Dr Mantombazana Edmie Tshabalala-MsimangMinister of Health
Dr Mantombazana Edmie Tshabalala-Msimang
Minister of Health
The first decade of democracy has seen substantial changes for women as a result of social, political and economic developments as well as changes in government policy and legislation. The South African Government has become a world leader in the empowerment of women and in its commitment to ensuring that women become actively involved in all decision-making that affects their lives and the lives of their families.
But all these changes would come to nought without the thousands of health workers and community leaders who have laboured tirelessly to ensure that policy is translated into reality and that legislation is worth more than just the paper it is printed on.
Today, 10 years after the first historic election, we pay tribute to the Women in Health who have served our communities, our clinics, our hospitals, our health departments and our ministries to ensure that all South Africans have equal access to quality health services.
These women operate in a very different environment from that of ten years ago. They work in a society in which the overwhelming majority of people have access to clean water and sanitation, in which millions of children are ensured of a meal during their school day and in which South African women are being empowered to take control of their reproductive health and of their health during pregnancy.
While access to basic services has contributed significantly to building a healthy nation, the health challenges women face have also increased. This overview paints a picture of hard working women who are dedicated and determined to tackle the challenges facing them and those close to them head on, in their quest to restoring the dignity of our people through health.
Dr. Manto Tshabalala-Msimang
Minister of Health
1. Introduction
The ushering of the new dispensation in South Africa provided the nation with a number of positive and far-reaching benefits. One of these remarkable achievements has been the inclusion of gender equality and equity in the transformation agenda. From the outset, integration of the fragmented health facilities and administrations presented an immense challenge. With such integration came a need to improve access to health services to the majority of people whose needs were not catered for during the apartheid era. Other challenges included ensuring that resources were allocated equitably to provinces. Included in that was a shift of resources to primary health care as well as the management of expenditure to ensure that the budget was effectively utilised. A vision for health care was set out by theHealth Sector Strategic Framework 1999-2004:
A caring and humane society in which all South Africans have access to affordable, good quality health care.
In line with this vision, Gender Policy Guidelines were initiated so that an effective framework is in place to develop, implement and monitor laws, policies, programmes, procedures and practices to ensure:
Through initiatives such as the Gender Policy Guidelines and Batho Pele: White Paper on the Transformation of Public Service Delivery, Government has sought to ensure that legislation, policies and programmes are more responsive to gender-specific issues such as violence against women. The challenge was taken up not only to promote transformation in how and who the department of health and supporting agencies serve but also to ensure transformation and gender equity amongst those who serve in the quest to provide access to affordable, good quality health care. Transformation has been underpinned by the introduction of legislation as a first step to dealing with institutional discrimination against women.
2. Legislating equality
A ground-breaking Constitution and over 780 pieces of legislation have created a framework to reshape South Africa and correct the imbalances of the past. Policy and implementation are more integrated thanks to government's cluster approach, provincial co-ordination, Integrated Development Plans in local government and the recently introduced National Planning Framework. Finalized in February 1996, the Constitution has entrenched a number of rights that are significant for women. These rights include:
Building on legislative reform, Government has also shown a policy commitment to addressing historical gender imbalances. Among the policies adopted - the health needs of women are recognised and contribute to reducing the burdens women face every day. These policies include:
2a) Universal access to Primary Health Care
Apartheid-entrenched inequalities have left a legacy of poverty particularly among rural communities. Women carry additional burdens and research in 1995 found that 49% of women-headed households were among the poorest compared to 31% of male-headed households. This feminisation of poverty, in turn, impacts on women's health and the health of their children. In April 1996 theMinister of Health announced a policy on universal access to primary health care. Linked to this was a departmental programme to upgrade and build new clinics. From September 1995 until the end of 1998, 495 new clinics were built and 249 clinics upgraded while some had maternity sections added to them. There are now over 4 350 primary health care access points available to the nation. This strategy improved access to health care for people who had never had access before.
Women and children under six now receive free healthcare in public health fascilities. One of the major successes has been the increase in the immunisation programme, from 63% in 1994 to 72% nationally in 2002, and through this, the elimination of deaths from measles and reducing incidences of polio. Those who have received antenatal treatment increased from 89% to 94% between 1994 and 1998, a level at which the decline in births that have received no antenatal care has been from 12% to 3%. Infant mortality has not yet declined, however, although deliveries at healthcare facilities have increased from 78% to 83%. The provision of clean water is an important contributing factor to a healthy nation. Lack of electricity or piped water affects women more than men since, in most cases, women have to fetch wood and water. By 2001, 85% of households had access to clean water at a cost to the Government of approximately R5 billion, an increase of 25% since 1996. Access to sanitation has increased at a slightly slower rate, from 49% in 1994 to 63% in 2003.
This has resulted in a decline in the rate of cholera infection. Women, particularly those in rural areas, continue to bear the brunt of poverty. Their health status impacts not only on themselves but on those who depend on them such as their children and extended families. The Department's Integrated Nutrition Programme acknowledges extreme inequities in our society and targets the most disadvantaged groups. It includes school feeding programmes, community nutrition projects and income generation projects. Since 1994/5 when 13 167 schools consisting of 5 628 320 learners were reached, the Primary School Nutrition Programme has increased school feeding coverage to a budgeted programme of R489,6-m in 2001/2, reaching 15 428 schools with 4 719 489 learners out of a total of 9 900 000 learners. A programme to fortify a basic staple, mealie meal, with a range of micronutrients is in place - to the benefit of poor.
2b) Access to Reproductive Health Care
The Constitution makes provision for the right to access to reproductive healthcare. This includes family planning advice, access to contraceptives and the choice of termination of pregnancy (Choice on Termination of Pregnancy Act of 1996). Although much education is still required to drive broader understanding of options related to reproductive health among South African women, 216 718 pregnancies had been terminated during the first four years since the Act was passed, with a 7.2% decrease in the incidence of severemorbidity associated with this procedure.
2c) Tobacco
Research indicates that there are currently about five million smokers in South Africa and this smoking population has been steadily reduced through Tobacco Control Legislation and tax policies. The number of adult smokers has declined from 34% in 1992 to 24% in 1998. About 42% of men and 11% of women smoke cigarettes. Snuff use is more common among women than men. African women are twice as likely to use snuff daily (12%) as to smoke cigarettes daily (5%). Coloured women (52%) are ten times more likely to smoke cigarettes than African women. Cigarette smoking prevalence rates are higher in urban than in rural settings, especially for women where the difference is two fold (13.2% urban vs. 6.6% rural). The benefits in reducing the number of smokers will be continue to be felt in years to come.
3. Implementing policy&programmes
3a) HIV and AIDS
Women's role in society is reflected in their health status and in their ability to access relevant health services. The HIV and AIDS pandemic remains one of themost critical health and development challenges facing South Africa, with women bearing the brunt of the onslaught. Government's HIV, AIDS and STD Strategic Plan for South Africa was launched early in 2000 and underpins a comprehensive prevention, treatment, support and care campaign. More than 59% of the 4.2 million HIV-infected persons in South Africa are women. In 1999, women of the age group 20-29 had the highest prevalence of HIV infection. By 2000, an estimated 2.3 million women and 95 000 children (0-14 years) are living with HIV and AIDS in South Africa.
Women in South Africa are especially vulnerable to the AIDS epidemic. Firstly, the risk of becoming infected with HIV during unprotected vaginal intercourse is as much as 2-4 times higher for women than men. Secondly, due to social inequalities that often lead to their disempowerment, women are often unable to negotiate within a relationship.
For this reason, there have been calls for government to engender the South African response to the HIV and AIDS pandemic in order to address the epidemic at the level of case, effect and manifestations. Women are usually infected during childbearing and productive years and are impacted not only by their own infection but of that of their partner and spouses and even children. Particularly older women are stepping in as caregivers within their extended families in caring for their children and grandchildren who are dying of AIDS. Women affected and infected with HIV need access to health care, information, counselling and wellness. Fighting the spread of HIV and AIDS has been one of the greatest challenges faced by government during this decade.
Government spending on HIV and AIDS has increased from R342 million in 1994 to a projected R3,6 billion in the 2005/06 financial year. Government has implemented various programmes, including life skills training through the South African AIDS Youth Programme and building partnerships with a wide range of organisations including faith-based, business, government, labour, media, traditional healers, the disabled and women's organisations. The Women In Partnership Against Aids (WIPAA) and Men in Partnership Against Aids (MIPAA) are two forums established under the umbrella of the South African National AIDS Council (SANAC) with the aim of addressing gender related aspects of HIV and AIDS.WIPAA addresses specific issues of women infected and affected by HIV and AIDS .
Other interventions include guidelines on opportunistic infections and improved district co-ordination, together with capacity building for primary healthcare workers. Mass media campaigns were also implemented. South Africa has begun the rollout of what is likely to be the world's largest comprehensive AIDS treatment plan which includes prevention, treatment, support, care and nutrition. The rollout of anti-retroviral treatment in the country's public health sector will involve a massive training and infrastructure overhaul and will cost in the region of R12-billion over the next three years.
3b) TB Control
South Africa has one of the highest recorded incidence rates of TB in the world and, although more men than women are diagnosed with TB, it remains a leading cause of death for women. Some studies indicate that women may have higher rates of progression from infection to disease and a higher case fatality in their early reproductive ages. In 1996, South Africa declared tuberculosis as the country's top health priorities and committed itself to reversing the infection trends. The DOTS (Directly-Observed Treatment Short-course) approach has now been adopted in more than 70% of all health districts with improvements in detection and cure rates in both DOTS and non-DOTS areas. High rates of treatment interruption and transfers, however, mean that treatment rates remain below the targeted 85%. This lower rate also indicates the compounding effect of drug-resistant TB, elements of which can be related to HIV and AIDS.
3c) Malaria
A total of 88 million Southern Africans live in malaria transmission areas including 14 million children under five and four million pregnant women, the latter groups considered to be at high risk from mortality if they contract the disease. TheWorld Health Organisation estimates that 19 to 22 million people get malaria in Southern Africa each year. Of these, 500 000 die of the disease. Efforts in South Africa to distribute chemically treated mosquito netting, combined with aerial spraying of mosquito breeding areas and, on the ground, the spraying of homes and yards, and the stocking of malarial medicines in the nation's healthcare facilities, reduced the number of malaria cases by 59 percent in 2001 and a further 42 percent last year. Malaria deaths in 2001 declined by an impressive 74 percent, and a further 21 percent in 2002, compared to the 2000 malaria season. Malaria case trends for the 2002-2003 season how shown a continued decline. Achievements of the malaria control programme in South Africa include the review and update of the National malaria treatment guidelines and prophylaxis guidelines, capacity development through training of environmental health officers, case management and community mobilisation. Together with the malaria programmes of Mozambique and Swaziland, South Africa successfully secured funding from the Global Fund to Fight AIDS, TB and Malaria for the trilateral Lubombo Spatial Development Initiative (LSDI) Project for five years. South Africa is in the process of initiating and strengthening cross border malaria and intercountry collaboration with Zimbabwe and Angola. The South African malaria programme successfully spearheaded the Race Against Malaria Rally campaign the largest health promotion campaign ever undertaken in southern African. All these initiatives have ensured that women in the region have been direct beneficiaries of this war againstmalaria.
