Environmental Health in Nigeria and the way forward

By Abiodun  Peter Bamigboye [Now late]

Introduction

Environmental factors play an important role in health and disease among the population of particular concern are young children and other high risk population group. Scientists have long worked to understand the environmental and humanity’s place in it. The search for this knowledge grows in importance as rapid increase in human populations and economic development intensify the stresses human beings place on the biosphere and ecosystems. People want to be warned of major environmental changes and, if the environment is under threat, want to know how to respond. Fortunately, rapid increases in scientific capability-such as recent advances in computing power and molecular biology and new techniques for sensing biological, physical, and chemical phenomena below, on, and above the Earth’s surface – together with the rediscovery that the human-environment relationship is a critical topic for the human sciences, are making it possible for science to provide much of this knowledge. The scientific excitement and challenge of understanding the complex environmental systems humans depend on, making the environmental sciences centrally important as humankind attempts a transition to a more sustainable relationship with the Earth and its natural resources.

The influence of the environment on health are varied and complex. Diarrhea, caused by unsafe water, inadequate sanitation and poor hygiene, accounts for 15 to 18 percent of child deaths annually. Malaria is responsible for 2.5 million deaths each year, mostly among young children. Acute lower respiratory infections (ART), mainly pneumonia – which has been closely associated with exposure to indoor smoke from cooking with biomass fuels, are the leading cause of death for children under five years of age.

A great deal of the underlying causes of disease, injury, and death in developing countries lie beyond the purview of the health care system. They cover a range of physical factors (inadequate sanitation, water, drainage, waste removal, housing, and household energy) and behavioral factors (personal hygiene, sexual behavior, driving habits, alcoholism, and tobacco smoking). Many of these environment- and occupation-related health problems turn into public health problems when they become widespread, a factor aggravated by inadequate public health infrastructure. Yet, policies in the sectors responsible for these negative health impacts are often not based on health criteria. The health sector itself tends to focus its interventions within the health care delivery system, not necessarily in other sectors that are the source of the problem^2,3. Similarly naturally occurring ecological factors that can exert negative impacts on all sectors (mosquito-borne diseases, arsenic in the water, floods, droughts, and so on) are seldom addressed systematically by any of the sectors at risk, even though some sectors may be exacerbating their effects (spreading mosquito habitats, consuming great quantities of water, or producing greenhouse gases that may worsen climate change). As a result, the enormity of health benefits possible through interventions outside the health sector is not being tapped. Environmental Health interventions are one of the important of those neglected areas.

The subject of Environmental Health (EH) is undoubtedly one that has generated a lot of debates both locally and internationally. It is a sector or sub-sector that is largely talked about but receiving little or no attention in many places particularly in developing countries of the world. The WHO’s concept of health brought in focus the ecological as well as the sociological paradigms of health with a view to holistically addressing issues relating to health and wellbeing. If health is seen not just as the absence of disease but also as a central goal of human development, then the protection of the environment and the protection and improvement of health are mutually supportive. It is against this background of increasing international focus on environmental sanitation, that the Committee on Environmental Sanitation was established by the first World Health Assembly in l948. The Committee’s first, groundbreaking report, published in 1949, concluded that physical development, health and survival, depended on the management of environmental factors which included excreta and community waste disposal; safe drinking water; food safety; healthy personal habits; understanding the causes of diseases; and, the control of disease vectors. It was decided to focus action on the reduction of infectious diseases by monitoring how they respond to environmental management, and that the lessons learned in public health engineering from the sanitary revolution in Europe and the Americas would be of particular value. Changes from old patterns of life were an essential precondition for the achievement of better environmental health. The historical account of the contribution of EH in 19th and 20th Century United Kingdom in ensuring good health and its adoption by the WHO as a fundamental approach to addressing global health situation underscores the relevance of this sub-sector.

