It’s been a year since the release of a damning Health Ombud’s report on Rahima Moosa Mother and Child Hospital (RMMCH). This month also marks the end of the last deadline the Gauteng Department of Health was given to act on recommendations in the report, writes Ufrieda Ho for Spotlight.
At 80-years-old, RMMCH is an iconic landmark in Johannesburg. But it has gone from a one-time outlier for excellence to being in steady decline, marked by what the report criticised as incompetent leadership, neglect and crumbling infrastructure.
In May 2022, the hospital suffered a public low point when paediatric gastroenterologist Dr Tim de Maayer penned an open letter slamming multiple failings at the facility. Public outcry resulting from the letter, complaints from hospital users, and a widely circulated video of pregnant mothers sleeping on hospital corridor floors, prompted the Ombud’s investigation.
When Spotlight visited the hospital at the end of last month (February), there were positive outward signs that recent maintenance work had been completed, per the Ombud’s recommendations. Some areas had been painted, and surfaces where underground sewer pipes had to be unblocked had also been tarred.
The stench from overflowing sewage has disappeared. Renovations to the antenatal care ward, shown in the video that went viral, are also near completion, and the ward is expected to be operational again by mid-March.
The hospital is also part of the roll-out of the provincial health information system (HIS) and admin staff were seen enrolling new patients on the system. The long-awaited HIS will modernise patient file storage and make files accessible at facilities province-wide.
These encouraging advances since the Ombud’s investigation get the thumbs up from hospital insiders. But they flag that even though the Gauteng Department of Health has announced a six-year renewal plan for the hospital and R53m was approved in December 2023 for the next phase of renovations, the department is playing catch-up and still dragging its feet.
CT scanner – empty promises
For Dr Z, the biggest of her current concerns is that the CT scanner has not been operational for 14 months.
“We have to beg other hospitals to do our scans. So even when you have a patient who actually needs a scan, you think twice – you ask yourself do they really, really need it or should you just watch them for another couple of months? It’s very demoralising and we keep hearing empty promises from management.”
A shortage of clerical staff means clerks are shared between departments, resulting in inevitable administrative glitches and delays, as well.
There is also a growing need for child mental health services, but the hospital doesn’t have in-patient psychiatry services and only has sessional psychological services.
The hospital has around 1 200 staff, serving up to 2 300 people admitted per month, as well as 10 000 outpatients each month.
Safety and security resurfaced as a concern last month, after a hijacking in the parking area. The Ombud’s report also looked into the hijacking of an intern’s car during its investigation period.
Parking, too, is a daily frustration – there are only 300 bays for staff on the campus but at least 400 vehicles need a place to park at peak times. Visitors have to park on the streets.
Mr Fixer
Acting CEO Dr Arthur Manning took up the job in an acting capacity in September 2023, as part of the Ombud’s recommendation to redeploy previous CEO Dr Nozuko Mkabayi, whom the government oversight body found to be a dismal failure.
Manning calls himself “a fixer”. His role, he recognises, has been to halt the slide for RMMCH, also to boost staff morale, restore communication channels, and regain the community’s trust in the facility.
“We are a system under pressure and we know there is burnout and low morale but we have improved counselling support and try to recognise and thank people. We held a nurses’ awards dinner last year exactly for these reasons,” he says.
The hospital organogram was last updated in 2006, but he has submitted a revised one to the Health Department. It makes the case for more admin and support staff, more junior and training doctor posts, and bolstering psychiatric and psychological services. These, he adds, are especially necessary because services for children are particularly neglected.
On the CT scanner, “procurement is under way”. It’s a planning failure that the machine is five years beyond its expected lifespan and was not replaced sooner, resulting in the current gap.
Manning says Gauteng Health is now piggybacking on Limpopo’s procurement contract. Piggybacking refers to provisions in the Public Finance Management Act that under certain conditions, allow a department in one province to procure goods and services via a contract that a department in another province has concluded with a service provider.
Manning says Gauteng is currently concluding an X-ray equipment tender, which has delayed the procurement of the CT scanner for RMMCH.
Approval to use Limpopo’s tender contract eliminates some red tape and means the scanner and maintenance contract has been secured for R30m. By May, he says, the hospital will also have an MRI-scanning facility.
Staff spruce up waiting area
Manning has been credited by some for shifting morale and competently overseeing the interventions set out in the Ombud’s report.
He points out a freshly painted waiting area in a department where children play with new toys and crawl on bright green Astro turf. More than half the money for this project came from doctors and nurses raising funds by cycling and running in race events in the city.
Keeping staff motivated means their concerns and working conditions – including the parking problem and safety and security – have to be priorities, he says.
On safety and security, the hospital has stepped up collaboration with local police and the community policing forums to increase patrolling around the hospital, especially around shift changes.
“We have expanded our CCTV camera coverage, requested armed security control, and we’re exploring panic button systems.”
Bigger budget, permanent CEO
There are two key outstanding issues from the Ombud’s report. The first is reclassification of the hospital – which is also an academic and training hospital – from a regional facility to a tertiary hospital.
“This involves national (department), but when reclassification is done, it will mean RMMCH's budgets and grants will be adjusted and we will be able to do so much more,” Manning said.
The second issue is the appointment of a permanent CEO, which is “being handled by central office”. Manning side-steps a question on whether his name is in the mix. It’s expected that there will be an announcement on the new CEO in April.
Professor Ashraf Coovadia, academic head of Paediatrics and Child Health at Wits University and who heads up this department at RMMCH, says Manning has “been good for RMMCH”, but, above the level of CEO, it’s the Gauteng Department of Health that needs to get its house in order. He says there has been a lack of communication, consultation, transparency and decisive action from Gauteng Health for years.
“A CEO can do only so much. When we have having acting heads in so many departments who are in acting positions for forever, it’s a joke. It means decisions don’t get made or decisions don’t get made for the long run, which compromises how the hospital is run and the care we give patients.”
Even though water and electricity supply issues at RMMCH have improved, infrastructure fixes remain patchy, he adds. “There are fewer issues of burst pipes and flooding, but it’s still happening.” Coovadia has been with the hospital for 26 years, and knows better than most the precariousness of the situation and why the hospital is not yet out of the woods.
“The negative attention did bring about some positive change. But it can make you cry when you see the slide over the past 10 years. The hospital is not collapsing, but there are daily collapses.”
See more from MedicalBrief archives:
SIU to probe Rahima Moosa after ombud’s report
Doctors flag high death risk as Rahima Moosa dysfunctionality exposed
Callous disregard at ‘dirty’, ‘filthy’, ‘unsafe’ Rahima Moosa – Ombud
Doctors back paediatrician’s account of Rahima Moosa collapse