Mothers allege some Gauteng hospitals are witholding newborn babies from foreign mums until bills for delivering at public hospitals are paid. Immigrant women also report health care workers have turned their children away or threatened to withold care without payment in violation of national legislation.

Renilda Shabangu alleges that Pholosong Hospital demanded she pay her R940 hospital bill before staff would release her newborn son.

“I did not have the R940 as I am not working,” said Shabangu, who delivered at the Tsakane hospital in December 2014 and is originally from Mozambique. “I then decided to sell my brother’s computer to get the money (and) I went back to hospital to collect my child.”

Shabangu is not the only mother to report her child was withheld from her until she could pay for delivering at the facility. Fellow Mozambican Albertina Mavi gave birth at the hospital in February and alleges the hospital also withheld her baby girl until she paid her bill.

“They told me to pay R940 so that they could give me my baby and her clinic card,” Mavi told Health-e News. “I did all I was asked to do to get the my child.”

Originally from Zimbabwe but living in Braamfischerville, Linda Mhlanga says that Leratong Hospital staff outside Krugersdorp threatened to have her arrested when she could not pay for the 2014 birth of her daughter.

“I was charged R800 for booking only, but I told them that I do not have money,” Mhlanga said. “They allowed me to give birth and threatened that they were going to send me to the police if I did not pay them.”

Hospitals’ actions in violation of National Health Act

According to attorney Sasha Stevenson with the human rights organisation Section27, health facilities turning away new mothers and young children could be in contravention of the country’s National Health Act.

“The National Health Act provides that all pregnant and lactating woman, and all children below the age of six – regardless of nationality – are eligible for free health care services,” she told Health-e News. “All persons regardless of nationality are entitled to free primary health care services.”

A 2007 Department of Health directive also made antiretrovirals free of charge for everyone regardless of status in South Africa.

South Africa is one of many countries worldwide including Sierra Leone to extend free health care to pregnant and breastfeeding mothers as well as young children.

A year after Sierra Leone launched free health services for pregnant women, new mothers and children, the country saw a 61 percent reduction in maternal deaths and a dramatic improvement in maternal complications, according to UNICEF South Africa.

Internationally, the UN body has estimated that investing in young children to prevent illness and death later could save the world up to R 7 billion annually by preventing child deaths. Deaths of new mothers and infants cost the world R250 billion in potential lost productivity each year, according to UNICEF.

• Read South Africa’s Uniform Patient Fee Schedule to find out what you are entitled to

Problems may stem from 2013 Gauteng Department of Health policy

[quote float= right]Everyone regardless of status must be given a means test and can be asked to pay for some services. Inability to pay cannot be used as a reason to deny care

But Mhlanga was one of two mothers to report that health workers had refused – or threaten to refuse – to treat their babies without cash.

“When my daughter was five months old, she got sick and when I took her to Leratong Hospital,” said Mhlanga, who added that her daughter was admitted after she paid R150 to open a file. When the girl was due for a check up months later, health workers allegedly turned the pair away after Mhlanga could not pay R300.

Helen Ndlovu, originally from Zimbabwe, claimed that West Rand hospital gave her an R800 bill stemming from her 10-month-old baby boy’s stay. She was told that if the boy fell sick again, Leratong Hospital staff would not assist her child until bills had been paid.

Thifulufheli Sinthumule is the national programme coordinator for the Consortium for Refugees and Migrants in South Africa (CoRMSA). According to Sinthumule, CoRMSA has also received reports that some Gauteng hospitals are denying foreign patients care based on a 2013 Gauteng Department of Health policy.

According to Sinthumule, everyone regardless of status should be subjected to a means test and may be asked to pay for some services, especially those at hospital level. However, he warned that some hospitals may be using foreign patients’ inability to pay as a reason to deny health care services.

In 2013, the policy was also blamed for some hospitals’ denial of HIV treatment to foreign-born patients.

Gauteng Department of Health Spokesperson Steve Mabona said the department will investigate claims and visit Pholosong Hospital, but added that in general, undocumented immigrants are treated like private patients and expected to pay in full.

“We provide services to people irrespective of their nationality, socio-economic condition, sexual preference or creed,” Mabona added. “We will visit the hospital to correct the practice of making patients to pay before being given their babies with immediate effect.”

However, he confrimed that fees for refugee or asylum seekers with valid permits are determined by a means test, which is also used for South African citizens. The cost of care is then also determined by the procedure needed and health facility type.

He added the department is currently reviewing this policy.

• Read the Gauteng Department of Health’s controversial draft policy on treating foreigners 

An edited version of this story also appeared on IOL.co.za and The Star newspaper.