Public Health Facilities in South Africa are buckling under the strain as overwhelmed health workers struggle to meet the health needs of burgeoning populations. Budgets required to deliver essential services are shrinking leaving many health workers without full-time contracts. This situation leads to poor work environments in the nation’s hospitals.
Cosmo City has already been in existence for more than 20 years. It is fairly typical of many other urban centres where the absence of public health facilities is of great concern.
Reflecting on the rapid growth of the local community, I as a resident of Cosmo City in extension 6, have identified what has worked, what has fallen short, and what lessons can be drawn to help improve life in Cosmo City. Its residents, aware of the need for a proper health facility, are deeply frustrated by the Gauteng Department of Health’s inability to provide such a resource.
Cosmo City has grown rapidly over the years as many people choose to live there. Backrooms are being built, mostly in RDP houses, and now even in the partially financed and bonded houses. Recent developments and job opportunities in Cosmo City have created a population influx into the area, which cannot be turned back.
The Current Situation
Cosmo City has a mobile clinic that was donated by Samsung through the Provincial Department of Health in 2013. It is open from Monday to Friday between 7.30am and 4pm.
The Cosmo City Mobile Clinic provides:
- Consultation of minor ailments,
- Monitoring of Chronic Diseases,
- Antenatal Care,
- Post-natal Care,
- Reproductive Health,
- HIV/AIDS Counselling and Testing,
- Immunisation (for children between 6 weeks and 12 years),
- Door-to-door home-based care, and
- Referrals for free male circumcision.
Sister Theodorah Khumalo, Sister in Charge of the Cosmo City Mobile Clinic when it was handed over, confirmed that at that time they attended to about 120 patients per day or close to 2,400 per month. The clinic is not open on weekends and public holidays. I do not have a figure of how many patients they attend daily as the Cosmo City Mobile Clinic Manager Mr. Masipa, did not respond to that question as well as the Gauteng Department of Health.
I am not aware of the staff complement as those questions were not answered either. The staff complement then was: Three Sisters, three nurses, two HIV/AIDS counsellors, seven extended public works programme workers who help with administrative work and queue marshalling, as well as 30 door-to-door, home based care workers.
The clinic currently has three consultation rooms and one HIV/AIDS consultation and testing space.
Sister Theodorah Khumalo insisted that there is a dire need for a hospital in the area as patients are sent as far away as Krugersdorp (Yussuf Dadoo Hospital) and Coronation Hospital in the Raheema Moosa District. You need a car to travel to these health facilities. The driving distance from Cosmo City to Dr Yusuf Dadoo Hospital in Krugersdorp is 24.6 km with an estimated travel time of about 34 minutes. The driving distance from Cosmo City to Coronation Hospital is 26.8 kilometres.
In an effort to get a sense of how the mobile facility is doing in terms of staff capacity, staff health and wellness, resources, the number of daily, walk-in patients, I contacted Mr. Masipa, the Cosmo City Mobile Clinic Manager in October 2025. However, my attempt proved fruitless as he referred me to the Gauteng Department of Health (GDOH).
Context of a vision for a Cosmo City Holistic Wellness Centre
Perfect Start Ministries, a Non-Profit Organisation (NPO) based in Cosmo City had a dream of building a Cosmo City Holistic Wellness Centre at the corner of Tuvalu Crescent and Australia Street, in Extension 4. Founder member of the NPO, Muzi Nkosi, says it is currently helping around 100 vulnerable children with food from a garden located on a 20,079 square metre (about two hectares) plot of land given to the NPO through a grant from the Johannesburg Property Council.
These vulnerable children are not only cared for, but they are also taught how to maintain a food garden and tend the land.
Nkosi said the NPO’s vision for the land is to create a holistic community facility that would include:
- A health clinic;
- A skills development centre;
- An early childhood development centre;
- An expanded food garden;
- An employment agency to help address unemployment;
- A foster home for destitute residents; and
- Social workers available on call at the facility.
The NPO also expressed its concerns about the lack of a health clinic in Cosmo City to the Provincial Department of Health under the leadership of then MEC for Health, Hope Papo in 2013
Perfect Start Ministries approached the Provincial Department of Health to secure funding to build the holistic health and wellness centre on the land it had been given. The response from the Gauteng Department of Health through Chief Director Peter Mathole was that the department had secured its own land at the corner of Tanzania Drive and Angola Street, and with the department’s resources and capacity, they would build a health facility for Cosmo City residents.
The NPO was surprised when the same Gauteng Department of Health sent two officials (Constance Mudau and Nthabiseng Nkopane) to request half the land to build a clinic. It was surprised because the Department said they had secured their own land and had the budget for its development in May 2013.
In a follow-up meeting in June 2013 with then MMC for Health Nonceba Molwele and delegates from the Gauteng Department of Health, the department said it was willing to work with the NPO on the land which belonged to the NPO Perfect Start Ministries to build the clinic. Perfect Start Ministries responded with a letter saying they were willing to work with the department.
