Maladministration, not foreigners, to blame for state of South African healthcare

Although foreign nationals' treatment sparks debate, the key question is: what is a hospital bed's true cost in SA, and what structural weaknesses does this expose?

- By Yeshiel Panchia

Recent demonstrations against foreign nationals at public healthcare facilities have intensified arguments that taxpayer-funded institutions, already overstretched, are being unfairly used.

Though these concerns are not entirely unfounded, as South Africa provides constitutionally protected healthcare to all inside its borders, the demonstrations reveal a deeper systemic issue in our public healthcare system.

South Africa's relative stability positions it as a migration destination for the citizens of many neighbouring countries, significantly impacting border healthcare facilities. Combined with the legacy of apartheid-era health infrastructure, the attention given to foreign nationals often becomes a distraction from deeper systemic issues.

The reality is that healthcare infrastructure has persistently lagged behind demand and population growth, irrespective of nationality. Many border-area hospitals face heightened pressure, not primarily from migration, but rather from longstanding underinvestment in capacity and resources.

South Africa's healthcare expenditure

About 8% of South Africa's GDP is dedicated to healthcare, translating to about R10,000 per person annually. This expenditure includes both public and private healthcare sectors.

It's about one-tenth that of Organisation for Economic Cooperation and Development countries, but similar to regional neighbours such as Namibia, which spends about R8,000 per person.

However, raw spending figures mean little without outcome comparisons using metrics such as life expectancy, which in South Africa is slightly higher than in Namibia or Botswana. But Professor Alex van den Heever, chair in the field of social security systems administration and management studies at Wits University, says life expectancy is "too broad as a metric". "Look at maternal mortality," he suggested.