VZCZCXRO2475
RR RUEHBZ RUEHDU RUEHMR RUEHPA RUEHRN RUEHTRO
DE RUEHSA #2547/01 3441222
ZNY CCCCC ZZH
R 101222Z DEC 09 ZDK
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 0583
INFO RUEHZO/AFRICAN UNION COLLECTIVE
RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHPH/CDC ATLANTA GA 2496
RUEAUSA/DEPT OF HHS WASHDC

C O N F I D E N T I A L SECTION 01 OF 04 PRETORIA 002547 
 
SIPDIS 
 
DEPT FOR AF/S CARSON AND OGAC E GOOSBY 
USAID FOR BUREAU OF GLOBAL HEALTH AND AFR/SA 
HHS/PHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS JMONAHAN 
CDC FOR GLOBAL HEALTH OFFICE SBLOUNT 
NIH FOR RGLASS 
 
E.O. 12958: DECL: 12/03/2019 
TAGS: EAID KHIV PGOV SF TBIO
SUBJECT: AMBASSADOR'S MEETING WITH MINISTER OF HEALTH AARON 
MOTSOALEDI 
 
REF: A. A. PRETORIA 2463 
     ¶B. B. USDEL SECRETARY/AFRICA 0006 
     ¶C. C. PRETORIA 1028 
 
Classified By: DCM HELEN LA LIME FOR REASONS 1.5 (C) AND (D) 
 
¶1. (C)  SUMMARY: The meeting between Ambassador Gips and 
Minister of Health Dr. Aaron Motsoaledi on November 30, 2009 
marked a new partnership between the United States and South 
Africa in health coordination and cooperation.  The Minister 
thanked the United States for the extensive  support we have 
provided through PEPFAR and other health programs in HIV/AIDS 
and TB. Minister Motsoaledi also outlined key priorities for 
the government that include ending AIDS exceptionalism by 
integrating HIV prevention, care, and treatment into the 
primary healthcare system, enhancing prevention efforts 
through engagement at a community and clinic level, engaging 
all existing partners in healthcare delivery including the 
private sector, NGOs, and civil society. The Minister 
highlighted the need for South Africans to unite to fight 
HIV/AIDS and welcomed the opportunity to develop a PEPFAR 
Partnership Framework.  End Summary. 
 
--------------------------- 
US-SA PARTNERSHIP ENDORSED 
--------------------------- 
 
¶2. (C) Ambassador Gips met with Minister of Health Dr. Aaron 
Motsoaledi on November 30, 2009 accompanied by the Health 
Attach, the CDC Director and the USAID Health Director.  The 
Ambassador acknowledged the enormous challenges facing the 
Minister and praised Motsoaledi as a true champion in leading 
the effort to improve health for all in South Africa and 
respond aggressively to HIV and TB.  The Ambassador 
emphasized his commitment to helping South Africa achieve its 
goals in health and asked that Minister Motsoaledi consider 
the United States as an ally and a friend.  The Minister 
thanked the Ambassador for the PEPFAR support -for HIV, AIDS 
and TB and the additional USAID funding for TB. 
 
-------------------------------- 
SOUTH AFRICA,S HEALTH CHALLENGES 
-------------------------------- 
 
¶3. (C)  The Minister said that the key weakness of the South 
African response to HIV/AIDS was that there was a parallel 
system to deal with HIV, and health institutions that did not 
see HIV/AIDS as part of their mission were not owning up to 
their responsibility for this battle.  The ambitious 
objectives of the South African National AIDS Council's 
(SANAC) 2007-2011  National Strategic Plan for HIV/AIDS, TB 
and STI, of decreasing new infections by 50 percent and 
putting 80 percent of eligible people on antiretroviral 
treatment requires good logistics and services at all health 
facilities.  The inherent capacity is lacking at the District 
level to ensure this.  Currently, the parallel HIV care and 
treatment services are out of reach for many people because 
of the long distances they must travel.  This leads to lack 
of adherence to treatment over time.  The Minister noted that 
an additional 3,000 primary healthcare facilities were built 
when Nelson Mandela became President reaching a total of 
4,000 facilities that were intended to improve healthcare 
access for all in South Africa after apartheid ended. 
However, embracing their new rights, 
South Africans believe it is their right to access the 
highest level and quality 
of healthcare at the hospitals and seek care at specialized 
Qof healthcare at the hospitals and seek care at specialized 
facilities for even the simplest health problems.  As a 
consequence, these facilities are overburdened and the 
primary healthcare system has collapsed. 
 
