Provincial health officials in Mpumalanga and Limpopo may be in contempt of court after refusing to provide the anti-AIDS drug nevirapine to certain hospitals that want to offer it to HIV positive mothers and their newborn babies.

However, doctors at Philadelphia Hospital in Mpumalanga – one of four hospitals refused nevirapine – are getting the drug from the Treatment Action Campaign (TAC) in defiance of provincial officials.

TAC has offered to supply nevirapine to hospitals that are prevented from getting the drug yet have the capacity to dispense it responsibly. Nevirapine can cut the transmission of HIV from mothers to their babies by up to 50%.

The High Court ruled in December that government must allow hospitals with capacity to dispense nevirapine to HIV positive pregnant patients. The Constitutional Court upheld the ruling earlier this month, pending the outcome of an appeal by the national Health Minister.

But provincial health “evaluating teams” have told two hospitals in Mpumalanga and two in Limpopo that they are “not ready” to supply the drug – although their healthworkers believe that they are.

At Philadelphia, one of the biggest hospital in Mpumalanga, this decision has led to all but one of the doctors, dentists and pharmacists signing a petition calling for Health MEC Sibongile Manana’s “immediate dismissal”.

In the seven-page petition, staff say that the provincial team lacks the expertise to make a proper evaluation, it failed to consult doctors and used “delaying tactics” such as lack of furniture to prevent the establishment of a prevention of mother-to-child HIV transmission (PMTCT)programme.

However the second Mpumalanga hospital has accepted the province’s “not ready” verdict and staff say they are too intimidated to resist.

There is a climate of fear in Mpumalanga’s public health facilities which has heightened following Manana’s dismissal of the superintendent of Rob Ferreira Hospital, Dr Thys von Mollendorff, after 21 years’ service.

He was fired for allowing the Greater Nelspruit Rape Intervention Project (GRIP), a non-governmental organisation that was giving anti-AIDS drugs to rape survivors, to operate from his hospital.

Another Rob Ferreira doctor, Dr Malcolm Naude, who organised staff memoranda in support of GRIP has not had his contract renewed, while one of the health directors who questioned Manana’s leadership to the Director General of the province late last year, was recently transferred out of the province.

Manana has persistently persecuted NGOs and activists involved with HIV/AIDS.

In mid-2000 she ordered an investigation into the links between her department and an award-winning NGO which had a good track record in providing HIV/AIDS care to orphans and those dying of AIDS. This investigation failed to demonstrate any wrong-doing by departmental staff. Despite this, the then, provincial HIV/AIDS programme manager, Dr Kelvin Billinghurst, was removed from his post, and eventually resigned at the end of April this year.

Mpumalanga has the second highest HIV/AIDS rate in the country, and 45% of pregnant women who agreed to take an HIV test at the province’s PMTCT pilot site at Shongwe Hospital were HIV positive.

However, Mpumalanga reported recently to parliament that it had not spent R59-million of its health budget, and had not spent a cent on prevention of mother-to-child transmission or home-based care. Less than 20% of the HIV/AIDS budget from national has been spent.

All attempts to get comment from the Mpumalanga health department failed.

Meanwhile, Elim Hospital in Limpopo also requested nevirapine after the court ruling. However, a provincial team visited the hospital in the absence of the superintendent and later verbally informed the hospital that it did not meet the province’s requirements to run a PMTCT programme. Elim staff say they have never been informed what the provincial requirements are.

A second hospital in Limpopo that requested nevirapine was also told it did not meet provincial requirements.

In the past, Mankweng Hospital, which is one of Limpopo’s PMTC pilot sites, has refused to accept HIV positive pregnant patients referred from other hospitals as it says it does not have enough nevirapine or milk formula.

However, provincial health spokesperson Charles Nkadimeng said there was a misunderstanding, as the two hospitals had applied to have a PMTCT programme, not just for nevirapine in terms of the court order.

“The province is committed to respecting the court order, but we understand that, in terms of the order, nevirapine is to be made available on a case-to-case basis when the attending doctors request it for their patients,” said Nkadimeng. “These hospitals applied to run a whole PMTCT programme and the provincial team felt they were not yet ready for this.”

Mark Heywood of TAC said that the “deliberate misunderstanding” of the court order was “shameful and unlawful and was denying parents the chance to reduce the risk of HIV infection to their children.”

“We want to be part of a constructive new partnership with government – but bitter-enders, such as Manana, want to prevent it. The sad thing is that Mpumalanga and Limpopo are shooting themselves in the foot. As provinces like Gauteng press ahead in the interests of people with HIV, the gap with poorer provinces widens – because of their own actions.”

A national Department of Health circular sent out to all hospitals made it clear that, in order to comply with the High Court’s ruling, superintendents and doctors at hospitals can decide whether they are in a position to offer nevirapine to patients. If the hospitals have voluntary HIV counselling and testing facilities, a minimum requirement of the court, and feel ready then they can apply for nevirapine and, in terms of the court order, the Department of Health is obliged to supply it to them.

“The Minister of Health has been very clear about the responsibility of the relevant health authorities to comply with the interim order of the Constitutional Court on nevirapine,” said national health department spokesperson Jo-Anne Collinge. “It is not appropriate to use the guidelines [for expanding PMTCT sites] to determine whether nevirapine should be given on a case-by-case basis as ordered by the court. The court sets its own standards which must be followed.”

However, a national task team set up to oversee the smooth rollout of the PMTCT countrywide – which could address the problems in Mpumalanga and Limpopo – has met only once and has no clear terms of reference.

– Health-e News Service.