Perfect Start Ministries received a letter of acknowledgement from then ANC Ward 100 Councillor Annacletta ‘Nonny’ Raphata that the councillor was endorsing the building of a Cosmo City health facility on site 3469 Tuvalu Crescent, the land belonging to the NPO Perfect Start Ministries.
In another telephonic follow-up to the Gauteng Department of Health, Services Director at the City of Johannesburg, Jabulile Rakhosa told me that the MMC had no final say on the matter of the clinic. This was further disturbing for the NPO.
Perfect Start Ministries has had difficulties securing resources to proceed with its vision. It planned a fun run to raise funds to build the Cosmo City Health and Wellness Centre - regrettably the event was not a success. The NPOthenorganised an official peaceful march requesting all Cosmo City residents to each bring one brick to build the wellness centre. Unfortunately, the turn-out was very low.
Feeling the frustration, Perfect Start Ministries secured an audience with the Public Protector. The outcomes of the subsequent meeting were disappointing:
• The Gauteng Health Department claimed to only have R200, 000 for the planning phase of the construction of the 24-hour Healthcare Facility. That amount would clearly not cover construction costs.
• Perfect Start Ministries wanted to know the estimated cost of the clinic. No budget was provided at the meeting.
• The NPO wanted evidence that the department had secured land and a plan showing when the construction of the clinic would begin. This information was not provided on the day.
The Public Protector official sitting on the conciliation meeting said monitoring would be done quarterly from the date of the inception of the meeting, which never happened.
The outcomes of the meeting made it clear that:
• Cosmo City needs a 24-hour Health Facility for the residents.
• The Gauteng Department of Health had not yet secured land for the facility.
• The Department currently has no budget for it.
• Perfect Start Ministries does have the land where a health facility can be built.
• The Health Department and the NPO have not been able to work together to agree on plans for the envisioned health facility.
• The Cosmo City community remains without a health facility that it so desperately needs. It is logical to conclude that an intervention is required.
Having thoroughly researched this issue, I fail to understand why the Gauteng Health Department is not working with Perfect Start Ministries. What does it mean if it claims that a health facility is a priority? How long does it take for a supposed priority to translate into actual action?
The Gauteng Department of Health MUST explain why it had claimed to have found a suitable plot but later admitted that it did not have any such land. How did that happen?
The residents of Cosmo City were able to rise up when a backroom was demolished by the Red Ants because it had not been built according to a proper plan – why are they not standing up to demand a health facility? The mobile facility currently in use is inadequate. The residents might one day band together and demand a 24-hour facility. Perhaps immediate intervention is needed.
Muzi Nkosi still has a letter dated 14 June 2016 from the then and current Minister of Health Aaron Motsoaledi, acknowledging the need for a 24-hour Cosmo City Health Facility. The letter clearly states that the Gauteng Department of Health would facilitate the process thus giving hope to Nkosi. Sadly, that promise has not materialised.
Nkosi also has in his possession, a letter dated 30 July 2015 from the Public Protector representative Mrs. M.W. Manyathela; signed by Gauteng Department of Health representative Mrs. M. Lerutla; and by Nkosi himself, representing Perfect Start Ministries, statingthat before 14 August 2015, the Gauteng Department of Health would have to provide a project plan for the construction of the 24-hour Cosmo City Health Facility.
The project plan should include a budget for the planning phase, estimated costs for the construction, and a letter of approval of the land from the City of Johannesburg, as well as a description of the land identified.
The Gauteng Department of Health has never fulfilled any of its commitments even though it claims to have prioritised the building of a 24 Cosmo City Health Facility ever since 2004.
In his most recent submission to me, Nkosi plainly states that the Public Protector has failed the residents of Cosmo City.
The latest response to me from the Gauteng Health Department says: “The project is currently on hold due to site issues and financial reprioritization”.
Speaking to the Gauteng Provincial Legislature (GPL) following a sitting to attend to petitions on Friday 13 March 2026: The petitioner is Mr. Amon Mbatha, an adult male who resides at 75 Virginia Crescent, Ext.10, Cosmo City. He submitted apetition on behalf of the Ward 100 community, Cosmo City, Johannesburg.
He said that Cosmo City was established over twenty (20) years ago as a mixed-income housing development that accommodates forty thousand (40 000) households. He noted that since its establishment, the community has grown beyond initial assessments and now boasts a population of more than 1.5 million people.
He said the ever multiplying housing developments in and around Cosmo City has led to its rapid population growth.
The greater number of residents has placed an unmanageable strain on the existing health infrastructure resulting in an urgent need for a hospital in Cosmo City. Only a fully-fledged hospital will be able to address the health needs of the community that is currently served by an under-resourced mobile clinic.
Mbatha further said a petition with 500 signatures raising these issues was sent to ANC Ward 100 Councillor, Lyborn Ndou. He never responded to the petition.
In October 2025, I questioned Ward 100 ANC Ward Councillor Lyborn Ndou about the provision of a 24 hour Como City Health Facility, before I heard of the petition from Mr. Amon Mbatha. He said land had been allocated for this purpose next to the Cosmo City Fire Station. Responding to a follow-up question, he claimed that the population of Cosmo City was around a half-million.
In that same month, I reached out once again to the Gauteng Department of Health to get some answers about the much delayed hospital and was given the usual run-around.
Spokesperson for the department at that time, Motalatale Samuel Modiba, referred me to Sandile Gwayi, who said he could not help and that was the end. I visited the Department and was introduced to Weyland Pooe who said Tinyiko Manyisa; head of Department would be willing to assist. Unfortunately, two weeks later when I followed up, Tinyiko Manyisa said he had left the department and referred me to Pinkie Numa.
The Health Department sent me a form to fill in before my questions could be answered. Its self-imposed deadline was 31 days. This period lapsed without any response, so I followed up once again. The official reply (see below) finally arrived eight months later.
“The City of Johannesburg should sign the land donation agreement of Erf 9009, title deed T84474/2007, South Africa Drive, next to the Cosmo City Fire Station, Cosmo City and issue Resolution and sign the Permission to Occupy and Build (PTOB).
“To date, the PTOB was only signed by GDID and Joburg Property Company (JPC) has not signed the РТОВ.
“According to the JPC, the process of signing the PTOB and obtain approval to donate the site from the City of Johannesburg, Joburg Property Company obtain comments from various departments within the Municipality and Council Resolution to finalize the donation agreement and sign the PTOВ.
“To date, JPC has not received any comments and council resolution as stated above. It is not clear as to when is scheduled for Council sittings and when JPC will obtain comments and approvals from various departments.”
This is the Health Department that claimed to have prioritised Cosmo City 24 hour Health Facility since 2004.
The Gauteng Department of Infrastructure Development (GDID) is still waiting for Municipal approval to enable the Gauteng Department of Health (GDOH) to commence with planning of the project. Planning can only begin once the council resolution has been issued and Permission to Occupy and Build (PTOB) signed by the Municipality.
“The project was delayed due to the unavailability of a suitable site in the area, and the process to acquire South Africa Drive Cosmo City owned by the City of Johannesburg,” says the Gauteng Department of Health.
“In July 2016, GDID on behalf of GDOH requested CoJ through the Joburg Property Company for the donation of Erf 9009 for the purpose of building a new Cosmo City 24 hour Health Facility.
“In April 2017, the Johannesburg Property Company (JPC) issued an Agreement of Sale and Purchase to be signed by Gauteng Department of Health (GDOH).
“In September 2017, (GDOH) requested GDID to enter into an Agreement with JPC as a custodian of Assets mandated to sign land sale or donation agreements.
“The transaction required that Treasury approves the donation in line with Treasury Regulation 21.3.1.
“In March 2018, GPT granted approval to GDID to accept the land donation.
“In December 2018, the Joburg Property Company (JPC) issued Permission to Occupy and Build (PTOB). Gauteng Department of Infrastructure Development (GDID) signed the PTOB and was with GPT signed donation acceptance letter.
Planning of the new Cosmo City 24 hour Health Facility should be prioritized to proceed once the City of Johannesburg issues the signed land agreement, Council Resolution and signed Permission to Occupy and Build (PTОВ), said the Gauteng Department of Health, since the Gauteng Department of Health made building a 24 hour Cosmo City Health Facility in 2004.
The Gauteng Department of Health said that priority should be given to the planning of the Cosmo City 24-hour Health Facility as soon as the City of Johannesburg issues the long awaited documentation. It further notes that the construction of the facility has been high on the departmental agenda since 2004.
Conclusion:
This is what the Gauteng Department of Health has been promising for the past decade. I do not see a 24 Cosmo City Health Facility happening anytime sooner from the interactions with the department in Cosmo City. On the face of it, no implementation follow up or oversight was made by the Public Protector South Africa.
I know that the people of Cosmo City still have no 24 hour Cosmo City Health Facility in their area; they must lodge a new complaint, to be screened, assessed and investigated, if accepted.
The Gauteng Department of Health had failed dismally to deliver on its commitments, the community needs to formally notify the Public Protector in writing, referencing the settlement agreement and the specific clauses that have not been honoured.
I advise that the community send a complaint to the Public Protector's office stating, "As per the settlement agreement signed on 30 July 2015 (File No: 7/2-019307/14), the Department of Health was to provide a project plan and quarterly progress reports. These have not been received as required.
The community can also request the Public Protector to convene a follow-up conciliation meeting with all parties to address non-compliance and set new, enforceable deadlines.
Alternatively the community may escalate the matter to Higher Authorities in the Department of Health. If they do not respond adequately, escalate the matter to provincial or national health authorities, or seek legal advice on enforcing the agreement.
This work was produced with the assistance of a grant provided by the Wits Centre of Journalism at the University of the Witwatersrand. The opinions held are of the author.