“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;
• 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:
• Haematology and Oncology;
• Endocrine and Metabolic diseases;
• 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.