Donor Resource Centre

The Process

Pre-Feasibility Study

 

After the Nelson Mandela Children’s Fund initiated the Nelson Mandela Children’s Hospital, a Pre-Feasibility Study on the need for a specialist children’s hospital in South Africa was conducted. The study confirmed the level of need and defined the vision for the Hospital.

 

Feasibility Study

 

Marvin Bostin and Associates and RSBD Architects, international consultant with experience in hospital planning were commissioned to conduct a full feasibility study, which was completed in 2008. The study concluded that there was indeed a need for a tertiary care referral centre to serve the tertiary care needs of children nationally, with a focus on specialised services. It also stated that this centre should also be a clinical research facility to partner with major hospitals around the world. The Feasibility Study also identified the site where the Hospital should be located.

 

The Pre-Feasibility and Feasibility stages were funded by a network of local and international donors.

 

Preparation of the Business Case
 KPMG, the international auditing firm, and Life Healthcare, a leading private hospital operator, were appointed to compile the Hospital business case with particular reference to the appropriate operating model, academic platform, financial model, as well as financial projections for the design and construction, and the operating costs of the Hospital.

 

Strategic Partnerships

 

Government National Department of Health (NDoH): In 2009, NMCH received support from the Minister of Health, Dr Aaron Motsoaledi. Grants were identified for the funding of the Operating Expenditure (Opex) of NMCH.

 

Gauteng (Province) Department of Health and Social Development (GDHSD): In 2010, the Hospital was awarded an exemption from the Private Hospital License (i.e. license to operate), which means that NMCH will be allowed to operate as an entity for public good. In addition, GDHSD signed a Memorandum of Understanding with NMCH, committing to support the Hospital.

 

Provincial and National Departments of Treasury: The department will oversee the implementation process of the government grant, and will be responsible for the allocation of the Opex.

 

Provincial and National Departments of Education: Due to NMCH’s training departments, NMCH will apply for grants from the departments to benefit health professionals training and researching here. Models for the training component of the Hospital will be formalised.

 

Strategic Partnerships with Universities

Once the ideal site was identified, the University of Witwatersrand, in 2009, committed campus land to NMCH as a site for the hospital. The site is on the Wits Education (JCE) campus in Parktown, Johannesburg, adjacent to the Wits Medical School and Charlotte Maxeke Johannesburg Academic Hospital. A Site Dedication Ceremony was held as part of Mr Mandela’s 91st birthday celebrations.

In addition, Wits will be a strategic anchor for the training and research platforms on a non-exclusive basis, thus allowing both local and international institutions to participate. Concept Design In 2010, Sheppard Robson International, in conjunction with John Cooper Architecture, GAPP Architects and Urban Design (SA), and Ruben Reddy Architects (SA) were commissioned to design NMCH. A detailed design will be concluded by the end of 2011.

Construction and Commissioning Construction will commence at the beginning of 2012, with commissioning and opening of the Hospital taking place in 2013.

Regional Significance

As a not-for-profit organisation, the Nelson Mandela Children’s Hospital will be a critical resource that not only services South Africa, but the rest of the Southern African region as well. It will offer specialised care to all children – fulfilling
Mr Mandela’s dream to make world-class health care available to all children in Southern Africa, while and creating a regional training platform.

 

Child Health Care

  • NMCH will offer specialised care for all paediatrics through referral protocol to its Centres of Excellence in Haematology and Oncology, Cardiology and Cardiothoracic Surgery, Endocrine, Renal, Neurosciences, Craniofacial, and Paediatric Surgery.
  • No child will be turned away because of their inability to pay.
  • The Hospital will provide a comfortable, safe, homely 
environment that prioritises children’s needs above all else.
  • The Hospital will offer accommodation for parents of out-of-town 
patients on long stays.
  • The Hospital will begin to change the perceptions of the South 
African health services, particularly as it relates to children. 
Training/Academic
  • NMCH will collaborate with medical institutions from throughout the Southern African region, and internationally.
  • The Hospital’s partnerships with global child health institutions will contribute towards improving skills, increasing knowledge, and new discoveries in treatments.
  • Bring new knowledge to tertiary and quaternary levels of paediatric medical services through research, teaching and training.
  • There will be interdisciplinary and collaborative clinical excellence to ensure holistic care.