3d) Cancer Control
Breast cancer and cancer of the cervix remain the most common forms of cancer among South African women. Breast cancer statistics show the largest incidence of cancers in women in South Africa, but it is argued that this could be due to fewer cervical cancer screening taking place. The department's National Guidelines for Cervical Cancer Screening were launched in November 2000 with the aim of facilitating comprehensive and systematic cervical cancer screening for all South African women. It aims to reduce the incidence of and mortality due to cervical cancer by more than 60% - with the ultimate goal of screening at least 70% of women nationally within 10 years of implementing the programme. About one in every 41 women will, within their lifetime, develop this form of cancer. It is the most common cancer in African (31%) and Coloured (22.9%) women, and second most common in Indian (8.9%) and fourth most common in White (2.7%) women. The success of screening programmes is dependent on good attendance rates by women at high risk. National Breast Cancer Awareness Month has developed into a significant annual collaboration between government, civil society and the private sector in a combined
effort to counter this form of cancer.
3e) Violence against Women
Gender based violence remains and continues to pose a challenge to our young democracy and is an obstacle to the achievement of the objectives of equality, development and peace. Gender-based violence represents a critical area for state intervention. Violence against women affects all spheres of women's lives, their autonomy, productivity and capacity to care for themselves and their children. It increases women's exposure to a wide range of negative health risks including HIV and AIDS. It carries great costs to the victim and many sectors of the society including the health care system, which has to respond to the consequences. South Africa has recognised violence as a health issue and has instituted a number of programmes to combat the scourge. Additional programmes have been put in place following the release of theWorld Report on Violence and Health - a report that came about as a result of a motion tabled by South Africa in 1996 at the world health assembly.
Non-natural causes remain the highest single cause of death with a significant proportion of the health budget spent on emergency services due to a high number of violence-related injuries. A central team, consisting of representatives from all major sectors responsible for violence prevention, was being set up, and an intersectoral plan put in place. The National Conference of Commitments on the Implementation of the SADC Addendum on the Prevention and Eradication of Violence Against Women and Children held in 1998, constituted the first year of the 16 days campaign. The lack of a comprehensive approach in the provision of care and collecting evidence in cases of rape and sexual assault negatively affects women and it constitutes another dimension of inequality in the provision of services. The department of Health therefore started with the preliminary programme for the Sexual Assault Care Practitioners Training Project that is aimed at providing skills for effective management and support for the survivors of violence, rape and abuse. The Department of Health also recently finalised the "Sexual Assault Policy", completed the Management Guidelines for Sexual Assault, and put in place a case record policy to help health workers assisting women survivors of violence.
4. Transforming the department
South Africa boasts the highest number of women at the highest level of political representation Cabinet - in Africa. There are now 16 men and 12 omen ministers in South Africa's executive, with 11 men and 10 women deputy ministers bringing the total to 43% of South African's cabinet. This commitment to gender representation at all levels is also being felt in the provinces where four of the nine premiers are female. There are ongoing initiatives within the Department of Health to change the gender and race balance for senior management appointments. The department is creating an enabling environment for its women staff members as well as women decision-makers. Institutional commitment is a pre-requisite for implementation and the Gender Policy Guidelines helps create an enabling environment to translate the commitment into reality. It establishes an institutional framework for the advancement of the status of women as well as the achievement of equality. The guide also aims to integrate the empowerment of women and transformation of gender relations into policies and programmes at all levels of the public health system. Finally, it aims to promote new attitudes, values and behaviour and a culture of respect throughout the health system. A representivity audit completed in 2001 showed that the National Department of Health had surpassed all of the original targets set by the Department of Public Service and Administration (DPSA) for government institutions:
At that stage, 58% of the national department's employees were female, and 42% male. Overall, female managers occupy substantial (and in some instances commanding) positions in proportional representation of post categories: Top Management (44%), Middle Management (59%), Junior Management (66%) and Low Level Supervision and Production (56%). The DPSA's target of 30% female managers in 1999 was surpassed with an average of 58% female managers in the national department. "In terms of gender equity, it is clear that the DoH has made major strides in building a balanced employee profile, despite the weight of patriarchy (male dominance) in broader South African society and institutions," said the report which noted that there were already processes underway to mainstream gender issues.
5. Global Involvement
After years of isolation, South Africa has, during the past ten years, emerged as an active player in the global health arena. South African delegations have participated in international conferences in Beijing, Dakar and the United Nations conference in 1995 leading to the ratification of the Eliminations of all Forms of Discrimination Against Women. South Africa was a signatory to the Gender and Development SADC Declaration signed in Malawi in 1997 and the SADC Declaration on the Prevention of Violence Against Women and Children in Mauritius in 1998. The basic components of sexual and reproductive health were policy in South Africa before they were articulated as international policy at the International Conference on Population Development (ICPD) in Cairo, 1994 and the Fourth World Conference on Women in Beijing, 1995. South Africa is a member of the board of the Global Fund to Fight AIDS, TB and Malaria where it represents the Southern and Eastern Africa Region. South Africa also chairs the African Regional Committee of theWorld Health Organization.
6. Conclusion
During the past 10 years, the focus has been on achieving amore equitable distribution of resources, most of which contribute to the quality of health care of the nation. Simultaneously there has been a focus on empowerment of the people, through wide ranging programmes including Batho Pele and gender equality initiatives. There is still much to be done before South Africa achieves a society in which all of our women and children have an equal chance at a healthy lifestyle. The foundation is in place, however, and the women honoured in this book are among the thousands who continue to build towards that goal with the loyal and tireless support of our community health workers.We honour all the women, known and unknown, who have made the health of our nation their life's work.
Dr Nkosazana Dlamini Zuma
Minister of Health 1994 - 1999
As South Africa's first Minister of Health after the historic 1994 democratic elections, Dr Nkosazana Dlamini Zuma led the creation of new health system within South Africa. Born in Kwa-Zulu Natal, Dr Dlamini Zuma matriculated from the Amanzimtoti Training College in 1967 before graduating with a BSc in Zoology and Botany from the University of Zululand in 1971.
She received her MB ChB from the University of Bristol in 1978 and served a two-year stint as House Officer, Surgery at the Frenchay Hospital in Bristol, followed by another two-year stint at the Canadian Red Cross Memorial Hospital in Berkshire.
In 1986, she received a Diploma in Tropical Child Health, School of Tropica lMedicine, University of Liverpool. During this time, her steadfast commitment to the ANC saw her elected to the position of Vice Chairperson, Regional Political Committee, Great Britain between 1978 and 1988, and she later became its Chairperson from 1988 to 1989.
Between 1980 and 1985, Dr Dlamini Zuma served as a Paediatric Medical Officer at the Mbabane Government Hospital in Swaziland before she returned to the UK where she served at the Wittington Hospital's Paediatric section between 1987 and 1989. During this time, she was also appointed as the Director of the Health Refugee Trust (Heart), Health and Development Organisation in England.
Dr Dlamini Zuma served on various ANC bodies and was elected to the ANC National Executive Committee (NEC).
She was appointed Minister of Health in 1994. Her leadership has been recognised by multilateral organisations and academic institutions alike. She was the Deputy Chairperson of UNAIDS in 1995, was inaugurated as the Chancellor of ML Sultan Technikon in Durban in 1996 and has been conferred with honorary Doctor of Laws degrees by the University of Natal in 1995 and the University of Bristol in 1996. The University of Transkei also awarded her with an honorary Doctor of Medicine (Honoris Causa) degree in May 1997.
In 1999, President Thabo Mbeki appointed her Minister of Foreign Affairs. Dr Dlamini Zuma is supported by her mother,Mrs Rose Dlamini and her four daughters - Msholozi, Gugu, Thuli and Thuthu.
Dr Mantombazana Edmie Tshabalala-Msimang
Minister of Health 1999 - 2004
A founder member of the ANC Health Department, South Africa's second Minister of Health Dr Mantombazana Tshabalala-Msimang has served in the health sector for over three decades. Born in Durban, she attended the Inanda Seminary where she matriculated in 1959. She graduated from the University of Fort Hare with a Bachelor of Arts degree in 1961. She left the country soon thereafter for political reasons and completed her medical degree (MD) at the first Leningrad Medical Institution in the former USSR in 1969.
She received a Diploma in Obstetrics and Gynaecology from the University of Dar-Es-Salaam Medical School in 1972, and her Masters degree in Public Health from the University of Antwerpen in 1980. Dr Tshabalala-Msimang was in exile for 28 years, from 1962 to 1990. During this time her medical work included positions as Registrar in Obstetrics and Gynaecology and as a Medical Superintendent. She convened the 1st International Conference on Health and Apartheid, under the auspices of the World Health Organisation in 1980 and is a founder member of the ANC Health Department, which was established in 1977.
Upon her return to South Africa she was closely involved with the National Progressive Health Care Network in developing policies on health, and also served on various committees promoting health and gender issues. In March 1998, Dr Tshabalala-Msimang was appointed as Chairperson of the Gender Committee of the National Executive Committee (NEC) of the ANCand as amember of the NEC'sCommittee on Policy Development and Safety and Security. She also serves as the Convener of the ANCWomen's League Policy Subcommittee.
She was Chairperson of the Portfolio Committee on Health in the National Assembly before her appointment as Deputy Minister of Justice in July 1996.
As Convener of the Steering Committee of the National Action Plan Human Rights she oversaw the development of South Africa's National Action Plan for Human Rights that was lodged with the United Nations on 10th December 1998 and convened the committee that prepared the first South African report on the African Charter in 1998. She was also active in the 1st Conference of Parliamentarians for Action of the African and Asian Countries on Population Development. Dr Tshabalala-Msimang was appointed as Minister of Health on 17th June 1999.
Dr Tshabalala-Msimang has two daughters and two grand children and is married to Mr Mendi Msimang, the Treasurer General of the ANC and the former South African High Commissioner in London.
Gwendoline Malegwale Ramokgopa
Gauteng MEC for Health
Gauteng MEC for Health Dr. Gwen Ramokgopa has held various leadership positions in student, youth, women and business organisations. Born in Atteridgeville, Pretoria, she qualified as a medical doctor (MB CHD) at Meduns a in 1989 and is currently studying towards her Masters in Public Health.
Her leadership positions over the years include being a president of the SRC atMendunsa, as well as Executive Committeemember of AZASO, later SASCO, SUCA, FEDTRAW, and SAMDP. She was a non - executive board member of NETCARE, served on the Black Economic Empowerment Commission as deputy chairperson and was also amember of the University Councils of Medunsa and Pretoria Universities.
Ramokgopa worked as medical officer at Garankuwa Hospital until 1992 and then joined the Independent Management Trust as National Health Programme Manager. In 1995, she was a member of the Strategic Management Team appointed by the Gauteng then MEC for Health, Amos Masondo, and also a Medical Advisor at the Gauteng Department of Health.
From 1995-1998 she served as Deputy Chairperson of the Executive Committee at the City Council of Pretoria. In 1998, up until her appointment as MEC for Health in 1999, a position she still holds today, she was Chairperson of the Standing Committee for Health in Gauteng. Ramokgopa is married with three children.
Sibongile Manana
Former Mpumalanga MEC for health 1999-2003
Millicent Ntombizodwa Sibongile Manana obtained a Diploma inGeneral Nursing from Themba Hospital (1983) and in a Diploma in Midwifery from Shongwe Hospital (1985). She received a degree in Nursing Science from UNISA (1992). Trained in management and Community Development and Family Planning, she also received a UNISA certificate for the Programme inWoman and Law.
As a student nurse at Themba Hospital, she rose to the position of district nurse with Emthonjeni Clinic in 1985 and then professional nurse at Embuleni Hospital in 1986. Between 1987 and 1994, she was a community health nurse with the then Transvaal Provincial Administration.
In 1994 she joined the Mpumalanga Provincial Legislature as a member of the ANC and chaired the ANC caucus as well as the Health and Welfare Standing Committee. She served on a number of committees including Finance, Public Accounts, Economic Affairs and Gaming, Environmental Affairs as well as Prioritisation and Programming. She was appointed MEC of Health in theMpumalanga Provincial Government in 1999, and in April 2004 she was appointed into Parliament serving the Health Portfolio Committee, the Housing Portfolio Committee, the Water Affairs Portfolio Committee and the Joint Standing Committee of Improvement on Quality of Life and Status of Women.
