City Profile: Johannesburg, South Africa

The city of Johannesburg offers insights into urban governance and the interesting interplay between managing the pressures in a rapidly urbanizing context, with the political imperatives that are enduring challenges. The metropolitan municipality of Johannesburg (hereafter Johannesburg), as it is known today, represents one of the most diverse cities in the African continent. That urbanization, however, came up hard against the power of the past. Areas zoned by race had been carved into the landscape, with natural and manufactured boundaries to keep formerly white areas ‘safe’ from those zoned for other races. Highways, light industrial plant, rivers and streams, all combined to ensure the Johannesburg landscape are spatially disfigured, and precisely because it is built into the landscape, the impact of apartheid has proved remarkably durable. Urban growth is concentrated in Johannesburg’s townships and much of it is class driven: the middle class (of all races) is increasingly being found in cluster and complexes in the north Johannesburg, while poor and working-class African and coloured communities in particular are densifying in the south. The racial and spatial divisions of the city continue to pose fundamental challenges in terms of governance, fiscal management and spatially driven service delivery.


Introduction
The metropolitan municipality of Johannesburg (hereafter Johannesburg) as it is known today represents one of the most diverse cities in the African continent. Its urban cosmopolitanism, however, is marred by appalling inequality and this strongly relates to the spatial form of the city. Apartheid spatial planning has meant that Johannesburg has been ranked as the most unequal city in the world, in the most unequal country in the World (Euromonitor, 2017).
Johannesburg began as a gold mining town, attracting investors, opportunists and workers from the early 1900s. According to scholars, the city became a site of unprecedented modernity within a few

Physical Environment
Ecologically, the city of Johannesburg falls within the grassland Highveld. Pockets of original indigenous Bankenveld vegetation are still in existence in the eastern part of the city (CoJ, 2014). However, with more than a century of residential suburban development, Johannesburg has developed a unique ecological profile and has the world's largest urban forest with an estimated 10 million trees (CoJ, 2014).
However, the city's environment is under severe threat from a number of factors associated with a rising population, densification and urban sprawl (SACN, 2018)-as well as from the reminders of its history as a mining town, which has left polluted aquifers, acid mine drainage and other risks to health and sustainability and the danger looms large as the city continues to expand. Johannesburg is also one of the few cities in the world that is not located on a major water source. The city is heavily dependent on the Vaal River, which, in turn, is augmented by water from Lesotho. As a result, the city is prone to problems of water scarcity as well as rising costs of accessing potable water (HSRC, 2014). PM10 1 concentrations across the city frequently exceed national air quality standards of 50 µ/m 3 , reaching highs of over 400 µ/m 3 (CoJ, 2008). Respiratory problems associated with poor air quality have resulted in the city spending an annual average of R280 million (CoJ, 2008). Vacant land at affordable prices is key for the state to try to manage the housing crisis-but the result for many has been the discovery that their dwelling unit is located on polluted aquifers. The health impact for all-notably infants and children-is self-evident.

Administrative structure
A year before South Africa's democratic transition in 1994, the Local Government Transition Act (1993) was formulated to shape the administrative landscape of the local government. The task at hand, which faced the new democratic state at local, provincial and national levels, was to shift from transitional forms of governance towards establishing metropolitan councils. At this stage, a two-tier system of metropolitan governance was provided through Transitional Metropolitan Councils, where councils deliberated upon the model that would shape its governance (Pieterse, 2002, p. 13). According to Pieterse (2002, p. 13) 'the models varied dramatically in terms of the degree of power that was centralised at metropolitan level, versus the degree to which metropolitan local councils had power'. Johannesburg had opted for a centralized model of single-tier governance in the metropolitan council. There were two main outcomes of this, which strongly resonate with the governance mechanisms, still at work today: metropolitan councils had 'exclusive legislative and executive authority over the spatial area they are responsible for', and executive power would be centralized in the office of an executive mayor (Pieterse, 2002, p. 13). The governance structure played out in three ways: (a) in the governance architecture; (b) in the fiscal organization and (c) spatially.
There was also the symbolic aspect. Incorporating Soweto as part of Johannesburg was both an act of democratic symbolism and necessary for redistribution of tax revenue from formerly white northern suburbs to Soweto (and other township areas zoned for different races under apartheid) for development and service delivery.
