As millions of South Africans head to the polling stations tomorrow to cast their votes in the local elections, the quality of municipal basic services – and how they directly impact our daily lives and health – is at the forefront of voters’ minds.

The constitutional responsibilities of local government are really about the basic elements of a healthy life: uninterrupted access to fresh water, clean air, functional wastewater treatment, and reliable access to and around our communities. While healthcare policy is determined nationally, the practical foundations of public health are decided locally – in our backyards, streets, and taps. When these basics fail, vulnerable communities pay the highest price.

Over the past weeks, Health-e News deployed our network of OurHealth community journalists across the country to investigate how local municipal performance directly shapes community well-being in our Elections 2026 series. The residents our journalists spoke with live alongside persistent infrastructure failures and they shared feelings of deep despondency, frustration and anger. 

From townships without running water for weeks despite multi-billion rand bulk water budgets, to communities choked by toxic smoke from burning municipal waste dumpsites, our reporting reveals a stark reality: local service delivery failures threaten to make us sick. 

A countrywide snapshot of municipal service failures

Water insecurity remains one of the most dire municipal failures impacting daily survival. In Limpopo, villagers in Giyani are forced to spend hundreds of rands buying water or turn to contaminated river sources as two of the five municipal boreholes have not been operational since March last year.

Children have been exposed to waterborne diseases as they wait for the long-delayed bulk water scheme to come online, amid corruption allegations and over R4-billion spent on it to date. 

In Skoonplaas township, Musina, houses are surrounded by untreated wastewater and children playing in streets flowing with raw sewage develop skin rashes and gastrointestinal infections. Frequent water shortages and dry taps compound the crisis, forcing residents to buy or collect water from risky sources. 

All three of the Polokwane municipality’s wastewater treatment plants are in a critical state with residents in Seshego reporting a double burden of a persistent stench of raw overflowing sewage outside their front doors and toxic fumes from waste burning at unmanaged municipal dumpsites.

Chronic air pollution and toxic air

In industrial Springs, municipal negligence has left essential air-quality monitors offline since July, when the last air quality index reading was classified as “unhealthy for sensitive groups” with community members complaining they are coughing from constant exposure to dust and emissions from nearby mine dumps.

Meanwhile, in Gauteng, a year after the City of Johannesburg announced a R150-million rehabilitation project for the Kya Sands landfill, nearby residents continue to suffer from the waste fires and illegal dumping fumes that threaten respiratory health and cause chronic coughing and asthma attacks.

Dangerous infrastructure and emergency access

Basic municipal infrastructure can literally be a matter of life or death. In the township of Meriting, in Lenasia South, delayed electrification forces residents into informal electrical connections, exposing young children to lethal electrocution hazards – locals say nine community members have been electrocuted this year alone, including five children.

In Hammanskraal in the City of Tshwane, unpaved roads and no pedestrian crossings create severe mobility hazards for blind and disabled residents navigating their neighbourhoods.

And in Lakeside Estate in Midvaal, a partially blind resident sustained injuries while cooking on open fires, during a four-month long electricity outage after a transformer broke, impacting 116 households.

In rural communities like Campbell in Limpopo, mobile network blackouts and severe infrastructure neglect leave residents unable to even call an ambulance during night-time health emergencies.

Accountability at the ballot box

Today’s vote isn’t about party politics, it comes down to the basics: our right to live in healthy, safe communities. Public health starts right outside our front doors – at the municipal tap, the local dumpsite, and the roads connecting our neighbourhoods. By voting today, we’re making our voices heard and reminding local leaders that basic service delivery is about human dignity, and that clean water, safe air, and functional infrastructure are non-negotiable foundations for our health.

Follow more of our coverage by our network of community journalist who spoke to residents across the country about the health impact of municipal failures