Candith Mashego-Dlamini
Former Mpumalanga MEC for Health 1994-1999
Candith Mashego-Dlamini started as a teacher at Mshadza Secondary School. She has a secondary teacher's diploma, a BA degree and a BEd in Educational Management.
She is currently studying for a Masters in Public Administration with the University of South Africa. When Mashego-Dlamini was appointed MEC for Health and Welfare in 1994, the health sector in Mpumalanga was divided into the Transvaal Provincial Administration, the Bophuthatswana Department of Health, KwaNdebele Department of Health, KaNgwane Department of Health and the Lebowa Department of Health. Her key task was to manage the integration, rationalisation and transformation of all five departments into one by mid-1995.
Mantsheng Anna Tsopo
Former Free State MEC for Health 1999 - 2004
Before joining the government in 1996 Mantsheng Anna Tsopo served her community as a teacher and a council official. In her previous portfolio as MEC for Health, she continued to serve the community she grew up in. Born in the Free State, Mantsheng Anna Tsopo completed a diploma in Pedagogics at the University of the North in 1982 and is currently studying a Bachelor of Management and Leadership with the University of the Free State.
Tsopo also participated in the Executive Programme for Leadership in Development at Harvard University in America in June 1998. Tsopo worked as a teacher in two high schools in the Free State from 1983 to 1986. She worked at the Masilo Town Council from 1988 to 1993. In 1994, she joined government and has since been deployed in various portfolios as the MEC for Local Government and Housing, MEC for Welfare, Sports, Arts and Culture and then MEC for Social Welfare until June 1999. She served as Leader of the House from January 1997 to June 1999.
Elizabeth Dipuo Peters
Northern Cape MEC for Health 1999 - 2004
Former Northern Cape MEC for Health, Elizabeth Dipuo Peters has a long history of advocacy of women’s rights and a track record of delivery in serving her community. Elizabeth Dipuo Peters attended the University of the North and obtained her BA Degree (SocialWork) in 1987. During that year she worked as a volunteer regional organiser for the South African Domestic Workers Union. Between 1987 and 1990 Ms Peters held the position of Head of Women's Department at the South African Youth Congress. In 1990 she joined the African National Congress Youth League, as the secretary forWomen Affairs.
As from 1992 to 1994 she worked as a social worker for the NCCR where she liased with other organisations on behalf of the Committee in the Northern Cape, administering grants for the disabled, aged and unaccompanied minors, and proposing and implementing service plans for individuals and groups of returnees.
Between 1994 and 1997 she was a member of parliament (National Assembly) and was responsible for the Northern Cape and ANC membership/Caucus Register. Before being appointed as the MEC for Health, Ms Peters was the ANC Chief Whip at the Northern Cape Provincial Legislature, as well as the ANC Northern Cape Provincial Treasurer. She was appointed NorthernCape Premier in April 2004.
Mmathulare Elsie Coleman
Former Mpumalanga MEC for Health 2003 - 2004
Currently studying for a BA Degree in Political Science through the University of South Africa (UNISA) Mmathulare Elsie Coleman has a certificate in Community and Women Development, a certificate in Public Relations and was trained in military secret communications in the USSR.
In 1992 she headed the Eastern TVL ANC Health and Welfare Desk before joining the provincial legislature as an ANC representative between 1994 and 1999. As a member of the provincial legislature, she participated in several portfolio committees including the Portfolio Committee on Local Government, Housing and Land (Chairperson), the Portfolio Committee on Rules, the Portfolio Committee on Sport, Recreation, Arts and Culture, Internal Arrangements, the Portfolio Committee on Programming and Priorization. In 1998/99, Coleman served on the Committee on Public Accounts (Alternate) as ANC whip. She was appointed MEC for Social Services, Population and Development in 1999 and served there until she was appointed Mpumalanga MEC for Health. In April 2004 she was appointed Mpumalanga MEC for Finance. She ismarried with a daughter.
Olive Shisana
DirectorGeneral ofHealth 1995 - 1998
Now an Executive Director of a South African national research programme on Social Aspects of HIV and AIDS and Health at the Human Sciences Research Council, the founder of the programme, Dr Olive Shishana was the first African and first woman to be appointed to the post of Director General in post-apartheid South Africa when she took up the position in 1994.
Dr Shisana matriculated from Lemana High School in Louis Trichardt in 1970 before studying at the Univesity of the North where she majored in psychology and social work in 1973. She completed a Master of Arts at Loyola College in Baltimore, Maryland before joining the University of South Florida as a doctoral student in clinical psychology. In 1984, she received a Doctor of Science (Sc.D), from Johns Hopkins School of Hygiene and Public Health, Department of Behavioral Sciences, Area of Specialty: Social Epidemiology.
Before joining the HSRC, Dr Shisana served as Professor of Health Systems at the National School of Public Health at theMedical University of Southern Africa, where she was a leading founder of a post-graduate diploma on the management of HIV and AIDS in the world of work, launched by the South African Deputy President in 2001. From July 1998 until July 2000, she served as Executive Director of Family and Community Health at theWorld Health Organization inGeneva. From June 1995 until June 1998, she served as Department of Health Director General overseeing the transformation of the public and private health sector. She has had numerous articles published in peer reviewed journals, books and special reports and has presented at international scientific conferences.
She has written on, among other subjects, HIV and AIDS including AIDS: a human security issue, history of public health in South Africa, financing of health services in South Africa. She was a principal investigator on the Mandela/HSRC study of HIV and AIDS, which is the first systematic national HIV and AIDS prevalence, behavioural risks and mass media impact survey, social and cultural determinants of South Africans, HIV prevalence and the impact of mass media on HIV prevalence in South Africa.
She was the principal investigator of another national survey of HIV prevalence among health workers, ambulatory and hospitalised patients in South Africa, which examined the impact of HIV and AIDS on South Africa's health care system. Dr Shishana has served on various national and international committees and has received numerous awards.
Mmathari Kelebogile Matsau
Deputy Director-General : Strategic Health Programmes
As the deputy director overseeing strategic health programmes, Mmathari Matsau's is on delivery of priority health programmes that answer to the defined strategic direction of the health care delivery system. These programmes include quality in health care, a district-based health system, control of communicable diseases, access to medicines, disease surveillance and information systems, monitoring of the health system, gender mainstream programme, reproductive health, mental health, and international relations in health.
In short, her mandate is to drive improved access to health and it is one she is well-placed to fulfil.
Mmathari Matsau obtained a BSc degree from the National University of Lesotho in 1977 and a Masters degree in Community Health from the Liverpool School of TropicalMedicine, UK, in 1980. In 1983 she obtained a post-graduate Diploma in Management from the University of Connecticut in Hartford, USA, and in 1989 a Diploma in Financial Management with the Management Advisors London in association with theUniversity of London.
For 15 years, from 1977 to 1992, she worked for the Health Planning and Statistics Division of the Department of Health in Lesotho heading the department during the last five years.
She then returned to South Africa and worked as Executive director the Association of Black Accountants of Southern Africa.
In June 1995, she was appointed by Health Minister Nkosazana Dlamini-Zuma, Chief Director for Operational and Technical Policy, principally responsible for development of policy norms and standards for different areas in the provision of health care.
When the department was restructured in 1997, she took up a slightly broader area of responsibility to include health information systems, health monitoring and surveillance, and research. As a result of the restructuring, the chief directorate was changed to Health Information, Evaluation and Research.
In June 2000 she was appointed Deputy Director-General for the branch StrategicHealth Programmes, a position she still holds today. Ms Matsau serves on the Board of the Medical Research Council, and internationally, she sits on the Board of International e-Health Association. She is a member of the American Public Health Association, and the International Society for Quality Assurance.
Kamy Chetty
Deputy Director-General: Health Service Delivery
Health service delivery in the public health sector has been a defining focus in the career and life of deputy director general Dr KS Chetty. Dr Chetty obtained a MB.ChB degree from the University of Natal Medical School in 1984 and a Master of Science in Urban and Regional Planning (MSc URP) from the same University in 1992. In 1993 she obtained her specialist degree in Public Health and was accorded Fellow of the Faculty of Community Health of South Africa at the College of Medicine. After serving her internship at King Edward Hospital, Durban, in 1985/86, she remained at the hospital as a MedicalOfficer/ Junior Registrar.
From 1987 to 1989 she was Primary Health Care Coordinator and National Organiser for the National Medical and Dental Association (NAMDA) and left to serve as a specialist in training in the Department of Community Health, University of Cape Town , until 1994. She was then seconded to the ANC Health Department, Head Office, where she played a key role in the drafting of the ANCHealth Plan during 1993/94.
Dr Chetty was initially appointed as a member of the Strategic Management Team and then as Chief Director in the Department of Economic Affairs and RDP - Western Cape. As such, she was responsible for the co-ordination of the Reconstruction and Development Programme (RDP) in theWesternCape until 1997.
She left to join the Gauteng Health Department as Deputy Director General and, as such, was responsible for the Health Service Delivery Branch. In addition, she acted as Head of Department on numerous occasions, and represented theHODand MEC in a number of forums. Dr Chetty joined the National Department of Health on July 1, 2000 and she serves as Deputy Director-General: Health Service Delivery where she has an overall responsibility with regard to the development of policy for the provision and management of hospital services, health technology, radiation control and emergencymedical services.
Latitia Rispel
Gauteng Department Head of Health
Dr Laetitia Rispel was appointed as the Head of Department of the Gauteng Department of Health in March 2001. Her career in the health sector spans many years, from her days as a student at the University of Cape Town in the eighties, her training at Groote Schuur and other hospitals and her work at the Red Cross children's Hospital, to the years she spent as a researcher at the Centre forHealth Policy.
It was her experiences at Groote Schuur Hospital which led Dr Rispel to get involved in progressive, anti-apartheid health organizations, and which have strengthened her commitment to transformation and equity. She has been in the Department of Health since September 1996, working in various capacities. From September 1996 until March 1999, she was the ChiefDirector for Strategicmanagement.
In April 1999, she took over the task of transforming hospital services in Gauteng. In August 2000, she was appointed Chief of Operations. At a formal level, Dr. Laetitia Rispel has a doctor of Philosophy degree, a Master's degree in community health, and an honours degree in epidemiology and statistics.
In August 2002, she completed a senior executive management programme at Harvard University in Boston, in conjunction with the Wits Business School. In 2003 she was named Shoprite CheckersWoman of the Year in theHealth Division.
H Nelly Manzini - Limpopo Department Head of Health
With her academic background focusing on General Nursing, Midwifery, Nursing Administration, Community Health Nursing, and Nursing Education, Dr. Manzini provides strategic leadership and management in the transformation and co-ordination of the health services as Limpopo Head of Department. Her tertiary educational focus was on Health Care with Diplomas in Nursing Administration, Midwifery and GeneralNursing in South Africa and a Diploma in Primary Health Care Education and Development (Unit II Management of PHC) from London University in 1993 in addition to her BA and MA.
Dr Manzini obtained her Doctorate in Literature and Philosophy at UNISA in September 1998. In August 2001 she completed a Senior Executive Programme for Southern Africa offered by WITS Business School and Harvard Business School. Formerly Regional Director of the Central Region (October 1998 to June 2000) she has presented numerous health-related papers and has contributed to a number ofHealth andWelfare -related publications.
She has been involved in Community and Social Activities, working with women and youth in the field of motivation and team building. A widowedmother of three, she speaks, reads and understands Tsonga, English, and Afrikaans and speaks and understands Pedi, Sotho, Tswana, Zulu, Xhosa and Venda.
