| Independently reported | |
| Ministerial estimate, May 2022 | 40 to 60 per cent of mothers delivering in some hospitals described as undocumented immigrants[1] |
|---|---|
| Substantiation for that estimate | None found by the open letter that examined it[1] |
| Foreign-born share of the population | About 3 per cent, attributed to Africa Check[1] |
| Free to all regardless of status | Primary health care, abortion, care for pregnant and breastfeeding women and children under six, HIV and tuberculosis treatment, and emergency treatment[2] |
| Statutory basis reported | Constitution section 27 and National Health Act section 4(3), the latter providing free services for people without medical aid with no limit by nationality or immigration status[2] |
| Who is charged | Undocumented people from outside the Southern African Development Community are expected to pay full hospital fees, with the exceptions above[2] |
| Travel-for-treatment clause | The National Health Act is reported to contain a clause allowing people travelling for medical care to be charged[1] |
| Regional pattern | Visa restrictions were said to have pushed many Middle Eastern patients toward Southeast Asia[3] |
| This entry has no primary-record band. The statutory and regulatory provisions described are reported through journalism rather than read in the legislation, and both reporting sources were written by staff of SECTION27, a public interest law organisation that litigates on health rights and is therefore a party to the argument. Their accounts of the law are used because no reading of the statutes themselves was obtained, and the bands reflect that. No South African count of commercial inbound medical tourists, no revenue figure and no outbound patient figure was located. No typical cost range is given. | |
Medical tourism in South Africa means something different from what it means almost everywhere else covered on this site. The country has a substantial private hospital sector and has long been promoted for cosmetic and dental treatment, but in South African public debate the phrase refers chiefly to an allegation that foreign nationals, particularly pregnant women from neighbouring countries, travel to South Africa to use free public health services. That allegation was made at ministerial level in 2022 with a numerical estimate that its critics could not find substantiated.
The ministerial claim
An open letter published by Spotlight on 27 May 2022, written by Kholofelo Mphahlele, a paralegal at the advice office of SECTION27, sets out statements it attributes to the health minister, Joe Phaahla. It records that he announced his department would study the treatment of foreign nationals at public health facilities, identified undocumented migrants as the issue and singled out foreign pregnant women seeking maternity services, and told the National Council of Provinces Select Committee on Health and Social Services that some people cross the border for maternity services in Tshwane, Johannesburg and Limpopo.[1]
It further records him stating that an estimated 40 to 60 per cent of mothers delivering in some hospitals are undocumented immigrants, that the department found clear evidence of people from neighbouring countries coming specifically for health services in several facilities, that billing patients’ governments or embassies was among the proposals, and that a team would work with provinces on a formal assessment to gather proper records.[1]
Two things in that sequence are worth separating. An official estimate of 40 to 60 per cent was given, and in the same remarks a formal assessment to gather proper records was announced as still to come. A range that wide, announced alongside the admission that proper records do not yet exist, is a statement of impression rather than measurement, whatever its accuracy turns out to be.
The challenge to it
The open letter states that it found no substantiation for the 40 to 60 per cent estimate, and argues the figure is implausible, applying at best to a few facilities or being simply inaccurate. It cites Africa Check for the point that only about 3 per cent of South Africa’s population is foreign-born, and argues that migrant use of the health system is likely to be in line with that share and may be lower, since some foreign-born people have become citizens. It attributes problems in public services to organisation, human resources and supply management rather than to migrants, and states that reliable data on documented and undocumented foreign nationals is lacking.[1]
The letter is advocacy and is identified as such on its face: Spotlight states that it is published by SECTION27 but editorially independent, and that the views are the author’s. Its argument that blaming migrants is xenophobic or dishonest, and its account of health workers refusing services they are legally required to provide, are positions rather than findings. Its three case accounts, including a woman who gave birth at a train station in June 2021 after being turned away by two hospitals, come from SECTION27’s advice office and are individual cases, not statistics.[1]
On the narrow question that matters here the letter’s position is nonetheless the stronger one, because the burden sits with the party making a numerical claim. No source located for this article provides a measurement of how many patients in South African public hospitals travelled there for treatment.
Who is entitled to what
An explainer by Sasha Stevenson, head of healthcare at SECTION27, published by Bhekisisa, sets out the reported legal position. Section 27 of the Constitution gives everyone a right of access to health care services and provides that no one may be denied emergency medical treatment. Section 4(3) of the National Health Act is reported to provide free services for people without medical aid, with no limits based on nationality or immigration status.[2]
On that account, services free to all persons regardless of status are primary health care at government facilities, abortion at government facilities, care for pregnant and breastfeeding women and children under six at public clinics or hospitals, HIV and tuberculosis care and treatment, and emergency treatment, which cannot be refused or require payment in advance. Undocumented nationals of Southern African Development Community countries, refugees and asylum seekers are treated like South African citizens at public hospitals and means-tested for hospital care. Undocumented people from outside that community are expected to pay full hospital fees, subject to the exceptions above.[2]
The explainer also records a 2007 national health department directive guaranteeing free HIV and tuberculosis care to anyone, a 2008 Gauteng memorandum stating that no patient should be denied any health service whether or not they hold a South African identity document, and the Gauteng Hospitals Ordinance Amendment Act 4 of 1999, which allows a hospital chief executive to require identification before admission except where deferral could have dangerous or detrimental consequences. Patients without South African identification may submit a foreign passport or an affidavit, and provincial health executives can impose additional criteria and fees for different groups.[2]
A circular, issued and withdrawn
The explainer records that a national circular told facilities to charge foreign nationals full rates, with exceptions for low-income refugees; that Gauteng passed the instruction on for non-South Africans other than documented refugees and then withdrew it; and that the national department said the circular should never have been issued. SECTION27’s position was that the Gauteng circular was unlawful under the National Health Act and could violate constitutional rights.[2]
That episode is the practical shape of the question in South Africa. Entitlement is contested not mainly in legislation but in circulars, provincial memoranda and the discretion of admitting staff, which means what a given patient is charged can depend on the facility and the month.
