VZCZCXRO6296
RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSA #1634/01 2071445
ZNR UUUUU ZZH
R 251445Z JUL 08
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 5208
INFO RUEHTN/AMCONSUL CAPE TOWN 5854
RUEHJO/AMCONSUL JOHANNESBURG 8244
RUEHDU/AMCONSUL DURBAN 0027
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA GA 2364
RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE

UNCLAS SECTION 01 OF 03 PRETORIA 001634 
 
SIPDIS 
SENSITIVE 
 
DEPT. FOR AF/S; OES/IHB 
STATE PLEASE PASS OGAC: BPATEL; PMAMACOS, MLIDSTONE 
STATE PLEASE PASS TO USAID/W FOR GH AND AFR/SA 
HHS/PHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS WSTEIGER 
CDC FOR GLOBAL HEALTH OFFICE SBLOUNT 
 
E.O. 12958: N/A 
TAGS: SOCI TBIO SENV EAID PGOV KHIV KSCA SF
SUBJECT:  Donor Coordination on Health Issues 
 
PRETORIA 00001634  001.2 OF 003 
 
 
¶1.  (SBU) Summary:  Health Minister Manto Tshabalala Msimang 
(Minister) at a recent high-level Annual Donor Consultation Meeting 
stressed that the national Department of Health (DOH) must 
coordinate donor efforts in the health arena in order to ensure 
equitable allocation of resources across provinces.  She voiced 
concern that donors concentrate too much on HIV/AIDS to the 
detriment of other health priorities and urged donors to think about 
how resources intended for HIV/AIDS programs could also be used to 
support other DOH priority areas.  The meeting came at a time when 
the Donor Community in South Africa is frustrated with the South 
African Government's lack of leadership with regard to improving 
donor coordination structures, especially with regard to HIV/AIDS 
programs.  The existing Donor Coordination Forum (DCF) for HIV/AIDS 
housed within the Department of Health (DOH) is largely ineffective, 
with neither donors nor the DOH satisfied with its results.  End 
Summary. 
 
 
-------------------------------------- 
Health Minister Urges Broader Approach 
-------------------------------------- 
 
¶2.  (U) The Minister voiced concern at a June 30 high-level Annual 
Donor Consultation Meeting organized by the Department Of Health 
(High-Level Meeting) that donors concentrate too much on HIV/AIDS to 
the detriment of other health priorities.  (Comment:  Although 
called "Annual High Level Meeting" by the DOH, the meeting had not 
been held in several years.  End Comment.)  The Minister emphasized 
at the High-Level Meeting that she would like to see a broader 
approach to health and is concerned that everyone who talks about 
health is really talking about HIV/AIDS.  She discussed promoting 
wellness and wellness centers.  The Minister urged donors that have 
prioritized HIV/AIDS to also think about how to use these resources 
to support other priority areas.  She listed the health department's 
priorities as meeting the Millenium Development Goals; promoting 
wellness; developing a rural-health strategy; strengthening primary 
healthcare; managing the burden of disease from non-communicable 
diseases such as cancer, cardiovascular disease and diabetes; human 
resource issues; and the health information system.  "You can't 
really run a department on the basis of HIV/AIDS or you might just 
as well change the name to the Department of HIV/AIDS," she 
commented in a discussion with the donors.  She added that the DOH 
will be arranging bilateral meetings with donors to further discuss 
the resource gaps in priority areas and how donor support can be 
utilized in a more coordinated manner. 
 
¶3.  (U) The Minister also commented that the DOH experienced a 
"challenge" when "a development partner working with NGOs decided to 
have a national conference focusing on a particular disease, for 
which the DOH provides almost all health services."  She said, "It 
cannot be correct that when the Department is largely responsible it 
does not play a significant role - this will not happen in most 
other countries."  The Minister noted that she "deliberately" was 
not mentioning the partner or the specifics of the conference. 
 