Daisy Mafubelu
Health Attaché - Permanent Mission of South Africa to the UN.
It has been a long journey from Acornhoek, Limpopo, where Daisy Mafubelu was born in 1959 to the United Nations. But, as the current Health Attaché at the Permanent Mission of South Africa to the United Nations and other international organizations in Geneva, Mafubelu has always served the health sector with pride.
Initially trained as a nurse, Mafubelu holds degrees in nursing (UNISA) and a degree in Business Administration (Stellenbosch University). She obtained several diplomas including a post-graduate diploma in Health Management (UCT). After spending 13 years in the nursing field, she was appointed a member of the Strategic Management Team of the Free State Health Department in 1994.
She has since held several senior management positions, the latest being that of Deputy Director-General. Mafubelu has received several awards including being named Oliver Tambo Fellow in Public Health Leadership in 1997, an award made in recognition of outstanding potential and commitment to provide leadership through public health service towards improving health and health care for all South Africans.
In 1999 she received a certificate of recognition from the University of the Free State for contributing towards initiating and developing the Free State Goldfields Management and Development Programme. She also served as amember of the Board of Directors for the same programme and of the Board of Patrons of the University of the Free State School of Management. She is also the coordinator of the African group on health matters in Geneva.Mafubelu is amother of four and a proud grandmother of one.
Nobayeni Dladla
Health Representative Embassy of South Africa -Washington DC
South Africa's health representative in Washington DC, Nobayeni Dladla, began her journey when she acquired her BA in Sociology and Public Administration at the National University of Lesotho. In 1984 she received a postgraduate certificate in Business Management from the Wits School of Business Administration. She then went on to obtain her Masters from the University of Massachusetts in Boston, USA.
During her educational years, Dladla was appointed by the then Minister of Agriculture to chair an expert committee on Food Security and Nutrition.
In August 1989, she joined the Botswana Red Cross where she developed a volunteer development programme, gave support in developing training programmes for volunteers and initiated fund-raising drives. In 1993 she was contracted to be the co-ordinator for Nutrition in the Drought Forum, which included broad consultation on nutrition issues within NGOs.
Consulting with the national Department of Health from 1994, she managed the process of policy formulation and stakeholder consultation. In August of 1995 Dladla was appointed Director of Nutrition. There she established the national Nutrition Directorate and supported the establishment of the provincial nutrition structures through the Integrated Nutrition Programme. She also managed the Conditional Grant budget and the Poverty Relief Programme. In January 2000, she was appointed Chief Director Social Sector. Since October 2002, Dladla has been the Health Representative at the Embassy of South Africa in Washington DC.
Catherine Makwakwa - Director: International Health Liaison
Since her days as a student nurse in 1965 at the HF Verwoerd Hospital in Pretoria, Catherine Makwakwa has had a passion for the training and development of nursing professionals in South Africa. Her nursing career started at the George Stedman Hospital in Rustenburg where she was in charge of the female Medical and Surgical ward. She took a year off to study midwifery then rejoined HF Verwoerd Hospital in Pretoria.
She completed her Diploma in Nursing Education at the University of the North and in 1973, joined Garankuwa Nursing College as a Senior Professional Nurse, lecturing to Nursing Diploma students at all year levels. In 1976 she was promoted to Chief Professional Nurse and, as a Senior Tutor, lectured General Nursing Science. Makwakwa was also involved with a number of community projects including organising the international celebration of health related days such as the Health Year of theChild and Year of the Youth.
During her tenure, she held various posts including chairperson within the Pretoria African branch of the SA Nursing Association. In 1992, Makwakwa was appointed Chief Nursing Service Manager in the International Health Liaison Directorate, responsible for liaison activities in local and international organisations in Africa and South Africa. This included managing the Technical Aid Programmes ofMalawi, Lesotho, Mozambique and Swaziland. In that same year, Makwakwa was appointed, to serve as a member of the South African Nursing Council. In 1996 she was again appointed a member of the South African Interim NursingCouncil where she served on its Education Committee.
Following a short stint in 1996 as Deputy Director: International Health Liaison, Makwakwa was appointed Director: International Health Liaison.
Patricia Anne Lambert
Advocate Patricia Anne Lambert was born 50 years ago in Springs, Gauteng. She attended school in Mpumalanga and Pretoria. She holds degrees in Arts, Education and Law from the Universities of Rhodes in the Eastern Cape; Pretoria; and Cape Town, as well as from the University of Newcastle Upon Tyne in the United Kingdom.
Patricia has worked in the theatre, as a schoolteacher, as a college lecturer and as an educational researcher. During the 1980s, a deeply troubled time in South Africa as a whole, and in the education sector in particular, feeling frustrated and powerless to make any significant changes in the apartheid system of education, Patricia decided to return to University in order to read law. She completed her legal training in 1993 and was admitted as an Advocate in the High Court of South Africa. Her areas of specialty include Constitutional Law, Human Rights Law, Labour Law, Health Law, Intellectual Property Law and Public International Law.
From 1997 to 1999, Patricia worked as a consultant in the Ministry of Justice. There her tasks included working on the equality legislation, the sexual offences legislation and the National Action Plan for the Promotion and Protection of Human Rights, which was lodged with the United Nations on the 10th December 1998. Since 1999, Patricia has worked as the Legal Adviser to the South African Minister of Health, DrME Tshabalala-Msimang. In her capacity as an adviser to the Minister of Health, Patricia has worked on legal and policy issues relating to access to affordable medicines, intellectual property and healthcare, the health of women and children, health and human rights, partnerships between the private and public sector in the field of health and tobacco control. From October 2000 until May 2003, Patricia took the role of the chief negotiator for the South African government in the negotiator for the South African government in the negotiations for the Framework Convention on Tobacco Control (FCTC). This is the world's first public health Convention. TheMinister of Health, on behalf of South Africa, signed the Convention on the first day that it opened for signature the 16th June 2003. It is hoped that theConvention will be ratified by the end of 2004.
Patricia is passionate about her work, and very proudly South African. She regards it as a privilege and an honour to serve the citizens of South Africa, in whatever way she can. When not working, Patricia is an avid reader and a keen gardener. Her favourite book is The Constitution of the Republic of South Africa.
Chief Directors in the National Department:
Chief Directors in Provincial Departments:
Shahnaz Adams
A leading figure in Traumatic Stress Debriefing in the Western Cape, Shahnaz Adams has responded above and beyond the call of duty in attending to the needs of both patients and care-givers in various multiple casualty incidents, including the PlanetHollywood bombing.
Adams is often called upon to co-ordinate debriefing and counselling services that extend long into the night. She also plays a pivotal role in dovetailing the activities of several governmental and non-governmental organisations in minimising the impact of trauma on patients and emergency personnel.
She has been particularly impressed by the positive changes over the last decade.
"In particular, the improvements in health care facilities and the strides made with regard to achieving parity and equity in remunerating nurses have been positive starting points," she says.
After joining the Trauma Unit of theWestern Cape's Tygerberg Hospital as a Registered Nurse in 1980, Shahnaz Adams became the hospital's Senior Registered Nurse (Trauma and Research Unit) in 1990. Six years later, she became the Chief Professional Nurse in the Emergency Medical Services (EMS).
In addition to various short courses, Adams has obtained Diplomas in Emergency Nursing Care and Nursing Administration as well as a B.Cur degree from the University of Western Cape. She also attained honours qualifications in B. Social Science as well as Human Resource Management.
Between 1994 and 2001, Adams was actively involved in South African Nursing Association and the Democratic Nursing Organisation of South Africa (DENOSA). She served on the National Board of DENOSA, is a former vice-chairperson of the Western Cape Provincial Board, has chaired the Industrial Relations Committee and served as a negotiator in the Bargaining Chamber.
Adams was a representative on the TRC'sHuman Rights Task Team.
"Every instance that I am able to empower, uplift or capacitate another person counts as a highpoint in my career."
Although the spiralling HIV and AIDS pandemic is a major cause for concern to her, Adams looks forward to a brighter future in rendering health care and a consistent improvement in health care services over the next ten years.
Elizabeth Crossley
"I entered the health services because of a deep passion for serving this sector," says Elizabeth Crossley. Presently a chief professional nurse in the Western Cape's Emergency Medical Services (EMS), Crossley previously worked at the Boksburg Benoni Hospital, Kimberley Hospital, Tara HM Cross, Groote Schuur Hospital, Jan S Marais and the Volks Hospital respectively.
Her core responsibilities include rendering emergency services, quality control, liaison with hospitals, infection control, co-ordination of advanced trauma life support, co-ordinating the Red Cross Air Mercy programme, serving on radiation committees (Koeberg), conducting airport disaster exercises, Critical Incident Stress Debriefing Counselling, manning first-aid rooms, delivering first-aid lectures, drug control of paramedics, follow-up and support in instances of needle-stick injuries as well as lecturing at the Ambulance Academy.
In addition to general training, Crossley is also trained in midwifery, psychiatry, theatre and has also completed the Nuclear PowerWorkers' and MonitorCourse, an Acromedical course and Life Line training.
Crossley was the first chief professional nurse in the country to be employed in the pre-hospital environment and has expended a great amount of her time and talent to develop the pre-hospital emergency services.
She has enjoyed particular success in diplomatically liaising with other health-related sectors to develop pre-hospital emergency care.
All the planning, consultations and liaison on disaster planning falls under Crossley's ambit. One of the founding members of the Red Cross Air Mercy Service Flight programme, she has voluntarily and without remuneration flown or co-ordinated several such missions.
In getting the "kangaroo method" of baby transfer implemented, she has succeeded in considerably decreasing the waiting times for neonatal transfer within the emergency care services.
Due recognition was accorded to Crossley in 2001 when she triumphed as the provincial winner of the Marilyn Lahana Trust Caring Award. "Being able to help patients by successful running a Mobile Treatment Unit that was operated from a truck and tent with limited facilities counts as one of the high-points inmy career," she adds.
She looks forward to further changes in the health sector over the next ten years.
Lynette Denny
Professor Lynette Denny has saved innumerable lives amongst rural women due to her commitment to combat the spread of cervical cancer in disadvantaged areas. Having started community-based research in 1996 with US $40 000, the viability of the project currently attracts an annual funding of US $750 000.
Together with her team of over forty women, she attempts to redress the lack of access to resources in remote settings through constant innovation. She has converted old shipping containers into clinics and is always searching for cheaper ways of detecting cancer and the means to link results with better treatment.
In a ground-breaking development, the result of a first-third world collaboration with Columbia University in the US, she recently discovered an alternative to the traditional "pap smear". Once implemented, this is projected to save the lives of approximately 250 000 women annually.
Last year, her efforts were nationally recognised when Denny scooped the Shoprite Checkers/ SABC 2 Woman of the Year Award in the Science and Technology category.
"One of the main considerations that motivated my entry into the medical field was my desire to catapult health issues to the public and political forefront," says Denny. Over the past decade, she has been particularly impressed by developments at the level of primary health care.
"The success of one of my randomised clinical research trials involving over 7000 women from a peri-urban settlement outside Cape Town, which began in 2000 and is ongoing, and the high quality data produced, counts as one of themajor highlights ofmy career," she adds.
Professor Lynette Denny began her internship at the Groote Schuur Hospital in 1984. A year later shemoved on to Paediatrics at the Red Cross Hospital before rejoining Groote Schuur in the field of emergency medicine (Obstetrics and Gynaecology). After a two-year stint in private practice as a general practitioner (1987-1989), Denny rejoined Groote Schuur as registrar (O&G). She has been a consultant to the hospital since 1993.
