The Roles, Impact and Challenges of Environmental Health Services in Communicable Disease Outbreak Response Focused on South Africa: A Systematic Review

Environmental health services play a critical role in communicable disease outbreaks by addressing environmental determinants of disease transmission. However, the scope, impact, and challenges of Environmental Health Practitioner (EHP)-led interventions remain insufficiently documented. Aim and objectives: This systematic review objectively assessed the role, impacts, and challenges of municipal environmental health services in outbreak response, with a focus on South Africa, to inform the standardisation and strengthening of disease surveillance and prevention. Methods: The PICO framework guided the development of search terms and research questions. PubMed, Scopus, Google Scholar, and Web of Science were searched for English-language, full-text studies published between 2010 and 2024. Studies not meeting these inclusion criteria were excluded. Screening and reporting followed PRISMA guidelines, and data were synthesised using a standardised extraction tool. Results: A total of 58 studies were included. The key EHP functions identified were water quality monitoring, vector control, food safety, waste management, and outbreak response. While South Africa demonstrated comparatively advanced systems, persistent implementation challenges remain, including the integration of environmental monitoring with disease surveillance. The findings emphasised the need for integrating environmental monitoring with disease surveillance systems and integrating WASH and climate-responsive strategies. Conclusions and recommendation: The review recommends strengthening guidelines and advancing evidence-based practice. Enhancing EHP roles within surveillance frameworks is essential for improving outbreak preparedness and public health resilience.