Saturday, April 30, 2011

Environmental Health in Nigeria , Yesterday, Today and Tomorrow

By

Sani Garba 2004



Environmental health is as old as man is though changes name from time to time, so it has been with us time immemorial. Environmental health is the control of all factors that may have direct or indirect effect on physical, social and mental well being of man in his society. As such, its public health importance cannot be overemphasized. This is because it dealt with many things that affect man's life in one way or the other from environmental and food hygiene to building/water sanitation technology and waste treatment disposal to healthful housing and control of disease[s] vectors and others.

In view of this, this paper looks at the historical background of Environmental Health Officer[s] [EHOs] in Nigeria , their duties, and the present circumstances the officers found themselves and what might be done to address the situation. About the historical background and their duties, I come across a book titled "Preventing disease through proper environmental management in the 21st century in Nigeria" [2001], published by the then Professional Association of Environmental Health Officers of Nigeria [PAEHON] and now Environmental Health officers Association of Nigeria [EHOAN] which I unashamedly so copiously quote for the reader to see and read clearly from the association of the profession, for no other information that will be better than theirs. My intention of quoting the book is to clear the darkness that circumscribed many people who see the profession [environmental health] that produces environmental health officers [or technologist] as unprofessional, unimportant, and even underrate it; and to re-inform other Nigerian about the role played by them since the time of colonial administration and the present Nigeria in shaping Nigeria's health sector which as at now has been downplayed in favour of other health services [especially curative aspect of health] that to some extent is far away within the community reach and costly to afford. More so to encourage leaders to focus their policy toward prevention, which is better and cheaper than cure in spending much on environment than fighting disease[s] elsewhere [hospital precisely].

YESTERDAY: HISTORICAL BACKGROUND IN NIGERIA

"This cadre of public health workers came into existing during the colonial era, their statutory function was purely sanitary inspection then as sanitary assistants to the colonial masters.

"In the 19th century, the colonial masters who executed the sanitary duties of our environment in Nigeria were known as sanitary inspectors while the African/Nigerians attached to them were known as sanitary attendants. These attendants acted as aides to their masters to discharge various sanitary inspection activities like marking of tall trees, service of abatement notice etc. under their masters’ directives and close supervision.

"As time went on these sanitary attendants were given more responsibility such as routine sanitary inspection, collection of water samples, survey for breeding places of mosquitoes, as well as acting as guides and interpreters.

“During the early 20th century, with improved educational background, these attendants gathered enough experience from their colonial masters, they were assigned duties such as cutting down tall trees that were close to the residential buildings, identification of infectious disease cases, disinfection and disinfestations, liaison between the colonial masters and villagers, verification of notices issued by their colonial masters [sanitary inspectors], retention of daily, weekly and monthly returns.

1920s-1980

"Dr Isaac Ladipo Oluwole brought about changes in the status of Nigeria health workers. In the 1920s, when Dr. Isaac came back from Britain as public health physician, he was the first African Medical Officer of Health [MOH] in the Lagos colony. He pioneered with vigour, school health services using the then sanitary attendants, including inspection of schools and vaccination of schoolchildren in their school. He started the first Nigerian School of Hygiene at Yaba Lagos in 1920, where qualified persons from all over the Nigeria trained as sanitary inspectors and obtained the Diploma of the royal institute of health [RIH] London, which was later, changed to Royal Society of Health {RSH} diploma, London.

"The first problem that faced the modern day Nigerian sanitary inspectors as early as the 1920 was the outbreak of bubonic plague in 1924. The professional was actively involved in the control of the plague epidemic. Dr. Oluwole revamped port health Duties and made sanitary inspection a vital instrument for the control of communicable diseases using entirely the Nigerian sanitary inspectors.



"All these brought recognition to the sanitary inspectors among other cadre of health workers in Nigeria . They were referred to as "Wole-wole" among Yoruba’s, "Nwaole-ala" among the Igbo’s and "Duba-Gari" among the Hausas. They were a force to reckon with in that colonial era in the area of preventive health services in Nigeria .

"In the 1930s, the educational qualification and training of sanitary inspectors had greatly improved. Thus, the colonial government assigned them the following statutory functions.

* Routine sanitary inspection of houses, markets, schools and communities.

* Waste disposal and environmental sanitation, pollution control and industrial sanitation.

* Water sampling and sanitation.

* Port health duties [air, land and seaports].

* Control of communicable disease [infectious diseases].

Other duties were,

* Building and urban planning

* Vector and pest control e.g. Malaria control

* Prosecution of public health offenders in the court &n bsp;

*Meat and food inspection

* The disposal of the dead [corpses]

*Occupational health and factory inspection

*Vaccination/inoculation of both schoolchildren and adults.

*Health education on personal and public hygiene was also included.

“The establishment of the World Health Organization [WHO] in 1948, brought about changes in the profession, thus many people with higher educational qualification were recruited into the profession and enhanced curriculum to accommodate the need of the society.

“This was evidenced in their immense role in the eradication of Yaws and Smallpox in the late 1940s and early 1970s respectively.