This played out in the governance architecture in the following way: The City of Johannesburg has an executive mayor who works with the assistance of a city manager, members of the mayoral committee (MMCs) and executive directors (ED). MMCs are political appointees and directors are administrative appointees. The executive mayor's role is crucial to city strategic planning and development trajectory, because the mayor can decide on what areas the City should focus on during his/her term in office, but this typically would devolve the operationalization to the city manager, and maintain the provision of a strategic vision. This has by no means been an even process; depending on the particular individuals occupying political office, the political culture or the relationship between the mayor and the city manager; there has over time been greater or lesser control of the operational mandate from the Mayor's office (personal communication, first City Manager of Johannesburg, March 2019).
In terms of the fiscal organization, the Greater Johannesburg Metropolitan Council (GJMC) experienced a severe financial crisis due to the sheer planning challenges having to do with the amalgamation process (Savage et al., 2003;Smith, 2006). The city manager at the time was appointed specifically to deal with the financial and organizational challenges that the City was facing. The iGoli 2002 Planfocusing on financial stability, service delivery, accountability frameworks, administrative efficiency and political leadership-was a strategy that was pivotal to the course of the City's development (Allan, Gotz, & Joseph, 2001;Smith, 2006). It meant development would have to be multi-focused and meet fiscal, governance, spatial and political objectives. The City adopted a corporatist model resulting in the creation of several municipal owned entities and utilities (Allan et al., 2001;Smith, 2006;interview with Antonino, Manus, CoJ), through which service delivery and revenue collection would be achieved. However, these entities did not manage the delivery and collection of all places evenly-there remain huge fiscal gaps in revenue collection of densely populated parts of the city, resulting in severe levels of indebtedness for national entities, which still manage delivery to particular areas.
The new formulation of the council also played out spatially. The interim Metropolitan Transitional Authority was put in place to manage territorial authorities which would eventually form the City of Johannesburg. During the transitional period, Johannesburg was one of the 843 municipalities, which would later become one of the six metropolitan municipalities and one of the only 284 municipalities in total, after the first local government elections in 2000 (SALGA, 2015). When the City of Johannesburg was formed, its administrative boundaries included a number of former administrative centres and the nature of urban growth was changed-then not by the movement of people, but on expanding the administrative boundaries of the City. In effect, the City had not only to manage service delivery of a larger area, and serve a higher number of people, but also inherited the spatial and service delivery challenges of those places. Thus, this phase of urbanization meant a massive jump in urban populations simply on the basis of redrawing the spatial boundaries of the administration.
That urbanization however came up hard against the power of the past. Areas zoned by race had been embedded into the landscape, with natural and manufactured boundaries to keep formerly white areas 'safe' from those zoned for other races. Highways, light industrial plant, rivers and streams, all combined to ensure the Johannesburg landscape, are spatially disfigured, and precisely because it is built into the landscape, the impact of apartheid has proved remarkably durable.
To ease the burden of administration, and to manage ease of access to residents, the city was divided into seven administrative regions (A-G). Each region is overseen by a regional director who reports directly to the city manager and has the mandate to ensure that service delivery happens at local level. In addition, there are ward-level substructures within regions, which bolster the advisory and decisionmaking processes of the local authority, and are contested in local by-elections every 5 years. Community engagement, representation and participation are facilitated through these metropolitan substructures or ward committees through the leadership of a locally elected ward councillor (Pieterse, 2002;Reddy, 2000). The ward-based administrative structure is representative in nature and is set up to be able to be the interface between the citizenry and local government, where councillors directly represent the interests of residents at council meetings, and other matters are raised by region directors at weekly joint operations committees, making the system potentially very responsive. Indeed, political contestation shaping ward level governance is critical to the idea of representation-if not always welcomed by governing authorities. Pieterse (2002, p. 14) highlights a significant matter relating to the governance arrangement at the executive level and limits power of local councillors and thus spatial politics: Even though substructures and/or ward, committees can be created, a metropolitan council cannot delegate powers (section 160(2) of the Constitution) such as: the passing of by-laws; approval of budgets; imposition of rates and other taxes, levies and duties; raising of loans; and approval of its integrated development plans. In other words, the legislative framework potentially prevents parochial localism that, in the case of the apartheid city, can reproduce highly unequal levels of access to municipal services.
