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Applicant   and MECFORHEALTH,MPUMALANGAAA8! FirstRespondent    MINISTEROFHEALTHQQ7! SecondRespondent   AY#) xd3E&A  @--! FOUNDINGAFFIDAVIT   AY#) xd3E&A  I,theundersigned, @YY"SIPHOKAZIMTHATHI  $ herebyaffirmandsay: ?3   ?32  1  3  0 1   Iamanadultwomanoffulllegalcapacityresidingat7RoritaCourt, #!$ StrubensRoad,Mowbray,Cape.?3݌ 1!1! Ќ   ?3   ?32  2  3  0 1   IamtheDeputyChairpersonoftheTreatmentActionCampaign,whichis Q(#* theapplicantinthismatter.IamdulyauthorizedbytheExecutiveCommitteeoftheTreatmentActionCampaigntobringthisapplicationandtomakethisaffidavitonitsbehalf.?3݌#,!(01!1! #Ќ   ?3   ?32  3  3  0 1   Exceptwherethecontextindicatesotherwise,thefactsstatedinthis  affidavitarewithinmypersonalknowledge.Tothebestofmyknowledgeandbeliefthecontentsofthisaffidavitaretrueandcorrect.?3݌ 1!1! Ќ  THEPARTIES d    ?3   ?3~ 2  4  3  0 1   TheApplicantistheTreatmentActionCampaign(TAC),avoluntary ^  associationwithlegalpersonalityandthecapacitytosueandbesued,locatedatTownOneProperty,SulaniDrive,SiteB,Khayelitsha,CapeTown.?3~ ݌ 1!1! Ќ   ?3   ?3& 2  5  3  0 1   IattachmarkedAacopyoftheConstitutionoftheTAC.?3& Q ݌z1!1! Ќ   ?3   ?3- 2  6  3  0 1   AnumberoforganizationsandindividualsareassociatedwiththeTAC. z TheyincludetheAIDSLawProject,theAIDSConsortium,theCongressofSouthAfricanTradeUnions,theNewWomensMovement,theSouthAfricanCatholicBishopsConference,andarangeofindividualswithHIV/AIDSandorganizationsofpeoplewithHIV/AIDS.?3- X ݌ 1!1! Ќ   ?3   ?3O2  7  3  0 1   TheprincipalobjectivesoftheTACaresetoutinparagraph4ofAnnexure %z* A.Theyincludethefollowing:?3Oz݌ 1!1! Ќ   @s   0 1 @s2  7  .  1  3  0 1!1!  tocampaignforaffordabletreatmentforallpeoplewithHIV/AIDS; ^*#0 and@s݌  ! ! Ќ   ^-&4  @s   0 1 @s2  7  .  2  3  0 1!1!  tocampaignforthepreventionandeliminationofallnewHIV d infections.@s$݌  ! ! Ќ   ?3   ?342  8  3  0 1   TheFirstRespondentistheMECforHealthintheProvinceof   Mpumalanga.SheisthememberoftheProvincialExecutivewhoisresponsibleforimplementingnationalandprovinciallegislation,anddevelopingandimplementingprovincialpolicy,withregardtohealthservices.SheiscitedinherofficialcapacityandasarepresentativeoftheProvincialGovernment,c/oTheStateAttorney,4thFloorSouthTower, d  FedsureForumBuilding,268VanDerWaltStreet,Pretoria.?34_݌ 1!1! Ќ   ?3   ?32  9  3  0 1   TheSecondRespondentistheMinisterofHealthintheGovernmentofthe  RepublicofSouthAfrica.SheisthememberoftheNationalExecutivewhoisresponsiblefordevelopingandimplementingnationalpolicywithregardtohealthservices.SheiscitedinherofficialcapacityandasarepresentativeoftheGovernmentoftheRepublicofSouthAfrica,c/oTheStateAttorney,4thFloor,SouthTower,FedsureForumBuilding,268Van d  DerWaltStreet,Pretoria.?3'݌ 1!1! Ќ  THEISSUE  d$(  ?3   ?32  10  3  0 1   TheHIV/AIDSepidemicisamajorpublichealthprobleminSouthAfrica, a' , andhasreachedcatastrophicproportions.?3 ݌ 1!1! Ќ   ?3   ?3#2  11  3  0 1   InthecaseofTreatmentActionCampaignandothers/MinisterofHealth +}%2 andothers(TPDcaseno21181/2001),towhichIwillreferinduecourse,it a-&4 wascommoncausethatHIVprofoundlydepletestheimmunesystem.Itleadstotheinabilityofthebodytofightopportunisticinfectionssuchastuberculosis,pneumoniaandmeningitis.Withouteffectivetreatment,themajorityofpeoplewithHIV/AIDSdieprematurelyofillnessesthatfurtherdestroytheirimmunesystems,qualityoflifeanddignity.?3#N݌ 1!1! Ќ   ?3   ?32  12  3  0 1   OneofthemostcommonmethodsoftransmissionofHIVisfrommotherto d  childatandaroundbirth.Governmentestimatesarethatsince1998,70000childrenareinfectedinthiswayeveryyear.?33݌ 1!1! Ќ   ?3   ?32  13  3  0 1   NevirapineisamedicinewhichhasbeenregisteredbytheMedicines d ControlCouncil.ItsubstantiallyreducestheriskoftransmissionofHIVfrommothertochildatandaroundbirth.Itsusecansavethelivesofmanythousandsofchildreneveryyear.?3݌ 1!1! Ќ   ?3   ?3p2  14  3  0 1   Nevirapineisadministeredthroughprovidingonetablettothemother,and  onedoseofsyruptotheinfant,atoraroundthetimeofbirth.Itissimpletoadminister:anyqualifieddoctorornursecandothis.ItisdesirablethatbeforeadecisionistakenbythemotherwhethershewishestoreceiveNevirapine,sheshouldundergovoluntarycounsellingandtesting.?3p݌ 1!1! Ќ   ?3   ?3!2  15  3  0 1   Theconstitutionalvalidityofthepoliciesandprogrammesofthe %* governmentwithregardtotheprovisionofNevirapineinthepublichealthsectorwaschallengedinTreatmentActionCampaignandothers/Minister (". ofHealthandothers(TPDcaseno21181/2001).Irefertothatcaseasthe d*$0 originalapplication.?3!!݌ 1!1! Ќ   d-'4  ?3   ?3$2  16  3  0 1   ThepurposeofthisapplicationistocompeltheRespondentstocomply d withtheirdutiesintermsoftheConstitutionwithregardtotheprovisionofNevirapineandrelatedissues,asdeclaredandorderedbytheConstitutionalCourtintheoriginalapplication.?3$.$݌ 1!1! Ќ  BACKGROUND  d   ?3   ?3&2  17  3  0 1   Intheoriginalapplication,on14December2001thisHonourableCourt a  madevariousordersrequiringtheRespondents(whoincludedthetwoRespondentsinthiscase)totakevariousstepstomakeNevirapineavailabletopregnantwomenwithHIVwhogivebirthinthepublichealthsector,andtheirbabies.Paragraph2ofthatorderreadasfollows:?3&.&݌ 1!1! Ќ   1 1CC0 1 0 1!1!ThefirsttoninthrespondentsareorderedtomakeNevirapine a availabletopregnantwomenwithHIVwhogivebirthinthepublicsector,andtotheirbabies,inpublichealthfacilitiestowhichtherespondentspresentprogrammeforthepreventionofmothertochildtransmissionofHIVhasnotyetbeenextended,whereintheopinionoftheattendingmedicalpractitioner,actinginconsultationwiththemedicalsuperintendentofthefacilityconcerned,thisismedicallyindicated,whichshallatleastincludethatthewomanconcernedhasbeenappropriatelytestedandcounselled.a' , ! !  ?3   ?3 +2  18  3  0 1   TheRespondents(andcertainotherRespondentsinthatapplication)applied a*#0 forleavetoappealagainsttheorderofthisHonourableCourt.?3 +7+݌ 1!1! Ќ   a-&4  ?3   ?3,2  19  3  0 1   TheApplicantsthenappliedforanorderthatpendingthefinal d determinationoftheappeal,theprovisionsofparagraph2oftheorder(whichIhavequotedabove)beimplemented.?3,,݌ 1!1! Ќ   ?3   ?3.2  20  3  0 1   On11March2002,thisHonourableCourtorderedaccordingly(the d  executionorder).?3.1.