Cablegate: Kwazulu-Natal Prioritizes Health Service Delivery

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1. (SBU) Summary. KwaZulu-Natal (KZN) Department of Health
(KZNDOH) is confronting the challenges of restoring its
tarnished image (Ref A) and improving health services in the
province with the highest rates of HIV and TB co-infection in
the world. The new KZNDOH leader is a hands-on practitioner who
has received wide political support and has set ambitious goals
for improving health service delivery in KZN. End Summary.

New KZN MEC for Health

2. Sibongiseni Dhlomo was appointed by KZN Premier Zweli Mkhize
in May 2009 as KZN MEC (Member of Executive Council, like a
`provincial minister') for Health. Dhlomo is a medical doctor
who has practiced medicine and has worked as a public health
lecturer. He also served as Municipal Health and Social
Services Manager for the city of Durban and as the Mayor of
Newcastle, a town in the KZN midlands. Dhlomo is credited for
initiating a clinical research program that supplied ARV drugs
to members of the South African Defense Force (SANDF). The
project called Phidisa (which means `to heal' in Setswana) is a
collaboration among SANDF, South African Military Health Service
(SAMHS), and the US Government's National Institutes of Health
who provide funding as well. Dhlomo developed a good
understanding of PEPFAR because of his work with SANDF through
the SAMHS and, as a result, appreciates the assistance PEPFAR is
providing in South Africa and KZN in particular. Dhlomo also
understands that PEPFAR funding is finite and wants to ensure
that KZNDOH is able to stand on its own when that time comes.
He is a respected public servant and has garnered broad
political support. (Ref B)

Daunting Challenges

3. (U) KZN faces some of the most severe socioeconomic
challenges in South Africa. Thirty-four percent of its 10.3
million residents (21 percent of South Africa's entire
population) live in `hunger and fear of starvation,' according
to KZN Department of Environmental Affairs and Rural Development
(DEARD). KZN has the highest rate of diseases associated with
underdevelopment and poverty and also has the highest mortality
rate. KZN also has the highest HIV prevalence rate at 15.8
percent and has 3.3 million people who are living with HIV -
more than half the total number nationwide. Three of the four
districts nationwide with an HIV prevalence of near 40% are in
KZN. Umkhanyakude district in northern KZN has the highest AIDS
mortality rate in the country, according to Statistics South
Africa. While tuberculosis is the leading cause of mortality in
KZN, 70 percent of those infected with TB are co-infected with
HIV. Life expectancy in KZN has dropped from 53 years in 1996
to 47 years in 2005 and, without intervention, is expected to
drop to 37 years by 2010, according to DEARD.

Ambitious Plan of Action

4. (U) Dhlomo has identified improving health care delivery as
one of KZNDOH's most important goals. `Meeting the public's
rising expectations for health is a marker of good governance
and a solid route to stability and prosperity,' said Dhlomo
during his July 30 inaugural budget speech. Using health
Millennium Development Goals as a measure, KZNDOH hopes to halve
the infant, child and maternal mortality rates by 2014; increase
the availability of ARV treatment by 80 percent by 2014; reduce
the number of new HIV infection rates by 50 percent by 2014;
reach a TB cure rate of 85 percent and reduce new cases of TB by
50 percent by 2014. Dhlomo told a meeting of health managers on
November 19 attended by Pol/Econ Assistant that Premier Mkhize
has directed him to `lead military-style interventions to
reverse the rising tide of TB, treating all people known to have
TB, ensuring strict adherence to treatment in an integrated
approach.' To this end, KZNDOH received a budget of R17 billion
($2.3 billion). In an effort led by Dhlomo to contain spending
and repay the money it owes the province, however, KZNDOH has
entered into an agreement with KZN Treasury to review its
finances and develop a budget management plan.

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5. (U) KZNDOH will embark on a variety of health care
initiatives this year. KZNDOH has developed the Phila Ma
Project, a cervical cancer early screening and vaccination
campaign. KZNDOH plans to support a national initiative that
will support research studies to promote indigenous knowledge
system and the use of appropriate traditional medicines. KZNDOH
also plans to enhance its telemedicine program, whereby
patients, specialists and clinicians are linked via video
conference from the Nelson R Mandela School of Medicine during
the academic term. KZNDOH will increase the bandwidth and
connectivity in rural areas and will develop an ongoing training
program for doctors and support courses in radiology, general
surgery, obstetrics and gynecology, pediatrics, pediatric
surgery, genetic counseling, and HIV management. KZNDOH also
plans to create a Volunteer Corps of 4000 youth to help
implement this ambitious plan.