Thus, while there are democratic forms of local governance, these do not translate into equal access to services, since ward level representation is potentially vulnerable to racialized spatial politics.
The racial and spatial divisions of the City pose fundamental challenges in terms of governance, fiscal management and spatially driven service delivery. In terms of governance, decision-making has to take into account the spatial unevenness in development, prioritization of particular places, and both fiscal prudence and political expedience. The current political issue is the fundamental change in administration, where, in the 2016 local elections, neither the African National Congress (ANC) nor any opposition achieved a majority. It required a coalition government, which was achieved by the two main opposition parties-the Democratic Alliance and the Economic Freedom Fighters. Longer term strategic frameworks of the previous administration continue to shape the urban spatial and development plans of the current administration, but medium-and short-term projects were either rebranded or canned altogether.
The city of Johannesburg was also a key player in demonstrating the importance of urban spaces in party politics. The ruling ANC, led by a president (Jacob Zuma) who clearly favoured rural areas with their local traditional leaders, strict controls and limited choice, scorned urban blacks, in particular. They, in return, voted the ANC out of power in Johannesburg and Tshwane-two of the three cities in Gauteng. In slightly over two decades, the ANC was sitting on the opposition benches, and political uncertainty had come to South Africa-at local level, anyway.
In terms of fiscal management, the challenge is to stimulate economic development, while paying attention to the spatial planning needs. As such, the City's spatial planning is linked to large-scale capital investment projects; in other words, it relates to 'economic growth within a citywide network of welldefined, mixed-use nodes that are linked to major transportation routes, with public transport as the major catalyst to facilitate access to the inherent job and economic opportunities' (Ahmad & Pienaar, 2014, p. 106). In line with this, the city has promoted and encouraged investment within its priority development nodes, and along the main transport corridors between them (Ahmad & Pienaar, 2014). Housing developments, which are also heavily investment-driven, are linked to provincial decisionmaking and land allocations, with the infrastructure investment then falling to the city.
As Johannesburg enters its new stage of political maturation, this is a recipe for political friction where the province is governed by the ruling party and the city, by the opposition. In sum, while the city is 'intent on working collaboratively with players in the market, its primary focus is to deliver on a spatial transformation agenda' (Ahmad & Pienaar, 2014, p. 114). The level of party's political hostility is high, and the risk to collaborate with city or province governance, within a broader city-region context, is equally high.
On the service delivery front, the spatial fragmentation of the city means that there is de facto inequitable provision of services, while there is a de jure equality of access. In areas that were under-served, there remain significant backlogs in provision, ailing infrastructure and rising demand on the provisioning infrastructure (Allan et al., 2001; interview with official at Johannesburg Water).

Demographics
Johannesburg is the most populous city in South Africa and had an estimated population of five and a half million in habitants in 2017 (Quantec, 2018), an estimated million more than the tally at the last census (2011). More than a third of residents in the province reside in Johannesburg.
The average annualized growth rate of the population in Johannesburg for the period 2002-2017 was 2.5 per cent. Crucially, as noted by the former city manager (personal communication), population growth is steady despite a decline in birth rates, which signals that in-migration is the key driver of population growth.
Johannesburg has a very young population, with more than half the population between 20 and 44 years of age. This age group represents the relative economically active segment of the population. According to scholars, this phenomenon largely relates to economically active segments of the population migrating into the city due to aspirations of employment and wealth (Rogerson, 2013;Stats SA, 2015); however, this is on top of a large existing local population that is also reproducing, so the competition for jobs (or other services and opportunities) is intense.
Available population data show that the urban population is not equally distributed across the various regions in Johannesburg. The most populous region is 'region D', 2 comprising the suburbs of Soweto, Diepkloof, Dobsonville, Protea Glen and Doornkop-areas that were designated as African townships during the apartheid spatial planning under the Group Areas Act of 1950. This region has over a third of the total city population within its boundaries and continues to grow with informal settlements tending to spring up alongside or within existing townships. Similarly, former Coloured and Indian townships continue to grow because of increasing numbers of informal settlements along its edges.
