Madiba hospital struggles to cover operational costs

It took R1-billion 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 and it can't cover its operational costs.

Built to help state and private patients needing cancer treatment, dialysis or heart operations, it was intended to be a model of what national health insurance could offer. But it needs R500-million a year to cover its operational expenses - and received only R150-million from the state for the 2017-2018 financial year. Some doctors fear it will become a white elephant.

The hospital has top-of-the-range equipment, and operating theatres from which procedures can be broadcast for training or involving specialists abroad.

It looks like a children's hotel, has free accommodation for 27 families of patients and an in-house radio station.

The Nelson Mandela Children's Hospital Trust told donors that the government would cover running costs.

Hospital CEO Mandisa Maholwana said the government "endorsed and committed to supporting the hospital as early as 2009".

But asked why all costs had not been covered, the Treasury told The Times: "This hospital was built by a non-profit [organisation] prior to formal financial commitments by the government."

The Treasury has allocated R150-million to the hospital for this financial year, and has earmarked R200-million for 2018-2019 and R300-million for 2019-2020.

An agreement between the trust and the government was signed last year, said Maholwana. The Treasury has not promised funding after the 2019-2020 financial year but would "re-evaluate as the commissioning takes place and in line with performance".

The hospital was to have opened in December but the Treasury did not allocate money beforehand so employees could not be hired.

Running costs of R500-million a year were calculated by consultants in 2010. Maholwana said that that estimate could rise, given the rand's weakness and the increasing cost of imported drugs and equipment.

He said the hospital trust was still raising funds. "The objective is to use government funding to cover the baseline cost and top up all the operational needs though fundraising."

The hospital opened in June. About 100 day patients have had CAT scans, which spared them from long waits at Chris Hani-Baragwanath Hospital or Charlotte Maxeke Hospital.

Doctors ask if the R150-million has been properly spent because top specialists are paid well to attend to just a few day patients. Two anaesthetists and a cardiologist are paid by the government. The paediatric ICU and paediatric nephrology head started work in September.

The Times visited the hospital last month. Two children underwent MRI scans in the entire day. That should have taken about three hours' work for one anaesthetist.

The Treasury said conditional grant funding for the hospital could legally amount to only 65% - at most - of its costs. The hospital would have to raise the balance.

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

Staffing is another problem. There is a countrywide shortage of specialist paediatric surgeons, cardiologists, paediatric anaesthetists and paediatric nurses.

"Recruiting these highly specialised staff is daunting. There are never enough specialist doctors and specialist nurses," said Maholwana.

"Do we need it?" asked a state doctor. "Yes, but considering they get R150-million 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."

Health department spokesman Joe Maila said the hospital was needed. "We need more. In other countries they have many more children's hospitals than the whole [African] continent," he said.