Thursday, December 8, 2011

MANAGEMENT OF ENVIRONMENTAL HEALTH OFFICE AND ITS COMPONENTS

BY Ebisike Augustine O.


PREAMBLE
Environmental Health refers to the control of all those factors in man’s Environmental that cause or are likely to cause deleterious effects on human health. As broad as this concept may look, it can be conveniently implemented by the institution in all necessary frame works ranging from modalities for the mobilization of personnel, equipment and other resources whose provision are central to the success of any intervention measure.

As important as the provision of those resources are, their utilization and/or application rests squarely on the availability of a good physical structure that will house both human and material resources employable for the attainment of the set goals and objective of any pubic/environmental health intervention. The organization of such human and material resources require professional handling quality assurance

HISTORICAL BACKGROUND
The Environmental Health Practice in Nigeria traces its route back to the Colonial Era when the Colonial Masters introduced the Sanitary Inspectors and tasked them to ensure all Communities in the country are sanitarily maintained. The Sanitary Inspectors operated from various Native Authority Offices in all the Regions. The Metamorphosis of the Sanitary Inspector over time through to the post colonial era brought along with it changes in domiciliation of the practitioner, until the time the Health Superintendent was domiciled at the Local Authorities where there was provision of Health officers in the Districts under the Local Authorities .

Besides the Local Authorities the State Governments also had their own Offices known as the Government Health office which were located in major towns across the state under the Supervision of what was known then as the Medical Officer of Health Superintendents who served as extension officers.

On the part of the District Health Offices which were under the supervision of the District health Superintendents, they served as the liaison spot for the delivery of Preventive Health Services to the nooks and crannies of the District. Majorly, these services ranged from Sanitary Inspection to Insecticide spray, Mosquito larva survey, meat hygiene, immunization against vaccine preventable diseases. Their exploits are still being reference in our present day Nigeria as they are yet to be matched. This is attributable to the fact that the Government paid the necessary attention to the Health Offices providing equipments and materials for the smooth operations of the Offices even though there were fewer Manpower available.

THE SITUATION NOW
Although the number of Health Offices has increased with the creation of new Local Governments, their output has been on the decline due to a number of factors chief among which include shortage of manpower, lack of working materials, poor financing, lack of political will. These and many other have played prominent roles in making the fortunes of the health offices to dwindle.

The situation is so pathetic that a good number of the offices are structurally defective and do not have basic needs of a decent office accommodation namely adequate space, furniture, stationery etc. that enable smooth running. These conditions are in themselves contrary to provisions in the various Public/Environmental Health Laws the offices are established to enforce. How worse could an Office be with no provision of sanitary conveniences for staff, waste collection and disposal, safety equipment etc. You will find horrible sights ranging from worn-out paintings, peeled off plastering to sagging ceilings, broken floorings etc.

The Se have made the Offices look horrible and make those inhabiting them have feelings of dejection and all motivation which in turn pushes them to truancy. EHOs in most instances become subjected to mockery from members of the public whose premises might have been inspected by the EHOs previously asserting that their premises are better off the Offices

All these factors have had their tolls on the fortunes of the Health Office resulting in mediocrity, indolence and apathy.

REVERSING THE TREND
Now that the profession is witnessing reform aimed at improving services delivery and efficiency, there is need for conscientious effort to be exerted in making things work again such that diseases prevalence can be reduced to the barest minimum.
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This can be achieved by reorganizing the smallest unit in Environmental Health Services Delivery i.e the Health Office. The reorganization can be done in the following manner.

3.1 INTEGRATION OF EH COMPONENTS INTO THE HEALTH OFFICE STRUCTURE
The Environmental Health Profession according to WHO consists of the following components Waste Management Food hygiene and control pest and vector control; environmental health control of housing and sanitation epidemiological investigation and control air quality management waster resources management and sanitation pollution control and abatement health promotion and education; enforcement of environmental health quality standards; and environmental health impact assessment

Currently only a few of the component are entrenched in the scheme of things in the Health Office while other are not visible at all. Control of housing and sanitation for instance is long conceded to the Works Ministry/ Department of the State/ Local Government, air quality management is no longer accorded any placement, health promotion and education long forgotten, pest and vector control relegated to the backstage, while environmental health impact assessment is still a mirage.

The subsisting component can be revalitised alongside incorporating those excised thereby making the office active again.

3.2 RESTRUCTURING OF OFFICE
The Health Office can bounce back to life if it is made business like in terms of manpower, coverage area and service delivery as follows.

