THE MUNICIPAL HEALTH SERVICES COSTING STUDY Municipal Health

THE MUNICIPAL HEALTH SERVICES COSTING STUDY Municipal Health Services Summit 01 February 2017 www. salga. org. za

INTRODUCTION • • • Municipal health services is a term that has evolved in South Africa to define the package of health services to be rendered by local government. It is a specified package that is described in the National Health Act 61 of 2003. It can thus be seen as a sub-set of the bigger basket of environmental health services. Municipal Health Services for the purpose of the National Health Act 61 of 2003 that was promulgated in May 2005 includes § Water quality monitoring; § Food control; § Waste management; § Health surveillance of premises; § Surveillance of communicable diseases, excluding immunisation; § Vector control; § Environmental pollution control; § Disposal of the dead; and § Chemical safety. www. salga. org. za

LEGISLATIVE FRAMEWORK The following pieces of legislation govern Municipal Health Services in South Africa: q The Constitution of the Republic of South Africa (Act 108 of 1996), Schedule 4 (Part B), lists Municipal Health Services as the functional area of Local Government. q The Municipal Structures Act, 1998 (Act 117 of 1998), Section 84 (1) (i), which identifies Municipal Health Services as a District Municipality function. q Government Notice 826 dated 13 June 2003, the Minister of Local Government and Housing entrusted the delivery of Municipal Health Services to Metropolitan (Category A) and District (Category C) Municipalities with effect from 1 July 2004. q National Health Act 61 of 2003 that was promulgated in May 2005. www. salga. org. za

LEGISLATIVE FRAMEWORK CONT… • The National Health Act, 2003 ( 61 of 2003 ), Section 32 (1), clearly stipulates that every Metropolitan and District Municipality must ensure that appropriate Municipal Health Services are effectively and equitably provided in their respective areas. • Government Gazette No. R 698, dated 26 June 2009, the National Minister of Health approved Regulations defining the Scope of the Profession of Environmental Health. • This lists all the functions that must be performed by Environmental Health Practitioners including the listed Municipal Health Services. www. salga. org. za

ADVANTAGES • The delivery of MHS by municipalities is an advantage as they are closer to the people and the impact of the work can be seen much quicker. • Also Municipalities can integrate MHS into service delivery at a local level through IDP. (if included into IDPs they can budget properly for the service) • Municipal Health Services are preventive services that requires an inter-sectoral approach for best outcomes to be achieved. • But with these advantages in mind, the service has seen many challenges (as mentioned in the next slides) www. salga. org. za

CHALLENGES The review of the Funding Model for Environmental Health • The local government equitable share is part of the division of revenue to national and provincial governments. • The equitable share of local government is the smallest of the three spheres. • Moreover, within the local government equitable share for basic services, Environmental Health is allocated the least amount. • Local government gets less than 10% of the total equitable share and the allocation of less than 3% of the funds for basic services goes to Environmental Health. www. salga. org. za

CHALLENGES CONT … The review of the Funding Model for Environmental Health • Basic service is delivered to communities as a whole and not provided to individual households. • There is very little data available on how much it costs to deliver Environmental Health Services in line with W. H. O. standards of 1: 10, 000. • The major cost driver for Environmental health is personnel (which is around 80% of the overall operating costs) and is separate from the costing of administration and systems needed to deliver the services. www. salga. org. za

PROCESS TOWARDS THE STUDY • It is against this funding model associated with the provision of MHS that the 2015 MHS Summit resolved as follows: (SALGA in partnership with the SAIEH and Institutions of Higher Learning to embark on a costing exercise on the provision of MHS). • In response to the resolution stated above, SALGA in partnership with the SAIEH and Institutions of Higher Learning convened a meeting on 05 October 2016 to explore the realisation of the resolution. • The meeting agreed that a service provider preferably with Environmental Health and finance background be contracted to assist with the development of a costing model for the provision of MHS as per section 24 of the National Health Act, 61 of 2003. www. salga. org. za

PROCESS CONT… Terms of Reference were subsequently developed with the following scope of work: Overall Objective: Analyse the budget allocations of a random sample of municipalities in selected provinces and provide a robust nationally representative picture of financial implications on the provision of MHS by municipalities. This must include both the planned and implemented services. The list of pilot municipalities to be a combination of metro and district. www. salga. org. za

PROCESS CONT… The study to focus on the following issues: Ø The current costing of rendering of MHS by various municipalities in the country. Ø The funding model if any, currently used by municipalities to provide MHS. Ø The funding ratio currently used to fund MHS: i. e. Own funding v/s the Equitable Share allocation from National Treasury and assistance from both the National and Provincial Departments of Health. Ø The study must also highlight the direct costs i. e operational costs e. g. salaries, administration, laboratory and Capital costs e. g. transport, equipment, office and furniture, and any indirect costs. www. salga. org. za

PROCESS CONT… Ø The study must also develop a comprehensive, per household, environmental health subsidy per municipality (district and metro) Ø The study must also develop a comprehensive person, per municipality environmental health subsidy (district and metro) Ø The study must also develop a comprehensive benchmark based subsidy (e. g. one environmental health practitioner per 10 000 people per municipality as recommended by the World Health Organization (WHO). www. salga. org. za

EXPECTATIONS FROM THE SUMMIT The delegates are therefore invited to further advise on: • What else should be included / excluded from the suggested terms of reference for the study • General Inputs & Comments to enhance the study www. salga. org. za

Acknowledgements • Dr Thuthula Balfour: Municipal Health Services in SA, Opportunities and Challenges • Dr Selva Mudaly • Representatives from the Academic Institutions www. salga. org. za

Thank you Contact: Winnie Manganye wmanganye@salga. org. za +27 (0)12 369 8000 +27 (0) 82 908 2884 www. salga. org. za