Discipline of Occupational and Environmental Health
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Department of Occupational and Environmental Health

Integration of Environmental Health Servcies into a District Health System in Durban, South Africa

Summary:

Jacques Oosthuizen, Noddy Jinabhai and Rajen Naidoo

Introduction:

The background to this research is the current initiatives by the National Department of Health in South Africa, which has committed itself to the development of a district health system. The primary focus of this system will be the provision of a package of essential primary health care. In the current draft health bills and the White Paper on transformation of Health Care, Environmental Health Services (EHS) have been included as part of that package.
International and national agencies have clearly defined the contribution of environmental health to protecting and promoting human health at the conceptual and strategic levels, the specific programmatic and operational integration of EHS at a local or district level in a Comprehensive Primary Health Care (CPHC) service is poorly defined.

The 2.8 million people living in the DMA face considerable environmental and occupational hazards. These hazards are managed by fragmented EHS provided by local and provincial government. In addition to this fragmentation, the division of the city into substructures with a degree of autonomy over services has resulted in inappropriate distribution of these services to areas of need. As part of the process of integrating Environmental Health Services (EHS) into a Comprehensive PHC (CPHC) programme in the Durban Metropolitan Area (DMA), a quantitative and qualitative analysis of existing EHS rendered by the various health authorities was undertaken. Existing policy documents relating to National, Provincial and Metropolitan health plans, EHS and CPHC were reviewed to provide a framework for the analysis.

Methods:

This was a cross sectional descriptive study describing existing EHS in the DMA using qualitative and quantitative methods for data collection.

Discussion:

The quantitative study revealed that human resource allocation seemed adequate and this was further supported by the use of population density ratios as surrogate measures of resource distribution and by the discussions of the key informant survey. A definition of the basic package of Environmental Health Services at a metropolitan, substructure and district level is necessary EHS could protect public health through control, monitoring and regulation of environmental hazards, and promote CPHC through the provision of adequate and appropriate water, waste removal, food hygiene and sanitation services. It is clear that for Industrial/Commercial Services a specialised, usually highly technical, single and centralised service should cover the entire spectrum of industrial and commercial enterprises. This should be at the metropolitan level, with established systems of reporting to the District Health Systems Management Team.

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