Population density has increased steadily for the past two decades, from just over 2000 persons per square kilometre in 2002 to 3281 persons per square kilometre in 2017 (see Figure 2). Compared to the two other metropolitan municipalities in the province-1690 persons per square kilometre in Ekurhuleni (Ekurhuleni Metropolitan Municipality [EMM], 2017) and 471 in Tshwane-the city's population is burgeoning. However, as the Urban Observatory astutely notes, this average density figure may be misleading if taken as an average and applied across the entire City. They argue, through mapping the City, that Census data reveals that population density varies noticeably from area to area. Small area census data do a better job depicting where the crowded neighborhoods are. …[A]reas of highest density exceed 30,000 persons per square kilometer. Very high density areas exceed 7,000 persons per square kilometer. High density areas exceed 5,200 persons per square kilometre. 3 The increasing density can be seen to lead to urban sprawl, since there is no clear urban edge despite there being administrative boundaries. This means that economically privileged segments of the population have tended to move further from urban centres, particularly to eco-estates, and the people who need to be closer to opportunities crowd into spaces near city centres, often living in backyard dwellings or shacks.
Some scholars argue that this is fundamentally transformative for the still very much segregated urban space economy (see Charlton & Shapurjee, 2013) and another concern is that this often happens in already precarious neighbourhoods (see Storie, 2017). While formal large-scale developments cater to a growing middle-class population, most situated in designated areas along transport nodes, backyard shacks and dwellings suit the needs of those needing to live closer to work, but not being able to afford mainstream bond or rental dwellings. According to the Gauteng City Region Observatory, which monitors urbanization trends in the province, the percentage increase in household dwelling type for formal stands from 2001 to 2016 stands at 38 per cent, while for security complexes (large-scale developments) it is 294 per cent and for backyard dwellings 204 per cent (see Gauteng City-Region Observatory [GCRO], 2016).
Much of this growth is concentrated in Johannesburg's townships of Diepsloot, Tembisa, Soweto (GCRO, 2018 4 ), but is also spread north-west of the Province. Much of it is class driven: the middle class (of all races) is increasingly found in cluster and complexes to the north of Johannesburg, while poor, working class African and coloured communities in particular are densifying in the south. The legacy of apartheid is indeed remarkable for its durability.
Johannesburg has been described as a city of migrants, with a highly diverse population comprising the multi-ethnic indigenous South African population and a growing component of people from other countries in Africa, the Indian sub-continent, eastern Europe and elsewhere. The last national census showed an estimated two million international immigrants, with just under half of those from neighbouring Zimbabwe (Stats SA, 2015).
The pattern of in-migration is also bolstered by the movement of South Africans from outside the Metro and the province. Indeed, the precedent was set historically when old Johannesburg was a town made up of aristocrats and migrant miners. According to Statistics, in South Africa, since the democratic turn, the pattern of international migration shifted as low-skilled immigrants, refugees, asylum seekers and illegal immigrants became more prominent (Stats, SA, 2015). The major pull factors include the availability of social infrastructure, educational opportunities, medical infrastructure, political unrest and both economic decline and political unrest in neighbouring countries (Cohen, 2008).

Education
Education is not a constitutionally designated function of the local government, and specifically here of the City of Johannesburg (CoJ) government. Going beyond the class and racial inequalities in education provision, many other education and work-related challenges remain in the CoJ, notwithstanding the relatively high qualifications noted below.
The Gauteng-and Johannesburg-populace has among the highest educational attainment relative to the rest of the country. Table 1 shows that the proportion of 25-64-year-olds with both secondary and post-secondary education is much higher than the national average in the two richest provinces, Johannesburg and Cape Town and that of the poorest province, Eastern Cape. In terms of provincial shares in post-secondary education, Gauteng ranked highest (38.0%) followed by the Western Cape.
Gauteng as a province, and Johannesburg as a city, normally feature at the top of their respective rankings in educational attainment, and in the matric pass rates, but the education system is by no means of uniform quality. It would be accurate to say that the quality of education provision in Johannesburg mirrors the spatial geography of the city, which, in turn, mirrors the racial and class divisions of the apartheid city. The best public schools are located in the inner periphery, the former white suburbs. Access to these schools is determined largely by residence so that the middle class composition of the student population remains largely unchanged, with the exception of a small proportion of children of domestic workers in these suburbs. The racial composition may be changing but the class composition is not.
Inequalities are further entrenched by the high costs of 'bussing' school children in from the 'townships' particularly to schools in areas such as Eldorado Park and Lenasia, where the schools may be of better quality than in Soweto but not as good as in the former white suburbs. This, in turn, reflects the politics of the apartheid era, where differently classified racial groups were given differential access and resources, as part of the divide and rule approach.
