Stuart Hess
Ayanda Ntsaluba does not enjoy the limelight. But his new position as director general of health has thrust him into the public eye.
Minister of Health Nkosazana Zuma appointed Ntsaluba three weeks ago. He replaces Olive Shisana, who left the department in June this year in the wake of the Sarafina II scandal. She has since taken up a top position in Geneva with the World Health Organisation.
The Department of Health was severely criticised for spending R14-million to produce Sarafina II, a drama intended to educate South Africans about Aids/HIV.
Despite the Sarafina 11 scandal, Ntsaluba believes the department has performed admirably in providing South Africans with health care.
“It’s true though there are landmark issues which have cast a cloud over the department,” says Ntsaluba.
He concedes the transformation process was always likely to lead the department into difficulty with powerful special interest groups.
“Any health minister in any country will tell you how difficult it is dealing with pharmaceutical companies and tobacco companies who have vast financial resources,” he says.
He believes Zuma is prepared to challenge these interest groups because she is “absolutely committed” to providing proper health care.
“However, because she is so focused she cuts herself off from other stakeholders and anything that may deviate her from her goal,” says Ntsaluba.
The department has faced a growing number of problems over the past 12 months. These include a lack of financial aid for hospitals, the slow distribution of human resources and drugs, and the Aids/HIV epidemic.
Ntsaluba says the department has no funds to bail out institutions. The Eastern Cape and Gauteng are in dire need of financial assistance to alleviate overspending by hospitals. But more funding will only be available in April next year, says Ntsaluba.
He admits current problems in the hospital sector are due to the government’s poor reviews of financial shortfalls in 1995 and 1996 and describes hospital management as “archaic”.
The government’s Aids/HIV policy has been clouded with controversy from the start. Paramount was the Sarafina II scandal that Ntsaluba says cost the department valuable time. He says it had a two-sided effect on the department.
“It was positive in that we could say where we went wrong, and negative in that it put us in a defensive position,” he says. “It’s bad being in a defensive position when one needs to make progressive decisions.”
The Aids/HIV epidemic will now be handled by an inter-ministerial committee on Aids/HIV to be chaired by Deputy President Thabo Mbeki. Ntsaluba says this should have been done years ago when the department made Aids/HIV a priority issue.
Recently the department decided to stop administering the drug AZT to pregnant mothers. AZT is able to reduce by 50% the transmission of HIV from mother to child.
Ntsaluba describes this as one of the most “painful” decisions the department has had to make, but says it was based on affordability. Instead, he says, the department will focus attention on preventing the spread of the disease and is targeting adolescents with an R80-million education project started by Mbeki last week.
The primary health care policy is one of the department’s great successes, Ntsaluba contends. Since the African National Congress came to power in 1994, the health department has built 560 clinics in rural areas.
He is currently involved in drawing up a patient charter that will significantly improve primary health care and help both patients and staff understand the kind of quality care that should be provided.
“People must learn what they should expect from nurses and doctors,” he says. “It’s not a favour, it’s what they are entitled to.”
Ntsaluba was schooled in Umtata in the Eastern Cape, before obtaining an MBChB from the University of Natal in 1982. Three years later he went into exile and became involved in the running of health facilities for exiled ANC activists throughout Southern Africa.
The hardest period of his exile was administering psychological treatment to young people who left South Africa after 1986 state of emergency.
Ntsaluba joined the department in 1995 as deputy director general for policy and planning.
Opposition parties describe Ntsaluba as pleasant, competent and reasonable, but stress that the crucial part of his job will be his relationship with Zuma.
Democratic Party health representative Mike Ellis says Zuma’s single-mindedness will make Ntsaluba’s job incredibly difficult.
“Should the new director general have points of his own, he would be well advised to hide them in the darkest recesses of his mind,” Ellis says.
National Party health representative Kobus Gouws says work on the tobacco and medical aids Bills will provide Ntsaluba with significant challenges. “We just hope he doesn’t become a puppet of the minister.”
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