݌ 1!1! Ќ   ?3   ?3-/2  21  3  0 1   ThepresentRespondentsandotherRespondentsthenappliedforleaveto   appealagainsttheexecutionorder.Thatledtofurtherapplications,thedetailsofwhicharenotrelevanthere.?3-/X/݌ 1!1! Ќ   ?3   ?302  22  3  0 1   On4April2002theConstitutionalCourtdismissedtheapplicationfor  leavetoappealagainsttheexecutionorder.Theconsequencewasthattheexecutionorderremainedinforce.?300݌ 1!1! Ќ   ?3   ?3B22  23  3  0 1   Meanwhile,theappealinthemainapplicationproceeded.On5July2002,  theConstitutionalCourtdeliveredaunanimousjudgmentinthisregard.TheConstitutionalCourtsetasidetheordersmadebythisHonourableCourtandsubstitutedthefollowingorders:?3B2m2݌ 1!1! Ќ  0 1 1.0 1!1!TheordersmadebytheHighCourtaresetasideandthefollowing d$( ordersaresubstituted.  ! !   d'!, &     0 1 2.0 1!1!Itisdeclaredthat:d ! ! 0 1 0 1!1!a)0 ! !Sections27(1)and(2)oftheConstitutionrequirethe d  government'd4todeviseandimplementwithinitsavailableresourcesacomprehensiveandcoordinatedprogrammetorealiseprogressivelytherightsofpregnantwomenandtheirnewbornchildrentohaveaccesstohealthservicestocombatmothertochildtransmissionofHIV.  ! ! 0 1 0 1!1!b)0 ! !Theprogrammetoberealisedprogressivelywithinavailable   resourcesmustincludereasonablemeasuresforcounsellingandtestingpregnantwomenforHIV,counsellingHIVpositivepregnantwomenontheoptionsopentothemtoreducetheriskofmothertochildtransmissionofHIV,andmakingappropriatetreatmentavailabletothemforsuchpurposes.  ! ! 0 1 0 1!1!c)0 ! !Thepolicyforreducingtheriskofmothertochild " transmissionofHIVasformulatedandimplementedbygovernmentfellshortofcompliancewiththerequirementsinsubparagraphs(a)and(b)inthat:  ! ! 0 1 0 1!1!0 ! !i)09 ! !Doctorsatpublichospitalsandclinicsotherthanthe d'!, researchandtrainingsiteswerenotenabledtoprescribenevirapinetoreducetheriskofmotherto childtransmissionofHIVevenwhereitwasmedically +%2 indicatedandadequatefacilitiesexistedforthetestingandcounsellingofthepregnantwomenconcerned. 9!9!  0 1 0 1!1!0 ! !ii)09 ! !Thepolicyfailedtomakeprovisionforcounsellorsat   hospitalsandclinicsotherthanatresearchandtrainingsitestobetrainedincounsellingfortheuseofnevirapineasameansofreducingtheriskofmothertochildtransmissionofHIV. 9!9! 0 1 3.0 1!1!Governmentisorderedwithoutdelayto:  ! ! 0 1 0 1!1!a)0 ! !Removetherestrictionsthatpreventnevirapinefrombeing  madeavailableforthepurposeofreducingtheriskofmothertochildtransmissionofHIVatpublichospitalsandclinicsthatarenotresearchandtrainingsites.  ! ! 0 1 0 1!1!b)0 ! !Permitandfacilitatetheuseofnevirapineforthepurposeof d  reducingtheriskofmothertochildtransmissionofHIVandtomakeitavailableforthispurposeathospitalsandclinicswheninthejudgmentoftheattendingmedicalpractitioneractinginconsultationwiththemedicalsuperintendentofthefacilityconcernedthisismedicallyindicated,whichshallifnecessaryincludethatthemotherconcernedhasbeenappropriatelytestedandcounselled.  ! ! 0 1 0 1!1!c)0 ! !Makeprovisionifnecessaryforcounsellorsbasedatpublic +%2 hospitalsandclinicsotherthantheresearchandtraining d-'4 sitestobetrainedforthecounsellingnecessaryfortheuseofnevirapinetoreducetheriskofmothertochildtransmissionofHIV.  ! ! 0 1 0 1!1!d)0 ! !Takereasonablemeasurestoextendthetestingand d  counsellingfacilitiesathospitalsandclinicsthroughoutthepublichealthsectortofacilitateandexpeditetheuseofnevirapineforthepurposeofreducingtheriskofmothertochildtransmissionofHIV.  ! ! 0 1 4.0 1!1!Theordersmadeinparagraph3donotprecludegovernmentfrom d adaptingitspolicyinamannerconsistentwiththeConstitutionifequallyappropriateorbettermethodsbecomeavailabletoitforthepreventionofmothertochildtransmissionofHIV.  ! ! 0 1 5.0 1!1!Thegovernmentmustpaytheapplicantscosts,includingthecostsof  twocounsel.  ! ! 0 1 6.0 1!1!Theapplicationbygovernmenttoadducefurtherevidenceisrefused.d!$ ! !  ?3   ?3nF2  24  3  0 1   TheConstitutionalCourtheldthattheoriginalApplicantshadbeen d$( substantiallysuccessfulinrelationtotheissuesraisedintheseproceedings.?3nFF݌ 1!1! Ќ   ?3   ?3G2  25  3  0 1   TheConstitutionalCourtheldthattheprogrammeinstitutedbythe (". Governmenthadtobemadeknowneffectivelytoallconcerned,andthatforapublicprogrammesuchasthistomeettheconstitutionalrequirementofreasonableness,itscontentsmustbemadeknownappropriately.TheCourt d-'4 heldthatitwasnecessarythattheprogramme,assupplementedtocomplywiththerequirementsofthejudgmentoftheConstitutionalCourt,becommunicatedtohealthcaregiversinallpublicfacilitiesandtothebeneficiariesoftheprogramme.?3GH݌ 1!1! Ќ   ?3   ?3J2  26  3  0 1   Sincethatjudgmentwasgiven,theApplicanthasbeenattemptingtoobtain    informationfromthevariousRespondentsintheoriginalapplicationastowhattheyhavedone,andwhattheywilldo,inordertocomplywiththeorder.?3JK݌ 1!1! Ќ   ?3   ?3L2  27  3  0 1   Asissetoutmorefullybelow,theFirstRespondent:?3LL݌d1!1! Ќ   @s   0 1 @sM2  27  .  1  3  0 1!1!  hasfailedtomakefullinformationavailableastoherprogramme, d despiterepeatedrequests@sMM݌  ! ! Ќ   @s   0 1 @sN2  27  .  2  3  0 1!1!  totheextentthatshehasprovidedinformation,hasprovided  informationwhichiscontradictoryoftheotherinformationwhichshehasprovided;@sNO݌  ! ! Ќ   @s   0 1 @suP2  27  .  3  3  0 1!1!  hasprovidedinformationwhichisfalse;@suPP݌"& ! ! Ќ   @s   0 1 @sQ2  27  .  4  3  0 1!1!  hasdemonstratedthatsheisprimafacieinbreachoftheorderofthis %* CourtassubstitutedbytheorderoftheConstitutionalCourt.@sQQ݌  ! ! Ќ   ?3   ?3S2  28  3  0 1   Thepurposeofthisapplicationisto:?3SFS݌d*$01!1!    +%2  @s   0 1 @s'T2  28  .  1  3  0 1!1!  compeltheFirstRespondenttoprovidefullandaccurate d  information,underoath,astowhatshehasdoneandwhatshewilldoinordertocomplywiththeCourtorder;@s'T^T݌  ! ! Ќ   @s   0 1 @sU2  28  .  2  3  0 1!1!  havetheFirstRespondentheldincontemptforherfailuretocomply d  withtheCourtorder;and@sUV݌  ! ! Ќ   @s   0 1 @s4W2  28  .  3  3  0 1!1!  compeltheSecondRespondenttocarryoutherconstitutionaldutyto   ensurethatthestatemeetsitsconstutitonalobligationsinrespectoftherightofaccesstohealthcareservices,assetoutinsec27(1)and(2)oftheConstitution.