Transcript Municipal Health Services

Municipal Health Services
The Local Government Perspective
Eastern Cape Example
SALGA
Consultative Meeting on Municipal and Primary Health
Care (Discovery Auditorium, Sandton)
08 April 2011
Background
 Legislative framework





Constitution (Act 108, 1996)– Schedule 4B
Local Government: Municipal Structures Act
(Act 117, 1998) – S84(i)
National Health Act (61 of 2003) – Definitions &
S32(1)
MINMEC decision – MHS and who should
render
DORA Bill, 2006 – MHS – “Basic Service”
Introduction
 SALGA requested the Eastern Cape to present on
our experience with the devolution of MHS
 Eastern Cape one of the poorest provinces
 The province consists currently of one Metro
(NMMM) and 6 District Municipalities
 One aspirant metro (Buffalo City)
Governance arrangements
 ECDoH facilitated and coordinated the Provincial Environmental
Health Devolution Task Team (PEHDTT) - 2003
 Chairperson of PEHDTT– alternated between ECDoH and LG.
 Consisted of Metro, DM and ECDoH environmental health
management
 Working Committees established to collect data
 Also established District EH Devolution Task Teams at each DM and
Metro
 Consisted of Local Government and Provincial EHPs
 Union representatives (Local Government & Government)
 Directors / Managers to whom EHPs report
 Politicians (Ad hoc feedback)
 Reported to District Management Team (ECDoH); Top
Management and Standing Committee and PEHDTT.
 ECDoH – reported to PHAC and PHC and subsequently to Parliament
Initial process
 PEHDTT’s Working Committees collected data necessary
for the devolution of MHS e.g. Staff information; available
equipment.
 Invited DWA – Share best practice with integration of
water function to the WSAs
 Invited Unions (Government) and the Bargaining Council
to inform them and to get direction – S197 of LRA Medical Aid and Pension fund issues.
 Regular PEHDTT meetings from 2003 till 2006 –
Aeroplane
Challenges
 No further substantial progress with ECDoH – irregular
meetings
 Numerous national due dates were set for devolution
(2004 then 2006 and the latest was April 2010) which
resulted in:


Provincial colleagues resigning – prolonged devolution
process.
 JGDM – 45% Provincial EHPs resigned in 18 months
 ADM – 5 Provincial EHPs resigned in one month
Provincial EHPs not benefiting from car allowances etc.
>90% EHPs are without transport
 Lack of establishment cost for provincial staff
 Provincial staff mostly without transport and equipment
 Lack of an exit strategy from DoH such as DWAs.
Challenges (Cont. 1)
 LG cannot populate organisational structures – wait for
provincial staff
 Shortage of EHPs at LG, services that are not properly
structured and little to no growth opportunity for EHPs at
DMs leads to frustration from LG’s own staff - JGDM 83%
EHP staff turnover in past 5 years
 Environmental health not regarded as priority

Support from authorities

Governments strategic monitoring of basic services – “Turn
Around Strategy” – LGTAS – did not reflect on MHS – weekly
monitoring (R 1; R 2; New conservancy).
Challenges (Cont. 2)
 Ratio of EHP per population (SA - 1:15 000) (WHO – 1:10
000) – Attitude of Management – can never have the ideal
situation.
 (Community Service EHPs – National Programme) – No
transport, office accommodation, some accommodated
without skilled EH support
 Sustainable funding beyond 3 year funding from ECDoH
(2009/10)– National Treasury model (MHS not income
generator)
 Equitable Share (Basic Services) not ring-fenced for EH –
R2m only received R200k internally.
Results
 After 2006 lack of progress through ECDoH, we resorted





to SALGA EC
Meetings with MEC for Health and LGTA
National surveys on the progress with the devolution of
MHS – 2006 and DBSA, 2007 – Presented at national
forums – give momentum.
Interaction with National Treasury – costing
Department Housing, Local Government and Traditional
Affairs made funding available - S78 municipal capacity
assessments (R280 – R300k)
Follow up PEHDTT – Workshops (Nov 2009)



Service Level Agreement
ECDoH – funding – 3 years at 100% (2006/07 till 2008/09)
Funding and transfer of staff not synchronised
Results
(Cont.)
 Presentations to SALGA EC resulted in buy-in
 SALGA EC – MHS Working Group established
Elevate to SALGA National
 SALGBC – 2010 - Working Group
Special Resolution submitted to April 2010 Local Government
Summit
Appointment of permanent National Environmental Health Director
Interaction at national level between DoH; COGTA and National
Treasury
Functional integration initiatives between LG and ECDoH to use
provincial staff locally.
ECDoH – negotiated with individual DMs for transfer
A few DMs in advanced stage to receive provincial EHPs by 1 July
2011.







Recommendations
 Develop a proper devolution framework and
monitor its implementation.
 COGTA should be more strategic – Municipal
Turn Around Strategy (LGTAS) – focus on “basic
services” but it does not reflect MHS
 Do such surveys on a regular basis also for MHS
– include legal requirements such as S78
capacity reports; budgets, inclusion of MHS in
IDP, ornanisational structures and vacancy rates;
progress with devolution and integration of MHS
at DMs and Metros, etc.
Recommendations (Cont.)
 Use and understanding of terminology which
negatively affects Environmental Health /
Municipal Health Services


