Unprecedented public distrust of the Department of Health is threatening its efforts to eradicate inequalities in the public health sector. In the month since Manto Tshabalala-Msimang was reappointed to a second term as health minister, the department has had to juggle two court cases, resignations of crucial staff and glitches in the anti-retroviral (ARV) roll-out plan.
Recent initiatives by the department have been hailed as excellent by experts — but the department’s failure to communicate the benefit of these new regulations has swung public opinion against them.
”My sympathies are with the government, but the problem is with the department’s communication,” said Jerry Coovadia, professor of HIV/Aids research at the Nelson Mandela School of Medicine, University of KwaZulu-Natal, in Durban.
He said department’s intention in most of its initiatives was to ensure the poor have access to free health care.
The resignation of key officials — including Nono Simelela, head of the HIV/Aids directorate — has created the impression that the department is a sinking ship.
This week the department faced two court challenges — one by doctors opposed to its attempt to curb their right to dispense medicine to their patients, and another by stakeholders in the pharmaceutical sector.
In the same week, the department created unnecessary panic among paediatricians providing ARV treatment to children by announcing that there could be difficulties in procuring the drugs.
Experts say the chaos is caused by a lack of ”buy-in”, or faith, in the department.
The events of the past month have been in the pipeline for most of the past decade. The department had a ”trial and error” style in the first half of the decade and, in the next half, it was bogged down by court cases, according to Nzapfurundi Chabikuli, director of Wits University’s Centre for Health Policy.
”Any type of change that goes so deep as to impact on the livelihood of professionals — you must expect resistance. You cannot force regulations down the throats [of health sector players] — you must consult widely.”
The department has been trying to bring affordable health care to all since 1994. And since that date it has had a good set of policies and legislation — but bad management at ministerial level, said Mark Heywood, director of the Aids Law Project at Wits University’s Centre for Applied Legal Studies.
He said the fault lay largely with Tshabalala-Msimang’s ”bull-in-a china-shop” management style.
”There are lots of vested interests [in the health sector] and the real challenge is how to make [these interests] work for the sector.” The management style should be flexible to outwit those who had a vested interest.
He said that although the intention behind the reforms was good, the execution was ”shocking” and affected health service delivery.
Since the long-running Aids debacle, said experts, Tshabalala-Msimang and her department have lost credibility with the public.
”Given the track record of the [health] minister this is not surprising, but she manages to exacerbate the distance between the public and the department,” Coovadia said.
Last straw for Simelela
The resignation of Nono Simelela, head of the Department of Health’s HIV/Aids directorate, came as no surprise to those working in the Aids field, considering the years she has spent holding down what may be the worst job in the government.
After four years of gruelling work to get the world’s biggest anti-retroviral (ARV) treatment programme off the ground, she leaves amid speculation that the reappointment of Manto Tshabalala-Msimang as health minister was the last straw.
Simelela’s appointment in 1998 came just before the president’s dissident phase.
She is said to have had good relations with civil society and academics who were pushing for the ARV treatment campaign. There is no doubt she was stuck between a rock and a hard place. The toll began to show last year when she was hospitalised, apparently for stress.
Perhaps she is wise to leave now; when the real work of implementing the complex programme needs strong political and technical leadership. And she can be forgiven for leaving a position which obviously was causing her mounting distress.
She will be remembered especially by the media for her standard response to all questions on ARV treatment: ”It’s difficult to get a policy when you haven’t done adequate research. And we’re hoping that at least not later than the middle of the second half of this year, we should have some guidance about what needs to be done.”