Grant asylum seekers and refugees right to NHI – call

CONCERNS have been raised that the National Health Insurance (NHI) Bill in its current form discriminates against the constitutional rights of asylum seekers' and refugees' access to healthcare services.

This came to light as civic organisation, the Scalabrini Centre, made a submission to the portfolio committee on health, which continued its virtual oral public hearings on the NHI Bill this week.

The objective of the NHI Bill is to provide universal access to quality health care for all South Africans as enshrined in the Constitution.

It is envisioned that the NHI fund will cover “South Africans of all races, rich or poor and legal long-term residents”, with one pool of health-care funding for private and public healthcare providers.

The NHI will be funded from general taxes, contributions of people earning above a set amount, and monthly contributions made by employees to the fund, collected and submitted in a similar manner to UIF contributions.

The organisation criticised the bill, saying while it mentioned asylum seekers and refugees, they were not afforded the same rights to health care.

Currently the bill states that: “An asylum seeker or illegal foreigner is only entitled to – (a) emergency medical services; and (b) services for notifiable conditions of public health concern.”

In terms of registration for the NHI, it also states that the minister (of health), in consultation with the minister of home affairs, “may prescribe any further requirements for registration of foreign nationals contemplated in the section”.

Scalabrini head of advocacy and legal adviser, James Chapman, said: “Refugees and asylum seekers have the right to the same basic health care and emergency health-care services as South Africans (referencing section 27 of the Constitution). To address health problems, you need to be inclusive, particularly if you're vulnerable. For example, the Covid-19 vaccine was extended to all, even undocumented migrants and the homeless, because to address health effectively you need an inclusive approach. The bill should be amended to express and make clear provision for asylum seekers and special permit holders.

“Migrants of special exemption permits should also be included under (section) 4(1),” Chapman said.

Most individuals on these permits are low-skilled employees and not high earners. “It is not enough in law that there is a ministerial discretion and special permit holders and asylum seekers should be expressly included categories,” he said.

Committee chairperson Dr Kenneth Jacobs said Chapman made a strong case for the vulnerable, “emphasising that these groups need to have access to health care in South Africa under the NHI”.

“Provision is made in the bill for services to be accessed by asylum seekers, illegal migrants and foreign nationals. The Constitution states that access to health care is available to all who live in South Africa and it does not specify citizens,” he said.

Meanwhile, the SA Medical Research Council (SAMRC) in its oral submission said the “NHI, will to a very large extent, flourish or flounder on whether the numbers of people who will require health care can be kept to numbers where it is possible to provide good quality care to all who need it”.

“Prevention (is) needed to reduce the numbers of people who develop communicable diseases such as HIV, TB and Covid-19 but also NCDs such as cancer, diabetes, heart disease, lung disease and mental disorder,” the SAMRC's Professor Melvyn Freeman said. The more people who particularly needed chronic care, “the more strain there will be on the NHI fund”.

In their recommendation, Freeman said: “A percentage of the NHI fund, a minimum of 2%, must be earmarked in the legislation for health promotion. A multi-sectoral structure such as a National Health Commission or National Health Promotion Foundation must be established as part of the NHI, and funded by the NHI fund, to promote health and ensure that fewer people require curative health care.”