CHAPTER 4: RESULTS
4.4 Q UALITATIVE RESULTS
4.4.7 I MPACT ON SERVICE DELIVERY
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“The biggest challenge that we facing is that no one wants to champion this from government. You find that we have the National Department of Health and we’ve got COGTA, then you have your Provincial Department of Health and the provincial COGTA, no one now wants to say: ‘Let us drive this process’.” (Focus group 1)
“He summed it up, no one was driving it; and that is why nothing is happening.” (Focus group 1)
“If this piece of legislation was drafted by the department of health, surely that department should be driving the process, because that understanding about the district system is their understanding.” (Focus group 1)
4.4.6.8 Misunderstanding the implications of the transfer
One respondent felt that the key people in the integration did not fully understand what the transfer would entail. This misunderstanding is a barrier to the integration
“There was a serious misunderstanding in terms of the full implications of the transfer. There could have been different interpretations of the same
legislation.” (In-depth 3)
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(delivery) has never been affected, because we’ve been having full control of the service as the municipality” (In-depth 2).
4.4.7.2 Positive impact
One respondent felt that the integration was going to be positive, as it will mean that environmental health will be part of a District Health System, which looks at health holistically: “I was excited that we were going to move into a district health system because the district health system is holistic system of providing health care, your preventative and curative medicine” (Focus group 1).
Some respondents mentioned that being part of the district will mean delivering an environmental health service of the same quality in all areas of the district.
“Well, the possible benefits will be what we call economies of scale, in the sense that you are able to respond to the needs of the environmental health on a more consistent and standardised kind of basis. You don’t want to have a situation where, in one area, the standards are low. You want to show some kind of harmony district-wise.” (In-depth 3)
“By us creating wall-to-wall municipalities you find that the health act talks about an effective and equitable service, and that is the only way you can do that: by making sure that people have the access to basic services.” (Focus group 1)
In addition, respondents felt they are likely to get a picture of the status of the district population through Environmental Management Plans when they become part of the district
“The Health Act talks about the districts doing an Environment Health Plan; an Environmental Health Plan will give you an idea of the status of your
communities; but at this stage we don’t know what the status is.” (Focus group 1)
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One respondent’s expectation was that communities lacking basic services, such as water and sanitation, will benefit from the integration, as the district municipality is also a water services authority.
“When it came to community benefits, we as DoH deal with a lot of rural communities where people do not have water. So it was going to benefit the community as well. The district provides water and sanitation, so it was going to be easy for us to be working with them, and the communities would
benefit.” (Focus group 2)
One respondent felt, that with the funding that is expected to follow the function, it might make it easy for all environmental health practitioners to deliver on their expected functions in all areas.
“In terms of the funding for the function, yes perhaps better, because there will be more emphasis now with the funding following function that you will be able to do your work. My work is more scientific and technical, and I need money to do that; and if I don’t have money to do that function I have a problem. If funding came with it, I was always excited about that. I thought I could now establish more stations and expand my network and get it across to the rural areas as well.” (Focus group 2)
Respondents also had an expectation of increased environmental health staff, which would mean more areas gaining coverage
“It does affect service delivery. If you were to look at the ratio of the EHPs, we might have more EHP’s in our area. We cover a very big area; it will be easier if there were more people to cover the areas. Community could benefit from that.” (Focus group 2)
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Some respondents mentioned that moving environmental health services from local municipalities to the district could mean that this service becomes further removed from the communities being served, and this could possibly have a negative effect on service delivery
“It could be that we’re just that bit further away, and there is just another bridge to cross before people can contact us. It may affect it (service delivery) in that way, and they may be a bit confused as well; initially maybe, not
forever.” (In-depth 1)
“For our local municipal customers, I thought it was going to be difficult to contact the district or to send the complaint to the district.” (In-depth 2)
Most respondents felt that service delivery has been compromised as a result of the delay in the integration process. Some areas within the district are not being serviced currently.
“There are non-existent services in some areas. Province, with their limited resources, needs to provide a service in those areas where there is no service; that is a major challenge for them.” (Focus group 1)
“What is sad about this whole process is the poorest of the poor are suffering:
the people who should be getting clean water, the people who should be getting sanitation, refuse removal. People who should be getting housing are not getting it, because there is not anyone driving those processes.” (Focus group 1)
“Serious negative effect (on service delivery). There is no service delivery in the real sense that is taking place. Maybe in built-up areas there could be an element of service delivery, because the community there is conscientious
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about the environment… but in the townships people are less demanding, and because they are less demanding we take them for granted.” (In-depth 3)
Some respondents felt that the high staff turnover, which is a result of the uncertainty and lack of progress, impacts negatively on service delivery, because local
municipalities are failing to retain skilled and experienced professionals, or at the very least to transfer these skills.
“Staff are leaving the profession and going to other fields….In the years to come I am not sure what is going to happen; the basic services are going to be compromised. It’s because they are not retaining their skills or transferring skills.” (Focus group 1)
Some respondents mentioned that carrying on a function without a mandate is also impacting on service delivery, as they are unable to enforce some parts of the legislation.
“As I sit here I cannot do certain functions….It has affected our service delivery. If the legislation is saying environmental health is a district function, you then cannot enforce some of the legislation, because you are not
employed by the district municipality. So now we are not enforcing anything;
we are like advisors.” (Focus Group 2)
“You cannot really do your job properly, because you do not have the power to do that. We can only advise people; you can’t do anything.” (Focus group 2)