@s4WkW݌  ! ! Ќ   ?3   ?3!Y2  29  3  0 1   TheSecondRespondenthasresponsibilityforensuringthatlaws,policies, d programmesandstrategiesareadequatetomeettheobligationsofthestateintermsofsection27oftheConstitution.Itbearstheoverallresponsibilityforensuringthatthestatecomplieswiththeobligationsimposeduponitbysection27.?3!YLY݌ 1!1! Ќ   ?3   ?35[2  30  3  0 1   TheSecondRespondenthasfailedtocarryouttheseresponsibilities,inthat d!$ thestatehasnotmetitsobligationsintermsofsection27asexplainedandorderedbytheConstitutionalCourt.?35[`[݌ 1!1! Ќ   ?3   ?3\2  31  3  0 1   TheApplicantthereforeseeksanordercompellingtheSecondRespondent d'!, tocarryouttheseresponsibilities.?3\\݌ 1!1! Ќ  UKUS.,  +}%2 THEFIRSTRESPONDENTSACCOUNTOFWHATSHEHASDONE SINCETHECONSTITUTIONALCOURTMADEITSORDER US.,UK., ^#C1C?(# }  ?3   ?3_2  32  3  0 1   TheConstitutionalCourtgavejudgmentintheoriginalapplicationon5  z July2002.?3_,_݌ 1!1! Ќ   ?3   ?3'`2  33  3  0 1   On9July2002theApplicantsattorneyMrBudlenderwrotetotheFirst ^  Respondent,drawingherattentiontotheorderoftheConstitutionalCourt.Heofferedtomakeacopyoftheorderavailabletoher,ifshehadnotreceivedacopy.Theletter(SM1)thenproceededasfollows:?3'`R`݌ 1!1! Ќ  0 1 0 1!1!Inparagraph3oftheorder,youareorderedwithoutdelayto:z ! ! 0 1 0 1!1!(a)0 ! !Removetherestrictionsthatpreventnevirapinefrombeing z madeavailableforthepurposeofreducingtheriskofmothertochildtransmissionofHIVatpublichospitalsandclinicsthatarenotresearchandtrainingsites.  ! ! 0 1 0 1!1!(b)0 ! !Permitandfacilitatetheuseofnevirapineforthepurposeof ^!$ reducingtheriskofmothertochildtransmissionofHIVandtomakeitavailableforthispurposeathospitalsandclinicswheninthejudgmentoftheattendingmedicalpractitioneractinginconsultationwiththeMedicalSuperintendentofthefacilityconcernedthisismedicallyindicated,whichshallifnecessaryincludethatthemotherconcernedhasbeenappropriatelytestedandcounseled.  ! !  ^-&4 0 1 0 1!1!(c)0 ! !Makeprovisionifnecessaryforcounsellorsbasedatpublic d hospitalsandclinicsotherthantheresearchandtrainingsitestobetrainedforthecounsellingnecessaryfortheuseofnevirapinetoreducetheriskofmothertochildtransmissionofHIV.  ! ! 0 1 0 1!1!(d)0 ! !Takereasonablemeasurestoextendthetestingand d  counsellingfacilitiesathospitalsandclinicsthroughoutthepublichealthsectortofacilitateandexpeditetheuseofnevirapineforthepurposeofreducingtheriskofmothertochildtransmissionofHIV.  ! ! 0 1 0 1!1!TheConstitutionalCourtalsofound(atparagraph123ofitsjudgment)thatinorderfortheprogrammetobeimplementedoptimally,itmustbemadeknowneffectivelytoallconcerned,downtothedistrictnurseandpatients:Indeed,forapublicprogrammesuchasthistomeettheconstitutionalrequirementofreasonableness,itscontentsmustbemadeknownappropriately.  ! ! 0 1 0 1!1!Asyouareaware,andastheConstitutionalCourthasfound,thisisamatterofgreaturgency,involvingasitdoesquestionsoflifeanddeath.  ! ! 0 1 0 1!1!Weshallbeobligedifyouwouldthereforekindlyadviseusofthefollowing:  ! ! 0 1 0 1!1!1.0 ! !Whatstepshaveyoutakento:d-'4 ! ! 0 1   1!1! 0 1 0 1!1!1.10 ! !removetherestrictionsthatpreventnevirapinefrombeing  madeavailableaspublichospitalsandclinicsthatarenotresearchandtrainingsites?  ! ! 0 1 0 1!1!1.20 ! !permitandfacilitatetheuseofnevirapineforthepurposeof    reducingtheriskofmothertochildtransmissionofHIVandtomakeitavailableforthispurposeathospitalsandclinics?  ! ! 0 1 0 1!1!1.30 ! !makeprovisionforcounsellorsbasedatpublichospitalsand   clinicsotherthantheresearchandtrainingsitestobetrainedforthecounsellingnecessaryfortheuseofnevirapinetoreducetheriskofmothertochildtransmissionofHIV?  ! ! 0 1 0 1!1!1.40 ! !extendthetestingandcounsellingfacilitiesathospitalsand d clinicsthroughoutthepublicsectortofacilitateandexpeditetheuseofnevirapineforthispurpose?  ! ! 0 1 0 1!1!2.0 ! !Whatstepswillyoutakeinfutureinrespectofeachofthese d!$ matters?  ! ! 0 1 0 1!1!3.0 ! !Whenwillyoutakeeachofthestepsreferredtoinparagraph %* 2above?  ! ! 0 1 0 1!1!Ishouldaddthatourclientsarewillingandanxioustoassistinanymannerwhichispossible.Theywouldwelcomeanindicationfromyouofhowtheycouldbehelpfulinthisprocess.d-'4 ! ! Ї0 1 0 1!1!Welookforwardtoyoururgentresponse.  ! !  ?3!   ?3s2  34  3  0 1   TheFirstRespondentdidnotrespondtothisletter.?3ss݌d 1!1! Ќ   ?3"   ?3t2  35  3  0 1   On23July2002,MrBudlenderwroteagaintotheFirstRespondent(SM2). d  HepointedoutthatitwasthreeweekssincetheConstitutionalCourthadorderedhertocarryoutherconstitutionalobligationswithoutdelay.HestatedthathewassurethattheFirstRespondentwouldappreciatethatthematterwasinherentlyurgentfortworeasons:itliterallyinvolvedquestionsofliveanddeath;anditinvolvedcompliancewithanorderoftheConstitutionalCourt.Heaskedforananswerwithinfourteendaystothequestionsintheletterof9July2002.?3tt݌ 1!1! Ќ   ?3#   ?3w2  36  3  0 1   TheFirstRespondentdidnotrespondtothislettereither.?3ww݌1!1! Ќ   ?3$   ?3x2  37  3  0 1   On9July2002MrBudlenderhadalsowritteninsimilartermstothe  SecondRespondent,theMinisterofHealth,aboutimplementationoftheorderoftheConstitutionalCourt.Iattach(SM3)acopyofthatletter.?3xx݌ 1!1! Ќ   ?3%   ?3az2  38  3  0 1   AcorrespondencefollowedbetweentheDirectorGeneraloftheNational "& DepartmentofHealth(DrNtsaluba)andMrBudlender,culminatinginameetingbetweenrepresentativesoftheApplicantandDrNtsalubaon21August2001.?3azz݌ 1!1! Ќ   ?3&   ?3|2  39  3  0 1   Theoutcomeofthatmeetingisreflectedinaletterdated21August2002 d*$0  whichMrBudlendersenttoDrNtsaluba(AnnexureSM4).Asappears +%2 fromthatletter,atthemeetingDrNtsalubaundertookinteraliatodothe d following:?3|@|݌ 1!1!   0 1  1!1!  @s'   0 1 @s0~2  39  .  1  3  0 1!1!  HewouldidentifyandadviseMrBudlenderofacontactpersonin   eachoftheprovinceswithwhomtheApplicantcouldraiseproblemswhichtheyidentified.@s0~g~݌  ! ! Ќ   @s'   0 1 @s2  39  .  2  3  0 1!1!  Hewouldobtainfromtheprovincesandmakeavailabletothe   ApplicantareportonwhattheyhadalreadydonetocomplywiththeordersoftheConstitutionalCourt,whattheystillintendeddoing,andwhentheywouldtakethosesteps.