WESTERN CAPE: ANNUAL REPORT ENVIRONMENTAL HEALTH SERVICES
2005
DC 1 West Coast
District Municipality
DC 2 Cape Winelands
District Municipality
DC 5 Central
Karoo District
Municipality
Unicity of
Cape Town
Metro
DC 4 Eden District
Municipality
DC 3 Overberg
District Municipality
2
INDEX
Page
1
Introduction
3
2
EHP/Population Ratio
3
3
Community Projects
4
4
Drinking Water
4
5
Sanitation
5.1
Sewage Disposal
5.2
Refuse Removal
5.3
Operation of Transfer Stations
5.4
Health Care Waste Disposal
6
6
7
9
9
6
Food Control
6.1
Certificates of Acceptability
6.2
Dairy Farms
6.3
Food Sampling
6.4
Food Poisoning
10
10
11
12
13
7
Poisoning by Agricultural Remedies
14
8
Complaints
15
9
Conclusion
17
-------------------------------------------
3
Western Cape Annual Report: 2005
Environmental Health Services
1
INTRODUCTION
This report reflects the state of Municipal Health Services (Environmental Health
Services) for 2005. The Metro and all District Municipalities (Category A and C) have at
this stage fully accepted their responsibility in terms of The National Health Act, 2003
(Act 61 of 2003) regarding the rendering of Municipal Health Services. However some
restructuring might still have a slight influence on the quality of the service. It seems as if
this process will be completed during 2006.
2
EHP/POPULATION RATIO
Although the National norm of 1:15 000 per population is met in 4 of the 5 District
Municipalities, Overberg District Municipalities has already addressed this matter and
should also reach the National norm in 2006. However the situation in City of Cape
Town (Metro) remains problematic with the ratio rising from 1: 27,399 in 2003 to
1:33,270 for the reporting period. (See Graph 1) The unsatisfactory situation can
possibly be contributed to the fact that a staff reduction due to voluntary severance
agreements occurred on the one hand and the abnormal influx of people to the Metro
region on the other hand.
Graph 1
EHP POPULATION RATIO 05
PROVINCE
21 659
METRO
33 270
WEST COAST DM
10 872
CAPE WINELANDS DM
11 657
CENTR. KAROO DM
12 667
EDEN DM
14 081
OVERBERG DM
18 447
4
3
COMMUNITY PROJECTS:
During 2005, EHPs in the Western Cape facilitated or were involved in a total of 282
community-based projects (Graph 2). This reflects a significant increase from the 123
projects in 2004. This is an indication that Category A and C Municipalities committed
themselves to the rendering of all the aspects of Municipal Health Services with less
involvement in unrelated functions previously performed by many EHPs working for local
municipalities. These projects range from Clean and Green, Adopt a River and several
Environmental Health Promotion/Education Projects.
Graph 2
NO OF COMUNITY PROJECTS: 2005
282
128
121
16
15
2
METRO
4
CAPE
OVERBERG DM
WINELANDS DM
EDEN DM
CENTR. KAROO
DM
0
WEST COAST
DM
PROVINCE
DRINKING WATER
A total of 6032 bacteriological and 2458 chemical samples of drinking water were
analyzed during 2005.The compliance rate of these samples is reflected in Graph 3.The
bacteriological compliance rate of 86,1% is a steady improvement from 81,3% in 2003
and 84,1% in 2004. The chemical compliance rate is unchanged. As was the case in the
previous year, the bacteriological quality of drinking water in some of the rural areas is a
matter of concern and should be addressed. The reason for the above could be two-fold
namely poor maintenance of infrastructure and also the fact that people living on
agricultural land in many instances does not have access to safe drinking water
reticulation as is the case in town areas.
5
Graph 3
WATER SAMPLE COMPLIANCE: 2005
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
Bacteriological
93.74%
78.22%
66.06%
83.22%
39.66%
75.11%
86.11%
Chemical
90.45%
94.47%
71.43%
83.82%
18.18%
77.78%
90.52%
The percentage of households with access to safe drinking water is reflected in Graph
4. The Cape Winelands District Municipality again could not provide any information in
this regard. The Provincial average is influenced by this lack of information and the
District Municipality should make a serious attempt to establish a dependable database.
The percentage of people with access to water but not on premises in the Metro rose
from 7,2% in 2003 to 17,4% in 2005. It is therefore assumed that this increase of people
utilizing communal taps could be attributed to the extension of informal settlements due
to the influx of people as previously mentioned.
