By Political Bureau

Nozizwe Madlala-Routledge, the outspoken deputy health minister many Aids activists wanted promoted, was instead on Wednesday axed by President Thabo Mbeki after she refused to resign.

It is the third time in just more than two years that Mbeki has fired someone in his administration, having previously axed his deputy Jacob Zuma in 2005 and NIA director-general Billy Masetlha in 2006.

Like Zuma and Masetlha, Madlala-Routledge was given the option to resign after meeting Mbeki in Pretoria on Tuesday night, but the defiant deputy was not about to be pushed, leaving it up to the president to act against her.

This was confirmed by government sources.

Meanwhile, fellow ANC MP, James Ngculu, on Wednesday attacked Madlala-Routledge.

Ngculu is the chairperson of the National Assembly's health committee and was speaking before news of Madlala-Routledge's change of fortunes became public knowledge. He accused her of creating a "hype" over conditions at East London's Frere Hospital.

"It's very easy for individuals to speak of a 'national emergency' when they are just creating a hype," said Ngculu, during a meeting with Eastern Cape Health MEC Nomsa Jajula.

A government official said on Wednesday night: "She should have been fired a long time ago. She was given a chance to mend her ways... but she clearly did not want to use it."

The official was referring to Madlala-Routledge's outspoken interview with weekend newspapers last year in which she made clear she disagreed with government policy and had issues with her boss, Health Minister Manto Tshabalala-Msimang.

In the interview, Madlala-Routledge also criticised Mbeki in relation to the Aids message that was communicated by the government, as well as the appointment of Herbert Vilakazi as chairperson of a "task team" on traditional medicine.

Her outspokenness over the past year saw non-governmental organisations, Aids activists and opposition parties latch on to her as the champion in the fight against Aids and the voice of reason, even calling for her to replace Tshabalala-Msimang.

With her boss seriously ill, the deputy health minister and Deputy President Phumzile Mlambo-Ngcuka received the plaudits, much to the minister's chagrin, especially in relation to the government's change in Aids strategy and the revamped SA National Aids Council.

During Tshabalala-Msimang's extended absence, Madlala-Routledge flexed her muscles further, writing to then acting health minister Jeff Radebe, suggesting a review of the public health system. It earned his displeasure and was rejected.

Returning to work from a liver transplant earlier this year, Tshabalala-Msimang asserted her authority, including at an international Aids conference in Durban, in which her deputy was billed as one of the main speakers, but withdrew after the minister complained.

Once again Madlala-Routledge was kept out of the loop.

An unannounced visit to Frere Hospital, after the Daily Dispatch exposed appalling conditions there, saw Madlala-Routledge describe it as a national emergency.

She was again praised in some quarters for her candour and in the same week was elected to the SACP's central committee.

A week later Madlala-Routledge was contradicted by Tshabala-Msimang who paid an announced visit there. Mbeki later publicly affirmed his minister's views in his ANC Today column and it was clear then the deputy was on thin ice.

The president later acknowledged to reporters that he was looking into the deteriorating relationship between the pair.

As the screws were turning on Madlala-Routledge, information of an unauthorised visit to Spain with her son and special adviser was selectively leaked to the Sunday media, setting the stage for this week's climax.

Speaking in East London on Wednesday, Ngculu said his criticism of Madlala-Routledge was motivated by her unfair comments about conditions at the hospital and the fact she had upset doctors and nurses there and not because he was privy to information that she was about to be fired.

During the hospital tour, Ngculu asked its head of Obstetrics and Gynaecology, Justus Hofmeyr, if there was any truth to Madlala-Routledge's comments that medical practitioners were "playing God" in deciding which patient lived or died.

Hofmeyr responded there was no truth in the statement.

The portfolio committee had visited the hospital following media reports which suggested that staffing and equipment problems at the hospital had led to hundreds of baby deaths every year.

Madlala-Routledge had said Frere's problems were an example of the health care system's massive systemic crisis, threatening a breakdown. Ngculu stopped short of calling her irresponsible.

"As to why someone would make such grotesque remarks, I don't know. We've been here yesterday and today and we have not seen a cause for a national emergency," said Ngculu.

He said he was "taken aback" by the deputy minister's comments.

The Treatment Action Campaign was in a meeting last night over the Madlala-Routledge dismissal and was not immediately available for comment.

The SACP and Cosatu were also waiting for official confirmation before commenting, while the DA expressed concern that Mbeki had taken sides and in its opinion fired the wrong person.