Manto frail but unbowed

Manto Tshabalala-Msimang looks frail and unrecognisably thin, but, on the evidence of her budget vote speech in Parliament on Thursday, she is as combative as ever, with targets ranging from private hospitals to medical researchers, pharmaceutical companies, and the national treasury.

Sticking precisely to her prepared text, and speaking in a thin, reedy voice, Tshabalala-Msimang laid out what amounted to a battleplan for the year, and left silences as redolent of conflict as her explicit pronouncements.

‘I am now well, re-energised and committed to ensuring that we proceed with the reforms in the health sector that we started,” she said.

Tshabalala-Msimang thanked President Thabo Mbeki and Deputy President Phumzile Mlambo-Ngcuka, the sole occupant of the ANC front benches, for their support. Her doctor Jeff Wing, and staff from the Johannesburg Hospital were present in the gallery, and got a round of applause from MPs.

But Jeff Radebe, who was acting minister in her absence, went unmentioned until parliamentary health committee chair James Ngculu, and numerous other speakers, thanked him for his work in the portfolio. In sharp contrast to Tshabalala-Msimang, Radebe has made explicit his concern about HIV/Aids, particularly since the death of his adviser, Ian Phillips, of Aids-related complications, in March.

Deputy minister Nosiviwe Madlala-Routledge, who has differed sharply and publicly with Tshabalala-Msimang on HIV/Aids also went unmentioned.

Their absence from Tshabalala-Msimang’s speech was the only hint of the tensions within the ruling party and government over her surprise return to the job, apparently following a request to Mbeki by her husband, ANC treasurer-general Mendi Msimang.

Members of the ruling party’s national executive committee say she now enjoys almost no support in that body, and that very few of her Cabinet colleagues were in favour of her return.

One ANC MP, reflecting on the ‘human” factors justifying her return, said ‘she would deteriorate very quickly if she didn’t have the work”.

But combat within her own party and ministry, and differences over HIV/Aids, will not be the end of it.

Medicine pricing is still hotly contested, and will become more so once benchmarking of prices takes effect. Tshabalala-Msimang made it clear that private hospitals are in her sights.

‘The Medical Schemes Council has found that in response to measures to decrease the cost of drugs, the private hospital sector increased hospital charges. We will be working with the council to see what can be done in this regard,” she warned.

HIV researchers are also on notice: Tshabalala-Msimang said she had asked the National Health Research Council to take a close look at the ethical standards in the controversial KwaZulu-Natal microbicide trials that recently suggested women using cellulose sulphate gel may be at increased risk of contracting the virus.

Meanwhile, medical professionals angry over the exclusion of some specialists from posts in Western Cape on employment equity grounds, will be interested to hear of the recruitment of more foreign doctors — now from Iran and Tunisia, rather than Cuba.

Journalists looking for Aids related controversy, however, were not disappointed. Tshabalala-Msimang said a ‘statistically significant drop” in infection rates among pregnant mothers was a vindication of the department’s stress on prevention, and she credited nutrition and immunisation with declines in infant mortality

Outside Parliament’s Old Assembly was a prominent display of fruits and vegetables mounted by the ‘5-a-day” programme which aims to boost consumption of healthier food. There was no garlic, or beetroot, as there were on the controversial stand at last year’s World Aids conference in Toronto. Your correspondent attempted to help himself to a particularly juicy looking orange, and was sternly admonished by the woman in charge of the stand. ‘It is for display purposes,” she said, ‘after the minister has made her tour — maybe.”

Other stands promoted TB control programmes, coronary health, and the medical insurer Discovery. HIV/Aids was once again conspicuous by its absence.