¶4.  (U) EU Ambassador Lodewijk Briet addressed the High Level 
Q4.  (U) EU Ambassador Lodewijk Briet addressed the High Level 
Meeting, noting that donors' funding of HIV/AIDS is important as 
antiretroviral treatment (ART) is still not reaching many who need 
it.  (Comment: The latest UNAIDS estimate is that only 28% of South 
Africans in need of ART are receiving it.  End Comment.)  He added 
that we should be working in South Africa to achieve the Millennium 
Development Goals of reducing infant and maternal mortality and on 
the response to HIV/AIDS and other diseases.  Briet commented that 
the donors would welcome DOH guidance on how to work better with the 
South African National AIDS Council (SANAC) to support South 
Africa's National Strategic Plan on HIV & AIDS and STI (Sexually 
Transmitted Infection).  Other donors, including the U.S., the 
United Kingdom, and Belgium, all noted that they are in the process 
of putting together programs looking toward 2010 and would like to 
find better ways to harmonize programs among donors and with the 
South African Government (SAG). 
(Comment: The Citizen newspaper criticized the Minister for 
downplaying the HIV/AIDS crisis at the High-Level Meeting, 
especially since HIV/AIDS is South Africa's major health problem. 
End Comment.) 
 
¶5.  (U) DOH Director General Thami Mseleku committed to look at the 
DOH ten-point plan to determine where donors could best fit in. 
(Comment: A presentation on financial gaps in the health sector from 
the DOH Chief Financial Officer was planned for the meeting, but did 
 
PRETORIA 00001634  002.2 OF 003 
 
 
not occur.  Donors commented that the presentation would have been 
very helpful.  End Comment.)  The donors requested that the Minister 
circulate South Africa's Global Fund application for 2009 to them, 
and the Minister agreed to do so.  The Minister expressed her 
appreciation to donors who have responded positively to her calls 
for assistance for the new clinical associates program.  This is a 
three-year program designed to train a cadre of professionals that 
will have a defined scope of practice and is geared to provide 
assistance to doctors in community health centers and district 
hospitals.  United States President's Emergency Plan for AIDS Relief 
(PEPFAR) funds are being provided to the professional associates 
program through the Centers for Disease Control (CDC).  Donors 
requested to share more detailed information on all donor supported 
health programs at a follow-up meeting that could serve as a basis 
for future coordination. 
 
--------------------------------------- 
Donor Coordination Forum Is Ineffective 
--------------------------------------- 
 
¶6.  (SBU) Embassy Health Officer attended a meeting of the DCF on 
July 2, 2008 that focused on possible changes in its future 
structure.  The DCF agreed that the DOH's International Health 
Liaison (IHL) Office will be asked to participate in the DCF's next 
meeting to report on ways to structure the DCF better, in line with 
the High-Level Meeting's outcomes.  The structure of the DCF has 
been at issue for some time as donors are generally dissatisfied 
with its operation.  Donors feel that coordination with other 
donors, as well as between donors and the SAG, is poor and that 
donors do not have an effective means to provide input to the SAG. 
Donors are so frustrated with the DCF that they have established an 
informal forum, the EU+ Donor Forum, coordinated by the Swedish 
Embassy.  The group's goal is to improve information sharing and 
understanding among donors of the HIV epidemic.  SANAC and DOH have 
made presentations to the EU+ group, and the U.S. actively 
participates. 
 
¶7.  (U) The DCF commissioned the firm Strategy and Tactics to review 
the role and functions of the DCF and make recommendations on how 
the DCF could more effectively fulfill its role of ensuring that 
donor funding appropriately supports the SAG response to HIV & AIDS 
in a coordinated manner.  The April 2007 report (DCF Report) noted 
that HIV/AIDS is a key focus of donor funding, receiving 
approximately 95 percent of all donor funding to the health sector. 
The DCF had been meeting bi-monthly, chaired by the HIV, AIDS and 
STI (HAST) cluster, with the support of the department's IHL office. 
 Members include UNAIDS, major donors, international development 
agencies, and the Treasury Department.  No other governmental 
departments actually attend, nor does the South African National 
AIDS Council (SANAC), nor major donor-funded NGOs, despite the forum 
being multi-sectoral and open to other organizations.  In addition, 
DOH representation does not reflect broader interests beyond the 
HAST cluster, such as pediatrics, maternal health, capacity 
development, or TB and other opportunistic diseases associated with 
Qdevelopment, or TB and other opportunistic diseases associated with 
HIV.  There is also no forum to discuss the broader health issues 
that the Minister would like to receive increased donor attention. 
 
