Lyn's Comment: South African's waited with great interest to hear which moves new President Jacob Zuma would make in his cabinet. His decision to replace Minister Barbara Hogan raised some concern. News reports bring different viewpoints:
Kaiser Daily HIV/AIDS Report - Wednesday, May 13, 2009
South African President Jacob Zuma on Sunday appointed physician Aaron Motsoaledi as health minister, replacing Health Minister Barbara Hogan, who was appointed to a public enterprises position, London's Guardian reports. Motsoaledi previously served as a provincial education minister. Hogan had been appointed to the post last year to replace former Health Minister Manto Tshabalala-Msimang (Smith, Guardian, 5/10).
According to AFP/Google.com, Zuma responded to concerns about the appointment, saying that Motsoaledi is a "well-known doctor who has handled this department at a provincial level in the past." Zuma added that Motsoaledi is "a very energetic and able comrade so I don't think you should be very worried."
HIV/AIDS advocates said the leadership change at the Health Ministry could hinder South Africa's efforts to address HIV/AIDS. Mark Heywood, a spokesperson for the Treatment Action Campaign, said Zuma's decision to replace Hogan is "very disappointing," adding, "We have an entirely new political team responsible for health at a time where the health system is in critical need of resuscitation and in need of continuity and understanding."
Zuma has said he is committed to fighting HIV/AIDS, and advocates are calling for "visible leadership for a strong national response," AFP/Google.com reports. According to AFP/Google.com, a "challenge" Zuma faces is finding enough funding to maintain the country's antiretroviral drug program, which is the largest national antiretroviral program worldwide and provided about 700,000 South Africans with treatment as of November 2008. The South African government plans to increase funding for HIV/AIDS programs by 932 million rand, or about $112 million, and double treatment over the next three years; however, the country also is facing its first economic recession in nearly two decades, AFP/Google.com reports (AFP/Google.com, 5/11).
Reprinted from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, and sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv . The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2009 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
TAC Electronic Newsletter
The Treatment Action Campaign (TAC) welcomes the appointment of Dr. Aaron Motsoaledi as the Minister of Health, and the re-appointment of Dr. Molefi Sefularo as the Deputy Minister of Health. Both the Health Minister and the Deputy Health Minister have an immense responsibility to protect the health and human rights of people in South Africa, and to achieve the targets laid out by the National Strategic Plan for HIV/AIDS 2007 – 2011.
TAC will support the ministry in its responsibility to rebuild the health system and to implement progressive policies and programmes. TAC will also continue to closely monitor health policy development and implementation, and resource allocation for health under the leadership of Minister Motsoaledi and Deputy Minister Sefularo to ensure that government commitments to healthcare delivery are achieved. This is particularly important in the current economic climate.
As of May 2009, about 700,000 people have been initiated onto ARVs in South Africa’s public health sector. But at least double the current number of people who are on ARVs need treatment urgently to survive. It is government’s responsibility to make ARVs accessible and sustainable, as stated in the NSP and enshrined in the constitutional right to the progressive realization of health care.
A severe lack of funding threatens the achievement of the NSP targets. Department of Health officials have admitted that the budget allocation for ARVs through the current HIV/AIDS conditional grant to provinces will not be nearly sufficient to treat 220,000 people this year.
There is also a drastic shortage of money to fund the other NSP target interventions and coverage. A Statistics South Africa report indicates that South Africa’s official unemployment figure has increased from 21.9% in the last quarter of 2008, to 23.5% by March 2009, with economists estimating that the real unemployment rate exceeds 30%. A recent report by the World Bank details the negative effects that rising unemployment and reduced earnings have on health outcomes.
Reduced income makes people less likely to seek medical attention when they are sick as they can no longer afford to travel. It also forces people to buy cheaper, less nutritious food which leads to an increase in malnutrition. Poor households are likely to be the worst affected because they have less room to re-adjust their expenditure. Despite the fact that clinic visits may contract in times of economic recession, the actual demand for these services increases as people face greater difficulties in accessing adequate food and housing.
Minister Motsoaledi and Deputy Minister Sefularo will have to confront the serious health challenges resulting from the economic downturn and to implement policies that cushion the poorest sectors of society from the effects of the downturn, as these communities bear the brunt of decreasing access to public health services.