Graph 4
% HOUSEHOLDS WITH ACCESS TO SAFE WATER: 2005
100%
80%
60%
40%
20%
0%
METRO
CAPE
OVERBERG
EDEN DM
WINELAND
DM
S DM
CENTR.
WEST
PROVINCE
KAROO DM COAST DM
No access
0.02%
0.00%
3.93%
2.09%
0.00%
2.70%
0.68%
Access but not on premises
17.37%
0.00%
9.54%
9.90%
0.37%
4.72%
14.93%
Water on premises
82.62%
0.00%
86.53%
88.02%
99.63%
92.58%
84.40%
6
5
SANITATION
5.1
Sewage Disposal
Graph 5 reflects the percentage of households with access to different types of latrine
facilities. The Provincial average for households with access to flush sanitation has
improved steadily form 88,9% in 2003 to 90,5% in 2005. However the 3 categories
which represent unacceptable latrine facilities namely, pit latrines (unventilated), buckets
and none still account for more than 6% of households in the Province. The phasing out
of the afore-mentioned problem areas should be a matter of priority. It has been proven
worldwide that poor sanitation can contribute significantly to the disease burden of a
country. The phasing out of the afore-mentioned problem areas should be high on the
agenda of Local Authorities when budgetary planning is done.
Graph 5
LATRINE FACILITIES: 2005
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
CAPE
CENTR.
OVERBE
METRO WINELAN
EDEN DM KAROO
RG DM
DS DM
DM
WEST
PROVINC
COAST
E
DM
None
1.88%
2.74%
0.07%
2.47%
0.76%
10.13%
Buckets
1.78%
0.16%
0.75%
1.08%
1.09%
0.96%
2.50%
1.44%
Pit
0.00%
4.40%
6.23%
10.40%
1.43%
5.69%
2.31%
VIP
2.03%
4.86%
0.04%
3.14%
6.83%
0.42%
2.26%
Chemical
1.51%
0.03%
0.00%
0.01%
0.00%
0.09%
1.02%
Flush
92.79%
87.81%
92.91%
82.90%
89.89%
82.71%
90.48%
In total there is 134 Municipal and 48 private development sewage plants in the Western
Cape. 1578 Municipal and 24 private sewage effluent samples were analyzed during
2005 and the compliance rate thereof is reflected in Graph 6. The poor quality final
sewage effluent of which a significant volume is disposed of into water sources such as
rivers remains a major problem. It seems as if the sewage purification plants are being
operated above their design capacity, which in turn leads to inadequately treated
sewage effluent being produced. From an Environmental Health point of view no new
developments should be allowed, unless it can be proven beyond doubt that the
particular sewage plant can safely accommodate the additional load from such
7
developments. The afore-mentioned situation has serious health implications and should
receive immediate attention from all responsible authorities.
Graph 6
PERCENTAGE EFFLUENT SAMPLES COMPLYING: 2005
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
% Municipal samples complying
% Private samples complying
5.2
METRO
CAPE WINELANDS
DM
OVERBERG DM
EDEN DM
CENTR. KAROO
DM
WEST COAST DM
PROVINCE
61.72%
65.96%
48.68%
73.33%
33.33%
22.50%
60.33%
0.00%
46.15%
66.67%
80.00%
0.00%
0.00%
58.33%
Refuse Removal
Graph 7 illustrates the percentage of households in the Western Cape with access to
effective refuse removal services. The Provincial average of 94,4% can be regarded as
satisfactory. The remaining almost 6% which might represent certain informal and also
rural areas receiving poor refuse removal services could once again represent a health
risk. The number of landfill sites decreased due to the closure of smaller unsafe sites
and the development of various regional refuse disposal sites. Graph 8 reflects the
percentage of waste sites with effective sanitary landfill procedures. From this graph can
be deduced that the larger regional disposal sites are being operated considerably more
efficient than smaller individual sites.
8
Graph 7
% HOUSEHOLDS WITH EFFECTIVE REFUSE REMOVAL SERVICE: 2005
100.00%
95.00%
90.00%
85.00%
80.00%
75.00%
Series1
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
97.58%
96.26%
82.90%
84.62%
84.79%
86.95%
94.38%
Graph 8
% WASTE SITES WITH SANTARY LANDFILL" 2005
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
M ETRO
CAPE
OVERBE
WINELA
RG DM
NDS DM
EDEN
DM
CENTR.