@s݌  ! ! Ќ   ?3'   ?3ﲁ2  40  3  0 1   By13September2002thatinformationhadnotbeenreceived..Mr d BudlenderthenwroteagaintoDrNtsaluba(SM5).HepointedoutthatitwastenweekssincetheConstitutionalCourthadorderedtheNationalandProvincialGovernmenttotakespecificstepswithoutdelay.DuringthosetenweekshehadmaderepeatedattemptstofindoutfromtheNationalandProvincialGovernmentwhattheyhaddonetocomplywiththeorder,whattheywoulddoinfuturetocomplywithit,andwhentheywoulddoit.Hestatedthattheinformationavailabletohisclientsindicatedthatwhiletherehadbeensomecompliancewiththeorderinsomeplaces,therehadbeenalargescalefailuretocomplywiththeorder:?3ﲁ݁݌ 1!1! Ќ  0 1 0 1!1!Theonlywaytodeterminewhetherthisisso,isfortheNationaland (". ProvincialGovernmentstodisclose(astheyareconstitutionally obligedtodo)whattheyhavedone,whattheyaregoingtodo,and +%2 whentheyaregoingtodoit.Fortwomonthswehavetriedwithoutsuccesstoobtainthisinformation. ! !   ?3(   ?3 2  41  3  0 1   TheletterstatedfurtherthatunlesstheNationalandProvincial   GovernmentsprovidedtheinformationbythecloseofbusinessonFriday20September2002,anurgentapplicationwouldbemadetotheHighCourtforappropriaterelief.?3 5݌ 1!1! Ќ   ?3)   ?3Ȉ2  42  3  0 1   DrNtsalubarepliedinaletterdated17September2002(AnnexureSM6). d  MrBudlenderrespondedinaletterdated18September2002(AnnexureSM7).On23September2002hewroteagaintoDrNtsalubastatingthathehadbeeninstructedtobringproceedingsintheHighCourtunlesswithinfourteendaystheNationalandeachoftheProvincialGovernmentsprovidedhimwithinformationsettingoutinrespectofeachoftheorders3(a),3(b),3(c)and3(d)oftheConstitutionalCourt:?3Ȉ݌ 1!1! Ќ   @s*   0 1 @s2  42  .  1  3  0 1!1!  whattheyhaddonetocomplywiththeorder;@s݌d  ! ! Ќ   @s*   0 1 @s2  42  .  2  3  0 1!1!  whatstepstheywouldtakeinfuturetocomplywiththeorder;and@s֌݌d!$ ! ! Ќ   @s*   0 1 @sԍ2  42  .  3  3  0 1!1!  whentheywouldtakethosesteps.@sԍ ݌d$( ! ! Ќ   ?3*   ?32  43  3  0 1   On4October2002,theRespondentsintheoriginalapplicationfinallymade d'!, availablesomeinformationastowhattheyhaddoneandwoulddotocomplywiththecourtorder.ThisinformationiscontainedinaletterofthatdatefromDrNtsalubatoMrBudlender(SM8).?3݌ 1!1! Ќ   d-'4  ?3+   ?3ܐ2  44  3  0 1   AnannexuretoSM8setoutintabularformtheinformationprovidedby d eachoftheProvincialGovernmentsfollowingrequestsbytheNationalDepartmenttothemtorespondtothevariouselementsofparagraph3oftheConstitutionalCourtorder.TheinformationprovidedbyMpumalangawasveryscanty.Itwasthefollowing:?3ܐ݌ 1!1! Ќ  0 1 Communicationeffortstothegeneralpublic:d 1!1! 0 1 Noinformationwasprovided. 1!1! 0 1 0 1!1!  ! ! 0 1 CommunicationofcourtorderandtheavailabilityofNevirapineto   hospitalsanddoctors:d1!1! 0 1 Noinformationwasprovided. 1!1! 0 1 0 1!1!  ! ! 0 1 Nevirapineavailability/uptake:1!1! 0 1 40facilitieshaveNevirapineavailableincludingEvanderHospital,ShongweHospital,PhiladelphiaHospital. 1!1! 0 1 0 1!1!  ! ! 0 1 Counselingfacilities/efforttotraincounselorsaroundNevirapine:"1!1! 0 1 Noinformationwasprovided. 1!1! 0 1 0 1!1!  ! ! 0 1 Otherefforts:d$(1!1! 0 1 Noinformationwasprovided. 1!1!  ?3,   ?3h2  45  3  0 1   On11October2002,MrBudlenderwrotetoMsRCharles,theHeadofthe (". DepartmentofHealthinMpumalanga,whowasidentifiedbyDrNtsalubaasthepersonwithwhomtheApplicantshouldcommunicateonbehalfoftheMpumalangaprovincialgovernment.Inthatletter(SM9)MrBudlender d-'4 drewattentiontotheverylimitedinformationwhichhadbeenprovidedinrespectofMpumalanga.HepointedoutthatMpumalangahadnotprovidedalloftheinformationwhichhadbeenrequested.Theletterproceededasfollows:?3h݌ 1!1! Ќ  0 1  1!1! 0 1 0 1!1! WewishtodrawyourattentiontothefactthattheConstitutional    Courtfoundthatinorderfortheprogrammetomeettheconstitutionalrequirementofreasonableness,itscontentsmustbeknownappropriately.Thecourtalsofoundthatinorderfortheprogrammetobeimplementedoptimally,itmustbemadeeffectivelytoallconcerneddowntothedistrictnurseandpatients.  ! ! 0 1 0 1!1!  ! ! 0 1 0 1!1!Wenowrequestthatyouprovideuswiththefollowinginformation:  ! ! 0 1 0 1!1!  ! ! 0 1 0 1!1!1.0 ! !PreciselywhichhospitalsandclinicsinMpumalangahave d Nevirapineavailable?  ! ! 0 1 0 1!1!  ! ! 0 1 0 1!1!2.0 ! !Whichofthosehospitalsandclinicsfalloutsidetheareasof " thedesignated pilotor researchandtrainingsites?  ! ! 0 1 0 1!1!3.0 ! !InwhichotherhospitalsandclinicswillNevirapinebemade d$( available,andwhenwillthisbedone?  ! ! 0 1 0 1!1!4.0 ! !Howmanycounselorshavebeentrainedintheuseof (". Nevirapineateachofthefacilitiesreferredtoinquestion1(werequestthatyouprovidethisinformationinrespectofeachfacility)?d-'4 ! ! Ї0 1 0 1!1!5.0 ! !Whatadditionaltrainingwillbeprovided,tohowmany d counselors,andatwhatfacilitiesandwhenwillthisbedoneinrespectofeachfacility?  ! ! 0 1 0 1!1!6.0 ! !Towhathospitalsandclinicshavethetestingandcounseling d  facilitiesbeenextended?  ! ! 0 1 0 1!1!7.0 ! !Towhatfurtherhospitalsandclinicswillthetestingand   counselingbeextended,andwhenwillthisbedoneinrespectofeachfacility?  ! ! 0 1 0 1!1!8.0 ! !Whatstepshavetheprovincetakentomakethisprogramme  knowtoactuallyorpotentialpatients?  ! ! 0 1 0 1!1!9.0 ! !Whatbudgetaryprovincehasbeenmadeinrespectofthe d mattersreferredtoabove?  ! !  ?3-   ?32  46  3  0 1   Theletterrequestedthatthisinformationbeprovidedasamatterof " urgency,andinanyeventnotlaterthantwoweeksofthedateofthisletter.Itstatedthatifacomprehensiveanswerwasnotreceived,oriftheanswerindicatedthattherehadnotbeenfullcompliancewiththeorderoftheConstitutionalCourt,anurgentapplicationwouldbemadetocourtforappropriaterelief.HesentDrNtsalubaacopyofthatletter.?3݌ 1!1! Ќ   ?3.   ?3u2  47  3  0 1   TheFirstRespondentdidnotrespondtotheletterof11October2002.?3u݌d*$01!1!    +%2  ?3/   ?32  48  3  0 1   On4November2002,MrBudlenderwroteagaintoMsCharles(SM10), d  notingthattherehadbeennoresponsewhatsoevertohisletter.Headvisedthatunlesswithintendayshereceivedasatisfactoryreply,applicationwouldbemadetotheHighCourtwithoutfurthernotice.HestatedthatinthatapplicationtheMECforHealth(Mpumalanga)wouldbecitedastheFirstRespondent,andtheNationalMinisterofHealthwouldjoinedasaparty.HesentacopyofthatlettertotheFirstRespondentherself,andtoDrNtsaluba.?3̨݌ 1!1! Ќ   ?30   ?32  49  3  0 1   Inaletterdated4November2002buttransmittedon6November2002   (SM11),MsCharlesrepliedonbehalfoftheFirstRespondenttotheletterof11October2002.?3݌ 1!1! Ќ   ?31   ?32  50  3  0 1   Inthatletter(SM11),MsCharlesprovidedthefollowinginformationasto  whichhospitalsandclinicsinMpumalangahadNevirapineavailable:?3/݌ 1!1! Ќ  0 1 0 1!1!EvanderandShongweHospitalsarepilotsitesandsurrounding d  clinicsarepresentlyprovidingNevirapine." ! ! 