HILLBROW HEALTH PRECINCT

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HILLBROW HEALTH PRECINCT Powered By Docstoc
					JOHANNESBURG MEDICAL QUARTER

                  Business Plan
                     Draft 1

                                         August 2005




International Organisation Development South Africa
GAPP Architects & Urban Design
PD Naidoo & Associates
Ingrid Obery
Alex van den Heever




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PROJECT DESCRIPTION

1      LOCATION
The Johannesburg Medical Quarter (JMQ) is located in an area covering about 2.5 km²
of the inner city and northern suburbs of Johannesburg. It falls partially within the
Johannesburg Inner City, and is bounded by Rock Ridge, Jubilee and Queen Streets in
the North, Boundary, Fife and Claim Streets in the east, Smit Street in the south and Jan
Smuts Avenue, Empire and Joubert streets in the west. This area falls within the
Johannesburg & West Rand Region (Region A) of the Gauteng Department of Health’s
administrative system.

The area comprising the JMQ is a mixed-use area with public and private health care
facilities, a medical school, residential areas and commercial business areas.
The public health facilities in the JMQ are:
     • Johannesburg Hospital is a National Department of Health, tertiary care and
         teaching hospital
     • Hillbrow Community Health Centre is a Gauteng Department of health facility
     • Esselen Street Clinic is a City of Johannesburg health facility that also serves as
         an important HIV/AIDS and reproductive health research and training facility for
         Wits University’s Reproductive Health Research Unit / RHRU
     • National Health Laboratory Services
     • National Council for Occupational Health
     • Johannesburg Medical-Legal Centre
     • National Blood Transfusion Services
All the above facilities, with the exception of Johannesburg Hospital, are located within
the Hillbrow Health Precinct (HHP). The HHP is one of the catalytic projects for the
development of the JMQ that is already underway and is subject to a separate business
plan and development programme led by the JDA.

Private health facilities in the JMQ are
    • Rand Clinic (Netcare)
    • Brenthurst Clinic (LifeHealthCare)
    • Park Lane Clinic (Netcare)

The only not-for-profit hospital in the JMQ is Donald Gordon Medical Centre. It is a non-
profit specialist training hospital associated with Wits Medical School. Although Medi-
Clinic recently bought a 49% share in the Donald Gordon Medical Centre, this will not
change its non-profit status or its focus on training.

A number of key development initiatives surround the area or have potential linkages to
the area. These include:
• Constitution Hill, which is a JDA-led tourism heritage and education precinct
    development comprosing the Constitutional Court and old Women’s Prison complex.
• Braamfontein Regeneration corridor, which entails streetscape improvements, the
    cultural campus gateway and civic theatre plaza upgrade
• Hillbrow-Berea Regeneration Initiatives, including the Ikhaya neighbourhood
    precinct, potential City of Johannesburg Economic Development Unit “sectional title


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    pilot projects“ and various “Better Building” programmes and private sector housing
    projects
•   Gautrain upgrade of Park Station and the Inner-City Distribution System, which are
    important to consider for purposes of accessibility and connectivity in the JMQ,
    especially around the planning for a proposed JMQ shuttle service.
•   Wits Spatial Framework: The campus of Wits University, which forms part of the
    JMQ, is to be redeveloped according to this framework. The framework has been
    approved by the Board of Wits University, but its implementation is contingent on the
    availability of funding. It would be important to synchronise implementation of the
    Wits Spatial Framework with the development of the JMQ, especially when it comes
    to the exploration of land use options.)
•   Greater Ellis Park Sports Precinct, which is being developed with a view to South
    Africa’s hosting of the Soccer World Cup in 2010. It will be especially important to
    coordinate support for the development of the Unit for Exercise Science and Sports
    Medicine in the JMQ with developments in this precinct.

The JMQ is strategically co-located close to these initiatives in the area and as they
develop, the JMQ should seek to forge links with, and strengthen inter-connectivity
between these developments.

2      GOAL AND VISION
The founding vision of the JMQ is to create an environment that enables delivery of
excellent, affordable, comprehensive health services, research and development
through partnerships between public, private, Not-for-Profit Organisations and academic
institutions.
This vision was agreed at a JMQ stakeholder workshop on 22 June 2005. It is
underpinned by the JDA-led commitment to promote and strengthen economic activity in
line with the Johannesburg 2030 vision.

3      STRATEGY
The strategy of the JMQ project for the JDA is to support the achievement of this vision
with an added emphasis on strengthening and growing economic activities in the health
sector primary economy and giving impetus to the development of a range of viable
secondary supportive economic activities.

The approach adopted in the Business Plan is based on the following fundamental
purposes:
1. Improving and expanding health, education, research and training cooperation and
    activities among all partners; and
2. Facilitating expansion of primary and secondary economy activities within the JMQ.

Implementation of the strategy for the development of the JMQ will pose unique
challenges to the JDA. The JMQ is not a short-term development, nor is it highly capital
intensive. Rather, it is an area-based initiative that focuses on economic growth and
service delivery within the health sector. Key to the sustainable development of the JMQ
will be the continuous identification of new development opportunities, facilitation of
partnerships and relationships to pursue those opportunities and ensuring a favourable




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policy and regulatory environment for the ongoing growth and development of the area
through such opportunities.

A large, complex and long-term development of this nature requires a strong institutional
home and driver, and JDA’s ongoing support for and involvement with this institution for
the three years from the adoption of this Business Plan will be very important.

The Business Plan focuses on the following five broad strategies to develop the JMQ:

3.1 Institutional Arrangements to drive and manage the development
The JMQ development will eventually be driven by a Coordinating Institution that will
guide and manage the continued development of the JMQ. This institution will comprise
of representatives of key stakeholders in the JMQ who will bring their organisation and
sector expertise to bear in directing the integrated and sustainable development of the
JMQ.

The institutional arrangements for the JMQ are discussed in more detail in section 8.

3.2 Development Nodes
Establish development nodes in health care delivery and in health-related research and
education, training and skills development.

3.3 Development of the Health (Primary) Economy
Increase the number of health service and health service support facilities and the range
of their provision.

3.4 Development of the Secondary Economy
Increase the range of secondary economic activities and facilities, including retail and
service activities.

3.5 Area-based Development
Establish an accessible and well-managed Quarter with a clearly recognised brand and
identity, acknowledged and integrated within city and provincial development strategies
and planning frameworks, and strengthen the current ‘missing link’ along the Park Lane
– Brenthurst Clinic access.


4       OBJECTIVES
Each strategy has project objectives, which will be delivered by a specific sub-project or
activity. The strategic objectives and proposed sub-projects for the development of the
JMQ are:

4.1     Institutional Arrangements
To put in place appropriate institutional arrangements to guide and oversee
implementation of the JMQ business plan and to eventually manage the continued
development of the JMQ.

4.1.1   Establish and support the Project Board and interim institutional arrangements.


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4.1.2   Monitor and review performance of the Project Board and develop a final
        Coordinating Institution with suitable legal persona and governance
        arrangements - most likely a Section 21 company.
4.1.3   Develop and implement a funding strategy for continued institutional operations,
        future sustainability and project interventions.
4.1.4   Produce the Coordinating Institution strategic plan for engagement with:
        • Gauteng Department of Finance and Economic Affairs to ensure continued
           alignment between the development of the JMQ and priorities in the Gauteng
           Growth and Development Strategy – also to draw on funding available for
           developments in the JMQ from this source.
        • City of Johannesburg for incorporation into the current IDP, Spatial
           Development Frameworks and operational plans of UACs;
        • City of Johannesburg and Gauteng Departments of Health and Public Works
           to ensure acknowledgement, alignment and incorporation of JMQ initiatives as
           appropriate in departmental operational plans;
        • Donor/funding partners in the sectors of International Development
           Cooperation and Corporate Social Responsibility for purposes of securing
           financial assistance for JMQ activities.

