VZCZCXRO8705
RR RUEHBZ RUEHJO RUEHMR RUEHRN
DE RUEHDU #0124/01 3650650
ZNR UUUUU ZZH
R 310650Z DEC 09
FM AMCONSUL DURBAN
TO RUEHC/SECSTATE WASHDC 1543
INFO RUCNSAD/SADC COLLECTIVE
RHEHAAA/NSC WASHINGTON DC
RUEAIIA/CIA WASHDC
RHEFDIA/DIA WASHINGTON DC
RUEHDU/AMCONSUL DURBAN 0925

UNCLAS SECTION 01 OF 03 DURBAN 000124 
 
SENSITIVE 
SIPDIS 
 
FOR AF/S, INR 
 
E.O. 12958: N/A 
TAGS: PGOV SF
SUBJECT: KWAZULU-NATAL PRIORITIZES HEALTH SERVICE DELIVERY 
 
REF: A DURBAN 123; B DURBAN 53 
 
DURBAN 00000124  001.2 OF 003 
 
 
¶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. 
 
DURBAN 00000124  002.2 OF 003 
 
 
 
 
 
¶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 
allegations. 
 
 
 
¶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 
 
DURBAN 00000124  003.2 OF 003 
 
 
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. 
 
 
 
Comment 
 
 
 
¶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. 
DERDERIANJ