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Cablegate: Healthcare in Kwazulu-Natal: A Spotty History

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R 301630Z DEC 09
FM AMCONSUL DURBAN
TO RUEHC/SECSTATE WASHDC 1541
INFO RUCNSAD/SADC COLLECTIVE
RHEHAAA/NSC WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
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RUEHDU/AMCONSUL DURBAN 0923

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

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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

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