As millions of South Africans head to the polling stations tomorrow to cast their votes in the local elections, the quality of municipal basic services – and how they directly impact our daily lives and health – is at the forefront of voters’ minds. The constitutional responsibilities of local government are really about the basic elements of a healthy life: uninterrupted access to fresh water, clean air, functional wastewater treatment, and reliable access to and around our communities. While healthcare policy is determined nationally, the practical foundations of public health are decided locally – in our backyards, streets, and taps. When these basics fail, vulnerable communities pay the highest price. Over the past weeks, Health-e News deployed our network of OurHealth community journalists across the country to investigate how local municipal performance directly shapes community well-being in our Elections 2026 series. The residents our journalists spoke with live alongside persistent infrastructure failures and they shared feelings of deep despondency, frustration and anger.  From townships without running water for weeks despite multi-billion rand bulk water budgets, to communities choked by toxic smoke from burning municipal waste dumpsites, our reporting reveals a stark reality: local service delivery failures threaten to make us sick.  A countrywide snapshot of municipal service failures Water insecurity remains one of the most dire municipal failures impacting daily survival. In Limpopo, villagers in Giyani are forced to spend hundreds of rands buying water or turn to contaminated river sources as two of the five municipal boreholes have not been operational since March last year. Children have been exposed to waterborne diseases as they wait for the long-delayed bulk water scheme to come online, amid corruption allegations and over R4-billion spent on it to date.  In Skoonplaas township, Musina, houses are surrounded by untreated wastewater and children playing in streets flowing with raw sewage develop skin rashes and gastrointestinal infections. Frequent water shortages and dry taps compound the crisis, forcing residents to buy or collect water from risky sources.  All three of the Polokwane municipality’s wastewater treatment plants are in a critical state with residents in Seshego reporting a double burden of a persistent stench of raw overflowing sewage outside their front doors and toxic fumes from waste burning at unmanaged municipal dumpsites. Chronic air pollution and toxic air In industrial Springs, municipal negligence has left essential air-quality monitors offline since July, when the last air quality index reading was classified as “unhealthy for sensitive groups” with community members complaining they are coughing from constant exposure to dust and emissions from nearby mine dumps. Meanwhile, in Gauteng, a year after the City of Johannesburg announced a R150-million rehabilitation project for the Kya Sands landfill, nearby residents continue to suffer from the waste fires and illegal dumping fumes that threaten respiratory health and cause chronic coughing and asthma attacks. Dangerous infrastructure and emergency access Basic municipal infrastructure can literally be a matter of life or death. In the township of Meriting, in Lenasia South, delayed electrification forces residents into informal electrical connections, exposing young children to lethal electrocution hazards – locals say nine community members have been electrocuted this year alone, including five children. In Hammanskraal in the City of Tshwane, unpaved roads and no pedestrian crossings create severe mobility hazards for blind and disabled residents navigating their neighbourhoods. And in Lakeside Estate in Midvaal, a partially blind resident sustained injuries while cooking on open fires, during a four-month long electricity outage after a transformer broke, impacting 116 households. In rural communities like Campbell in Limpopo, mobile network blackouts and severe infrastructure neglect leave residents unable to even call an ambulance during night-time health emergencies. Accountability at the ballot box Today’s vote isn’t about party politics, it comes down to the basics: our right to live in healthy, safe communities. Public health starts right outside our front doors – at the municipal tap, the local dumpsite, and the roads connecting our neighbourhoods. By voting today, we’re making our voices heard and reminding local leaders that basic service delivery is about human dignity, and that clean water, safe air, and functional infrastructure are non-negotiable foundations for our health. Follow more of our coverage by our network of community journalist who spoke to residents across the country about the health impact of municipal failures Author Brigitte Read Brigitte Read is Health-e News’ Associate Editor. She works on creating innovative journalism projects and believes effective health reporting can empower and transform communities. View all posts https://health-e.org.za/ Associate Editor/Fundraising Officer

