Consultative meeting on Municipal and Primary Health Services MUNICIPAL HEALTH STATUS

1. Consultative meeting on Municipal and Primary Health Services MUNICIPAL HEALTH STATUS National Department of Health Presenter: Aneliswa Cele Venue: Sandton Central 08 April 2011. 1

2. OVERVIEW OF THE PRESENTATION Overview of Legal framework for Municipal Health Services Roles and responsibilities of the Spheres of Government Municipal Health Service Status in the Country. Progress Challenges Conclusion

3. OVERVIEW OF LEGAL FRAMEWORK FOR MHS • CONSTITUTION; • Section 24 of the Constitution states that everyone has a right to an environment that is not harmful to their health or well-being • Section 152: Provides a clear mandate for local government to take on environmental management responsibilities including sustainable provision of services to communities and promoting a safe and healthy environment • Schedule 4 (Part B) lists Municipal Health Services as a competency of Municipalities • NHA 61 2003,The Act defines various health rights and define general functions of different spheres of Government (roles and responsibilities in relation to environmental health).

4. OVERVIEW CONT… • THE MUNICIPAL STRUCTURES ACT 1998 (ACT 117 OF 1998) deals with executive authority of various structures: • Section 84(1), assigns certain functions relating to environmental health to the district municipality and; • Section 84 (1) (i) states Municipal Health Services as one of functions delegated to District Municipalities. • HEALTH PROFESSIONS ACT 1974 (ACT NO. 56 OF 1974): • In June 2009 the Minister of Health enacted the amendments to the Health Professions Act, 1974 (Act No. 56 of 1974) clearly defining the scope of practice of Environmental Health Practitioners. This Regulation (Regulation 698 of 26 June 2009) clearly spells out what functions an EHP can carry out.

5. OVERSIGHT FOR THE PROVISION OF ENVIRONMENTAL AND MUNICIPAL HEALTH SERVICES • The National Minister of Health is the custodian for the provision and monitoring of all types of health services by individuals, the public and private sectors. • The National Health Act accords similar custodian roles and responsibilities to Members of the Executive Councils (MECs) for Provincial Departments of Health to oversee implementation and monitoring of health services by Provinces, Health Districts and Municipalities as reflected in Sections 27 (1) (ix), (x) and 31(3) (b). • Section 76 also requires Municipalities to report health information data to the provincial health department.

6. ROLES AND RESPONSIBILITIES OF SPHERES OF GOVT ON ENVIRONMENTAL HEALTH SERVICE • National Department of Health • Take the lead in the development of policies, strategies , guidelines , Norms and Standards, SOPs etc. on environmental health activities. • Create conditions that ensure success, namely adequate resource allocation to environmental health services at all levels. • Monitor the implementation of Environmental Health Services

7. ROLES AND RESPONSIBILITIES ON ENVIRONMENTAL HEALTH Cont, • Provincial Department of Health • Provide environmental pollution control services, • Plan, coordinate and monitor : • Port health services • Malaria control and • Hazardous substances • Monitor all State owned facilities on behalf of National DoH • Monitor the rendering of Environmental Health Services

8. ROLES And RESPONSIBILITIES ON ENVIRONMENTAL HEALTH Cont. • Local Government • Municipal Health Services In terms of Section 1 of the National Health Act, 2003, (Act 61 of 2003) Municipal Health Services refer to: • Water Quality Monitoring • Food Control • Waste Management • Health Surveillance of Premises • Surveillance and Prevention of Contagious Diseases, excluding Immunisation • Vector Control • Environmental Pollution Control • Disposal of the Dead, and • Safe Handling of Chemical Substances but excludes Port Health, Malaria Control and control of Hazardous Substances

9. MUNICIPAL HEALTH SERVICES STATUS, PROGRESS AND CHALLENGES

10. 2009/2010 ASSESSMENT Why was the assessment conducted ? • Devolution process that is not complete • Can not appropriately plan for EHS • Have no baseline infor at National- no reports received • Lack of uniformity in providing MHS throughout the Country • Lack of leadership in driving the process • Frustrated Professionals

11. MHS ASSESSMENT PROCESS • The DoH together with COGTA conducted assessment workshops in 8 Provinces SALGA participated in Eastern Cape • This assessment was conducted between November 2009 and January 2010 • An assessment tool was developed and shared with Provinces and Municipalities as a guiding document in preparation for status report presentation prior to the workshops • During the workshops DoH and COGTA did presentations on the roles and responsibilities

12. ASSESSMENT Cont. The tools had questions requiring: • Status on communication link at Local,Provincial and National levels- Communication structures • Section 78 assessments, how and whether the process was conducted or at what stage it is? • MHS Structure approved by Council, whether there is the MHS structure approved by Council?

