Health Systems Research Unit

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

This section presents recommendations arising from this study followed by suggested routes for implementation or sub-recommendations, as appropriate.

Key recommendation 1
Environment and health departments in local government should develop a policy which defines how communities will be incorporated into decision-making, and should establish a mechanism for the implementation of this policy.

Routes for implementation

• Series of metro-level workshops, involving the major stakeholders, including officials, councillors and representatives of civil society, to establish a broad framework for the policy on community participation.
• Literature review of local government policies on community participation developed elsewhere in South Africa and internationally (focusing on the Southern African region) to inform discussion and policy formulation.
• Clear time-frames for implementation of the policy.

Key recommendation 2
Methods and procedures used by councils, and specifically by health and environment departments, to facilitate community participation and empowerment with respect to service delivery should be evaluated and, where shown to be effective, strengthened and expanded.

Methods and procedures that could be explored include

• A broad process of information dissemination at the community level to inform residents of local government services and other activities. Language should be accessible and technical terminology minimised. This could include notice boards in communities outlining how service delivery or other problems, such as unauthorised dumping, can be reported.
• Simple information sheets informing the public of items on the agenda of each municipal council and CMC meeting and where further information can be obtained. Community radio may also be a useful medium for disseminating such information.
• The role of Community Liaison Departments (as created in one MLC) in facilitating intersectoral coordination as well as community participation .
• The potential of existing statutory structures, such as the Provincial Development Council, for facilitating better communication between policy stakeholders.

Key recommendation 3
Explore the feasibility of developing and implementing a training programme to build the capacity of councillors to participate in decision-making at local government level.

Implementation options

• Link with similar initiatives developed at the national level (for parliamentarians) and similar programmes funded by UK DFID.

Key recommendation 4
Existing administrative systems are not often conducive to efficient functioning, nor are they appropriate for new demands placed on local government. Attention therefore needs to be paid to developing new systems that function efficiently within existing resource constraints, and that streamline bureaucratic procedures.

Suggested changes

• Establish a database of policies formulated by MLCs, CMC and national structures (where appropriate). This database could act as a reference point for decision-makers, implementers of policy and the public.

Key recommendation 5
Clarify the objectives of intersectoral / departmental collaboration and, if appropriate, decide on the most appropriate structures to achieve these objectives.

Suggested changes

• Departments should be encouraged to collaborate through financial or other incentives, perhaps as part of the IDP process i.e. release of resources could be tied to proof of effective intersectoral collaboration. This may encourage joint budget planning between local council departments.
• Develop innovative cross-sectoral structures in the environmental health domain, bringing together environmental health, environmental management and conservation departments, and sharing resources across these currently under-resourced departments.
• Identify a strong lead agency within local government which can ‘champion’ intersectoral initiatives and take primary responsibility for their implementation.
• Identify ‘champions’ for intersectoral policies within council and other structures of civil society who can assist in driving these initiatives.

Key recommendation 6
Local government in Cape Town appears to be suffering from ‘restructuring fatigue’. In the context of debates on the ‘megacity’ option, the damaging effects of further restructuring should receive serious attention from local and national policy makers. If further restructuring is unavoidable, consideration should be given to the timing and the speed of implementation.

Key recommendation 7
There are concerns regarding the location of environmental health departments within the health sector. A multi-sectoral task team should be established to examine the role and functions of environmental health departments and to make recommendations regarding their location within local government structures.

List of references

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