The 1980- to the present day

“In 1988, the name of the profession was changed to environmental health officers in line with the internationally accepted name of practitioners of the profession and also to accommodate members of the profession who graduated from the university with a degree in public health, environmental health and epidemiology.

“Apart from the general environmental health duties which had hitherto been mentioned this cadre of officer has been very useful in the implementation of primary health care services in the country at all level of government [federal, state, and local government]”.

But one may ask who is this environmental health officer [EHO], what even qualifies one to be called so? In attempting to answer these questions, I will still quote the paper I have been quoting.

“The present day EHO is a professional group whose nomenclature had changed over the years from the then nuisance inspector of the 1930s to the sanitary inspector of the 1950s and 1960s to the public health superintendent of the 1970s and finally to the present day environmental health officer.

“Today, an environmental health officer in Nigeria under goes four years training in public health with courses as Epidemiology, Anatomy and Physiology, Control of epidemic and control of infectious diseases, First aid treatment, Emergency preparedness and response, Waste management, Building technology, Entomology, Public health laws and administration, Microbiology, Environmental monitoring, Pollution control and abatement, Biostatistics among other course.

“After the four years training, a compulsory one year practical attachment is required as part of training [THOUGH NOW IT IS NOT SO]. This training is either in a School of Health Technology or School of hygiene or in the university. At the end of training, the student sits for the professional examination conducted previously by Royal Society of Health [ London ] but now by a regional body, the West Africa Health examination Board [WAHEB]. The diploma of the board is HND approved by the National Board for Technical Education [NBTE] the regulatory board for polytechnics in Nigeria [emphasis mine].

By the civil service nomenclature the holder of this diploma is an Environmental Health Technologist or Officer” [emphasis mine].

Their duties world over which among others include the following: protection of water sources, waste water treatment, waste management, vector control, prevention and control of land, air and water pollution, food hygiene and safety, air quality management, occupational noise management, occupational health and safety, accommodation establishment, port health duties, accident prevention environmental health aspect of public recreation and tourism etc.

Today: The Present circumstances

With all the roles they have played, now the story is different. The profession is dying and being painted or branded as olden days profession and has nothing to offer in the health sector by some other health professionals. Even though a federal ministry was created and other agencies of environment, yet they cannot perform to the expectation due to poor structures that incorporate environmental health officers in most or all department and non challant attitude of our governments.

There is no part of Nigeria that has no environmental health problems ranging from waste [solid, liquid, and gaseous ], erosion, desert encroachment, environmental pollution [air, water, and land] etc, yet not much is being done to tackle the problems.

Now environmental health officers are not regarded as it was before due to government I do not care attitude to their services. It is not even amazing for our leaders to see how dirty and unhygienic our environment is with waste everywhere, markets, schools, drainages, health institution, government offices, residential and occupational environment etc, yet the concern that the leaders ought to show in giving more attention in tackling the situation by reviving public health laws and environmental sanitation is no where to be found.

Environmental health officers are not properly represented in many aspect of health that border on their profession. More so, each Dick and Harry is claiming to be an environmentalist despite not being so. It now reach a stage where by most or all the policy makers in federal, state ministries of environment and other environmental control agencies are occupied by wholly[and or partially] none any environmental health officer[s] or other professional that has little or no knowledge on the environmental health.

The position of Environmental Health Officers in Primary Health Care [PHC] has been hijacked by medical health practitioners [Most especially medical doctors], whom their professional orientation centred wholly on curative health, thus they are not giving any attention to the preventive aspect of health due to their poor knowledge on environmental health. They now dictate where the pendulum of the PHC will swing by hijacking every thing whether or not it is within their profession, for they do not separate their duty with those of other profession.

Another lack of attention to the environmental health officers by the government is that majority of government or all institution has no provision of office of environmental health officers. For instance, no any federal medical centres have such office, federal hospitals [with the exception of the few], states hospitals and many other health institution/ministries. While in hospitals, no any health professional that you will not see, it is only environmental health officers that cannot be found, as if they do not have any role to play. A case of example is one specialist hospital in Kano where it is common to sight excreta and other obnoxious waste plus offensive odour in some cases, yet the hospital management is not much to address the problem though I learnt now the situation has been corrected. Had it been there is an office of for the officers, the story could have been different for it is their duty to take care of such. I wonder why and how they cannot be employed or an office to be created for them to look after the healthy environment of the hospital[s] and other duties in relation to their profession.

At educational level, EHO also are facing lack or even non-availability of wide ranges of courses in relation to their profession that they can further their education. Even the degree programme of environmental health and epidemiology started by OAU Ile-Ife has been cancelled since with no standard reason. Courses like occupational health, preventive and social medicine, public health etc are nowhere to be found in our universities. Prior to 1995, the highest level of qualification EHO holds is Diploma [of 3 years], it was only in 1995 that HND programme is introduced which produced the first graduate it first set in 1998. Despite of Environmental health as the oldest profession in Nigeria , it is very unfortunate that they can only graduate at HND level due to non- availability of degree course in the profession and even post graduate level. It is only Masters in Public Health that can be found in our Nigerian universities, which only admit medical doctors at the expenses of other health practitioners whom the profession is also applicable to them. Therefore, this wide educational gap between environmental health practitioners and other health practitioners cost them to be left behind, for as at now I do not know much of professors in Environmental health, Epidemiology etc compared to those in medical profession and others. Majority of EHO that passed out then and now preferred to switch to other profession[s] to further their education due to non-availability environmental health related courses in our Nigerian universities, infact even those that graduate through HND were no longer allowed to participate in NYSC since 1999 after the first two set of the HND programme passed out, and worth still there is no position as to when will the situation be rectified.

