Test and Treat requires immediate access to testing and treating for all. Treatment as Prevention – including PreP – programmes require easy and continued access for all.
We will not make gains towards 90:90:90 targets without ensuring everyone can access treatment. The Department of Health has a worrying track record of scapegoating foreign nationals for the poor performance of the South African national healthcare system.
A short piece on this issue was published in December 2018 in the excellent HIV Nursing Matters magazine.