¶8.  (SBU) The DCF Report found that that the DCF had largely failed 
in its mandate to coordinate donors effectively.  Comments from 
survey donor respondents included: "One gets a sense that the 
department is ambivalent about the DCF and that senior management 
does not really want it"; "No genuine dialogue where donors and 
government officials share their needs and views openly"; and 
"Government representatives were ill prepared and often meetings 
were postponed or agenda items dropped."  Respondents from the DOH 
also voiced unhappiness with the existing mechanism, saying: "Donors 
have failed to reduce the high transaction costs associated with 
donor assistance"; "Donors have not harmonized their actions with 
each other, nor have they aligned to existing DOH strategies"; 
"Donor missions are not joint and remain time consuming, 
particularly for provincial-level staff." 
 
--------------------------------------------- -- 
Recommendations for Improved Donor Coordination 
--------------------------------------------- -- 
 
¶9.  (U) The DCF Report recommended the formation of two donor 
coordinating forums to replace the existing DCF.  A forum to be 
located within SANAC would coordinate donors in the HIV & AIDS 
sector and ensure that development partners align and harmonize with 
 
PRETORIA 00001634  003.2 OF 003 
 
 
the NSP.  Membership could expand to include all key role-players. 
A second forum would be located within the IHL Office of the DOH to 
coordinate all donors in the health sector and membership expanded 
to include representatives from all clusters within the DOH. 
 
¶10.  (U) The DCF Report acknowledges that establishing the DCF 
within SANAC could be difficult because the existing SANAC structure 
emphasizes national representation within the council.  However, the 
Report noted that donor coordination could be managed within the 
Resource Mobilization Committee (RMC) of SANAC, chaired by the 
Health Minister.  The RMC emphasizes coordination and implementation 
of Global Fund Activities, but may also look at other opportunities 
for resource mobilization to support implementation of the NSP. 
(Comment:  There is no current donor representation on SANAC unlike 
most National AIDS Councils in other African countries, although 
UNAIDS provides support to SANAC and attends meetings in an 
"observer" capacity.  Since the RMC supervises the Global Fund 
process, this means that Donors have no real input into South 
Africa's applications to the Global Fund and no knowledge of its 
content while being formulated.  End comment.) 
 
--------------------------- 
DOH Rejects Recommendations 
--------------------------- 
 
¶11.  (U) The DCF, at its October 2007 meeting, endorsed the 
recommendations of the Report to establish two donor coordinating 
forums, to replace the existing DCF.  The DOH reported, at the April 
23 DCF meeting, that it had rejected the Report's recommendations 
following its review.  The DOH stated that since the SANAC 
Secretariat is in the process of restructuring and SANAC lacks the 
capacity for donor coordination, the Forum should stay as is, 
chaired by the DOH HAST Cluster.  The UK Department for 
International Development (DFID) reported at the July 3 DCF meeting 
that it had written a formal request to outline the DCF 
recommendations to SANAC, but had not yet received a response. 
 
¶12.  (U) Many of the complaints outlined in the DCF Report were 
echoed in the Report on the First Phase of the Evaluation of the 
Implementation of the Paris Declaration Country Level Evaluations 
completed in February 2008 (PD Report).  The PD Report states that 
while the Development Partners are frustrated by the lack of a 
national Development Partner coordination forum, South Africa does 
not see the need for one.  It notes that continued "silo" thinking 
and capacity issues weaken interdepartmental coordination.  The PD 
Report recommends that the parties discuss a mutually agreed way 
forward: "The national Development Partner coordination issue needs 
to be debated further by the Partner Country and Development 
Partners to unpack both the fears and motivations for and against 
such a forum and determine: What is the gap and how can it be 
filled?  How should division of labor be decided?" 
 
 
¶13.  (SBU) Comment:  The dysfunctional nature of the DCF was 
highlighted by the fact that none of the DOH participants at the 
July 2 DCF meeting had either attended the High-Level Meeting or 
been briefed on it.  No one from the IHL office of the DOH was even 
present at the DCF meeting.  Mrs. Mokgadi Phokojoe, Director of the 
Qpresent at the DCF meeting.  Mrs. Mokgadi Phokojoe, Director of the 
HIV, AIDS and STI office within the DOH, is chair of the DCF, but is 
not perceived by donors to be sufficiently senior to be influential 
within the Department.  There is no immediate impetus for reform of 
the coordination structures in view of the Mbeki administration 
nearing its end.  It is likely that the donor community will remain 
frustrated with the coordination structures and maintain parallel 
efforts to coordinate among themselves, unless a new Health Minister 
in a new administration sees the need for more effective donor 
coordination.  End comment. 
 
Bost