6. (U) Dhlomo announced during a radio program on December 8
that KZNDOH will fund and implement King Goodwill Zwelithini's
plan to reinstate male circumcision, which has not been
practiced among the Zulu since it was banned by King Shaka.
Circumcision studies give hope that reviving the practice among
Zulu men may lead to a significant reduction in the HIV
infection rate, said Dhlomo.

Dhlomo's Leadership Style

7. (SBU) Dhlomo has shown himself to be a hands-on manager.
Since his appointment, he has made several unannounced hospital
visits to see for himself the state of KZN hospitals and
interact with healthcare workers and patients. During a
healthcare workers union strike in June, Dhlomo led a mediation
team to address strikers' demands. Dhlomo negotiated with
doctors to end the strike and also personally provided medical
care in many hospitals in Durban and Pietermaritzburg during the
strike action. Regional Secretary of National Education and
Health Workers Union (NEHAWU) Khaye Nkwanyana who was part of
the union delegation that met Dhlomo during the strike told
Pol/Econ Assistant on June 26 that Dhlomo handled negotiations
with `maturity and fairness. Dhlomo was a tough but reasonable
negotiator who sympathized with doctors but was firm on the need
to protect the interest of patients and the general public,'
said Nkwanyana. The leader of the official opposition in the
KZN legislature also praised Dhlomo for the manner in which he
handled the strike.

8. (U) In contrast, during the 2007 public servants strike,
which saw many hospitals shut down, former KZN MEC for Health
Peggy Nkonyeni was heavily criticized by opposition parties and
members of the public for her failure to deal decisively with
the situation. Many hospitals saw violent clashes between
striking workers and the police. There were also reported
incidents of violence directed at non-striking health workers
during this strike. The ANC, which was then led by Thabo Mbeki,
accused the Congress of South African Trade Unions(COSATU) of
calling for a strike to embarrass Mbeki's government. Many pro
Zuma leaders including Nkonyeni were accused by the then-ANC
Spokesperson Smuts Ngonyama of collaborating with COSATU during
the strike to undermine Mbeki's government prior to the
watershed ANC Polokwane conference. Nkonyeni denied the

9. (U) Responding to reports of ARV treatment shortages and
excessive wait times for patients, Dhlomo made an emergency
visit to Edendale Hospital outside Pietermaritzburg on June 1.
After his visit, Dhlomo fired District Health Manager May
Zuma-Mkhonza and Edendale Hospital Chief Executive Officer Ms.
Dlamini and instructed Edendale staff to order immediately all
drugs that were in short supply. By August 1, a new district
health manager and hospital CEO were appointed and drugs had
been procured. The leader of the official opposition in the KZN
legislature Bonginkosi Buthelezi commended Dhlomo for his `quick
intervention at Edendale and encouraged him to do the same at
other problematic hospitals. Treatment Action Campaign

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Spokesperson Desmond Mpofu praised Dhlomo for his `swift action'
at Edendale hospital.

Political Opposition

10. (SBU) Dhlomo's ambitious plan has the potential to make a
lasting impact on healthcare service delivery in KZN. However,
in his efforts to root-out corruption and implement his
turn-around strategy in KZNDOH, Dhlomo might face resistance
from senior managers still loyal to former MEC for Health
Nkonyeni. Former Chief Operations Officer at KZNDOH Sipho
Nkosi, who was removed from his position immediately after
Dhlomo took over, accused Dhlomo of purging all managers who
were appointed by Nkonyeni. `Dhlomo is dealing with
incompetency in the department and is not interested in purging
people for petty political reasons,' said Dhlomo Spokesperson
Chris Maxon to Pol/Econ Assistant on October 29. `Dhlomo's
consultative leadership will help him win over skeptics and
those officials who are still loyal to Nkonyeni,' added Maxon.


11. (SBU) The support and respect that Dhlomo has so far
received will go a long way in helping him improve KZNDOH. His
straight-forwardness, decisiveness, frankness, and willingness
to partner have brought a breath of fresh air to a department
that was characterized by bad publicity, fear, and alleged
mis-management and corruption. Unlike his predecessors, Dhlomo
acknowledges the contributions of PEPFAR and seems eager to
enhance that relationship.

© Scoop Media

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