The public protector has released a damning report into delays in repairing fire damage that gutted parts of the Charlotte Maxeke Johannesburg Academic Hospital.

A fire broke out at the institution in April 2021, leaving it with extensive structural damage. Five years later, the repair work has not been fully completed. The public protector’s brief was to establish whether the Gauteng Department of Infrastructure Development (GDID) and the Gauteng Department of Health (GDoH) had “unduly delayed” the repairs. This would have compromised the medical care provided by the hospital.

The report determined that this was the case.

After the fire, an inspection by the City of Johannesburg Fire Department found that the building was not compliant with various fire prevention standards. The rebuilding would need to ensure that the rebuilt facility was compliant with them.

The report laid out how responsibility for the project was shifted, firstly from the GDID to the GDoH and later to the Development Bank of Southern Africa (DBSA). Each of these was premised on a failure to get the project moving forward.

The report attributed the delays primarily to a failing administrative system, where approvals were slow in coming and where departments were unable to cooperate.

“After a holistic review of submissions,” the report said, “it is apparent that the causes of delays in this project are largely attributable to broader, underlying administrative and systemic circumstances such as delayed regulatory approvals, disagreements concerning project scope, transfer of the custodianship of the hospital from GDID to GDoH, failure to adhere to [the project execution plan], poor planning, poor project management, lack of proper coordination, and budget underspending. The investigation has further shown a recurring trend or pattern of lack of coordination and inefficient use of public resources between GDID, as an implementing agent for government capital infrastructure projects, and its client departments in Gauteng.”

The report expressed a harsh judgement of the “poor planning, poor recordkeeping, and incomplete documentation” at the GDID, a violation of its requirements under the Public Finance Management Act.

To give a sense of the scale of the failing, it was pointed out that the GDoH had a budget of R666.8 million for the project between 2021 and 2024. By the end of March 2014, only R324.2 million was used – equivalent to 51.3%. It was particularly serious issue in 2023/24, where budget utilisation stood at only 45%.

“This illustrates significant maladministration, poor project management, administrative delays, procurement bottlenecks/irregularities and planning misalignment by GDoH and GDID. These delays have also caused an escalation in costs due to inflation-related adjustments.”

In 2023/24, however, close to all the budget allocation was used, which suggested that the DBSA had the systems to perform work – unlike the provincial government departments.

Noteworthy was that the projects carried out by private contributors to the repair efforts were performed efficiently and on time.

It added that some R1.7 billion was reported to be needed to upgrade the entire facility to acceptable fire protection standards. This has not been funded.

The report noted too that this was not an isolated case, with similar problems having been encountered in projects involving school and clinic construction. “The public protector has noted with concern a recurring trend or pattern of lack of coordination, accountability for deliverables, and inefficient use of public resources between GDID, as an implementing agent for government capital infrastructure projects and its client departments in Gauteng. This improper conduct is often fuelled by bureaucratic conflicts and disagreements, which hamper service delivery and compromises good governance."

South Africa’s state is sometimes billed as a “developmental” one, which should take a central role in driving both social upliftment and economic growth. It also has aspirations to take over the healthcare value chain through the National Health Insurance initiative. The public protector’s report is a string refutation of these ambitions.