Municipal Health Services in South Africa, the Challenges and Opportunities

Municipal health services (MHS) include most environmental health services and according to the Constitution of the Republic of South Africa, are part of a basket of services that have to be provided by local authorities. With the promulgation of the New Health Act 61 of 2003 in 2005 providing a final definition of municipal health services and the allocation of funding in 2006 by Treasury for municipal health services, the provision of these services by local authorities needs review with the aim of determining the challenges and opportunities that still exist in the provision of municipal health services. This paper attempts to clearly outline the evolution of municipal health services in South Africa and some of the opportunities and challenges in the provision of such services. INTRODUCTION South Africa still has a high burden of preventable diseases which can be mitigated through improvements in the environment. Investigation of outbreaks of disease, monitoring of the environment and health promotion have in the main been provided by environmental health practitioners, most of whom are employed by local government. With the long period of uncertainty around the responsibility for the delivery of primary health care (PHC) services at a local level and the delay in role clarification around municipal health services, municipalities have tended to invest less in health services in general and this has led to diminished growth and prominence of environmental health services at a local level. According to the Municipal Structures Act 117 of 1998, municipal health services are a function of metro and district municipalities. This function has historically been executed by local municipalities and provinces, with minimal services outside the cities and main towns. Capacity has to be created and strengthened at a district municipality level for the efficient delivery of these services to all communities. District municipalities are already struggling with delivery of the services that have been delegated to their level by the provincial and national spheres of government and therefore will need support in taking over municipal health services. KEY DEFINITIONS Figure 1 below illustrates the relationship between municipal health services, environmental health services, PHC and health.