Health Systems Research Unit

Findings
Linking health and environment in Cape Town, South Africa: The view from local government, July 1998

Research data is presented according to the predominant themes that emerged during qualitative analysis. Themes do not represent homogenous viewpoints, but include both trends and diverging views. These are highlighted by quotations from interviews to preserve an element of the specific within a necessary degree of generalisation. Where possible, remarks are made linking the dimensions of process, actors and context, in recognition that these can make the difference between effective and ineffective policy choice and implementation (Walt, 1994).

The local government policy process in Cape Town 

Theme 3.1.A:
Perspectives on the nature of policy - flexibility, accountability and consistency
A useful starting point for this examination of policy making and decision making at local government level is to explore how local actors understand and use the concept of ‘policy’. Widely diverging perspectives on what constitutes "policy" were elicited, as encapsulated by the following response:

"What comes to my mind is that obviously you can define policy differently. There could be, say, political policy, there could be government policy, there could be statutory policy and you can go down the line, implementational policy, operational policy. Depends how you want to define it. Health policy. A definition of policy would be as soon as there is a specific action that has been agreed by authority, that becomes policy."

Within the local government context, policy was felt by both councillors and officials to be a means of providing a broad framework for consistency of actions and a mechanism of setting parameters and standards. An oft-cited example of the need for the latter was with respect to informal trading policy, which is currently inconsistent across the metropole. At the time of interview this was a political hotspot, obtaining much media coverage amidst accusations made by street traders of unwarranted local authority interference with entrepreneurial activity and counter accusations by formal traders that MLCs were not doing enough to protect the business of legitimate rate-paying traders. Citing the informal trading example indicates a recognition by officials of the immediacy of policy as a means of dealing with potentially sensitive issues with political ramifications both for councillors, who have to take ultimate responsibility for policies, and for service providers, who have the responsibility of implementing policies. There was a feeling that while policy should allow for some flexibility, it should also provide for a minimum level of uniformity across the metropole, particularly with regard to issues such as air or water pollution which cut across the boundaries of the Metropolitan Local Councils.

While policy was seen as a guide or framework for decision making. Different measures were perceived as necessary for issues in which strict enforcement is required:

"One of our functions is to actually provide policy and guidelines. Now if you are talking policy and guidelines, that's all it is. There's nothing anyone can force you to do, it's merely a policy … we try to subscribe, but it's obviously therefore better to have it in legislation."

A related point for emphasis was that development of effective policy would require political will and broad buy-in. Clearly policies which are inconsistent in either content or application have the potential to create conflict between stakeholders.

Both bureaucrats and councillors perceived policy as a way to promote transparency and accountability to the public. Thus, in the words of two officials:

"I think it’s also a part of transparency. The public can then know generally what the framework for decision making is with their local authority. I believe it’s absolutely essential."

and

"I think the objective of the policy is obviously, it's there to help us, it's there to help the community, that people know there are certain parameters that are being kept, certain standards that are being expected."

However, not all respondents viewed the development of environmental or environmental health policy as a priority. Given the need to move rapidly to redress inequalities in municipal service allocation, one senior official noted that the development of indicators to measure performance of local government was a more pressing concern.

Although mostly seen as an essential tool, discussion centred around the need for a "subtle balance" between practical versus ideal policy. Thus:

"… it has to be practical. If it's not practical it'll lie on the shelf and there're many, many examples of that in this metropolitan area. … And it's that subtle balance, you have to take into account what the resource constraints are ... if you're not realistic, then don't waste your time and effort and consume valuable resources trying to do it."

An opposing view stressed that "unrealistic" policy could be a powerful tool to lever for more resources, but for this to happen, meaningful community buy-in for the policy would be needed in order to apply the necessary exogenous pressure. This is a good example of the complex non-linear nature of policy-making, with policy in this case being deliberately used to garner resources. The example indicates that planners are well aware of the profoundly political nature of the policy-making process and the fact that policy needs to be adapted to available resources or be capable of generating further resources.

The determining influence of the power base of actors involved in the policy process was raised in the context of development of environmental health policy for the Western Cape province. Because of the greater environmental health resources at local government level, any policy developed, noted a provincial government respondent, would most likely be in favour of local government, with little reflection of broader provincial interests.

Located within the context of uncertainty as to the respective roles of different local government structures, it is not surprising that the need for policy to provide clarity on different roles and procedures was highlighted. Moreover, responses indicated that policy should serve to focus attention on specific issues, help to achieve consensus, and assist in dealing with sensitive issues - thus policy should be facilitative and play a role in conflict resolution. The function of policy was also brought down to the concrete level of service delivery:

"Policy formulation should enable service delivery to take place a lot quicker and hopefully be far more effective."

