In August 2022 Phophi Ramathuba, the government’s head of health in South Africa’s Limpopo province, caused a stir when she was recorded confronting a Zimbabwean national for seeking medical care at one of Limpopo’s public hospitals.
In a now viral video, Ramathuba can be heard telling a patient: ‘You are killing my health system. When you guys are sick you just say, ‘Let’s cross the Limpopo river, there’s a MEC there who’s running a charity department.’’
Limpopo is South Africa’s most northern province, and borders neighbouring Zimbabwe, Botswana and Mozambique.
Ramathuba’s comments drew criticism from some. But others appeared to support her message. “We are trying to fix our healthcare system but we can never do it unless what our MEC is saying is addressed,” tweeted Mike Ramothwala, a senior clinical manager at the Limpopo Department of Health.
“The last statistics showed that 80% of women giving birth at Musina hospital are illegal Zimbabweans,” he wrote. His tweet was shared more than 3,500 times.
Several readers asked Africa Check whether there was any truth to Ramothwala’s 80% figure. Here’s what we found.
‘Numbers do get thrown around’
Africa Check looked into similar claims made by then health minister Aaron Motsoaledi on 14 November 2018. At a nurses’ summit, Motsoaledi said South Africa’s health system was “overburdened” by care for more people than it could afford.
In an interview the next day, the minister blamed this on inadequate funding and the “issue of foreign nationals”. Asked if there were statistics on the share of foreign nationals using public healthcare, Motsoaledi said the health department did not officially collect this data as it was a “very sensitive matter”.
But he did say he had a “lot of anecdotal data’, such as the number of “not South African” babies born at three public hospitals in the country. For example, he said, out of 10 babies delivered at Messina (or Musina) hospital in Limpopo, seven were not South African. That’s 70%.
Africa Check asked Neil Shikwambana, spokesperson for the Limpopo department of health, for figures on the number of babies born to foreign nationals at Musina hospital. He said that “on average per week, the hospital delivers about 21 babies”. Out of those, “11 are foreign nationals and 10 are South Africans”.
Taking Shikwambana at his word, that means roughly half – 50% – of the babies born at the hospital are, on average, “not South African”. This is lower than both Motsoaledi’s 70% and Ramothwala’s 80%.
The high number of migrants giving birth at Musina Hospital made sense, Lorena Nunez Carrasco, an associate professor in the department of sociology at Wits University, told Africa Check at the time. Her research explores the links between health and migration.
“If you need to give birth and there is a better service right there, a few kilometres away, but it belongs to another country, then you would go,” she said.
Musina Hospital is just 15 kilometres from the Zimbabwe border. It’s also within reach of people from Mozambique to the east, and Botswana to the west.
Africa Check asked Shikwambana whether the figures he previously gave us had changed.
“I have not been exposed to those stats,” he told us. But in the wake of Ramathuba’s video, and sensing that statistics would be an issue, Shikwambana said he had asked colleagues to provide a report on the current situation.
“The problem with numbers: they do get thrown around and you might find they are not necessarily factual. It’s a general statistic everywhere.”
Official data not readily available
But does the public hospital in Musina collect official data on the nationality and legal status of its patients?
It must be able to account in terms of payment and billing, Shikwambana told Africa Check. Hospital forms require either a South African ID number or information that shows whether a person is in the country legally. The hospital should therefore be able to access that data, Shikwambana said, but it wouldn’t be published anywhere. “It’s for internal processes and workings.”
At a provincial and national level, statistics on the total number of babies born to undocumented migrants at public health facilities are not available. “Our health facilities do not keep statistics on foreign nationals,” national health minister Joe Phaahla wrote in a written reply to questions posed by the Inkatha Freedom Party in May 2022.
Data on the number of undocumented migrants using public health facilities for reasons other than giving birth were also not available, the minister wrote, because it was not a health department policy requirement.
National discourse encourages medical xenophobia
Without official data, it is difficult to verify claims like Ramothwala’s. But what of the broader idea that foreign nationals put a strain on South Africa’s public health system?
At a national level, migrants had “very little” impact, Jo Veary, an associate professor with the African Centre for Migration and Society, previously told Africa Check. Her research areas include how migration affects health development in South Africa.
Migrants from elsewhere in Africa weren’t attracted to South Africa for the quality of its healthcare system, she said. “Individuals know that the system is not functioning at the level it should be, and people know that the treatment received as foreign nationals is poor.”
According to Loren Landau, a professor of migration and development at the University of Oxford in the UK, migrants to South Africa are looking for work, seeking protection, or hoping to proceed to other countries. (For more on this, read our factsheet on how to talk about migration in South Africa)
Jo Hunter-Adams, a postdoctoral research fellow at the University of Cape Town’s Health Economics Unit, previously told Africa Check there was a “national discourse” that encouraged “medical xenophobia”.
“The narrative that foreign nationals are a ‘burden’ to the South African health system seems to be an example of scapegoating, where migrants are blamed for broader systemic problems with the health system."
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