Challenges in integrating municipal health services in uMgungundlovu District Municipality, KwaZulu-Natal. 55 Figure 3: Percentage of county population served by each local municipality and provincial health department.
INTRODUCTION
- I NTRODUCTION
- B ACKGROUND TO THE RESEARCH
- W HAT IS KNOWN SO FAR ?
- W HAT NEEDS TO BE KNOWN ?
- W HY IS THIS IMPORTANT ?
- S TATEMENT OF THE PROBLEM
- P URPOSE OF THE STUDY
- O BJECTIVES
- D EFINITIONS OF TERMS
- S COPE OF THE STUDY
- S TRUCTURE OF THE DISSERTATION
- S UMMARY
The study will try to establish why the integration of municipal health services in the uMgungundlovu district has not happened. To make recommendations, based on the findings of the study, to guide the implementation of the integration of municipal health services in the district municipalities.
LITERATURE REVIEW
I NTRODUCTION
P URPOSE OF THE LITERATURE REVIEW
Reveal how the current study differs from what has already been done and what contributions the current study can make.
S COPE OF THE LITERATURE REVIEW
- D EFINING E NVIRONMENTAL H EALTH S ERVICES
L ITERATURE REVIEWED
- C ONTEXT FOR THE TRANSFORMATION OF THE HEALTH SYSTEM
- L EGISLATIVE FRAMEWORK
Since the initial publication of the ANC National Health Plan in 1994 and the White Paper for the Transformation of the Health System in South Africa in 197, the. In the National Health Act, important elements of the District Health System (DHS) were finally established.
O THER DEVELOPMENTS TOWARDS DECENTRALISATION AND PROGRESS MADE
- T HE D ISTRICT H EALTH S YSTEM EXPLAINED
- D ISTRICT H EALTH S YSTEM DEVELOPMENTS AND PROGRESS MADE
Health district boundaries drawn prior to the delimitation of boundaries in terms of Local Government: Delimitation Act (Act 27 of 1998) (Republic of South Africa, 1998b) had to be aligned with the boundaries of metropolitan and district municipalities. Each of the district municipalities was divided into two or more local municipalities (type B).
F UNDING A RRANGEMENTS FOR M UNICIPAL H EALTH S ERVICES
The available literature shows that provisions have indeed been made for the financing of the function from the budget of the district municipalities. This was more likely to be a problem in district municipalities without health staff, and thus limited awareness of health issues.
D ECENTRALISATION IN OTHER COUNTRIES
Balfour (n.d.) also raised concerns about funding for MHS being included in the fair share, as opposed to a conditional grant. In the case of South Africa, community involvement in the decentralization processes was minimal and communities were not empowered to take responsibility for their own development.
T HEORETICAL FRAMEWORK
- T HEORY OF ORGANISATIONAL CHANGE
Institutionalization: What plans are in place for the long-term maintenance of the MHS once it is fully integrated. It was expected that the same process would be followed for the successful implementation of the integration at UMDM.
R ESEARCH FINDINGS ALREADY IN USE
Managing change involves thoughtful planning and sensitive implementation and, above all, consultation and involvement of the people affected by the change (Chapman, 2005). Employees who will be affected by the changes are generally expected to deal with the change as soon as it happens without giving much thought to the effect of the planned change on them as individuals.
S TRENGTHS AND WEAKNESSES OF OTHER STUDIES
Investigations have highlighted the need to carry out the section 78 assessments prior to the transfer of MHS by the district municipalities. Industrial Development (CECID), on the provision of municipal health services by district municipalities in South Africa.
S UMMARY
The CECID study was able to quantify and chart the progress made in terms of county municipalities implementing MHS. However; the fact that all data for the CECID study were collected by telephone, without follow-up or verification of the information collected, weakened the study's findings.