4.2     Development Nodes
To assist member institutions to achieve individual and collective goals of excellence in
health care delivery, and in health-related research and education, by building on
existing and encouraging the growth of expertise to establish development nodes

4.2.1   Establish a development node for health-related training and education, including
        facilities, equipment and specialist training packages;
4.2.2   Facilitate development of the Centre for Exercise Science and Sports Medicine,
        with due attention to related developments;
4.2.3   Facilitate communities of practice (cross-fertilisation of skills and experience)
        among management and practitioners (for example around biomedical research
        and hospital management) to strengthen links and identify commercial
        opportunities within current initiatives to build knowledge-based industries.

4.3     Development of the Health (Primary) Economy
To stimulate economic development and health service delivery through the expansion
of the number of health facilities and activities in the JMQ:

4.3.1   Facilitate expansion of current health facilities operating at high capacity through
        planning support, land identification and development facilitation;
4.3.2   Facilitate provision of further doctor’s rooms in the JMQ
4.3.3   Investigate and engage for a facilitative regulatory regime in operating licences.

4.4     Development of the Secondary Economy
To minimise economic leakage from the JMQ, build the secondary economy within the
area:

4.4.1   Identify and market land opportunities for secondary economy activities (eg retail)
        and supporting facilities (eg accommodation, transport);




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4.4.2   Engage with JMQ stakeholders to identify potential opportunities for outsourced
        and subcontracted work for suitable Black Economic Empowerment (BEE) and
        Small and Medium Enterprise Enterprises (SMMEs).
4.4.3   Conduct consumer and market research to inform the potential for different kinds
        of retail developments and the location of such developments in the JMQ.

4.5     Area-Based Development
To ensure ongoing development and growth of the JMQ:

4.5.1   Present a business case and (if positive) facilitate the establishment of a JMQ
        shuttle service, with due attention to the Integrated Transport Plan and
        developments around the Inner-City Distribution System and the Gautrain Feeder
        Distribution System, as well as possible cost sharing arrangements with the
        existing Wits University student bus service;
4.5.2   Plan and implement small-scale capital works for public transport, traffic, signage
        and streetscape improvements including, amongst others, relieving traffic
        congestion around Johannesburg Hospital, facilitating pedestrian traffic around
        Park Lane and Brenthurst clinics, and addressing safety issues around Park
        Lane, Brenthurst and Rand clinics and by improving lighting.
4.5.3   Put forward the establishment and operation of a City Improvement District for
        consideration by the Project Board.
4.5.4   Implement a marketing and branding exercise to create a JMQ identity and
        presence.
4.5.5   Conduct detailed research to confirm development opportunities in the JMQ,
        including the site of the Youth Theatre.


5       OUTCOMES AND KEY INDICATORS
The outcomes and key indicators of the development of the JMQ are as follows:

 Objective              Outcome                                   Indicator
 Institutional          Different JMQ stakeholders are actively   Effective representative Institution
 Arrangements           cooperating in the development of the     established and operational by end
                        area                                      of Year 1
 Development Nodes      Viable development partnerships           Increase in number of new research
                        among practitioners and institutions in   projects, training and service
                        the JMQ in areas of health service        delivery opportunities being pursued
                        delivery, training and research           by effective Communities of Practice
                                                                  from a pre-determined baseline.
                                                                  Public and Private sector
                                                                  stakeholders agree on curricula for
                                                                  training of different categories of
                                                                  health care workers by end Year 1.
                                                                  A coordinated programme for
                                                                  practical training of health care
                                                                  workers include stations in both
                                                                  public and private facilities by end
                                                                  Year 2.




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                                                                        Plan for the optimal utilisation of
                                                                        available health technology in the
                                                                        JMQ agreed between public and
                                                                        private stakeholders by end Year 1.
 Development of the          Increased economic activity related to     • Increased beds and facilities for
 Health (primary)            the Primary (Health) Economy in the          health institutions operating at
 Economy                     JMQ                                          high capacity
                                                                        • Increase in the number of people
                                                                          working in the health sector in the
                                                                          JMQ
                                                                        • Increase in the budget of public
                                                                          health facilities in the JMQ
                                                                        • Increase in the number of patients
                                                                          in public and private hospitals in
                                                                          the JMQ
                                                                        • Increase in number of potential
                                                                          developments
                                                                          projects/opportunities identified by
                                                                          the Project Board
                                                                        • Increase in the number of
                                                                          students, researchers and clients
                                                                          at the Centre for Exercise Science
                                                                          and Sports Medicine
 Development of the          Increased economic activity ion the        • Increase in the number of
 Secondary Economy           JMQ related to the Secondary Economy           enterprises in the JMQ by the
                                                                            end of Year 2
                                                                        • Increase in the number of people
                                                                            employed in the secondary
                                                                            economy in the JMQ by the end
                                                                            of year 2
 Area-Based                  Better managed public, private and         Increase in valuation of property
 Development                 institutional property stock in the JMQ
 Area-Based                  Improved public perception and image       Annual survey of public perceptions
 Development                 of the area                                (include JMQ in existing Surveys)

6        ALIGNMENT TO POLICY AND STRATEGY FRAMEWORK
6.1      Johannesburg 2030
Joburg 2030 is the vision and strategy for the growth and development of the city for the
next 25 years. Development of the JMQ supports Joburg 2030 in the following respects:

Vision 2030                                JMQ aspect
Research, training and skills              The JMQ will facilitate growth in all three of these areas,
development are key focus sectors in       particularly through identifying opportunities for research and
supporting economic growth                 training in the medical and health care fields and facilitating
                                           partnerships to pursue these opportunities and to grow related
                                           clusters of economic activities.
Integrating the vision and strategies of   Development of the JMQ will give impetus to the integration of the


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the Province with that of the City of     vision and strategies of the Province with that of the City of
Johannesburg                              Johannesburg by identifying areas where the two spheres could
                                          work jointly, including to improve urban management and
                                          governance and to reduce duplication between spheres of
                                          government and seek improved ways of integrating or
                                          coordinating health service delivery in the JMQ.
Improved spatial planning to facilitate   The Urban Design Framework for the JMQ assists in improving
economic growth                           spatial planning to facilitate economic growth.

Joburg 2030 is being reviewed and re-aligned with the consultation process on its key
components scheduled to being in July 2005. Given the economic significance of the
health sector in the JMQ (which has an expenditure of at least R1.5 billion per annum),
this provides an opportunity for a case to be made for the inclusion of the health sector
as a focus of sectoral support via accelerated investment and creation of an environment
conducive for development.

6.2      Mayoral Priorities
The Executive Mayor of Johannesburg has identified six priorities for his period of office.
These are Inner City regeneration; economic development and job creation; public order
and safety; service delivery excellence; good governance; and addressing the HIV/AIDS
epidemic. The JMQ complies with these priorities in the following areas:

Mayoral Priority                          JMQ aspect
Inner City regeneration                   • Parts of JMQ within inner city already being upgraded as part
                                             of Hillbrow Health Precinct, including Esselen Street.
                                          • Current regeneration initiatives in areas surrounding JMQ are
                                             having a positive impact and will be taken into account in
                                             ongoing planning of the JMQ.
Economic development and job              • Direct contribution through growth of health sector/services and
creation                                    creating secondary economic growth opportunities.
Public order and safety                   • Contribution by private sector facilities to ensuring security
                                            along their street frontages and public thoroughfares.
Service delivery excellence               • Integrated, comprehensive health care provision by creating
                                            partnerships between public and private sectors.
                                          • Standards of service delivery improved through research by
                                            communities of practitioners.
Good governance                           • Different authorities and stakeholders involved in management
                                            and ongoing development of JMQ, through the project
                                            coordinating institution. The Project Board will build cooperative
                                            governance and stakeholder partnerships.
Addressing HIV/AIDS                       • Ongoing work by RHRU/Esselen Street Clinic, with scope for
                                            involving other JMQ stakeholders;
                                          • Roll-out of Anti-Retroviral treatment programme at
                                            Johannesburg Hospital and Esselen Street Clinic;
                                          • Clinical trials for new drugs;
                                          • Research to improve diagnostic procedures.