The clause that does address medical travel
The open letter records that the National Health Act contains a clause allowing people travelling for medical care to be charged, and notes that proving women travel for care would be difficult. The explainer contains no provision on people who travel to South Africa specifically for treatment.[1][2]
So South African law does appear to distinguish the medical traveller from the resident foreign national, and the difficulty is evidential rather than legal. Establishing purpose of travel at the point of admission is exactly the problem the announced formal assessment was meant to address.
South Africa is separately promoted as a commercial destination for cosmetic surgery, dentistry and orthopaedics, served by large private hospital groups. No official South African figure quantifying that activity was located for this article, and none has been estimated.
Limits of the evidence
Neither statute nor regulation was read directly for this entry, which is why it carries no primary-record band and why every legal statement is framed as reported. Both sources were written by staff of the same public interest law organisation, which is disclosed rather than treated as neutral. The ministerial statements are reported at second hand, by way of a news report the letter cites. No outcome of the announced formal assessment was located, and neither source gives national figures on health spending, hospital capacity or private sector size.
See also
- Medical travellers and resident foreign patients, the distinction this debate turns on
- Cross-border healthcare for border communities, the likelier explanation for much of the movement
- Refugee access to cross-border healthcare, and the means test applied to asylum seekers
- Medical tourism and local access to care, the harm the ministerial claim asserts
- Medical tourism statistics, and an official estimate with no measurement behind it
References
- Mphahlele, K. Open letter: Dear Minister Phaahla, the medical tourist mom is little more than a convenient myth. Spotlight, Comment and Analysis, 27 May 2022. Independently reported: the letter was opened and the author’s position as a paralegal at SECTION27’s advice office, Spotlight’s statement that it is published by SECTION27 but editorially independent and that the views are the author’s, the statements attributed to health minister Joe Phaahla including the planned departmental study, the identification of undocumented migrants and foreign pregnant women, the remarks to the National Council of Provinces Select Committee on Health and Social Services about Tshwane, Johannesburg and Limpopo, the estimate that 40 to 60 per cent of mothers delivering in some hospitals are undocumented immigrants, the claim of clear evidence of people from neighbouring countries coming specifically for health services, the proposal to bill patients’ governments or embassies, the announced formal assessment with provinces to gather proper records, the letter’s statement that it found no substantiation for the 40 to 60 per cent estimate, the citation of Africa Check for the figure that about 3 per cent of the population is foreign-born, the argument that reliable data is lacking, the report that the National Health Act contains a clause allowing people travelling for medical care to be charged together with the observation that proving such travel would be difficult, the references to the Constitution and the Immigration Act, and the three individual case accounts from SECTION27’s advice office were read directly. Retrieved 23 October 2026.
- Stevenson, S. Can foreigners get medical aid, free healthcare in South Africa?. Bhekisisa Centre for Health Journalism. Independently reported: the article was opened and the author’s position as head of healthcare at SECTION27, the citation of section 27 of the Constitution on access to health care services and the prohibition on denying emergency medical treatment, the account of section 4(3) of the National Health Act providing free services for people without medical aid without limits based on nationality or immigration status, the list of services free to all persons regardless of status comprising primary health care, abortion, care for pregnant and breastfeeding women and children under six, HIV and tuberculosis care and emergency treatment, the means-tested treatment of undocumented Southern African Development Community nationals, refugees and asylum seekers on the same footing as citizens, the expectation that undocumented people from outside that community pay full hospital fees subject to those exceptions, the 2007 national health department directive on free HIV and tuberculosis care, the 2008 Gauteng memorandum, the Gauteng Hospitals Ordinance Amendment Act 4 of 1999 and its identification provision and exception, the documentation alternatives of a foreign passport or affidavit, the power of provincial health executives to impose additional criteria and fees, the national circular instructing facilities to charge foreign nationals full rates and its transmission and withdrawal in Gauteng together with the national department’s statement that it should never have been issued, SECTION27’s position that the circular was unlawful, the quotation of Gauteng Health MEC Gwen Ramokgopa to Business Day, and the absence of any provision on people travelling to South Africa specifically for treatment were read directly. The article carries no publication date in its content. Retrieved 23 October 2026.
- Chambers, A. Trends in U.S. Health Travel Services Trade. Office of Industries, United States International Trade Commission, Executive Briefing on Trade, August 2015. Independently reported: the briefing was opened and the statement that visa restrictions had pushed many Middle Eastern patients towards Southeast Asia was read. The briefing states that the views expressed are the author’s and not those of the Commission. Retrieved 23 October 2026.
Sourcing note: this entry carries no primary-record band because no South African statute, regulation or circular was read directly; every legal statement is reported from journalism and framed that way. Both sources were written by staff of SECTION27, a public interest law organisation that is a party to the dispute, and that is disclosed rather than smoothed over. The ministerial estimate is reported as what it is, an official statement, alongside the finding that no substantiation for it was located. Individual case accounts are identified as cases, not data. Nothing has been estimated.