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RR RUEHBZ RUEHJO RUEHMR RUEHRN
DE RUEHDU #0123/01 3641630
ZNR UUUUU ZZH
R 301630Z DEC 09
FM AMCONSUL DURBAN
TO RUEHC/SECSTATE WASHDC 1541
INFO RUCNSAD/SADC COLLECTIVE
RHEHAAA/NSC WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
RUEAIIA/CIA WASHINGTON DC
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 
 
DURBAN 00000123  001.2 OF 002 
 
 
¶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