METHODS
- I NTRODUCTION
- T YPE OF RESEARCH
- S TUDY SETTING
- S TUDY DESIGN
- T ARGET POPULATION
- S TUDY POPULATION
- I NCLUSION AND EXCLUSION CRITERIA
- S AMPLING AND SAMPLE SIZE
- S AMPLING METHODOLOGY
- S AMPLE S IZE
- D ATA S OURCES
- M EASURING I NSTRUMENTS
- D ATA C OLLECTION
- D ATA H ANDLING
- V ALIDITY AND R ELIABILITY
- E THICS
- I NSTITUTIONAL E THICAL R EVIEW
- P ERMISSION FROM I NSTITUTION AND P ARTICIPANTS
- S UMMARY
Of the seven local municipalities in the district, only three have EHP employees. Thematic analysis is the search for themes that seem relevant to the description of a phenomenon (Daly, Kellehear & Glicksman, 1997). Inductive thematic analysis occurs when the researcher observes themes from the data without having any particular preconceived notions about the various themes that will emerge.
On the other hand, deductive thematic analysis is guided by the specific thematic interest of the researcher and attempts to analyze a specific area of data. A letter communicating essential information regarding the evaluation was sent to each of the participants in the data collection, and written informed consent was obtained from all participants (Appendix F). The next chapter will describe the results of the study obtained using this methodology.
RESULTS
I NTRODUCTION
The first group consisted of five participants (two women and three men), whose number of years of experience as an EHP ranged from 15 to 40 years. The second focus group had four participants (two women and two men), with experience ranging from five to 30 years.
R EVIEW OF DOCUMENTS RELATING TO THE INTEGRATION PROCESS
- P OLICY
- R EPORTS
- M INUTES OF MEETINGS
- A GREEMENTS
The documents take note of the regulations and legislation that influence the transfer process from GGDs to districts. 2 Report of the Strategic Executive Manager: Community Services to the Management Committee of the District Municipality of uMgungundlovu, dated 16 July 2005. Report of the Strategic Executive Manager: Community Services to the Environmental Health Practitioners based in the seven local municipalities within the jurisdictional area of uMgungundlovu (undated) .
7 Implementation of Chapter 5 of the National Health Act (Act 61 of 2003): Devolution of Environmental Health Services. 8 Minutes of the District Municipality Environmental Health Technical Team meeting held on 6 July 2004 at the uMgungundlovu District Municipality Council Chamber. 10 Minutes of the inaugural meeting of the Municipal Health Services Forum meeting held on 6 June 2006 at the uMgungundlovu District Council Chamber.
Q UANTITATIVE DATA RESULTS
However, the provincial Ministry of Health still provides municipal healthcare services to a quarter of the population of uMgungundlovu district. As Table 1 below shows, the range of environmental health services provided by each local municipality and the provincial Department of Health varied within the district. Local municipalities continued to provide services defined in the National Health Act (Act 61 of 2003) (Republic of South Africa, 2003) as the responsibility of the provincial department, while the province continued to provide services under environmental health services, defined as Municipal Health Services.
However, environmental management services are generic to both the provincial department of health and local municipalities. As shown in Table 2, the proportion of filled environmental health positions in the three local municipalities and the provincial department of health services varied considerably within the district. Overall, while almost half of the EHP positions in the district were vacant (48%), most other EH positions were not (7%).
Q UALITATIVE RESULTS
- I MPLICATIONS OF THE N ATIONAL H EALTH A CT (A CT 61 OF 2003)
- A WARENESS - RAISING
- A DOPTION
- P ROGRESS WITH INTEGRATION
- S ERVICE LEVEL AGREEMENTS
- B ARRIERS TO THE INTEGRATION
- I MPACT ON SERVICE DELIVERY
- S TAFF I SSUES
- C HANGE NEEDED
Some of the respondents felt that there was no connection between the district and the local. Most respondents identified a lack of understanding of the environmental health function as one of the barriers to integration. One respondent felt that the district municipality was not fully committed to the integration process and to providing the service to the communities as required.
Most respondents felt that service delivery has been compromised as a result of the delay in the integration process. Most respondents felt that there is a general lack of public understanding of the work that Environmental Health Practitioners do. One respondent felt that it was premature for the county municipality to inform the EHPs about the integration and raise their expectations before proper plans were implemented.
S UMMARY
When money is given, who monitors and evaluates how the money is spent. If funds have been given, what funds have gone to the district municipality, and what monitoring and evaluation do they have in place to ensure that the service is delivered.” (Focus group 1). The implementation of the said plan should be closely monitored by all municipal leaders.” (Depth 2).
