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MBABANE – Emaswati, more especially pregnant women and children under the age of six, can now receive free medical services in South African public health hospitals.

This will be made possible because of the Gauteng High Court in Johannesburg on Friday, April 14, 2023, upheld the rights of all pregnant and lactating women, as well as children under the age of six, to be provided with free health services at public hospitals. It said these rights were included for foreign and undocumented patients. However, the ruling mentioned that they would only access the services only if they happened to need them while in South Africa, not specifically visiting the neighbouring country for their free medical services.
Worth noting is that most emaSwati residing in communities along the borderlines frequently cross to South Africa through informal crossings for several services, including health services. Adding to the health services, they also travel to South Africa for shopping and schooling. The ruling comes after Gauteng Department of Health denied free healthcare to foreign pregnant women and young children.

Public Interest Law Centre, in section 27, said it welcomed the court’s decision. Section 27 explained that the court ordered that the policy introduced by the Gauteng Department of Health in 2020 denied free healthcare services to foreign pregnant women and young children, was now declared unlawful. The judgment also ordered the Gauteng Department of Health to amend its policy by October 16, 2023. “The court also declared that any other similar policies or circulars that prevent pregnant and lactating women and children under six from accessing free health services are declared inconsistent with the National Health Act and are invalid,” it said. The court also made two orders to spread and increase awareness of the court order.

Firstly, the National Department of Health will have to issue a circular to all provincial departments of health by May 15, 2023. The circular must state that pregnant and lactating women, as well as children under six, who are not members of medical aid schemes and did not come to South Africa for healthcare, are eligible for free health services at any public health facility. Secondly, the National Department of Health was instructed to prepare and display posters or notices in all health establishments in all provinces no later than July 17, 2023. “The posters must state that all pregnant women, all lactating women, and all children below six years of age are entitled to free health services at any public health facility, regardless of their nationality or documentation status, unless they are members of medical aid schemes or came to South Africa solely for healthcare,” Section 27 said.

The order follows a court application brought in May 2022, together with two women who were denied access to free health services while pregnant and another whose young child was denied free healthcare. Swaziland Mine and Migrants Workers Association (SWAMIWA) Secretary General Vama Jele welcomed the court’s decision. He noted that relatives of migrant workers struggled to access health services in public health facilities. He mentioned that they were, however, looking on how the decision would pan out because they understood that there were regulations that needed to be drafted. Director of Health Services in the Ministry of Health Dr Velephi Okello said they were closely monitoring the implementation of the decision given the fact that South Africa had a higher number of migrants in the region. She noted that the decision would force the SA government to increase its health budget.

Coming to Eswatini, Dr Okello said health services in the country were highly subsidised by government. She noted that even the registration upon visiting public health facilities required identity cards strictly for record keeping purposes. She noted, however, that there were restrictions when it came to maternity services such as giving birth. She said migrants paid certain amounts for those services but they were not as steep, while for the other services they paid the normal registration charged by the facilities. She noted that despite that, the services became costly for government and the form of model was not sustainable as it put more strain on government. “Due to the high costs of health services and the strain they bring to government, the World Health Organisation (WHO) has advised its member States to form national health insurance,” she said. She said everyone would contribute in the insurance to ensure that healthcare services were efficient as they would be heavily subsidised by government.