web_vol47 4.pdf - International Hospital Federation

Management: Paediatric hospitals
The proposed Nelson Mandela
Children’s Hospital, Johannesburg:
Providing the best care for children
in the developing world
KEITH BOLTON
LEAD CLINICIAN, NELSON MANDELA CHILDREN’S HOSPITAL, SOUTH AFRICA
ABSTRACT: Construction will soon commence on the Nelson Mandela Children’s Hospital (NMCH) in Johannesburg, South
Africa. The Hospital will have 250-300 beds and will provide tertiary and quaternary care to children in specific Centers of
Excellence. Admission to this referral facility will be based entirely on medical needs. The disciplines that are catered for
include Paediatric surgery, oncology, nephrology, cardiology, intensive care and imaging. The NMCH will be South Africa’s
first “Private Hospital – Not for Gain”. Funding for capital expenditure is currently being raised by the Trust. Operational
expenditure will come from the Department of Health, private insurers and neighbouring governments.
South Africa has a long history of provision of health care
services of a very high standard. In the Apartheid era the
White minority enjoyed superior “first world” care while
Black Africans were relegated to much lower standards of care.
Since democratization, a two-tier system persists; with the
medically insured minority population receiving excellent care while
the uninsured majority rely on a failing public health system. As
noted by Ataguba et al. (2011): “South Africa represents a classic
example of the inverse care law; the lowest socio-economic
groups bear the largest burden of ill-health but have the lowest
level of health service utilization and derive the least benefits from
service use.”
The South African government has concentrated its efforts on
the provision of primary and secondary care. This is appropriate
especially in the face of the rampant HIV and tuberculosis
epidemics. After a shaky start, the HIV campaign is beginning to
bear fruit with a plateau in new infections and a marked diminution
of mother-to-child transmission. Unfortunately, there has been an
inevitable, gradual deterioration of some tertiary and quaternary
services. The Nelson Mandela Children’s Hospital (NMCH) aims to
address some of these deficts in the northern part of South Africa
and the sub-continent.
South Africa has, at present, one dedicated, comprehensive
children’s hospital, the Red Cross Memorial Children’s Hospital.
The hospital enjoys a high reputation for paediatric care. This
facility is situated in Cape Town, at the Southern tip of the
continent and is not ideally situated to easily provide care outside
of the region. Spurred on by the CEO, Sibongile Mkhabela, the
Nelson Mandela Children’s Fund decided to build a tertiary
children’s hospital in Johannesburg to provide for very specific
paediatric needs in a central area of the country and accessible,
not only to the local children but to the region. The hospital will be
a private-public partnership; the first South African hospital run on
a “private but not for gain” mandate.
The vision of the NMCH
The facility will be a state-of-the-art paediatric academic referral
hospital providing child-centered, best quality medical care, in
specific disciplines, to children of Southern Africa, irrespective of
their social and economic status. The project is strongly
supported by our patron, Mr Mandela and his wife, Graça Machel
who chairs the NMCH Trust.
The hospital
The NMCH will be situated on land donated by the University of
the Witwatersrand, adjacent to the Health Sciences Facility and
the Charlotte Maxeke Johannesburg Academic Hospital. There
will be 250 beds initially with a phased-in planned increase to 300
beds. The design has been facilitated by international and local
architects with clinician input at every stage. Building will
commence early in 2012.
The NMCH will form an integral part of the service, teaching,
training and research platforms of the Deaprtment of Paediatrics
and Child Health of the Faculty of Health Sciences of the
University of the Witwatersrand. There are also close affiliations
with other university faculties in the region. Partnerships and
“twinning” with international faculties are envisaged.
The “centers of excellence”
To optimise the effectiveness of the NMCH, we have identified
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