Hillbrow Health Precinct

The Hillbrow Health Precinct (HHP) is in the heart of inner-city Johannesburg, in Hillbrow. It is bordered by Kotze and Rissik streets to the north, Joubert Street to the west, Smit Street to the south and Klein Street to the east.

To its immediate north is Constitution Hill; the Civic Centre is to the west. Many other important developments surround it, such as:

• the Braamfontein regeneration corridor;
• the Hillbrow-Berea regeneration initiative;
• Park Station; and
• greater Joubert Park.

The area – a high-density, overcrowded suburb of medium-rise and high-rise buildings – is a troubled one, which makes this project so crucial. It’s a part of Johannesburg that is subject not only to the inner-city decline that characterises urban settlements across the world, but also to the exacerbating effects of apartheid planning.

One thing the greater area does boast, however, is a number of public and private health facilities – including the Johannesburg Hospital, the Donald Gordon Medical Centre, the Rand, Brenthurst and Park Lane clinics, and the Wits Medical School.

The goal of the HHP is to create an integrated, safe, secure and functional area by:

• being the preferred location for primary healthcare providers;
• consolidating the research base and operational connections among stakeholders;
• enhancing existing residential accommodation; and
• creating world-class education and training facilities.

Rationale behind the HHP’s business plan is to:

• improve the precinct’s external environment and thus prevent urban blight;
• build the confidence of existing NGO, institutional and commercial residents,
• encourage investor interest and reinforce the positive impact of Constitution Hill;
• nurture the Centre of Excellence as the anchor tenant that will lure NGOs and similar bodies to a supportive environment;
• improve urban management through CID-type visible security, signage, parking, public lighting and possibly CCTV; and to
• approach the precinct’s development in phases, according to the availability of resources, beginning with the Centre of Excellence node along Esselen Street.

The nine broad strategies or features of the business plan are: governance and sustainability; primary healthcare; a Centre of Excellence; social and support services; residential accommodation; world-class education and training facilities; safety and security; integration and functionality; and the maximising of development impact. These are discussed in detail under projects.

Key Documents

• Hillbrow Health Precinct Business Plan, October 2004 [pdf]
• Appendix 1: Precinct Plan and Urban Design Framework [pdf]
  (Photographs and diagrams have been excised)
• Appendix 2: Traffic and Transportation [pdf]
• Appendix 4: Civil and Electrical Infrastructure [pdf]
• Appendix 5: Land Use Study [pdf]
  (Photographs and diagrams have been excised)
• Appendix 6: Financial [pdf]

1. Health services in the area

It is this neighbourhood’s wealth of health services that makes it an obvious base for a development such as the HPP. The City’s department of health provides primary healthcare and local clinics, and the provincial department of health offers higher-stage services and district-level facilities.

Esselen Street Clinic
The City of Johannesburg’s Esselen Street Clinic handles tuberculosis, sexually transmitted infections, contraception and HIV counselling and testing. The clinic, a partnership between the City and Wits University’s Reproductive Health Research Unit, sees up to 350 people daily and plans to increase this to up to 1 000 – which will require significantly more space.

Hillbrow Community Health Centre
This provincial health facility is based in the old Hillbrow Hospital complex, much of which had been decommissioned by 1998. The Hillbrow Community Health Centre (CHC) provides a range of services, including:

• family planning, ante-natal and post-natal services, pregnancy termination;
• home-based care;
• medical and legal facilities to tackle child and sexual abuse, and domestic violence;
• 24-hour casualty services; and
• physiology and radiology

The centre is being upgraded to consolidate, within a single building at the southeast of the site, services such as:

• maternity and obstetrics;
• mother and child health;
• 24-hour casualty services and minor theatre;
• a polyclinic and outpatient services;
• psychology; and
• dental care.

This will free up buildings for disposal or alternative use. In addition, the provincial health department is considering re-opening the Hillbrow Hospital as a small 100-bed district facility.

The proximity of these City and provincial facilities provides a compelling opportunity for expanding the Centre of Excellence concept at Esselen Street. Under-used land and property has the potential for adaptation to accommodate a wider range of organisations that could improve healthcare provision and impart synergy. These include departments from Wits University, government social service and welfare providers, and a variety of health NGOs. The precinct already houses others in the health sector, such as the National Centre for Occupational Health, the SA Institute for Medical Research and the National Laboratory Service.

2. Hillbrow’s developmental, economic, social and environmental issues

Johannesburg’s inner city has the most acute and multi-faceted urban problems in the country. But it is also the crucible in which new approaches are tested and implemented.