In this schema, African schools (and townships) received the lowest budget allocation, with (slightly) more going to officially classified 'coloureds' and more again to those classified as 'Indian' and far more reserved for whites. Eldorado Park, for example, is a former 'coloured' township near Soweto; while Lenasia is a former Indian township: their schools and services are an obvious magnet for residents in nearby Soweto.
It would be fair to conclude that education in Johannesburg during the democratic era has been transformed from one based purely on racial criteria to one that is now overtly defined by class, but feeding off previously racially based difference and disadvantage. The point can be extended beyond education.
Functional illiteracy refers to those who have not completed their primary education (Grade 7). In the City of Johannesburg, for example, region D (Soweto) had the highest number of people who could not read or write between 1996 and 2010. The illiteracy rate increased by 50.7 per cent between 1996 and 2011 in region G, which includes Deep South, Ennerdale and Orange Farm (HSRC, 2014). Here we see the long-lasting impact of apartheid's in the form of under-served areas, primarily populated by black South Africans, and the challenge to extend quality services to those areas under democracy.
Despite 'constitutional constraints' regarding the role of local government in education, there is much that CoJ can do to address the education and associated economic challenges beyond the 'fetishization' of school leaving certificates, and pass rates-which is currently how the city measures its success in delivering education. It is however disputed as to whether or not the matric pass rate is a good indicator of quality and efficiency in the South African schooling system. A key challenge here is the very high number of 'dropouts' in secondary schooling, particularly in grades 11 and 12. There is a widely held belief that large numbers of (weaker) students are 'culled' in these years. This is either part of a strategy to allow only those students who are considered to have the potential to pass the matric examination years and subsequently progress or done by schools who want to push up their own pass rate. This also allows children from poorer households to legally be able to leave school at the age of 16 years and try to find work. These factors inflate the matric pass rate relative to what it might have been if weaker students were allowed to progress and/or were able to remain in the system.
A learning city approach may take CoJ and Gauteng out of the annual contest over 'the best matric pass rate' and rather focus on the entire spatial units under their aegis, by focusing on the needs of all residents as they pursue lifelong learning (not just formal education) in order to help the city and province meet their growing challenges towards a highly developed and demanding economy.

Economy
The economy of Johannesburg has its roots in the extractive sector, and based on a major cities comparison, Johannesburg has the potential to attract and retain investment, professional staff and international tourists due to a relatively low price or inflation level, a mid-level wage index and high domestic purchasing power (Mushongera, 2013). The economic output measured by gross value sdd (GVA) shows an unsurprisingly uneven spread of GVA from the different regions in Johannesburg, with the wealthier northern suburbs-formerly zoned for whites, and now home to a partially racially mixed middle classshowing greater GVA-where rapid growth has spurred new forms of industrialization, employment opportunities, increasing exports and expansion of wealth (Hodge, 1998)-and the growing township economies relatively smaller, but nonetheless also growing.
Crucially, Johannesburg is the main contributor to the province's output, amounting to 40 per cent of its GVA. The finance and real estate sector contribute to over a third to Johannesburg's GVA, which is demonstrated by the concentration of financial institutions and the Johannesburg Stock Exchange in the north Johannesburg.
In terms of the municipal finance, Johannesburg's revenue is mainly drawn from its own revenue collection of service charges for utilities, property rates and taxes through its various basic provisioning entities, and a smaller percentage comes from grants and the equitable share (South African Cities Network [SACN], 2015[SACN], , 2016. The official statistical definition of unemployment in South African is interesting-it is not measured by an earning line, but rather, by estimating it on the basis of those of working age who during the reference week did not work for at least an hour, and were not business owners (Stats SA, 2017). Work, then, is a complex question and part time or piece meal labour and participation in the informal economy are considered forms of employment. For this reason, the unemployment figures may indeed be underestimated as it relates to people's ability to make a living on a day to day basis. Unemployment in Johannesburg has risen from 6.8 per cent in 1993, to over 23 per cent in 2017 (Stats SA, 2017). Despite the previous administration's 2014 Jozi@Work Programme, which provided municipality facilitated service delivery jobs in local areas like clean-up, paving, or grassing cutting (CoJ, 2014), these were only short-term contracts, and the initiative ended with the change in administration.