SERVICE DELIVERY
Environmental Health Services are diverse in nature cutting across all spheres of human endeavour form the home fronting to work places which include emerging and re-emerging issues and diseases. Besides the traditional House- to- House inspection, regulated premises inspection. Market Inspection that have become hallmark, of the Health office, services such as abattoir inspection, Meat, fish and poultry inspection must be given adequate attention in view of their importance. Other areas requiring attention of the health office include mosquito survey for the determination of the various species and their habitats which will then enable adequate control measures including outdoor spray of larval and pupal growth areas. This will not only get infested areas rid of mosquitoes but also help in bringing down malaria incidence rates and reduce the escalating resistance to anit- malarial to the barest minimum. This will reduce the volume of foreign exchange expended on the importation of anti malaria drugs, bed nets and the number of illnesses and deaths associated with this disease in Nigeria.

For a very long time, water sampling analysis has become extinct from the function of the health office owing to its neglect by governments in succession resulting in grave consequences to public health. Hospital records show increasing prevalence of water- borne diseases across the country in addition to figure recorded during epidemics.

Decentralization/ specialization
Traditionally, Environmental Health practitioners carry out all environmental health duties all year round. At this age of advancement the status quo should not be maintained for any efforts of making meaningful any attempts to revolutionise the profession to succeed. One can not imagine how a few officers in any given health office cope with myriad of issues in such offices with no classification of schedules between them. This obviously results in incoordination and ineffectiveness.

This paper aims therefore to suggest taking a modern approach that will see to the introduction of schedules (teams) in the health office in order for efficiency to be entrenched. Officers could be assigned any particular schedule for a rotational period of one year thereby making grounds for enhancements in their services deliveries. The underlisted would be appropriate schedules for which one two or more EHPs can be assigned to handle.

Food establishments including restaurants, dairies, bakeries
Water packaging premises and their likes
Residential dwellings
Recreational establishments including hotels, guest house, stadia etc
Commercial premises including markets, supermarkets, etc
Animals slaughter houses and meat shops, cold rooms etc
Special, team whose task will include water quality surveillance vehicular emission inspection.
Schools Offices premises
Industrial premises inclusive of major process factories offensive trade outfits, carpentry, mechanical, technical workshops ect.
Building construction sites, construction companies construction safety, health and environment, building approval appraisal and approval etc
Sanitary complaints documentation and investigation, court procedural actions and litigation etc.
Data management, research and planning, advocacy and public relations
Although this may look too elaborate for the standings of the health office, it is nonetheless futuristic in that some of the schedules could be merged depending on the nature of the community (rural, urban or semi-urban) being served, the manpower available as well as the size and population of the area. For areas like say, Lagos Abuja, Portharcourt and Kaduna all the listed schedules can apply.

For Environmental Health Practice to regain its lost glory, it has to fit into the political landscape of the country where there is a paradigm shift from the conservation postures to more liberal ones. The Health system in general has been adapted to this shift with the introduction by the National Primary Health Care Development Agency of the Ward Health System in 2002. The system emphasizes or recognizes the Political Ward as the smallest until of the health care delivery system. This brings to fore the need for Environmental Health offices of be located in all the Ward throughout the Country for better reach.


Personnel
The delivery of any service depends to a large extent on the adequacy of personnel assigned the task. Population of Environmental Health Personnel have in a very long time been on the decrease owing from embargo on employment which makes impossible, replacement of deceased, retired or resigned EHOs from the services of Federal, States and Local Government services. This unfortunate development no doubt has contributed immensely to the deterioration of the practitioner’s output wherein only a few hands are saddled with the ever increasing tasks.

The situation can be handled squarely when the needed manpower are engaged. For effective coverage regimentation needs to be applied based on seniority hence a health offices ought to be managed (headed) by a Chief EHOs with an Assistant Chief as the second in command. Others are.
1 PEHOs
2. SEHOs
3 HEHOs
4 EHTs
EHAs
1 clerical officer

Financing
The Health Office has had to suffer a lot of neglect due to financing problem. One will not be wrong to assert that it is the only government outfit that is run without government funds and hence allowed in the mercies of the people running them. One unpardonable excuse employers always advances is the fact that the Health Office is a liability and hence deprives it of the desired financing. There is no gainsaying that this lackadaisical attitude of government led to deterioration inherent in the health offices because all working materials are self-provided by the staff hence their excesses in generating funds by illegal means.

For this ugly development to be reversed therefore, Government must create budget line for the health office to enable it dispense its roles and responsibilities. Enough money should be voted for essentially over-head costs that will be devoted to the day to day running of the office like transportation and procurement of stationeries etc.