0 1 Theletterlistedfifteensites(namelythosetwohospitalsand13surroundingclinics),whereMsCharlessaidNevirapinewasbeingprovided. 1!1!  ?32   DCC?32  51  3  0 1   Irespectfullydrawattentiontothefactthatthisisinconsistentwiththe (". informationwhichtheFirstRespondenthadprovidedintheattachmenttotheletterof4October2002fromDrNtsaluba(SM8),inthefollowingrespects:?3,݌d-'41!1! Ќ   @s3   0 1 @s±2  51  .  1  3  0 1!1!  On4October,DrNtsalubasaidthattheprovincialgovernmenthad  informedthenationalgovernmentthatNevirapinewasavailableat40sites.Amonthlater,theprovincialgovernmentsaidthatitwasavailableatfifteensites.@s±݌  ! ! Ќ   @s3   0 1 @s2  51  .  2  3  0 1!1!  On4October,DrNtsalubasaidthattheprovincialgovernmenthad d  informedthenationalgovernmentthatNevirapinewasavailableatthePhiladelphiaHospital.Amonthlater,theprovincialgovernmentdidnotlistPhiladelphiaasahospitalwhereNevirapinewasavailable.@sܳ݌  ! ! Ќ   ?33   ?3ﴵ2  52  3  0 1   Irespectfullydrawattentiontothefollowingfurtheraspectsoftheletter d SM11fromMsCharles?3ﴵߵ݌ 1!1! Ќ   @s4   0 1 @s2  52  .  1  3  0 1!1!  Order3(c)oftheConstitutionalCourtorderrequiredtheFirst  RespondenttomakeprovisionifnecessaryforcounsellorsbasedatpublichospitalsotherthantheresearchandtrainingsitestobetrainedforthecounsellingnecessaryfortheuseofNevirapine.@s ݌  ! ! Ќ  0 1 0 1!1!MrBudlenderaskedhowmanycounsellorshadbeentrainedateachfacilitywhichwasprovidingNevirapine.  ! ! 0 1 0 1!1!TheletterfromMsCharlesstatesthattwohavebeentrainedperfacility(Hospital).Thisappearstomeanthatnocounsellorshadbeentrainedattheclinics,andonlytwoateachofthetwohospitalsatwhichNevirapinewasbeingprovided.d-'4 ! ! Ї @s4   0 1 @sк2  52  .  2  3  0 1!1!  MrBudlenderaskedwhatadditionaltrainingwouldbeprovided,to d howmanycounsellors,atwhatfacilities,andwhenthiswouldbedoneinrespectofeachfacility.@sк݌  ! ! Ќ  0 1 0 1!1!MsCharlesfailedtoprovidethisinformation.Shereplied:  ! ! 0 1 0 1!1!0 ! !NationalRolloutplan,PMTCT[preventionofmotherto d  childtransmission]trainingstartedonthe15October2002to19August2002(sic)and22August2002to26August2002.  ! !  @s4   0 1 @s2  52  .  3  3  0 1!1!  Order3(d)oftheConstitutionalCourtorderof5Julyrequiredthe  FirstRespondenttotakereasonablemeasurestoextendthetestingandcounsellingfacilitiesathospitalsandclinicsthroughoutthepublichealthsectortofacilitateandexpeditetheuseofNevirapine.@sE݌  ! ! Ќ  0 1 0 1!1!MrBudlenderaskedtowhatfurtherhospitalsandclinics,testingandcounsellingfacilitieshadbeenextended.#CDC #DCCMsCharlesrespondedby " listing90siteswhichattheendofJuly2002wereequippedto d!$ providevoluntarycounsellingandtestingservices.(Irevertlatertothislist.)  ! ! 0 1 0 1!1!MsCharlesdidnotindicatethattestingandcounsellingfacilitieshadbeenextendedtoanyfurtherhospitalsorclinicsatall.  ! !  @s4   0 1 @s2  52  .  4  3  0 1!1!  MrBudlenderaskedwhatstepstheprovincehadtakentomakethis +%2 programmeknowntoactualorpotentialpatients.@s݌d-'4 ! ! Ќ  0 1 0 1!1!MsCharlesdidnotreplyatalltothisquestion.  ! !  ?34   ?32  53  3  0 1   Irespectfullysubmitthatevenleavingasidetheambiguitiesintheletter   fromMsCharles,onthefaceofthatletteritisclearthat:?3݌ 1!1! Ќ   @s5   0 1 @s2  53  .  1  3  0 1!1!  theFirstRespondentisinbreachoforders3(b),3(c)and3(d)ofthe d  ConstitutionalCourt,inthatonherownversionshehasnottakenthestepsorderedbytheConstitutionalCourt@s݌  ! ! Ќ   @s5   0 1 @s2  53  .  2  3  0 1!1!  theFirstRespondenthasnotcarriedoutitsdutytomakethe d programmeknowntoactualorpotentialpatients,whichisanecessaryelementforaprogrammesuchasthistomeettheconstitutionalrequirementofreasonableness.@s݌  ! ! Ќ   ?35   ?3y2  54  3  0 1   BecauseofambiguitiesintheletterSM11,on14November2002Mr  BudlenderwroteagaintoMsCharlesonbehalfoftheFirstRespondent(SM12)askingforconfirmationthat:?3y݌ 1!1! Ќ   @s6   0 1 @s2  54  .  1  3  0 1!1!  theonlyhospitalsandclinicsintheMpumalangawhichcurrently "& haveNevirapineavailablearethoselistedinparagraph1oftheletterof4November(SM11),namelyEvanderandShongweHospitalsandtheirsurroundingclinics.@s0݌  ! ! Ќ   @s6   0 1 @s2  54  .  2  3  0 1!1!  thehospitalslistedinparagraph2oftheletterof4Novemberwhich d*$0 falloutsidethedesignatedpilotsitesdonotyethaveNevirapineavailable.@s݌d-'4 ! ! Ќ  0 1 MrBudlenderalsoaskedthatiftherewereanyhospitalsotherthanEvanderandShongweHospitalsandtheirsurroundingclinicswhichcurrentlyhaveNevirapineavailable,theyshouldbelistedintheFirstRespondentsresponse.#CDC#d 1!1!  ?36   ?32  55  3  0 1   TheFirstRespondentdidnotrespondtothisrequestforclarification,orto d  furtherlettersof19Novemberand25November.?3݌ 1!1! Ќ   ?37   ?32  56  3  0 1   On2December2002MrBudlenderwroteagaintoMsCharles(SM13),   repeatingthequestionsraisedintheletterof14November,andaskingthatMsCharlesalsolethimhavealistoftheclinicsservedbyEvanderandShongweHospitalswhichhaveNevirapineavailable.Theletterthreatenedanapplicationtocourtunlessthisinformationwasnowprovided.?3&݌ 1!1! Ќ   ?38   ?322  57  3  0 1   On4December2002,MsCharlesrepliedonbehalfoftheFirstRespondent.  Thisletter(SM14)statedasfollows:?32]݌ 1!1! Ќ  0 1 0 1!1!1.0 ! !ThehospitalswhicharepilotsiteswhichhaveNevirapine d!$ availableareShongweandEvanderHospitals.ThesurroundingfeederclinicshaveaccesstothesehospitalsforpurposesoftheNevirapineprogramme.Alistoffeederclinicsisattached.[Theattachmentreferstotwelvefeeder d'!, clinics].(". ! ! 0 1  1!1! 0 1 0 1!1!2.0 ! !Thefollowinghospitalshavebeenapprovedfor +%2 implementationoftheNevirapineprogramme:d-'4 ! ! 0 1  1!1! 0 1 0 1!1!0 ! !Themba  ! ! 0 1 0 1!1!0 ! !RobFerreira  ! ! 0 1 0 1!1!0 ! !Ermelo  ! ! 0 1 0 1!1!0 ! !Standerton  ! ! 0 1 0 1!1!0 ! !Witbank  ! ! 0 1 0 1!1!0 ! !Philadelphia.d  ! !  ?39   ?312  58  3  0 1   Irespectfullysubmitthatthefollowingaspectsofthisletterarerelevantand d  infactveryrevealing.?31\݌ 1!1! Ќ   @s:   0 1 @sm2  58  .  1  3  0 1!1!  Thenumberofinstitutionswhichallegedlyhaveaccessto  Nevirapinewasbythisletterfurtherreducedfromfifteentofourteen(asopposedtotheoriginalstatementofforty).@sm݌  ! ! Ќ   @s:   0 1 @s2  58  .  2  3  0 1!1!  