May 2005
Rags and riches
Back to contents

EHJ May 2005, pages 21-23

How does delivering environmental health in South Africa differ from the UK? David Lyons visits Cape Town and talks to colleagues whose responsibilities range from dealing with the luxurious to desperate poverty

The office of the Co-ordinator for Specialised Environmental Health Services for the Cape Town region generates a vague sense of familiarity. As we discuss a broad range of topics, none of which would be unfamiliar to environmental health practitioners in the UK, only two things persuade me that I am not back working for a local authority in the north east of England.

First, it is early March and if it wasn't for the air conditioning, I would have evaporated by now in the morning heat, which has already passed 30oC and is heading towards to 40oC with every minute noon approaches.

Second, the view out the window is not a post-industrial landscape of a strange and dark river bank, but of the lower slopes of Table Mountain, with its acolytes - the Devil's Peak and the Lion's Head - sweeping down to the crisp blue water of Table Bay; combined with the cloudless sky it would be impossible to mistake this for anywhere in "blighty".

Between the bay and the mountain the city of Cape Town has grown and spread since it was founded in the middle of the 17th century. Now a city of over 3 million inhabitants, it occupies a strategic and historic position at the southwest tip of Africa.

It is also a city of incredible contrasts. While South Africa describes itself as the world in one country, Cape Town could almost be the world in a single city. For starters its architecture makes it perhaps the most "European" of African cities. Glorious examples of the Victorian era are mixed in with the cleaner lines of art deco. Quite a few of these buildings, having suffered with the decline of the downtown area, are now the centrepieces for a significant regeneration effort.

In contrast to the classic architecture, the city has its fair share of informal settlements or townships as they were once known, including those in the notorious Cape Flats area. The poverty here is in stark contrast to the boutiques and designer shops of the Victoria and Alfred Waterfront and the superlative defying luxury of the Blue Train.

This eclectic city should, on the face of it, provide unique environmental health challenges, but the discussion revolves around what it seems are universal themes in local government in general and environmental health in particular - reorganisation; enforcement versus education; recruitment, training and retention of staff; fragmented legislation; compliance building, especially in respect of Haccp; and, of course, resources.

The themes may be universal, but what quickly becomes apparent is that the environmental health challenges differ hugely in scale and scope to those found in the United Kingdom and Ireland.

To deal with them there are 130 EHPs (including management), all of whom must be registered by law with the Health Professions Council of South Africa (HPCSA). Training to become an EHP in South Africa requires studying through a three-year course to obtain a national diploma, with the training containing a strong practical element.

Change is afoot, though, in this area as the course moves to become a four-year University of Technology BTEC degree course, with a provision allowing students who have completed two years' study, to work as registered environmental health assistants under the supervision of a registered EHP.

When students have qualified academically, they must register with the HPCSA and then complete a year of community service with an environmental health department before they can be registered for independent practice.

The HPCSA is made up of 12 boards covering a range of health professionals, including doctors and physiotherapists, as well as EHPs. The professional groups elect a number of representatives to their governing board while other representatives are appointed by the government.

In the case of the EHP professional board, seven representatives are elected while six more are drawn from the South African Institute of Environmental Health, the training universities and institutions, the Department of Health and from community groups.

Registration costs ZAR500 (about £42) while defaulters failing to register incur a penalty of 10 times the registration fee, plus the outstanding fees - not something the CIEH should be encouraged to adopt.

Once qualified and registered, EHPs deal with a full spectrum of issues including housing, environmental protection, drinking water quality and food control. The city also operates its own food and milk laboratory under-taking a broad range of analyses in support of the work done by the EHPs.

The city boasts over 11,000 licensed food businesses, including 460 factories, many of which supply export markets. Coupled with this are a large number of informal traders who mostly operate around the public transport terminals and taxi ranks supplying food to commuting workers.

Sampling surveys aimed at these traders have yielded surprisingly good results, which may be attributed to the fact that many simply deal in a single product and carry a fixed amount of stock each day. Once this is sold, they simply close up and head home, to return the next day. Problems, however, have been identified with personal hygiene and these have been addressed through the provision of training to the traders.

At the other end of the scale, many of the restaurant chains and factories have embraced Haccp, the requirements of which are contained within national legislation, although industry sectors must apply to the minister of health to have the legislation made applicable to their sector.

To help ensure Haccp is implemented training is provided through a "Haccp academy" - an initiative delivered through the local college of technology, which will see some 500 people receive training in 2005.

Haccp has also featured in a number of successful seminars run by the Food Control Committee of the Western Cape, which are targeted at both food businesses and EHPs.

Beyond food control, Cape Town's EHPs are responsible for tobacco control in places they normally visit for other purposes, for example restaurants and bars. The legislation, introduced in 2001, prohibits smoking beyond designated areas. It allows a maximum of 25 per cent of an establishment's floor space to be given over to smoking, and for the smoking area to be physically separated and well signed.

The work of EHPs also extends into the informal settlements and a visit out to the Athlone district reveals the practicality of the problems faced by EHPs. Typically settlements may have populations of between 2,000-3,000, although some are much larger.

The objective is the "upliftment of poverty" and much of the work undertaken is to address basic problems of hygiene and sanitation, for example the provision of toilet facilities and clean water supplies as well as removing refuse and controlling pests.

EHPs also engage in the education of residents in the settlements in the use of communal facilities, as many of them, having moved from rural areas, will be unused to living in close proximity to others and having to share facilities and living space.

The district office itself forms part of a health centre, which is a positive hive of activity. Within the complex, various clinics are being run covering dentistry, re-hydration, HIV, TB and sexual health.

The centre also has a chill out room for a project called "loveLife" which aims to promote healthy living and positive sexuality for young South Africans. The chill out room allows adolescents to come in and talk to other adolescents about their sexual health and receive information and advice on such issues as HIV - a major public health issue in South Africa.

At the end of a long hot day with Cape Town's environmental health department, it is apparent that a single day spent in their company will only ever be a superficial review of the work and the city. On the surface much of what goes on would be familiar to many EHPs, but it is quite apparent that the city's uniqueness is reflected in the work of its EHPs making environmental health there a singular experience

David Lyons MCIEH is a contracts manager with the Food Safety Authority of Ireland. Tel: 00 357 1 8171320, e-mail: dlyons@fsai.ie

Further information