In addition to these high expectations of the ability of policy to facilitate action, the study also revealed differing degrees of familiarity with "policy speak". As respondents ranged from planners with decades of policy experience to new entrants to local government with much experience of activism but little knowledge as yet of the peculiarities of the local government policy arena, this is to be expected and resulted in an interesting and illuminating diversity of views.

Theme 3.1.B:
The policy development process - institutional memory, discretion and participation
This section explores respondents’ views on the policy development process, including how policy development has changed under the new dispensation; the participation of different stakeholders in the process and constraints to local government policy development.

Past practices:
Within a context of wide-ranging conceptions of policy and differing degrees of familiarity with policy level actions, officials and councillors had clear, although in some cases contrasting, views on how policy should not be developed. In recognition of the new orientation of local government, discussion around policy development tended to contrast past practices with the (currently perceived) ideal. Thus in the past, policies were seen to have been developed in isolation, which led to lack of policy integration and to inconsistency both within structures and across the metropole:

"So you get a policy on this and a policy on that, but you get no integration, no relationship. They are developed on an ad hoc basis."

A related point is that policies were developed in a reactive rather than proactive mode:

"But there are two things there. I mean, the one is an historic thing where policies came about at a council level as a reactive thing, like the Second Dwelling Policy or Wendy House Policy or anything like that. But, I mean what we’re talking now is a proactive, almost like a mission driven set of things. Which is relatively new."

Respondents with much experience in local government noted the lack of a filing system for policies in the past. This meant that in many cases policies only existed in the memory of an individual and there was no reference system for checking even for the existence of a policy, let alone for an implementation strategy.

"There was no policy file kept so we have no means of finding out what policies we actually have, except in terms of people’s active memories. Policy management has been very poorly handled."

Policy development in the new dispensation:
Looking into the future, officials and councillors felt that new policies needed to be adaptive rather than prescriptive, and should allow for creativity within a certain framework:

"Policy needs to be adaptive, to give you a framework. We need flexible policy that can be adapted to local conditions."

Related to the need for policy to be practical, non-linear policy making processes were felt to be a means to achieve this:

"It should be incremental and one should get into the cyclic rather than the linear approach to policy formulation and be realistic."

"Policies that you develop have got to be realistic, based on reality. I think this is what is quite interesting about this new concept in local planning - your integrated development frameworks - along with the plan has got to go budget, the plan has to be reflected in the budget or the budget has got to be reflected in the plan. And I think that in South Africa today it is critical. There's no point coming up with pie in the sky. You have to say: what can I realistically achieve?"

Public Participation in policy development - a means of reducing discretion?
While the notion of ‘participation’ is further discussed in a later section of this report, there was stated agreement on the need for wide-ranging public participation during policy development. Detailed responses, however, revealed fundamental differences in views on the way in which policy should be developed to achieve this. These ranged from supporting a ‘bottom-up’ approach to support for a somewhat more ‘top-down’ approach where officials proposed first developing a pro-forma policy and then distributing that for public comment. An example of an unsatisfactory practice, cited by a provincial government representative, centred around the non-participatory development of environmental health policy for the Western Cape province. A Strategic Management Team of senior officials had been given an extremely limited time to compile a policy, with no input from the public or from councillors. The process had become stalled as the document had been sent back to the regions for amendment.

Another response proposed a different starting point for policy formulation:

"The practice and knowledge around these things must be drawn from those who have the experience. Around that particular question of differential standards in the city, surely you draw on those environmental health officers that have been working in low income areas, in particular in Langa and Gugulethu ... and come together and ask ''What is your practice that should inform policy?'. Surely you need to say, what is the practice that informs what should become the policy in that instant, and start from that point …"

What we are perhaps seeing here is a tension between the ‘technocratic’ approach to policy making, which emphasises the input of skilled professionals, and a more inclusive approach, which acknowledges the value of wide participation, including representatives of civil society. This leads one to the question of exactly what is meant, at particular times and within particular contexts, by community or public participation in policy development? There was agreement among councillors representing disadvantaged areas and an NGO representative that policy development in the past had not involved the public in any meaningful way. Despite this acknowledged shortcoming, development of the metro environmental policy, currently ongoing, was largely instigated by The Green Coalition, an umbrella grouping of environment / development NGOs, and their working group, the Coalition for Sustainable Cities, through lobbying and engagement with local government

Apart from inertia to change, an additional reason for failing to embrace public participation in policy making was suggested by an experienced official:

"Now, obviously, if you have policy frameworks that are publicly developed and bought into and endorsed and then there is some form of public monitoring of those policies, and there is a lot of communication around them, that reduces discretion on the part of councillors, and it reduces discretion on the part of officials…. It removes their personal power base where they can allocate favours to constituents; and they are very opposed to having a policy that is publicly endorsed."