Health Services
Environmental management
 Facilitate a proper national costing study for
MHS – National Treasury challenges our
figures.
 Clarify the use and preparedness of LG for
accepting and managing Community Service
EHPs.
“Usana olungakhaliyo lufela
embele kweni”
CLAIM YOUR SPACE!!!!
Support for Municipal Health Services from
National and Provincial Structures
Institution
Good %
Average %
Poor %
EC
Nat
EC
Nat
EC
Nat
NDoH
0
0
17
24
83
68
PDoH
33
24
17
44
50
29
DPLG
17
9
33
18
50
65
SALGA
0
3
17
21
83
53
SAIEH
0
3
67
32
17
59
Unions
17
24
17
24
33
34
Source: National devolution progress surveys - January and July 2006 and
DBSA survey, 2007
Eastern Cape Province in relation
to South Africa
MUNICIPALITIES
Metropolitan = 6
District
= 46
Local
= 229
Time Line
Draft National
Environmental Health
Policy October 2004
DBSA Development
Dialogue on MHS,
Midrand , March 06
Financing EHS in
SA May 2004
National Summit
Polokwane May 2004
MINMEC Decision
21 August 2003
FFC Submission:
Financing PHC
and EHS in SA
August 2004
National Framework for the
Devolution of EHS in SA –
Implementation Strategy,
March 2004
Monitoring the Impact
of MHS Policy
Implementation
January 2005
National EH
Indicators –
George, October
2004
DBSA Research,
Delivery of MHS
by DMs in SA,
July 07
SAIEH
Conference –
Municipal Health
Services Feb
2006
SALGA: Workshop
on MHS March
2005, JHB
Seminar on
Implementing
MHS, July
2006, Pretoria
MHS Conference,
East London 2830 November
2006
2 year transitional period
9 October 2002
Cabinet decision
1 July 2004
Implementation
date
1 July 2005
First Municipalities
taking over functions
Developments with regard to the interpretation and implementation of MHS in South
Africa since the Cabinet decision that EHS will be MHS and the function of
Metropolitan and District Municipalities from 1 July 2004.
JOE GQABI DISTRICT MUNICIPALITY
Municipal Health Services
March 2008
Progress with the devolution/consolidation of
MHS (New or extended service – Municipal Systems Act)
Eastern
Cape %
National
%
Section 78 assessment undertaken
100
60
Approved S. 78 report
83
23
DMs Service Level Agreement with LMs
67
13
MHS part of Integrated Dev. Plan
83
60
MHS budgeted for 2006/07
100
27
Integrated Multi year budget approved
100
21
DMs take transfer of staff from LMs
40
27
Variables
Sewerage pump station
Sewerage Balance Drain –
Engineering solution - >10 years
New Sewerage Pumps – 6 months
after transfer of LM EHPs to DM
Sewerage spills in communities
Sewerage spills monitored weekly
by EHPs
Broken sewerage connections – Who
cares?
 Politicians, Engineers and communities want structures.
 MHS/EHS concerned with operations not causing a health hazard
to communities to prevent illnesses from occurring – sometimes
conflicting – substandard facilities.
 Damage to infrastructure - maintenance
Housing development: Quality of
Workmanship
Condition at landfill site – lack of control and
management
Infrastructure damaged due to a
badly managed landfill site
Local municipal workers offloading waste
in non demarcated area on landfill site
MHS monitors and compliance enforce as
part of pollution control and waste
management
 each year at least 3 million
children under the age of 5 die
due to environmental related
illnesses
 90% of Acute Respiratory
Infections world wide
 80-90% of Diarrheal cases contaminated water and
inadequate sanitation.
 90% of malaria cases are
attributed by environmental
factors
Millennium Development Goals??
After 6 years of continued monitoring by EHPs – improved
sewerage system – only clean for 2 months – Honey sucker
services terminated – EHPs frustrated – what is my role and
purpose?
Current cost of MHS – 2009/10
Expenditure
Income
Balance
Alfred Nzo DM
12,176,334
5,659,000
-6,517,334
Amatole DM
22,818,963
14,069,196
-8,749,767
Cacadu
11,402,877
4,741,000
-6,661,877
Chris Hani DM
23,818,521
11,400,000
-12,418,521
OR Tambo
19,749,963
20,779,000
1,029,037
Joe Gqabi DM
10,225,788
5,208,487
-5,017,301
NMMetro
29,162,483
13,726,000
-15,436,483
Buffalo City (Metro)
22,767,107
10,674,804
-12,092,303
152,122,037
86,257,487
-65,864,550
Future funding implications Eastern
Cape - Shortfall
2009/10
Expenditure
2010/11
2011/12
2012/13
152,122,037
166,573,630
182,398,125
199,725,947
Income
86,257,487
86,257,487
86,257,487
86,257,487
Shortfall
-65,864,550
-80,316,143
-96,140,638
-113,468,460
Per Capita Cost
R23.58
Per Capita Income
R13.37
Balance
-R10.21
R 60.00
R 12.00
R 50.00
R 10.00
R 40.00
R 8.00
R 30.00
R 6.00
R 20.00
R 4.00
R 10.00
R 2.00
2018/19
2017/18
2016/17
2015/16
2014/15
2013/14
2012/13
2011/12
2010/11
2009/10
R2008/09
R-
Financial Years
Per Capita Cost
NDoH
Equitable Share per Household
Per Household
R 14.00
2006/07
Per Capita
Equitable Share Allocation for MHS - Prediction to Reach
R13/head
5 – Yrs - DoH
Per Capita and Household Income and
Expenditure for 2009/10 – MHS
Per Capita and Household Income and Expenditure: MHS - 2009/10
NDoH – proposal –
HST costing study
130
120
110
100
90
80
70
60
50
40
30
20
10
0
Income
Cost
Per Capita
Per Household
Equitable Share
NDoH Target