WORLD ENVIRONMENTAL HEALTH DAY CONFENCE NATIONAL ENVIRONMENTAL HEALTH

WORLD ENVIRONMENTAL HEALTH DAY CONFENCE NATIONAL ENVIRONMENTAL HEALTH NORMS AND STANDARDS Municipal Audit Findings 2016 27 September 2016

Presentation outline q. Norms and Standards Background and Introduction q. Audit purpose and Audit Process q. Areas of audit q. General Audit Findings q. Contributing Factors to non-adherence q. Identified interventions areas by various entities q. Way forward and conclusion

Introduction and Background q. DG of Health published National EH Norms and Standards in GN 39561 of 24 December 2015; In terms of Chapter 3, Section 21(2) (b)(ii) of the National Health Act, 2003 (Act No. 61 of 2003); q. The over-riding goal of the department through these norms and standards is to strengthen the provision of EHS and ensure the attainment of the highest possible level of EHS in South Africa; q. The norms and standards further aims to: Øprovide a national, uniform and standardised approach to EHS delivery; Øset a benchmark of quality against which delivery of EH services can be assessed and monitored. q. Based on existing legislation and reflects international best practice;

Audit process q. Annual auditing to monitor adherence to the set norms and standards in rendering EHS; q 52 Municipalities audited between January-September 2016; q Audit tool utilized as an internal NDOH resource to achieve the objectives of monitoring; q. Essentially establish a baseline for EHS in SA; Status in the provision of services; q. To assess availability of systems for rendering EHS in Municipalities; determine the adequacy thereof;

Audit process q. To identify gaps, challenges in service delivery, in the same breath identify and highlight strengths and Best Practices –provide a platform for benchmarking; q. Identify corrective action required to address identified gaps (national, province, Municipality); q. Tool for advocacy and motivation for adequate resource allocation; q. Set minimum requirements (high priority and low priority areas) – at least 51%;

Audit areas (1) q 5 audit Domains , components and elements; v. Clients rights – administration (communication about MHS, clients experience of care), client service organisation; v Human Resources – staff allocation and use, staff identity, HR capacities; professional standards; continued development; v Infrastructure – systems for internal and external communication, disaster preparedness; v. DH system support and planning– DHIS reporting, alignment of plans (EH OPPs, SBDIPs, IDPs and DHPs), intergovernmental relations, cooperation and collaboration ;

Audit areas (2) v. Operational – Proactive planning on EH functional areas, budgeting; (vector management, waste, Environmental Pollution Control, Water quality monitoring) – monitoring of EH related disease trends, prevalent pollutants, polluting sources; v. Systems for Law enforcement –Municipal public health By-Laws, training, delegation of powers (NHA), support legal system, relevant legal documentation;

Audit areas (3) q. Systems to ensure structured monitoring and control for health surveillance of premises; v. Certification of premises; v. Inspection checklists, reports, databases; record keeping; v. Frequencies of inspections, for control purposes; v. Sharing of information with various stakeholders, government (DBE, DSD, DWS) and Industry (funeral undertakers, accommodation establishments, food retail, chemical manufacturing and retail) to promote self regulation; q. Systems to enable complaints management; q. Programmes to proactively and reactively manage EH community awareness, education and mobilisation;

Audit Findings (1) q Thirty five (35) Municipalities – achieved (51% and above); q? ? ? Met minimum requirements –Norms and standards Not generally met; q 51% = Some systems were found to be in place to render EH services – Available systems not effective to proactively and reactively render effective services for protection of public health nor improve health outcomes; q 17 Municipalities (below 51%) - showed weak systems to even minimally render EHS; q. Poor administrative, management, Inadequate Human Resources, Inadequate resource allocation;

Audit Findings (2) q Poor communication about MHS to the public – poor marketing, branding and awareness; q. Staff identification and visibility – no standard dress code, very few had some form of uniform/dress code and/or identification tags; q. Most Municipalities have approved organisational structures in place Lack of adequate EH human resources - No HR plans are in place to address shortage and deal with current and growing populations; q. Some Municipalities had flat structures where the line of command seemed impossible; q No alignment of planning between Municipalities SBDIPs, IDPs and the DHPs – most Municipalities;

Audit Findings (3) q. Poor and/or lack of structured operational planning for MHS – not based on objectives, targets, outputs, outcomes, with special attention on need/ areas requiring attention; q. Utilisation of available budgets not informed by plans; q. Lack of standardisation of service standards within same districts; q. Lack of adequate priority for EHP capacity building on issues of legislation implementation and enforcement; q. Intergovernmental structures exists – not formalised to protect sharing of information;

Audit Findings (4) q. Issues relating to functional area planning (pollution control, water, waste, disaster, air quality) –no direct control over these plans or functions –EH monitoring poor; q. Lack of MHS specific plans to provide public health oversight role – compliance monitoring; - role of EHP not clearly understood/outlined; q. Some Municipalities prioritising some services within the 9 key functional areas – not full MHS package rendered; q. Environmental Surveillance of communicable diseases (cholera, typhoid) lacking – no plans/limited for environmental disease monitoring; q. Lack of law enforcement support systems in place – no By-Laws, legal documentation, peace officer training, health officer appointments (NHA, 2003);

Audit Findings (5) q. No structured manner of operation – inspections; q. No structured inspection checklists used for inspections for various premises guided by relevant legislation; no databases for control purposes; q. Communication to clients driven only through compliance notices - no sharing of inspection reports after inspections; q Insufficient resources to meet recommended frequencies of inspections or complaint management turnaround times; q. Most Municipalities have systems in place for MHS complaints management – no formalised documented standard operating procedures;

Key contributing factors to non -compliance q. Vacant posts not filled and in other cases posts are abolishment when vacated; q. Allocations for MHS not based on Treasury allocations (staffing norms – cost driver for EHS); q. EH clustered with other departments which end up taking the lead in priority - strategic managers not qualified EHPs which results in non prioritisation by decision makers; q. The integration of MHS did not address organisational structure issues; q. Developmental approach – poor law enforcement in EH; q. New norms and standards – guide to motivate for resources;

Best Practices/Highlights q. KZN province – Legislation management – good points of reference for EHPs; q. City of Tshwane - database management for control purposes; q. West rand – SOPs for (complaints management, handling of applications for premises requiring certification);

Interventions by all role players to support MHS q Role of provinces to monitor and support provision of EHS to Municipalities requires strengthening; - facilitate alignment of plans between District health and MHS; q. NDOH - to advocate and facilitate for resources to render Environmental Health Services with relevant stakeholders (NT, COGTA); vstrengthen legislative framework for EH – functions that environmental can claim on all shared mandates; vthe Health act to go beyond listing MHS and other EHS - provide a framework within which each function must be rendered; v. Capacitate municipalities on the norms and standards; q. SALGA - Guidance should be provided to Municipalities to honour their legislative mandate to ensure that full MHS – direct district function;

Interventions by all role players to support MHS q. COGTA - implement systems to monitor if Municipalities are adhering to their mandate fully and attention is given to MHS as a basic service; ensure a full coverage of the services is realised - ensure funds earmarked for MHS are not removed or diverted to other services; q. HPCSA –review the requirement as CPD, malicious compliance - not meet purpose for professional development; q. Fees for accreditation high – Create difficulty in employers to support CPD aligned training; q. Institutions training of EHPs – utilize norms and standards;

END Thank you