Some respondents felt that the district municipality should learn from best practices from others who have successfully managed integration. Decentralization has already taken place in some municipalities; they must consult with other municipalities and learn from them.” (Focus group 2).
DISCUSSION
- I NTRODUCTION
- H UMAN RESOURCES FOR ENVIRONMENTAL HEALTH FUNCTION IN THE DISTRICT
- P ACKAGE OF ENVIRONMENTAL HEALTH SERVICES PROVIDED
- I MPLICATIONS OF THE N ATIONAL H EALTH A CT (A CT 61 OF 2003)
- S ERVICE LEVEL AGREEMENTS
- B ARRIERS TO THE INTEGRATION PROCESS
- B UDGET ALLOCATION
- T HE RELATIONSHIP BETWEEN DISTRICT AND LOCAL MUNICIPALITIES
- C OMMUNICATION
- L ACK OF A CHAMPION / LEADERSHIP
- C APACITY
- M ISUNDERSTANDING OF THE IMPLICATIONS OF THE TRANSFER
- L ACK OF UNDERSTANDING OF ENVIRONMENTAL HEALTH
- I MPACT ON SERVICE DELIVERY
- L INKING THEORY TO THE CHANGE PROCESS
- S TAFFING ISSUES
- C HANGE NEEDED
- A CHAMPION FOR THE PROCESS
- B ETTER RELATIONSHIPS AND BETTER COMMUNICATION
- M ORE EDUCATION
- A STAGED PROCESS
- M ONITORING AND EVALUATION
- L IMITATIONS OF THE STUDY
- S UMMARY
Most of the issues affecting integration are those that have been general concerns and. Existing literature has referred to a lack of adequate funding – one of the main challenges to the integration and decentralization process. In the current study, capacity was mentioned as one of the key challenges for the integration process, as the district municipality lacked the necessary capacity to plan and follow up the handover process.
It was also evident in the current study that key people involved in implementing the transfer process in the district did not fully understand the implications of transfer. However, in the current study, as there was no plan for the actual implementation of the change process, no consideration was given to the long-term maintenance of the change process. Integration planning and implementation gaps were identified using organizational change theory using Goodman, Steckler and Kegler's four-stage model.
CONCLUSION AND RECOMMENDATIONS
I NTRODUCTION
C ONCLUSIONS
Challenges to the integration process, as discussed in the previous chapter, need to be addressed to ensure a shift in focus to service delivery and improving public health.
R ECOMMENDATIONS FOR IMPROVEMENTS
- L EGISLATION AND RESOURCE PROVISION
- I NTEGRATION OF MHS NEEDS TO BE FAST - TRACKED
- S ERVICE LEVEL AGREEMENTS
- B UDGETING
- D EVELOPMENT OF PLANS
- S ECTION 78 ASSESSMENT
- S UGGESTED ACTION PLAN FOR THE TRANSFER OF MHS IN THE U MDM
This will allow the district to begin to take ownership of the function, get a feel and understanding of MHS operations, and gauge the district's MHS needs. The business plan would be discussed at the following levels of the district municipality, seeking agreement and decision-making on the appropriate service delivery mechanism. The county municipality must request an estimate of accrued staff benefits of all affected staff members as of the date of transfer, ie.
The district municipality must make available the necessary resources for receiving and performing the function. The transfer of function shall be carried out in accordance with the requirements of Section 197 of the Labor Relations Act (Act 66 of 1995) (Republic of South Africa, 1995). Implementation of the transfer of function in accordance with the requirements of Article 197 of the Law on Labor Relations.
R ECOMMENDATIONS FOR FURTHER STUDIES
S UMMARY
Legislation and the structure of DHS in South Africa: An assessment as of August 2002. Independent Municipal and Allied Trade Unions & Others v The President of the Republic of South Africa. Decentralization and municipalities in South Africa: an analysis of the mandate to provide basic services in South Africa.
In your opinion, do you think that the planning for the implementation of the requirements of the law could have been done differently? We all know that, in terms of the National Health Act 2003, section 32(1), it is the exclusive competence of each metropolitan (Category A) and district municipality to ensure the provision of municipal health services. The purpose of the study is to gain an in-depth understanding of the various challenges faced by district municipalities regarding the integration of municipal health services in district municipalities, using UMDM as an example.
