HEALTHCARE IN KWAZULU-NATAL: A SPOTTY HISTORY

UNCLAS SECTION 01 OF 02 DURBAN 000123 SENSITIVE SIPDIS FOR AF/S, INR E.O. 12958: N/A TAGS: PGOV SF SUBJECT: HEALTHCARE IN KWAZULU-NATAL: A SPOTTY HISTORY REF: DURBAN 53 DURBAN 00000123 001.2 OF 002 ¶1. (SBU) Summary. Healthcare in KwaZulu-Natal (KZN) has gone from extreme disparity of services under apartheid, to mismanagement post apartheid. While KZN Department of Health (KZNDOH) saw improvements under its first post-apartheid leader, it experienced overspending and service delivery setbacks under its second. The newly appointed KZNDOH leader faces many challenges but seems well-suited for the position. End Summary. KZN Healthcare under Apartheid ¶2. (U) Two separate administrations were responsible for health care provision in KZN before 1994 in line with the apartheid policy of segregation. The Natal Provincial Administration was responsible for health provision in white and Indian areas while the Government of KwaZulu Territory was responsible for health provision in black townships and rural areas. The government of the day spent substantial resources on the healthcare of white South Africans and little on non-white residents, resulting in dramatic health care disparities. Improved KZN Healthcare Post Apartheid ¶3. (U) After South Africa's first democratic general elections in 1994, health service delivery in KZN was integrated under a single administration, KZNDOH. The first Provincial MEC (Member of Executive Council, like a `provincial minister') for Health was Dr. Zweli Mkhize (now Premier of KZN). Mkhize led the KZNDOH for ten years and is credited for improving healthcare service delivery in the province. During Mkhize's tenure, KZN started an HIV/AIDS antiretroviral (ARV) drug program and a mother-to-child HIV prevention program even though the national government was officially opposed to such programs. KZNDOH was one of the best run health departments in South Africa during Mkhize's tenure, according to civil society organizations Treatment Action Campaign (TAC),Health Systems Trust (HST) and Health E news. KZNDOH Backslides under Nkonyeni ¶4. (SBU) In 2004, Peggy Nkonyeni, a history and English teacher from Port Shepstone, succeeded Mkhize as the MEC for Health. (Reftel) Her appointment, however, was greeted with an outcry from the Democratic Alliance (DA),who pointed out that Nkonyeni lacked expertise and understanding of the health sector. Nkonyeni aligned herself closely to the views of her mentor, the then-National Minister of Health Manto Tshabalala-Msimang, who was portrayed by TAC and opposition parties as an HIV/AIDS denialist. Soon after Nkonyeni's appointment, hospitals providing ARVs were put under scrutiny by KZNDOH. A number of health care professionals who publicly challenged her views on HIV/AIDS were suspended or expelled. Nkonyeni was also criticized for supporting a traditional healer who claimed to have a cure for HIV/AIDS. ¶5. (SBU) Health service delivery in KZN deteriorated during Nkonyeni's tenure. In 2005, both the Association of Rural Health Doctors and South African Medical Doctors Association reported a serious lack of capacity to deliver healthcare in KZN, especially in rural hospitals. KZN Legislature's Portfolio Committee for Health in KZN reported in June 2007 a shortage of medical staff, pharmacists and medicine in many hospitals. Also, in 2007 the area of uMsinga was affected by the spread of an extremely drug resistant TB called XDR TB, resulting in 16 deaths. Much of the blame went to Nkonyeni and KZNDOH, as there was a shortage of TB treatment in the uMsinga area. Corruption Charges, Redeployment DURBAN 00000123 002.2 OF 002 ¶6. (SBU) In February 2008, KZNDOH reported that it had overspent its budget by R2.2 billion ($293.9 million). In September 2008, the National Prosecuting Authority charged Nkonyeni with corruption. Specifically, she was accused of receiving bribes and kick-backs from a company (allegedly owned by her boyfriend) that received tenders from KZNDOH. Opposition parties called for Nkonyeni to step down, but she refused and was defended by the then-KZN premier Sibusiso Ndebele (now the national Minister of Transport) and the ANC. Former KZN DA Provincial Leader Roger Burrows and former KZN Premier Lionel Mtshali of the IFP alleged to Pol/Econ Assistant that the ANC protected Nkonyeni because she was a close ally of ANC President Jacob Zuma. ¶7. (SBU) In June 2009, charges against Nkonyeni were provisionally withdrawn when a key state witness became unavailable `due to illness'. After the April 2009 general election, Zweli Mkhize became KZN Premier but did not include Nkonyeni in his new cabinet. Nkonyeni was instead redeployed as the Speaker of the KZN Legislature. Sibongiseni Dhlomo, M.D. was appointed KZN MEC for Health in May 2009. Comment ¶8. (SBU) The mettle of new KZN MEC for Health will be tested as he attempts to undo the damage of years of neglect and mismanagement. In addition, Dhlomo will face the daunting challenge of working in a province with the highest rate of HIV infection in the world. Dhlomo is no stranger to hard work and innovation, however; and he is known to be a natural leader and consensus builder - skills which will serve him well in his new post. DERDERIANJ