6.3      Integrated Development Plan

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The CoJ Integrated Development Plan 2005/06 (IDP) emphases the need to deepen
local democracy, to continue to build developmental local government, especially by
further improving social and economic development, to enhance political and economic
leadership, to speed up service delivery, and to further enhance an integrated approach
to development. The JMQ business plan either incorporates or is aligned with these in
the following ways:

IDP                                        JMQ aspect
Deepen local democracy                     • Local stakeholders will be involved in planning and decision-
                                              making around the development of the JMQ
Build developmental local government,      • Development of the JMQ will involve relevant CoJ departments
especially by further improving social     • Key to the development of the JMQ is the identification of
and economic development                     economic and social development opportunities and the
                                             creation of strategic partnerships to pursue these opportunities
Speed up service delivery                  • The growth and improvement of health service delivery is
                                             explicit in the development of the JMQ
Enhance an integrated approach to          • Development of the JMQ will require local and provincial
development                                  authorities, as well as stakeholders from the private sector,
                                             non-profit sector and academic institutions to discuss and
                                             coordinate development of the JMQ

6.3.1 Sector Plans
The IDP sets out a series of sector plans to give effect to the Joburg 2030
Strategy, aligned with Mayoral priorities. Of relevance for the JMQ are the Integrated
Transport Plan (ITP) and the Inner-City Distribution System (ICDS), which is one of the
key programmes being prioritised in the ITP for 2005/2006.

ITP                                        JMQ aspects
Safe and efficient transportation with a   • A proposed JMQ shuttle service is to be investigated and, if
public transport focus that will support     viable, implemented. Linkages to the Inner-City Distribution
a world class city                           Plan and Gautrain Feeder Distribution System are taken into
                                             account.
Connecting businesses, people and          • The proposed JMQ shuttle service will be aimed at facilitating
places in a sustainable and cost-            access to health facilities in the area
effective manner
Improving standards of living and          • The proposed JMQ shuttle service will be aimed at facilitating
quality of life of inhabitants and the       access to health facilities in the area
overall competitiveness and growth of
the CoJ’s economy

ICDS                                       JMQ aspects
Improve accessibility and connectivity     • The proposed route for the JMQ shuttle takes account of the
within the Inner City                        ICDS. From Park Station it links the ICDS to a shuttle route
                                             that provides access to the health facilities in the JMQ

6.3.2 Urban Development Zones



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Legislation introduced at the end of 2003 allows for a tax incentive in respect of the
erection, extension, addition or improvement of buildings demarcated within Urban
Development Zones (UDZs) in selected cities of South Africa, including Johannesburg.
The UDZ tax incentive is directed at the stimulation of the regeneration of declining
urban areas, in targeted inner city areas across South Africa, and the encouragement of
economic development. The Johannesburg UDZ covers the area known as the Inner
City, which has been promulgated as the only UDZ for Johannesburg.

The UDZ creates opportunities for the development for those areas of the JMQ that falls
within the inner city. This will support and complement implementation of the JMQ
Spatial Design Framework.

6.3.3 City Scorecard and Key Performance Areas
The IDP links mayoral and Joburg 2030 priorities to overall performance of the council
administration via the ‘City Scorecard’ and key performance areas (KPAs). The JMQ
aligns to the following KPAs identified for attention in 2005/06:

City Scorecard and KPAs              JMQ aspects
Enhance customer service and         • The growth and improvement of health service delivery in the
improve basic service delivery and     public and private sectors is explicit in the development of the
provision of free basic services       JMQ
Enhance human development and        • Development of the JMQ will improve and enhance health
ensure consolidation of HIV/AIDS       services in the city
initiatives within the city          • Through development of the JMQ, key stakeholders in the
                                       health sector in the city will discuss and coordinate planning
                                       and development of the JMQ, including HIV/AIDS initiatives.
Ensure inner city regeneration       • The Hillbrow Health Precinct, which is located in the inner city,
                                       forms part of the JMQ
Ensure financial sustainability,     • Development of the JMQ will focus on development of both the
economic development and job           primary (health) economy and the secondary (retail) economic
creation                               in the area. A key indicator of successful development is the
                                       creation of jobs.

6.3.4 Inner City Regeneration Strategy
The Inner City Regeneration Strategy (ICRS) was approved by the CoJ Mayoral
Committee on 27 February 2003, and has a goal to raise and sustain private investment
leading to a steady rise in property values.




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The ‘five pillars’ of the Strategy are to:



                                Raise & sustain private
                           investm ent leading to steady rise
                                  in property values



                                                                                     Maintain
                            Ripple-           Support           Intensive
                                                                                         /
         Address             pond            Econom ic            urban
                                                                                     upgrade
        sinkholes           invest-           sectors           m anage-
                                                                                       infra-
                             m ents                               m ent
                                                                                     structure




•   Address Sinkholes (slummed and neglected properties and neighbourhoods)
•   Promote Ripple-pond investments (catalytic, concerted investments in property
    that create confidence for further investment in adjacent areas)
•   Support Economic Sectors (interventions to promote and assist growth of
    economic sectors that are of current or potential importance).
•   Undertake Intensive Urban Management (by-law enforcement, regular or improved
    delivery of services and utilities, and maintenance of the public realm)
•   Maintain and upgrade infrastructure (maintenance and improvement of service
    delivery infrastructure)

The programmes and projects identified to give effect to the Inner City Regeneration
Strategy are set out in the Inner City Business Plan 2004/07 (approved March 2004),
where the HHP is identified primarily as a project to support economic growth. As the
part of the JMQ that falls within the inner city, the HHP aligns with all five pillars of the
ICRS.

6.3.5 City Plan for Health (IDP 2004/2005)
The plan of the City of Johannesburg health department, as articulated in the IDP for
2004/2005, places a strong emphasis on the provision of primary health care, including
promotive and preventative health service delivery, while identifying HIV/AIDS and the
increasing demand for health services as a result of urbanisation among its main priorities.
To contribute to a healthy population and a healthy environment in the City of Johannesburg,
the health department has identified a number of Key Performance Areas, the following of
which the development of the JMQ will facilitate and contribute to:

City Health Key Performance Areas     JMQ aspects
Enhance health service delivery       • The growth and improvement of health service delivery in the
                                        public and private sectors is explicit in the development of the
                                        JMQ
Improve access to and optimise        • Planning of the JMQ considers aspects of accessibility and



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comprehensive primary health care         connectivity
service delivery within the city       • Esselen Street Clinic and the Hillbrow Community Health
                                          Centre, both of which provide PHC services, are located in the
                                          JMQ
Effectively address the challenge of    • Esselen Street Clinic, which is well-known for providing
HIV/AIDS in the community                 HIV/AIDS services and care in an inner-city catchment area,
                                          and which is a site where RHRU conducts research andt
                                          raining in HIV/AIDS care and support, is situated in the JMQ
Develop an integrated approach to      • Stakeholders from the public and private sectors, as well as the
optimise health services city wide        non-profit sector and academic institutions will plan and
                                          coordinate the development of the JMQ, including health
                                          services
Impact on inner city regeneration      • The Hillbrow Health Precinct, which is located in the inner city,
                                          forms part of the JMQ

In addition, the department identifies staff training, development & re-orientation, with a
focus on customer service, as a priority. Planned activities in the JMQ will have a strong
focus on education and training and could contribute directly to this.