TAC’s support for the previous Health Minister, Barbara Hogan, was premised partly on Hogan’s extensive background in financial management as the chair of parliament’s Finance Portfolio Committee, but also on her commitment to engage in and understand the severity of the problems of healthcare delivery. During her time as Health Minister, Hogan worked tirelessly to improve the South African health system. After the enactment of an antiretroviral ‘moratorium’ in the Free State province – a four month period during which no new patients were initiated onto ARVs as a result of poor fiscal planning and management in the province – Hogan planned for the establishment of a team of budgeting experts to monitor the budgeting processes of provincial Departments of Health.
TAC is therefore disappointed that Minister Hogan was not reappointed as the Minister of Health, but congratulates the Minister on her appointment to the Department of Public Enterprises. TAC is confident that her leadership and expertise will have a positive impact on her important new position. Minister Motsoaledi and Deputy Minister Sefularo must continue the decisive work done by Minister Hogan. Specific attention must be given to reforming the Department of Health, implementing measures to alleviate the critical shortage of human resources in the public health sector, scaling-up the ARV roll-out and achieving the targets of the NSP, and vastly improving the implementation of TB control measures and treatment.
For further comment please contact:
TAC’s General Secretary, Vuyiseka Dubula: 082 763 3005
TAC’s Chairperson, Nonkosi Kumalo: 074 194 5911
TAC’s Policy, Communication and Research Co-ordinator, Rebecca Hodes: 079 426 8682.
Many in the health sector have expressed disappointment over the removal of Barbara Hogan as health minister and have adopted a wait-and-see attitude towards her largely unknown replacement Dr Aaron Motsoaledi, Education MEC in Limpopo.
Traumatised by the legacy of former health minister Dr Manto Tshabalala-Msimang, all those contacted for comment said they thought that Hogan had been doing a good job and it would have been in the interest of a health system that is teetering on the brink of collapse to bring some stability into the sector.
However, President Jacob Zuma moved Hogan to the Public Enterprises ministry, which many reluctantly agree is a better fit for the finance boffin, and replaced her with the 50-year-old Limpopo doctor and father of two.
Very little is known about Motsoaledi’s recent activities other than his career in the Limpopo legislature where he has largely held the Education portfolio with short stints as health and agriculture MEC in the poverty stricken province.
However doctors who fought the apartheid government in the eighties remember him from their struggle days when the National Medical and Dental Association (NAMDA) was formed.
NAMDA came into existence in 1982, a couple of years after a group of doctors broke away from the then Medical Association of South Africa (MASA) when the Black Consciousness leader, Steve Biko, was killed in police detention.
He had been inadequately cared for by three doctors who belonged to MASA and were never disciplined by the organization.
“I know him from way back during the NAMDA days,” confirmed Dr Peter Barron, who has been working as a freelance consultant for the health department.
“I remember him as a very energetic, enthusiastic and competent person,” recalled Barron, echoing the sentiments of several other public health specialists contacted for comment.
Motsoaledi is also believed to be close to the widely respected deputy health minister Dr Molefi Sefularo and enjoys the support of KwaZulu-Natal premier Zweli Mkhize, chair of the ANC’s health committee.
Member of the Democratic Alliance, Michael Holford battled to produce much criticism of the man he worked with in the Limpopo legislature for the past couple of years, describing him as a “big talker”, but “fairly effective, an approachable and likeable chap”. Holford said Motsoaledi would not be afraid to shift incompetent people: “He likes people who can do the job.”
A source within the African National Congress who asked to remain anonymous said there was speculation that Hogan had been shifted at the behest of the Congress of South Africa Trade Unions and others who were not happy with her questioning around the National Health Insurance policy which is being thrashed out within the party’s health structures.
“Everyone has their own interests at heart and Hogan was determined to ensure there was public consultation and the process is transparent. I think Motsoaledi will have to show strong leadership to manage all the stakeholders,” he said.
Democratic Alliance leader Helen Zille said her party was relieved that there was no place in the Zuma Cabinet for a number of ministers from the previous administration whose tenures were nothing short of disastrous, including Tshabalala-Msimang.
She said appointments which raised alarm bells included the shifting of the “highly effective Barbara Hogan from Health to Public Enterprises in what appears to be punishment for her outspoken comments on the Dalai Lama”.
Questions about the strength of the health ministry
Johannesburg - President Jacob Zuma tapped an obscure provincial politician to guide the nation through the world's worst HIV crisis, raising questions about the strength of the health ministry.
Aaron Motsoaledi, a medical doctor currently serving as a provincial education official, will take office as the new health minister on Monday - the second change in the post in less than a year.
The outgoing minister Barbara Hogan had won praise for breaking with the denialist policies of former president Thabo Mbeki and his health minister Manto Tshabala-Msimang, known as Dr Beetroot for shunning life-saving drugs for vegetables.
