Environmental health practice in a South African metropolitan municipality: professional, ethical and legal responsibilities and challenges

Poswa, Tobias Thobile
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The purpose of this study on environmental health practices in South Africa was two-fold. It first attempted to articulate what the “ideal” ought to be regarding the legal, professional and ethical practice of Environmental Health Practitioners (EHPs) in South Africa. Thereafter, empirical research was undertaken comprising a case study of a group of EHPs practising in a metropolitan municipality to assess the “reality”, on the ground, in terms of the level of awareness and understanding among EHPs about their legal, professional and ethical responsibilities and related challenges. The ultimate aim was to perform a normative analysis in which the ideal was compared to the reality on the ground, in order to identify shortcomings and propose possible interventions or other actions to rectify the shortcomings. Another way to express this aim is to say that the “ideal” represents how things ought to be, and the “reality” represents how they actually are. The study had four objectives: First, to articulate the ideal in terms of the fulfilment of the professional, ethical and legal responsibilities of environmental health practitioners in South Africa. Second, to explore the awareness and understanding among environmental health practitioners regarding their professional, ethical and legal responsibilities in practice, using eThekwini Metropolitan municipality as a case study; Third, to examine challenges facing EHPs in fulfilling their professional responsibilities as found in the case study; and Fourth, to normatively compare the ideal versus the reality on the ground to identify shortcomings. A qualitative research design was employed using two methods of data collection. A normative approach was adopted involving a literature review and analysis of relevant legislation, policies and procedures to determine the current designation of legal, professional and ethical responsibilities of EHPs in South Africa. Thereafter, empirical data were collected using one-on-one interviews with a total of 35 EHPs employed in the metropolitan municipality that served as the site of the case study. This approach helped in gathering EHPs’ views on their understanding of the legal, professional and ethical aspects of environmental health practice and how they enacted these responsibilities “on the ground”. Findings from the study revealed that a combination of South African laws make provisions for the scope of the work of EHPs. However, whilst the laws promote enforcement and compliance, the qualitative data clearly show that many EHPs feel that they have not been adequately prepared and trained to handle complex situations, where legal measures fell short. EHPs interviewed in this study experienced difficulties in making decisions on non-technical issues, for example, in the investigation of environmental health complaints. They thus relied on their own discretion which often caused conflicts with their superiors. Professionalism of EHPs in South Africa is governed by the Health Professions Council of South Africa (HPCSA), through the professional Board of Environmental Health Practitioners. EHPs have been found to be aware of their professional responsibilities but are concerned about the lack of active engagement with their professional board. Moreover, the EHPs interviewed held general ideas about ethics but lacked specific environmental health guidelines at their workplaces as well as ethical support to assist them in handling ethical issues. The study noted the absence of a code of ethics for an environmental health ethics in South Africa and lack of ethics support programmes and ethics training for EHPs in the workplaces. Among the recommendations emanating from the study, was that support was needed to address challenges EHPs faced in enforcing laws and adopting strategies to sensitise them about people's rights. It is also important to help people to understand the reasons for compliance and the impact of non-compliance, coupled with advancing justice through the review of the laws. A better communication and engagement strategy between the professional board and EHPs needs to be developed. Moreover, an ethics infrastructure to promote a culture of ethics within the environmental health workplaces should be established. This programme should ideally be driven by an ethics structure with appointed lead agents.
A thesis submitted to the Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Doctor of Philosophy, Johannesburg, 2017
Environmental Health Practices