Repositioning environmental and public health services at PHC level in Kano state

By Sani Garba Mohammed

Kano state did not have an agency to regulate or monitor primary health care activities until 25th March, 2012 when the then governor Dr. Rabiu Musa Kwankwaso signed the law setting up of Kano State Primary Health Care Management Board. The primary health care concern is providing quality, effective, efficient, equitable, affordable, reliable,acceptable, comprehensive, and accessible health care services at the grassroots for the promotion and protection of the general public. To achieve this, there must be multisectoral collaboration between various components of human resource for health, as no one component can deliver all the health services alone.

Considering how some health services received more attention than others, I will look at how environmental and public health services, which are central to the success of other health services, can be repositioned at primary health care levels for better and efficient interventions in Kano state.

 Environmental health as defined by the World Health Organization is “the control of all factors in man’s physical environment which exercises, or may exercise, a deleterious effect on his physical development, health or survival”. While public health is “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals”. And historically, public health starts with sanitation, therefore, ‘environmental health’ and ‘public health’ goes together. The following includes the functions or component of environmental health services: solid waste management; medical waste management; housing and environmental planning; food sanitation; sanitary inspection of premises; pest and vector control; epidemiological control; air quality management; occupational health and safety; market and abattoir sanitation; water sanitation; management of urban drainage; protection of recreational environment; pollution control; control of reared and stray animals; disposal of dead [man and animals]; port health services; environmental health impact assessment; weed and vegetation control; hygiene education and promotion among others, hence, the outcome of environmental health services are prevention, detection and control of environmental hazards which will affect human health Therefore, for this to be achieved we need to go back to the basic of first generating environmental and public health info of every premises be it residential, commercial, industrial, educational, hospital, etc., of our physical environment which is one of the position of National Council of Health meeting in 1994, 2000, and 2003 in Jos, Ilorin, and Kano respectively. 

 In order to achieve these, federal government produced national guidelines on environmental sanitation, sanitary inspection of premises, excreta and sewage management, school sanitation, solid waste management, market & abattoir sanitation, pest and vector control, food hygiene and control, injection safety & healthcare waste, laws and regulations, environmental health guidelines for sanitation in child care centres [pre-school] and special homes in Nigeria, environmental; health guidelines on meat inspection and abattoir sanitation, among others. In order to generate these information, section 5 subsection 2 of Kano state public health law, no 3 of 2019 provided that every premises shall have a file to be opened by Environmental Health Officer by filling a form call EH1 which contains all the necessary public health information identified in the above policies and empower him/her by section 5, subsection 1, section 6 [subsection a-c], section 11 [subsection 1-4], to enter any premises and do his work and even have the power of police constable while discharging his/her duties via section 52 and protected by section 55 while discharging his/her duties. When and if every premises has a file and its information is compiled, each would be classified according to its class, and its peculiar public health inspection checklist would be apply to it for routine inspection [form EH2] from time to time to ascertain its public health worthiness, whereby a certificate of either fitness for habitation, fitness for continued habitation or fitness for continued use of premises would be issued. The information generated/identified in any premises, public health issues detected, action taken are all documented monthly [via form EH 8] and at the end of the year [via EH 14/15/, is summarized for records and other government interest. 

 Considering these activities as important as it is, but were not being felt by the government, it set up an executive committee on sanitation in 2015 to see how these services could be integrated in one place for coordination and better results. The committee recommended what is called ‘Kano State Environmental and Sanitation Board’ KESAB to be domiciled at Kano Ministry of Environment, but that could not be achieved because there is no money to create a new agency, and the enormity & specialty of the designated responsibilities of the supposed board could not allow its integration into the then Refuse Management and Sanitation Board, REMASAB, a department of environmental and public health was created instead at the state primary health care management board on 9th December, 2015 at the state executive council meeting. For the department to succeed, discharge its duties as identified above, and justify its relevance in the scheme of health services and maintain a lead, impact, dedication, and direction, it must be innovative, accommodative and responsive, for, the coinage ‘environmental’ and ‘public health’ placed a great task on it, and government is looking to see more of its activities, via regular report & activities, and others, precisely now that the new nomenclature in the world is ‘environmental public health’, which places more burden on it. 

 The state public health was amended in 2019 to be in tune with the current needs, all policies, regulation, laws [around 50] in my count, should be made available to every practitioner [technician, technologist and officer] to study, and be familiar with it, so that they can apply it at the specifications of their jobs description. Equipment like Dissolved Oxygen (DO) meter, calorimeter, measuring tapes, thermometers, P.H meter, turbid meter, noise peak meter, carbon- monoxide (CO) analyzer, infrared analyzer, and others should be provided for environmental health workers to do their work scientifically. 

 Also, the department should liaise with relevant ministries and units where there are environmental health officers for synergy and collaboration to avoid conflict while discharging their duties. With this put in place, it should develop a short, medium and long term planning based on the ‘national strategic plan for environmental health 2015-2025’ for measuring performance against the plan.

 These activities as important as it is, cannot be done without training of the practitioners involved in the modern approach of practice which is now digital and technological, as such, their services need to be scientifically sound, socially acceptable, educationally to the standard, and go with the current trend as it is obtainable elsewhere. If environmental public health could be given serious attention by relevant authorities, certainly, the burden of diseases and other preventable tragedies can be prevented and put under control. 

This is a task that must be done to make Kano free of not only preventable diseases, but also lead in health, safety and environmental issues. Now that the Executive Secretary of Kano state primary health care management board, Dr. Tijjani Hussaini is reforming and modernizing every aspect of primary health care services, I am very sure he will give this suggestion a serious thought for the improvement and betterment of primary healthcare services.