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Municipal Health Services The Local Government Perspective Eastern Cape Example

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Municipal Health Services The Local Government Perspective Eastern Cape Example SALGA Consultative Meeting on Municipal and Primary Health Care (Discovery Auditorium ... – PowerPoint PPT presentation

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Title: Municipal Health Services The Local Government Perspective Eastern Cape Example


1
Municipal Health ServicesThe Local Government
PerspectiveEastern Cape Example
  • SALGA
  • Consultative Meeting on Municipal and Primary
    Health Care (Discovery Auditorium, Sandton)
  • 08 April 2011

2
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

3
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)

4
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

5
Initial process
  • PEHDTTs 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

6
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. gt90 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.

7
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 LGs 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).

8
Challenges (Cont. 2)
  • Ratio of EHP per population (SA - 115 000) (WHO
    110 000) 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.

9
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

10
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.

11
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.

12
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.

13
Usana olungakhaliyo lufela embele kweni
CLAIM YOUR SPACE!!!!
14
Support for Municipal Health Services from
National and Provincial Structures
Institution Good Good Average Average Poor Poor
Institution 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
15
Eastern Cape Province in relation to South Africa
MUNICIPALITIES Metropolitan 6 District
46 Local 229
16
Time Line
DBSA Research, Delivery of MHS by DMs in SA, July
07
Draft National Environmental Health Policy
October 2004
DBSA Development Dialogue on MHS, Midrand , March
06
Financing EHS in SA May 2004
FFC Submission Financing PHC and EHS in SA
August 2004
SAIEH Conference Municipal Health Services Feb
2006
Seminar on Implementing MHS, July 2006, Pretoria
Monitoring the Impact of MHS Policy
Implementation January 2005
National Summit Polokwane May 2004
MHS Conference, East London 28-30 November 2006
MINMEC Decision 21 August 2003
National Framework for the Devolution of EHS in
SA Implementation Strategy, March 2004
National EH Indicators George, October 2004
SALGA Workshop on MHS March 2005, JHB
2 year transitional period
2007
2003
2004
2005
2006
2002
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.
17
JOE GQABI DISTRICT MUNICIPALITY
41
Municipal Health Services March 2008
18
(No Transcript)
19
Progress with the devolution/consolidation of MHS
(New or extended service Municipal Systems Act)
Variables 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
20
Sewerage pump station
21
Sewerage Balance Drain Engineering solution -
gt10 years
22
New Sewerage Pumps 6 months after transfer of
LM EHPs to DM
23
Sewerage spills in communities
24
Sewerage spills monitored weekly by EHPs
25
Broken sewerage connections Who cares?
26
  • 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

27
Housing development Quality of Workmanship
28
Condition at landfill site lack of control and
management
29
Infrastructure damaged due to a badly managed
landfill site
30
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
31
  • 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??
32
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?
33
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
34
Future funding implications Eastern Cape -
Shortfall
2009/10 2010/11 2011/12 2012/13
Expenditure 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 Per Capita Cost R23.58
Per Capita Income Per Capita Income R13.37
Balance Balance -R10.21
35
5 Yrs - DoH
36
Per Capita and Household Income and Expenditure
for 2009/10 MHS
NDoH proposal HST costing study
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