Technology

The use of advanced, modern technology will:
• be crucial to the training of medical professionals across the

region (for example, the use of telemedicine);
• improve on the current practice of paediatric healthcare in the

region, and indeed the continent;
• contribute towards not only patient care and treatment, but also

administrative tasks associated with the cost-effective running of the Hospital.

“We must use time wisely and forever realise that the time is always ripe to do right.”

Infrastructure

• NMCH will be built by a not-for-profit organisation, through collaborative partnerships between government and non- government organisations.

• There will be additional bed and theatre capacity, easing the current resource strain on the health sector in Southern Africa.


• Building the hospital within easy reach of international and regional airports, NMCH will be in the favourable position to receive patients from throughout the region in the shortest possible time.


How will the Nelson Mandela Children’s Hospital affect funding for other hospitals?


The Nelson Mandela Children’s Hospital (NMCH) does not aim to compete with other hospitals – it will complement them and their work in paediatric medicine, and will not affect funding initiatives for other South African hospitals.

What about primary and secondary health care?


Primary and secondary healthcare facilities will continue to be taken care of by the State. It was found that the biggest backlog is in the treatment of level-3 (tertiary) care for children. For example, at one South African hospital, there is an estimated backlog of 300 children awaiting cardiac surgery. This could result in some of them dying without this needed surgery.

Who will fund the running of the Hospital?


Capital funding of NMCH will come entirely from donors, and once the Hospital has been established, its operational expenditure will be funded by the National Department of Health, through the Treasury funding regulations.

How did you choose the Centres of Excellence?


Research and consultation with various clinical specialists showed that the biggest gap in paediatric healthcare, and therefore the biggest need, was in treating conditions associated with certain specialities. NMCH will have the following Centres of Excellence: Haematology & Oncology; Cardiology & Cardiothoracic Surgery; Neuro- sciences; Renal; Endocrine; Craniofacial; and Paediatric Surgery.

Why have the Hospital in South Africa?


NMCH will be in Parktown near Wits Medical School in Johannesburg. Gauteng is the hub of South Africa and many developments in Southern Africa. South Africa has among the best healthcare professionals in the world, and with the Hospital in Gauteng, it will mean patients have access to world-class health care through NMCH’s collaboration with other medical institutions. In addition, Johannesburg being the hub of South Africa and a gateway to the region means the Hospital will be easily accessible by public transport and by air.

Why have a dedicated children’s hospital?


Children’s healthcare needs are different from those of adults, and having a dedicated facility that caters for children (from neonates up to a 14 years old), as opposed to a paediatric centre in an “adult” hospital, means NMCH will be a child-friendly environment with an ethos focussed on a well-rounded healing experience for children. It also ensures that the Hospital is specifically designed and equipped for their needs.

How were the architects chosen?


Architects from around the world, with children’s hospital design experience, were invited to be part of an architectural design competition, where the most-qualified bidders were chosen to present design proposals. A panel of qualified professionals from various industries then scored them and the top four bidders were interviewed. The collective that was chosen consists of Sheppard Robson and John Cooper Architecture (both from the UK), working with GAPP Architects and Ruben Reddy Architects (both from South Africa). The collaboration with South African architects was to bring capacity to the local industry and ensure that it conforms to local conditions and meets statutory architectural requirements.

The hospital costs appear to be high in comparison with other hospitals. Why is this?


Tertiary services are expensive by their nature, and paediatric tertiary services are even more expensive. This is due to the high-tech equipment required to diagnose and treat children. The costs for NMCH are on par with international norms.

he hospital costs appear to be high in comparison with other hospitals. Why is this?


The Nelson Mandela Children’s Hospital (NMCH) does not aim to compete with other hospitals – it will complement them and their work in paediatric medicine, and will not affect funding initiatives for other South African hospitals.

What about primary and secondary health care?


Primary and secondary healthcare facilities will continue to be taken care of by the State. It was found that the biggest backlog is in the treatment of level-3 (tertiary) care for children. For example, at one South African hospital, there is an estimated backlog of 300 children awaiting cardiac surgery. This could result in some of them dying without this needed surgery.

Who will fund the running of the Hospital?


Capital funding of NMCH will come entirely from donors, and once the Hospital has been established, its operational expenditure will be funded by the National Department of Health, through the Treasury funding regulations.

How did you choose the Centres of Excellence?


