1. MHS SUMMIT 2017
ENVIRONMENTAL HEALTH SERVICES (SUCCESS AND ACHIEVEMENTS IN TYHE PAST TWO DECATES)
Mr Murdock Ramathuba
National Director: Environmental Health
National Department of Health
Lord Charles Hotel, City of Cape Town
Western Cape Province
1 February 2017

2. Outline of Presentation
12/4/2018
Background
Role of Key Stakeholders
Legislative Changes
Introduction of Environmental Health Policy Framework
Environmental Health Training and Human Resource Capacity

3. Outline of Presentation (cont...)
12/4/2018
6. Environmental Health Monitoring and Evaluation Framework
7. International and Regional Obligations
8. World Environmental Health Day Commemoration
9. Way Forward

4. Background
12/4/2018
Environmental health has gone though tremendous stages of evolution since 1994, politically, administratively and technically.
Most of these changes were based on the political changes that took place in the country in the past two decades.
Other changes saw the legislation changing, resulting in a change on the landscape of environmental health in the country;
Despite challenges brought by the political and legislative reforms that affected Environmental Health, various milestones were reached that has made an impact on environmental health as a service and as a profession currently;

5. Role of Key Stakeholders
12/4/2018
National Department of Health
drafts, develops, amend, implement relevant legislation, policies and guidelines;
Set Norms & Standards & provides guidance/support/monitoring & evaluation.
Provincial Departments of Health
develops provincial legislation, policies and guidelines and implement them;
provide support, oversight, monitoring & evaluation to Municipalities.
Local Government (District and Metropolitan Municipalities)
develops Bylaws, LG policies, strategies, guidelines & operating procedures/tools;
implements National/Provincial/Local Government legislation, policies, strategies, guidelines and bylaws.
NGOs, CBOs etc.
Assist Government in implementing Government Policies to serve SAns.
Play activism role to ensure that SAns are getting the services deserved.

6. Legislative Changes
12/4/2018
Enactment of the National Health Act 2003, (Act No. 61 of 2003) saw those EH services defined as Municipal Health Services devolved from Local Authorities (Category B Municipalities) and Provincial Departments of Health to the current system (Category A and C) ;
The National Health Amendment Act 2013, (Act No. 12 of 2013) assigned the responsibility of coordinating Port Health Services to the National Department of Health, from provincial Health Departments;
Due to the international nature of port health services, this change aimed to ensure uniformity , and a high level and quality of the services .

7. Legislative Changes (cont...)
12/4/2018
In addition, the National Health Amendment Act provided, in Section 83(1), legislative security for environmental health by ensuring that environmental health work can only be performed by Environmental Health Practitioners, registered as such with the Health professions Council of South Africa;
The Scope of Profession for Environmental Health was promulgated by the Minister of Health for in Notice No. R 888 of 26 April 1991 and amended in a gazette No. R. 698 of 2009 and lastly 05 August 2011.
Although it came with own challenges in implementation – Environmental health was regulated as one of health professions to conduct compulsory community service to address the need; .

8. Introduction of Environmental Health Policy Framework
12/4/2018
Introduction of Environmental Health Policy Framework

9. Environmental Health Policy, 2013
12/4/2018
The Minister of Health, published the first National Environmental Health policy for implementation;
GG No of 04 December 2013;
Provides a framework for provision of environmental health services in the country.

10. National Environmental Health Strategy, 2016
12/4/2018
The Minister of Health approved the National Environmental Health strategy, in June 2016;
Provide for systems to be implemented to strengthen the provision of EHS in the country; and
Provides an action plan with specific, measurable, achievable, realistic and timely actions for various levels of government to achieve EH policy goals.

11. National Norms and Standards for Environmental Health, 2015
12/4/2018
The Minister of Health, published the first National Environmental Health norms and standards for implementation;
GG No of 24 December 2015;
Provide a national approach within which EHS can be standardized and establish a level against which the delivery of EHS can be assessed and gaps identified;

12. National Norms and Standards Implementation
12/4/2018
The first audits were conducted to determine the status of Municipalities in rendering EHS against the set norms and standards;
The audits revealed various gaps and challenges, some expected and known, however some not expected (such as a lack of systematic manner in which routine inspections and investigation are conducted, record keeping, external communications and professional standards);
Most importantly, best practices were identified documented, to promote benchmarking across various entities rendering EHS;
Second audits saw some municipalities improving tremendously on systems issues (communication to and information provision to the public, reporting, inspection documentation such as checklists etc);

13. Climate Change and Health Plan, 2014
12/4/2018
NATIONAL CLIMATE CHANGE &
HEALTH ADAPTATION PLAN
Climate change as an emerging risk and challenge to environmental health was prioritised;
The Minister of Health approved and endorsed a Climate Change and Health Adaptation Plan, ;
Aims to ensure health sector readiness to the effects of climate change in order to capacitate South Africans with the skills and knowledge to adapt to climate change effects.