Government could also make the health office an internally Generated Revenue (IGR) earner in this finance crunch time. Below are some of the services that can earn the government the much needed IGR.

Certification of Premises for habitation
Certification of Premises for continued habitation
Food vendors permit
Fines from EH Laws offenders
The model environmental health management plan the model environmental health management plan is meant to be used as a guide and/or framework for the creation of premises specific environmental health plan
Excavation permit
Fill material permit
Well sinking permit
Swimming pool permit
Septic tank emptying plan permit
Septic tank abandonment permit
Food concession permit at special occasions e.g conference, sporting activities etc.
Waste water permit
Issuance of fumigation certificate

Staff Reorientation
The long neglect of the health office has brought along with it the diminishing productivity of the EHPs as they resort to perpetrating unprofessional conducts to the detriment of the job. It is common knowledge that bribery is thriving very well in all the health offices in the country.

This is situation that must change hence the need for the staff to be exposed to specialized training at interval which will only aim at attitudinal change. Another strategy that will pay off well is the stepping down of the servicecompact (SERVICOM) to the ward level with a view to making those responsible appreciate the need for them to serve their communities to the best of their ability. Part of reorientation will be retraining on specific areas which are critical to services delivery as well as structured and formal education undertakings in various institutions of learning.





Shift Duty
The issue of Environmental Health practice has become a 24 hours job. The concept of 8am to 4pm Monday to Friday has to change as job requires a 24 hour 7 days a week, 365 day job. There is therefore need for the health office to run on a 24hour bases running three shifts of 8 hours each. This should also mean that a special salary scale should also be considered for these practitioners.

Data Management
Data generation remains a key challenge in environmental health because of the long time negligence of the sector. Activities undertaken are not recorded. Such that basic information regarding for instance the number, type and category of premises key elements in their monitory and appraisal are completely lacking.

Concerted effort must be made to ensure the formulation of an environmental health management information system (EHMIS) that will have the health office as its primary input source and linking with local, state and federal government authorities responsible for environmental health matters.

Reporting Lines/Linkages
The following flow chart will serve as the hierarchy of the reporting system .
Filed terms (1,2,3,4,5,6,7,8……….denoting schedules)

Filed teams leaders (A1,2,3, B1, B2,C1,C2,….(denoting grouped schedules)

Teams Coordination

Assistant Chief EHO

Chief EHO (i/c Health Offiec)
Deputy/ Assistant Director Unit Health (LGA headquarters)


Director, Environmental coordinating for Health Offices

Note: A Team Leader coordinating more than 1 teams
The same structure can apply to the Health Offices belonging to the State Government for uniformity
Office Accommodation
Owing to the established neglect majority of health offices do not have office accommodation. Where they have in most cases they are situated within health clinics, markets and other public buildings which often than not are dilapidated, too small and inadequate.

The health office as custodian of health well- being of the environmental should be befitting for habitation hence the need for its modernization to current standards. A model (prototype)comprising of the following could be adopted for building in all the Ward across the country.
4 nos. Offices 12” x12” in dimension
3 nos. Office 16” x 16” in dimension
1 no. Conference room 20” x20” in dimension
1no. Front office (Waiting room)12”x12” in dimension
1no. Library
1 no. Store

Equipping
It is an established fact that no work can be executed without working materials. This is applicable to the health office which is left to function without provision of the necessary working equipments.
Depending of the location and size the health office should be given adequate attention in terms of equipment with the following as necessity.

At lest unit of Lap-top Computer
2 no. desk jet printer
1 no. Refrigerators
Knap- sack sprayers
Water sampling kits
Fogging machine
Safety equipments e.g Overall, coverall, boots, helmet, masks etc
Dissolved Oxygen (DO) Meter
Colorimeter
Noise Level Meter
Air Samplers
Dust Sampler
Units of Desk- top Computer
2 to 3 motor- cycles for outreach
Service/ Data Generating Forms e.g Abatement notice Inspection forms etc.
Measuring tapes
Cold boxes
Thermometers
P.H Meter
Turbid Meter
Noise Peak Meter
Carbon- Monoxide (CO) Analyzer
Infrared Analyzer

CONCLUSION
One is of the opinion that the time to act is ripe for the profession to fashion out ways of collaboration with major stakeholders i.e Government Practitioners and communities on one hand and on the other mobilize support of international donor partners, multi-national and national corporations towards improving services delivery. This will serve as catalyst for the realization of the MDGs which have direct bearing on environmental health.

This collaboration should focus on capacity development, logistics, and provision of infrastructure, community mobilization, and advocacy all targeting at entrenching international best practices.