Tribute to Dr. Manto Tshabalala-Msimang

On the 17th of June 1999, she was appointed Minister of Health – the culmination of an interesting life spent in service of healing. This is where she was to endure a love-and-hate relationship with the media as she reshaped the unequal and fragmented South African health care system.

The Department of Health, under her leadership, promulgated a number of progressive legislations aimed at providing a policy framework for a universal access to quality health care. This was also to end racial segregation in hospitals and address the shortage of skilled health professionals in rural areas.

Her mission was to give the public health care sector a complete face-lift. Through the Hospital Revitalisation Programme, 30 hospitals have been renovated and more than 1 600 clinics built to improve access to health care since her first time in 1999. Improvements in hospital management have also been facilitated.

She formed a joint initiative with Namibia to establish a cardiac unit in Windhoek Hospital, the first in the history of that country, and the third in the African continent after South Africa and Egypt, to provide comprehensive care for heart disease. Leading up to its official inauguration by the former President of South Africa Mr Thabo Mbeki and President of Namibia Mr Hifikepunye Pohamba in August 2008, nine historic heart surgeries were successfully performed on patients aged between 14 and 25 years – a historic moment for a country that records more than 3000 cardiac cases a year needing surgical correction.

The Traditional Health Practitioners Act, 2007 (Act No 22 of 2007) was developed and signed by the President in January 2008. It led to the establishment of the Traditional Health Practitioners Council, which promotes the practice of traditional medicine, foster relevant research and observational studies on medicinal plants, advocate for the protection of indigenous knowledge, as well as creating the environment for local production of such medicine.

When Cabinet decided to transfer the medico-legal (state) mortuaries to the Health Department in 2006, she led the reviewing process of the services provided, and they were fragmented and uncoordinated.

The transfer process ushered the establishment of the country’s first comprehensive Forensic Pathology Service. A modernisation plan to improve the quality of the forensic service for the departed was developed and more than R1,5 billion was allocated for its implementation.

In an effort to recruit and retain health workers in the public health sector, especially in rural and underserved areas, the Department entered into a number of international agreements with overseas countries and finalised the Human Resources Plan, to address the challenges of supply, distribution and capacity of human resources in the health sector.

In March of 2004 she established the midlevel healthcare worker programme, which in August 2008 culminated to the introduction of the training of Clinical Associates – a fully funded programme through provision of bursaries covering tuition fees, monthly stipends and student books for the first two cohorts of Clinical Associate students.

Supported by the private healthcare sector, she established a health professionals bursary in 2000. A total of 50 medical students from disadvantaged communities have benefited from the Manto Tshabalala-Msimang Health Professionals Bursary Trust. The bursaries have had a positive impact on the students, evidence being their excellent 90% pass rate received since its inception.

She introduced two new vaccines to the Expanded Programme on Immunisation (EPI) in September 2008 to prevent viral pneumonia and second viral diarrhoea in children, and she contributed to the development of the African Health Ministers’ Strategy, which was later described as the continent’s first overarching health strategy for 2007-2015 and was endorsed by the WHO as comprehensive and far-sighted.

She established the Confidential Enquiry into Maternal, Infant and Child Deaths. Supported by professionals from research institutions and universities, she further developed a Perinatal Problem Identification programme (PPIP) and more recently the Child Problem Identification Programme (CHIP), to identify the weaknesses in the care of babies and children under five.

She signed a cooperation agreement with the Defence on August 2008, to solidify a partnership to allow the Department of Health and the South African Health Military Services to pool their professional health care cadres, resources and experience to tend to the traumatized; the infirm and the poor.

She experienced much resistance from the Pharmaceutical Industry with regard to the implementation of the Medicines Act, which seeks to increase access to affordable and quality medicine. For her, compromise was not an option as the lives of millions of South Africans are dependant on improved access to affordable medicine.

On July 2001, South Africa scored a landmark legal victor over the pharmaceutical giants wanting to stop the Minister from importing affordable AIDS drugs from around the world to tackle the scourge.

On June 2004, she introduced the single exit price regulations as part of the Medicines and Related Substances Amendment Act, which later resulted in about 20% savings for consumers of medicines.

The much-contested issue was South Africa’s response to HIV and AIDS, which included a range of debates centred on the following::

– National Strategic Plan a HIV and AIDS and STD’s, which was developed and adapted in 2000

– The establishment of SANAC in 2000

– The Operational Plan for HIV and AIDS, Management Treatment Care and Support which was adopted 2003 November for implementationn

– The review of the 2000-2005 NSP in 2006/077

– The review of SANAC and its subsequently restructuring in April 2006/07

– Midterm review of Comprehensive Plan in 2006/07

She drove the drafting of the Comprehensive Plan for the Management, Care and Treatment of HIV and AIDS, which was later adopted by Cabinet in 2002. It was later hailed as the most comprehensive response encompassing prevention and strengthening of health system. It offered people with HIV and AIDS the right to choose from a number of services including nutrition support, food supplements, and treatment of opportunistic infections, traditional medicine and anti-retroviral therapy.

The progress she has made in emphasizing the developmental approach to health was indeed not easy – while being criticised for highlighting poverty as the underlying factor in the spread of infectious diseases.

Compromise on her developmental agenda was not an option as she felt these were issues of life and death for many South Africans. Today, the role of nutrition in the promotion of good health in general can no longer be disputed.

The WHO agrees that there is a need to consider social determinants of health such as poverty, underdevelopment, poor nutrition and lack of access to basic services like water and sanitation when dealing with HIV and AIDS.

She led the department on a massive public health awareness campaign aimed at addressing lifestyles that undermine health. The healthy lifestyles campaign aims to reduce communicable and non- communicable diseases as well as non-natural causes of death. It encourages good nutrition, regular physical activity, safe sexual behaviour and tobacco control. It also addresses the challenge of alcohol and substance abuse.