As an Associate Professor and Senior Specialist in the Department of Obstetrics and Gynaecology at Groote Schuur Hospital and the University of Cape Town, one of her core responsibilities entails teaching under-andpost graduate medical and nursing students. Denny also provides training to registrars, including specialist training in fields such as colpocopy, chemotherapy, gynae-cancer surgery and the management of rape survivors. She has conducted extensive research into cervical cancer prevention in low-resource settings, cervical cancer prevention in HIV positive women as well as themanagement of rape survivors.
Academically, Denny obtained her MB ChB from UCT in 1983, her FCOG(SA) (1993), and her MMed (O&G) in 1994. Denny graduated with her doctorate in 2000 and was made Associate Professor in January 2001.
Norma Dawn Jordaan
The present CEO of the Free State Provincial Government's Thusanong, Nala and Mohau Complex hospitals, Norma Dawn Jordaan began her career as a professional nurse at Bloemfontein's National Hospital in 1973.
She also worked as a professional nurse (lieutenant) in the military services of the South African Medical Services from 1975 to 1977. As a senior professional nurse, she lectured at the Nursing College in Welkom.
She hereafter became a Professional Nurse and Assistant Matron, a Chief Professional Nurse and Nursing Service Manager before becoming the Deputy-Director (Regional Manager) under Region D (Kroonstad) of the Free State Provincial Government in 1996.
Three years later, she became the Senior Executive Officer at Kroonstad's Boitumelo Regional Hospital. In 2001 she assumed her current CEOposition.
In addition to various professional qualifications, Jordaan also attained honours degree in B.Social Science (Nursing) from the University of the Free State in 1973. She supplemented these qualifications with a Community Health Nursing Certificate, an Advanced Diploma in Nursing and her Masters Degree in Public Administration (1998).
Between 1990-2003, she chalked up four merit awards as well as a 3rd notch performance appraisal.
"My passion for nursing was probably kindled when I began caring for my hemiplegic mother at the age of eleven," says Jordaan.
Although she presently occupies a management position, she says that she is kept in touch with the basic fundamentals of nursing care because her husband and son are both diabetics.
She is intensely proud to be part of the Free State Department of Health.
In particular, she relishes the improved communication channels, openness and transparentmanagement styles exhibited by her seniors.
"Workplace improvements and the government's determination to improve the quality of public health care has considerably narrowed the gap between the public and private health care sector to the point where high quality treatment at comparatively lesser rates are available from public hospitals," states Jordaan.
She regards her elevation to the post of CEO as one of many highpoints in her life: "It has enabled me to make a positive difference to the public health care system."
Over the next 10 years, Jordaan would like to see a continuation and expansion of the changes ushered in; greater accessibility to health care facilities, especially for those living in remote areas; and, greater support and training for home-based care workers so that the quality of care given to the aged and those infected and affected with HIV and AIDS is substantially improved.
Thuli Gladys Khoza
Thuli Gladys Khoza always wanted to be amember of the noble profession and serve her community.
"From my youth I admired the nurses travelling around the clinics in the rural area where I grew up outside Nelspruit. When my mother asked me what I wanted to study, I said I want to be a nurse."
She grew up with her paternal grandparents in the Crocodile Valley area before being sent to school in Swaziland. She returned to complete her Junior Certificate and stayed at home for a year because of lack of funds. Then, in 1974, she started at Shongwe Hospital as a nursing assistant. The next year, she enrolled in a two-year nursing course. In 1980, she received a diploma in general nursing and, the next year, received her diploma in midwifery. From 1984 to 1996 she worked as a clinical instructor, supervising learners at Shongwe Hospital.
"I enjoyed that. I amhappy with what I did and the people I trained," says Khoza who remains a role model to her former students. “Nursing is a noble profession. It needs people who serve our patients and our communities," she says passionately. "Nursing is like the sea. When the waves come to the shore, it takes back all the bad things."
In 1986, she worked in a maternity ward at Shongwe hospital before doing an advanced midwifery course at Chris Hani Baragwanath Hospital.
Then she spent two years teaching midwifery students before being appointed chief professional nurse in charge of a nursing school in 1990.
She held this position for four years before working as a facilitator in a decentralised programme formidwifery.
In 1994 she was appointed nursing service manager at Shongwe Hospital and in 1999 she joined Rob Ferreira Hospital as nursing Service manager in charge of nursing services. Her numerous leadership roles include chairperson of the Nurses Managers' Forum in Mpumalanga and chairperson of quality assurance committee at Rob Ferreira Hospital.
Khoza is general secretary of the Women's Manyano in the Methodist Church circuit and chairperson of the local burial social club. Her community involvement includes giving educational talks to the clubs on issues such as living with people with HIV and AIDS including support, nutrition and hygiene.
Apart from transformation in the health sector, Khoza notes that there have been a lot of legislative changes in the last 10 years that have impacted positively on health. Also, notes Khoza, the free primary health care services will make affordable health care accessible to everyone.
"I really appreciate Batho Pele. It is reinforcement of what our profession should be, how professionals should act towards themselves and the communities they serve. "Over the next 10 years, I would like people to be aware of what health is. I would like to see all the hospitals revitalised to be first world hospitals and for primary health care services to reach all South Africans."
Matlhodi Mary Monyepao
Matlhodi Mary Monyepao from Polokwane has been dedicated to the health profession for more than 10 years of her life. She started her professional health career in 1982 at the Department of Health and Welfare George Masebe Hospital mortuary.
She has a passion for working with people: “I got very interested in working with people since my husband is a Pastor and is constantly working with the community.
"As a Pastor's wife I also get to work with the community and that brought about the interest to be a mortuary operator and help those who have lost their loved ones".
According to Monyepao, the counselling service that she offers has had an impact on people - now they are not so afraid of coming to the mortuary to identify their loved ones.
Last year this inspirational woman made headlines within Polokwane when she was awarded best mortuary operator in the region.
Said Monyepao: "I was very pleased since all my life I had not expected to receive such high recognition for my work. This helped me realize that there are people who appreciate the work I have been doing."
This is only a stepping-stone for Monyepao and this award has added tremendous value to her life.
As chairperson of the Elsa Women's League, Monyepao has a strong community presence. In addition, she plays a key role in the Evangelical Lutheran Church in Polokwane. At work, Monyepao is the George Masebe Hospital recreation committee member, bereavement committee member and the chairperson of the housing committee.
However, Monyepao will be giving up her active role at the George MasebeHospital to take on new ones.
Says Monyepao, "I will be retiring in the year 2006 and, together with my husband, will open an orphanage to continue my work to assist those in need."
“As a Pastor's wife I also get to work with the community and that brought about the interest to be a mortuary operator and help those who have lost their loved ones.” Matlhodi Mary Monyepao
Nomakhosi Gxagxisa
Dr Nomakhosi Gxagxisa's sterling work is driven by her "deep commitment to justice, the equality of all people and the restoration of the dignity of being African and black".
"Within this, is the construction of a truly revolutionised and effective health care delivery system that we can all be proud of," she adds. As a current hospital manager of the Prince Mshiyeni Memorial Hospital (PMMH) in Umlazi which, with its capacity of 1200 beds and an annual budget of R300 million, Gxagxisa oversees the largest hospital in KZN.
After schooling in Soweto (her birthplace), Transkei and KZN, Gxagxisa left South Africa in 1975. She graduated as a medical doctor from the Odessa State Medical Institute in the then Soviet Union in 1982 and returned to South Africa nine years later.
After stints at Baragwanath Hospital and the Soweto Community Health Centre, she became head of the Orlando Clinic. She also helped establish the firstChild AbuseClinic in Zola, Soweto.
Gxagxisa worked in the North-West Province since 1997 and played a crucial transformational role in the merging of two historically divided district hospitals in the Lichtenberg area.
Familial considerations motivated her transfer to KZN in 2001 where she assumed the post of Junior Superintendent at Durban's Wentworth Hospital. She was part of a team that helped the hospital attain a 100% Accreditation Status.
Four months later she was transferred to PMMH as acting hospital manager. Under trying and volatile circumstances she initiated a process of transformation, reconciliation and revitalisation, eventually succeeding in bringing a gradual sense of stability, tranquility and a shared future vision amongst a divergent set of stakeholders.
Without formal managerial qualifications, it was her creativity, tenacity, personal enthusiasm and drive which allowed her to succeed.
In getting the senior management and professionals, the provincial Portfolio Committee, the Department of Health, organised labour and the grass-roots workforce to collectively re-envision a new future, new possibilities are emerging for a truly world-class hospital in Umlazi.
She is currently working on two projects in partnership with UNICEF.
The first relates to Youth Friendly Centres which cater for youth who are infected and affected by HIV and AIDS. The other project involves the Department of Home Affairs and seeks to register babies within 12 hours of birth.Over 1000 babies are born at PMMH per month.
A single parent, Gxagxisa is a mother of five and care-giver to ten. "In all things, I am strengthened bymy faith in God," she says.
Machelle Crystal Gordon
A chief professional nurse at the Hout Bay Community Health Centre, Machelle Crystal Gordon began her career as a student nurse at the Western Cape's Tygerberg Hospital in 1986.
On completing her internship four years later, she moved to the Claremont, Broad Road and Lentegeur Hospitals respectively, before transferring to the Community Health Services Organisation (CHSO) in 2001.
Gordon possesses the B.Cur (N) qualification from the University of Western Cape, including specialisation in Midwifery, Psychiatry and Community Health Nursing Services. She has distinguished herself in a broad spectrum of her job related activities such as the planning, organisation, co-ordination and supervision of Comprehensive Health Services at health sub-district level. Gordon is also responsible for optimising the management and utilisation of the budget and resources under her jurisdiction.
Also at the forefront of personnel development through education and training, ensuring safe and quality nursing care, the promotion of community participation in health matters and the implementation of the district health care delivery system, Gordon is a district co-ordinator for health information and a zone co-ordinator for Occupational Health and Safety issues. In addition, she renders yeoman service to the Hout Bay Community Health Centre where she is often expected to combine the roles of professional nurse, pharmacist and doctor. The psychiatric support she offers to mental patients is also extremely valued.
Her devotion to her patients at the Hout Bay CHC often saw her reporting for duty on days when she was scheduled to be on leave.
During her free time she has attended to the basic needs of the blind by volunteering her expertise at the League of Friends.Gordon also pioneered the implementation of a "Complaint or Compliment Box" at the CHC and successfully initiated an appointment system to minimise the time that patients spent waiting for treatment. Not surprisingly, Gordon emerged as the provincial winner and the first runner-up nationally of the Cecilia Makiwane Awards for excellence in nursing service in 2003. "My interest in nursing was sparked by my fondness for working with people since my childhood. The fact that many of my family members worked in the health profession also served as inspiration," says Gordon.
Over the last ten years, Gordon has witnessed a brain-drain from the public health services. On the flip-side, though, she says that the requirement that medical students perform community service has helped alleviate the human resource shortage.
“Our work environment in the last decade has seen an increase in the numbers reliant on the public health sector."
Hester Martha VanDer Linde
A Chief Professional Nurse at the Ellisras Hospital since 1998, Hester Martha Van der Linde started as a professional nurse at the ErmeloHospital in 1980.
In addition, she has also served at the Van Velden Gedenk Hospital before returning to the Ellisras Hospital as a professional nurse in 1992. Three years later she became the hospital's Senior Professional Nurse before becoming their Chief Professional Nurse. Van der Linde has also been a unitmanager of the maternity ward at EllisrasHospital since 1995.
A student nurse at Ermelo Hospital since 1977, Van der Linde obtained her Diploma in General Nursing and Midwifery in 1980. She also completed self-study certificated courses in midwifery and neonatal care together with short courses in labour relations, basic Aids education and counselling, a computer course and breastfeeding course. She also acquired a certificate for the voluntary counselling and testing of patients forHIV and AIDS.