In Johannesburg it is estimated that more than half a million people are employed in the informal economy (Stats SA, 2017). Given the spatial inequalities, unemployment is higher in certain regions than others-in particular regions G, D and E, which comprise Orange Farm, Soweto and Alexandra, respectively. Yet even areas with high GVA contributions still have relatively high levels of unemployment. For this reason, it is typical that abject poverty and conspicuous opulence characterize particular places.
Similarly, because of Johannesburg's extreme inequality, income distribution in South Africa is highly skewed-the income Gini coefficient for Johannesburg and Gauteng is above 0.60 for 2002, 2008 and 2014. Scholars argues that failure to secure employment is linked to high rates of crime, which has a cyclic impact on deterring investment and hampering potential economic growth (Mushongera, 2015).

Health
The South African health system can be divided broadly into four parts governed through the three spheres of government in accordance with the Constitution of South Africa (Constitution) (Republic of South Africa, 1996). Three of these relate to the public health service and include the national sphere which oversees national policy and implementation; the provincial sphere which has the constitutional mandate for health services held concurrently with the national sphere; and local government, in this instance Johannesburg, which has the mandate for health functions that do not involve clinical healthcare services (such as environmental health and sanitation).
Local governments are responsible for the provision of health services assigned to it by a provincial Member of the Executive Council (MEC) 5 in terms of section 32 of the National Health Act (National Department of Health, 2003) and, therefore, lack the authority to determine alone what they make available. Municipal health services are non-clinical in nature and focus on environmental health functions such as sanitation and aspects of population health.
The fourth part of the health system is through private health service providers and funded by private health insurance (referred to as medical schemes). The private health system is mainly regulated through national legislation falling under the jurisdiction of the Minister of Health. A regulator, the Council for Medical Schemes, which reports to the Minister of Health, supervises medical schemes. At one level, the story of post-apartheid health is likely to reproduce the story of post-apartheid education, in terms of race and class skews; but this has been significantly compounded by the HIV and AIDS pandemic, which has South Africa at its heart.
Following the change in Government from April 1994, a cornerstone of the new policy framework for the health system involved the implementation of a coherent third tier to the health system-referred to as the District Health System (DHS). Ultimately a mixed bag of approaches had emerged by 2003, with the National Health Act of that year merely outlining a rather weak (advisory) oversight framework, District Health Councils (DHC), to be implemented by provinces and no community involvement. As municipal health services are not defined in the Constitution, the mix of delivery and financing options for local authorities are largely at the discretion of a health MEC. Local authorities are however in a position to finance services at their own discretion, but are unlikely to do so where the mandate is unclear and where the province may be antagonistic.
The bulk of government revenue is raised through national taxes and allocated to national, provincial and local government through the Division of Revenue Act (DORA). The allocations to national departments by the National Legislature take the form of voted budget allocations. The voted allocations to both provinces and local governments however become substantial source of resources for these structures.
Their legislative structures subsequently vote on final allocations taking account of both their own revenue sources and that derived from the national government.
The distribution of national government expenditure is heavily weighted towards national government and the provinces at 47.7 and 43.3 per cent respectively in 2018. Local government only received around 9 per cent in 2018 with most of their budgets financed through their own taxes, utility fees and transfers from provincial governments.
When analysed as a percentage of gross domestic product (GDP) expenditure levels in the public and private health systems have remained relatively stable over a very long period. However, both the public health systems and private medical schemes have seen a structural increase: from 3.3 and 3.4 per cent respectively in 1994 to 4.1 and 4.0 per cent respectively in 2014 (van den Heever, 2012(van den Heever, , 2016. While the expenditure trends have remained stable and rising, the populations served by the two systems have not. Dramatic cost increases in the private medical schemes system appear to have constrained the proportional of population served (a drop from 19.8% of the total population in the late 1990s to around 16% at present), with the public sector catchment population increasing slightly faster. By 2016, the public sector needed to protect 47.5 million while medical schemes offered coverage to 8.7 million. This is most pronounced in cities such as Johannesburg, which are magnets attracting people from across South and southern Africa; and the health system alone attracts people who come to Gauteng purely for healthcare.