6.3.6 Spatial Elements
Development of the JMQ addresses and is aligned with several priorities in the Spatial
Development Framework, including to the following:

Spatial Development Framework          JMQ aspects
Ensure movement                        • JMQ Proposed Shuttle Service
Promote nodal development              • Several potential development identified, including
                                         development node for Training and Skills Development and the
                                         centre for Exercise and Sports Medicine
Reinforce Corridor Development         • JMQ forms part of an institutional belt including the University
                                         of Johannesburg, the SABC, various schools, the University of
                                         the Witwatersrand, Wits Technikon, the Johannesburg Civic
                                         Centre and several health care institutions
Implement area-based initiatives and   • JMQ is an area-based initiative
interventions

6.4      JDA Business Plan
The JDA Business Plan 2005-2006 identifies five Strategic Objectives that will guide it to
delivering the six Mayoral Priorities for the City of Johannesburg. Development of the
JMQ, is included as project number 15 in the current JDA portfolio. Developments are
already underway in the Hillbrow Health Precinct, which forms part of the JMQ.
Development of the JMQ will contribute in the following ways to the delivery of the JDA
Business Plan 2005-2006:

JDA Business Plan Strategic            JMQ aspects
Objective
Promoting economic growth through      • Development of the JMQ is aimed at promoting economic
the development and promotion of         growth of and related to the health sector/industry



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efficient business environments in
defined geographic areas
Regenerating decaying areas of the         • HHP, which forms part of the JMQ and is located in the inner
city so as to enhance their ability to       city of Johannesburg, focuses on the regeneration of the area
contribute to the economic                   around the Esselen Street Clinic and Hillbrow Community
development of the city and the quality      Health Centre
of life it its residents
Promoting economic empowerment             • JDA-led capex projects will adhere to affirmative procurement
through the structuring and                  requirements
procurement of JDA developments
Promoting productive partnerships and      • A Project Board representative of all relevant stakeholders in
cooperation between all relevant             the JMQ will guide and inform the process of developing the
stakeholders on area-based initiatives       area
Developing best practice and               • Proposed Coordinating Institution will be the first of its kind in
organisational expertise in respect of       South Africa and will draw on lessons learnt from comparative
area-based development management            bodies in the USA


6.5 Gauteng Provincial Growth and Development Strategy
Development of the JMQ is aligned with the principles underlying the Gauteng Provincial
Growth and Development Strategy (PGDS) and its goals of accelerating economic
growth and job creation, to build sustainable communities and to develop healthy and
productive people. Within the context of relevant sectoral priorities, policies and
strategies, it will also give impetus to the six strategic objectives of the Gauteng PGDS:

Gauteng PGDS Strategic Objective                JMQ aspects
Provision of social and economic                • Contribute to effective health facilities and services
infrastructure and services that will build
sustainable communities and contribute to
halving poverty
Accelerated labour absorbing economic           •   Promote high-level labour-absorbing growth
growth that increases per annum and that            opportunities and development activities in the health
will create long-term sustainable jobs and          industry
contribute to halving poverty
Sustainable socio-economic development          •   Creating partnerships between public and private
                                                    sectors, but not dependent on government support and
                                                    resources
Enhanced government efficiency and              •   Strong emphasis on training and skills development,
cooperative governance                              including for public sector institutions
                                                •   Enhanced efficiency and effectiveness of public
                                                    institutions, regulatory environment and the interface
                                                    between the three spheres of government in health care
                                                    research, training and service delivery
Deepening participatory democracy,              •   Management of JMQ participatory and inclusive of all
provincial and national unity and citizenship       relevant sectors, spheres of government and community
Contributing to the successful achievement      •   JMQ activities and opportunities aimed at regionalising
of NEPAD’s goal and objectives                      and internationalising where possible




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Some of the strategic levers identified in the Gauteng PGDS provide real opportunities
for partnerships with the Gauteng Provincial Government, including the following:

Gauteng PGDS Strategic Levers                    JMQ aspects
Provision of accessible, affordable, reliable,   • The proposed JMQ shuttle service will expand and
integrated and environmentally sustainable          augment existing plans
public transport system
Public safety and Urban Information system       •   Initiatives to improve public safety in the JMQ could be
                                                     integrated with existing electronic surveillance systems in
                                                     the City of Johannesburg
2010 Football World Cup                          •   Centre of Exercise Science and Sports Medicine
                                                 •   World-class medical facilities accessible from Ellis Park,
                                                     Soccer City and associated training facilities
Public Health Services                           •   JMQ offers an opportunity and environment in which
                                                     consultation and collaboration can be pursued between
                                                     the provincial Health Investment Forum and financial
                                                     institutions, private sector operators, education
                                                     institutions, medical insurance schemes, medical
                                                     professionals and labour around the development of
                                                     business solutions to utilise the skills, resources and
                                                     opportunities of the public and private sectors and the
                                                     development of proposals for public sector hospital
                                                     recapitalisation and management revitalisation.
                                                 •   JMQ offers an opportunity and environment for the
                                                     development and offering of internationally competitive
                                                     health services and world-class medical facilities
Human Resource Development                       •   Training and skills development, including Continuous
                                                     Professional Development, have been identified as a key
                                                     driver of development in the JMQ
                                                 •   Opportunities for projects to unlock SETA funding will be
                                                     prioritised
                                                 •   Development initiatives in the JMQ will be driven by their
                                                     potential for economic development, therefore to
                                                     strengthening relationships between business and
                                                     academia, especially with respect to commercialisation
                                                     of research and development innovations
SMME development                                 •   Development of the JMQ holds potential for the
                                                     development of SMMEs in the area of manufacturing, as
                                                     well as clinical and non-clinical support services to health
                                                     care, research and education/skills development
                                                     practitioners/providers.
Government Institutional Efficiencies            •   Ongoing development of the JMQ will require close
                                                     collaboration and coordination between the three
                                                     spheres of government, as well as between government
                                                     and private sector stakeholders
NEPAD: The Gauteng PGDS identifies               •   JMQ has the potential to be a flagship provincial project
medical services as an important regional            in regionalisation and internationalisation in the health
integrator and the ‘high-end health hub of           industry
Africa’



                                                       14
6.6      Gauteng Department of Health Priorities
Development of the JMQ is aligned with the mission of the GDoH in that it will:
   • support the development and implementation of best practice health care
      strategies
   • contribute to the development of a caring climate for health service users
   • create opportunities for the forging of partnerships
   • contribute to the provision of excellent and appropriate training for health
      workers.