13. 2009/2010 ASSESSMENT. • Dedicated budget, whether there is a dedicated budget in line with National Treasury • Strategic Planning (IDP), whether there is alignment of IDP and DHP. • Service Level Agreements, whether there are SLAs between B and C Municipalities and between Province and C Municipality and • No/percentage of transferred staff, number or percentage of transferred personnel vs. total no to be transferred

14. OUTCOMEOF ASSESSMENT PER PROVINCE

15. Eastern Cape Province • The ECDoH signed SLAs with all Municipalities except Ukhahlamba and Chris Hani DMs. • All six DMs reported to have conducted Section 78 assessments and opted to the delivery of the service internally with the exception of Cacadu DM • Due to a lack of continuous cooperation between the ECDoH and the affected municipalities and the uncertainties on funding provision the process stopped in 2006.

16. Kwa-Zulu Natal Province • Some Local Municipalities and the Provincial Health Authority were still rendering MHS without signed service level agreements or having conducted a Section 78 assessment • Local Municipalities(B- Municipalities) within the Province were still employing EHPs to render MHS. • Provincial Department of Health had among others stalled the transfer from the Provincial Department of Health to District Municipalities

17. Gauteng Province • Local Municipalities and the Provincial Health Authority were still rendering MHS without signed service level agreements. • Section 78 assessments not conducted in all District Municipalities.

18. North West Province: • Some Local Municipalities and the Provincial Health Authority still rendering MHS without signed service level agreements. • Section 78 assessments not conducted in some municipalities . • Resources were not transferred with personnel. • In certain areas personnel were absorbed to District Municipalities without following the correct procedures.

19. Northern Cape Province • Local Municipalities and the Provincial Health Authority still rendering MHS without signed service level agreements. • Section 78 assessments not conducted by District municipalities. • Both the Province and the Municipalities were eager to start engaging each other for smooth finalization of the process.

20. Mpumalanga Province • Some Local Municipalities and the Provincial Health Authority still rendering MHS without signed service level agreements. • Section 78 processes not conducted. • Resolutions of the bargaining chamber in the province, which required the process to be completed as planned, were taken in the absence of Municipal/District chamber and thus hindered the process.

21. Free State Province • Some Local Municipalities and the Provincial Health Authority still rendering MHS without signed service level agreements. • Section 78 assessments not conducted by all Districts. • The process of devolution not facilitated well. Some Districts such as Xhariep only started rendering Municipal Health Services on the 1st of December 2009.

22. Limpopo Province • 3 District Municipalities completed the process and 2 were still in the process. • Section 78 assessments was conducted in some Districts such as Waterberg where the Council had approved the S78 report. • The Devolution Task Team was no longer active. • Communication through the Provincial Office was also perceived to be nonfunctional.

23. Western Cape Province • Process was complete during the period of assessment • MHS Structures were in place • DMs and a Metro had allocated budget for the service • Environmental Health Forum active and functional No workshop was conducted in the Province

24. SUMMARY OF OVERALL FINDINGS • Devolution process not complete in 8 out of 9 Provinces • Lack of uniformity in providing MHS throughout the Country • Lack of leadership driving the MHS devolution process • No MHS structures or organograms in Municipalities

25. SUMMARY Cont. • Lack of leadership in Municipalities understanding the service • No Service Level Agreements • IDPs not aligned with DHPs • Very low staff moral

26. HUMAN RESOURCE CAPACITY

27. PROGRESS • Municipal Health Service devolution document finalised- awaiting the DG’s approval • National MHS task team comprising of DoH, COGTA, SALGA and National Treasury was established which will facilitate and ensure the process is finalised • Progress quarterly reports have been received by National DoH from Provinces- new developments have been noted in Eastern Cape and in some Municipalities in KZN. • Amendment to Community Service Regulation which will give an opportunity to Municipalities to appoint Community Service EHPs

28. CHALLENGES • Funding -Misdirection of budget allocated for MHS at Municipal level. • Communication challenges between Provinces and Municipalities • Continuous challenges of locating community service EHPs (150 unallocated) • Professionals threatening to charge the Department for making the profession redundant

29. CONCLUSION • DoH will continue to closely monitor progress through the quarterly reports received from Provinces • COGTA offered to assist Municipalities undergoing Section 78 process and would like to urge the Municipalities to use the opportunity • The National MHS task team will from time to time meet to ensure that the process is brought to its finality.

30. THANK YOU