TheletterimpliesthattheclinicsdonotinfacthaveNevirapine  availablethemselves,butonlyhaveaccesstohospitalswhichhaveNevirapine.ThissuggeststhatinfactthatthereareonlytwoexistingsiteswhichhaveNevirapineavailableonsite,andnotfourteen,fifteen,orfortyaspreviouslyalleged.@sT݌  ! ! Ќ   ?3:   ?3\2  59  3  0 1   TheletterSM14referstohospitalswhichhavebeenapprovedfor %* implementationoftheNevirapineprogramme.ThiscanonlymeanthattheFirstRespondentrequireshospitalstoobtainherapproval,ortheapprovalofherDepartment,beforetheycanmakeNevirapineavailabletotheirpatients.?3\݌ 1!1! Ќ   d-'4  ?3;   ?3q2  60  3  0 1   ThisinterpretationisconsistentwithotherevidencetowhichIwillreferin d duecourse.?3q݌ 1!1! Ќ   ?3<   ?32  61  3  0 1   TherequirementthathospitalsobtainapprovalbeforemakingNevirapine   availableisdirectlyinbreachoftheordermadebytheConstitutionalCourt.ThatorderveryclearlyplacesthedecisionastowhetherNevirapineshouldbeprovided,inthediscretionoftheattendingmedicalpractitioner,actinginconsultationwiththemedicalsuperintendentofthefacilityconcerned.?3݌ 1!1! Ќ   ?3=   ?32  62  3  0 1   Thatispreciselyoneofthemajorissueswhichwereindisputeinthe   originalapplication.TheRespondentshadadoptedapolicywhichrestrictedtheuseofNevirapinetoidentifiedpilotorresearchortrainingsites.DoctorsatothersitesinthepublichealthsectorwerenotpermittedtoprovideNevirapinetotheirpatients.Thisrestrictionwaschallengedintheoriginalapplication.?3!݌ 1!1! Ќ   ?3>   ?3T2  63  3  0 1   TheConstitutionalCourtheldthatthispolicywasinconsistentwiththe d  constitutionalobligationsoftheRespondents.TheCourtfoundthattheattendingmedicalpractitionerandthemedicalsuperintendentwereinthebestpositiontodecidewhethertheprovisionofNevirapinewasmedicallyindicated,andthattherespondents(thepoliticalauthorities)wereunderanobligationtomakeitavailablewheretheattendingmedicalpractitionerandsuperintendentsodecided.?3T݌ 1!1! Ќ   ?3?   ?3 2  64  3  0 1   Theletterof4December2002(SM14)showsthattheFirstRespondentis d*$0 actingdirectlyinbreachoforders3(a)(and(b):?3 6݌ 1!1! Ќ   d-'4  @s@   0 1 @sm2  64  .  1  3  0 1!1!  shehasnotremovedtherestrictionwhichpreventstheprovisionof d nevirapineoutsidetheresearchandtrainingsites;and@sm݌  ! ! Ќ   @s@   0 1 @s2  64  .  2  3  0 1!1!  shehasnotpermittedandfacilitatedtheprovisionofnevirapine   whereintheopinionofthemedicalpractititonerpractitionerinconsultationwiththemedicalsuperintendent,thisismedicallyindicated.@s݌  ! ! Ќ   ?3@   ?32  65  3  0 1   ThatthisinterpretationoftheletterSM14iscorrect,isconfirmedbyaletter   writtenbytheFirstRespondentherselftotheProvincialLegislature,Mpumalangaon26August2002(SM15).Inthatletter,theFirstRespondentstatesthatPhiladelphia,RobFerreira,WitbankHospitals d appliedforauthorizationtodispenseNevirapine.?3݌1!1! Ќ   ?3A   ?32  66  3  0 1   ThisisfurtherconfirmationthattheFirstRespondentisimplementinga  policywhichrequireshospitalsorclinicstoapplyforauthorizationinordertodispenseNevirapine.?3E݌ 1!1! Ќ   ?3B   ?32  67  3  0 1   TheFirstRespondentsletterof26August2002(SM15)issignificantina " furtherrespect:itassertsthatLebogangandMbalenhleclinicsareprescribingNevirapine.Mbalenhleclinicappearsontheannexuretotheletterof4December2002(SM14)asEmbalenhle.However,Lebogangdoesnotappearonthelistof4December.ItseemsthatLebogangmaypreviouslyhaveprovidedNevirapine,butisnolongerdoingso.?3݌ 1!1! Ќ   ?3C   ?32  68  3  0 1   AtbestfortheFirstRespondent,betweenAugustandDecember2002all d*$0 thattheFirstRespondentdidtocomplywiththeorderthatNevirapinebemadeavailableonanextendedbasis,wastoincreasetheavailabilityfrom d-'4 twohospitalsandtwoclinicswithinthepilotsites,totwohospitalsandtwelveclinicswithinthepilotsites.?3A݌ 1!1! Ќ   ?3D   ?3K2  69  3  0 1   Inotherwords,therewasnorolloutofprovisionbeyondthepilothospitals   andtheirfeederclinics.?3Kv݌ 1!1! Ќ   ?3E   ?32  70  3  0 1   Thisissodespitethefactthat:?3݌d 1!1! Ќ   @sF   0 1 @so2  70  .  1  3  0 1!1!  accordingtotheFirstRespondentsletterdated4November(SM11)@so݌d  ! ! Ќ  0 1 0 1!1!VoluntaryTestingandCounsellingisavailableatallhospitaland d someCHC[communityhealthcentres]. ! !  @sF   0 1 @sp2  70  .  2  3  0 1!1!  AnnexureBtothatletterlisted90siteswhichattheendofJuly2002  were@sp݌  ! ! Ќ  0 1 0 1!1!equippedtoprovideVCT[voluntarycounsellingandtesting] d  services.Inotherwords,therearebothhumanandmaterialresourcestoprovideVCTserviceshumanresourcessuchastrainedprofessionalnursestodobothcounsellingandtesting,andmaterialresourcessuchastheHIVrapidtests.d$( ! !  ?3F   ?3E2  71  3  0 1   Order3(b)oftheConstitutionalCourtplacedtheFirstRespondentundera d'!, positivedutytopermitandfacilitatetheuseofnevirapinewhereintheopinionofthemedicalpractititoner(actinginconsultationwiththemedicalsuperintendent)thisismedicallyindicated.Shewasorderedtodothiswithoutdelay.?3Ep݌d-'41!1! Ќ   ?3G   ?3l2  72  3  0 1   Hospitalsandclinicsthathavetestingandcounsellingfacilitiesshouldbe  abletoprescribeNevirapinewherethatismedicallyindicated.?3l݌ 1!1! Ќ   ?3H   ?32  73  3  0 1   AttheendofJuly,therewere90facilitieswhichhadthehumanand d  materialresourcesdotothenecessaryvoluntarycounsellingandtesting.Despitethis,theFirstRespondentfailedtofacilitatetheprovisionofNevirapineatanyoftheapproximately75siteswhichwereoutsidethepilotareas.?3݌ 1!1! Ќ   ?3I   ?32  74  3  0 1   IsubmitthatthisestablishesthattheFirstRespondentisdirectlyinbreach d oforder3(b)oftheConstitutionalCourt.?3݌ 1!1! Ќ   ?3J   ?32  75  3  0 1   FarfromfacilitatingtheprovisionofNevirapine,theFirstRespondentand  herofficialshaveattemptedtopreventandobstructtheprovisionofNevirapine,andtopressurisedoctorswhoprovideitwithoutherpermission.?3D݌ 1!1! Ќ   ?3K   ?32  76  3  0 1   Forexample,on27August2002representativesoftheApplicanthada d!