The JMQ also supports several of the strategic thrusts of the GDOH, including the
following:

Gauteng Dept of Health strategic         JMQ aspects
thrust
Promoting health, and preventing and     • The growth and improvement of health service delivery in the
managing illnesses with an emphasis        public and private sectors is explicit in the development of the
on poverty and lifestyle                   JMQ
                                         • One of the initiatives of the Centre for Exercise Science and
                                           Sports Medicine specifically address health issues related to
                                           lifestyle, while another concerns outreach to the poor living in
                                           inner-city communities
Effective implementation of the          • Esselen Street Clinic, which is well-known for providing
comprehensive HIV and AIDS strategy        HIV/AIDS services and care in an inner-city catchment area,
                                           and which is a site where RHRU conducts research and
                                           training in HIV/AIDS care and support, is situated in the JMQ
Strengthening the district health        • Development of the JMQ provides an opportunity and
system                                     environment for piloting and establishing the District Health
                                           System
Becoming a leader in human resource      • Proposed Development Node for Training and Skills
development and management for             Development in the JMQ
health
Operating smarter                        • Growing and improving health service delivery through
                                           partnerships between stakeholders in the JMQ

6.7      National Legislation and policy
6.7.1 National Health Act, 2004
The National Health Act of South Africa is aimed at regulating national health and to
provide uniformity in respect of health services across South Africa. The development of
the JMQ has to take place within the legislative framework set by the National Health
Act. While the JMQ supports various aspects of the National Health Act, it will be
important for the Project Board to ensure that the legislative environment remains
conducive to the ongoing development of the JMQ.
Areas of alignment between the JMQ and the National Health Act include the following:

National Health Act                      JMQ Aspects
Establishing a national health systems    • The JMQ provides an opportunity and environment in which
which encompasses public and private        greater cooperation and coordination between public and


                                                    15
providers of health services and              private providers can be facilitated.
provides in an equitable manner the
population of the country with the best
possible health services that available
resources can afford
The National Health Act distinguishes       • The JMQ creates opportunities and an environment in which
between the roles and responsibilities        implementation of the District Health System can be piloted,
of the national, provincial and local         including clarification of roles and responsibilities of provincial
spheres of government in the delivery         and local government and functional integration.
of public health services and it formally
establishes the District Health System
Adequate resources must be available        • The Development Node for health and health-related training
for the education and training of health      in the JMQ will contribute to the delivery of health care
care personnel to meet the human              personnel to South Africa and beyond. It will also provide for
resources requirements of the national        flexibility in the development and implementation of new
health system.                                training programmes that might be required for new categories
                                              of health care personnel.
Health research priorities are to be        • The JMQ provides opportunities and an environment in which
identified and advised by the National        Essential National Health Research priorities can be pursued
Health Research Committee                     in a coordinated manner.

The National Health Act also presents a possible legislative constraint to the
development of the JMQ in that it introduces the concept of certificate of need. This is
required for the establishment, construction, modification or acquisition of health
establishments of health agencies, including increasing the number of hospital beds in a
particular hospital, acquisition of health technology by a health facility, or providing a
specific service in a particular area/location. The JMQ will engage in the implementation
of this regulation and seek to ensure that it is applied in the JMQ development
objectives.

6.7.2 Strategic Priorities for the National Health System 2004 -
      2009
The strategic priorities for the National Health System for the period 2004 to 2009 and
the ways in which development of the JMQ contributes and aligns either directly or
indirectly to these can be summarised as follows::

National Health System Strategic Priorities                JMQ Aspects
Improving governance and management of the                  • The JMQ provides an opportunity and
National Health System                                        environment in which greater cooperation and
                                                              coordination between public and private
                                                              providers can be facilitated.
Promoting healthy lifestyles                               • One of the initiatives of the Centre for Exercise
                                                             Science and Sports Medicine specifically address
                                                             health issues related to lifestyle
Contributing towards human dignity by improving
quality of care                                            • The growth and improvement of health service
Strengthening primary health care, Emergency                 delivery in the public and private sectors is
Medical Services and hospital service delivery               explicit in the development of the JMQ
systems


                                                      16
Strengthening support services                    • Development of the JMQ provides opportunities
                                                     for strengthening relationships between health
                                                     care institutions and support services
Planning, managing and developing human            • The Development Node for health and health-
resources                                            related training in the JMQ will contribute to the
                                                     delivery of health care personnel to South Africa
                                                     and beyond. It will also provide for flexibility in the
                                                     development and implementation of new training
                                                     programmes that might be required for new
                                                     categories of health care personnel.
Strengthening international relations.             • Opportunities for regionalisation and
                                                     internationalisation of development initiatives in
                                                     the JMQ will be explored around service
                                                     delivery, training and skills development

In general, emphasis in the JMQ will be placed on the identification of development
challenges and opportunities in the health sector, and the facilitation of partnerships to
address and pursue these. The scope of activities is likely to address a variety of
challenges and opportunities related to the delivery and management of health services,
but also to health-related research, education and training. The good practices
‘incubated’ in the JMQ and its centres of excellence could benefit services, practitioners
and clients throughout the health system.

6.7.3 Private-Public Health Sectors Charter
The charter aims to kick-start discussions aimed at transforming the South Africa health
sector to ensure equity, and improve quality and access to health care for all South
Africans. It hopes to address these issues by, inter alia,
• encouraging dialogue for constructive cooperation between the public and private
   sectors
• basic training and Continuous Professional Development of larger numbers of
   personnel and the retention of trained personnel, which will require greater parity in
   working conditions and salaries between the public and private sectors
• putting greater emphasis on Broad-Based Black Economic Empowerment (BBBEE) in
   the health sector, specifically in the ownerships and management of health care firms
   and facilities. It sets specific targets for ownership and control by black people of firms
   and businesses in the health sector and calls for greater commitment from the private
   sector in implementing procurement policies and processes that are favourable to
   firms owned or controlled by black people.

The Charter, which was released on 11 July 2005, has been met with mixed reaction
from the private sector and political parties and will have to be kept under review by the
Project Board. Nevertheless, it is believed that the JMQ offers opportunities and creates
an environment where stakeholders can constructively engage in the development of the
health sector in line with the resolutions proposed in the Charter.

7        CURRENT SITUATION, CONDITIONS AND RISK
7.1      CURRENT SITUATION

                                             17
7.1.1 Health care facilities
Public health care services in the JMQ are provided by the CoJ Department of Health
(primary health care and local clinics) and the Provincial Department of Health (higher-
stage services and district-level facilities, including the Hillbrow Community Health
Centre and Johannesburg Hospital). Private health care facilities in the area include
Brenthurst Clinic, owned by Life Health Care Group (formerly Afrox Health); as well as
Rand Clinic and Park Lane Clinic, both owned by Netcare. The Donald Gordon Medical
Centre (DGMC) was established by the University of the Witwaterstand and Donald
Gordon Foundation as an NGO that provides sub-speciality training. Medi-Clinic recently
bought a 49% share in DGMC. This means that all three the major companies involved
in the private hospital sector in South Africa, namely Netcare, Medi-Clinic and
LifeHealthCare are now represented in the JMQ.

7.1.2 Urban Design Framework
a.     Urban Design

SECTION BEING RE-DRAFTED

b.     Traffic and Transportation

Traffic and public transportation are critical to the success of the JMQ in the sense of
facilitating access to the area and ensuring connectivity between the various medical
facilities. The current situation with regard to traffic and public transport in the JMQ is
characterised by the following:

Johannesburg Hospital (JH):
   • Klein Street is a wide and generally uncluttered road.
   • There are regular bus and minibus taxi services between Johannesburg Hospital,
      Johannesburg Station, Bree Street and Rosettenville.
   • There is a bus terminus at the entrance to the JH, where passengers can be
      dropped off and picked up. Minibus passengers can be dropped off at the
      entrance to JH, but cannot be picked up there.
   • There are metered taxi ranks at the entrance to JH.

Hillbrow Hospital/ Esselen Street Clinic
    • These facilities are relatively close to Johannesburg Station and regular taxi
       services run along Klein Street.
    • The pedestrian sidewalks are wide and generally uncluttered.

Park Lane Clinic and Brenthurst Clinic
    • There is an informal metered taxi rank in the close vicinity of Park Lane and
      Brenthurst clinics.
    • On-street parking is relatively well-utilised and not in short supply. There seems
      to be a sufficient supply of visitor and staff parking lots. Parking lots are relatively
      under-utilised, particularly staff parking areas.
    • There is currently a large volume of pedestrian traffic through the Park Lane
      grounds.


