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Thursday, February 24, 2022

The challenges faced by Environmental health Practitioners in Nigeria

By Aniefiok Moses, FRSH, FSEH, MEN, PhD Culled from Journal Of Environmental Health, Vol 3, No 2, June 2006
For the purpose of this discussion, we shall consider the challenges under three main heading. These are • Structural and political • Attitudinal and psychological (human Factors • Attitudinal and technological Structural and political The Nigerian nation health policy (revised) and health resource allocation are skewed in favour of curative services. Although the health policy emphasized primary health care as its corner stone, budgetary provision has been deliberately made to strengthen and sustain expensive medical care at the expense of preventive health services at the ratio of 5: 1. 

Again the total budget for the health sector has continued to fall short of World Health Organization’s recommended 11% of total budge to be allocated to health in developing countries. The lack of equity in the allocation of health resources to keep the system going. Disproportionate allocation of resource to preventive health services started from the time of first national development plan, where allocation was N6.0m for curative and N1.0M for preventive health service. This trend has continued unabated to date. Equally, the proposed National Health bill being described as national hospital and health facility bill” has been drafted to strengthen the provision of medical services in the proposed bill. 

Obviously, environmental health services are resource intensive and the outcome is usually intangible at least not immediately, unlike building a health Centre or procuring an ambulance for the district cottage hospital. Politicians are usually engulfed in this web of maneuvering resources to please the sensibility of the public at the expense of their health. The politicians end up using public resources to build disease palaces and create a vicious circle where sick of malaria, for instance, go to the hospital to get ‘cured’ and returned to community, get sick again and return to the hospital again; and this process continue unstopped. Although we always recite that prevention is better and cheaper than cure, the reverse is the order in our society. 

Well! An aspect of environmental health which usually attracts the attention of the politicians is solid waste disposal. Their aim is to move the waste from sight in an attempt to maintain clean environment and also to provide patronage to political stooge by hiring any supported as a waste management contractor. At the end more confusion is created as the emergency contractors moved and dump waste everywhere without any recourse to public health implications of their actions. This is what can be termed politicking with the health of the public. Within this scenario, much more is spent on health while very little is achieved. Therefore, there is an urgent need to reverse this trend to put environmental health on the national agenda.

 Environmental health services should be well planned and implemented. There should be public-private sector collaboration in a well-coordinated system where professionalism and expertise are the watch word. Attitudinal and psychological (human factor) We have earlier started that environmental health practice and services are both human focused. This makes it one of the most difficult professions, attitudes and general way of life. It involves ‘probing’ into people’s privacy and challenging their very way of life. Most of the time the job of inspection and abatement of nuisances involve entering people’s sitting room, bedroom, kitchen and toilet. For this reason, the practitioners are always in contact with community members. Invariably, most community members usually develop resistance to this ‘probing’ and may also develop and demonstrate some sort of uncooperative attitudes. While this persist, time is usually lost and sometimes the nuisance in question may cause more damage, which may be life threatening or may lead to actual loss of lives.

 On the other hand, the practitioners’ attitude and general disposition to their job and the general public is always being called to question. Most EH practitioners have been accused of insensitivity to public feeling and general despondency to their job. Few practitioner have been accused of pursuing self-interest and materialism. Some of these accusation have been quite embarrassing to the profession. The greatest challenge is the negative image these attitude posed to the profession. Some suggestions have been on how to tackle image problems in the profession. 

It is pertinent to state that the environmental health officer’s registration council of Nigeria is positioned to deal with negative attitudes and tendencies of the practitioners and to ensure that the profession achieved the objective it was set out to achieve. In this respect, the council will do all in its power to limit negative attitude and ensure compliance to set standard and professional code of ethics so as to preserve the dignity of the profession at all time. In between the attitude of the public and that of the practitioners are psychological issues. Environmental health relates with several other occupation and professional groups. Sometimes there are inter-professional squabbles with the intension to prove professional to superintend over public health issues, the tendency are always to pull down its fabrics against all norms thereby creating inferiority complex among its members. This complex therefore impinged on the psychology of the practitioners either the capability to shift his focus from his professional roles. Indeed, this is a very negative weapon which is not only intended to weaken the profession, but also to ridicule its goal and mandate including its statutory responsibility to the public. Closely link to this is the low educational and socio-economic status of the practitioners. 