KAROO
DM
WEST
COAST
DM
PROVIN
CE
0.00%
55.56%
29.41%
33.33%
Communal
100.00%
0.00%
0.00%
Small
100.00%
100.00%
53.85%
0.00%
0.00%
14.29%
32.50%
0.00%
100.00%
20.00%
100.00%
0.00%
0.00%
50.00%
Large
100.00%
100.00%
0.00%
100.00%
0.00%
0.00%
100.00%
H-h
100.00%
0.00%
0.00%
0.00%
0.00%
0.00%
100.00%
H-H
100.00%
0.00%
0.00%
100.00%
0.00%
0.00%
100.00%
M edium
9
5.3
Operation of Transfer Stations
The number of transfer stations in the Western Cape as well as the number operated
nuisance free is reflected in Graph 9. The fact that 92% of these transfer stations are
being operated nuisance free underscores the previous point as these stations are being
utilized in conjunction with regional disposal sites.
Graph 9
OPERATION OF TRANSFER STATIONS: 2005
25
20
15
10
5
0
5.4
METRO
CAPE WINELANDS
DM
OVERBERG DM
EDEN DM
CENTR. KAROO DM
WEST COAST DM
PROVINCE
No of transfer stations used
7
5
4
4
0
5
25
No operated nuicance free
7
5
4
4
3
23
Health Care Waste Disposal
Sustained attention to safe health care waste disposal by Municipal Health Sections has
contributed to the fact that 95% of all generators dispose of their health care waste
safely (Graph 10). The availability of approved contractors for the disposal of health
care waste in the rural areas might become problematic in future due to the fact that
relative low waste quantities and distances negatively impact on their profits. The
relevant role players namely Department of Environmental Affairs, Local Authorities,
Department of Health etc. should collectively investigate and address this issue where
necessary.
10
Graph 10
HEALTH CARE WASTE DISPOSAL: 2005
3500
3000
2500
2000
1500
1000
500
0
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST
COAST DM
PROVINCE
No of HCW Generators
2003
266
151
438
36
161
3055
No of generators with safe disposal
2003
266
77
374
36
147
2903
2
0
2
0
0
0
4
No of reg. Treatment sites
6
FOOD CONTROL
6.1
Certificates of Acceptability (C.O.A’s)
The percentage of food premises with C.O.A’s has increased from 77,3% for formal food
premises and 51,6% for informal food premises in 2003 to 90% and 73,8% respectively
(Graph 11). This improvement represents a significant input by EHPs, which will
ultimately contribute to safer foodstuffs in the Province. However there are still specific
areas of concern such as proper cleaning of food processing equipment as recently
highlighted in the media. It is recommended that municipalities develop guidelines
specifically aimed at addressing these problem areas.
11
Graph 11
% FOOD PREMISES WITH COAs: 2005
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
6.2
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
% Formal Food Premises with COA's
97.60%
67.21%
84.59%
98.23%
85.12%
61.92%
89.91%
% Informal Food Premises with COA's
87.66%
36.56%
20.48%
90.91%
85.23%
21.04%
73.76%
Diary Farms
Graph 12 reflects the diary farms with C.O.A’s. Contaminated milk can have serious
health implications, due to the fact that it is a very good growth medium for disease
causing organisms. The high percentage of dairy farms complying is commendable. The
Provincial Environmental Health Component has initiated the compilation of a Western
Cape database for food premises and milking sheds with valid C.O.A’s. This database
can be utilized in various ways and will also be made available to all role players.
Graph 12
% DAIRY FARMS WITH COAs: 2005
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
Series1
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
65.38%
98.26%
93.14%
92.48%
100.00%
82.61%
91.53%
12
6.3
Food Sampling
The total number of bacteriological and chemical food samples analyzed during 2005 is
illustrated in Graph 13. The compliance rate in terms of the Foodstuffs, Cosmetics and
Disinfectants Act, 1972 (Act 54 of 1972) is reflected in Graph 14. The compliance rate
for the Province is consistent with the rate for the last 2 years namely ± 70% and 80%
for bacteriological and chemical analysis respectively. However the compliance rate,
bacteriologically and chemically in some of the rural regions, especially Cape Winelands
and West Coast District Municipalities is matter for concern. Planning at the Western
Cape Food Control meeting as well as the various Environmental Health Forums should
centre around rectifying the low compliance rate of foodstuffs available to the public.
Bacteriologically, dairy products were once again the main reason for non-compliance
while bottled water and spices also contributed to this figure to a lesser extent.
Preservatives, Colourants, Flavourants, Aflatoxin and also incorrect labels were the
main reasons for chemical non-compliance. All Category A +C Municipalities in the
Province has now been re-authorized in terms of the Foodstuffs Act, 1972. In
comparison with the other provinces food control in the Western Cape remains generally
satisfactory.
