IOL said she was "reviled" and "disastrous",[3] the Mail & Guardian said had "a reputation as Mpumalanga's own Nurse Ratched",[2] and the Treatment Action Campaign said she was "a disaster".
[3] Her tenure coincided with the peak of the HIV/AIDS epidemic in South Africa, which was especially severe in Mpumalanga, but she adhered to the AIDS-skepticism propagated by the national government under President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang and she actively resisted the roll-out of antiretroviral drugs in public health facilities in the province.
[4] Manana said that the provision of antiretrovirals constituted an attempt to undermine the government's policy and ordered GRIP to leave the public hospitals where they worked.
[5] When doctors and administrators in public hospitals objected, they faced reprisal: at least five senior administrators were charged with gross misconduct for advocating for GRIP to remain in their facilities,[4] while at least three doctors were fired from public hospitals in the province for having signed memoranda in support of the prescription of post-exposure prophylaxis for rape victims; the Labour Court later found that they had been dismissed unfairly.
[7] At the same time, after the Constitutional Court ordered in 2002 that public hospitals had to provide access to mother-to-child transmission prevention drugs, Manana was viewed as "the worst offender" in failing to implement this directive.
The opposition United Democratic Movement said that "going to jail in solidarity with her MEC is the first constructive proposal she has ever made in her entire term of office".
[7] In late August 2003, Premier Mahlangu announced that two forensic audits into the department had "revealed issues of management and aspects of gross negligence in the procurement of medical equipment and the use of the HIV/Aids budget".
[3] He therefore reshuffled the Executive Council, appointing Manana as MEC for Sports, Recreation, Arts and Culture;[3] she remained in that portfolio until the 2004 general election.