Flexibility of policy was an issue raised a number of times, as policies that were perceived to reduce discretion too much may be resisted, both by officials and politicians:

"So we’ve got lots and lots of jolly nice looking policies but, you must also understand that councillors don’t like policies, and often senior managers don’t like policies either, because it reduces their flexibility. They don’t like plans and they don’t like any kind of framework that says ’this is what you will do’."

It must, however, be noted that not one of the councillors interviewed expressed this reported dislike for policy, with all emphasising the desirability of policy as a means to promote accountability. Nevertheless, the recent case of councillors allegedly bypassing council housing waiting lists to allocate housing to the friends and family of prominent gangsters, contrary to council policy, may reflect an attempt by councillors to use their position to allocate ‘favours’. This is by means a phenomenon unique to Cape Town or to developing countries: senators and house representatives in the United States are often assessed by their ability to direct public investment into their state through what have become known as ‘pork barrel’ policies. This study suggests that the public have a role both in developing policy and in ensuring adherence to these policies by government officials. Reducing the discretion of policy makers to take arbitrary decisions may be an important aspect of public accountability.

Collaboration across sectors and levels of government:
A major question raised was how to bring about the required degree of cross-sectoral and vertical coordination and collaboration required for policy making around cross-cutting environmental and environmental health issues. A critical factor in environmental policy making is early buy-in from the line departments responsible in particular for service delivery. Issues of coordination appeared to be a pressing and general problem, and reference is made to these throughout this paper.

Significantly, it was felt that the capacity building opportunities of policymaking processes should be harnessed. An example provided was the need for the CMC, as the metro-scale structure with better resources than the MLCs, to play a capacity building role during current development of an environmental management policy for the CMA.

Issues were raised around the level at which policy formulation should take place. Within the localised context of the CMA, most respondents agreed that the Cape Metropolitan Council had a role to play in the collaborative formulation of metro level policy. However, Local Councils would need to develop specific policy for local conditions. One dissenting view, expressed by a provincial government representative, was that because primary responsibility for local government lies with the MLCs, primary policy should emanate from these structures. Additional comments on this subject are made in the section on relations between different spheres of government.

A fundamental issue within the restructuring context was whether the restructuring process will ensure that the most effective structures for environmental policy making and implementation are put in place. As opposed to the metro-level environmental policy process in Durban, structure has preceded function in the CMA. Middle-level officials expressed concern that despite representations to council and to senior officials, recommendations regarding an appropriate structure to facilitate an overarching and integrated approach to environmental management had not been taken up. A number of reasons were postulated for this reluctance: senior management may be "protecting their own turf" and not wanting an overarching structure to interfere with their autonomy; the lack of extra staff or funding; and environmental management not being seen as a priority, possibly because of the failure to see environmental issues as including the "brown" and health issues. The formalisation of structures in advance of decisions on function may impede policy development by creating barriers to cross-sectoral policy inputs

Constraints to policy development:
A number of constraints to policy development were noted. Firstly, there was a perceived need for policy to be based on information which, certainly in the case of routine environmental health information, is currently not seen as particularly useful or reliable. Although local authorities collect environmental health information on a regular basis, policy generated at a national level is reportedly not informed by this information, but rather depends on the particular agendas of policy makers.

A second major constraint, in the dynamic South African policy environment, is the lack of coordination and consistency across the multitude of policies currently under development. Thirdly, officials, within the context of recent restructuring, noted lack of capability, experience, resources and time as constraining factors to co-ordination. The need to develop the capacity of service providers and their institutions to manage effectively was highlighted. In the first instance, there is little experience of cooperative governance in local government structures:

"...so we are trying to call on an institutional memory that’s non-existent. Over and above that, you are then asking for co-operative governance in the absence of a cooperative framework. .... places severe constraints on local government ........ no development framework, local government has an underdeveloped development agenda. "

Secondly, in addition to unsupportive administration systems, one councillor suggested the need for programmes of re-orientation and training to change the ethos of the public service in general:

"You have to run a program that will change the culture of working within the public sector. It’s a very laid back culture. You join the public service and you don’t have to work too hard, you don’t need to be very competitive. We in council have decided not to encourage people or to give them the opportunity to develop their capacity to deliver better service. ….and so hopefully the man is working, that is good enough. We don’t encourage and yet we want a competitive service. How can that guy compete with the private sector if we don’t give him enough skills?"

