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IMPLEMENTING THE MUNICIPAL HEALTH SERVICES (MHS) POLICY IN SOUTH AFRICA “District Health in South Africa” Conference : 5th & 6th August 2004 Ross A. Haynes.

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Presentation on theme: "IMPLEMENTING THE MUNICIPAL HEALTH SERVICES (MHS) POLICY IN SOUTH AFRICA “District Health in South Africa” Conference : 5th & 6th August 2004 Ross A. Haynes."— Presentation transcript:

1 IMPLEMENTING THE MUNICIPAL HEALTH SERVICES (MHS) POLICY IN SOUTH AFRICA “District Health in South Africa” Conference : 5th & 6th August 2004 Ross A. Haynes Researcher Health Systems Trust

2 WHAT IS MHS? decisions!! MHS IS !!?? IMPLEMENTING MHS the what the how impacts THE PRESENTATION This work forms part of a DANIDA-funded project

3 MHS? WHERE DOES IT COME FROM? a Constitutional phenomena - powers and functions of municipalities [section 156 (1)(a) Part B of Schedule 4] Primary Health Care services minimal “midi” maximal the original possibilities (definitions) previous health activities at municipalities - mainly local (B’s) and metro (A’s) municipalities - clinics (p&p) and environmental health services - focused on the urban areas (prov s served non-urban) - included “own” funds

4 MINISTER OF PROVINCIAL AND LOCAL GOVERNMENT MHS devolution set for 1st July 2004 A and C municipalities responsible C’s may delegate to B municipalities SOME IMPORTANT DECISIONS Health MinMEC >> NAT. HLTH BILL (Aug 2003) MHS is a “list of environmental health services”

5 WHAT IS MHS? decisions!! MHS IS !!?? IMPLEMENTING MHS the what the how impacts THE PRESENTATION

6 MHS is ………. a “list of environmental health services”.. devolved to District and Metro municipalities.. as from 1st July 2004.. which can be delegated to Local municipalities (i.e. agency basis) Consider this in the light of the new environmental health policy and LGs position for intersectoral collaboration a “list of environmental health services”..

7 “list of (9) environmental health services” water quality monitoring food control waste management health surveillance of premises surveillance and prevention of communicable diseases, (excluding immunisations) vector control environmental pollution control disposal of the dead chemical safety EH services retained as Provincial responsibilities Other EH services delivered by municipalities ?? port health control of hazardous substances malaria control

8 WHAT IS MHS? decisions!! MHS IS !!?? IMPLEMENTING MHS what the how impacts THE PRESENTATION the what

9 Implementing MHS … (the what) District / Metro Municipalities Provincial structures Local Municipalities 1. Devolving the function ? Funding ? Staff transfers ? Equipment ? Agreements (SLA, MoU) Some barriers legislative environment funding policies / tools Why District level? MHS 1st July 2004

10 WHAT IS MHS? decisions!! MHS IS !!?? IMPLEMENTING MHS the what how impacts THE PRESENTATION the how

11 Implementing MHS … (the how) RESOURCES MONITORING & EVALUATION CO-ORDINATION & POLICY DEVELOPMENT are there monitoring tools and an EHIS system in place? MHS - a LG competency (DPLG) but ….. NDoH responsible for the health of the population (provinces?) no unfunded mandates! Treasury!! what do the services cost? >>> how many EHPs/support staff are required? >>> smoothing out the inequities >> Report: Financing EHS in South Africa [www.hst.org.za]

12 How many EHPs are required? - Current numbers Filled postsTotal posts% filled Eastern Cape17523774% Free State158 100% Gauteng40246487% KwaZulu Natal35057661% Limpopo18625374% Mpumalanmga12218267% Northern Cape526876% North West11014079% Western Cape31635789% NATIONAL1 8712 43577% TABLE: EHPs post establishment in South Africa

13 How many EHPs/support staff are required? - Coverage FIGURE: Inter-provincial comparison of population size per Environmental Health Practitioner (filled posts) 1/15 000 36 437 Community members / EHP

14 How many EHPs/support staff are required? – Intra-provincial coverage Table: Coverage of EHP’s, per Metro and District Municipality, in the Eastern Cape Province TOTALLGPROV Population / EHP EHP posts (filled) population Total/Average DC44 Alfred Nzo DC15 OR Tambo DC14 Ukhahlamba DC13 Chris Hani DC12 Amatole DC10 Cacadu Nelson Mandela Metro Eastern Cape Province 1 005 776 36 437175115606 376 391 50 036110 550 400 79 832210 1 676 480 34 1321091341 321 35 71321147749 979 44 9803721161 664 251 22 83417 0388 184 17 34158544 X

15 What do the services cost? - 1 82 261 15 208 10 456 22 811 26 509 73 532 108 307 22 945 31 020 Western Cape North West Northern Cape Mpumalanga Limpopo KwaZulu Natal Gauteng Free State Eastern Cape 1/15000Actual Total costsOperational costs Personnel costs Per capita costs 18.18 4.95 11.61 6.56 5.43 7.80 11.53 8.48 4.86 17.35 9.22 13.40 12.46 9.50 14.01 17.96 9.68 11.82 10.768.78393 04880 284312 765NATIONAL TABLE: EHS delivery costs (in R000s) in the country – for 2002/03 (provinces) and 2001/02 (LG) National population ( 44,819,733) x 1/15 000 per capita cost (R10.76) = R482,26 mill. Actual

16 What do the services cost? - 2 FIGURE: Inter-provincial comparison of per capita cost (in Rands) of delivering Environmental Health Services, for 2002/03 (provinces) and 2001/02 (Local Government) R8.78 (actual per capita) R10.76 (@1/15 000) R13.00 (national figure) Costing based on EHPs only. Cost of delivery actually higher with support staff.

17 WHAT IS MHS? decisions!! MHS IS !!?? IMPLEMENTING MHS the what the how impacts THE PRESENTATION impacts

18 Implications - actual and potential insecurity and demotivation lack of clarity - on LG budgeting processes - transfers and secondments - current status quo arrangements potential fragmentation enhanced intersectoral coordination urban / rural differences in MH services training of future EHPs

19 Implications - actual and potential MHS – a Constitutional disaster or golden opportunity ? - stemming the flow - preventative and promotive “high % diseases by environmental factors” - developmental EHS / MHS - intersectoral co-operation - LG’s accountability to the people

20 IMPLEMENTING THE MUNICIPAL HEALTH SERVICES (MHS) POLICY IN SOUTH AFRICA “Strong leadership, the necessary political will and a high level of professionalism can ensure effective implementation of the MHS policy leading to improved health status of the community.”

21 THANK YOU …. delightful for being a wonderful audience attentive ???

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