Involvement at the Local and Regional Levels

Box 2.2: Cooperation of ministries in Bulgaria

In Bulgaria, work on environmental health is changing greatly. Under the previous cen-trally controlled administration, the ministries of health and of the environment viewed their roles as separate and distinct. The Ministry of the Environment concentrated on en-vironmental damage, without necessarily referring to health, while the Ministry of Health concentrated on primary health care and various aspects of public health. Obviously, in dealing with such closely related fields, the work of the two ministries sometimes over-lapped. It was therefore wasteful of resources and sometimes counterproductive.

In recognition of the pitfalls of such a system, the Ministry of the Environment has es-tablished a new institutional framework to deal more effectively with policy formulation and environmental health service delivery. First, the Ministry has created a new policy forum: an Interministerial Council with representatives from all the relevant ministries in the Bulgarian Government. This intersectoral Council will advise on the best way forward on environmental health issues, while keeping in mind the other social and economic needs and policies of the country. Such an approach allows a realistic view of important problems by examining issues as a whole rather than in isolation, and permitting strategic preparatory planning instead of ad hoc responses to crises. To support the Council, and to further develop an intersectoral approach to environmental health services, the Minis-try of the Environment has established a unit dealing with ecological risk assessment. It is to be headed by a medical doctor or a toxicologist, and will complement the unit in the Ministry of Health that deals with health risk assessment.

With the Ministry of the Environment, the Ministry of Health has carried out environ-mental monitoring since 1975. Both ministries have agreed to exchange information on their regulatory activities related to environmental health. At present, most environmental health problems are addressed jointly by the two ministries.

Involvement at the Local and Regional Levels 67

in the local administration, and mistrust and resentment in the population that the admin-istration tries to serve.

In the CCEE and NIS the central adminis-tration still controls many local services, and vertical or “top down” controls are applied to regional offices of the central ministries (Fig. 2.1). Although these units are geared to deliver services at the local level, they cannot easily respond to particular local needs, and they may not necessarily offer the service that the local population wants or requires.

In this respect, municipalities can con-tribute significantly to the appropriate provi-sion of environmental health services. Mu-nicipalities, controlled democratically by loc-ally elected representatives, can give the local population a sense of control and ownership of the services provided. A

cen-trally formulated policy is obviously needed as a framework for the efforts of municipal-ities. This can ensure a consistency of ap-proach, with local commitment to national policies. Within the framework, however, municipalities should be permitted to adapt and develop their priorities, and to obtain the means of financing their activities.

Further, the provision of environmental health services by a municipality allows an intersectoral approach, linking environ-mental protection with public health func-tions. It also means that considerations of environmental health can be built into local decision-making and fiscal processes. Ser-vices provided at the regional level by satel-lite offices of central ministries do not al-ways offer the same opportunities for inter-sectoral collaboration (Box 2.3).

Fig. 2.1: Environmental health services in Bulgaria

In addition, a two- or three-tier system can provide environmental health services at dif-ferent levels. Such systems are commonly found in western Europe, where central gov-ernment authorities and services take re-sponsibility for matters of strategic and national importance, while municipalities provide services at the local level.

In summary, the powers and responsibil-ities of services at the local level are quite un-clear and continuously developing. Highly centralized and highly decentralized struc-tures work in parallel and sometimes in op-position. The central authorities alone set standards and regulations, but they are con-tinually hindered in this work by political

decisions to decentralize. A compromise – local decision-making within a strong national framework – is required for the ef-fective delivery of services.

Whatever the structure adopted to provide environmental health services at the local level, the services must be adequately fi-nanced. The local unit’s ability to pay will de-termine its ability to carry out any planned programmes. Centrally controlled units are normally centrally funded, with little ability to develop new ways of obtaining resources.

Municipalities can usually raise tax revenue from the local population and businesses to supplement central funding, but municipal-ities throughout the Region complain that Box 2.3: Regional and local administration in Estonia

In Estonia, the Health Protection Inspection Department in the Ministry of Health oper-ates 21 regional offices of the Health Protection Service in the 15 administrative districts, in 4 major towns and at border control points. The highly centralized organization and de-tailed regulations of the Service mean that local influence on the setting of priorities is very limited.

The main tasks of the Service are inspection, control, monitoring and the collection of data. It is involved in local planning and environmental impact assessment as far as health issues are concerned. It can impose various sanctions for non-compliance with require-ments.

The local offices are not subject to control by municipalities, which has both advan-tages and disadvanadvan-tages. The current system allows these offices to be independent of local politics and financial constraints and to make unbiased, considered decisions. They cannot, however, develop environmental health services beyond the centrally controlled priorities, and they are not accepted by the local public.

In 1990, Local Nature Protection Departments were founded in 4 major towns and the 15 districts. They are responsible for setting tax rates to protect natural resources and to control pollution, for issuing permission for the use of natural resources, for determining limits in natural resource management, and for carrying out environmental impact assess-ments at the local level. The departassess-ments are subordinate in terms of organization to the local district authorities, but the Ministry of the Environment supplies coordination, gen-eral standards and policies.

The representatives of the Nature Protection Departments in neighbouring districts meet regularly. These departments and the Health Protection Service cooperate because they carry out similar or overlapping activities, but each type of unit distrusts the abilities and intentions of the other. The Health Protection Service accuses the Nature Protection Departments of being interested only in technical problems and collecting pollution taxes, not in the health problems of the local population. The Departments, considering themselves a new type of institution, accuse the Service of being unwilling to cooperate, closely bound to former modes of thought and action, and unable to use modern methods and technologies.

Intervention and Control 69

central administrations give them responsi-bilities without sufficient resources to carry out the work required.

The funds for certain responsibilities can be assigned “ringfenced”, or reserved solely for these tasks, to ensure that the required service is actually carried out. Local environ-mental health services can be financed in many other ways, from charges for inspec-tions to pollution taxes. Whatever the financ-ing system adopted, however, it is extremely important to ensure that it is geared towards improving environmental health conditions, not perpetuating the status quo.

Fig. 2.2 illustrates the cyclical system of control that remains typical of the approach to many environmental health problems in the CCEE and NIS. The system is self-per-petuating, ensuring continuous monitoring without the necessary action. The weak-nesses in this system are apparent, and now

that they are recognized efforts are being made to create more appropriate systems of control.

The main task of environmental health ser-vices is to improve environmental conditions through the application of legal require-ments. The effectiveness of these provisions varies, and a well balanced service should de-velop a range of interventions for application to particular circumstances and problems.

Many countries have developed fiscal pol-icies with punishments or rewards to encour-age commerce and industry to comply with regulations and norms. Fines, however, must be of a size that not only reflects the