Zuma immediately sought to dispel concerns about the appointment, calling Motsoaledi "a well-known doctor who has handled this department at a provincial level in the past".
"He is a very energetic and able comrade so I don't think you should be very worried," Zuma added.
But activists warned that repeated changes in a ministry known for disorganisation would do little to focus the nation's efforts on easing the plight of the 5.7 million South Africans living with HIV.
"I have to say that it's very disappointing," said Mark Heywood, spokesperson for the Treatment Action Campaign pressure group, noting that changes in leadership had also been made at the provincial level across the country.
"We have an entirely new political team responsible for health at a time where the health system is in critical need of resuscitation and in need of continuity and understanding."
Zuma carries heavy baggage into his fight against HIV. He's a polygamist in a country where multiple sex partners have pushed up infections, and was number two under Mbeki, who caused long delays in the roll out of life-saving drugs.
But his biggest credibility challenge will be overcoming a 2006 bombshell while on trial for rape, for which he was acquitted, when he said he faced a small risk of infection in unprotected sex with his HIV positive accuser.
Zuma, who headed the country's national Aids council at the time, went on to say that he had showered to minimise the chance of contracting the disease.
The much-ridiculed statements have haunted him ever since, despite an apology and his political comeback to the country's top office.
"Zuma's 'shower theory' has undermined his authority on HIV/Aids and raised concerns about his capacity to effectively lead the government in the struggle against HIV/Aids," said Elizabeth Mills of the University of Cape Town.
"Zuma has not demonstrated leadership with regards to sexual monogamy nor condom use," she added.
The new president has committed himself to strong Aids messages but activists want visible leadership for a strong national response.
"I hope we will avoid destructive messages and controversies which detract from combating the HIV epidemic," said Laetitia Rispel of the Centre for Health Policy at the University of the Witwatersrand.
Another challenge will be finding cash to maintain the world's largest anti-retroviral drugs programme that had nearly 700 000 South Africans on treatment at the end of November.
The government plans to boost its battle by R932m and double treatment over the next three years. But Zuma's team is facing the country's first recession in 17 years.
"I look forward to seeing how he translates rhetoric into practice as our new president. Time will tell," Mills said.Should Zuma prove us wrong in our cautious optimism, then South Africans will stand up together and fight until we are heard. We've done it before, and we'll do it again."
11 May 2009
Incoming Minister of Health Dr Aaron Motsoaledi may be unknown to many but he will soon be making headlines because of the huge and difficult job awaiting him.
Although he has served as an MEC for education in Limpopo, Motsoaledi is faced with one of the biggest challenges in the new Cabinet – restoring the public’s faith in the public health system.
Motsoaledi has the unenviable task of fixing the dysfunctional department of health.
Treatment Action Campaign spokesperson Rebecca Hodes said that her organisation welcomed Motsoaledi’s appointment.
“But Motsoaledi has to work hard to be able to deliver on the national strategic plan which aims to provide 80percent of people living by 2011 with HIV with treatment,” Hodes said.
She said that Motsoaledi must also eradicate the ARV waiting list because people were dying of opportunistic infections because of low immune systems.
May 11, 2009
The newly elected president Jacob Zuma made sweeping changes to Cabinet on Sunday as he unveiled a team of 34 ministers.
One of the surprises in the new cabinet was when Zuma named Aaron Motsoaledi health minister and moved Barbara Hogan to the key ministry of public enterprises after just six months at health, during which she was widely praised for taking into hand a shambolic portfolio.
The new Health Minister Aaron Motsoaledi, has a Bachelor of Medicine and a Bachelor of Surgery from the University of Natal. He is a former acting premier in the Limpopo province and was previously also an education MEC in the same province. His deputy Molefi Sefularo was health MEC in the North West province and appointed Deputy Health Minister by Motlanthe last year.
The African Christian Democratic Party (ACDP) announced their surprise at the appointments and said: "One would have expected Barbara Hogan to have been reappointed as Minister of Health in view of the widespread acclaim she has received in this position. The relatively unknown Dr Aaron Motsoaledi who has been appointed in her place leaves unsure whether his appointment will bring the necessary service delivery in this important ministry."
They added that it was hoped that Hogan's reassignment to public enterprises would bring a fresh approach to this ministry in view of the huge challenges facing parastatals such as SA Airways, the SABC and others and the billions of rands of state funds being spent on parastatals. – (Sapa, May 2009)
By Susan Comrie
When Jacob Zuma is sworn in as president on May 9, he will not only inherit power and prestige, he will also inherit a country crippled by HIV and Aids.