Van der Linde has also attended several workshops on neonatal care, Batho Pele standards, the Employment Equity Act and Performance Management Systems.
There are various programmes on which Van der Linde is involved.
These include the TURC programme which aims at preventing maternal and neonatal deaths; the Neonatal Care Programme; the Prevention of Mother to Child Transmission programme; administrative re-organisation and improvement of service to clients; meeting co-ordination; and, a programme aimed at declaring the hospital as a "baby-friendly" hospital.
"I entered the nursing profession because of my desire to help people.
Besides, my older sister was a nurse and this also inspiredme," says Van der Linde.
According to Van der Linde, the introduction of optimal patient care system ranks as one of the most positive developments in her work environment over the past ten years.
"Optimal patient care requires us to go to every length to ensure that patients receive everything that they require, including information and support," explains Van der Linde.
Last year, Van der Linde received a Platinum Award in an awards ceremony for the Best Midwife in her district. She also scooped platinum at theMEC's award inNovember last year.
"These rank as the most significant highpoints of my career," remarks Van der Linde.
Over the next ten years, Van der Linde looks forward to significant improvements in the health and safety of her patients, to the extension of optimal patient care to as many clients as possible and to a drastic reduction in the rate of mother-to-child transmission of HIV and AIDS.
Sekutu Monicca Mochadi
A Chief Professional Nurse , Sekutu Monicca Mochadi gave up her career as an educator in 1985 to join the nursing profession.
Having commenced her studies towards her People Nursing Certificate in 1986, Mochadi became an enrolled nurse at Saint Ritas hospital three years later. She became a Professional Nurse in the operating theatre of the hospital but soon attained the rank of Senior Professional Nurse before becoming Saint RitasHospital'sChief Professional Nurse in 1999. She has also received further training in HIV and Aids Voluntary Testing and Counselling; Train the Trainer Mentors; literacy tutor; Microsoft Word; Occupational health and safety (programmes, legislation and policies); prevention of mother to child transmission; management of leprosy; Chief User (procurement); and, waste management.
Mochadi is presently engaged in concurrent studies towards her Diploma in Human Resource Management as well as herMaster of Science qualification in Public Health.
In addition to her mainstream responsibilities, Mochadi is also coordinator of HIV and Aids and STIs for Saint Ritas Hospital and is the Sekhukhune District co-ordinator for Infection Control. She has also trained NGO, CBO and faith-based organisations in health care and HIV and Aids-related issues at hospital and sub-district levels.
Apart from being an active grass-roots champion of issues pertaining to HIV and Aids, STIs, life skills and moral regeneration, Mochadi has also delivered an Aids education talk in Scotland. Mochadi has occupied several leadership positions and is currently the project manager for a ComprehensiveHIV and Aids Care and Treatment programme.
Ordained as a youth pastor for moral regeneration in 1995, she is still heavily involved with the church in dealing with community issues.
Last year, she was conferred with an honorary Doctorate Degree of Divinity from the International Theological Seminary in California. In 2002, Mochadi scooped the Batho Pele Provincial Award (Excellent Clinical Nurse). Last year, she was the country's Khomanani Health Care Worker Excellence Award winner and she also excelled at the Premier's Service Excellence Awards.
Financially constrained from pursuing her dream of becoming a medical doctor, from a young age Mochadi was deeply inspired by the care and treatment rendered to her chronically ill mother by doctors and nurses. The greatest career highlight forMochadi was her qualification in 1997 as an Infection Control Nurse. “The knowledge I gained has enabled me to help many people who are afflicted with infections as diverse as HIV and Aids, TB and malaria.”
Over the next ten years, Mochadi looks forward to seeing greater availability and accessibility of health care facilities, especially primary health care, so that the government's goal of “health care for all” could be realised.
Ranie Pertab
To her patients, Ranie Pertab is staff nurse Ranie or Ma Pertab. To her colleagues she is an example of a professional who takes Batho Pele principles seriously and strives to put clients first under all circumstances.
Her managers value her professionalism and the dignity she accords patients, her initiative and enthusiasm and zeal.
Pertab enrolled as a nurse at Northdale Hospital in 1975 after the staff-strapped hospital approached her school to encourage matriculants to take up nursing. In 1978, a year after completing her training, she married and moved to Newcastle where she worked until 1999. When her husband's transfer to Ellisras meant the couple had to move again, Pertab was determined to remain in state-provided healthcare. She moved to Marapong Clinic.
"Nursing is a real calling. At a clinic the routine is that you have to be alert and know what you are doing. You need to be able to handle a crisis and work hand in hand with your colleagues so that the patients are served.
Patients come first you need to see to everyone's needs," she adds.
"There have been a lot of improvements over the last 10 years, a lot of ongoing training and information. The changes have been good for health care."
Pertab would like to see more than just ARV support for HIV positive patients.
“People are testing freely now and I would like to see HIV patients getting Anti-Retroviral Drugs. But nutrition is also important and resources are very few.We need to see how we can get proper nutrition to people who are ill.”
“There have been a lot of improvements over the last 10 years, a lot of ongoing training and information. The changes have been good for health care.” Ranie Pertab
Kesekwaemang Mary Thole Thuntsi
In 1973 Kesekwaemang Mary Thole Thuntsi boarded a train in Kimberley en route to the Transkei to start a career journey that she remains passionate about. Having just matriculated at St Boniface Girls High School in Kimberley, the health sector seemed the best career choice at the time.
At Umlamli Mission Hospital she not only received the training she desired but also gained a passion to serve others while studying for her Diploma in General Nursing Science: "It was a mission hospital and we were assisted in developing a love to serve our communities." She left to join St Mary's Hospital in Natal to study for a Diploma in Midwifery Science and was soon teaching and training young nurses. "It is beautiful to watch people whom you have trained progress and go on to serve others. " From 1985 to 1993, she was the senior tutor at the Henrietta Stockdale Nursing College and was promoted to Nursing Service Manager: Vice Principal at the college in April 1993.
During the ensuing years she continued her own studies, completing a diploma in Nursing Education, a Diploma in Psychiatric Nursing Science, and her BA (CUR) Nursing Administration and Community Health Nursing Science through UNISA in 1992. She also completed a certificate in Junior Management Training, studied Management for International Public Health at Emory University at Atlanta Georgia, Health Systems Development in Sweden and began her Masters of Social Science in Nursing at the University of the Free State. She completed this in 2003 and received an Academic Award for outstanding achievement.
In 1994 she was seconded to the Provincial Department of Health and Welfare to assist in formulating policy for transformation on the Strategic Management Team Planning towards the Reconstruction and Development of a Provincial Health and Welfare Department. During that year she participated in the compilation of a draft report of the Commission for Human Resource Development. In 1995 she was appointed acting Manager of Human Resource Development at the Department of Health and Welfare in the Northern Cape and in 1996 she was appointed district manager for theDiamond Fields Region. A position she still holds today.
"Transformation has taken place in a lot of areas and we can now say that the foundation of change has been laid," says Thuntsi.
Integration of the health services has been one of the highlights of the last 10 years, says Thuntsi.
In the next 10 years, Thuntsi would like to see policy being refined and the requirements of health care service delivery being met. And nurses being taken care of: "We call our nurses the gatekeepers of healthcare in South Africa.We need to look after them."
Noeleen Phillips
Port Shepstone Hospital manager Noeleen Phillips always wanted to serve her community. And nursing was the vehicle she chose for service. Phillips began her career in 1972 as a professional nurse with the then Transvaal Provincial Administration based at Tara Clinic.
In 1975 she became a senior professional nurse managing the specialist adolescent unit and later the specialist psychotherapeutic unit at the centre.
She also held the position of Chief Professional Nurse until 1983 when she moved to the Department of National Health as Nursing Service Manager.
"I always felt the need to provide service to my people and the place to do that was in the health sector," says Phillips.
Four years later, she became the Senior Nursing Service Manager at the thenNatal Provincial Administration where her responsibilities included management of sexual health services and training in the province. Phillips has held management positions at various levels of the health service from 1983.
She feels that the quality of management within the health sector has changed for the better in the last ten years, and that opportunities for women have been created to prove themselves within the health profession.
Academically, Phillips holds Diplomas in General Nursing, Midwifery and Psychiatric Nursing. She also attained a B. Cur degree in Education and Administration and holds a Masters degree in Social Science.
Currently she reading for a M.Phil:MCH.
She regards being in charge of maternal, child and women's health in the KZN department of health from 1997 to 2002 as one of the many highlights in her profession.
Over the next decade, Phillips would like to see an emphasis on primary health care as well as maternal, child and health issues.
On a personal note she would like to have a position in the Provincial Health Department where she can contribute in the decision-making and the improvement of primary health care in the province.
Marcelle Theresa Bendile
Marcelle Theresa Bendile is passionate about the health service and community work. In fact she is so passionate that instead of enjoying her retirement, at 76-years of age she is still involved in the sector doing what she loves most. Having entered the health services as a staff nurse at the Amelia Home for Crippled Children in 1953, Bendile formally retired in 1993.
"I chose nursing above the only other alternative namely teaching, because of my deep-rooted interest in the welfare of people. The fact that I was an only child probably encouragedme to reach out to the needs of others," she says.
Bendile believes that from a health services perspective, the country has a lot to celebrate: "In particular, the removal of the separate and unequal ethos of the pre-1994 era, especially with regard to unjust salary disparities and apartheid-enforced inequities in health-care facilities, have had a major positive impact in the work environment of nurses.”
Her career is colourful. After a one-year stint at the Amelia Home, she served as a Teaching Sister at Bloemfontein's National Hospital (10 years) and at the Pelonomi Hospital (1965-1968). In 1969 she became a tutor at PelonomiHospital and, four years later, the hospital's senior tutor.
Bendile became the principal of Pelonomi Hospital in 1980, before assuming the principal-ship at the Mangaung NursingCollege in 1986, a post which she held until 1992.
Presently, Bendile's expertise is utilised in various health department provincial projects and she also sits on the Board of the Universitas Hospital. Proficient in 6 different languages, Bendile empowered herself academically in order to meet the challenges of her professional career. Having acquired nursing diplomas in General Nursing and Midwifery, a Nursing Education Diploma as well as a Nursing Administration Diploma, she obtained her masters in Social Science (Sociology) from the former University of OFS in 1989.
Over the years, Bendile has pro-actively promoted the interests of nursing in particular and of the health service in general. Bendile was a member of the Central Board of the South African Nursing Association as well as the SA Nursing Council. Her membership of the latter organisation extended from 1984 to 1994, during which time she also served on their Education and DisciplinaryCommittees.
Bendile also has an impressive history of involvement in community, NGO and formal academic structures. The indefatigable pensioner has, inter alia, enjoyed membership to the Academic Children's Trust (UFS); the Bloemwater Board; Unique Training Solutions Board; and, the UniversitasHospital Board and the Joint AdvisoryCommittee.
She currently serves as a Councillor in the Mangaung LocalMunicipality. According to Bendile, it was the limited opportunities available to black women who wanted to advance themselves academically that saw her enter the nursing profession.
Bendile says she looks forward to the day when medical aid becomes more affordable to a greater number of South Africans and primary health care is entrenched as a basic right accessible to everyone.
Patti Lorraine Joshua
A former hairdresser, Patti Lorraine Joshua has been a long-serving member and ex-chairperson of the Eshowe ChildWelfare Society and a co-ordinator of theNorthernNatalWomen'sDevelopment Forum.
Her post-school studies range from Reflexology to Peace Research; International Relations and Foreign Policy; training in district health systems; and, training in Behaviour Change Programmes (BCP) for HIV and AIDS. These qualifications were obtained in a diverse array of countries that include South Africa, theUSA, Switzerland, Zimbabwe,Norway, Kenya and Tanzania.