$ meetingwiththeFirstRespondent.TheFirstRespondentwasawarethattheApplicanthadarrangedforsuppliesofNevirapinetobemadeavailabletodoctorsatPhiladelphiaHospital,whohadprescribeditfortheirpatients.Insteadofexpressingappreciationforwhathadbeendone,theFirstRespondentsaidatthatmeetingthatthedoctorswereluckythattheyhadnotbeenprosecutedunderthePublicFinanceManagementActfornotreportingthattheyhadreceivedadonation.?3݌ 1!1! Ќ   d-'4  ?3L   ?32  77  3  0 1   AfurtherexampleappearsfromareportpublishedintheMailand d GuardiannewspaperduringSeptember2002.Inthatreport(SM16),  DumisaniMlangeni,spokespersonfortheFirstRespondentsdepartment,condemnedthedoctorsgrowingrebellionandwarnedthattheprovincewouldbeforcedtochargeanyonefounddispensingnevirapineonhospitalpremises.?3 ݌ 1!1! Ќ   ?3M   ?3; 2  78  3  0 1   ThereportSM16isalsorelevantbecauseMrMlangenistatedthatahospital   coulddispensenevirapineonlyifthesuperintendentruledthatitiscapableincludingconfirmationthatithasthenecessarymilkformulastockpilesforallaffactedaffectedbabies...Hospitalsmustpayforsuppliesfromtheirownbudgets.?3; f ݌ 1!1! Ќ   ?3N   ?3l 2  79  3  0 1   Therequirementthathospitalshavesuppliesofmilkformulaisonewhich  wasimposedbytheFirstRespondentandherdepartment.Itisafurtherbreachoforders3(a)and(b)oftheConstitutionalCourt.?3l  ݌ 1!1! Ќ   ?3O   ?3 2  80  3  0 1   TothebestofmyknowledgeneithertheFirstRespondentnoranyoneelse " actingonherbehalforonbehalfofherdepartmenthaschallengedtheaccuracyofthereportSM16.BecauseoftheurgencyofthismatterIhavenotyetbeenabletoobtainaconfirmatoryaffidavitfromJustinArenstein,oneoftheauthorsofthatreport,confirmingthatthisiswhatMrMlangenisaidtohim.Ishalldosoandfileitveryshortly.?3 8݌ 1!1! Ќ  OTHEREVIDENCEOFBREACHESOFTHEORDERSOFTHE +%2 CONSTITUTIONALCOURT  a-&4 Ї ?3P   ?32  81  3  0 1   On28November2002TheStarnewspaperpublishedextensivereportson d theuseoftheAIDSbudgetinMpumalanga.Iattachacopyofthefrontpagereport(SM17).ThisledtoresponsesbytheFirstRespondentwhich,Isubmit,yetagaindemonstratedbreachesoftheordersofCourt.?3)݌ 1!1! Ќ   ?3Q   ?32  82  3  0 1   On28NovembertheFirstRespondentwasinterviewedonRadio702.    Duringthecourseofthatinterview,NonkosiKhumalooftheApplicanttelephonedintotheradiostationtoputquestionstotheFirstRespondent.Iattach(SM18)therelevantextractfromatranscriptoftherelevantpartoftheinterview.FatimaHassan,whoheardtheinterview,confirmsinSM19thatSM18is,tothebestofherknowledge,anaccuraterecordofwhatwassaid.?3݌ 1!1! Ќ   ?3R   ?32  83  3  0 1   Intheradiobroadcast,MsKhumaloreferredtoletterswhichtheFirst  RespondenthadsaidshehadreceivedfromtheRobFerreiraandThembaHospitals,andtootherlettersfromWitbankandBarbertonHospitals.TheFirstRespondentthenstatedasfollows:?3݌ 1!1! Ќ  0 1 0 1!1!Yes,Ididindicateearlierthismorningtothepeopleof d!$ Mpumalanga.ThecopythatIhavefromRobFerreiraandThembawasccedtome,becausethecourtorderwasveryclear,itissayingthattheSuperintendentmustaskpermissionfromtheHOD.DrSasisentacopytomyoffice.ThatiswhyIamfullyawarethatthesetwohospitalshaverequested.(". ! !  ?3S   ?32  84  3  0 1   ThereferencetoHODisareferencetotheHeadofDepartment,inthis +%2 caseMsCharles.?3H݌d-'41!1! Ќ   ?3T   ?3X2  85  3  0 1   Irespectfullysubmitthatthisistheclearestpossibleevidencethat,in  breachoftheorderoftheConstitutionalCourt,theFirstRespondentrefusestoallowthemedicalpractitionersandsuperintendentstoprovideNevirapinetotheirpatientsunlesstheyhaverequestedandobtainedpermissiontodosofromtheprovincialgovernment.?3X݌ 1!1! Ќ   ?3U   ?32  86  3  0 1   TheFirstRespondentalsohadaaanewspaperadvertisementinhername   widelypublished,inreplytothearticleinTheStar.Iattach(SM20)acopy d  oftheadvertisementwhichappearedinCityPressof1December2002.?3݌ 1!1! Ќ   ?3V   ?3k2  87  3  0 1   Inthatadvertisement,theFirstRespondentsaysthattheprovinceisreadyto  implementinphases,anevirapinerolloutplanearlynextyear,2003'.Irespectfullysubmitthatthefollowingaspectsarerevealing:?3k݌ 1!1! Ќ   @sW   0 1 @s!2  87  .  1  3  0 1!1!  PhiladelphiaHospitalisoneoftheHospitalsincludedinthisplanned  rolloutfornextyear.DrNtsalubastatedon4OctoberthatNevirapinewasavailableatPhiladelphiaHospital.@s!Q!݌  ! ! Ќ   @sW   0 1 @s"2  87  .  2  3  0 1!1!  Thisisnotthefirstsuchpromisewhichhasbeenmade.InAugust "& 2002MrDumisaniMlangeni,thespokesmanfortheMpumalangaHealthDepartment,announcedthattheprovincewasworkingonaplantoensurethateveryhospitalandcliniccanrolloutthedrugby31December.Iattach(SM21)acopyofareportofthatannouncementinanelectronicnewsservice,MpumalangaToday. d*$0 Tothebestofmyknowledge,thishasneverbeendeniedbyoronbehalfoftheFirstRespondent.Again,Iwillshortlyfileanaffidavit d-'4 byMrArensteinconfirmingthatthisiswhatMrMlangenisaidtohim.@s"#݌  ! ! Ќ   ?3W   ?3S&2  88  3  0 1   Theprovincialgovernmentdidnotdowhatithadsaiditwoulddo.Now,   theFirstRespondentsaysineffectthat:?3S&~&݌ 1!1! Ќ   @sX   0 1 @s'2  88  .  1  3  0 1!1!  farfromrollingouttoeveryhospitalandclinicby31December, d  therehasstillnotbeenanyrolloutatallbeyondthepilotsitesandsurroundingclinics@s''݌  ! ! Ќ   @sX   0 1 @s5)2  88  .  2  3  0 1!1!  onlysixfacilitieswillprovideNevirapineinthefirstphaseofthe d planwhichwillbeimplementedonlysometimeearlynextyear;@s5)l)݌  ! ! Ќ   @sX   0 1 @s*2  88  .  3  3  0 1!1!  hospitalswithlessthan150bedswillnotparticipateeveninthe  secondphase,whichwilltakeplaceatanunspecifiedlaterstage;@s**݌  ! ! Ќ   @sX   0 1 @sF,2  88  .  4  3  0 1!1!  noclinicsorcommunityhealthcentreswillparticipateinthatsecond d  phase;and@sF,},݌  ! ! Ќ   @sX   0 1 @s-2  88  .  5  3  0 1!1!  thecommunityhealthcentres,clinicsandhospitalswithlessthan "& 150bedswillparticipateonlyinthethirdphase,atanevenlaterunspecifiedtime.@s--݌  ! ! Ќ   ?3X   ?3-/2  89  3  0 1   Irespectfullysubmitthatthisdemonstratesthatlittleifanyreliancecanbe (". placedonundertakingsmadebytheFirstRespondentandherstaff,andcertainlyageneralisedstatementofthekindcontainedinSM20.?3-/X/݌ 1!1! Ќ   d-'4  ?3Y   ?302  90  3  0 1   TheFirstRespondenthashoweverbelatedlystartedmakingarrangements d tohaveNevirapineprovidedatsixhospitalsinMpumalanga.TheseincludeRobFerreira,PhiladelphiaandWitbankHospitals.TheApplicantwelcomesthatbutitistoolittleandtoolatetoconstitutecompliancewiththeorderofCourt.Andinaddition,itremainssubjecttotheFirstApplicantsinsistence,contrarytothetermsoftheorderofCourt,thathospitalsandclinicsobtainpermissionfromtheprovincialgovernmentbeforetheyprovideNevirapinetotheirpatients.?301݌ 1!1! Ќ   ?3Z   ?332  91  3  0 1   Iattach(SM23)aletterdated2December2002fromMsCharlestothe   ActingSuperintendentoftheRobFerreiraHospitalinNelspruit.Thisreadsasfollows(emphasisadded):?334݌ 1!1! Ќ  0 1 0 1!1!Yourletterdated2ndDecember2002,referswhereinyourequest  permissiontoimplementtheNevirapineprogramme.d ! ! 