The residential centre of the inner city is Hillbrow. At least 90 percent of its residents live in blocks of flats. Although the 2001 census put the neighbourhood’s population at 49 600, officials believe that to be an underestimate due to overcrowding and migration.

Urban design framework
The urban design framework and related assessments have identified a range of development issues:

• Historic buildings: a significant number occupy the site, which will restrict physical restructuring through demolition.
• Ad-hoc development: much of the precinct comprises a dense agglomeration of buildings; there is minimal open space.
• Declining quality of building stock: the older built fabric has started to decay faster than usual because of the ingress of storm water and the lack of maintenance of under-used and empty buildings. Vandalism is also a problem.
• Rationalisation and demolition: the rationalisation of activities and the demolition of buildings will be needed to restructure the precinct, introduce parking and establish the envisaged public environment.
• Urban management: physical restructuring and reorganisation will help the management of the precinct and enable development (which is dependent on financial and institutional arrangements) in incremental phases.
• Parking: the introduction of parking is an important component, especially for accessibility to the precinct.
• Access and transport: the precinct is well served by public transport and is accessible by foot from all sides.
• Pedestrian movement: busy traffic routes hinder the safe movement of those on foot. Pedestrian crossings are a high priority for those who walk or rely on public transport.

Economic issues
Hillbrow is primarily a residential area: economic activity is confined to a small number of nodes. The direct economic-growth potential of the HHP is fairly limited, given its focus on public health. But indirect benefits may flow from the Centre of Excellence.

In addition, the expansion of health training will lead to an increase in the number of staff and trainees who visit or need to stay in the area. The demand for accommodation provides an important opportunity to restore buildings to productive economic use.

Social issues
Key social issues identified in the studies supporting the Hillbrow-Berea Regeneration Initiative include: street children; homeless people; sex workers; drug abuse; and sexual and domestic violence.

Hillbrow also hosts a high proportion of the 235 properties the City has identified as bad buildings. These under-maintained, “slummed” buildings are usually overcrowded residential blocks. Such properties, the tenants of which are exploited by unscrupulous landlords, become associated with atrocious living conditions and anti-social activities.

Environmental issues
Hillbrow is a high-density residential suburb without accessible, pleasant, safe and secure public open space. An important element of the spatial development plan will be to identify and open up suitable spaces for public use.

The HHP comprises an agglomeration of land with institutional use. But these buildings are clustered in such a way that they face inwards and are isolated from their surroundings. The latter has also prevented the development of thoroughfare linkages, effectively forming movement barriers.

In particular, the layout of the Hillbrow Hospital complex is unintelligible due to ad hoc building over the past 100 years.

The urban design framework report sets out the following broad development principles for the precinct:

• making connections;
• a grid of streets;
• a public open space network;
• a mixture of land use;
• landmark elements;
• catalytic projects; and
• “putting it all together”.

3. Implementing the urban design framework

The adjusted urban design framework is based on the urban design scoping study and comprises the following elements:

• Crossroads and quadrants
  To reinforce the crossroads principle the HHP is structured into four quadrants. The north-south axis of the cross is Hospital Street and the east-west link De Korte Street, with an extension through the Hillbrow Hospital site to link to Klein.
• The crux and functionality
  The crossroad is not a divisive element, but literally and figuratively forms the “crux” around which the identity, public image and functionality of the health precinct is formed. It is to act as a seam, providing vehicular and pedestrian access to each of the quadrants. This “crux” also establishes design principles that aim to improve the overall legibility and imageability of the area. It provides for the collective and cohesive unity of the HHP, while allowing each quadrant to have nuances of individual character depending on particular function, use and nature.
• Public space
  The “crux” is reinforced by two public spaces. The first is the existing park within the grounds of the National Health Laboratory: it is proposed that this is opened to public use. The second is the proposed combination park and square at the intersections of Hospital and Smit streets. The proposed public space is to be multi-functional, providing for structured parking, a public park on the surface of the structured parking and retail activities.
• Linkages
  The four quadrants are connected by a system of public environment linkages in the form of pedestrian pathways, parking courts and public areas (not unlike local access lanes) that allow for vehicular and pedestrian movement.

4. Stakeholders

This development has the potential to attract dozens of stakeholders. Those who are on board already are:

• the City of Johannesburg health department;
• the University of the Witwatersrand’s Reproductive Health Research Unit;
• the Johannesburg Development Agency; and
• the Gauteng department of health.

