R 280839Z JUL 09
FM AMEMBASSY PRETORIA
TO SECSTATE WASHDC 9169
INFO AMCONSUL CAPE TOWN 
AMCONSUL JOHANNESBURG 
AMCONSUL DURBAN 
DEPT OF HHS WASHDC
CDC ATLANTA GA 2475
SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE

UNCLAS PRETORIA 001519 
 
 
USAID FOR BUREAU OF GLOBAL HEALTH AND AFR/SA 
HHS/PHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS JKULAKOWSKI 
CDC FOR GLOBAL HEALTH OFFICE SBLOUNT 
NIH FOR JHERRINGTON 
 
E.O. 12958: N/A 
TAGS: TBIO PGOV AMED KSTH KSCA KHIV SENV SF
SUBJECT:  AMBASSADOR ERIC GOOSBY'S MEETING WITH THE SOUTH AFRICAN 
MINISTER OF HEALTH 
 
REF: 08 Pretoria 2643 
 
¶1. Summary:  On July 19, Office of Global AIDS Coordinator, 
Ambassador Eric Goosby met with recently appointed South African 
Minister of Health Aaron Motsoaledi.  Minister Motsoaledi was 
accompanied by Department of Health Deputy Director General Yogan 
Pillay.  The meeting took place on the margins of the International 
AIDS Society Conference in Cape Town, South Africa. 
 
¶2. Ambassador Goosby started the conversation by noting that 
international health issues were important to the Obama 
Administration.  He emphasized that South Africa's needs are also 
important and the U.S. would like to work with South Africa as a 
model for other countries in the region.  He said the U.S. hopes 
that South Africa might be in a position to offer technical 
assistance to other countries in the region.  The United States also 
has a high level of interest in working with South Africa to ensure 
that health strategies and development strategies are converged.  In 
these matters, Ambassador Goosby said, the USG hopes to engage in a 
long term dialogue. 
 
¶3. Minister Motsoaledi thanked Ambassador Goosby for the visit and 
confirmed that health is also a key priority for South Africa's new 
government.  He noted that U.N. AIDS representative Michel Sidibe 
had also suggested that South Africa serve as a model for the 
African continent.  Minister Motsoaledi then spoke on the subject of 
the administration and organization of South Africa's fight against 
HIV/AIDS. 
 
¶4. He noted that the Deputy President of South Africa, Kgalema 
Motlanthe, is the Deputy Chairman of the South African National AIDS 
Coalition (SANAC).  Deputy President Motlanthe was "painfully aware" 
that there was a lack of focus and incessant infighting over the 
HIV/AIDS issue in the past.  "We wasted too many precious years," 
said the Deputy President.  The Deputy President was also aware of 
the significant role that South Africa plays in the regional 
context. 
 
¶5. Minister Motsoaledi then noted how many foreigners were working 
in South Africa, especially in the mining industry.  TB is a special 
problem among migrant mine workers, and the burden of HIV is very 
high in the country.  When migrant workers return to their 
countries, they bring with them various infections.  Thus, if South 
Africa is not able to manage its healthcare problems, it will 
certainly impact the rest of the region. 
 
¶6. The Minister explained more about SANAC's role.  He said that all 
elements of South African society were represented in SANAC: 
non-profits, government, laboratories, education, civil society, 
private sector, etc.  He noted that the Department of Health would 
work within the National Strategic Plan that SANAC had prepared. 
The specific goals of the plan were, by 2011, (a) to cut the rate of 
new infections by 50 percent and (b) to provide treatment to 85 
percent of the patient population. 
 
¶7. The Minister then spoke on the issue of funding.  He started this 
discussion by recalling that the Free State had suddenly run out of 
funding for ARVs, almost forcing patients to stop treatment in the 
middle of their programs.  There was a high possibility of similar 
disruptions in six of the other nine provinces in the near term. 
The USG funded drugs for Free State on an emergency basis and 
prevented a stock out. 
 
¶8. The Department of Health has started to work with the Treatment 
Action Committee (TAC) as a good partner.  TAC is advocating that 
treatment be given when the CD4 count falls to 350, up from 200 as 
stated in current policy.  They want faster uptake.  They are 
advocating for more second line drugs.  Finally, they were adamant 
that financial and administrative problems such as those of the Free 
State be avoided at all costs in the future.  Minister Motsoaledi 
acknowledged that he had to agree with many of the TAC's 
recommendations and the challenges they raise keep him awake at 
night. 
 
¶9. The Minister also acknowledged that South Africa's HIV/AIDS 
program has significant management challenges.  Human Resources are 
a huge issue.  Indeed, many of South Africa's neighbors are doing 
better on doctor and nurse training than relatively-wealthy South 
Africa.  Many of these HR issues are rooted in the former system of 
Bantu education under which Africans were not allowed to learn math 
or science.  Reversing the effects of Bantu education will take many 
years. 
 
