LOS TRASLADOS DEL PACIENTE

The eThekwini metropolitan municipality (with Durban as the largest city24) in the Kwa- Zulu Natal Province was chosen as the site of the empirical research amongst the eight25 metropolitan municipalities in South Africa (Figure 2.1). Permission to use the maps is attached as Annexure 11. Environmental health services in South Africa fall under health services which, according to Section 32 of the National Health Act, no. 61 of 2003 (Republic of South Africa,

23 _{Qualitative studies by nature derive findings via naturally unfold processes dominated by use of interview} methods contrary to statistical methods used in quantitative studies (Golafshani, 2003, pp.597-606).

24 _{This confirmed by Yes Media. 2017. Provincial Government of South Africa [Online]. Yes Media. Available:} https://provincialgovernment.co.za/ [Accessed 25 October 2017.

25 _{Whilst South Africa has Nine Provinces, there are eight metropolitan municipalities such as: Buffalo City} and Nelson Mandela Bay Metropolitan Municipalities (both in the Eastern Cape Province); City of Cape Town (in the Western Cape Province); [City of Johannesburg, City of Tswane and Ekurhuleni Metropolitan Municipalities (all three in the Gauteng Province)]; eThekwini Metropolitan (in the KwaZulu Natal Province); Mangaung Metropolitan Municipality (in the Free State Province). Ibid.

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2004) and are the responsibility of metropolitan and district municipalities26(South African Local Government Association (SALGA), 2011). Of the eight, eThekwini metropolitan municipality was the most convenient in terms of location, and thus formed the site for my study.

Figure 2.1: Map showing the location of Kwa-Zulu Natal Province in the South African map where eThekwini metropolitan municipality is located. Source: Map adapted and used

with permission from Yes Media [Online]. Available https://provincialgovernment.co.za/ - The Local Government Handbook.

26 _{The South African Local Government Association (SALGA) defines municipalities based on the provisions} of the Constitution and the Local Government Systems Act, no. 32 of 2000 as organs of state that consist of the political structures and administration of the municipality and the community within the municipal area. These are categorised into three types: A metropolitan municipality has exclusive authority to make rules over its area of jurisdiction; a local municipality shares authority with district municipality in whose area it falls and a district municipality has authority to administer and makes rules in areas which includes more than one local municipality. (SALGA. 2011).

eThekwini metropolitan municipality

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eThekwini metropolitan municipality is a “Category A municipality” in terms of Section 155(1)(a) of the Constitution of the Republic of South Africa, and performs all functions of the local government for a city that employs EHPs and offers environmental health services (Republic of South Africa, 1996b).This site provided a good mix of environmental health practitioners in terms of gender, age distribution and cultural groupings.

eThekwini metropolitan municipality is also the only metropolitan municipality amongst the 10 Kwa-Zulu Natal district municipalities (Figure 2.2). According to the 2011 census (Statistics South Africa, 2012, p.95), it has a total population of 3 442 361 distributed across an area of 2 297km2 with 956 713 households (Statistics South Africa, 2014). This municipality population mix has a diverse culture that I presumed to be a good source for determining challenges to service delivery. eThekwini metropolitan municipality is predominantly Zulu speaking city with a racial makeup of 73,8% Black Africans, 16,7% Indians, 6,6% Whites and 2,5% Coloured persons. This municipality has an average household income distribution of R112 830 which is 73.6% higher than the R83 050 of the Kwa-Zulu Province (Statistics South Africa, 2012, p.42). In terms of rankings in service delivery related categories with the other seven South African metropolitan municipalities per (Statistics South Africa, 2014), the eThekwini metropolitan municipality ranking is depicted in Table 2.2:

Table 2.2: Comparison of eThekwini metropolitan municipality performance status in relation to other South African metropolitan municipalities

Category Rank Size Leading City Ranking

Population size 3 3 442 361 City of Johannesburg 4 434 827

Number of households 4 956 713 City of Johannesburg 1 434 856

Weekly refuse removal 4 86,1% of population City of Johannesburg 95,3%

Flush toilet connected to sewerage

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Figure 2.2: eThekwini Metropolitan in relation to Kwa-Zulu Natal District Municipalities.

Source: Map adapted and used with permission from

https://municipalities.co.za/provinces/view/4/kwazulu-natal - The Local Government Handbook: South Africa.

The eThekwini municipality attained its metropolitan status in 2000 resulting in the full merger of the formally independent small municipal entities into the metro. New boundaries combined township, semi-rural, urban and industrial environments. This restructuring made eThekwini a good case study area to test the effectiveness of environmental health practice and challenges faced by environmental health practitioners, being a mix of both a rural and urban households. The area distribution of health facilities (eThekwini Municipality, n.d., eThekwini Municipality, 2011) is shown in Figure 2.3.

New boundaries are broken down into 3 main areas, the West, North and South districts units, where the environmental health offices are located as shown in Figure 2.3. These district health units are sub-divided into 18 sub-districts offices denoted by letters S1-S8 in the south, N1-N6 in the north and W1-W4 in the west. The southern and western areas are predominantly

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rural compared to the more urban and industrial north district. I considered these features when sampling the study population so as to ensure balance between the three formerly independent entities which provided a rich and diverse environment with different socio-economic conditions. Such history is important in determining the provision of environmental health services and understanding the nature of challenges faced by EHPS, the nature of public constraints and how EHPs respond to them.

To summarise, the eThekwini metropolitan municipality provided the following:

 A suitable ground to evaluate environmental health services covering city centre, township and rural setting conditions.

 Enabled the evaluation of environmental health practice in a diverse cultural environment that mirrors the South African society, thus affording a good environment for obtaining diverse views.

 As one of the leading metropolitan municipality in South Africa, environmental health findings in respect of eThekwini metropolitan municipality, would seem to reflect the picture of South African practice.