Research and consultation with various clinical specialists showed that the biggest gap in paediatric healthcare, and therefore the biggest need, was in treating conditions associated with certain specialities. NMCH will have the following Centres of Excellence: Haematology & Oncology; Cardiology & Cardiothoracic Surgery; Neuro- sciences; Renal; Endocrine; Craniofacial; and Paediatric Surgery.

Why have the Hospital in South Africa?


NMCH will be in Parktown near Wits Medical School in Johannesburg. Gauteng is the hub of South Africa and many developments in Southern Africa. South Africa has among the best healthcare professionals in the world, and with the Hospital in Gauteng, it will mean patients have access to world-class health care through NMCH’s collaboration with other medical institutions. In addition, Johannesburg being the hub of South Africa and a gateway to the region means the Hospital will be easily accessible by public transport and by air.

Why have a dedicated children’s hospital?


Children’s healthcare needs are different from those of adults, and having a dedicated facility that caters for children (from neonates up to a 14 years old), as opposed to a paediatric centre in an “adult” hospital, means NMCH will be a child-friendly environment with an ethos focussed on a well-rounded healing experience for children. It also ensures that the Hospital is specifically designed and equipped for their needs.

How were the architects chosen?


Architects from around the world, with children’s hospital design experience, were invited to be part of an architectural design competition, where the most-qualified bidders were chosen to present design proposals. A panel of qualified professionals from various industries then scored them and the top four bidders were interviewed. The collective that was chosen consists of Sheppard Robson and John Cooper Architecture (both from the UK), working with GAPP Architects and Ruben Reddy Architects (both from South Africa). The collaboration with South African architects was to bring capacity to the local industry and ensure that it conforms to local conditions and meets statutory architectural requirements.

The hospital costs appear to be high in comparison with other hospitals. Why is this?


Tertiary services are expensive by their nature, and paediatric tertiary services are even more expensive. This is due to the high-tech equipment required to diagnose and treat children. The costs for NMCH are on par with international norms.

How will the NMCH be staffed?


Management: The NMCH Trust will establish a Hospital Board of Directors to manage and run the day-to-day operations of the Hospital. The Board will appoint the senior executive team, consisting of a CEO, CFO, COO, Head of Nursing, Head of Clinical Services and so forth.

Clinical staff will be jointly appointed with the provincial Department of Health, and would be augmented, where required, by expertise from the private sector. Nursing staff and allied workers will be employed by NMCH. Non-core services will be outsourced to an appropriate hospital management company. The severe shortage of paediatric specialists and nurses has a direct correlation to the cost of training and retaining these professionals.


How will NMCH change the lives of children?


There are nearly 450 million children in Africa, and only four children’s hospitals – two in Cairo, one in Kenya and one in Cape Town. The children of Africa have limited access to paediatric care as it is, and without the NMCH, a countless number of children could die due to an inability to afford or access healthcare facilities. NMCH will also create capacity in the region so that more children can be treated, the waiting lists will be shorter, and reduce the child mortality rate.

“A children’s hospital will be a credible demonstration of the commitment of African leaders to place the rights of children at the forefront. Nothing less would be enough”. – Nelson Mandela
The Nelson Mandela Children’s Hospital (NMCH) represents the culmination of a lifetime committed to fighting for the basic rights of all South Africans, in this case specifically the rights of children to proper specialist care.
The Hospital sets the bar for modern child-centred healthcare facilities, introducing unique approaches to its funding, operations, staffing and training capabilities. Above all, the Nelson Mandela Children’s Hospital represents the ultimate legacy project to carry the great patriarch’s name as a living legacy and final tribute to his unbounded love of children.

 

The Need for a Children’s Hospital

 

In recent years, one of Nelson Mandela’s wishes has been to offer the children of South Africa, of Southern Africa, and indeed of Africa, a state-of-the- art hospital. The Nelson Mandela Children’s Fund (NMCF) and I have personally been entrusted to realise Madiba’s wish. A board has been established and a huge amount of thought and institutional setting has been generated. – Mrs Graca Machel
The desire to establish a children’s hospital is about entrenching Mr Mandela’s values in our society, particularly his value for the care of children, and his love and compassion for children. It helps to address a very real need in the Southern African region. The Nelson Mandela’s Children’s Fund (NMCF) was privileged and honoured to be asked by Mr Mandela to champion this very important initiative.