While opposition parties are anxiously waiting for the final results, some facts and figures remain unchanged.
About six million South Africans are HIV-positive and 60 percent of those who desperately need ARV treatment still have no access to the drugs that could save their lives.
This week marks 25 years since scientists discovered the Human Immunodeficiency Virus (HIV).
At the time, the US secretary of health hailed the discovery as a major turning point in the battle against Aids and predicted it would take as little as two years for a vaccine to be available.
Twenty-five years later there is little to celebrate.
Optimists point out that at least the country's HIV infection rates have finally stabilised, but the harsh reality of statistics like these is that for the 1 000 South Africans who are infected with the virus every single day, another 1 000 die too young and with little dignity.
The ANC describes South Africa's ARV treatment programme as "amongst the best and most comprehensive in the world", and with 700 000 people on treatment, South Africa does have the largest treatment programmes.
At the moment, though, only four out of 10 people who need ARVs have access to them.
This is despite the fact that the government approved the rollout of ARVs to all HIV-positive South Africans more than five years ago.
The government's National Strategic Plan on HIV and Aids aims to provide 80 percent of HIV-positive South African with treatment by 2011.
But lately no one has been feeling very optimistic about the government's ability to deliver on that promise.
"As we're rolling that out we're coming up against massive constraints," says Lance Greyling, chief whip of the Independent Democrats.
"Even rolling out to 80 percent will be hard, because we're experiencing massive difficulties now. We don't have enough health professionals and we don't have enough funding."
Funding the Department of Health's ballooning ARV costs is a problem most political parties have been reluctant to tackle. But department director-general Thami Mseleku has made it clear that the Zuma government won't have the luxury of putting off the decision, saying earlier this year that "the numbers (of new patients) are very huge and are rising fast".
He added: "As a country, we will get to a stage where we will never be able to afford the figures required for treatment."
In the Free State that point has already come and gone - 15 000 people who were due to start treatment in November were told they would not get ARVs because the province had already used up its ARV budget.
Last year the health department asked the Treasury for an extra R1 billion to meet the rapidly increasing number of HIV-positive South Africans who immediately need treatment; it got R300 million.
"From a human rights perspective, we cannot even allow such a choice that because of constraints we are going to leave some people without treatment," says Deputy Health Minister Dr Molefi Sefularo.
"But there is an element of realism in the government's targets and we have to accept that we won't be able to reach everyone.
"People will always fall through the system."
Reckless spending by the health department has been devastating in the past and the new Zuma government will be under pressure to show that it is as tough on corruption as it claims to be.
The DA, for one, has raised questions about how the Kwazulu-Natal health department could afford to spend R824 586 on the opening function for a clinic in Greytown that cost R600 000 to build.
The new health minister, Barbara Hogan, and her deputy have promised that under their leadership there will be "fewer parties with freebies and caps" and more focus on spending where it's needed - training nurses to distribute ARVs and supporting home-based care projects. The ANC has also promised to cut new infection rates by 50 percent through an aggressive awareness campaign.
South Africa has a long history of ineffectual and misguided campaigns to raise awareness about the risks of unprotected sex and multiple partners, and both the ANC and opposition parties agree that in the future less needs to be spent on glossy magazine ads and more on face-to-face interactions in communities.
Unfortunately, awareness campaigns are often overshadowed by political leaders and prominent celebrities who provide a never-ending list of people who "forgot to play it safe".
The question is whether president-in-waiting Zuma can provide the leadership necessary to change the country's endemic attitude problem towards HIV/Aids.
Cope says Zuma's statements during his rape trial are proof that he should not be trusted to bring a change in attitude among South Africans.
"The fact that the ANC has chosen a man who does not take the issue of HIV/Aids seriously is something very devastating," says Cope spokesman Palesa Morudu.
"We need to be serious about HIV/Aids and our views on women.
"And we are not convinced that he can provide that kind of leadership."
One suggestion put forward by almost all opposition parties is for government ministers and members of parliament to undergo public HIV tests, to encourage ordinary South Africans to get tested.
"I hope more and more prominent leaders in government would step forward for voluntarily tests," says Sefularo.
"But it's a very delicate situation - there are questions of stigma and privacy.
"When I go into the townships I'm struck by the extent to which HIV is becoming more and more of an open conversation, but we need to meet their courage halfway.
"It has always been the ordinary people who have taken the lead with many epidemics, but the elite do need to narrow the gap."
This article was originally published on page 6 of Pretoria News on April 25, 2009