OPINION | Environmental health funding deficit costs lives

There is a need to urgently prioritise the funding of the preventative health function even under the constrained fiscal environment because not doing so costs more in both rands and lives. The escalating cases of food poisoning in the country, which have led to deaths and illnesses, especially among school children, is a matter of concern.

This unfortunate situation does not only threaten the health and wellbeing of citizens but is a potential threat to peace and stability in communities. Municipalities have a major role to play when it comes to food safety and, according to the norms and standards of the World Health Organisation (WHO), one environmental health practitioner (EHP) is required for every 10,000 people.

With the current SA population estimated to be over 63-million, this means SA needs about 6,300 EHPs to ensure regular surveillance, monitoring and control of potential health hazards at all places.

SA has one EHP per over 36,000 people; a 72% deficit. The reason for this high shortage is largely due to inadequate funding. The National Health Act assigns the environmental health function to metros and district municipalities.

The local government equitable share formula’s community services component provides an allocation of R12.41 per poor household per month for the environment. This allocation is to subsidise the provision of municipal health services to poor households and is based on the number of poor households in a municipal area as reported by Stats SA census figures.

The rest of the population is expected to contribute towards the funding of the function through payment of property rates. However, district municipalities are not authorised to collect property rates. Therefore, they rely on intergovernmental transfers only to fund this function.

All district municipalities, except for Amathole district in the Eastern Cape, receive local government equitable share allocation for municipal health and related services of R12.41 per poor household per month. This leaves a funding gap for the provision of the service to non-poor households and businesses outside metro areas.

According to Stats SA, a poor household is a household whose total monthly income is less than double the value of the old age grant per person (R4,200). With the threshold set so low, many households in the district areas are not provided for in the equitable share provision.

No local municipality, including intermediary cities such as Msunduzi and Polokwane, receive any allocation for the municipal health function. However, out of desperation, some of these municipalities step in to perform this unfunded function to protect communities.

District municipalities with local municipalities performing the function in their respective jurisdiction, must pass the funds to those local municipalities. However, district municipalities don’t pass on the meagre funds available to them because the need is much bigger in the other parts of the district outside the intermediary cities.

Many households in metro areas who cannot afford to pay municipal rates are also excluded from the formula allocation, yet they do not pay rates and do not contribute to the funding of the service.

All metropolitan municipalities, except for the Eastern Cape's Buffalo City, do not get the allocation of the community services component of the equitable share. Therefore, they are expected to fund all community services including roads, streetlights, street cleaning, parks and environmental health service for all households and businesses from rates income without any financial support from the national fiscus.

This state of affairs points to the long-standing argument by local government that there are crippling gaps in the funding framework which has had a cumulative effect over more than 20 years, and this is one of the many consequences of that gap. The current events emphasise more than ever the need to resource the environmental health functions, despite the fiscus constraints.

Kolisa is chief officer for infrastructure delivery, spatial transformation, inclusive communities and municipal sustainability at Salga.