When 85-year-old Simon Seshibe and his 67-year-old wife, Rahab cannot get their diabetes medication at their local clinic in Sebayeng village northeast of Polokwane, they face a costly search for supplies that sometimes leaves them without treatment for days. The couple rely on chronic medication to manage their diabetes and hypertension. Rahab was diagnosed with Type 2 diabetes in 2009 and Simon in 2014.  The Seshibes collect their chronic medication monthly. When there are medicine shortages at Sebayeng Clinic, they sometimes have to travel to other public health facilities without knowing whether the medicine they need will be available. “When I don’t find these drugs at the community clinic, nurses refer me to either Mankweng, Rethabile or Pietersburg [clinics],” says Rahab.  The pensioners recall severe medicine shortages specifically in February and August this year. During those two months, the elderly couple spent more than R1,000 on medication for both of them at a private pharmacy in Polokwane and around R400 on petrol for a return trip each time. Simon says he is prescribed seven different tablets and ointments, but during stockouts, the responsibility for funding the medication falls to him. “To be diabetic can be costly when drugs are not available at public healthcare facilities.” Missed doses during medicine shortages During medicine shortages, the Seshibes sometimes miss doses for a day or two while trying to find medication at other health facilities or pharmacies. During these periods, Rahab experiences severe thirst, while Simon reports fatigue and frequent urination.  Diabetes is now the leading underlying cause of death in South Africa, accounting for 6.1% of all registered deaths, according to the latest mortality figures from Statistics South Africa. The Seshibes receive old-age grants and supplement their income by renting out a tractor during the rainy season. They also rely on subsistence farming, and their daily diet consists of fruits and vegetables, grown in their backyard, with pap.  But unexpected medicine costs put pressure on their limited household finances. Rahab says they generally manage their grocery budget, but unexpected medication costs means they can’t pay for other essentials like electricity during those months. Other patients face chronic medicine shortages The Seshibes are not the only elderly patients reporting difficulties accessing chronic medication in the area. 76-year-old Mapula Dikgale from the nearby Solomondale township east of Polokwane, says she was referred to Mankweng Hospital, about 16 kilometers away, after her local clinic ran out of her chronic medication in August. She managed to obtain only some of her medication at Mankweng Hospital and was told to return several days later for the rest. “At least there I found some of my medicine but was advised to return for the rest after three to five days. I couldn’t return because I didn’t have transport money,” she says. Dikgale had to go a few weeks without some of her chronic medication until she could borrow transport money from a fellow church member to return to the hospital. Health Department acknowledges supply challenges The Limpopo Health Department acknowledges that public health facilities experience shortages of diabetes medication and other chronic medicines at times. “Medicine availability can occasionally be affected by various factors, including supply-chain disruptions, procurement challenges and market-related constraints,” says department spokesperson Neil Shikwambana. The province’s medicine supply system has faced wider challenges. A controversial 2023 tender to outsource the provincial pharmaceutical depot was followed by reported delivery failures in late 2025, placing hundreds of clinics and hospitals in Limpopo at risk of shortages of essential medicines. Medicine shortages are also affecting healthcare facilities nationally. The National Department of Health recently confirmed supply challenges affecting several essential medicines. These include metformin, used to treat Type 2 diabetes – among the medications prescribed to Simon Seshibe. Department spokesperson Foster Mohale attributed the shortages to several factors, including regulatory compliance problems among some local manufacturers. “The Department has been actively engaging with suppliers and is procuring alternative medicines from other sources to minimise the impact on patients,” Mohale said. “When these facilities are out of stock, I’m forced to buy medication from private pharmacies,” says Rahab. “They are costly, considering that we buy them with social grants.” Author Moyahabo Mabeba Moyahabo Mabeba is an all-round reporter whose journalism career spans almost three decades. He has worked for several national publications and is a former editor of The Journal newspaper. His reporting has a strong human-interest focus, particularly on the experiences of vulnerable communities. A softball fanatic, he also works in marketing and publicity in sporting circles. View all posts

Managing a chronic condition like diabetes requires clear guidance, but a lack of adequate patient education in local clinics is turning routine daily treatments into dangerous hazards. More than four million South Africans are living with diabetes – a condition characterised by high levels of sugar in the blood. It can be treated with drugs and managed through healthy eating and exercise. But if it’s not managed well, it can be life-threatening.  Diabetes is now the leading cause of natural death in South Africa, but patients do not always receive sufficient hands-on training or practical instructions on how to use their medication safely – or what to do in an emergency. As community journalist Tholakele Mbonani discovered, the consequences can be frightening for patients and their families. For many people living with diabetes, insulin is a lifeline. But for my father, Sipho Mhlanga, a 63-year-old resident of Duduza on Gauteng’s East Rand, managing his insulin is the most frightening part of living with the disease. He has never been given training or ongoing education on how to administer his medication correctly.  “When we go to the clinic, they give us medication and tell us how much to inject and how many times a day. But nobody really sits down with us to teach us how to inject ourselves properly. They just give us the medication and expect us to know what to do,” he says. After a seizure that led to hospitalisation in 2023, a doctor asked how he measured and administered his insulin. My father explained that whenever he had a seizure or felt dizzy, he would inject himself with insulin. The doctor explained that he was overdosing on insulin and advised him to stick to his prescribed schedule of injecting in the mornings and at night. “I thought I was doing the right thing because I was taking my insulin the way I understood I was supposed to. It was only when I ended up in hospital that I realised I did not understand everything about the dosage and how dangerous it could be.” My father believed he was helping himself when he felt unwell, but he did not understand the risks of taking additional insulin. Like many other diabetes patients we know, he felt inadequately equipped to manage his condition safely once he left the clinic. Living with a lifelong condition He was diagnosed with Type 2 diabetes in 2020, and life has not been the same since. What started as a condition requiring medication and lifestyle changes has become a daily struggle, not only for him but for our entire family.  There are things we often take for granted, like taking a bath, walking around the house or going about our day without worrying about what could go wrong. For my father, these are no longer things he can do without caution. Last year, he had a seizure while bathing. Since then, he has stopped using the bathtub and washes himself using a basin. It might seem like a small adjustment, but it shows how much independence he has lost. He injects insulin twice a day, in the morning and at night. His blood sugar levels sometimes rise too high or drop dangerously low. We have watched him experience seizures, become disoriented and struggle to communicate. At times, his body stiffens, leaving him seemingly unaware of what is happening around him. My dad used to get seizures a few times a year. Lately he has had one almost once a month. When he has a seizure, I call an ambulance and he is taken to the hospital, where they monitor him for 24 hours. Sometimes they monitor him for longer. After that he is discharged and sent home. We are never advised what to do when seizures occur or how to recognise the warning signs. We are also never advised what to do while waiting for the ambulance.  My father also lives with hypertension. His seizures started before doctors discovered a brain tumour in March this year, but the cause of the seizures has not yet been established. Watching someone you love go through that is frightening. You never know how serious the next episode will be. What should happen at the clinic? His experience raised a question for us: how many patients are expected to manage insulin at home without fully understanding the risks? Pamela Jwili, a registered nurse working at a nurse-led diabetes education and wellness practice in Boksburg, says patients need practical training, not simply instructions about how many units of insulin to inject. “Prescribing insulin is only one part of treatment. Preparing the person to use it safely at home is equally important,” she says. Jwili says healthcare workers should demonstrate the injection process and ask patients to show it back to them – a technique called the Teach-Back Method. Mistakes should not automatically be blamed on patients, she adds, because unclear instructions and inadequate follow-up can contribute to errors. Community lifelines When my father has a seizure, there are moments when I genuinely do not know what to do. During these frightening episodes, I turn to his friends and our neighbours, particularly Refiloe Mabuza, his longtime friend and our neighbour, who has become an important part of our support system. During one such incident in 2023, Refiloe helped me position him safely while we called an ambulance. She also shared what she knew about his medication and daily routine, things I was still learning to understand. His other friends, some of whom also live with diabetes, often step in to help too. However, despite being someone we rely on during emergencies, Refiloe admits that she, too, has never formally learnt how to administer medication or respond to diabetes-related emergencies. “I never received any formal training on how to administer diabetes medication. Everything I know, I learned from my mother, who later died from diabetes. Even at the clinic, nobody showed me how to administer the medication properly. They only told