Potential partners include:

• Wits University’s schools of public health, law, architecture and human and community development;
• the City’s social services in Region 8;
• NGOs in the fields of social development and HIV/Aids;
• health and medical institutions;
• loveLife;
• the Central Johannesburg Partnership;
• the Johannesburg Property Company;
• NGOs and private residential developers and managers;
• current and future international development cooperation partners; and
• current and future local corporate social-responsibility partners.

1. Main project objective

Each of the nine broad strategies has project objectives, which will be delivered by a specific sub-project or activity.

Governance and sustainability
The aim here is to create sustainable partnerships and leadership for the development and management of the precinct. This will involve:

• confirming project coordination roles, responsibilities and individuals on the basis of the memorandum of understanding;
• identifying and securing clear lines of committed operational and capital expenditure in all key partners’ budgets;
• identifying key funding requirements against the projected business plan budget to inform fundraising strategy and activities;
• designing and establishing viable joint venture special-purpose vehicles for the development of the precinct; and
• broadening the base of active consultation with other current and potential stakeholders in the HHP.

Primary healthcare
This will consolidate existing service providers and encourage new ones to move to the precinct. This will mean:

• determining a precise portfolio of primary healthcare services currently provided and planned over five years in a single schedule that covers space requirements and costs;
• confirming a target list of potential NGO tenants and plan for relocation and space take-up; and
• confirming the allocation of an NGO centre as the preferred location for NGO tenants.

Centre of Excellence
The aim is to support the Reproductive Health Research Unit’s Centre of Excellence initiative by:

• developing Esselen Street as a Centre of Excellence node – the heart of the first phase – through coordinated environmental improvements, urban management and refurbishment of selected buildings; and
• establishing a youth centre.

Social and support services 
Social services will be encouraged to move and the provision of services will be coordinated, entailing:

• assessing the activities of service providers who could move to the Centre of Excellence node or elsewhere in the precinct, and developing space and activity plans;
• identifying and developing suitable buildings for adaptation and re-use as hospices, facilities for orphans and vulnerable children, and similar activities.

Residential accommodation
The task is to facilitate the improvement of residential properties in the precinct and to encourage the development of new residential accommodation. This will need to:

• identify a portfolio of properties suitable for refurbishment or conversion to residential accommodation (including social housing) within the precinct; and
• showcase the property portfolio initially to the inner-city Property Owners and Managers Association as investment opportunities, with emphasis on financial incentives.

World-class education and training facilities
This will enable the provision of top-quality education and training facilities in the precinct. This project will:

• facilitate the RHRU’s objective of providing world-class education and training facilities (appropriate services for the cultural and economic context) by prioritising planning and building-plan approvals, and providing appropriate project management of physical developments.

Safe and secure
The aim is to promote better urban management and enhance public security. This will then mean:

• the establishment of a visible security presence (of the kind common to the city improvement districts) along Esselen Street;
• the installation of improved street lighting along Esselen Street and King George Street; and
• the investigation of technical specifications and costs for the installation of closed circuit TV cameras around the Centre of Excellence.

Integrated and functional
The objective is to:

• conclude an integrated spatial and development plan – with provision for improved pedestrian and traffic access, and public open space, and with clearly identified development phases – beginning with the Centre of Excellence.

Maximise development impact
The goal is to identify and implement economic and regeneration opportunities for communities in the wider area. This will entail:

• organising street works and building refurbishment contracts in line with the expanded public-works programme guidelines; and
• developing and managing the property portfolio (directly or in close coordination with the managers of provincial health facilities) to maximise property development opportunities, meet operating requirements of current and future service providers, and create viable and tradable assets.

2. Alignment to policy and strategy framework

The HHP is aligned with all the major policy and strategy frameworks of the City of Johannesburg. These are:

Johannesburg 2030
This is the vision and strategy for the growth and development of the city for the next 25 years. It identifies HIV/Aids and safety and security – both of which are addressed in the HHP – as two threats to economic growth. Joburg 2030 also identifies research, training and skills development as key sectors in supporting economic growth. The plan also calls for improved spatial planning – another objective to which the HHP will contribute.

Mayoral priorities
Johannesburg’s executive mayor has identified six priorities for his period of office. The HHP is relevant to all of these:

• inner-city regeneration;
• economic development and job creation;
• public safety;
• service-delivery excellence;
• good governance; and
• HIV/Aids.

The inner-city regeneration strategy
The goal of the inner-city regeneration strategy is to raise and sustain private investment, leading to a steady rise in property values. The five pillars of the strategy, all of which are supported by the HHP, are to:

• address sinkholes;
• undertake intensive urban management;
• maintain and upgrade infrastructure;
• promote ripple-pond investments; and
• support economic sectors.

