Controversy over Nelson Mandela Children’s Hospital funding

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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.

Management says, however, that the hospital in a “comfortable position”. According to a City Press report, Dr Mandisa Maholwana, CEO of the hospital says that she is not worried about the finances of the hospital.

“I think it was clear from all the conversations today that there is a clear commitment, from Treasury and the National Department of Health to assist Nelson Mandela’s Children Hospital with operational expenses. So, on our side I do feel confident that Treasury and department of health will come through with that commitment,” she said.

Dr Ernest Kinoshi, the acting head of the Gauteng Health Department, said that the government was aligned to fully supporting the initiatives of the hospital by setting aside R600m towards the running of the hospital.

But, the report says, perhaps one of the highlights of the hospital’s birth has been the collaborative effort by the City of Johannesburg. Dr Mpho Phalatse, mayoral committee member for health and social development said that the City was committed to offering assistance to the hospital, and that by identifying some of the ailments which the children are brought in with, the city would be able to identify certain “hotspots” in the city that could be the cause or reason for children getting sick.

“We’ve got a huge commitment to prioritising healthcare in the City of Johannesburg. Access to early childhood development is important for us because these children grow up to become important people,” Phalatse said.

The report says the hospital pharmacy as well anaesthesiology were operational in June, and by the end of this financial year the next phase of the hospital was expected to open which includes the cardiology outpatient department and the renal and surgical units.

 

 

Built by the Nelson Mandela Children’s Fund and owned by a trust established by it, Business Day reports that 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 report says, 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 long-term 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.” And, Maholwana said the government “endorsed and committed to supporting the hospital as early as 2009”.

But the report says, Treasury said it never made such an undertaking. “This hospital was built by a non-profit 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 “re-evaluate 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 in the report that 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.

 

 

The Nelson Mandela Children’s Hospital says when it’s running at full capacity it will have the funds to cover operational costs. And, Maholwana says in an Eyewitness News report, R150m received from the government is enough for now.

“The R150m is for us to start for the first financial year, so it’s adequate and was budgeted accordingly with the National Department of Health for us to deliver services. Our operational model for the hospital was always a combination of government funding but also some donor funding.”

Meanwhile, Health Minister Aaron Motsoaledi has criticised claims that government has failed to honour its agreement to fund the hospital. Motsoaledi says this is nonsense as the money is being released in stages.

 

 

The Times has, meanwhile, defended its report on the hospital’s funding crisis. The report says: “Power FM talk show host‚ Bob Mabena‚ has called the TimesLIVE‚ Business Day and Sowetan story on the crisis “sensational” three times‚ suggesting that the facts had been twisted. The report says that this was during his interview with  Maholwana‚ on why the hospital was still not open after nine months and had a funding crisis.

The report says: “This is our response to Mabena’s claims.
“First some background: The hospital was set to open in December 2016‚ according to the trust’s own documentation still available on their website. Donors‚ some that gave R100m in one go‚ were told that the government would fund operational costs‚ as is still stated on the website. It does not appear that donors were told that the grant that funds it by law can only pay 65% of its operating costs. And the hospital has seen around 100 day patients since June for MRI scans but has no overnight patients despite the fact it was supposed to open last year.”

The report says here are some of the claims from the interview:
Claim 1: Mabena claimed the Nelson Mandela Children’s Hospital was the only hospital that a sick child confined to bed could see out of the window.
Mabena said: “A child would not be able to see outside the hospital if they were staying in a normal hospital. Just a simple thing like that … to be able to see life outside the hospital. The Nelson Mandela Children’s Hospital has such facilities.”
Fact: Nelson Mandela Hospital is unique in that every bed has a window view‚ but there are other hospitals where some children’s beds are near windows. Red Cross Children’s Hospital has many beds with a window view‚ TimesLIVE confirmed with staff at the hospital.

Claim 2: Maholwana said: “We are comfortable we received enough funding from Treasury to be able fund us for the first financial year. It was agreed to open the hospital in phases‚ so it is of no surprise to people in the know as to why we are opening in the manner that we are.”
Fact: In her interview with TimesLIVE‚ Maholwana said the hospital needed at least R500m to run each a year and had received R150m for this financial year. She said the oncology department would not open this financial year. She said they were still fundraising and that it needed more money. Maholwana to the TimesLIVE: “The main objective for us is to use the government funding to cover the baseline cost and be able to top up the all operational needs though fundraising … We are actively doing a fundraising drive with the (Nelson Mandela Children’s Hospital) trust. We are looking donors to make an impact outside of South Africa (and treat children from other countries). We are still relying on donations.”

Claim 3: Mabena said TimesLIVE/Business Day stories “were sensationalism at best”.
Fact: The hospital would not open its oncology wards in the next financial year‚ the CEO confirmed. It is almost 10 months since the opening of the hospital and the intensive care unit (ICU) is not open. It has yet to have a single overnight patient. A paediatric surgeon has not been hired so no surgery can take place yet. What is sensational is that if an almost empty hospital is taking up R150m and needing months and months to open and is already 10 months late.

Claim 4: Mabena: “I was at the hospital when it opened in December and it is really quite fantastic.”
Fact: Yes‚ it is fantastic inside with beautiful paintings on the wall depicting images from kid’s story books‚ gorgeous design‚ Seshweshwe wallpaper inspired by kids’ doodles and top-of-the range medical equipment. But it technically it hasn’t opened. It was a launch party. It took seven more months from the 2 December party to late June before it saw its first patient for an MRI scan.

Claim 5: Government agreed to fund it.
Maholwana said: “There was a conversation in 2009 with Madiba and we had an agreement that he would build hospital in terms of infrastructure and then Treasury would give funding for operational expenses.”
Fact: This is true‚ government said verbally it would fund it. But Treasury has said there was no funding commitment after 2019 /2020 financial year and the hospital was built before any written agreement. According to Treasury: “Government has not made commitments beyond these amounts at this point in time and will re-evaluate as the commissioning takes place and in line with performance. Note that this hospital was built by a non-profit prior to formal financial commitments by government.”

Claim 6: A hospital needs a year to 18 months to open. Maholwana said: “It is the nature of hospitals – this is what it entailed to commission and open a facility like this.”
Fact: No hospital needs a year to 18 months to open.

Claim 7: Mabena: “The sensational report that specialists are under-utilised and seeing 30 patients a week. This is from sources so to speak?”
Fact: The specialists are under-utilised. And yes‚ journalists have sources. The cardiologists at the hospital do not do catheterisations for closing holes in infants’ hearts because there is no ICU open. The anaesthetists have a handful of patients a day to sedate for MRIs.

Claim 8: Nelson Mandela is a purely referral hospital with no walk-in patients.
Yes‚ it is. Maholwana said it was a referral hospital and had seen cases referred from Charlotte Maxeke Johannesburg Academic Hospital and Chris Baragwanath Hospital.
Fact: Even though it is a referral hospital‚ this does not explain why it has so few patients 10 months after the launch.

City Press report
Business Day report
Eyewitness News report
The Times report


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