More Manto than Manto

It’s really hard to take anything Peggy Nkonyeni says seriously. As MEC for Health in KwaZulu-Natal (KZN), home to about one in four people living with HIV in South Africa and the epicentre of the global extensively drug resistant (XDR) TB epidemic, Nkonyeni is the epitome of arrogance, incompetence and malevolence. Every time she opens her mouth, she seems to spew vitriol, lies and misrepresentations.

Take her recent budget address to the KZN legislature, in which she devoted considerable time and energy to unfairly attack a doctor from the rural Umkhanyakude District. Much has already been written about Dr. Mark Blaylock’s run–in with provincial health authorities. But Nkonyeni upped the ante, making sweeping allegations of racism and misconduct that have little basis in reality.

Of course, racism and misconduct are indeed rife in the kingdom, in particular within the health department. For proof, one needs to look no further than Nkonyeni herself. In a transparent reference to white rural doctors, for example, she spoke about “people masquerading as doctors”. Indeed, “quack doctors” abound in KZN. But Blaylock and his colleagues at Manguzi Hospital are not among their ranks.

Other examples abound. The same doctors providing essential public health services to people with HIV are said to be unconcerned about people and only interested in making profits. They engage in “political point scoring over our people’s sicknesses instead [of] work[ing] with us in finding solutions.” For Nkonyeni, their whiteness matters. So much so, that many posts remain unfilled because only white doctors are available to fill them.

And then there’s the misconduct. Now, as a lawyer, I’m prepared to give the honourable MEC the benefit of the doubt. Unless and until the recent allegations are proven, she cannot be presumed to be guilty. But I also define misconduct more broadly, as does my MacBook: “behaviour that is not in accordance with accepted moral or professional standards” and “incompetent or dishonest management of something, especially on behalf of others.” Point made.

But, as always, I digress. As I indicated upfront, I find it hard to take anything she says seriously. But let’s try, examining some of the astonishing admissions made in her budget speech.

For starters, let’s look at how she explains over–expenditure on antiretroviral (ARV) treatment. On her own account, she states that her department only budgeted for 81 000 patients, but had 120 000 people on ARV treatment in the previous financial year. The difference accounted for an additional R158 million, meaning that only R310 million –- or thereabouts –- had actually been budgeted. Interestingly, albeit disturbingly, only R322 million has been budgeted for this year.

Now I’ve done my sums, considering KZN’s “share” of the HIV epidemic, the estimated national costs of ARV treatment as set out in the National Strategic Plan (NSP) that was finalised more than a year ago, and the data presented by Nkonyeni. Doing a little arithmetic, it’s easy to see that the actual amount budgeted fell way below the NSP’s estimated cost. Had her department actually done its work, it would have budgeted significantly more, obviating the need for any over expenditure.

On TB, her admissions are even more alarming. Here’s how she attempted to justify over–expenditure in this area: “In the implementation of the TB crisis management programme, we had to increase Tracer Teams and associated resources such as vehicles and establish more TB designated wards”. She continued: “The strategic plan for the 2004/05 to 2008/09 financial year was crafted prior to the emergency of the current patterns of the MDR and XDR TB strains.” So, had they known in time, they would have adjusted their budget accordingly, as they seem to be doing now?

Interesting, because the outbreak of XDR TB at Tugela Ferry in rural KZN was first brought to Nkonyeni’s department’s attention in late 2005. This should have resulted in urgent action and a revised budget for 2006/07. But it was not until much later, when the concerns were already in the public domain, that some steps were taken. And even then, the budget for the following financial year -– 2007/08 –- was not appropriately adjusted. Instead, we had over expenditure.

On her own account, Nkonyeni is not fit to govern KZN’s health department. With her not–so–uncommon brand of populism, her unreconstructed denialist views on ARV medicines and her inability to do the difficult job given to her, Nkonyeni mirrors her mentor -– Manto Tshabalala Msimang. But whereas the Minister has recently started to backtrack on her support for quack “remedies” such as uBhejane, the MEC had the chutzpah to prominently display a Matthias Rath publication in a recent meeting with the Treatment Action Campaign.

Who would have thought: more Manto than Manto!