Joshua has also rendered Trojan service to several CBOs, school and church committees.
For example, in 1997 she represented the KwaZulu-Natal CBO Network on the provincial TB forum which introduced theManagement of Integrated Support for Health Direct Observed Treatment (MISHDOT) programme. She also played a key role in a pilot programme for HIV and AIDS, TB and STIs for the KZN CBO Network which was sponsored by the National Health Ministry. The pilot was presented as a case study to theWorld Health Organisation / AMREFConference at Arusha in 1997.
Between 1996 to 2003 she conducted over 126 workshops on an integrated HIV and AIDS provincial programme.
Presently, she is involved in the management of human resource development at the Senzokuhle CBO network. In addition to facilitating training in development and orphan management for the NPA in Rwanda, in 2002 she also co-ordinated an exchange programme between Rwandan and Senzokuhle members.
"The kind of work I do involves the integrated development of the whole person. When someone comes to us with a problem we try and solve it by working in an integrated way through the network," she explains.
According to Joshua, most of her skills have been obtained from short courses, workshops and practical experience.
"I have learned a lot from rural communities where I spend my time being enriched by their wisdom, while sharing my skills. I support a holistic approach to life, working towards creating balance with all living energies in the community," she says, adding that the Community Internship and Development Centre at theUniversity of Natal (Durban) has played amajor mentoring and support role in her work.
She regards the past ten years as the most exciting in her life. "It has been a confidence-building decade where more people are committing themselves to volunteering their services so that they can domore for themselves and our country.”
Joshua perceives the need for wealth creation and acquiring the necessary tools and resources for economic transformation of all communities as the greatest challenge of the next ten years.
Modiegi Rebecca Mapheto
Retired nurse Modiegi Rebecca Mapheto gave up a research position atWits University in 1989 to start a much-needed community project in the Badiegile community.
Exposed to a dire community need while researching teenage pregnancies, Mapheto identified a lack of resources for pupils, a growing scourge of rape and the growing number of HIV and AIDS infections as a reason to start acting immediately.
She used her pension money to start the Badiegile Community Project and today the project has expanded to include home based care, counselling, dealing with domestic violence, all forms of abuse and care for orphans.
A qualified nurse and nursing manager at two hospitals,Mapheto began training nurses after receiving a diploma in nursing education. She taught nurses and assisted the South African Nursing Council in marking papers.
In August 1997 she went on pension and soon found herself assisting with research at Wits University's adolescent programme looking at the reasons for teenage pregnancies.
"We realised that most of the children were sexually active.We found their parents were not there and they were left with their grandmothers. We found some of them were being raped… and with the scourge of AIDS, I decided that this would be best contribution I can make. I took my pension money and started
Badiegile Community Project," Mapheto recalls.
Mapheto says she would not have been able to have started the project without the help of her retired colleagues, Flora Ndlovu who was also a matron at the hospital, Georgina Mangwakwane and ReverendDavid Bekwa.
Initially, she operated from home providing physical and emotional support to victims of abuse and their families. The workload soon increased and she was joined by volunteers who assisted with the home care.
The project is based in Lenyenye, just outside Tzaneen in the Limpopo province.
"We are now doing home based care, dealing with issues of domestic violence, all abuse, counselling and care of orphans," says Mapheto.
“How do I care for them? We are just volunteers doing voluntary work," says Mapheto, adding that Coca-Cola has assisted with support for the project.
I decided that this would be best contribution I can make. I took my pension money and started Badiegile Community Project,” Modiegi Rebecca Mapheto
Mpho Judith Sebanyoni- Motlhasedi
In the next ten years people should be knowledgeable about health care issues and be able to care about the people around them. This is the view of community leaderMpho Judith Sebanyoni-Motlhasedi. Her parents motivated her to become a nurse and the death of her husband from leukemia inspired her to help those around her.
In 1983 she applied to the Jubilee Community Hospital to become a nurse and worked there for eight years. Since then she acquired a B-tech degree in Oncology and is currently studying for herMasters from Tshwane University of Technology (TUT).
A professional nurse, Sebanyoni-Motlhasedi founded the Moretele Sunrise Hospice, based in Temba in the NorthWest, in 1997. In 2000, received a diploma in Palliative Care from the Hospice Association of South.
Today Moretele Sunrise Hospice is used by tertiary institutions to conduct workshops and gather information for research purposes. Attracting visitors from around the world, the centre offers facilities for training support group meetings, voluntary counselling and testing, orphan and vulnerable children's programmes, respite care and homegrown medicinal herbs. She helps with producing foods like oil, tea, ointments and poultices for those who are affected by HIV.
"During the last ten years of being in the health environment, I have seen tremendous change.
Government has supported the Hospice and its developments," said Sebanyoni-Motlhasedi.
Sebanyoni-Motlhasedi has also received many awards. In 2000 Elle magazine recognized her as 'The Woman who makes a visible difference'. In 2002 she was recognized by the Shoprite Checkers "Woman of the Year" Award, she received a "'Hero of the month" award from Marie Claire Magazine in London and the "Volunteer of the Year" award from Tshwane Municipality.
In January 2003 she received the "Mpumelelo Award" from the Department of Health and in October she also received the "International Award in Nursing Ethics and Human Rights" in Amsterdam from the International Center for Nursing Ethics University of Surrey UK.
“During the last ten years of being in the health environment, I have seen tremendous change. Government has supported the Hospice and its developments,”
Elaine Maane
Being diagnosed in 1997 as HIV-positive provided Elaine Maane with a Damascene conversion.
Today, Maane is at the forefront of providing mentorship, counselling and support for pregnant women who are HIV-positive. This new life is a far from the glamour life of the fashion industry where she worked for three years but it is more fulfilling...
After working on the Sizophila Project in Gugulethu (1999-2000),Maane became an integral member of the Mothers To Mothers To Be (MTMTB) programme at the Groote Schuur hospital in 2000. She has worked forNAPWA (National Association of People Living with HIV and AIDS) since 2001.
To help her with her work, Maane has equipped herself with Therapeutic Counselling and HIV and AIDS Management course. Her patients mainly mothers-to-be who are HIV positive view her as their counsellor, mentor and source of inspiration. The passion with which she renders assistance, care and support to women in her situation sees her supervising the Mowbray Maternity Hospital's MTMTB initiative.
"I am extremely grateful for this opportunity as it enables me to make a tremendous difference and a huge impact in the lives of my patients," saysMaane.
She is actively involved in championing HIV and AIDS issues at community, provincial and national level. She has also been involved in theHealth Department's "Tool Kit" project. In 2002, Maane represented the MTMTB programme at the International Aids Conference in Barcelona.
"It is extremely heartening to note that theMTMTB programme is spreading around Cape Town as well as to other centres such as Kimberley, Mpumalanga and possibly KwaZulu-Natal. I am also buoyed by the positive changes I have witnessed over the past years in the treatment and care of HIV positive people.” The greatest change among doctors and health care-givers, she says, has been attitudinal. Maane is regularly invited into staff-meetings by doctors at Mowbray, indicating that her efforts on the MTMTB programme are widely recognised and that her contributions are highly valued.
She states that the biggest high-point of her work is when HIV positive mothers return to her after giving birth to inform her that their baby has tested negative. For Maane, this means that all the counselling, advice and care given to such mothers during their pregnancy have been beneficial.
Over the next decade, Maane looks forward to a total de-stigmatisation of HIV and AIDS, an entirely accepting environment by the health-care sector, greater HIV and AIDS preventative programmes and the roll-out of the Comprehensive Plan on the Management of HIV and AIDS which includes treatment, support, care and nutrition.
There is no doubt Maane will be instrumental in ensuring that the environment she dreams of will become a reality.
Margaret Mashele
Working as a nurse for three decades inspired Margeret Mashele to forgo her retirement and instead, work for the community.
In 1999, she established a home-based care project in Thembelihle, Mpumalanga to serve a dire community need.
"I saw how people were ill and how they were left alone while their families went to work. I approached the district health manager who said we should look at how many such ill people were at home. When we started the home based care, we had to go to the chief, the councillors and we had to get support from the community," she recalled. The community response was overwhelming and many volunteers came forward. The region was divided into 10 zones with two to three volunteers assisting in each zone.
"We go into the villages and help those sick people who have nobody to take care of them. We identify orphans and refer them to the social workers who make the decision on their care.We take care of those who are chronically ill with TB, strokes and HIV and AIDS," Mashele explains.
Mashele started training as a nurse at Shongwe Mission Hospital in 1959 at the age of 18. Over the years she worked at various hospitals in the region, receiving a diploma in general nursing in 1975 and one in community nursing science in 1988. In May, 1999 she completed a "Trainer of Trainers in Home Based Care".
“Because of the suffering of the people in the village, I am still able to go on. I am passionate about people," she says, adding that the nursing clinics need help as they are often short-staffed. Mashele will not rest until every sick person in her community is well looked after.
“We go into the villages and help those sick people who have nobody to take care of them. We identify orphans and refer them to the social workers who make the decision on their care.We take care of those who are chronically ill with sicknesses such as TB, strokes and HIV and AIDS” Margaret Mashele
Rebecca Tsiane
In a city of diamonds, Rebecca Tsiane stands out as a true gem. She studied dress design after matriculating but the sight of a pre-school age child begging on the streets in 1994 changed her life forever.
"I thought something was very wrong. I started to go out to visit them and take them food. Then I realised that they did not only need food they needed a home and shelter, they needed parents," she recalls. A year later, Tsiane received a house from Public Works and agreed with her husband Martin that she would live with the children for a year. Ten years later and there are now four such homes in the Kimberley area which cater not only for street children but also for abused, abandoned and neglected children.
And the school operates an Adult Basic Education and Training (ABET) centre with two teaches paid for by government. Today the Khusong Children's Shelter has over 151 children and she tries hard to make their lives happy relying on donations and striving to buy them at least one new outfit a year at Christmas. Through the years, she has taken in 193 children and more than 300 babies for short-term care. "I have a two-year-old baby who was brought to me when she was just seven days old," says Tsiane with pride. The children attend 25 schools in the region and many have completedmatric and gone on to tertiary institutions, including university.
"You see the progress and that little progress encourages you to go on," she says pragmatically. Tsiane's life-story is an embodiment of community outreach and self-improvement. Apart from a fashion designing and dress making diploma from Moremogolo College, she has completed various courses ranging from bread making to business skills. A member of the Evangelical Lutheran Church of South Africa, her community involvement includes the Rina's Women's Club, and the Manna Community Skills for Unemployed Women. She has been honoured by a range of awards including the Eskom/Sowetan Woman of the Year Award in 1997, the Sowetan Old Mutual Simunye 1 Community Building of the Year Award in 1999, a 2001 Community Builder of theDecade Award in 2001, the 2002 Kimberlite of the Year award and a Human RightsNational Award in 2003.
In the early nineties, she was awarded the highest international Rotary accolade, the Paul Harris Fellowship, an award in honour of the Rotary Club founder.
“In the next ten years I wish that people will stop abusing their children … and that these children can be accepted by the community. I definitely think people should get involved in caring for our children. I think its not just my problem it's a business problem, it's a community problem.”
Charlotte Ntshebo Mtetwa
At 74, Charlotte Mtetwa continues to serve her community as the project manager of the Phaphamani Home Based Care centre.
She started her nursing training five decades ago and was a general nurse at Chris Hani Baragwanath Hospital in Soweto - the biggest hospital in the Southern hemisphere - in 1951. In 1955 she trained in midwifery at the Edenvale Hospital in Pietermaritzburg. Over the years, she worked at several hospitals including Germiston hospital, Natalspruit hospital and Vereeniging hospital. She returned home to work at the Themba hospital in Kabokweni. In 1975 she attended classes in Ward administration and clinical teaching at the Kalafong hospital in Pretoria and the next year was tasked with starting the clinical department at ThembaHospital.
