Areas of joint municipal organization for environmental health care

There are six laws to regulate and three ministries to guide environmental health care in Finland. "The working terrain is so multifaceted that it's hard for one person in a municipality to do it. That is why we have settled on joint municipal organization areas, where among other things office holders' specialization will ensure a variety of expertise and improve oversight and services," says Jari Keinänen, Director of the MSAH group on environmental health.

Earlier, in small municipalities an environmental health inspector or veterinarian would be in charge of all tasks concerning environmental health care, from the inspection of grocery stores to household mould problems, from monitoring bathing water to animal conservation.

"In the 1990s we started to hear noises from the municipalities that having the expertise of a single health inspector was insufficient for dealing with such wide-ranging tasks. The municipalities called on the government to help. In the first half of the 2000s, a resolution was taken on promoting cooperation by municipalities in order to ensure the expertise necessary. The government gave the resolution on joint municipal organization in environmental health care, and the municipalities were supported with funding for the joint collaboration experiments", says Jari Keinänen.

Cooperation backed by law

In June 2009 a law came into force that obliges municipalities to form cooperation areas, if they do not have at least 10 person-years for environmental health care duties.

Municipalities had until the end of 2009 to decide on the establishment of cooperation areas. If the municipality did not decide on the matter, the government can decide on municipalities belonging to areas of joint municipal organization by the end of 2011. These areas are to start functioning at the latest by the beginning of 2013.

Many municipalities have already formed joint municipal organization areas. At present, there are 126 environmental health care units. Some of these are formed by individual municipalities, others by areas of joint municipal organization. 60 of the units meet the minimum requirement of 10 person-years.

"When municipalities' current plans are implemented, the number of municipalities or areas of joint municipal organization that meet the minimum requirement will be about 80 by the beginning of 2013", says Keinänen.

The aim is for there to be 60 areas of joint municipal organization that fulfil the minimum requirement.

Decisions still unmade

Some 10 municipalities have yet to decide on the organization of their environmental health care in line with the law. For some municipalities long distances pose an obstacle to cooperation. Other municipalities are reluctant to be part of a joint municipal organization area because of the increase in costs. The costs of the joint municipal organization area are divided according to the number of residents. If in some municipalities there had been no previous investment in environmental health care, it may be that forming joint municipal organization areas with municipalities that have invested more in environmental health care will increase costs.

"In autumn 2010, the Regional State Administrative Agencies will start negotiations with those municipalities that have not decided on the matter. The law allows for a deviation from the minimum requirement in Lapland, for example, because of the long distances", says Keinänen.

The joint municipal organization areas have formed mainly on the basis of expert networks that have grown up around food and environment laboratories. Environmental health care and primary health care have some common joint municipal organization areas. Most environmental health care joint municipal organization areas are, however, formed together with environmental protection and/or building supervision.

"The tasks involved are well attended to in this way. Good links with primary health care should, however, exist particularly in attending to epidemics, but the connection with primary health care on a day-to-day basis is fairly slight", says Keinänen.

Paying for better services

The aim of the reform is that the level of environmental health care will improve and that those using the system will receive a better service. In Keinänen's view employee motivation will improve when they are able to focus on a particular sector and are in a position to provide a better service.

In forming the joint municipal organization areas the principle being followed is that no one is downsized. On the other hand, there is little chance of creating new posts in the current municipal financial situation.

In some municipalities and joint municipal organization areas it has been possible to establish new posts in environmental health care by making use of fees. For instance, in Helsinki a few new posts were created pertaining to the monitoring of the Tobacco Act using sales permit fees imposed according to the act.

Jari Keinänen says that those using the system have not grumbled much at the environmental health care service charges, though employees have. It is unpleasant for them to levy charges. On the other hand clients are more demanding when they have to pay for oversight and services. No one wants to pay for useless services, and this encourages their improvement.

Merja Moilanen