Johannesburg has the largest population that exclusively make use of private services funded through medical schemes, at 25 per cent. Over half the medical scheme population is in only five metros, with less than 50 per cent distributed through all the remaining local authority regions. On an average only 11 per cent of the total population, in these remaining areas, is covered by the private medical schemes.
Rapid population growth requires a constant adjustment of services to the increased populationwhich requires continuous asset investments together with capacity building and increasing professional staff. It is however not clear that whether the provincial equitable share formula together with the conditional grants effectively compensate for this dramatic level of change.
Gauteng and Johannesburg have a marked burden of disease profile. While deaths due to communicable diseases, maternity-related causes, perinatal causes, nutrition-related causes, HIV and tuberculosis, and ill-defined deaths (often HIV-related) are in decline, deaths due to injuries and non-communicable disease (hypertension, cancers, diabetes, etc.) are on the rise. 'Lifestyle' diseases, often associated with population growth, urbanization and rising incomes among the working poor, are a marked feature of Johannesburg. Johannesburg and Cape Town have the largest number of life years lost due to these causes specific to their provinces.
The burden of disease in Johannesburg is consistent with that of dense, fast-growing population. Included in this mix is the problem of ageing populations combined with the breakdown of extended families. Care for the aged has a major gap in both the health and social services and requires a combined local government and provincial initiative to properly support families of all income groups.
Historically, the Johannesburg metro has been involved in the delivery of primary healthcare services and emergency medical services. It will make a lot of sense to deepen its involvement in health service provision-particular as Johannesburg lies at the heart of the fastest growing region in the country. There is value in a coordinated diversification of public players in the public health system, especially as the metros are closer to the served population than the provincial governments. Continued improvements will depend on the quality of the health service and the degree to which there is coordination between the provincial and local authority health services.

Planning
Based on the historical spatial legacy of the city, and its concomitant administrative restructuring, Johannesburg has a complex multi-nodal structure (OECD, 2011). One of the key planning imperatives has its ideological roots in the political imperative of deracializing and transforming the space economy. For instance, residents of former black townships that were deliberately built on far-flung areas disconnected from economic opportunities face the added burden of long commutes to work or face long distances to look for work. In other words, the spatial design of the city, has a profound impact not only on the facilities, infrastructure and services in the city, but also on entrenching inequalities within the urban population (SACN, 2016).
The pattern of urban development was designed to meet political imperatives, systemic inequality, spatial fragmentation and economic demands, and as such, large-scale planning projects often embodied these varied priorities. As a result, transit-oriented spatial development zones, with high capitalization grants from national Treasury through its city support programme, were formulated to manage land use, integrated transport systems and direct development (CoJ, 2011). One such example was called the Corridors of Freedom project, which had symbolic and material import, linking spatially disparate zones to transport corridors and residential projects. Long-term planning linked to the city support grant has tended to outlast local government's political transitions, but short-term planning and projects have tended to fall away.
Development projects for the provision of large-scale rental or low-cost housing stock is related to massive backlogs in housing provision, and apparently rising numbers of informal settlements. According to Ballard and Rubin (2017), megaprojects, delivered by private residential developers represent a pragmatic approach to support the sheer volume and urgency of housing delivery in the province and by extension, in the city. According to scholars the city has a 'vibrant private sector that is driving spatial development in a complex relationship with the spatial policies of government' (Harrison et al., 2014, p. 3).
While there have been significant strides in the provision of infrastructure and housing since the inception of South Africa's Reconstruction and Development Programme (RDP), there remain urgent challenges with the pace of urbanization, urban infrastructure dilapidation and urban demand. The City's Spatial Development Framework (SDF) (CoJ, 2011(CoJ, , 2016SDF, 2018) has identified what it calls 'strategic growth nodes' and transformation zones in which adequate investment capacity is to be channelled to ensure that there is adequate infrastructure to accommodate urbanization and economic growth needs (CoJ, 2016).