A 60-year-old woman from Meriting informal settlement in Lenasia South fears losing her remaining eyesight after developing eye complications associated with diabetes. Ayanda Ndlovu*, who has Type 2 diabetes, lost sight in her right eye after her vision deteriorated while waiting for specialist care between 2022 and 2024. Her vision in her left eye continues to worsen while she waits for cataract surgery at St John’s Eye Hospital at Chris Hani Baragwanath Academic Hospital. “It has been two years since I have waited for surgery to save my left eye. The right eye has lost vision completely. I wish the processes from the hospital can be quicker before I lose my remaining sight,” she says. Ndlovu* was diagnosed with bilateral diabetic retinopathy in 2022, a complication of diabetes  that weakens the blood vessels in the retina and can lead to vision loss in both eyes. In 2024, doctors also discovered a cataract affecting the vision in her left eye, a condition more common in people with diabetes.  High blood sugar during pregnancy Ndlovu was first diagnosed with high blood sugar in 2002 at Mayibuye Clinic in Tembisa while she was pregnant.  “I found out that I was diabetic in 2002 during my antenatal check-ups. Nurses who were treating me at the time said it might be because of pregnancy and continued to monitor the diabetes as I attended antenatal treatment.” Her blood sugar remained high after giving birth in 2003, and she continued receiving diabetes treatment. By 2013, healthcare workers prescribed insulin and metformin, medicines prescribed to treat Type 2 diabetes.  In 2019, Ndlovu* was hospitalised for three weeks at Tembisa Hospital after healthcare workers struggled to control her blood sugar levels. She says her eyesight began deteriorating around this period. Losing sight in her right eye while waiting for treatment Ndlovu* says she returned to Mayibuye Clinic in early 2020 because of her worsening eyesight. She was referred back to Tembisa Hospital for specialist eye treatment.  She says she attended numerous hospital appointments over two years without receiving a diagnosis. “I went to a private doctor to consult because the waiting at Tembisa Hospital was getting too long and I was racing against [losing] my vision. I consulted with the ophthalmologist twice in April 2022 and I was diagnosed with bilateral diabetic retinopathy.” Ndlovu* was unable to afford private healthcare and returned to Tembisa Hospital.   She was referred to Steve Biko Academic Hospital in 2023, where she attended several appointments, but the facility was unable to perform specialised eye surgery. In 2024, she was referred to St John’s Eye Hospital at Chris Hani Baragwanath Academic Hospital for surgery. “It was already too late for my right eye because I lost sight completely.” Waiting for cataract surgery Ndlovu has been waiting for cataract surgery on her left eye at St John’s Eye Hospital since 2024. The procedure involves removing the eye’s cloudy natural lens and replacing it with an artificial intraocular lens. “Every time I have to go for my surgery there’s always something, from waiting for the correct lens size, lenses being unavailable, or no theatre equipment. I cannot see, I am not even sure if my remaining sight will be restored,” she says.  Vision loss caused by cataracts can be reversed with cataract surgery but will not reverse vision loss caused by other underlying eye diseases. Ndlovu’s* next follow-up appointment for cataract surgery is scheduled for March next year, but no date has been confirmed for the procedure yet. In October, the Gauteng Department of Health conducted a cataract surgery drive to reduce waiting lists for patients needing operations. It is unclear why Ndlovu*, who has been waiting for surgery since 2024, was not included in the initiative. Ndlovu* says her right eye remains painful even after she lost sight in that eye. “At times I get painkillers from the hospital but it’s usually not enough to cover until the next hospital visit. So we just buy over-the-counter painkillers.” Losing her independence Ndlovu* now relies on her son and caregiver, Nomsa Mbatha*, to help with everyday chores at home and to accompany her to hospital appointments. “She tries to do her laundry, clean the yard and cook, but she is failing. She is dependent on us, and I try my level best to support her,” Mbatha says. “Her son is unemployed, but he is discouraged to find work far from home, just to support her and extend his help.” “The only help I need is the outstanding surgery so I can at least see with my left eye,” says Ndlovu.* Importance of eyecare in diabetes patients Dr Wezi Gloria Maphenduka, an ophthalmologist and head of the clinical unit at Charlotte Maxeke Academic Hospital and the University of Witwatersrand, says bilateral diabetic retinopathy can develop without noticeable symptoms and eventually cause permanent vision loss. She adds that pregnant women with diabetes should be closely monitored and treated because retinopathy can worsen during this period.  “More than 90% of diabetes-related vision loss can be prevented or delayed through early detection, timely treatment, and good control of blood glucose, blood pressure, and cholesterol levels.” The Gauteng Department of Health was approached for comment on delays in accessing specialised eye treatment and surgery in public hospitals in the province. The department acknowledged receiving the questions but was unable to respond by the time of publication.  Warning signs of diabetes-related eye problems *Ayanda Ndlovu requested that her real name and that of her caregiver be withheld out of fear of stigma within the Meriting community. Author Lerato Kodisang Lerato Kodisang is a journalist with experience engaging communities through civil society and local platforms at district and provincial level. She is passionate about health and people-centred reporting that centres lived experiences and gives voice to issues that matter to communities. View all posts