He was known for unilaterally ordering the expansion of the province's antiretrovirals programme during the HIV/AIDS epidemic, in defiance of the policy of the national government under President Thabo Mbeki.
A founding member and former chairperson of the Inkatha Freedom Party, Mtshali was also national Minister of Arts, Culture, Science and Technology in the government of President Nelson Mandela from 1996 to 1999.
[5] In late 1998, the respected director-general of the Department of Arts, Culture, Science and Technology, Roger Jardine, resigned from the portfolio, reportedly due to difficulties in his relationship with Mtshali.
[1] Jardine was reportedly concerned about the use of state funds for this purpose, especially because the feast was perceived by critics as an instrument of partisan IFP campaigning ahead of the 1999 general election.
[12] He also decided unilaterally that all business of the KwaZulu-Natal government would be conducted in Ulundi, an IFP stronghold; the decision met strong resistance from the ANC and the Democratic Alliance (DA).
In 2001, when the Treatment Action Campaign sued the government in an attempt to force it to expand its mother-to-child transmission prevention programme, Mtshali backed the lawsuit.
[4] Then, in January 2002, Mtshali announced in a press release that he would defy the national government and distribute nevirapine to every pregnant HIV-positive woman in the province, in order to curb mother-to-child transmission.
I have turned upside down the scientific facts to find a reason which can justify the failure to act and ameliorate the suffering and reduce the death of so many of our children and I have found none.