Next wonder is when diseases that are environmentally preventable are being discussed in term of prevention and control, you hardly hear or see any role[s] assigned to the environmental health officers. For instance, this Roll Back Malaria [RBM] programme, among its four intervention strategies, prevention and responses to epidemics [which Nigeria needs] is the least important. Emphasis on it was downplayed in favour of the other three measures which are: early diagnosis and prompt treatment; use of insecticides treated bed nets and mosquito control; and provision of malaria treatment for pregnant women to reduce impact of malaria infection on their health, and on the health and development of their children, are of economic gain to the companies and the promoters of goods to be used than that of prevention, hence the non giving priority to the prevention. This does not mean these three measures are not in order but they should go hand in hand with the prevention so that within few years to come the disease can be prevented and control at the same time. However, if always the curative aspect of it {malaria and many other environmental/preventable diseases] is being given high attention, we should be certain that all our mission and vision on controlling a disease[s] can never be realizable. More so in malaria prevention, environmental management is the key factor towards it prevention and even the control. Therefore the role of EHO is indispensable in this context and will cost less [and even if it will cost much it is only for some time before environmental situation of the nation be put in order], yet according to Dr Magashi “the pre-occupation of federal ministry of health, UNICEF, and WHO on RBM, is the provision of mosquito nets which commenced last year[2002], which is not within the reach of common man in the villages and town and also not affordable to afford” [emphasis mine].

To cap it all, environmental health officers in Nigeria are not in proper set up[which is in contrast with our South African brothers as presented in www.hst.org.za/sahr/99/chap20.htm that gives them room and chances of practice without being interfered or not allowed at all as a result of government factor by preferring other health services [precisely curative] to the detriment of their service and other health professionals factor that see environmental health as stumbling block to their source of livelihood which they must not allow to thrive and become relevant, and also the problem that the officers might have created on their own by being very passive in protecting and fighting for their professional rights. Therefore, if these kinds of problems are allowed unchecked, the officers will remain where they are and nowhere to go. Though all these problems are being address one by one by EHOAN at the national level [though some how passive], I hope better and reliable position will be reach and taken as we stand to hear from them, for they [we] have an arduous task ahead.

What we are hoping to see is the outcome of the recent meeting of technocrats and experts on environmental issues on environmental sanitation policy, which took place in Abuja recently to see whether or not it will be implemented or it will be left there as is common to us to discuss issues and left before implementation.

Tomorrow: Recommendation

For the recommendation, I quote [from 1-5] that of the 36th national conference/workshop of the Professional association of Environmental Health Officers of Nigeria [PAEHON] now EHOAN, which state thus:

1 “If public health must improve and get back to the level it was during the colonial era and in the early years after independence, the training and deployment of adequate number of Environmental Health Officers must be reconsidered and pursue as a developmental option on Nigeria.

2 “The increase in number of Environmental Health Officers in the service of the various tiers of government must be increased to meet the world Health Organization minimum requirement for the cadre which is 1 EHO to 8000 population.

3 “With industrialization, so many chemicals are being indiscriminately disposed of in various communities in Nigeria . An example of such community can be found among people living around river Kaduna and around Bompai industrial area of Kano . The issue of discharge of waste from industries should be made a local government issue. The health department and the affected community in the LGs areas should be strengthened to better monitor industries in their locality to ensure that industrial pollution is monitored before much damage is done to the health of innocent people.

4 “Urban development in Nigeria is in crises. There is no difference between a residential area and commercial area anymore. This has resulted in flawed development pattern seen in all our urban areas with its attendant high cost to health. Decree 88 of 1992 should be amended to ensure that the environmental health officer whose duty in settlement development can’t be over looked is given an opportunity to perform that the role unhindered. If public health must be the centre of development, Nigeria must once more restore the role of the environmental health officers to what it was during the colonial times.

5 “The relationship between disease and the environment is well documented and accepted. Nigeria has not been able to implement programme, which address the problem adequately from the environmental health perspective. If sustainable development is to be realized, policies in health and environment must be thoroughly examined and redress the imbalances which continue to ensure that our health system place more emphasis on drug and treatment instead of prevention through environmental health control”.

6 Lastly, the government at all level should create room or office or department for environmental health officers in their entire establishment [be it ministries, agencies, health institutions, local government in particular etc.], for their roles there cannot be overemphasized. So also in industries, markets, estate, residential settlements etc.

We do hope our leaders at all level will see reason and give more emphasis on preventive health services rendered by environmental health officers and other professional to the community, in order to save millions of naira being spent on diseases that are preventable with little or no success.

Sani Garba, contribute this piece from No 302, New Hospital Road , Kano .