A closer look at the DA's 2017/2018 Integrated Plan shows that these programmes still exist but has been rebranded from the spatial development zones to Spatially Targeted Investment Areas (STIAs); from revitalization of the inner city to cleaning up the inner city; from Corridors of Freedom to development of transit oriented development corridors; from informal settlement upgrading to revitalizing informal settlements; and from a (provincial) focus on building township economies to building secondary economic zones. The coalition government has aligned capital budget planning with its development strategy and priorities referred to in the Joburg GDS 2040, the Integrated Development Plan (IDP) and the SDF (CoJ, 2017). The objective is to properly maintain infrastructure in ways the meet the pressures that come with urbanization. The city's medium-term expenditure framework states that: The focus for capital investment in the 2017/18 MTEF is balanced between firstly, ensuring that the current infrastructure and facilities are properly maintained and functional, and secondly, to ensure adequate investment to respond to urbanisation and growth needs. (CoJ, 2017, Built Environment Performance Plan 2017/2018 According to scholars, the key planning challenge is maintaining a long-term systemic approach (see Ahmad & Pienaar, 2014;Pieterse, 2019), which will '[g]uard against the temptation of "chasing the market" on the urban perimeter and demonstrates the opportunity costs in relation to investment in higher-priority growth areas' (Ahmad & Pienaar, 2014, p. 115).
Another key challenge, according to urban planners, will be balancing the rationalities of planning and management, which include matters like clean-ups, and urban control, with more visionary approaches about the kind of city that residents and government wish to achieve (Dinath, 2014, p. 249).

Critical Evaluation
There remain key urban governance challenges in the City of Johannesburg, and this is particularly stark at the time of writing, which is just before the national government elections. The opposition Democratic Alliance aim to win a majority in the province, and the ruling party, is desperate to keep it, after having lost its place governing the city in the 2016 local elections. Indeed the ANC, in a bid to win back votes in the province, draws its relative strength from the pre-election protests aimed at the failure of the coalition administration to deliver services (particularly) in highly politicized townships in Johannesburg. In sum, this speaks about the political centrality of Johannesburg in the political landscape in the province.
One of the main urban governance challenges in Johannesburg remains the legacy of the non-payment for energy in those townships, which for historical redress and political reasons, do not receive electricity from City Power, but directly from the ailing state-owned Eskom. National bailouts to Eskom and concessions for an almost 20 per cent increase in the cost of electricity in 2 years, will exacerbate the problem of non-payment, pressure on the provisioning infrastructure, and mainly on household expenditure. The City is thus not likely to see a reduction in dangerous illegal connections, in both neighbourhoods where there is no formal electricity provision, and those neighbourhoods in which electricity is provided, but deemed too expensive to pay. This is a recipe not only for a severely strained local public, but also for social discontent and anomie in the city. According to Everatt (2014, p. 80) the 'far more complex challenge now is knitting together a rent social fabric, and changing policy gears so that deeply seated redistribution provides a solid base from which to challenge inequality'.
A second key governance concern is managing the relationships between national, provincial and local spheres of government, particularly of those competencies like education, health and safety that are funded nationally but realized locally. While this again belies political friction, it is the more fundamental task of balancing mandates and responsibilities, where these flare up in matters, for example, relating to zoning of land or managing land occupations-where the zoning is done by the city, but the land often belongs to the province. Of course, the approach requires strong political will and commitment, which in turn implies an ability to work across party political differences in the local/provincial/national spheres of government, alongside effective governance mechanisms in place and operating and appropriate resource mobilization. As Pieterse argues (2019, p. 37) '[g]overnance becomes meaningful and effective when short-term drivers in urban management are tempered by substantive, informed and politically embedded long-term perspectives.' As we approach the local government elections in 2021, the key governance issue will be who governs-and urban governance here will require parties to build strong support, and to demonstrate their commitment to local challenges, which is all part of the theatre of urban politics. Achieving this without pressure on the public purse will be a massive challenge. Urban governance in the largest metro will remain a challenge, since it constantly requires a fine balancing act between the rapidly growing urban population, and the abilities and capacities of coalition government to manage it, a capacity not yet shown.

Conclusion
Many of the features of urban governance in the city are similar to those in other major cities across the world-balancing delivery challenges, political imperatives and budgets, while co-creating a vision of the city that is not merely related to smooth functioning of the local state apparatus. Johannesburg like several other major cities in the developing world is densifying and continuing to attract migrants locally and from the region. What sets it apart appears to be a long-term strategic planning, which is already in place, and that continues to chart a successful trajectory despite the everyday political administrative challenges it faces. It seems that the biggest challenge the city faces, moving forward, will be balancing local politics with decision-making strategies, which will see Johannesburg continuing as an economic and socio-cultural powerhouse in the region.