Delivering basic services is the key to delivering good health to South Africans

local government electio
(Photo: Lilita Gcwabe)

Political parties and their leaders have spent two months knocking on doors, trying to win votes in this local government election. But where do their commitments lie when it comes to delivering good health services, and what does the constitution hold them accountable for? 

“We just notice one another suffering from the same thing. Only to find that these illnesses are caused by the way that we live here,” Lerator Tskea, a resident of Organic Market informal settlement in Johannesburg, told Health-e News.

Tskea says the settlement is overcrowded and basic services are almost non-existent. There are about 500 shacks in the settlement.

The City of Johannesburg established the Organic Market informal settlement in 2017 after the High Court ruled that it had to find space for people displaced after being evicted from a private building.

Refuse removal and good health

Tseka says refuse removal is irregular. The community uses one giant metal container to throw their waste into.

 “We used to throw our waste in a pile on the street and sometimes people would burn it so that we could continue throwing waste in that spot and others. I think it was two years ago when they delivered this container and at first, it was emptied monthly, but now, the truck only comes once every two months or after an even longer time,” she said.

 Tseka explained that on the days that the refuse removal truck collects the waste, the container is not left empty and some waste remains at the bottom of the container and around it. Leaving people to pile old waste with new waste.

 “We live in a place that stinks every day. Next to the waste container, we have only seven portable toilets that are used by the more than 200 people who live here. The other seven toilets have been locked by other residents who have claimed them for personal use. We get sick and have to go to the clinic not knowing what has caused it. Having severe stomach aches and headaches often and not being able to link the reason why. We just notice one another suffering from the same thing. Only to find that these illnesses are caused by the way that we live here.”

Studies have shown that living within 5km of a waste site was significantly associated with asthma, tuberculosis, diabetes, and depression.

Tseka hopes the problems faced by informal settlements will be top of mind to local authorities after the elections are over and the votes counted.

Much more to health

Laetitia Rispel Professor of Public Health at Wits University. says under the constitution, health services are the domain of national and provincial governments. But it says the local government is responsible for municipal health services, which is described as environmental health.

“Health is influenced by much more than health services. Access to clean water and sanitation, refuse removal all fall squarely in the metros responsibility This all plays a huge role in ensuring good health. Local government plays a huge role in managing the social determinants that impact health,” says Rispel.

 The EFF manifesto promises to increase the number of healthcare facilities, build new 24 hour clinics, and employ more skilled staff to improve services.

“The EFF is interesting, they try to be specific. But the local government cannot upgrade clinics. This is the role of the provincial government,” Rispel says.

 She says the EFF’s promise to employ more healthcare workers is very ambitious. “This promise is not very cost-effective from a staffing perspective Municipalities have had trouble in employing doctors as most of them want to work in larger facilities.”

The ANC’s promises around healthcare have been more general.

“They are talking about the strengthening of the public health systems. They do talk about the widening access to health care. When you look at the government as a whole it has done a lot to increase access to healthcare. The ANC has been clever in how they phrase some of the issues. They have been around the block on what is realistic and what is achievable.”

She says the DA has been even vaguer.

“They (the DA) talk about phasing out paraffin, minimising the risks that lead to poor health…responding effectively to health emergencies – your guess is as good as mine as to what that means. It’s so vague that it is largely meaningless,” says Rispel.

Voting for better roads                                       

What are the responsibilities of local government?
What are the responsibilities of local government?

*Bonga Sigcawu, 37, is from a small town called Butterworth in the Eastern Cape. Born without limbs, he has used a wheelchair for most of his life. He is hoping his new ward councillor will do more to better the lives of people living with disabilities.

 “I have been using this wheelchair for more than 20 years. The wheels have gotten old and I constantly have to get the motor fixed. Even though I don’t like being pushed, when I have to go somewhere, I prefer it, because we still have gravel roads in some areas and it is difficult for my wheels to move. In town it is also difficult because the roads have many potholes, some are very big and it is difficult for me to safely avoid them,” said Sigcawu.

Environmental health is an urgent public health matter

John Nyambi from the South African Institute of Environmental Health (SAIEH) says political parties must prioritise the environmental health of the people living in SA.

 “It needs to be seen as a way of protecting people’s right to life because that right is also equal to the right to a safe and healthy environment. Our bodies respond to our environments, and are both mentally and physically affected by them,” said Nyambi.

 Nyambi says the coal-powered stations in the Mpumalanga Highveld are an example of the consequences of not prioritising environmental health. 

“The Highveld shows how low environmental health is in the issues that are affecting the lives of people living in SA, across all demographics, and all areas. Air polluted with toxins, dirty water, areas exposed to excessive noise, piles of uncollected refuse, are all a part of environmental hazards that we are becoming more exposed to, which are harmful to us” he says. – Health-e News



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