South African Health Review 2008 - Health Systems Trust

metropolitan municipalities, as these were already
providing environmental health services, and were
mostly well resourced entities. For district municipalities,
the implementation of the decision was fraught with
challenges, as these were newly established entities, with
little revenue generating powers, and were lacking in staff
to oversee the process. Progress at this level was thus slow,
as it was also seen as an unfunded mandate. 12 In 2006,
the National Treasury provided limited financial resources
for environmental health services, as part of the equitable
share funding process (basic services component) to district
municipalities. 12,13 The High Court of South Africa, on 10
April 2008, made a ruling regarding the interpretation of the
definition for municipal health services, as stipulated in the
National Health Act, to embrace PHC, which was rendered
by municipalities before the Act was enacted. 14 This has
far reaching implications for municipalities and creates
further challenges to district municipalities with regard to
the availability of resources, as well as organisational and
administrative arrangements.
A number of studies have shown that the devolution of
municipal health services has been uneven; while some
provinces such as the Eastern Cape, the Free State and the
Western Cape were doing well, others were struggling.
By February 2007, two thirds of the district municipalities
provided municipal health services, with the other third of
local municipalities (category B) still playing a significant
role in rendering environmental health services. 12 There were
signs of progress, as municipal health services were fairly
well integrated into municipal planning processes (especially
long-term processes). Furthermore, resources for services
were deemed to have improved at a macro level (i.e. national
and provincial) since devolution of service, but at micro
level (i.e. metropolitan and district municipal) significant
differences continued to occur. 7,12
Studies also show that most of the key national and
provincial role players, such as the South African Local
Government Association (SALGA), the national Department
of Health (NDoH) and the Department of Provincial and
Local Government (DPLG), designated to lead the devolution
of municipal health services, played a very limited role in
giving support and direction to metropolitan and district
municipalities. 12,15
The following are key challenges for district municipalities
in implementing municipal health services.
Overlaps and conflict in the allocation of powers
and functions
This is well illustrated with pollution control,
where local and district municipalities, as well as the
Department of Environmental Affairs and Tourism
have pollution control functions. 10,16,17 The various
powers, functions and responsibilities for the different
categories of local government have been determined.
However, there is still uncertainty with regard to some
environmental health services activities that are divided
between local and district municipalities. This should be
viewed against the legislative backdrop that has given
the function for rendering municipal health services
exclusively to metropolitan and district municipalities
(see Box 3). 2,10,11,16 Most problems with powers and
functions between local and district municipalities are
being sorted out through consultation. Yet the split in
provision of environmental health services is regrettable,
as it makes planning for the services unnecessarily
complex.
Legal compliance
District municipalities have to comply with different
legislation, which addresses a vast array of issues to
facilitate appropriate service delivery. The Municipal
Systems Act (Act 32 of 2000) requires in sections 76,
77 and 78, that all municipalities should carry out
investigations (so called section 78 investigations) into
their current and future capacity, when receiving a
new municipal service or when a municipal service is
extended significantly. 18 The metropolitan and district
municipalities should also be statutorily authorised by
the Ministry of Health under the Foodstuffs, Cosmetics
and Disinfectants Act (Act 54 of 1972) to enforce this
Act. 19
However, a study by the Development Bank
of Southern Africa showed that the section 78
requirement was not adhered to by 40% of district
municipalities. Additionally, nearly 60% of district
municipalities had not been authorised by the Ministry
of Health (section 23(1) of the Foodstuffs, Cosmetics
and Disinfectants Act) by September 2007, to enforce
the Foodstuffs, Cosmetics and Disinfectants Act in their
respective areas of jurisdiction, to control food quality
issues. 7,12,19 Opportunities for improving the quality of
municipal health services rendered were thus missed
as section 78 investigations gauge the capacity of the
municipality to render any municipal service.
Staffing levels
Environmental health staffing levels have decreased
in a number of provinces, following the devolution
of environmental health services to district
municipalities. 12,20 Transfer of environmental health
staff from most provincial health departments and
some local municipalities, has yet to take place. 12,15,20
The reason for this is due to the uncertainty around
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