14. Environmental Health Training and Human Resource Capacity
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Environmental Health Training and Human Resource Capacity

15. EH Capacity and Development
12/4/2018
Before 1994, environmental health was a more male dominated profession , most of the then “health Inspectors” being white males. In the past 20 years the profession saw a huge change, with both black and white females graduating as EHPs;
Environmental health Assistants were introduced/formalised for the first time in South Africa, to augment and increase productivity and effectiveness of Human Resources and services;
The number of EHPs trained and introduced into the health system has since doubled since before 1994, which contributed positively in the provision of EH services in the country – although much is still to be done in this area to match the increased service needs.

16. EH Capacity and Development (cont...)
12/4/2018
Training of Environmental health has evolved over the past 20 years and Minister has supported the transition of the qualification of environmental health, from a Diploma in Environmental Health, to a BSC in Environmental Health to align with international developments ;
To align to international developments, the environmental health professional name has evolved many times from Sanitary Inspectors to Health Inspectors to Environmental Health Officers, to what is currently known as Environmental Health Practitioners;
Since Port Health Services became a national competency, the EH unit of the NDOH has grown from being a Directorate to a Cluster: – with the highest position of Chief Director with four Directorates;

17. EH Capacity and Development (cont...)
12/4/2018
National Department of Health have proactively trained Environmental Health Practitioners (EHPs) both in the Provinces and Municipalities in the following areas:
Hazardous Substances Control
Health Care Waste Management
Pesticide and Chemicals Management
Climate Change and Health
Environmental Health Impact Assessment
Indoor Ai Quality
Health and Hygiene Strategy
International Health Regulations
Port Health Services
Tobacco Control
Disease Outbreak Response
Environmental Health Norms and Standards

18. EH Monitoring and Evaluation Framework
12/4/2018
The first set of the national environmental health indicators were chosen, revised and included as part of the National Indicator Data Set in 2013, collected through the District Health Information System (DHIS) – this enabled NDOH to monitor service rendering and status of compliance by all spheres;
A set of climate change and health indicators were also chosen to enable monitoring of climate change effects and adaptation capacities of the health sector;

19. International & Regional Obligations
12/4/2018
South Africa is signatory to a wide range of International agreements and protocols of which EH forms an integral part.
These include the following:
International Health Regulations (2005).
United Nations Framework Convention on Climate Change
Basel Convention on control of the trans-boundary movement of hazardous waste and their disposal.
Montreal Protocol on ozone depleting substances
Stockholm Convention on POPs
Rotterdam Convention on the PIC Procedure for certain hazardous chemicals and pesticides in international trade.
Minamata Convention on Mercury
Libreville Declaration on Environment and Health

20. International & Regional Obligations (cont...)
12/4/2018
Environmental Health is party to the Southern African Pesticide Regulators Forum (SAPReF).
Aim: To foster regional collaboration and partnership with SADC countries on pesticide management.
Forum assisted and supported by international and national bodies like United Nations Food and Agriculture Organization (FAO); Swedish Chemicals Agency (KEMI) and University of Cape Town (UCT).
Set a benchmark in mass evacuation of deceased South Africans from Nigeria to South Africa in collaboration with South African Health Millitary
Services. Other states are learning from our experiences worldwide.

21. WEHD Commemoration
12/4/2018
Since the declaration of World Environmental Health Day by a proclamation of the International Federation of Environmental Health in 2011, the NDOH has taken a lead and facilitated the commemoration of this day every year, since September 2012;
WEHD has provided a platform for the environmental health fraternity to share information, network, and discuss various issues affecting the profession and EH service delivery;
WEHD has also been used as a platform to recognise those individual practitioners who continue to make a difference and show dedication in people’s everyday lives through environmental health
the Alfred Nzo Environmental Health Excellence Awards is awarded annually to such professionals.

22. Way Forward
12/4/2018
In discharging its mandate as custodian of Health Services, the National Department of Health will strive and endeavour to:
Strengthen and improve delivery of Environmental Health, and in this case MHS, through annual national audits of norms and standards.
Develop, review, update and amend legislation, policy and other related EH documents timeously and systematically.
Capacitate and/or facilitate training of EHPs in all spheres of government.
Strengthen and nature collaboration, cooperation, communication and coordination with relevant sectors and departments at all levels including networking and exchange of information/capacity.
Collaborate with all existing and yet to be established NGO`s, NPO`s, CBO and partners who offer to contributing anything towards enhancement Environmental Health Services and ensuring Long and Healthy Life for all including individuals.

23. 12/4/2018
Inspirational quote:
“Success is no accident. It is hard work, perseverance, learning, studying, commitment, sacrifice and most of all, love of what you are doing or learning to do.”

24. Thank You Ndo Livhuwa Baie Dankie Ndiyabulela
12/4/2018
Thank You
Ndo Livhuwa
Baie Dankie
Ndiyabulela