 

Africa as a whole suffers from a dire lack of dedicated paediatric facilities, with only four such facilities on the continent – two in Cairo (a general paediatric hospital and an oncology centre), one in Nairobi and one in Cape Town. This compares dismally to the 23 children’s hospitals in Canada, 19 in Australia and 20 in Germany.
Cognisant of the role that a children’s hospital can play in providing specialist care in the region, admissions will be open to children from the SADC region, who most need specialised care.
A concept that is central to the development, design and operation of the Hospital is that children are not ‘little adults’ and therefore have specific needs that are not adequately catered for in a paediatric ward of a general hospital. The hospital’s founding partners, administrators and staff are committed to recognising the right of all children to be cared for in a child-focused environment.

 

A study confirmed that:
• The current levels of paediatric service provision is generally 
overwhelmed by the demand for health services;
• Waiting times for tertiary services are too long;
• The high mortality rate for children under the age of five in SA 
and neighbouring countries is unacceptable, even by developing 
nation standards;
• The increase in primary and secondary healthcare requirements 
has, in some cases, resulted in a reduction in budgetary allocation for tertiary care.

 

Realising the Dream

The decision to go ahead with the concept as envisioned by the NMCF is substantiated by a comprehensive study conducted under the auspices of local and international advisors including KPMG and Life Healthcare. 
The findings of the full feasibility study conducted by Marvin Bostin and RBSD Architects, international consultants with experience in paediatric hospital planning and design, highlighted that:
• There is an urgent need for a specialist tertiary care referral centre 
to serve the needs of children nationally, irrespective of socio- economic status;

 

• The hospital should also be a clinical research facility forming partnerships and alliances with major local and international hospitals;
• The hospital should contain 308 beds with a number of Centres of Excellence, which is aligned to the SA Department of Health’s Modernisation of Tertiary Services strategy;
• The hospital should be implemented in phases to strengthen viability, with the initial phase comprising 200 beds.

 

Nelson Mandela Children’s Fund – The Promoter

 

The Children’s Hospital is the being driven by the Nelson Mandela Children’s Fund (NMCF), which has evolved since its establishment in 1995 from a purely grant-making organisation into an internationally recognised advocacy institution focusing on the rights of children.

 

The Hospital project ties in directly with the Fund’s vision to ‘change the way society treats children and youth’. It is now a separate corporate entity, with a Board of Trustees and management team established for the project.

 

A key factor that will enable the long-term success of the Hospital is the collaboration with the South African Department of Health as its operations partner that will bear the operational costs.

 

Key Partners and Stakeholders

 

The nature and scale of the project are dependent on a broad range of stakeholders working toward a single goal, contributing funds, networks and skills to see the Nelson Mandela Children’s Hospital become reality. 
To this end, the Hospital Board of Trustees and management have established relationships that represent a unique public-private partnership approach to public healthcare in the region.
These partners include:

• National and Gauteng Departments of Health who will oversee certain operational success factors

• National and Provincial Treasury that will provide the funding to
cover operational expenses

• University of Witwatersrand in Johannesburg as the owner and land rights to the site location as well as providing the academic link with industry.

 

 

The NMCH Hospital Profile

 

The Nelson Mandela Children’s Hospital will provide:

• Intensive Care Unit, including
• Neonatal and Paediatric Intensive Care Units, as well as Neonatal and Paediatric High Care Units;
• Chemotherapy, cath lab and theatre, MRI and CT;
• Theatres, including: Cardiac, Neuro, Ophthalmic and ENT, Orthopaedic and Craniofacial;

• Screening rooms;

• Nuclear medicine, Angiography, Ultrasound, and Panorex;

• Overnight facilities;

• Counselling rooms and prayer room;

• Waiting rooms and parents accommodation;

• Pathology lab;

• Pharmacy;

• Coffee shop, laundry, cleaning, catering, administration, admissions and pre-admission facilities;

• Gardens, playrooms and play spaces for children;

• Outpatient clinic area;
• Small trauma resuscitation facility;

• Parent residential accommodation;

• Academic clinical research support areas;

• Academic teaching area and library.

 

The essence of the Hospital is to be a dedicated specialist referral children’s hospital that focuses on optimising the healthcare experience from the child’s perspective.

