Local Government environmental health services: fundamentals for effective municipal service delivery and preventive health outcomes

Abstract

One of the main reasons proposed for the widespread community protests in South Africa has been ineffective service delivery by local municipalities. The growing frustration of citizens has led to violent unrest, damage to infrastructure, service payment boycotts and litigation. Official reports have highlighted weaknesses including flawed governance, financial management, operational processes, and inter-governmental relations. This also applies to environmental health services (EHS) which is an intrinsic part of municipal health services, despite being the first line of defence in protecting the population against environmental risks. This grounded theory study, which forms part of a PhD dissertation, applied an integrative literature review to identify the fundamentals of effective environmental health service delivery. Four factors emerged: mandate cognisance; mandate execution; leadership support; and community satisfaction. Using the Schutte-dendrogram technique, the prerequisites for effective preventive environmental health services were explored and a conceptual model with sub-components was constructed. Viewing the model through a systems theory lens underscored the relational aspect of effectiveness. Rather than each factor independently contributing to effective service delivery, the interconnections and reliance on collaboration, communication, and contingencies among them lead to success. A strength or inadequacy in one of the four fundamental domains affects all the others, allowing progress or deterioration to permeate the entire system to enhance or weaken goal achievement. Improving the effectiveness of local government basic services thus requires a holistic view of the organisational system and the relational nature thereof.