For ten years she served as a chief professional Nurse at the Themba hospital in Kabokweni. During this time she continued to study and received her diploma in community and nursing administration through UNISA in 1982 and in 1992, she obtained her BCur through the same institution. In 1990, she was promoted to nursing service manager at Themba hospital a position she held until she retired in 1994.
Mtetwa and two colleagues established the Phaphamani Home Based Care centre in 1997. Based in Kabokweni, a semi-rural area in Mpumalanga, the organization provides support to HIV and AIDS infected and affected persons. It supports them by visiting them at their homes, training home care givers in health, helping the patients by referring clients to hospitals, working together with social workers in helping the orphans and also helping the needy to survive.
They conduct HIV and AIDS awareness campaigns and, in order to overcome illiteracy, have started a drama group to spread the message.
Mtetwa has received many accolades for her work including Impumelo Silver award in 2004. She was the runner up in the Sowetan Community Builder of the Year competition.
She has travelled and spoken widely on HIV and AIDS issues including sharing a platform with former President Nelson Mandela during 1994.
"The apartheid regime used to hold people back and we can challenge issues and we can work closely together too.
“In the next ten years there should not be a shortage of doctors and nurses if we keep on helping and educating people around us. Primary health issues should decrease," saysMtetwa.
Glory Molebogeng Ndinisa
It was Glory Molebogeng Ndinisa's active and tireless involvement in alleviating the plight of the indigent in her poverty-stricken Eerstehoek community that attracted the attention of a matron from the Embhuleni Hospital inMpumulanga.
She was encouraged by the hospital to submit a business plan to the provincial Department of Health and, since 1999, has been involved with the department as a home-based caregiver. Glory Molebogeng Ndinisa is a co-ordinator with the Elikwatini Nhlazatshe Community Home Based Care in Mpumalanga province.
She attended a three-year Home Nursing course at the Mpumalanga Province Health District as well as a seven-month Home Based Training Course for Care Workers at the Gugulethu Home for the Aged. Ndinisa says that she has witnessed various positive changes within her work environment over the past five years.
"In particular, people are becoming increasingly aware that AIDS is a killer disease," she says, adding that people were now more open to disclosing their HIV and AIDS status. With poverty levels exacerbating the HIV and AIDS crisis, Ndinisa is instrumental in facilitating community vegetable gardens to ease the suffering induced by hunger and starvation. "We have started many such gardens which are tended by AIDS orphans as well as people affected by HIV and AIDS," says Ndinisa.
The start of support groups, coupled with a greater willingness to adopt preventative measures, count as highlights in her career. "The communities are becoming really afraid of AIDS and are being very careful when it comes to their sexual behaviour and condom use," she emphasises. In addition to more government support for home-based care-givers over the next ten years, Ndinisa is optimistic that the following decade will see a significant decline in the prevalence ofHIV and AIDS.
“With the high levels of awareness about the diseases, the incidence of HIV and AIDS will drop significantly," she concludes.
Marie Wilmans
Kimberley Hospital Complex Board chairperson Marie Wilmans has served her community since 1974 when she was nominated by the Cape Women's Agricultural Association to serve on the KHC board. From 1991 to 1993, she served as vice-chairperson.
During the last 10 years, she has had a bird's-eye view of transformation as she was promoted to chairperson of the Board in 1994, bringing community input and insight into a public service .
"The standard of service has changed. The hospital complex has been upgraded with all the services. It's been a wonderful experience for us.
"We recently installed a CAT Scan machine that is the best in Africa. This means a lot for Kimberley and the Northern Cape as our patients used to have to go to Bloemfontein and now they can have this check-up done in a fewminutes," she says with pride.
"The building has been upgraded. Four new operating theatres with state-of-the art equipment were taken delivery of. It's a pleasure for patients and a much better place to work at. Another positive thing that has happened in the last 10 years is the introduction of the CEO awards which is done by surveying patients on the service they receive. This gives the hospital staff much-needed recognition and is good for morale," says Wilmans.
"I can see how they blossom because of the recognition. They do their best to ensure service delivery."
Wilmans says the hospital complex used to get lots of complaints and these have decreased substantially.
As branch chairperson of the Kimberley West Women's Agricultural Association, Wilmans has always been an active member of the Kimberley community. In 1994, she was a nominee in the Kimberlite of the Year Competition and in 1996 was an adjudicator for the award. Before that, from 1980 and 1984 as well as from 1988 to 1989 she organised fouryearly charity functions as Mayoress.
As chairperson of the KHC board, she oversees the finance committee and represents the board at hospital functions such as the Kimberley Hospital's 127 year anniversary celebrations.
“For me, the highlight of the last 10 years would have to be the upgrading project, the CEO awards and the CAT scan machine. It's been wonderful to be a part of that."
Looking ahead
The 10th anniversary of freedom invited an opportunity to reflect how far we havemoved towards achieving the goals we held to bemost precious.
In health, our direction was determined from the outset by the simple principle that South Africa belongs to all who live in it and every citizen deserves access to essential health care at the time of need.
It is a responsibility that has demanded fundamental changes in the health system and the introduction of laws that have not always been popular.
Health care for all
One of the first requirements of our “health care for all” mandate was to establish the infrastructure for the effective delivery of primary health care services.We have substantially achieved this.
We claim progress not perfection in primary health care, because there is still an unacceptable variation in the standard of primary care that is being offered across the country, and this is linked largely to resources. Expenditure on primary health care per person per year among provinces ranges from R50 to R300.
Equity in service provision is the critical measure that determines who lives and who dies; who suffers permanent harm and who is restored to good health.
Let us never forget this reality as we rededicate ourselves to service in the second decade of freedom. The second major area of transformation in health care was the hospital sector, where physical revitalization, rational planning and better management were the key objectives.
The investment in capital projects has steadily gained ground. In the year ahead, about R2-billion will be spent on infrastructure and the building of new hospitals. R911-million will be spent on 27 major hospital projects including the building of 18 new hospitals.
The third major area of innovation was the expansion of programmes for disease control and prevention and the establishment of new programmes.
Immunisation
We have expanded the child immunisation programme in line with WHO guidelines and introduced additional vaccines against Hepatitis B and Haemophilus influenza and made immunization part of our every day clinic operations. The results have been the eradication of polio and the sharp drop inmeasles.
We have seen a drop in the number of deaths due to diarrhoeal disease caused by a combination of factors including improved access to clean water, sanitation, promotion of breast-feeding, and prompt treatment of diarrhoea and education of the public.
We tackled the long-standing problem of tuberculosis by introducing the community-based treatment programme. This improved our ability to identify TB patients, to test them and to supply them with the correct drugs all free of charge. TB remains amajor challenge and it is further complicated by development of a multi-drug resistant strain. We therefore need to re-double our efforts against TB. There is no room for complacency.
In the face of a huge escalation in malaria, we took the bold step of re-introducing residual indoor spraying with DDT and we did this with the consent of the international community.
By taking this step and working closely with Swaziland, Mozambique, soon to be followed by Zimbabwe, DRC and Angola we effectively turned the tide of malaria infection in the year 2000.
SA National AIDS plan
HIV infection and the impact of AIDS had begun to emerge as a serious public health threat by 1994, but there was no national programme to speak of as freedom dawned. In the past decade, enormous resources have been committed to HIV and AIDS and South Africa has indeed followed international best practice in its national strategy.
Few countries would be able to claim an increase of 2000% in AIDS spending in less than 10 years from R22m in 1994 to R660m (in the National Department alone). Few would be able to point to greater investment in prevention strategies; and few could claim such widespread mobilisation across sectors. The South African National AIDS Campaign is an achievement.
We should not allow our progress to be overshadowed by the sheer scale of HIV infection.We should take the magnitude of the problem as a challenge, not a defeat.
I would be the first one to concede that it is not sufficient to have stabilized our HIV infection rates we need to put them into reverse gear. Therefore, we are committed to strengthening the national response to HIV and AIDS through the Comprehensive Plan adopted by Cabinet. The Plan requires simultaneous action onmany fronts across the health sector.
South Africa is a member of the board of the Global Fund to Fight AIDS, TB and Malaria where it represents the Southern and Eastern Africa Region. We also chair the Afro Regional Committee of the World Health Organization.
Tobacco legislation
Through far-sighted Tobacco Control Legislation and tax policies, Government has reduced the size of the smoking population. Given the relationship between tobacco use and various cancers and cardiovascular disorders, the population is likely to reap the benefit of this decisive move by Government in years to come.
Universal access
A critical factor in our ability to ensure universal access to health care is equity in the distribution of resources.
Bluntly put, it is our ability to overturn the huge imbalance in resources between the private and public sectors, on the one hand, and between urban and rural areas on the other.
We have tackled this in two ways, firstly by redistributing financial and human resources in the public health sector and secondly, by legislation that encourages more efficient use of health resources in the private sector.
The impact of initiatives for redistribution in the public sector is visible:
Most of the 900 new clinics we have built are in rural areas.
There is a narrowing in gap between the health spending of best-resourced provinces - Gauteng and Western Cape and that of the least developed rural provinces.
Through community service and government-togovernment agreements, we have improved the professional staffing of rural facilities quite dramatically. This year alone, more than 3 000 young graduates are doing community services and the proportion in rural areas is the highest yet. And we introduced a unique system of allowances for 33 000 health professionals in rural areas and 66 000 professionals who have skills that are in scarce supply.
Despite all these measures, the health gap between the major cities and rural towns remains unacceptably high.
We need to boost the rural areas further and we cannot do this simply by siphoning grants from the urban areas. We would seriously urge Parliament to look more closely at the size of the health pie and at the relatively low priority that certain provinces attach to health care as a percentage of global social spending.
We seriously need to consider whether we can achieve peace, progress, social justice and better quality of health care on the current spending levels.
Health legislation
Various laws have been passed to safeguard private sector health consumers and promote better value formoney in that sector. These include the Medical Schemes Act and the Medicines and Related Substances Control Amendment Act of 1997, which advance the cause of more affordable and quality medicine.
The National Health Bill replaces the old Health Act of 1977 and ensures that the health sector is in line with theConstitution.
This Bill lays the foundation for rational health planning and the proper coordination of all the elements of the public and private health sector, and from this perspective of national interest, it requires that all health establishments be certified to provide health services.
Health care cannot be left to the whims of the market. Government has stewardship to ensure that every citizen has equal access to quality health services. The health agenda in the first decade of democracy has, necessarily, asserted the health rights of the poor and of vulnerable groups.
In order to fulfill our Constitutional mandate of access to health care for all, we have at times challenged the established practices of powerful interest groups. This action has not been malicious. It has been intended to serve the greater good.
The next ten years
During the next decade, we will focus on the following priority areas:
We will improve our understanding of the causes of deaths in South Africa in order to ensure proper planning and appropriate allocation of resources;
We will accelerate the revitalization of health facilities to reverse apartheid planning;
We will improve human resource planning and training to deal aggressively with the shortages and fair distribution of health workers throughout the National Health System.
We will implement a comprehensive school health programme as this will lay the foundation for health promotion among the youth;
We will accelerate the programme of making sure that medicines are available to all South Africans at an affordable price;
The goal of achieving equity between rich and poor, between urban and rural, between provinces and within provinces, will continue to drive our health sector reform programme;
We will increase the pool of those who havemedical aid and protect them against unscrupulous schemes.
We will promote solidarity in health by ensuring those who can afford contribute to the health of the poor and indigent.
The new decade is a new opportunity!
Dr Manto Tshabalala-Msimang
Minister of Health