--------------------------------- 
INTEGRATION AT PRIMARY CARE LEVEL 
--------------------------------- 
 
¶4.  (C) The Minister's goal is to end HIV "exceptionalism," 
integrating HIV into every healthcare professional's and 
facility's responsibility, to strengthen the primary 
healthcare system and ensure that everyone has access to 
quality healthcare near their homes.  Motsoaledi shared his 
experience as a physician in remote rural areas of Limpopo 
and noted that people would wait to see him during his weekly 
or bi-weekly visits if they were not seriously ill. The 
 
PRETORIA 00002547  002 OF 004 
 
 
Minister asked that the United States help South Africa by 
identifying and testing new models of care and ways to 
decrease the costs and improve efficiency within these 
models.  The Ambassador endorsed the Minister's proposal and 
committed our support to do this.  The Ambassador also 
discussed the President Obama's Global Health Initiative 
noting that it emphasized this type of integration at the 
primary healthcare level and hoped that we could further 
support South Africa in the future. 
 
--------------------------- 
PREVENTION HIGHEST PRIORITY 
--------------------------- 
 
¶5.  (C) Minister Motsoaledi emphasized the need for a 
concerted HIV prevention effort noting that there is a full 
spectrum of response to HIV and that treatment is at the end 
of that spectrum when all else has failed.  He remarked that 
the goal of decreasing new HIV infections by 50 percent 
requires a  massive change as there is no guarantee that 
there will be a cure or a vaccine.  The current focus on 
treatment is not stemming the continued increase in cases and 
a change in the mindset of South Africans towards prevention 
needs to occur.  Motsoaledi wants to bring prevention to the 
village and clinic level and empower communities to lead the 
effort in prevention.  He noted that the debate in South 
Africa around proposed National Health Insurance, like the 
debate in the United States, is on cost estimates of a 
curative system centered around highly specialized hospitals. 
 A focus on prevention at the primary health care level could 
decrease the cost considerably. 
 
------------------------------------ 
HEALTH SERVICE DELIVERY PARTNERSHIPS 
------------------------------------ 
 
¶6.  (C) The Minister anticipated the Ambassador's request to 
keep the NGOs involved in HIV efforts by explaining that 
SANAC has established a Task Team headed by SANAC Co-Chair 
Mark Heywood to represent civil society. The team will take 
stock of all the private sector, non-governmental 
organizations and civil society programs currently addressing 
HIV and TB in South Africa to understand what each can 
provide and where they are working.  PEPFAR representatives 
at the meeting informed the Minister of the ongoing PEPFAR 
Partner Inventory with similar aims and to provide 
geo-mapping for all activities and programs.  The Inventory 
results will be available in April 2010 and we will share 
these with the Department and the SANAC Task Team.  The 
Minister reported that he had met with the Captains of 
Industry emphasizing their responsibility in this area and 
the need for their leadership in this area.  He was dismayed 
that their response was to put forward the products they 
could sell to the government as they scaled up their 
response.  Motsoaledi took them to task for this approach and 
reminded them that many of their employees have HIV and their 
support as part of their Corporate Social Responsibility is a 
sound business strategy.  In fact, Discovery Health has 
offered to support the massive voluntary counseling and 
testing campaign that will be launched in March 2010.  A team 
from the private sector has been tasked to meet and outline 
how they can contribute to the fight against HIV. 
 
------------------- 
SANAC STRENGTHENING 
------------------- 
Q------------------- 
 
¶7.  (C) The Minister also noted that SANAC needs to be 
re-organized and strengthened.  With the new leadership of 
SANAC CEO Dr. Nono Simelela he believes this can be done. 
Motsoaledi will ask the Cabinet to approve elevating 
Simelela,s position to the level of Director General so that 
she can join the Director General Meetings and work in the 
political context to gain support.  He also asked for highly 
skilled people to be seconded to SANAC to help them in their 
task.  The Ambassador offered staffing assistance to the 
Minister for the National Department of Health as they also 
scale-up their response and the Minister thanked the 
Ambassador. 
 
