South African Primary Health Care Conference: Strengthening Primary Health Care
This conference aims to advance towards universal health coverage through a comprehensive approach involving whole of government and society to strengthen primary health care services in South Africa. Emphasizing collaboration and innovation in healthcare delivery for better outcomes and access to quality care.
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South African Primary Health Care Conference Towards universal Health Coverage. Strengthening primary health care. A whole government, whole of society approach. ENVIRONMENTAL AND PORT HEALTH SERVICES IN SOUTH AFRICA - GOOD PRACTICES AND CHALLENGES 14 -17 November 2023, East London ICC, Eastern Cape Ms Aneliswa PR Cele Chief Director: Environmental Health and Port Health Services and Acting CD Communicable Diseases Control
CONTENTS Introduction and Background Environmental health and port health services Successes Challenges Conclusion
Introduction and background Environmental health is a critical component of Primary Health Care (PHC), and is essential for an effective health system and improved health outcomes; In South Africa, a large proportion of the burden of disease can be attributed to preventable environmental health conditions; Environmental Health Services contribute to the promotion of wellness and prevention of disease, through the control of environmental conditions and factors that may impact negatively on human health if not properly managed; The quality of the air we breathe, water quality, the food we eat, the availability of adequate shelter, sanitation and hygiene services, the use of chemicals amongst others, all determine the quality of life;
Cont South Africa faces a quadruple burden of disease, consisting of high levels of communicable diseases (including HIV/AIDS and TB), high maternal, neonatal and child mortality, a growing burden of non-communicable diseases, and high levels of violence and injuries, with the consequent health toll; Therefore, in order to curb the rise of the quadruple burden of disease, need to give higher priority to addressing up-stream health determinants. This requires recognizing that the social determinants of health arise from the conditions in which people are born, grow, live, work and age; Amongst the key social determinants of health are environmental determinants, which make up environmental health services.
Cont In addition, the effects of climate change, are more visible, frequent and intense. Natural disasters, biodiversity loss and pollution are all disproportionately affecting the people who are least capable of protecting themselves. In terms of health impacts, these events increase the incidence of injuries, malnutrition, vector-borne diseases like dengue fever, malaria and non- communicable diseases such as asthma, chronic respiratory diseases, stroke, heart attack and many others. Health for All is reliant on an enabling environment that enables services to be provided equitably to all, including environmental health services and to empower communities with the skills to adapt to the effects of climate change and build resilient Primary health care services.
Environmental health services In South Africa environmental health services is governed in terms of the Regulations Governing the Scope of Profession of Environmental Health, published under the Health Professions Act, 56 of 1974, as amended, to include: Environmental pollution control Disposal of the dead Chemical safety Water Quality Monitoring Food control Health surveillance of premises
Image Title Waste management and general hygiene monitoring Surveillance and prevention of communicable diseases excluding immunisation Radiation (ionising and non-ionising) monitoring and control Malaria control Control of hazardous substances Vector control Port health
Cont.. EH services in SA are a concurrent function between the three spheres of government, (National, Province, Local government); National - Policy and legislation provision; Province - Malaria Control and the control of hazardous substances; Local - 9 Municipal health functions defined in terms of the National Health Act, 61 of 2003 (as amended); EH services rendered through a public entity i.e. Border Management Authority (Port Health Services);
Cont South Africa is signatory to the International Health Regulations (2005) outline obligations and recommendations that enable countries to better prevent, prepare for and respond to public health risks; 11 8 53
Port Health Focus Areas FOODSTUFFs TOBACCO PRODUCTS HUMAN REMAINS HUMAN TISSUE COSMETICS DISINFECTANTS HAZARDOUS SUBSTANCES MEDICINES (SAHPRA) Monitor onboard Verify documentation Monitor contaminated/health matter onboard conveyance vector control removal of risk IMPORTED GOODS CONVEYANCES Prevent importation of communicable diseases Implement surveillance measures Facilitate medical assessment of suspect case Participation in ORT Arrangements/system in place for transportation of traveller from the point of entry to the nearest health facilities. COMMUNICABLE DISEASE CONTROL POINT OF ENTRY FACILITIES Monitor supply, food safety & take samples Ensure PoE maintained condition Have contingency plans in PoE safe water facilities safe effective Protection of human health from risks arising as a result of international travel and trade 10
Successes Various policy and legislative framework have been provided, including; National EH policy and strategy provides a framework within which Environmental health services should be provided in the country; National Environmental health norms and standards provide a benchmark within which the delivery of Environmental Health services can be monitored and assessed. Promotes standardization in the rendering of services. Various guidelines - issued to provide technical support to Environmental Health Practitioners on matters relating to service delivery; Integration of environmental health aspects within the legislation of other government sectors including the environment, water and sanitation, social development ; Continual capacity building interventions for ground level practitioners increase competency and confidence in service delivery. 11
Cont Climate change and health adaptation response; National climate change and health adaptation plan 2014; National heat health action guidelines 2021; Health risk vulnerability assessment (RVA) developed for 52 health districts ; National climate change and health adaptation multisectoral steering committee; A well established and functioning training for EHPs 7 Institutions of Higher Learning offering Environmental Health successful upgrade of the EH qualification from a National Diploma to a Bsc degree; 12
Challenges Slow progression in the realization of the EHP/population ratio as per the World Health Organisation recommendations Inadequate operational budget allocations due to competing priorities at local government level; Inadequate planning for Environmental Health Services and lack of alignment with District Health Plans as prescribed within the National Health Act; Fragmentation of EHS within various government departments resulting in unclear roles and responsibilities, overlaps and duplication of functions; The transfer of Environmental Health Services from the provincial level of government to District and Metropolitan Municipalities incomplete;
Concluding Remarks Environmental Health Practitioners continue to play a critical role of identifying, assessing, correcting and monitoring factors in the environment that may impact negatively on human health in order to ensure Health for All. "As a country we have to go back to the basics of primary health care. We have to prevent diseases even before they occur, we have to act now Minister Motsoaledi, July 2010; Prevention is better than cure!