0 1 0 1!1!Accordingtoyourletter,RobFerreirahospitalisreadytoimplementtheNevirapineprogramme.Youarethusgranted " permissiontoimplementtheNevirapineprogramme.Pleaseensure d!$ thatyouobtainthenecessarysuppliesfromthePharmaceuticalDepot.AcopyofthisletterhasbeenforwardedtoMrSimonChomaatthePharmaceuticalDepot.%* ! !  ?3[   ?382  92  3  0 1   IrespectfullysubmitthatthisprovesthattheFirstRespondentcontinues, (". evennow,toactdirectlyinbreachoforder3(a)madebytheCourt.?38<8݌ 1!1!    +%2  ?3\   ?392  93  3  0 1   AsappearsfromSM15,whichisdated26August2002,theRobFerreira d  Hospital,theWitbankandthePhiladelphiaHospitalhadpreviouslyapplied  forauthorisationtodispenseNevirapine.AccordingtotheFirst d  Respondent,thehospitalsconcernedwereassessedandtheydidnot   complywiththecriteria.Thehospitalsthenrealisedthattheystillhave d  someconstraintswhichhavetobeaddressed.?399݌  1!1! Ќ   ?3]   ?3<2  94  3  0 1   IinvitetheFirstRespondenttostate:?3<<݌ 1!1! Ќ   @s^   0 1 @sp=2  94  .  1  3  0 1!1!  whoassessedthesethreehospitals;@sp==݌  ! ! Ќ   @s^   0 1 @s>2  94  .  2  3  0 1!1!  whatarethecriteriawithwhicheachofthemdidnotcomplyatthe  time;and@s>>݌  ! ! Ќ   @s^   0 1 @s?2  94  .  3  3  0 1!1!  whathaschangedsincetheendofAugust2002ateachofthem,with d theresultthattheydonowcomplywiththecriteria.@s? @݌  ! ! Ќ   ?3^   ?3RA2  95  3  0 1   TheFirstRespondenthasfailedandcontinuestofailtofacilitatethe " provisionNevirapineonanextendedbasisdespitethefactthataccordingtoher,atthebeginningofJuly2002everyhospitalandsomecommunityhealthcentres,90sitesinall,wereabletoprovidevoluntarycounsellingandtesting(SM11).?3RA}A݌ 1!1! Ќ   ?3_   ?3_C2  96  3  0 1   AsIhavestatedabove,hospitalsandclinicsthathavetestingand (". counsellingfacilitiesshouldbeabletoprescribeNevirapinewherethatis medicallyindicated.TheFirstRespondentisnotentitledtorequirethemto +%2 obtainpermissiontodoso.ThatisarestrictionwhichtheFirstRespondentwasobligedtoremove.?3_CC݌ 1!1!    ?3`   ?3E2  97  3  0 1   IrespectfullysubmitthatitisclearthattheFirstRespondenthasfailedto   comply,andcontinuestofailtocomplywiththeorderofCourtthattheextensionoftheprovisionofNevirapinetakeplacewithoutdelay.Thereiscontinued,inexcusableandunjustifiabledelay.Thereisnoexplanationwhy:?3EE݌ 1!1! Ќ   @sa   0 1 @sG2  97  .  1  3  0 1!1!  everyhospitalcouldnotalreadyhavebeenenabledtoprovide   Nevirapinewhereintheopinionoftheattendingmedicalpractitioner(inconsultationwiththemedicalsuperintendent),thisismedicallyindicated;ad@sGG݌  ! ! Ќ   @sa   0 1 @sI2  97  .  2  3  0 1!1!  thosecommunityhealthcentresandclinicswherevoluntarytesting d andcounsellingareavailable,couldnotalreadyhavebeensimilarlyenabledtoprovideNevirapine.@sII݌  ! ! Ќ   ?3a   ?3%K2  98  3  0 1   Instead,theFirstRespondentrequireseachofthemtoawaithercentrally d!$ controlledprogrammeofpermissionandapprovaltoreachthem,regardlessofwhethertherelevantmedicalauthoritiesonsitearereadytoproceed.?3%KPK݌ 1!1! Ќ   ?3b   ?3L2  99  3  0 1   IsubmitthatthisisaclearbreachoftheorderoftheCourt.?3LM݌d'!,1!1! Ќ  THEFIRSTRESPONDENTSPERSONALKNOWLEDGEOFTHESE +%2 MATTERS  a-&4 Ї ?3c   ?3MN2  100  3  0 1   TheFirstRespondentwasoneoftheRespondentsintheoriginal d application.Theorderwasmadeagainsther.Sheisunderalegalobligationtocomplywiththatorder,andtoensurethatthoseinherDepartmentdoso.?3MNxN݌ 1!1! Ќ   ?3d   ?3O2  101  3  0 1   TheFirstRespondentmustbefullyawareofwhatishappeninginher    Department.On19July2002sheissuedaninstruction(SM24)thathenceforththeDirectorate:HIVandAIDSwouldreportdirectlytoherandtotheHeadofdepartment(MsCharles).?3O(P݌ 1!1! Ќ   ?3e   ?3Q2  102  3  0 1   TheFirstRespondentcanthereforenotevaderesponsibilityforthenon d compliancewiththeorderofCourt,byclaimingalackofknowledgeofwhathastranspired.?3QQ݌ 1!1! Ќ   1    9 URGENCY    ?3f   ?3S2  103  3  0 1   Theurgencyofthismatterisdemonstratedbytheattachedaffidavitsof }" StellaDubazana(SM25andSD1).MsDubazanaisaprofessionalregisterednurse,nursecounsellorandHIV/AIDScaregiver,practisingassuchatCotlandsBabySanctuary,wheresheistheHeadNurse.?3SS݌ 1!1! Ќ   ?3g   ?3|U2  104  3  0 1   Cotlandsisasanctuaryforabandoned,abused,neglectedandterminallyill a' , children.Atanyonetime,about60%to70%ofthechildrenaresufferingfromHIV/AIDS.MsDubazanasaffidavitsarebasedonherexperienceasanurseworkingwithsuchchildren.?3|UU݌ 1!1! Ќ   a-&4  ?3h   ?3jW2  105  3  0 1   MsDubazanadescribestheterriblepainandsufferingwhichHIVpositive d childrenendure,andshedescribesthedeathofthesechildren,anditsconsequences.IwillnotburdentherecordbyrepeatinginthisaffidavitwhatisstatedbyMsDubazana.?3jWW݌ 1!1! Ќ   ?3i   ?39Y2  106  3  0 1   ThefailuretoprovideNevirapineisliterallyamatteroflifeanddeath,inits    effectsonchildrenborntowomenwhohaveHIV.EverydayinwhichthereisanunreasonablefailuretoprovideNevirapinewhereitismedicallyindicated,resultsinavoidablepain,suffering,anddeathofchildren.?39YdY݌ 1!1! Ќ   ?3j   ?38[2  107  3  0 1   Applicantrecognisesthedifficultiesinherentinconductingthismatteras d theholidayseasonapproaches.ItthereforeasksforonlylimitedshorteningofthetimelimitsprescribedbytheRulesofCourt.TheApplicantgivesnoticethatitwillseektoholdtheRespondentstothetimelimitssetoutintheNoticeofMotion,andthatinduecoursetheJudgePresidentwillbeapproachedforadateforthehearingofthisapplication.?38[c[݌ 1!1! Ќ   ?3k   ?3]2  108  3  0 1   Iaskthatbecauseoftheurgencyofthismatter,theCourtcondonethe " Applicantsfailuretocomplywiththetimelimits,formsandproceduresprescribedbytherules.?3]]݌ 1!1! Ќ   ?3l   ?3D_2  109  3  0 1   IaskthattheCourtgrantanorderasprayedintheNoticeofMotion.?3D_o_݌%*1!1! Ќ  0 1 0 1!1!0 ! !09 ! !09!9!0!!0A!!򀀀d*$0A!A! 0 1 0 1!1!0 ! !09 ! !09!9!0!!0A!! SISPHOKAZIMTHATHI d+%1A!A!   b,%2 SIGNEDANDAFIRMEDAFFIRMEDBEFOREMEATCAPETOWNONTHISDAY OFDECEMBER2002,THEDEPONENTHAVINHAVING/GSTATEDTHATSHEHASCONSCIENTIOUSOBJECTIONSTOTAKINGTHEOATH,THATSHEREGARDSTHEAFFIRMATIONASBINDINGONHERCONSCIENCE,ANDHAVINGAFFIRMEDINTHEMANNERPRESCRIBEDBYREGULATION.0 1 0 1!1!0 ! !09 ! !09!9!0!!0A!!0A!A!񀀀񀀀 d   A!A! 0 1 0 1!1!0 ! !09 ! !09!9!0!!0A!!0A!A! COMMISSIONEROFOATHS