¶10. The Minister continued to say that he was very grateful for the 
support of all development partners.  A new position as the CEO of 
SANAC has been created.  In the Minister's words, they have chosen 
an excellent person for this position, which would be at an equal 
level to the Director General in the Department.  The SANAC CEO will 
be responsible for meeting the SANAC goals, including those of 
women's health and TB.  Ideally, HIV and TB could be treated in the 
same facilities. 
 
¶11. Ambassador Goosby asked if SANAC will help with setting the 
priorities and implementing programs, if policies will be developed 
by SANAC under the (nominal) leadership of the Deputy President of 
South Africa, and if the SANAC CEO is responsible for implementation 
of those policies. 
 
¶12. The Minister confirmed that this was the intent, but there was a 
transitional process currently underway.  The intent was to move to 
an arrangement where the SANAC CEO had full responsibility for 
implementation of HIV/AIDS policies and the Department was only one 
constituent part of SANAC.  With regards to HIV/AIDS, "the 
Department of Health will operate under the SANAC umbrella."  The 
Minister noted that there have been too many plans.  Now is the time 
to implement and then evaluate weaknesses.  "We don't need any more 
T-shirts," the Minister said. 
 
¶13. In response to Ambassador Goosby's query of how the U.S. might 
assist, the Minister replied that they were finalizing a plan to 
bring a total of 1.4 million individuals into treatment programs by 
¶2011.  However, the budget gap is a huge problem, especially as 
there are so many other competing needs.  The Minister again raised 
the specter of the Free State and noted that running out of money to 
pay for ARVs is his most urgent fear.  In addition, communication 
and social mobilization is urgently needed to cut new infections by 
50 percent.  Deputy Director General Pillay then noted that 
information systems to evaluate programs are also a high priority. 
 
¶14. Ambassador Goosby asked the Minister to further discuss specific 
concerns about resources.  The Minister returned to the issue of the 
Free State precedent.  He noted that South Africa was running out of 
money to purchase ARVs and that there might very well be funding 
gaps in the near future.  Minister Motsoaledi admitted that, to a 
certain extent, this was due to bad planning.  He noted that they 
were working very hard to improve their planning and budgeting 
process to ensure that funding gaps did not happen again in the 
future, but in the immediate term they were vulnerable. 
 
¶15. Ambassador Goosby asked if the Minister had discussed the issue 
with other funders.  Minister Motsoaledi replied that he hoped to 
discuss the situation with the Global Fund and others. 
 
¶16. Ambassador Goosby then asked if the Department had maximized 
their purchasing power by buying generic drugs.  The Minister 
replied that sometimes the Ministry purchased drugs by tender at 
prices that were above global prices.  He explained that this was 
due to industrial policy.  Also, he noted that the WTO Trade Related 
Intellectual Property Rights (TRIPS) might sometimes be an issue 
that led to higher purchase prices.  However, he noted that they 
"were not married" to a particular tender system and that it was 
possible that they could reduce purchase prices further. 
 
¶17. Minister Motsoaledi continued by comparing his role as Minister 
of Health to his previous job as MEC for Education in Limpopo.  In 
his former job, he was required to purchase text books at above 
market prices.  He complained to his Provincial Premier, noting that 
his primary responsibility was to teach children - not support text 
book manufacturers and he was permitted to buy text books at market 
prices.  The drug tender situation might be similar. 
 
¶18. Minister Motsoaledi explained that DDG Pillay was in the final 
stages of completing analysis on the immediate term funding short 
fall and that he would be able to provide accurate information on 
the South African funding gap by next week.  Pillay complained that 
it was hard to piece together all of the Provincial data due to the 
lack of a real-time, system-wide information network.  Pillay also 
commented that British entrepreneur Richard Branson was interested 
in helping to develop such an IT network.  The DDG suggested that he 
would be happy to share the result of his funding gap analysis with 
the PEPFAR team within the next week. 
 
¶19. Ambassador Goosby closed the meeting by noting that the United 
States is seeking partnerships that enable governments to carry out 
effective programs.  He said that the U.S. government would like a 
common platform of work with Ministries of Health that starts from 
the premise of cooperation with an exit strategy.  Ambassador Goosby 
continued by saying the USG would like to support Ministries to 
build administrative and management capabilities and would like to 
expand capacity to help implement your vision and meet your unmet 
needs.  While this process might be slower (than directly funding 
NGOs), it is also more durable.  In this way, he said, the U.S. 
hopes to be able to expand capacity to meet increased demand, but 
not at the expense of reducing quality. Ambassador Goosby added that 
through this means the U.S. hopes to engage South Africa and 
increase mutual trust.  He concluded by saying the USG would like to 
build the relationship so that South Africa can reveal issues of 
greatest concern in a trusting environment. 
 
 
CONNERS