VZCZCXRO0714
RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSA #0099/01 0201410
ZNR UUUUU ZZH
R 201410Z JAN 09
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 7035
INFO RUEHTN/AMCONSUL CAPE TOWN 6483
RUEHJO/AMCONSUL JOHANNESBURG 8825
RUEHDU/AMCONSUL DURBAN 0607
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA GA 2429
RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE

UNCLAS SECTION 01 OF 02 PRETORIA 000099 
 
USAID FOR BUREAU OF GLOBAL HEALTH AND AFR/SA 
HHS/PHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS WSTEIGER 
CDC FOR GLOBAL HEALTH OFFICE SBLOUNT 
NIH FOR JHERRINGTON 
 
SENSITIVE BUT UNCLASSIFIED 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: TBIO PGOV EAID KHIV SF ZI
SUBJECT:  THE AMBASSADOR MEETS MINISTER OF HEALTH - FINALLY 
 
Ref:  08 Pretoria 2135 
 
PRETORIA 00000099  001.2 OF 002 
 
 
¶1.  (SBU) Summary: The Ambassador had a productive meeting with 
Minister of Health Barbara Hogan January 19 on the eve of his 
departure from post.  The Ambassador conveyed his frustration that 
he had not been able to meet with the Minister's predecessor, 
emblematic of challenges in working with the Ministry under the 
previous minister.  Minister Hogan thanked the Ambassador and the 
USG for their perseverance in fruitfully implementing the PEPFAR 
program in South Africa.  She agreed on the need to meet quickly and 
often to coordinate programs, harmonize donors, and aim for 
sustainability.  The Minister stated that all the provinces were 
experiencing unprecedented funding crises and shortages of 
antiretrovirals.  End Summary. 
 
---------------------- 
New Minister - New Day 
---------------------- 
 
¶2.  (SBU) The Ambassador's meeting with Minister of Health Barbara 
Hogan on January 19 on the eve of his departure showed that our 
bilateral relationship in the health sector has moved on the right 
track since her appointment last September.  The Ambassador noted 
the importance of the U.S. President's Emergency Plan for AIDS 
Relief (PEPFAR) program in South Africa, which reached about $600 
million this year.  He noted that early in his tenure he had been 
successful in persuading President Bush to significantly increase 
the program in South Africa given the extent of the epidemic there. 
The Ambassador noted that South Africa is the largest PEPFAR 
recipient, receiving $1.5 billion over the last five years.  He 
stated that his and congressional delegations' inability to meet 
with the former Minister was emblematic of the total lack of 
cooperation from the Ministry at that time, forcing the USG to work 
in a vacuum, in effect, circumvent the Ministry, and work directly 
with Provincial and local partners.  The Ambassador emphasized that 
this state of affairs was not desirable and he stated that the USG 
sought greater collaboration and information exchange to achieve 
appropriate sustainability.  He said that funding would likely 
decrease over time, but not precipitously. 
 
¶3.  (SBU) Minister Hogan, who was accompanied by special advisors 
Fatima Hassan and Dr. Nicholas Crisp, thanked the Ambassador for the 
USG support, even thanking the USG for its persistence during the 
"unfortunate period" under the previous regime.  She gave special 
acknowledgment of USG support for the increased roll-out of 
antiretrovirals (ARV).  Hogan fully embraced the Ambassador's 
request for frequent discussions at the staff level to coordinate 
programs and donor activities, aiming for sustainability.  She 
expressed interest in more discussion on defining what everyone 
means by and how we measure sustainability.  In addition, she called 
for increased donor harmonization to reduce risk of duplication of 
efforts, to which the Ambassador fully agreed. 
 
----------- 
Way Forward 
----------- 
 
¶4.  (SBU) Health Attache stated the USG sought to transition from 
service delivery to technical assistance and training in support of 
South African initiatives, accompanied by a measured decrease in 
funding.  The Ambassador reassured that the decrease would be based 
on collaboration and consensus and not precipitous, but would be 
Qon collaboration and consensus and not precipitous, but would be 
based on the need for South Africa to use its own resources and take 
more ownership.  He emphasized that the USG would not "make 
decisions without you", but would rather reach mutually-endorsed 
decisions and approaches.  Health Attache noted that the second 
five-year PEPFAR program aimed to establish a partnership compact 
with each country, identifying needs, capacity, and goals.  The 
Minister agreed that it would be useful to start discussions in this 
area. 
 
¶5.  (SBU) Special Advisor Fatima Hassan reiterated appreciation for 
USG contributions and called for collaborative monitoring and 
evaluation of efforts in the public, private, and not-for-profit 
sectors.  In addition, she called for sharing data and identifying 
indicators to improve monitoring.  Hassan and the Minister made 
frequent mention of the new bilateral country-level team, which 
would identify priorities and augment coordination consistent with 
the national strategic plan. 
 
---------------------- 
 
PRETORIA 00000099  002.2 OF 002 
 
 
New Funding Challenges 
---------------------- 
 
 
¶6.  (SBU) The Minister noted that the global financial crisis was 
adversely affecting economic growth and credit access and had 
precipitated an unprecedented funding crisis in all the provinces. 
Special Advisor Dr. Nicholas Crisp said this problem would 
necessitate a 10 percent cut in health budgets to balance funding 
gaps, which could negatively affect service and ARV delivery.  The 
Ambassador observed that the USG had helped out with funding for 
ARVs this year in Free State and last year in Western Cape, noting 
that we could again be helpful as long as there were assurances of 
good management practices and that funds were being spent well.  The 
Minister agreed with the need for appropriate oversight and noted 
that assessment teams were still analyzing the cost drivers and 
provincial expenditures for her.  In addition, she has established a 
Ministerial advisory committee to facilitate bringing the health 
care system to where it should be. 
 
----------------------- 
Zimbabwe and the Border 
----------------------- 
 
¶7.  (SBU) The Ambassador shared observations and expressed concerns 
from his recent travels to Harare, Zimbabwe and to the South 
African-Zimbabwe border in Limpopo to assess the status of the 
cholera epidemic.  The Minister agreed that the epidemic and 
collapse of the Zimbabwean health care system was a tragedy, further 
noting the lamentable politicization and partisanship of health care 
provision in Zimbabwe.  She noted that the problem was not limited 
to cholera, but included TB and HIV among others, possibly leading 
to increased drug-resistant TB and HIV, for example.  She sought to 
find ways to deliver care into the hinterland and had cautious 
optimism for a SADC initiative to facilitate the distribution of 
humanitarian assistance.  Hogan emphasized that, from a health 
perspective, it was preferable to facilitate legal entry of 
Zimbabweans fleeing their country into South Africa and that she had 
initiated discussions with the Departments of Home Affairs and 
Safety and Security.  She proposed that donors work together to 
subsidize unpaid salaries for health professionals in Zimbabwe to 
help get hospitals and clinics up and running again. 
 
¶8.  (SBU) COMMENT: The Minister did not hesitate to apologize for 
the mismanagement and lack of communication from her predecessor's 
Ministry.  She was effusive in thanking the Ambassador for his 
efforts personally and the efforts of the USG to implement the 
significant PEPFAR program.  South African provinces now face 
critical funding gaps, changing the old perception that the country 
has adequate financial resources, but only suffers technical, 
management, and implementation capacity gaps.  The Minister's strong 
financial background and fresh perspective will continue to be a 
positive in moving the MOH forward in partnership with PEPFAR.  In 
parting, the Ambassador presented the Minister with the book, 
"Building Diplomacy, the Architecture of American Embassies." 
 
Bost