Developing an Integrated Municipal Environmental Health Framework for Communicable Disease Surveillance and Prevention in South Africa: A Mixed-Methods Study Protocol

Communicable diseases remain a significant public health burden in South Africa, particularly where environmental determinants of health intersect with fragmented surveillance systems. Environmental Health Practitioners (EHPs) are legally mandated to implement the surveillance and prevention of communicable disease services at the municipal level. However, this function is inconsistently operationalised and often remains reactive (outbreak-driven), with limited integration into broader national surveillance systems. This study protocol outlines a mixed-methods investigation to develop a practical framework to strengthen the communicable disease surveillance and prevention function within Environmental Health Services in South Africa. The study will assess existing guiding tools, operational practices, and intersectoral collaboration mechanisms supporting surveillance across metropolitan and district municipalities. Quantitative data will be collected through a national survey of EHPs, while qualitative data will be generated through key informant interviews with national stakeholders, focus group discussions with municipal health managers, and a targeted review of municipal documents. Quantitative data will be analysed using descriptive and inferential statistics, while qualitative data will be thematically analysed and triangulated across data sources. The expected outcome is an integrated framework that clarifies roles, strengthens data flow, and promotes proactive, coordinated surveillance and prevention of communicable diseases within environmental health. The developed framework is anticipated to inform policy discussions and may contribute to efforts aligned with Sustainable Development Goal 3, Target 3.3, on reducing communicable disease burdens, by strengthening municipal communicable disease surveillance and prevention.