Graph 13
NO OF FOOD SAMPLES ANALYSED 2005
3500
3000
2500
2000
1500
1000
500
0
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
Bacteriological
787
516
130
393
24
192
2042
Chemical
2232
466
69
221
75
213
3276
13
Graph 14
% FOOD SAMPLE COMPLIANCE 2005
100.00%
90.00%
80.00%
70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
6.4
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
Bacteriological
83.86%
54.26%
64.62%
77.61%
83.33%
59.38%
71.65%
Chemical
92.07%
51.93%
60.87%
58.82%
85.33%
44.60%
80.22%
Food poisoning
Graph 15 illustrates the number of food poisoning outbreaks for 2005. The fact that only
5 outbreaks were reported is a clear indication of under reporting.
It is therefore recommended that:
•
•
Medical personal be sensitized to the reporting of cases of food poisoning.
The present legislation regarding notifiable medical conditions should be revised
due to the fact that an outbreak of food poisoning is currently defined as being 4
or more cases.
14
Graph 15
FOOD POISONINGS 2005
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Food Poisonings
7
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
0
1
0
3
0
1
5
POISONING BY AGRICULTURAL REMEDIES
A total of 44 poisoning cases, due to agricultural remedies, were reported during 2005
with the majority emanating from the Metro, Overberg and Eden District Municipalities
(Graph 16). Indications are that this is another notifiable condition that is substantially
under reported, especially in some of the Districts. It also seems that not all reported
poisoning cases are being brought to the attention of the relevant EHPs for investigation
as the number of cases reflected by Provincial Information Management does not
correspond with the number reported by EHPs.
Pesticide poisonings place an additional load on the already over-burdened public
health facilities and therefore all role players, should be made aware of their various
responsibilities, be it reporting, investigation of poisonings or the safe handling of these
substances.
In terms of The National Health Act, 2003 (Act 61 of 2003) the Provincial Environmental
Health Section is responsible for the control of the trade in Hazardous Substances. A
total number of 174 Hazardous Substances licenses were issued during 2005.
Furthermore this section has also compiled a database of all premises licensed to trade
in Hazardous Substances. This dataset will be updated on a regular basis and be
available to other role players.
15
Graph 16
PESTICIDE POISONINGS 2005
45
40
35
30
25
20
15
10
5
0
Pesticide Poisonings
8
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
15
5
12
10
1
1
44
COMPLAINTS
There has been a marked decline in the number of environmental health related
complaints received from 62,254 in 2003, 48,601 in 2004 to 32,640 in 2005. (Graph 17)
Pest control related complaints were once again the main contributor to the total number
of complaints received, with housing and vacant land second and third highest
respectively. (Graph 18) Tobacco related complaints were the only category, which
showed an increase (524 in 2003 to 583 in 2005). A possible reason for this increase
might be the fact that non-smokers are becoming increasingly aware of their rights in
terms of the Tobacco Products Control Act.
16
Graph 17
TOTAL COMPLAINTS: 2005
35000
30000
25000
20000
15000
10000
5000
0
Series1
METRO
CAPE
WINELANDS
DM
OVERBERG
DM
EDEN DM
CENTR.
KAROO DM
WEST COAST
DM
PROVINCE
23204
2539
1064
2295
65
3473
32640
Graph 18
2005 COMPLAINTS WESTERN CAPE
Vacant land
4148
Food
1848
Water 2755
State premises
567
Soil 3173
Animal
2622
Air 1593
Noise 927
Housing
4950
Tobacco related
583
Pest control
9474
17
9
CONCLUSION
At this stage it appears as if the restructuring of Environmental Health, due to the
placement of Municipal Health Services with Category A and C Municipalities has
brought about a more efficient service delivery to communities. This should result in a
safer environment that could help to lessen the load on public curative services. The
National Department of Health is currently in the process of developing a national
indicator set for environmental health and the Western Cape provided a significant input
in this regard. However it seems as if this process will not be finalized soon, therefore
the present indicators for the Western Cape will remain in use until the National
environmental health information system is implemented.
Local Authority Environmental Health Sections are once again thanked for their effort in
enabling this Department to produce this report. The annual report plays an invaluable
role in this Department’s function of monitoring Municipal Health Services in terms of
The National Health Act, 2003 (Act 61 of 2003) and it is trusted that Local Authorities will
also find it valuable in evaluating their services.
.................................................................