Challenges in the integration of municipal health services in the uMgungundlovu District Municipality, KwaZulu-Natal.
The National Health Act (Act 61 of 2003) defined Municipal Health Services and gave full responsibility for this function to district municipalities and metropolitan municipalities. District municipalities were required, by law, to provide municipal health services which were previously rendered by local municipalities and the Provincial Department of Health. This, therefore, required the transfer of staff, assets and liabilities from local municipalities and the Provincial Department of Health to district municipalities. The purpose of the study was to identify barriers to and facilitating factors for the transfer of municipal health services from the seven local municipalities and the Provincial Department of Health to the uMgungundlovu district municipality. A cross-sectional, descriptive study design was employed. A structured questionnaire was used to collect quantitative data from local municipalities and the Provincial Department of Health on the package of environmental health services offered and the available human resources. Qualitative data was collected through in-depth interviews and focus group discussions with key role players in the provision of environmental health within the district. The key findings of the study were: There were no changes to the package of environmental health services offered by local municipalities and the Provincial Health following the definition of Municipal Health Services. The Provincial Department of Health continues to play an important role in the provision of Municipal Health Services in the district There was a lot of awareness-raising on the integration process; however planning for the integration was very poor. The lack of progress in integration has had a negative impact on service delivery and on the environmental health personnel involved. The relationship between district and local municipalities, a lack of understanding of environmental health, budget allocation, communication, lack of commitment, capacity, and lack of a champion were seen as the main barriers to the integration process. The study was able to identify possible gaps in the planning process that, if revisited could assist the district municipality in better handling the process.