As a profession that relate closely to community members, the professionals are sometimes seen from the spectrum of those they serve. Economically, environmental health service is still regarded as public service. Most people do not believe that the services should be paid for. Indeed, to date over 99.1% of the practitioners are employed in public institutions and agencies. In fact, record from the council registry showed that none of the 3,000 EHOs so far registered is self-employed, with the low income of the practitioners, they are always looked down upon. This creates negative socio-psychological impact on the practitioners and the profession. Low educational status of the practitioners is a great hindrance to environmental health development.

 The history of environmental health indicates that from the inception of the profession in Britain. The practitioners were poorly trained, albeit to the level of skills needed at the time. As a highly skilled profession, environmental health practitioners should be well trained and always ready to respond to the need of the society. The pedigree of environmental health manpower development has affected the status of the profession. 

The development of environmental health profession has also been hampered by inadequate personnel with the prerequisite knowledge and skills to function efficiently. Again lack of resource persons to impart the necessary knowledge and skills have been a serious hindrance to the development of the profession. To date and before the present effort by the council to reposition the profession to meet the various challenges, there was no university in Nigeria that offered courses in environmental health at the degree level. Since the BSc in environmental & epidemiology program in university of life, now Obafemi Awolowo University [OAU] was scrapped in the 80s, the program could not be mounted by any other university in the country. This situation is likely to persist for a long time unless serious intervention is undertaken by relevant government agencies to liaise with institution outside Nigeria to establish linkage and exchange programs to build up a critical mass of environmental health trainers and faculty members that will be able to deliver environmental health core sources at the BSc degree level.

 Environmental and Technological The environment which the professionals operate is very hostile. Apart from inadequate basic infrastructures like good road, water supply and other amenities that supposed to facilitate environmental health services, people awareness about EH matters is still abysmally low. It is still very difficult to show the relationship between environmental health factors like fifth, heat, poor ventilation, poor food hygiene practice, etc. and the health of the community. With such low awareness, it is sometimes very difficult to prescribe any form of strategy to abate environmental nuisance that impact negatively on public health. Indeed there is total lack of environmental health culture in Nigeria. Environmental health technology like environmental health culture is lacking in Nigeria. Most of the basic equipment used for environmental health services are still being imported.

 To this end such equipment becomes very costly and unaffordable. There is obvious relevant technology gap. The heavy reliance on imported equipment and sustenance of efficient environmental health services. The problem is compounded by lack of inadequate budgetary provision for equipment, high cost imported equipment, wrong choice of equipment, diversion of equipment to other uses, high stock of obsolete equipment, poor technical support, lack of maintenance culture and lack of spare part. The situation calls for urgent intervention. Nigerians are very creative and innovative. Public-private sector partnership would result in the possibility of harnessing our huge potentialities to develop home grown technology for environmental health services. Institution like product and equipment development Agency (PRODA), Enugu should be encouraged to fabricate equipment for environmental health service. 

Indeed, there is need to look inward for community-based approach to tackling environmental health problems so as to ensure good health and sustainable development in Nigeria. Conclusion Enforcement of environmental health standards and regulations is hinged on availability of enabling environment; structural re-alignment; focused, holistic and sustained environmental health policy which is pro-preventive health; building positive environmental health culture and acquisition of appropriate technology and proper reorientation of public perception and attitude towards environmental health matters. For the profession to meet the emerging challenges there should be a deliberate policy to increase funding to support training of the practitioners and for the building of environmental health infrastructure and technology.

 Environmental Health Officers must seek for information and develop capacity to synthesize and make use of such information for their professional development. As a basic and essential service, environmental health should not only be seen as a public good, hence entirely public provided; it should also be seen as a mean to achieving a better health, indeed as window to shop for health for all (HFA), which appear very illusory challenge and leave behind every cynicism and move forward with renewed vigor to change the environmental health landscape for posterity.

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