Tuesday, July 5, 2011

Should Environmental health be retained in Ministry of health?

December 31, 2005

Environmental health means many things to many; some see it as 'waste management affair', 'inspection of premises' and others as 'control of diseases' only. Whichever divide you fall or see environmental health you are right, for, it does not only include them but encompasses every aspect of human struggle and survival. For the purpose of this paper, and the current National Environmental sanitation Policy, I would quote the meaning of environmental health as "the principles and practices of affecting healthful and hygienic conditions in the environment to promote public health and welfare, improve quality of life, reduce poverty and ensure a sustainable environment"

"A pleasant environment" said the policy "which is hazard free and promotes healthful living, is a fundamental right of all Nigerians. There is an increasing national consciousness on the need for judicious management of Nigerian environment in a sustainable manner; therefore, ensuring improved Environmental sanitation standard has become high on the political agenda of the government in the current democratic dispensation. This is demonstrated in the creation of Federal ministry of Environment [and state too: my emphasis] to address amongst other things, the problems of poor environmental sanitation and is expected to engender improved productivity and foster equitable share of the job and joy of national economic development"

I think it is based on these [perhaps] that recently Kano state government set up a committee to harmonize and transfer some departments and all environmental health practitioners from the state ministry of health to the ministry of environment to avoid duplication and fragmentation of environmental health services. Accordingly, if the transfer is affected, it will increase and maximize the efficiency of the practitioners in their new re-deployed ministry. Though the move is good considering the mission and vision of the current state government on environmental health, and more so they will be more relevant there [ministry of environment]in the thinking of the state, nevertheless, if implemented, it will create a problems and further complication between the two ministries over some works which are purely environmental health services on whether or not which ministry they supposed to stay. These and many more, will be discuss in this article for the state to look on the pros and cons of the move if implemented.

Ministry of Health [MOH] is the center point or nucleus of all health related issues of a state or nation, as such it is there that all policies about health and disease control are formulated and implemented in conjunction with other relevant authorities as the case may be through multisectoral approach. In any ministry of health, we have three [3] main divisions [notwithstanding other divisions, which directly or indirectly relates to either of the three]: protective, sanitary and medical divisions. The first two divisions employs public health and sanitary inspectors [aka EHO], and the later division which includes the National Health Services, employs trained medical staff like doctors, Nurses, microbiologist etc.

The protective and sanitary divisions are wholly preventive which is the work of environmental health practitioners in the ministry of health, and the medical division the work of other health workers; let us see the work of each division.



Protective Division



The protective division main responsibilities in the control of health and disease include the following: to ensure a high standard of food hygiene to control the spread of food-borne diseases; to ensure supply of water for drinking [urban areas], and to prevent pollution of public water supply to control the spread of water borne diseases; to prevent carriers of infectious diseases from foreign from entering the country at airports, seaports, and border stations; to organize vaccination and screening programmes [usually carried out by local health authorities]; to be alert to any outbreak of infectious diseases in the district and inform the public on the precautions to take to control its spread; to keep all public places, such as markets, public latrines, drains, etc, clean and free of pests and disease causing organisms. This includes killing stray dogs and many others [Ramlingam 1993].



Sanitary division



This division has the following responsibilities: to ensure the removal and proper disposal of refuse, especially in urban areas; to make sure that refuse is collected and disposed of properly; and to keep public burial grounds and cemeteries clean and hygienic. [Ramlingam 1993]

It is also the duty of sanitary division to ensure sanitation of abattoir and slaughter slab, sanitation of bake houses, housing sanitation, sanitation of public places, markets, hospitals and institution, sanitation of recreational facilities and hospitality industry and health & hygiene education.



Medical Division



This division provides the medical services essential in the control and treatment of diseases. It is, therefore, responsible for: setting up and supervising general hospitals, clinics, maternity centres and health centres; providing school health services, school dental services and welfare services; employing doctors, nurses, midwives and other medical staff for the above establishments; and supervising the filing of medical records and the compilation of health statistics [Ramlingam 1993].

Environmental health should and must be in the ministry of health, notwithstanding the creation of ministry of environment, for each of them has a role to play in collaborating with each other to make environment more conducive and hazard free for living and economic development. There is no point whatsoever to depend the move of the state government to engage in massive transfer of environmental health practitioners to ministry of environment without adequate arrangement.

Can't the state imitate the federal government where by the public health department [in charge of environmental health services] is still in the ministry of health not environment? For instance, departments like disease surveillance, port health services, epidemiology, immunization etc are still in the ministry of health, is FG unaware that it still retain them? Both the ministries are working together where they share similarities [though sometimes there is some form of conflict over who have control on so so]. But if the point is to avoid duplication and fragmentation [which perhaps Kano state think of], then the case is beyond harmonization. For environmental health services does not start and ends in a single ministry, it circumscribed any ministry.

Even though the current policy on environmental sanitation is formulated by the Federal ministry of environment, nevertheless, it alone can not do it, as various ministries are incorporated and inculcated to participate for better optimum results. Accordingly the federal ministry of environment [and state also] shall "formulate, review and produce" said the policy "environmental sanitation policy and guidelines; enact, review and harmonize existing legislation on environmental sanitation………develop master plan for biomedical waste and ensure its implementation……" . On the other hands the federal ministry of health shall "generate and disseminate data on environmental sanitation related diseases; collaborate with federal ministry of environment [FMOE]on vector borne disease control, especially in the environmental management control strategies for malaria, schistosomiasis, guinea worm etc; collaborate with FMOE in the promotion of sound food sanitation; and collaborate with FMOE on capacity building of environmental health programmes in sound environmental sanitation practice.

Based on these, the state government of Kano state should rescind her decision of deploying all environmental health practitioners to the state ministry of health, for doing that is ill timely prepared and not in good conscience. The most important issue to be address in order to enhance capacity building and efficiency, the environmental health practitioners in the two ministries should work as a team [depending on where your duty falls], and the state government should re-enforce the limit and boundary which each practitioner in the ministries can go.

But if the state government insist on deploying all environmental health practitioners to ministry of environment, then they must go with all environmental health related services [immunization inclusive], which there is inter professional fighting on whether it is preventive or curative medicine, while we know it is preventive, nevertheless, the current move by some medical practitioners is to ensure environmental health practitioners has no hand in immunization [which is purely their professional duty] is ignorance and greedy.

In fact I recently gathered that a final decision is reach on the deployment, the implementation is hampered by the lack of budget to accommodate them [which has been passed already before the effecting of the decision], whatever is the reason for the delay, the state government should rescind her decision. Even though I learnt that many interested parties are happy over the deployment such they can occupy the position that will soon be vacant, and the new to created [if any], nevertheless, the issue of professional competency should be regarded than personal interest of those to benefit from this ill conceived move.

I am also insisting that, if the deployment become necessary, let those affected move with all their professionally related works [departments] in their former place of works, this is the hard way and the only way.



Sani Garba Mohammed, contribute from PHC Department, Karaye Local Government, Kano state.