 

Furthermore, it will complement and consolidate specialist paediatric care by operating as a public benefit organisation that provides services to children referred from both the private and public sectors. This role will be enhanced through its proposed research and teaching capabilities that will be entrenched through partnerships with local and international academic institutions and leading medical schools. It is expected that this will have the added benefit of introducing new knowledge to tertiary and quaternary levels of medical services.
Admission to the hospital will be strictly through referral according to structured clinical criteria, with a view to extending the reach of the Hospital into the SADC region over the medium term.

 

Centres of Excellence

 

The Centres of Excellence will serve multiple purposes that will have a clear and definite long-term impact on the provision of specialist paediatric care in the region.
The Centres of Excellence will provide specialist care and produce research in the fields of:

• Cardiovascular;

• Neurology;
• Haematology and Oncology;

• Endocrine and Metabolic diseases;

• Renal;

• Paediatric surgery including cranial/facial surgery;

• Multiple systems, Gastrointestinal and Respiratory diseases.

NMCH Location and Design

 

The Hospital will be located in Johannesburg, Gauteng, South Africa’s most densely populated province. It is both the economic and transportation hub for the entire SADC region, and therefore the most logical and central location if it is to meet its mandate of serving the region’s population. The selected site is on the Wits Education (JCE) campus in Parktown adjacent to the Wits Medical School and Charlotte Maxeke Johannesburg Academic Hospital. The Nelson Mandela Children’s Hospital has been designed by a consortium consisting of Sheppard Robson and John Cooper Architecture of the UK, and GAPP Architects and Ruben Reddy Architects from South Africa. The interior of the building has been designed to provide optimally for paediatric care and patients through appropriate spatial layout of treatment facilities and patient accommodation, recreational and learning areas. The building will also draw heavily on the latest in environmental design principles and techniques that will reduce electricity and other operational costs.

 

NMCH Governance Structure

 

The governance structure of the NMCH is as unique as all other elements of the project, and is designed to facilitate representation of its strategic partners in all decision-making processes of the hospital.
This structure comprises the NMCH Trust as the initiator and custodian of the project, with the Asset Company (AssetCo) and Operating Company (OpCo) set up as not-for-profit organisations that will managed the assets and operations respectively.
Some of South Africa’s leading philanthropic and business heavyweights sit on the Board of Trustees. This group is led by Mrs Graca Machel, wife of Nelson Mandela and a participant in numerous high-level people-centred projects including the UN Foundation, the African Leadership Forum and the International Crisis Group. Other notable board members include Zenani Mandela-Dlamini, daughter of Nelson Mandela and Winnie Madikizela-Mandela, Moss Ngoasheng, a respected business leader and former Robben Island political prisoner, and former Reserve Bank Governor Tito Mboweni who chairs the NMCH Fundraising Committee. The Trust and the OpCo aims to adhere to the principles of the King III Code and the best practice recommendations in the King III Report.

 

NMCH Staffing Strategy

 

The intention has always been to draw primarily on South African medical professionals to staff the Hospital, with specialist expertise ‘imported’ to supplement skills where necessary. Given the exodus of medical skills from South Africa over the past two decades, the Hospital is expected to act as a catalyst to repatriate skilled individuals who share its vision and goals.
Attracting the right level and mix of professionals is a key consideration in formulating the staffing strategy, with incentives, remuneration and the work environment and schedule designed to draw the best and most dedicated talent.
Doctors can expect a doctor to inpatient day ratio of 1:1,6, which is expected to produce the appropriate care for a high care unit such as the Hospital. Their work schedule is also designed so that they spend 70% of their time on direct and indirect patient care and 30% of their work week on formal teaching duties.

 

NMCH Financial Requirements

 

A public-private collaboration arrangement, incorporating philanthropic giving and donor funding as well as government and medical insurance reimbursement are the cornerstones of the Hospital’s financial model.
The Hospital requires between R800 million – R1 billion for the first phase (200-bed facility), with operating expenses calculated at about R417 million per annum. The operational costs will be covered by the South African Department of Health through its unique partnership with the NMCH.
The entire Capex component is expected to be raised through donor funding, with the NMCH Trust’s fundraising committee working to secure funding from a broad range of international institutional and private sources.

 

The Way Forward

 

The project is entering the final development phase, with the past four years dedicated to finalising the concept, operations and funding of this unique Hospital. Construction will commence during the latter part of 2011, with commissioning and opening of the Hospital taking place in 2013.