During the 1 990s, a series of reports from think tank agencies, the World Health Organization (WHO), and the Centers for Disease Control and Prevention (CDC) rated environmental concerns among the most important health issues and global threats. They also ranked environmental public health and sanitation accomplishments among public health’s greatest accomplishments. The 30-year increase in life expectancy to 76.7 years from 1900 to 1998 has been attributed to environmental public health monitoring and regulation of the water supply, sewage systems, and food quality, as well as to immunizations and primary preventive care. As a result of proper sanitation, more than 80% of human disease has been eliminated The strong tradition of environmental public health and sanitary services was maintained through the middle 1 960s, when new environmental problems gathered attention: globalization of the food supply; contamination of drinking water; air and noise pollution; ionizing radiation; proliferation of solid and hazardous waste, disease vectors, and wastewater; and degradation of housing, institutional services, and environmental conditions in child-care facilities.

What is EH?

Environmental Health has been defined as the science which study the biological, chemical or physical agents introduced into the environment or occurring naturally and their effects on human health and ecological systems. The field also includes the study of human activities, a vital component in our complex ecosystem 6 (UGA, 2005). In another sense, ER is understood as the science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. Toxicology and occupational health are also included in this category.

Environmental health as used by the WHO Regional Office for Europe, includes both the direct pathological effects of chemicals, radiation and some biological agents, and the effects (often indirect) on health and wellbeing of the broad physical, psychological, social and aesthetic environment which includes housing, urban development, land use and transport. In general term, EH comprises those aspects of human health, including quality of life, that are determined by physical, chemical, biological, social, and psychosocial factors in the environment. It also refers to the theory and practice of assessing, correcting, controlling, and preventing those factors in the environment that can potentially affect adversely the health of present and future generations. It would be seen from the foregoing that the scope of this field is wide and varied. These areas in which EH should focus include but may not be limited to those in table 1 below.

Table 1: Typical Responsibilities of Environmental Health and Protection Programs

• Ambient air quality
• Indoor air quality
• Water pollution control
• Safe drinking water
• Noise pollution
• Radiation
• Food safety
• Industrial hygiene
• Childhood lead poisoning
• Acid deposition
• Disaster planning and response
• Cross-connection elimination
• Healthy housing
• Institutional environmental control
• Recreational area environmental control
• Solid waste management
• Vector control
• Pesticide control
• Toxic chemical control
• On-site liquid waste disposal
• Unintentional injury control
• Bioterrorism
• Global environmental issues.

These services are provided by various cadres of trained personnel generally referred to as environmental health personnel who serve the general welfare by safeguarding and improving the quality of food, shelter, air, water and other natural resources. The role of EH in health and disease cannot be underestimated. One is quick to refer to the great sanitary reforms which follows the historic cholera outbreak in UK and the various feat achieved in the control and/eradication of some other diseases. The contributions of EH to the global burden of disease is also very significant (see table 2 below).

Table 2: Environmental Factors and the Global Burden of Disease: Proportion of Global DALYs Associated with Environmental Exposures (1990)

Diseases	Global DALYs 1000)	% attributable to envtal. factors	Envtal DALYs (1000)	% of all DALYs (all age group)
ARI	116,696	60	70,017	5.0
Diarrheal diseases	99,631	90	89,670	6.5
Vaccine preventable infections	71,173	10	9,117	0.5
T.B	38,426	10	3,843	0.3
Malaria	31,706	90	28,535	2.1
Injuries Unintended	152,188	30	45,656
Intended	56,459	NE*	NE	3.3
Mental health	144,950	10	14,495	1.1
Cardio vascular disease	133,236	10	13,324	1.0
Cancer	70,513	25	17,628	1.3
Chronic respiratory diseases	60,370	50	30,189	2.2
Total these diseases	975,350	33	320,470	23.0
Other diseases	403,858	NE	NE
Total all diseases	1,379,238	23	320,470

Source: WHO (1999). NE-Not Estimated

Failure to address peculiar EH problems has very grievous and economic implications with serious development implications. For instance, it is one record that the global neglect of EH sub-sector has the following development implications:

• 2.4 billion people lack access to basic sanitation
• 2 million people die every year from diarrheal diseases (including cholera) associated with inadequate water supply, sanitation and hygiene
• The majority are children in developing countries
• Water, hygiene and sanitation interventions reduce diarrhea incidence by 26% and mortality by 65%
• 200 million people, in 74 countries, are infected with schistosomiasis and soil-transmitted helminthes and 20 million suffer severe consequences
• Basic sanitation reduces schistosomiasis by up to 77%
• 500 million people are at risk from trachoma and 146 million are threatened by blindness
• Trachoma can be prevented by improving sanitary conditions and hygiene practices.

The need to reverse this ugly trend became necessary globally and WHO had many years ago realized this necessity. To spearhead these changes WHO was asked to develop/refine international sanitary standards and guidelines for national health services to involve them in priority environmental health programs, and to educate the public. Specifically the organization undertook to:

• Link environmental sanitation with other health-related activities
• Cooperate with other UN bodies
• Undertake demonstration projects, especially for rural sanitation
• Promote research and disseminate information
• Cooperate with governments in strengthening national health services in environmental matters, and develop human resources.

Since its inception in 1948, WHO has had to define how it would pursue the achievement of “The improvement of EH as called for in Article 2(1) of the Constitution. “The First World Health Assembly gave environmental sanitation the same priority as malaria, maternal and child health, tuberculosis, veneral diseases and nutrition and these priorities became known as ‘the big six’. It is a known fact that while some most developed countries have accorded such priority to EH, many of the countries in the South had not.

WHO has always maintained that EH and particularly sanitation is literally the foundation on which a sound public health structure must be built. The organization has also maintained that over 75% of all communicable diseases affecting humans are environmentally related. Over the last 50 years WHO has generated, evaluated and Shared new knowledge on safe disposal of excreta, sewage and community waste and has also been at the forefront of exploring the linkages between environmental pollution and change, and people’s health and livelihoods. There is no doubt that people, especially poor people living in countries where basic infrastructure is lacking, are seriously affected by environmental degradation. In addition, the ongoing and deteriorating situation of sewage causing environmental pollution needs urgent and serious attention.

The Millennium Development Goals (MDGs), adopted at the Millennium Summit of the United Nations in September 2000, call for a dramatic reduction in poverty and marked improvement in health h of t he poor. Access to safe water and sanitation is fundamental for better health, poverty alleviation and development; and improving water and sanitation services has been recognized as a crucially important strategy towards meeting the MDGs . Such an achievement is feasible, but given the scale of the problem, especially for sanitation facilities, far from assured.

Experience shows that while the importance of sanitation is recognized, progress is lagging far behind compared to the provision of safe water. The toll on human health is high, resulting in about 2 million deaths per year from diarrheal diseases and approximately 2 billion people infected with schistosommiasis and soil-transmitted helminth infections globally. A host of other diseases are related to poor disposal of human excreta, poorly constructed or managed latrines, and poor solid waste management and drainage. If the toll on human health and human life of all of these sanitation-related conditions could be effectively added up, it would truly reveal a tragedy of grave proportions. Therefore something has to he done.

The Challenges EH

Efforts at improving El-I services must address specific problems and challenges so as to accelerate service delivery for greater effectiveness. Globally, EH challenges operate within the context of the following issues

• Increasing urbanization

• Ageing physical infrastructure coupled with lack of preventive maintenance

• Sharpening inequalities, polarization of society and choices

• Decaying family and community fabric

• An ageing population

• Increasing stress

• Centralization of decision making and power – but local nationalism

• Extremism/fundamentalism/terrorism

• Environmental degradation

• Diminishing natural resources

• Need for sustainable environments and sustainable lifestyles

These challenges are also manifesting in an environment whereby specific issues likely to hinder effectiveness arc apparent. These constitute serious threat to El I services in many places in the world. As a matter of fact, predictions for specific future of EH services should bear in mind:

• Emerging & re-emerging pathogens

• Resistant and virulent strains

• Bio-terrorism

• Global warming – related health problems & natural disasters

• Population movements

• Water shortages. & related conflicts

• Energy shortages

• Infrastructure failures

• Social polarization

• Globalization of markets and products

• Greater awareness of Genetic susceptibility of individuals and groups

• Improved toxicological techniques

• Better informed public; class actions

In Nigeria, efforts directed at improving EH services are challenged by the following factors:

1. Weak Governmental policy and legislations.

Many people had argued that policies are non-existent but the fact is that no nation exists without one form of policy or the other. Policies directed towards improving EH services in Nigeria are weak and ineffective. There also seem to be some constitutional defects in the role definition as regards responsibility for ER matters. While it is generally believed that ER services are largely the responsibility of LGAs. It is a known fact that LGAs as presently constituted, financed and managed would be unable to ensure a healthy environment. The need for a reappraisal may be necessary. The National Policy of Environmental Sanitation championed by the Federal Ministry of Environment is a right step towards addressing this problem. However, its implementation must be devoid of sentiments, and unnecessary bureaucracies.

In addition to this is the fact that most EN legislations are either obsolete, inconsistent or had failed to take cognisance of the cultural settings in which they are supposed to operate. The need for suitable legislations to address specific EH issues is urgent.

2. High level of ignorance.

To a large extent, many people including many of those expected to provide EH services have not fully appreciate the significance of the environmental dimensions of health and the correct issues involved. Specifically many people particularly mothers have not fully understood the link between personal/public hygiene, health and disease as well as the ways to break the link. In addition to these, many policy makers and professionals still hold on to the restrictive bio-medical approach to health and disease.

Where knowledge is low, incomplete or incorrect, there is the tendency that people’s ability to make informed decision about their health would be limited and their exposure to risks aggravated.

3. Poor political will and commitment.

In many places, there is poor political will and commitment. This lack of will also include the lack of will to make realistic plans and the poor will to implement plans. EH services required commitment on the part of all stakeholders towards the realization of program goals. It must be appreciated that mobilization in favor of improved ER has been poor, non-specific and sometimes misdirected. There is need to increase the commitment of all. This is particularly required at the LGA level.

4. Poor funding of EH Services.

Funding for ER services have been poor over the years compared with other sub-sector. Though it is difficult to obtain how much had been spent by each tier of government on ER , it is generally believed that the sector had not been favoured in the allocation of needed resources. In many states of the federation, many LGAs are without a functional refuse van while other implements required are either insufficient or non available. The success of most EH programme is directly dependent on the amount of resource inputs and this has to be appreciated. In addition to this, lack of resourcefulness is another factor that has bedevilled the sector. In most cases, the little resources allocated are really not available to prosecute ER services due to undue corruption. In many places, EH services are seen as one of the main conduit pipes through which funds are siphoned. The need to be more resourceful is considered very important.

5. Training and Human resources Development.

By an large the training of most ER personnel takes place at the state government-owned Schools of Health Technology/Hygiene which are expected to be of the status of a Monotechnic . There are about 35 of such schools in Nigeria. The standard of many of these schools leaves much to be desired. Coupled with this is the fact that the country used to be the pioneer of a University-based ER training programme in Africa. The then UNIFE (Now Obafemi Awolowo University, Ile-Ife) B.Sc EH programme was famous during its years of existence as the only one in Africa. Today the story is different as the programme was rationalized under questionable circumstances around 1990. Training and human resources development must be seen as an important aspect of evidence- based ER service delivery. The Council’s effort in this direction is welcomed and its expected to be complemented by training institutions so that more competent professional could be trained.

The way forward

Moving ER service forward in Nigeria requires a radical approach towards the provision of improved services. The services are expected to be universally accessible to people irrespective of where they live. It should also be culturally, economically and socially adapted to each local setting and directed towards addressing specific health and development problems.