                                              18
    • Some of the key traffic and transportation problems in the area are:
        Illegal parking particularly at patient drop-off and pick-up areas that further
        restricts the flow of public transportation and vehicular movement within the
        quarter
        A lack of on street parking bays on Princess of Wales and Queen Streets
        Existing parking bays are a distance from hospital entrances and are therefore
        under-utilised
        Pedestrian sidewalks are usually narrow and poorly designed
        There is a general lack of security and surveillance in the quarter
        Lack of direct public transport from transport terminuses to and between
        various health centres
        Patients are required to walk long distances between health centres and
        transport terminuses
        Lack of mini-bus taxi ranks for the Johannesburg Hospital (JH)
        Competition between two different taxi associations servicing JH
        High volume of pedestrian traffic through Park Lane Clinic grounds
        Overall lack of signage in the quarter (typified by patients getting lost when
        referred from one institution to another).

7.1.3 Economic Development
Currently, the physical environment in the JMQ is not conducive for economic
development in the area. There is poor connectivity – both physically and relationship-
wise – between medical facilities and the general perception of all the facilities and their
surroundings is one of despair, barrenness and insecurity. This deters investors and
reduces the desire of health staff, patients and visitors to engage in any significant way
with the area outside of the facilities where they work or visit. The overall impression of
the area is that, although geographically well located, it is currently highly fragmented,
with virtually no connectivity and no integration into the local economy. The result is
substantial loss of revenue and economic opportunity.

Combined expenditure on public and private health services in the broader
Johannesburg catchment area is valued at R9.4 billion, of which R2.9 billion in the public
sector and R6.5 billion in the private sector. All hospitals in the JMQ (public, private and
non-profit) are estimated to spend around R1.4 billion in 2005, of which R826 million by
Johannesburg Hospital, R456 million by the three private hospitals (Park Lane,
Brenthurst and Rand Clinics), and R154 million by the Donald Gordon Medical Centre. A
relatively crude estimate of the total budget for another key stakeholder in the JMQ,
namely With Medical School, is R60 million per annum and for the Hillbrow Health
Precinct R1.9 billion per annum.

This direct expenditure is generally associated with a secondary multiplier effect that is
associated with the ability to generate an economy that surrounds, supports and
services the direct economy which, in the case of the JMQ, is the health economy.
Because of the relative under-development of such a secondary or surrounding
economy in the JMQ, the potential economic spin-offs for the area “leak” to other areas
and regions. In the absence of reliable data, the concomitant economic loss to the area
is based on a conservative multiplier effect of 0.3 times the direct expenditure, which
amounts to R562 million. Based on the international benchmark provided by the Texas




                                             19
Medical Centre, a multiplier effect of 1.2 would apply and the estimated economic loss to
the JMQ would be R2.2 billion.

7.1.4 Social

The JMQ represents a transition area between the inner city and suburbs of
Johannesburg. In this sense it represents a sharply defined zone of transition. The
conflict between “suburban-based” facilities and inner-city communities is transmitted
into real or imagined perceptions of poor public safety, most notably on the border with
Hillbrow. Key social issues identified in the studies supporting the Hillbrow-Berea
Regeneration Initiative include:

•   Street children – an estimated 300 in Hillbrow
•   Homeless people – an estimated 5 000 in the Inner City, of whom only a relatively
    small proportion sleep on the Hillbrow streets
•   Sex workers
•   Drug abuse
•   Sexual and domestic violence

In addition, Hillbrow has a very high proportion of the 235 properties identified by the
CoJ as bad buildings by the end of 2003. Bad buildings in Hillbrow - under-maintained,
‘slummed’, with tenants exploited by unscrupulous landlords – usually take the form of
overcrowded residential blocks. Absentee landlords, often owing millions of rands in
rates and services charges, abandon properties. Such properties, along with the ‘sleazy
hotels’ identified in various criminology studies and targeted by the CoJ and SAPS,
become associated with atrocious living conditions, by-law infringements, criminal and
anti-social activities.

Stakeholder consultations during the development of this Business Plan suggest that
   • Some negative perceptions exists about the location of Rand Clinic and
      Brenthurst Clinic and their proximity to Hillbrow/Berea
   • managers of health facilities are increasingly managing their locations rather than
      isolating themselves from it. For example, private hospitals in the JMQ are
      pricing and packaging services to make it more accessible for inner-city and
      privately paying patients and the sense of having to “protect” facilities from the
      inner-city catchment area is declining.

There has been some discord between the health facilities and local community groups
in the JMQ, most notably around proposed development plans for the Donald Gordon
Medical Centre.

7.1.5 Environment
The environment in the JMQ ranges from very high residential suburbs in Hillbrow and
Berea, with little public open space, to the open, accessible and green environment that
characterises former “white” high-income residential suburbs. The proposed urban
design framework for the JMQ emphasises the maintenance of the green environment.




                                            20
An important environmental issue that needs to be kept under review in the development
of the JMQ is adequate medical waste management to ensure that environmental
hazards from medical waste are not created as the area develops.

7.1.6 Stakeholder analysis
Agency/Organisation               Role in JMQ                    Activity
Gauteng Department of Finance     • Delivery of commitments in   • Close relationship with Project
& Economic Affairs                   Provincial Growth and         Board
                                     Development Strategy that   • Liaison with NEPAD and other
                                     align directly with JMQ       relevant multi-lateral structures,
                                     initiatives                   specifically around skills
                                                                   transfer, capacity building
                                                                   promotion and knowledge
                                                                   exchange

Gauteng Department of Health      • Project Board member         • Participation in Project Board
                                  • HHP Centre of Excellence     • Alignment of operational and
                                    partner                        development plans for GdoH
                                                                   facilities
CoJ Health                        • Project Board member         • Participation in Project Board
                                  • HHP Centre of Excellence     • Alignment of operational and
                                     partner                       development plans
                                  •
CoJ Region 8 Social Services      Potential partner              Provision of social and welfare
                                                                 services to enhance JMQ
                                                                 development
University of the Witwatersrand   Project Board member           • Participation in Project Board
                                                                 • Implementation of Wits Spatial
                                                                   Framework
                                                                 • Facilitation of Partnerships
                                                                   (including internationalisation of
                                                                   activities in JMQ)
University of the Witwatersrand   Project Board member           • Lead partner in research and
Medical School                                                     education activities
                                                                 • Lead partner in development of
                                                                   Centre for Sport & Exercise
                                                                   Science
Wits Health Consortium            Project Board member           • RHRU is one of Health
                                                                   Consortium programmes
                                                                 • Facilitation of public-private
                                                                   partnerships
Netcare                           Project Board member           • One of lead partners in private
                                                                   sector facilities and services
                                                                 • Growth of primary economy
                                                                   activities
Medi Clinic                       Project Board member           • One of lead partners in private
                                                                   sector facilities and services
                                                                 • Growth of primary economy


                                                21
                                                                         activities
Life Healthcare Group                Project Board member             • One of lead partners in
                                                                          private sector facilities and
                                                                          services
                                                                      • Growth of primary economy
                                                                          activities
Johannesburg Development             Initially Project Board member   • Initially drive implementation
Agency                                                                     of the JMQ Business Plan
                                                                      • Provide technical support
Health-related institutions (NLS,    Potential partners               Provision of professional services
NCOH, SAIMR)                                                          to enhance development of JMQ
Johannesburg Property Company        Potential partner                Manager and developer of state-
                                                                      owned assets
Various NGOs in social               Potential partners               • Provision of services
development and health                                                • professional and lay staff
(including HIV/AIDS)                                                      training to enhance
                                                                          development of JMQ
Current and future international     Potential partners               Source of operational and ideally
development cooperation                                               capital finance
partners
Current and future local corporate   Potential partners               Source of operational and capital
social responsibility partners                                        finance
                                                                      Clients of services provided by
                                                                      JMQ institutions
NGO / private residential            Potential partners               Developers and managers of
developers and managers                                               residential property for private
                                                                      and social housing.