Third, financial limitations, resulting in inability to fill vacant posts and contributing to demoralisation of staff, and a politically fraught context mean that local authorities will require creative mechanisms to fulfil their increased role: "you have to create a way of working … asking local authorities with less resources for more responsibilities." In some cases critical posts, such as those to carry out intersectoral collaboration functions in the provincial government health department, are the ones to be unfilled - perhaps indicating that this function is not seen as a priority.

Collaborative policy making was seen by one respondent as a means of ameliorating these constraints:

"I think that under the circumstances and given the constraints, we need to come together in a think-tank framework and apply ourselves on the basis of that, as to how we establish roles and responsibilities on a collaborative basis, using our collective knowledge …"

and

" … local authorities have no institutional memory to draw on. You can't call on the past and ask how it was done in the past …There isn't an experience of collaboration, there isn't an experience of doing it for less, let alone experience of having done it before."

Finally, respondents were also in agreement that past policy making ventures had allocated inadequate thought to implementation mechanisms:

"And also what happens is everyone is locked into this mission statement in the beginning, everybody's got a mission statement and the policy is drawn up but they're not actually carried through to implementation. In other words, they're actually fuzzy policies."

Policy development and implementation are often in practice difficult to separate. A certain amount of overlap with the following section is therefore an unavoidable mirror of reality.

Theme 3.1.C:
Problems with policy implementation - 'n boer maak 'n plan
Policy implementation can clearly be a complex process, involving multiple players at different levels of government and in civil society. It goes without saying that many policies, however well intentioned, are not implemented, only partially implemented or implemented only for a short time. Several examples of failed implementation were raised in this study, including the former Cape Town City Council's Environmental Policy and policies on informal trading. Sabatier et al (1979 p484) have identified a number of steps which, if followed, should be sufficient for policy implementation. These are listed below.

Conditions for effective policy implementation:

• The programme is based on a sound theory relating changes in target group behaviour to the achievement of the desired end-state (objectives).
• The statute (or other basic policy decision) contains unambiguous policy directives and structures the implementation process so as to maximise the likelihood that target groups will perform as desired.
• The leaders of the implementing agencies possess substantial managerial and political skill and are committed to statutory goals.
• The programme is actively supported by organised constituency groups and by a few key legislators (or the chief executive) throughout the implementation process, with the courts being neutral or supportive.
• The relative priority of statutory objectives is not significantly undermined over time by the emergence of conflicting public policies or by changes in relevant socioeconomic conditions that undermine the statute’s ‘technical’ theory or political support.

This study did not examine in detail the stages of implementation for policies within local government structures. One respondent, however, described the process as follows:

'It's not that because you now have a new policy you need to change the organisation to enable the implementation of that policy. Particularly with regard to planning, it's a sieve process you would actually go through. It means that the applications you are receiving need to be in conformity generally with the policy. So, where you didn't have that sieve to push the application through, you now have a sieve and the staff who were processing those applications were informed and brought up to speed with the policy and applied it accordingly.'

The process, as described, has a number of components: a mechanism to assess the conformity of projects, applications or activities with existing policy; the resources to enable this mechanism; training of staff to apply or implement the mechanism; and informing the public of the new procedure. Planners across departments at the local, metropolitan and provincial levels and local councillors expressed a range of concerns regarding these different stages of implementation. For the purposes of discussion, these responses have been grouped into those relating to the context in which policy implementation occurs; those relating to the input of the major actors and those relating to the process of implementation itself.

The Context
Within South Africa there are obvious conflicts between policies which attempt to protect or enhance environmental health, redressing past inequalities and promote sustainable development, and the need to rapidly create jobs and provide services to previously disadvantaged groups. Respondents in this study commented that it is difficult for local government to apply or enforce certain policies if these are seen to negatively impact on development and jobs, as one respondent summarised, '… the enforcement will always be weak, because the economic forces are stronger'. This may be a particular problem with policies which have long term environmental health benefits, but are seen to restrict development in the short term. The question which then arises is how policy-makers strike a balance between the long and short term benefits and disbenefits, be they health, economic or political.

