In a move that seems to have baffled even those close to her, Health  minister Dr Manto Tshabalala-Msimang has opted to lash out at Gauteng’s  moves to expand the nevirapine programme that will see the distribution of  the drug to thousands of HIV positive pregnant women in the province’s  hospitals.

The only possible explanation for her outburst comes from a lone voice in  the health department who claims that she had been angered by the fact that  she had read about Gauteng’s expansion plans in the media.

“Nobody had bothered to inform her after they had decided at Minmec that the  progress report would be studied before any decisions would be made,” said  the source. “But it is unclear why she has opted to take it into the public  arena.”

Tshabalala-Msimang accused Gauteng premier Sam Shilowa of breaching the  agreed position on how to proceed.

She distanced central government from Shilowa’s announcement on Monday that  Gauteng would provide nevirapine at all state hospitals, saying that it  contradicted national policy.

But in  another twist, it now appears as if Gauteng Health MEC Dr Gwen Ramokgopa also heard about her province’s expansion plans for the first time, when the premier announced it.

Ramokgopa failed to admit during an interview on SABC radio that Shilowa had consulted her beforehand on his announcement to expand the programme.

Ramokgopa said that the premier had informed her that he would be making an announcement regarding “time frames”.

She sidestepped any questions on whether she had been consulted beforehand, whether she was happy with the announcement or whether the province was in a position to expand the programme to all state hospitals.

Tshabalala-Msimang’s statements stood in stark contrast to that of her director-general Dr Ayanda Ntsaluba who said in a statement on Monday that he had every  confidence that Gauteng had based its expansion on its experiences in the  research sites that were launched in the province from May last year.

Ntsaluba said the province had the benefit of information from other research sites across the country as well as its own where more than 17 000  mothers had been seen to date.

“Furthermore, Gauteng has historically strong health services and a  substantial HIV/AIDS budget. The Gauteng Health Department is therefore in a  position to advance the programme within the parameters set by the Health  Minmec,” Ntsaluba said, in clear approval of Gauteng’s announcement.

Those close to Ntsaluba said he was keen to expand the prevention of mother  to child programme. In a recent interview with Health-e, Tshabalala-Msimang pointed out “We are  all at war with each other over 15% of the babies born each day to HIV  positive women.” (30% of HIV positive pregnant women transmit the HI-virus  to their babies during birth. Drugs such as nevirapine halve this figure)

 She said she was adamant about addressing issues of sustainability,  breastfeeding vs formula feed, implementing the protocol that included the  training of staff, making sure there were adequate facilities to counsel  women meaningfully and confidentially and the need to follow the first  infants until they are 12 months old.

But Tshabalala-Msimang hinted during the interview that those who had the  capacity or facilities to offer nevirapine would go ahead and expand.

“The director-general (Dr Ayanda Ntsaluba) is interacting with each  provincial head of department to talk about the problems at each individual  site and to find ways to overcome these hurdles.”

She also indicated that the head of HIV/AIDS Dr Nono Simelela would be  visiting the individual sites, a clear commitment towards overcoming any  barriers.

“There is no use in just rolling out and it all falls flat at the end of the  day with marches in the streets again,” she said.

“There is not a single province that can roll out. Yes, there are pockets in  some provinces that are in a position to expand,” Tshabalala-Msimang said.

But many thought, Tshabalala-Msimang’s political hurdle had been removed  when President Mbeki said in his state of the nation address that when a  province was ready to expand the pilot sites, the policy would not stop  them.

Eastern Cape Premier Makhenesi Stofile said this week that the first batch  of midwives in state hospitals would undergo training to administer  nevirapine to pregnant women in the next two weeks.He said the tests from the two provincial pilot sites would inform the  department how to deal with the pandemic.