7.1.7 Competitor analysis
The JDA has no direct competitor agencies vis-à-vis its role as development manager
for the JMQ. The JMQ stakeholders have allocated this role to the JDA, which was
confirmed with decisions at a stakeholder workshop that was held on 22 June 2005.

7.2      PRE-CONDITIONS AND IMPLEMENTATION
Pre-conditions for JMQ in line with this Business Plan are as follows:
   • Business Plan confirmed and adopted by the JMQ Project Board
   • Activate cooperation and participation from all relevant sections of Provincial and
       City Health
   • Availability of capex and opex budgets from the JDA in the early stages of the
       development of the JMQ.




                                                     22
7.3      RISK ANALYSIS
7.3.1 Financial
 Risk / Estimated Risk      Consequences                Indicator                 Preventative Action/
 Level                                                                            Risk Minimisation
 Reduction in CoJ’s         Inability of JDA to meet    Budget approvals;         JDA engages with CoJ
 Health budget /            its operational role in     cash flows                to secure capex
 Medium                     managing development                                  allocations.
                            of JMQ.
 Slow and inefficient       Project time slippage       Cash flows                JDA regular business
 financial transfers to                                                           planning
 JDA / Medium

7.3.2 Operational
 Risk / Estimated Risk      Consequences                Indicator                 Preventative Action/
 Level                                                                            Risk Minimisation
 Regulatory                 Prevents development        • Applications for        Project Board engages
 Environment:               and growth of Health          additional hospital     at high level with
 Certificate of Need        (Primary) Economy             beds in JMQ             Gauteng Department
 works against                                          • Applications for        of Health
 concentration/                                           doctor’s rooms in
 clustering of health                                     JMQ
 care providers and
 facilities / Medium
 Tension, competition       Viable development          Unfulfilled development   Project Board and JDA
 and distrust between       partnerships not            opportunities             to encourage and
 stakeholders / Medium      identified or pursued                                 facilitate open
                                                                                  discussions on
                                                                                  development
                                                                                  opportunities among
                                                                                  partners and to seek
                                                                                  quick, small successes
                                                                                  and “win-win” projects
                                                                                  to build trust and
                                                                                  confidence
 Inadequate institutional   Lack of coherence and       Slow decision-making.     Ensure complete buy-
 arrangements / Low         direction in project        Persistence of            in from all parties to
                            development                 individual/corporate      institutional
                                                        agendas                   arrangements and
                                                                                  facilitate effective
                                                                                  operation of the Project
                                                                                  Board




                                                       23
8      INSTITUTIONAL ARRANGEMENTS
Sustainable development of the JMQ relies on effective institutional arrangements. To
facilitate this development, it was agreed at a JMQ stakeholder workshop on 22 June
2005 that a representative Project Board should be established to oversee
implementation of the JMQ business plan, but that JDA should remain as ‘driver’ of this
process. JDA support for this arrangement should remain in place for up to three years
with the intention that a fully-fledged development and implementing institution will be in
place as soon as possible to facilitate the JDA’s exit at the end of this period, or sooner.

                       JMQ: Coordinating Institution: Proposed Interim Arrangements

                                                                            Drawn from JMQ stakeholders.
                                            Project Board                   Advises and oversees
                                                                            implementation of business plan



                                                                                Executing Agency for Business
                                            JDA (including                      Plan component
                                        Stakeholder Coordinator)
                                                                                 Identification of opportunities for
                                                                                 development and growth in
                                                                                 primary (including service
                                                                                 delivery, research and
                                       Technical Consultants
                                                                                 education/training) and secondary
                                          Support Group                          economies


International benchmarking indicates that a development such as the JMQ is a dynamic,
ongoing process that requires a dedicated facilitating and management function. On a
more permanent basis, the management of the JMQ is envisaged to reside in a structure
such as the following:
                            JMQ: Coordinating Institution: Proposed Structure


                                              Board




                                Institution Section 21 Company




                                   Development Coordinator




       Health Sector                       Company                              Technical
        Coordinator                       Administrator                     Consultant Support
                                                                                 Group

(ADD: INNOVATION COORDINATOR)



                                                   24
The Coordinating Institution must have an appropriate legal persona, most likely a
Section 21 company. It will be independent and financially self-sustainable through
providing services to stakeholders and stakeholder institutions in the JMQ.


9      OPERATING PLAN, OUTPUTS, OUTCOMES AND
       RESOURCES
9.1    OPERATING PLAN
The operating plan for the HHP remains in place and stands alone as a current
development project within the overall JMQ (Refer to the HHP Business Plan, October
2004). The operating plan for the JMQ will initially be implemented in parallel with the
current HHP operating plan, but the operating plan for the JMQ should over time include
further development of the HHP.

9.1.1 Implementing Transport and Urban Design Recommendations
Specialist studies on Urban Design and Traffic and Transportation point to the need for
improving overall connectivity within the quarter. This includes improving the overall
pedestrian environment through safety and security, upgrade of public environment and
improving transportation.

There is a need for enhancing the connectivity between JMQ and surrounding precinct
developments to effectively overcome the inward-focussed and spatially dislocated
development of these precincts. As such, the JMQ forms the ‘missing link’ between a
range of precinct developments in the city. Development of the JMQ can strengthen,
support and cohere existing precinct developments underway in the area.

From an urban design perspective, the following would be key developments in the
JMQ:
   • Through a clear access agreement with the Wits University, access to the sports
      and cultural facilities on the Wits Education Campus (the Centre for Exercise
      Science and Sports Medicine in particular) will provide recreation within the
      Medical Quarter.
   • Within the vacant and under-utilised land in the area, specialist medical retail and
      service facilities (e.g. pharmaceuticals, medical insurance) may be provided on
      site.
   • Improvement of the street-building interfaces will help remove barriers and bring
      back the streetscape.

These developments must be supported by the following:

1) Safety and Security
    • Upgrade of surrounding public spaces making them more pedestrian friendly by;
       opening up more pedestrian entrances, paving walkways, installing benches,
       improving lighting and installing more pedestrian crossings and traffic calming.
    • Dispatching security guards, and trimming of vegetation, particularly along
       Queens Road


                                           25
2) Upgrade of public environment
    • Increased width of pedestrian sidewalks, improved lighting and trimming back of
      vegetation
    • Introduction of street furniture such as additional benches for awaiting bus
      passengers and patients waiting to be picked-up
    • Upgrade of existing bus shelters
    • Landscaping along major pedestrian routes
    • Improving accessibility for the physically disabled
    • Refurbishment and improvement to existing building facades and facilities

3) Improving Transportation
The introduction of a shuttle service is considered an important component of the JMQ,
particularly in terms of enhancing accessibility and connectivity. The shuttle service is to
run through the JMQ, linking key facilities in the Quarter to Park Station.

A detailed feasibility study (currently outside the scope of the business plan) for a shuttle
service needs to be undertaken. This will include a detailed traffic and transport count to
assess the feasibility of an independent shuttle service for the quarter, as well as an
investigation as to its linkages to the Inner-City Distribution System and the Gautrain
Feeder Distribution System and its impact on the economy of existing bus, mini bus and
metered taxis currently servicing the area.

The JMQ shuttle service will augment and extend the Inner-City Distribution System and
so contribute to the Provincial Growth & Development Strategy’s objective of
augmenting and extending the City’s “hard economic infrastructure to create
connectivity, efficiency gains and competitive advantage”.