--------------------- 
PARTNERSHIP FRAMEWORK 
--------------------- 
 
PRETORIA 00002547  003 OF 004 
 
 
 
¶8.  (C) Ambassador Gips informed the Minister Motsoaledi that 
we will need to work with South Africa to develop a 
Partnership Framework led by South Africa to outline a 5-year 
multi-sectoral strategy for HIV efforts, emphasizing country 
ownership, key strategic goals, responsibilities of 
government, PEPFAR and other donors that will be tied to 
financial commitments.  The Minister was very receptive and 
informed the Ambassador that there were existing structures 
in place through SANAC, including the SANAC Plenary chaired 
by Deputy President Motlante, the Resource Mobilization 
Committee that he chairs, the Program Implementation 
Committee, the SANAC Leaders Forum, and the Inter-ministerial 
Committee and suggested we work with all these groups in 
developing the Partnership Framework. 
 
--------------------------------------- 
SOUTH AFRICANS TO UNITE IN HIV RESPONSE 
--------------------------------------- 
 
¶9.  (C) Finally the Minister noted the need for South 
Africans to unite to effectively respond to the challenge of 
HIV.  He has put together all the international and South 
African data available, including the confidential enquiries 
commissioned by the government and the recent Lancet series, 
and presented an overview of the South African HIV situation 
to SANAC.  Each of the sectors had appreciated the problem as 
it affected them but the full picture brought everyone to 
attention.  The Minister noted that South African had never 
responded to this crisis and needs to respond now.  This has 
led to a debate about the validity of the statistics while 
other groups are suggesting that ex-President Mbeki and his 
then Minister of Health Manto Tshabalala-Msimang should be 
charged with genocide.  Motsoaledi sees this dividing the 
country and diverting efforts away from the task at hand and 
is challenging people to leave the divisions aside.  If TB 
and HIV can unite as such powerful allies why can't people do 
the same, asked Motsoaledi.  He felt that focus on these 
controversies puts the wrong war at center stage and is fed 
by the media who look for controversy.  The real war to fight 
is HIV, he noted. 
 
-------------------- 
ARV FUNDING WELCOMED 
-------------------- 
 
¶10.  (C) The Minister thanked the U.S. for the additional 
funding for antiretroviral drug (ARV) purchase and gave the 
Ambassador a preview of the announcements made by President 
Zuma at the SANAC World AIDS Day event summarized in Pretoria 
¶2463.  He noted that the Minister of Finance has committed to 
providing additional funding for HIV treatment and will 
announce this in February when he makes his Budget Speech to 
Parliament.  Motsoaledi will also present the results of the 
recent Health Sector review that he asked WHO and UNAIDS to 
conduct with PEPFAR participation to the National Treasury 
once an implementation plan has been developed and costed. 
This review recommends integration of HIV prevention, care, 
and treatment at the primary care level.  The Health Minister 
is prepared to tackle the issue of the high prices South 
Africa pays for ARVs and noted that it is estimated that 
250,000 more people could be put on treatment if South Africa 
purchased ARV at prices similar to what other African 
countries pay. 
 
-------- 
Q-------- 
COMMENT 
-------- 
 
¶11.  (C) The Ambassador's first official meeting with 
Minister of Health Motsoaledi was frank, endorsed the 
partnership between South Africa and the U.S. in the fight 
against HIV and TB, and underlined the leadership and 
commitment of the Minister in tackling the significant 
challenges of rebuilding the South African healthcare system 
and responding effectively to the epidemic of HIV by calling 
on every individual to take on this effort.  The United 
States is recognized as a significant partner in this effort. 
 Ambassador Gips emphasized ongoing U.S. support and 
contribution in continuing efforts and responding to the 
Minister's request for assistance in defining innovative and 
cost efficient models of care, strengthening prevention 
efforts and health systems, and assisting SANAC and the 
 
PRETORIA 00002547  004 OF 004 
 
 
Department of Health with capacity building. The Minister is 
visionary in his approach, willing to tackle hard issues, and 
has set high standards and expectations for all South 
Africans. 
 
GIPS 
GIPS