Post on 05-Jan-2016
transcript
IMPLEMENTING THE MUNICIPAL HEALTH SERVICES
(MHS) POLICY IN SOUTH AFRICA
“District Health in South Africa”
Conference : 5th & 6th August 2004Ross A. Haynes
ResearcherHealth Systems Trust
WHAT IS MHS?
decis
ions!!
MHS IS !!??
IMPLEMENTING MHS
the what
the how
impacts
THE PRESENTATION
This work forms part of a DANIDA-funded
project
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 (provs served non-urban) - included “own” funds
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”
WHAT IS MHS?
deci
sions
!!
MHS IS !!??
IMPLEMENTING MHS
the what
the how
impacts
THE PRESENTATION
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” ..
“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
WHAT IS MHS?
deci
sions
!!
MHS IS !!??
IMPLEMENTING MHS
what
the how
impacts
THE PRESENTATION
the what
Implementing MHS … (the what)
District / MetroMunicipalities
Provincial structures
Local Municipalities1. Devolving the function
? Funding
? Staff transfers
? Equipment
? Agreements (SLA, MoU)
Some barriers• legislative environment• funding• policies / tools
Why District level?
MHS
MHS
1st July2004
WHAT IS MHS?
deci
sions
!!
MHS IS !!??
IMPLEMENTING MHS
the what
how
impacts
THE PRESENTATION
the how
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]
How many EHPs are required? - Current numbers
Filled posts Total posts % filled
Eastern Cape 175 237 74%
Free State 158 158 100%
Gauteng 402 464 87%
KwaZulu Natal 350 576 61%
Limpopo 186 253 74%
Mpumalanmga 122 182 67%
Northern Cape 52 68 76%
North West 110 140 79%
Western Cape 316 357 89%
NATIONAL 1 871 2 435 77%
TABLE: EHPs post establishment in South Africa
How many EHPs/support staff are required? - Coverage
10,000
15,000
20,000
25,000
30,000
35,000
40,000
Co
mm
un
ity
me
mb
ers
pe
r E
HP
population per EHP
FIGURE: Inter-provincial comparison of population size per Environmental Health Practitioner (filled posts)
1/15 000
36 437
Community members / EHP
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 03611011550 400
79 832210211 676 480
34 1321091341 321
35 71321147749 979
44 9803721161 664 251
22 83417170388 184
17 34158544
X
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
What do the services cost? - 2
4.00
6.00
8.00
10.00
12.00
14.00
16.00
18.00
20.00
Eas
ter n
Cap
e
Free S
tate
Gau
teng
KwaZulu
Nata
l
Limpop
o
Mpum
alanga
Northern
Cap
e
North W
est
West
ern
Cape
NATIONAL a
vera
ge
Ran
ds
pe
r p
ers
on
per capitat cost (in R) of EHS
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.
WHAT IS MHS?
deci
sions
!!
MHS IS !!??
IMPLEMENTING MHS
the what
the how
impacts
THE PRESENTATION
impacts
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
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
IMPLEMENTING THE MUNICIPAL HEALTH
SERVICES (MHS) POLICY IN SOUTH AFRICA
“Strong leadership, the necessary political will anda high level of professionalism
can ensure effective implementation of the MHS policyleading to improved health status of the community.”
THANK YOU ….
delightfulfor being a wonderful audience attentive ???