Mandela hospital faces funding crisis

• Treasury denies it promised to cover running costs • Not part of Gauteng’s budgeting plans

It took R1bn in donations to build the Nelson Mandela Children’s Hospital in Johannesburg, but nine months after its launch party, the world-class facility is not fully open yet and lacks funding to cover operational costs.

Built by the Nelson Mandela Children’s Fund and owned by a trust established by it, it was envisaged that the hospital would be a state-of-the-art facility for children needing cancer treatment, dialysis or heart operations.

It has top-of-the-range equipment, theatres that can broadcast operations to remote locations for training or for communicating with specialists abroad. It looks like a children’s hotel, is decorated with wallpaper inspired by doodles, has free living facilities for 27 families and an in-house radio station.

But the hospital has never been part of government’s long-term infrastructure or budgeting plans. It is estimated that it needs half-a-billion rand to cover annual operating expenses, but got R150m from the Treasury for the 2017-18 financial year.

The Treasury has allocated R200m for 2018-19 and R300m for 2019-20 as the hospital is gradually commissioned. There are fears among some doctors, though, that it will become a white elephant.

Government-owned tertiary hospitals are funded 65% by the national government and 35% by the government of the province in which they are located.

But the Nelson Mandela Children’s Hospital has not attracted any funding from the Gauteng health department, with which it is yet to build a relationship.

The hospital is not part of the long-term health plan for Gauteng or the tertiary services longterm infrastructure plan, says the Treasury.

When it was built, the trust told donors that the government would cover running costs. Its website says: “The government has committed to funding the annual operational running costs of the Nelson Mandela Children’s Hospital.” Hospital CEO Mandisa Maholwana said the government “endorsed and committed to supporting the hospital as early as 2009”.

But the Treasury said it never made such an undertaking.

“This hospital was built by a nonprofit organisation prior to receiving any formal financial commitments by government.”

An agreement between the trust and government was

signed only in 2016. “Towards the end of 2016, this commitment was formalised with a written agreement between the hospital and government,” Maholwana said.

The Treasury has not promised funding after the 2019-20 financial year, but would “reevaluate as the commissioning takes place and in line with performance”, it said.

Maholwana said the hospital trust was fundraising to gather the balance. “The main objective for us is to use the government funding to cover the baseline cost and be able to top up all the operational needs though fundraising.” The hospital was supposed to open in December 2016, but took in its first patients only late in June 2017. About 100 day patients have had Magnetic Resonance Imaging (MRI) scans or cat scans. The procedure spares them from joining waiting lists at the Chris Hani Baragwanath or Charlotte Maxeke hospitals.

But doctors want to know if the R150m can be seen as money well-spent when top specialists are being paid handsomely to attend to a few day patients.

Two anaesthetists and a cardiologist, paid by the government, have been employed. The head of paediatric intensive care unit and paediatric nephrology started in September. Tiso Black Star journalists visited the hospital in August and during the entire day two children received MRI scans — about three hours’ work for one anaesthetist.

“Do we need it?” asked a state doctor. “Yes, but considering they get R150m a year and are seeing maybe 30 outpatients a week, we could do a lot more with that money if it went to clinics seeing hundreds of patients a week.”

It is already a “white elephant”, said one private doctor.

Maholwana said safety concerns around child patients had delayed the opening. But the Treasury put the postponements down to a shortage of funds, saying operations would be ramped up as capacity and resources became available.

Maholwana said that staffing in general posed a problem.

There was a countrywide shortage of specialised paediatric surgeons, cardiologists, paediatric anaesthetists and paediatric nurses. “You must appreciate when trying to recruit these highly specialised staff, it is a daunting task. There are never enough specialised doctors and specialised nurses,” he said.