She has put the interests of South Africa, Africa and the developing world firmly to the fore. She played a leading role in shaping the agenda of the SADC, Africa and more importantly, the World Health Organisation – among other things in 2005 signed an agreement with Mozambique to collaborate resource sharing and co-ordinate patient referral system between the two countries. The agreement considered daily movements of Mozambique nationals who frequently crossed the border to access health services in South Africa.

She served on the Board of the Global Fund to fight AIDS, Tuberculosis and Malaria representing Southern and Eastern countries. In addition to all the accolades she received the following honorary awards:-

– The Walter Sisulu Award for Leadership Excellence from the South African Students Congress in July 2008. She is the second person to receive this award named after a humble architect of our democracy, Cde Walter Sisulu

– The Medical Education for South African Blacks honoured her in 2005, for her contribution to health care delivery in South Africa

– She was also honoured by the National AIDS Trust Fund in 2005, for her work in the prevention, care and treatment of HIV and AIDS.

– She received an award from World Health Organisation (WHO) in 2004, for her commitment and delivery on Inter-country and Cross-Border collaboration on Malaria.

– In 2000 she was bestowed the Luther L.Terry Award from the American Cancer Society, for her effective work in Tobacco Control. South Africa’s legislation in tobacco control is quoted as the most progressive ever to the extent that countries like Sweden have asked to model their policies and legislation on it.

She survived a liver transplant and hostile media criticism in 2006 to be elected in the voting polls for the ANC’ national executive committee, and went on to receive the confidence of the African Heads of States and African Health Ministers who in June 2008 appointed her to lead the Africa’s Movement to improve maternal health and promote child survival and development in Africa, beyond 2015. She was also the CAMH3 Chairperson of the AU Ministers of Health, and the Chairperson of the SADC Health Minister in 2008.

Her last public appearance as Minister of Health was at the Research Colloquium into African traditional medicine in Johannesburg, where she spoke about the need to harness research for validation of African Traditional Medicine. This followed the 6th Commemoration of the African Traditional Medicines Day in Cameroon, where she chaired panel discussions on traditional medicine as a primary approach to health care, and on the establishment of Africa’s traditional medicine’s pharmaceutical manufacturing plan.

She facilitated the development of the draft policy on African traditional medicine which provides for the establishment of a National Institute of African traditional medicine, to enable the creation of the focal point for research into African traditional medicine. She established the South African Journal of the African Traditional Medicine to document research on medicinal plants. The traditional healers’ sector applauds her for placing traditional medicine on the high agenda of the health system of the country.

She was sworn in as Acting President of the Republic of South Africa by the Constitutional Court in September 2003. In keeping with the Constitution of the Republic of South Africa she, together with three other Ministers, were to alternate as Acting President of the country until the next election in 2009.

She served as the Minister of Health for two terms, before being re-deployed to the Presidency on 25th September 2008.

She is proud to have been part of the transformation of the health care system and to have occupied an equally important position as the Minister in the Presidency as it dealt with critical issues of gender, women, children and people with disabilities. Issues affecting vulnerable groups have always been close to her heart. She dealt with gender issue as the Deputy Minister of Justice and in Health championed issues of women and child health, as well as youth and adolescent development.

As the Minister in the Presidency, the position she held for seven months until the appointment of the new Cabinet on 10 May 2009, she assisted in building the capacity of the newly elected women from the Nepal Constituent Assembly. South Africa’s transitional justice process had been hailed by the international community as one of the best friendly processes.

She assisted in finalising the AU Gender Policy document and intensified the national campaign for 50/50 representation of women in politics and decision making positions, and launched the Beyond Inequalities Women in Southern Africa Book to provide accessible information to engender development processes in the SADC.

She facilitated the formation of the National Youth Development Agency, to ensure seamless integration, sustainability and responsiveness to the demands and aspirations of South Africa’s youth, through the merger of the National Youth Commission and Umsobomvu.

She produced the National Youth Policy and on 07 May 2009 signed the African Youth Charter at the African Union Health Quarters. The Charter is a continental political and legal document which serves as a strategic framework that gives direction for youth empowerment and development at continental, regional and national levels, as well as to provide an avenue for effective youth participation in development processes. The signed document forms part of the efforts to implement the African Union Commission’s (AUC) Horizon Strategy (2004-2007.

She promoted efforts to strengthen the National Gender Machinery, supported the review of the institutional mechanisms for the promotion of women’s empowerment and gender equality and facilitated consultative meetings about the establishment of the Women’s Ministry.

She instituted successful talks on harmful traditional practices including child abduction, forced and early marriages “ukuthwala”, and launched an Integrated Human Trafficking National Action Plan, to fight this scourge, which disappropriately affects women and children.

She ended her 3rd term with the launch of the Situational Analysis of Children in South Africa (2007-2008) and the introduction of the Children’s Website to improve access to information and technology.

In 2009, Dr Tshabalala-Msimang became a Member of Parliament, serving under the portfolio committees of tourism, women and children, and human settlement.

And such is the essence of true greatness. The greatness that comes from understanding the complexities of the human condition; a greatness that rests in the humility of touching a human being from the moment of birth to the final departing breath and a greatness that consistently strives to make quality of life possible for every one of her people.

By Charity Bhengu (Bhengu is a former Media Liaison Officer of the late Dr Tshabalala Msimang)

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Editorial Notes: Tshabalala-Msimang was pronounced dead by her doctor Prof. Jeff Wing on the 16 December 2009. She died in the Wits University Donald Gordon Medical Centre & Medi-Clinic ICU shortly before 3pm. Professor Wing announced that she died from complications related to her first liver transplant in 2007.

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