The Integrated Development Plan
The City’s Integrated Development Plan of 2003 to 2004 includes the local integrated development plan and spatial development framework for Region 8, covering the inner city. A number of its features are relevant to the HHP:

Sector plans
The IDP sets out a series of sector plans to give effect to the Joburg 2030 strategy. These include economic sectoral development, skills development, economic regeneration and HIV/Aids. The immediate priority areas for economic regeneration include the inner city, within which the HHP is to be found. The HHP will obviously contribute to the achievement of the HIV/Aids sector plan.

City scorecard and key performance areas
The IDP also links mayoral and Joburg 2030 priorities to the overall performance of the council administration through the “city scorecard” and key performance areas (KPAs). The HHP is aligned with the following features identified for attention in the inner city in 2003 to 2004:

• by-law enforcement;
• increasing residential occupation;
• increasing the rates base; and
• building confidence to attract investment by reducing inner-city crime.

City plan for health
The service-delivery plan of the City’s department of health sets out specific KPAs with which the HHP is closely aligned. These include:

• improved performance in reproductive health, HIV/Aids and STI services;
• support for inner-city regeneration;
• the introduction of new health programmes;
• training; and
• the development and physical upgrading of the health precinct infrastructure.

Spatial elements
The Region 8 spatial development framework of June 2003 describes Hillbrow and Berea as a sub-area experiencing social and economic decline, as well as poor housing and environmental quality. The key development objective is to create “sustainable and viable residential neighbourhoods”. The HHP will clearly contribute to this objective.

The JDA business plan
The HHP is identified as Project 015 in the JDA’s business plan 2003/08. It is incorporated as the initial catalyst to the development of the wider Medical Precincts project, which covers an area up to and including the Johannesburg Hospital and Wits Medical School.

The JDA project timescale distinguishes the following phases:

• detailed investigation (complete by end 2004/05);
• business plan (complete by end 2004/05);
• implementation (commenced 2004/05; complete 2005/06) and;
• JDA exit and evaluation (complete by end 2006/07).

Alignment with Gauteng Provincial Strategic Plan 2004 to 2009
The HHP is also in line with the Gauteng provincial government’s strategies. The health MEC, Gwen Ramokgopa, has highlighted the foundation of a comprehensive HIV/Aids programme:

• health promotion;
• the prevention and management of illnesses; and
• addressing psychosocial factors that exacerbate health problems, particularly those that are related to poverty, lifestyle and violence.

The province has the following objectives for the management of HIV/Aids, which will be facilitated by the successful establishment of the HHP. These include:

• ongoing prevention to reduce new infections, especially among the youth;
• comprehensive HIV/Aids care and treatment, including anti-retroviral therapy;
• developing community capacity for prevention and care through partnerships with civil society and the private sector; and
• coordination of all efforts across government and civil society for maximum impact.

The HHP will contribute to the achievement of these targets.

3. Phases of development

At this stage only the earliest phases can be outlined. More detailed planning and preparation will produce more specific information.

Phase zero (preparatory activities), set to take place from July to August 2004, involve:

• confirming the business plan, operational roles and funding requirements;
• developing a marketing brochure and presentation based on the business plan;
• developing a fundraising strategy and initiating fundraising activities; and
• confirming operational and capital expenditure and identifying funding gaps.

Phase one (governance), which will also cover July to August 2004, will involve:

• confirming the parameters for the design of the special-purpose vehicle.

Phase one (urban upgrade and buildings), will run from July to December of the same year. This will entail:

• implementing the Esselen Street streetscape upgrade;
• confirming space requirements for the expanded RHRU activities;
• confirming space requirements of potential tenants in the NGO centre;
• securing development agreement for the nurses homes, Solomon Building and former Streetwise property;
• confirming the Y-Centre establishment arrangements and securing the site;
• initiating discussions with POMA and showcasing potential properties;
• supporting residential and social housing developments by fast-tracking planning approvals, decision turn-round times and incentive packaging; and
• collating property information as a portfolio database.

Phase one (safe and secure), will also be completed at the end of December 2004. This will consist of:

• initiating the establishment of the CID.

Phase two, from January until December 2005, will focus on:

• implementing property upgrades for the RHRU and NGO centre, depending on the availability of funds;
• implementing the east link through the hospital site or public space, or both, in quadrant two, depending on the availability of funds;
• expanding coverage of the CID; and
• drawing up the property portfolio.

Residential developments will be under way and the special-purpose vehicle will be operational by the end of December 2005.