As Sabatier et al (1979) noted, policy makers have only modest control over their policy environment and policy issues are often highly interrelated. Actors in other sectors, such as economic planning, and contextual factors may have more influence on environment and health policies, albeit indirectly, than policy makers in environment or health departments. In this regard, Sabatier et al (1979 p500) note that ‘It is in responding to such changes that support for a particular program from key legislators, organised constituency groups, and implementing officials become crucial. If they are sensitive to the effects that changes in seemingly tangential policies and in technical assumptions can have on ‘their’ program, they can take steps to see that these repercussions are addressed in any new legislation [or programme].’

Another contextual issue impeding the implementation of policy is the process of local authority restructuring. A number of respondents commented that the focus of local authorities since the transition had been on restructuring and that policy implementation and service delivery had taken second place. This is explored in more detail in the section on restructuring which follows.

Interestingly, although financial constraints were seen to impede policy implementation, policies were also viewed as a 'mechanism' of generating funds.

' … by putting those regulations in place you actually provide the impetus to generate that capacity. When it becomes obligatory on someone, even the state, they tend to make a plan. " 'N boer maak 'n plan, you know. You develop that capacity. So I think that the idea is to put these [regulations] in place to drive the authorities, the consultants, the private companies to create the capacity to deal with it."

It is conceivable that policies could be strategically developed at local, provincial or national level with the intention of driving budget allocations in a particular direction. Respondents suggested that policy embedded in legislation is a more powerful tool for garnering resources than policy which exists only as guidelines.

The Actors
Many interventions that improve environmental health are very broad and require co-ordination between and within departments for successful implementation. Housing is a good example, requiring input from planning, engineers and health departments at the very least. Walt (1996) has argued that policies which involve multiple actors with differing agendas and organisation of work are more difficult to implement than those which are operationalised through one department only. This view was supported by respondents in the study, one of whom described how cross-cutting structures were rejected by senior management. This is further discussed in the section on intersectoral collaboration. Another respondent described some of the problems experienced in establishing a cross-cutting structure for environmental management:

"I know the previous council tried it [an integrated management system for environmental issues]. They formed at a political level an ad hoc Committee on the Environment. They took all the standing committees and each one had to give a representative. But if there was a housing project, this environmental committee said 'Hang on, hang on, this is impacting on the environment', and then the conflict immediately started. So it's a very difficult thing to deal with, to manage."

The respondents in this interview proposed that a co-ordinating group for environmental management be established to resolve differences in approach across departments and that the group reports directly to a senior level in council. By structuring reporting and accountability in this way, rather than to a particular department, the group might be seen as independent or neutral. It is possible that such a structure might assist in the implementation of multisectoral policies. However, having said that, it should be pointed out that attempts by the Office for Reconstruction and Development (within the Office of the Deputy President) to co-ordinate other departments in implementing the Reconstruction and Development Programme do not appear to have had much success. It is clearly important that the lead implementing agency possess sufficient political, managerial and financial ‘clout’ to drive co-ordination or that incentives exist to encourage interdepartmental collaboration on cross-cutting issues. This is further discussed in the recommendations.

The Process
Ensuring that policies are designed to include mechanisms for implementation was another issue raised by respondents:

"It's all right to build a policy framework and say in such and such a situation we shall do this, but unless you actually build in place the mechanisms, and the mechanisms may be a simple management structure, a particular public process creating expectation which then holds bureaucrats and councillors to account, empowering an external group to conduct monitoring and putting in place training."

"The policy is fine but should not remain just a piece of paper. We need to attach a programme to that to ensure that it will be implemented in the process."

The necessity of equipping relevant officials to implement policy effectively was highlighted as a critical factor. An example provided was the failure to train Environmental Health Officers to implement the no-smoking policy developed by the former Cape Town City Council:

"I think it’s a question of when we developed a policy we should have looked at equipping the environmental health people to use it as well, so that when it was official and they actually became part of it and had to go and speak to people, that they were equipped and felt comfortable to go and do it. But I think there was a fear initially that this is something new that we haven’t been doing, what if they ask me this … You’re talking of a situation of confronting a guy in a restaurant after he’s had half a bottle of wine . ."

These views seem to indicate that not enough attention is being paid to developing implementation plans with clear objectives and indicators for new policies. These may be very simple plans, such as the introduction of a new data collection item, or much more complex initiatives involving several departments for infrastructure delivery. These problems are by no means unique to local government in Cape

Town or South Africa. As outlined above, a carefully thought through plan is a crucial component of policy implementation in most settings. This needs to include an assessment of the importance of different actors in the implementation process and the incentives and disincentives for these actors, which might include different local authority departments or structures of civil society, to become involved and take ownership of the policy being implemented.