18 August 2007

South Africa: What is Really Going on in the Health Ministry?


Cape Town — The eternal optimist, Nigerian mathematician Leonard Karshima Shilgba, once wrote: "Seasoned commentators on national and international issues have this nifty ability to sway the audience whether with polemics or reason. They hold in their hands the master stroke for hope or dismay."

This nifty ability to sway audiences has been at work in South Africa in the form of myths that have taken flight since President Thabo Mbeki relieved Nozizwe Madlala-Routledge of the position of deputy health minister.

One would be less concerned were it not for the importance of understanding our social reality in relation to the right citizens have of access to information, especially on critical social issues such as our public health system.

Most of these myths fall under four categories: first, the single-handed driver of the HIV and Aids National Strategic Plan (NSP), without which the NSP is destined to collapse; secondly, the intolerant president and "Mrs High and Mighty" Minister of Health (a Sunday newspaper's phrase) opposed to the plan; thirdly a president and minister antagonistic to independence of thought and lofty democratic ideals, measured most remarkably by a deputy minster's opposition to government policy, and lastly, the two villains conspiring against "Mrs Down to Earth" (the same Sunday newspaper) by setting her up for a trip to an international HIV and Aids vaccine conference and on her return kicking her out of government - their conspiratorial arts having finally borne fruit.

Sadly, like all myths not exposed to the light of fact, they are in danger of assuming the respectability of truth.

Myth one: the NSP is now collapsing.

In response to the HIV and Aids epidemic, the government seven years ago adopted the Strategic Plan 2000-2005 and in 2003 the Operational Plan. This was done in consultation with stakeholders who in turn embraced the plan as a guiding framework.

It served to broaden the involvement of agencies beyond the Department of Health and established and expanded key programmes such as health education, voluntary counselling and testing, prevention of mother-to-child transmission and anti-retroviral therapy.

At the end of the plan's five years, the South African National Aids Council (Sanac), under the leadership of Deputy President Phumzile Mlambo-Ngcuka, mandated the Department of Health to lead a process of developing the NSP for 2007-2011.

It was developed through an intensive and inclusive process of inputs from a wide range of stakeholders, who share the approach premised on four pillars: prevention; treatment, care and support; research, monitoring and surveillance; and human and legal rights.

As it did before, Cabinet exercises political authority while implementation is primarily the responsibility of the Department of Health. Responsibility for co-ordination across government rests with the Inter-ministerial Committee on Aids, comprising eight ministries.

Sanac provides guidance and political direction, support and monitoring of the sector programmes. It operates on three levels - a high-level council, chaired by the deputy president and with a civil society deputy chair; a sector level, with sectors taking responsibility for their own organisation, plans, programmes, monitoring and reporting to Sanac; and a programme level, led by the social cluster.

The myth some seem intent on peddling is that the NSP runs the risk of collapsing because of Madlala-Routledge's removal from office. This would be an unprecedented development. Few, if any, government policy programmes have been or could have been propelled by a single individual, in particular this programme, which depends more than most on a wide range of departments and structures inside and outside of government.

Myth two: the angel versus the villains.

This myth holds that Mbeki and Tshabalala-Msimang were so opposed to the NSP that they set out to weed its supposed jockey out of government.

The facts presented above speak of a different reality - one of leadership and support of the NSP by the president and the entire Cabinet. Why then the continued propagation of this myth?

One can offer at least two plausible explanations. The first is that there appears to be a yawning gulf between public commentary on the one hand and the reality of government policy on the other. This leads, among other things, to an inadequate appreciation of the impact of policy objectives and the progress we could realistically have made relative to the myriad challenges we face. Secondly, the myth is perhaps employed as part of the contest of political space (nothing wrong if this was disclosed for all to know precisely what we are dealing with!).

It seems that caricatures of all sorts are made of those who promote a holistic approach to the fight against HIV and Aids, rather than specific demands advocated by some pressure groups.

This is not without its social costs. It shifts focus from the real work that has been and continues to be done, not only in the fight against HIV and Aids but also to improve the public health system as a whole.

Here lies Shilgba's concern about the nifty ability to sway audiences, in hope or dismay.

Myth three: the independent thinker versus the kowtowing Cabinet.

At a press briefing two days after she was removed from office, Madlala-Routledge stated that she did not disagree with government policy on HIV and Aids. Yet, the myth that she was removed from office for opposing government policy must not die yet.

The myth holds that she was an independent voice in government while her colleagues are supposedly kowtowing to presidential decree after decree. The broader myth is that Mbeki is intolerant and stops at nothing to purge anyone who differs. This is despite the fact that government engages in robust debate and discussion, often with the encouragement of the president.

This myth is neither new or about to go away. A handful of "independent free thinkers" have emerged, whose purview broadly falls within an ideological paradigm that is opposed to the government and the liberation movement as a whole.

The independents may, at times, have legitimate concerns. But it is their ideological predisposition and not the legitimate concerns they may once in a while express, that has them placed in high seats in institutions of consciousness-formation.

But there is double-think in this myth. Suppose that Madlala-Routledge had indeed been removed for her opposition to government policy? Which public or private institution, the world over, keeps someone opposed to its policy? One would have thought that it would be a matter of course that anyone opposed to the policies of an institution would seek employment in institutions that uphold views with which they agree.

Myth four: the set-up for dismissal.

Perhaps the most absurd of the myths is that the president set up Madlala-Routledge to undertake a trip to an international conference on HIV and Aids in Spain in order to fire her. This suggests that the president would have conspired with the conference organisers to invite her, knowing that she would defy him when he disapproved of the trip.

The facts, which Madlala-Routledge has not disputed, are as follows: every member of Cabinet and deputy minister is required to seek the president's consent before they travel internationally. With regard to this trip, the president conveyed his decision on the morning of June 11, a day before she said she would travel. She nevertheless left the country on the evening of the 11th.

Madlala-Routledge claims she learnt of the president's decision while she was in Spain and immediately took the next flight home. She did not, however, communicate with the president to inform him of the supposed misunderstanding. Neither did she do so even after the matter was leaked to a Sunday newspaper.

The president cited the Spanish trip in his letter relieving Madlala-Routledge from office. Most importantly, he drew attention to the significance of collective work - of which he concluded she failed to be part - in the development and implementation of national policy. Where could the set-up be, one might ask?

Mukoni Ratshitanga is president Thabo Mbeki's spokesperson. He writes here in his personal capacity.

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