In addition, there are a number of immediate actions that may be undertaken in order to
alleviate some of the traffic problems experienced within the quarter. These include;
    • Introduction of a taxi-rank at JGH, Hillbrow Hospital and Esselen Street Clinic
    • Enforcement of illegal parking restrictions
    • Enforced pick-up and drop-off area at the hospital entrance
    • Re-allocation and redistribution of parking bays between visitors and staff.
    • Remarking of parking bays.
    • Increasing of time limit for on-street parking
    • A change in the design of on-street parking, and enforcement thereof may
        reduce congestion
    • Increased width of pedestrian sidewalks, improved lighting and trimming back of
        vegetation
    • Additional benches for awaiting bus passengers and patients waiting to be
        picked-up

The project board will have a significant role to play in coordinating the provision of
service infrastructure aimed at enhancing the pedestrian environment (parking, signage)
and improving overall connectivity of the quarter. The implementation of urban design
and traffic and transportation projects will be subject to the decision making and
prioritisation processes of the project board.

9.1.3 Catalytic Interventions

                                             26
a.      Establishing the Project Board and Coordinating Institution
Development of the JMQ requires a participatory, developmental approach. The
establishment of a representative Project Board is therefore seen as the most important
catalytic intervention for the development of the Quarter. Initial support to the Board will
include clarification of roles and responsibilities, developing a work plan and, importantly,
agreeing to a set of values to guide its operations. International experience highlights the
importance of constructive, open relationships between Board Members and the
stakeholders they represent to successfully develop the Quarter.

Specialist studies were conducted to inform the development of this business plan.
However, because of the approach taken in the development of the JMQ, the findings
and recommendations of these studies, specifically in relation to catalytic projects,
should be subject to consideration by the Project Board. The Project Board should
develop a set of criteria to prioritise these catalytic projects and any other developments
they may identify as important. An important criterion would be the extent to which a
particular project activates and supports the achievement of strategic priorities of
institutions in the JMQ. It would also be important to consider the knock-on economic
development potential of any particular project.

At the end of three years, the Project Board will phase its operations and responsibilities
into an independent, self-sustainable Coordinating Institution and the JDA will exit its
role as the driver of the development of the JMQ.

b.     Centre for Exercise Science and Sports Medicine

The Centre for Exercise Science and Sports Medicine is part of the School for
Therapeutic Sciences at Wits University. It is located on the campus of the former
Johannesburg College of Education, where essential facilities such as a swimming pool,
running track and gymnasium are already available.

The CESSM in the School of Therapeutic Sciences has a close relationship with a
similar centre based at the University of Cape Town which is run by Prof Tim Noakes.
The vision is that the CESSM will provides facilities and services at altitude, while the
centre in Cape Town will provide facilities and services at sea level. It is possible that
both centres will use the same name and branding and will service the same athletes.

FURTHER INFORMATION DUE: AN ASSESSMENT OF THE POTENTIAL FOR A
CATALYTIC PROJECT ASSOCIATED WITH THE CESSM WILL BE MADE ON THE
BASIS OF MEETING WITH DR DIMITRI CONSTANTINOU (TUESDAY, 30 AUGUST).

c.     Strengthening Training and Skills Development in the JMQ

The strengthening of medical and health-related training and skills development in the
JMQ requires a programmatic intervention aimed at facilitating a process through which
stakeholders and communities of practice can identify and pursue opportunities for
development and collaboration in this area. To inform this process, existing data about
medical and health-related training and skills development currently ongoing in various
facilities in the JMQ requires further refining. Also, the current and planned use of the
Netcare Training Academy based in Auckland Park should be investigated with a view to
possible synergies with and linkages to this initiative.


                                             27
At this stage, involvement of the Health and Welfare Sector Education and Training
Authority (HWSETA) as a source of support and funding for strengthening training and
skills development in the JMQ is premature. The HWSETA should, however, be
approached once the planning for these developments have been firmed up.

d.       Establishment of an Innovation Centre

SECTION BEING DRAFTED BY STEVE

9.1.4 Phases of Development
(TIMESCALES TO BE FINALISED IN CONSULTATION WITH JDA)
Phase / Activities                                                Timescale
Phase 0 Preparatory Activities                                    From Business Plan
Confirm business plan, operational roles and funding requirements Current
Commission and conduct Marketing and Place-Branding Strategy      Early 2006

Phase One: Governance
Convene Project Board
Contract Stakeholder Coordinator
Clarification of roles and responsibilities of the Project Board and its constituent
members (and broader process facilitation)
Project Board develops operational plan
Project Board revises and adopts JMQ Business Plan
Project Board considers strategic plans of JMQ stakeholder institutions against
set criteria to identify and prioritise catalytic developments
Partners confirm opex, capex and identify funding gaps
Develop fundraising strategy and start raising required funding

Phase One: Urban Upgrade / Buildings
Identify and prioritises upgrade and building interventions to support
implementation of business plan and strategic plans of JMQ stakeholder
institutions in accordance with proposed strategies to develop the “missing
middle”

Phase One: Traffic and Transport
Commission and conduct detailed Transport & Traffic Impact Study

Phase One: Training and Skills Development
Collect and consolidate hard data about medical/health training/skills
development taking place within institutions in the JMQ
Identify Development Nodes for Training and Skills Development

Phase One: Economic Growth Opportunities
Conduct Consumer Survey and Market Research to identify needs and
priorities for retail developments and the location of these developments
Analyse existing referral patterns to inform plans for increasing doctors’ rooms
in the JMQ
Project Board identifies strategic partnerships and relationships to be



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established to support implementation of business plan and strategic plans of
JMQ stakeholder institutions
Project Board facilitates strategic partnerships and relationships identified

Phase Two:
Formalise Coordinating Institution and register Section 21 Company
Appoint Development Coordinator
Appoint Health Sector Coordinator
Coordinating Institutions continues implementation of identified development
opportunities


9.2      OUTPUTS AND OUTCOMES
9.2.1 Outputs
    •    There is a target of X new permanent jobs in public sector health provision by the
         end of 2007, including in health service provision and management, as well as
         medical and health-related training and skills development. In the monitoring of
         this output, cognisance should be taken of challenges associated with the
         measuring of job creation in the nursing sector. While nursing positions are often
         created as a result of growth and increasing patient numbers in health care
         facilities, these positions are often filled by nurses from an existing “pool” that
         work in different facilities (and sometimes in both the pubic and private sectors).
    •    X permanent jobs could also be created through implementation of measures to
         improve safety and security in the JMQ, as well as the implementation of the
         proposed JMQ shuttle service.
    •    Short-term jobs (primarily during construction stages) can be more accurately
         calculated once contract prices have been finalised.
         Get formula from Agmat
    •    Broad-Based Black Economic Empowerment and Small Medium & Micro
         Enterprise outputs can be calculated against contracts let. Given the JDA’s
         affirmative procurement targets, it will be a requirement that a minimum of 60%
         of contract value will be given to BEE.

9.2.2 Outcomes
Projections on economic activity outcomes (property rates increase, re-use of vacant
and underused buildings and business confidence) will be firmed up as Phase One and
Two components are finalised.

9.3      RESOURCE REQUIREMENTS
Resource requirements for the implementation of the business relate mainly to the initial
operating costs of the Project Board, including
   • a dedicated, equipped project office, ideally housed at the JDA
   • a dedicated Stakeholder Coordinator, on a project-linked contract, with
       administrative support




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   •   process facilitation to clarify roles and values and develop an operating plan /
       schedule
   •   printing and photocopying
   •   catering for meetings.

These requirements will be reviewed and finalised with the organisational design of the
Coordinating Body and institutional arrangements.

It is recommended that funding earmarked by JDA for development of the JMQ is
allocated to the Project Board as a discretionary budget for the initial funding of priority
catalytic projects as identified by the Board. This will be supplemented with funding
raised by the Board through its fundraising strategy.

9.4    FINANCIAL INFORMATION
The current costs for the physical developments identified in Phase One are set out in
the attached spread sheet Development Cost Estimate. This information will be
supplemented with more detailed operational and capital expenditure figures as this
business plan is refined, leading to a substantive project budget.




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