Sunday Times (Johannesburg) - August 31, 2003
S'thembiso Msomi

Throughout its history as a political entity, South Africa has never had a popular health minister.

For a variety of political, administrative and personal reasons, past health ministers often found themselves embroiled in controversy and fierce battles for political survival.

But none was ever as infamous and besieged as incumbent Health Minister Dr Manto Tshabalala-Msimang.

The 63-year-old minister's controversial stance on HIV/Aids and the provision of antiretroviral drugs to people living with the virus has led to sustained calls from opposition parties and lobby groups for her resignation.

Outspoken Independent Democrats leader Patricia de Lille recently went a step further by calling for Tshabalala-Msimang to be "tried for gross human rights violations" because she was "responsible for thousands of deaths".

In one instance, the minister got into an embarrassing slinging match with a passenger who refused to sit next to her on an international flight back to South Africa.

Not even the government's recent pronouncement that it was drawing up an operational plan that would lead to the eventual roll-out of antiretroviral treatment in public hospitals has won Tshabalala-Msimang a reprieve.

Instead, her political detractors responded to the news by expressing doubt that a large-scale roll-out would take place with Tshabalala-Msimang in charge of the health portfolio.

Despite all the negative publicity since she took office in 1999, Tshabalala-Msimang's star within the ruling party seems to be on the rise.

At the ANC's national conference in December last year, she emerged number 15 on the list of those elected into the party's national executive committee - garnering more votes than some of her seniors in the Cabinet.

In the run-up to this weekend's ANC Women's League's national conference, Tshabalala-Msimang is touted as the front-runner for the ailing organisation's presidency - a position abdicated by populist politician Winnie Madikizela-Mandela following her conviction recently.

Tshabalala-Msimang, who is married to ANC national treasurer and liberation struggle stalwart Mendi Msimang, is competing with popular ANC MP and former guerrilla Thandi Modise and Deputy Home Affairs Minister Nosiviwe Mapisa-Nqakula.

Party insiders give a number of reasons for the dichotomy between Tshabalala-Msimang's image as an ineffective minister and the popular support she enjoys within party structures.

One such theory is that her consistent stance in defence of President Thabo Mbeki during the bruising HIV/Aids debate won her much favour with many party loyalists.

Closely linked to this theory is the argument that the party always closes ranks in support of any of its comrades seen to be under attack from "hostile elements" - be they from the opposition or the media.

Tshabalala-Msimang herself dismisses opposition to her actions as insignificant: "People criticise for the sake of criticising. They don't even read our strategy documents and annual reports to see the amount of work we have done.

"I will not do wrong things just to please certain people. In fact, as I move around I find that many people support what I am doing. These are ordinary people, not the type of people who read Business Day," she says.

Her supporters argue that the kind of support she enjoys within party ranks is deserved as she has delivered on the mandate given to her when she was appointed health minister.

Her aides point to the results of an SABC/Markinor opinion poll conducted in November, which indicated that 65% of South Africans believed that the government was handling the HIV/Aids pandemic well and that the public health sector was well managed.

About 69% of those who responded in this way were black, a key constituency for the ANC.

Since taking office, Tshabalala-Msimang points out, there has been a steady improvement in the country's healthcare system.

Cases of malaria, which remains one of the biggest killers on the African continent, have been reduced by 90% since 2000.

Tshabalala-Msimang says she is also happy that under her ministry, the provision of healthcare to vulnerable groups, including poor women and children, has increased.

"As we speak, 70% of all children are fully immunised as a result of our programmes. This has led to positive results, such as the elimination of neo-natal tetanus, and has ensured that, since 1999, there have been no deaths due to measles," she says.

In July this year, she introduced free health services for the disabled.

She says South Africa could soon be declared a polio-free country, with polio-immunisation programmes already surpassing the World Health Organisation's 80% coverage for the vaccine.

Despite a high rate of unwanted pregnancies in the country, the Department of Health says HIV and syphilis prevalence among the youth has dropped by more than 5% in the past four years.

Tshabalala-Msimang, however, concedes that - despite these gains - huge challenges remain.

Among these is the high maternal mortality rate. According to a report released by the department in March this year, about 150 out of 100 000 pregnant women die while giving birth in South Africa.

Then there is tuberculosis, which remains a major problems in certain parts of the country despite the average 68% national cure rate.

One subject that is close to Tshabalala-Msimang's heart - and one that has plunged her into much controversy in recent months - is nutrition.

Tshabalala-Msimang recently concluded a deal with the milling industry, which will see mealie-meal being fortified with nutrients from October in an attempt to reduce malnutrition.

"It is an important issue because really, we are what we eat. About 26% of children suffer from stunted growth because of poverty and the food they eat, which lacks micro-nutrients like zinc and iron," Tshabalala-Msimang says.

The department provides meals to 4.5-million children in about 15 000 schools in poor areas.

That nutrition is important is not in dispute, but it is the manner in which Tshabalala-Msimang has handled the issue which has caused so much controversy in the HIV/Aids saga.

Her past utterances seemed to advocate nutrition as a substitute, rather than as complementary, to the provision of antiretroviral drugs for people living with the virus.

She has since modified her position on the issue, saying "good nutrition is not a substitute for appropriate treatment".

Despite this qualification and her undertaking to carry out Cabinet's decision to roll out antiretroviral treatment, some of her remarks remain worrisome:

"I still think antiretrovirals in the main are toxic. I don't think you will get good value from them when you do not get proper food. One of the achievements we have made was to put nutrition on the agenda of this country."

Tshabalala-Msimang, who has worked in the HIV/Aids field since the 1980s when she was in exile, recently told a gathering in Soweto that she had personally seen HIV-infected people's lives being improved as a result of proper diet.

She would continue advocating what the media describes as "her concoction" no matter how much she was laughed at, she defiantly told the Soweto crowd.

"We should eat garlic because of its antibacterial and antifungal properties, lemon because of vitamin C, and olive oil as a source of vitamins A and E . . . It is good stuff . . . Don't let people deceive you," she was quoted as saying.

Tshabalala-Msimang feels that her case has been strengthened by recent remarks made by World Food Programme director James Morris that "food is the first line of defence" in the fight against HIV/Aids.

Now that the dust is settling, does she think she handled HIV/Aids in the correct manner?

With hindsight, would she change anything in her approach ?

"No. I would have handled issues in the same way.

"When I took over I rushed to Uganda because everybody was talking about their successes in combating HIV and Aids.

"I came back with my head full of ideas but then I soon realised that without a proper plan, everything was going to fall on its face.

"So we needed a proper plan before we could talk about drug roll-out," she says.

Almost as an afterthought, she says communication is her ministry's biggest weakness.

"Maybe we have been bad communicators. We are not proactive in marketing what we do. We wait for controversies before we react," she says.

But it is HIV/Aids that is her major weakness, says the Democratic Alliance's HIV/Aids spokesman, Mike Waters.

"She is a dissident and the only reason she is still in the Cabinet is that she is supported by the President who shares her views," Waters says.

With national elections a few months away, the big question is whether Mbeki will retain Tshabalala-Msimang in her post when he appoints a new Cabinet.

Some say a change of scene would do both Tshabalala-Msimang and the country good.

030831
ST030827

Always watch for outdated information. This article first appeared in 2003. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2003. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .