Chris Hani Baragwanath Academic Hospital (colloquially known as Bara) is a hospital in Johannesburg, South Africa. It is the largest hospital in Africa and seventh largest hospital in the world. It has 6,760 staff members, 3,400 beds and occupies 70 ha (170 acres). The hospital is located in Soweto, south of Johannesburg. It is one of the 40 Gauteng provincial hospitals, and is financed and managed by the Gauteng Provincial Department of Health. It is a teaching hospital for the University of the Witwatersrand Medical School, along with the Charlotte Maxeke Johannesburg Academic Hospital, Helen Joseph Hospital and the Rahima Moosa Mother and Child Hospital.
Entrance to Chris Hani Baragwanath Hospital in Soweto. Photo: AFP
Did you know? Chris Hani Baragwanath hospital is the largest hospital in the southern hemisphere. This little fact featured in the wrappers of iconic South African chewing gum brand Chappies for years. The legendary Chappies wrapper.
From Military Hospital to Civilian Institution
Chris Hani Baragwanath began its life as a military hospital, serving British troops in the Second World War. The Imperial Military Hospital, Baragwanath, was built in what today is Diepkloof in 1942 for convalescing British and Commonwealth soldiers. Its name was derived from Cornishman John Albert Baragwanath. Sometime after the discovery of gold in 1886, a young Cornishman, John Albert Baragwanath, arrived on the gold fields to make his fortune. He decided to open a refreshment station near the place where the roads from Cape Town and Kimberley met, about a day's journey by ox-cart south of Johannesburg. He called it The Wayside Inn, but transport riders simply called it Baragwanath's place. After the First World War an aerodrome was built close by and it was called Baragwanath as well.
At the beginning of the war the South African government, Parliament and electorate were divided on whether or not to join Great Britain in the war against Germany. When South Africa did declare war against Germany, her forces were committed to serve in Africa only. In September 1940 the British government asked the South African government to provide health care facilities for Imperial troops of the Middle East Command. It suggested two hospitals of 1,200 beds each in the Cape and Natal. South Africa decided to rather build one of the hospitals near Johannesburg, Transvaal.
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There was already a university medical faculty, a nurses' training college, and facilities for rehabilitation. The site of the proposed hospital was to be on the farm Diepkloof, south-west of the centre of town. The ground was bought from The Corner House mining group and it was to be situated at the 8th milestone on the road from Johannesburg to Potchefstroom. The initial estimate of the cost of erecting the hospital was £324,000, but it was then decided to make provision for 1,544 beds (instead of 1,200) because of the increase in hostilities in the Middle East. The layout of the hospital resembled a military camp with many huts containing the various wards. There were about 50 wards that could accommodate 40 beds each. The Johannesburg municipality provided electricity, water and drainage. Construction commenced on 3 November 1941 and the first patients were admitted on 28 May 1942. The final cost of the hospital was £328,000.
The people of Johannesburg supported the hospital throughout the war by providing entertainment and gifts for the patients. In February 1943 bowling greens were donated by the local bowling associations. As the war in the Far East expanded, so the number of soldiers contracting tuberculosis increased. Johannesburg with its warm climate and dry winters was an ideal location to treat such patients. By 1944 Baragwanath had predominantly become a hospital for the treatment and convalescence of tuberculotics. Even after the war ended there were still many soldiers convalescing in the Baragwanath Hospital.
The royal family visited the hospital on 5 April 1947. In the surgical section King George VI invested Flight Lieutenant E.R.H.Watson, Royal Air Force, with the Distinguished Service Cross (United Kingdom). On the lawn Colonel Scott was invested as Commander of the Order of the British Empire, while Principal Matron C. Hose became a Lady of the Royal Red Cross. Captains T.S. Protheroe and J. Devine became Members of the British Empire. Squadron Leader R.A.
The Transvaal Provincial Administration paid the British government £1 million for the buildings, remaining equipment and stores. The military left on 1 September 1947. Dr J.D. Allen was the first civilian Superintendent. The first Matron was Joan MacLarty. They started converting the facilities at Baragwanath to accommodate the non-European section of the Johannesburg General Hospital. Initially the hospital was called the NEH, but later the name Baragwanath was used again.
Apartheid Era and Expansion
After 1948, and the establishment of apartheid, the hospital found itself in the centre of a black township, Soweto, and became a civilian hospital for black patients. From this start, grew Baragwanath Hospital (as it became known after 1948), reputedly the largest hospital in the southern hemisphere.
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Historian Dr Simonne Horwitz read for a Ph.D. on the pre-1994 history of Chris Hani Baragwanath which was subsequently published as Baragwanath Hospital, Soweto. She told Africa Check that a lot of the initial stress on the hospital’s size came from the minority National Party government which wanted to show that it looked after black people in the country. This was part of efforts to portray its policy of separate development as viable, despite strong international criticism. "The apartheid government used Bara as its showpiece... Some of the original discussion was [about] how big it was,” Horwitz said.
Links were immediately forged with the University of the Witwatersrand and Bara would over time become one of its largest teaching centres. This link brought medical students and their teachers into direct contact with apartheid in the medical sphere. This book will contribute to studies of the history of apartheid that have begun to provide a more nuanced account of its workings.
The history of Baragwanath and of the doctors and nurses who worked there tells us much about apartheid ideology and practice, as well as resistance to it, in the realm of health care.
However, the development of the townships was magnified and accelerated by the desire of the apartheid regimen to eradicate established black enclaves in order to make space for white working class suburbs. Soweto was the result of the apartheid “Native Housing Policy” based on academic housing research undertaken by idealistic architects influenced by LeCorbusier and the Garden City Movement.
Only in 2002 were they integrated into Johannesburg. Initially the townships were intended to provide much needed accommodation for black workers. However, the development of the townships was magnified and accelerated by the desire of the apartheid regimen to eradicate established black enclaves in order to make space for white working class suburbs.
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Soweto became the “City of Stress.” This stress resulted in predictable alcohol abuse and frustration-fuelled violence that filled the Baragwanath emergency room with victims of fights with guns, bottles, or knives every weekend, but more so after paydays, a very predictable phenomenon delayed only by severe rain.
On the medical side Soweto’s social conditions created strong generalists who manage large numbers of patients with competence and speed. Baragwanath’s 500 physicians, almost 2,000 nurses, and support staff totaling about 6,700 are hardly generous numbers given the workload.
The experience of large numbers of patients and limitations of the institution formed practice and allowed for clinical experience to take center stage, i.e., for clinical observation after penetrating peritoneal trauma rather than exploratory laparotomy or radiological examination. This practice may have grown out of the observation of the futility of the other approaches, but was rigorously evaluated based on the prospective observation of hundreds of patients.
In addition to clinical competence the restricted means and often unreliable support services created an esprit de corps of the medical staff. The physicians who practice here are aware of their competence and proudly do their unique work apart from the resource-rich practice in the other academic hospitals of Johannesburg.
Post-Apartheid Era and Renaming
After the advent of democracy in 1994, struggle stalwart Chris Hani's name was coupled to that of Baragwanath and in 1997, the hospital was renamed Chris Hani Baragwanath hospital. It was also in that year that the hospital submitted an application to the Guinness Book of Records to be recognised as the largest hospital in the world, hospital spokesman Nkosiyethu Mazibuko confirmed to Africa Check.
“We still record the Chris Hani Baragwanath hospital as the largest hospital in the world by number of beds, [with 3,294],” Guinness World Records PR Manager Doug Male told Africa Check. He said that records are either initiated in-house or, as was the case with Chris Hani Baragwanath, an organisation applies for the record. If it is an application for a record, their researchers will check that the record claim is true.
COMMSA Baragwanath Hospital Project: A Day in the Life
Challenges and Modernization
Chris Hani Baragwanath hospital is not as big as it used to be. Staffing problems, maintenance issues and ward renovations mean that it has fewer hospital beds available than before. It was reported last year that emergency patients were being referred to other hospitals because of renovations at Chris Hani Baragwanath's emergency unit. In January, medical casualty was still closed.
In 2011, it was announced by health minister Aaron Motsoaledi that the hospital would be downscaled to 1,200 beds, in line with international standards. The hospital’s Mazibuko told Africa Check that no wards had been closed but that some were being renovated. He said that this process was almost completed. “The bed occupancy is 3,400 [with] 2,888 usable,” he said.
Bigger is also not necessarily better. A serious concern with a hospital as large as Chris Hani Baragwanath, which has grown haphazardly for the last 70 years, is that “it is so expensive to maintain”, said Prof Stephen Hendricks, a public health specialist in South Africa.
“When Bara was built it was much smaller than it is now and they have just been adding on sections,” Hendricks said. The wiring, plumbing and engineering techniques range in age and efficiency, making maintenance expensive. “There are discussions at high levels to decentralise Bara into three possible hospitals, which will be more in line with the vision of the National Health Insurance. That is more accessible. Soweto has 4 to 5 million people and they all come to Bara,” he told Africa Check.
During the COVID-19 pandemic in South Africa, the Gauteng government spent R 528 million on the hospital; this included a new 500-bed facility. In August 2020, the Public Protector found administrative deficiencies that led to inefficiencies in the delivery of primary health care services.
Chris Hani-Baragwanath hospital lies at the border of the community it serves. Coming from Johannisburg, a four-lane highway leads directly to its gates-with its guards and their machine guns. From Soweto the patients stream into the hospital over a large bridge that crosses the highway in front of it. Many patients come by mini-bus and exit the busses in front of the hospital. Behind the wall surrounding its campus a large new outpatient facility has replaced the collection of barracks that had served this purpose for decades.
Global Ranking and Size Comparison
Chris Hani Baragwanath considers two hospitals larger than itself: the West China Hospital and the Chang Gung Memorial Hospital, Mazibuko told Africa Check. The West China Hospital, which is affiliated with Sichuan University in the city of Chengdu, is said to have 4,300 beds. Using our trusty friend Google we then methodically searched for the largest hospitals on each continent.
Hospitals such Ahmedabad Civil Hospital in India (“more than 2,000 beds”) and Hospital das Clinicas with the University of Sao Paulo Medical School (with its 2,200 beds) trail behind the Soweto-based hospital. The United States also has a number of large hospitals, such as New York-Presbyterian (2,328 staffed beds) and Florida Hospital Orlando (2,247 beds), but doesn’t nearly reach the number of beds Chris Hani Baragwanath is claimed to have.
We did find one hospital that is bigger: the Clinical Centre of Serbia.
Here's a comparison of bed numbers in some of the world's largest hospitals:
| Hospital | Number of Beds |
|---|---|
| Chang Gung Memorial Hospital | 9,000 |
| Clinical Centre of Serbia | 3,470 |
| West China Hospital | 4,300 |
| Chris Hani Baragwanath Hospital | 2,888 (usable) |
| New York-Presbyterian | 2,328 |
| Hospital das Clinicas (Sao Paulo) | 2,200 |
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