To make environmental health a really potent force in the 21st century, important changes are needed. To some extent, these changes are a problem of money and resources and pose a political question: what priority should be given to environmental health within the full array of social needs and wants? But they also raise problems in communication, in education and in technology development itself

Reflecting WHO’s corporate strategy, EH activities should focus on six strategic areas of work which are:

• Ethical and evidence-based policy.

• Stimulating research and development, testing new technologies and comparing performance.

• Technical and policy support for sustainable capacity building.

• Setting. validating, monitoring and guiding the implementation of norms and standards.

• Assessing status and trends.

• Developing tools and guidelines for disease control and risk reduction.

Revitalization of environmental public health services in the country is important for four reasons:

1. Many environmentally related conditions affect the health and lives of millions of citizens at significant cost,
2. Many emerging and re-emerging public health problems require innovative enviromnental public health services interventions,
3. Environmental public health is an important part of the public health response to terrorism and other emergencies, and
4. Environmental public health services issues are becoming more complex.

Specifically, the following has to be addressed as a way forward for effective ER in

Nigeria:

1. EH policy and Regulation.

There is need for Government at all levels to ensure that policies are directed towards addressing environmental health problems. Policies must clearly indicate what is to be done, by who and also include system for monitoring and evaluation of activities. In addition to this, there is need for appropriate legislations to address specific issues. The obsolete Public Health Laws (1958/59) as applicable in different parts of the country must be reviewed. EHOAN/EHORECON’s initiative to get a suitable legislation should be supported by all. If there are grey areas that need to be addressed, this should be sorted out.

2. Advocacy.

In a system where both government and individual priorities are misplaced in disfavour of ER, the need for a planned advocacy strategy becomes very needful to sensitize all stakeholders towards improved services. There is need for both policy advocacy as well as personal advocacy in favour of ER. To ensure service sustainability requires indigenous advocacy. In this wise everyone must be involved. Everyone who cares can be an effective policy advocates. The media has a unique role in this strategy particularly in providing correct information to members of the public, in letting the government know what they should be doing, and in advocating for good practices.

3. Intensifying Hygiene Education

ER professionals must take leading responsibility in modifying their approach to providing ER services. It must be clear to all that most traditional approaches towards service delivery are no longer fashionable. Efforts must be geared towards achieving positive behavioral changes in matters relating to El-I. This might require a review of the present curriculum of instruction in the training schools as well as a re-orientation of all stakeholders.

4. Inspiring a Shared vision.

Application of the concept of shared vision is important for improved EH services. Efforts directed at improvement as well as the strategies to be adopted must be shared among all stakeholders. Shared vision demands partnership and collaboration which is expected to have multiplier effects towards realization of targets. Coupled with this is the need for team work among all stakeholders. Levels of government must see the joint responsibility in ensuring a safe environment for health.

5. Fostering Leadership

This is important so as to ensure that the goal of ER services is enhanced by environmental public health services and also develop strong working relationships among the stakeholders in EH services and to assist state, tribal, territorial, and local health entities and other stakeholders to improve the practice of EH This goal requires development of a National programme to create a cadre of well-trained specialists who will become leaders at all levels of ER service delivery. The professional association in collaboration with the Council would be expected to champion this course.

6. Communication and Social Marketing

The intent of this goal is to improve communication and information sharing among EH professionals and other public health agencies, communities, policy makers, and others and enhance the significance and understanding of environmental public health. Achieving the goal also will define the structure of an effective system for sharing EH information. This goal will be accomplished by promoting and disseminating strategies. Education approaches, and models of best practices to engage communities and policy makers in discussions about EH issues.

7. Developing the Workforce

This strategy is expected to promote the development of a competent and effective EH workforce to deliver contemporary services and address emerging needs. Implementation of this approach includes defining the scope of work as well as the size, composition, performance standards, and competencies of the ER workforce and its current leadership. Accomplishing this goal will include activities that outline ways to develop an EH workforce training stem. Development of the National Environmental Health Service Corps or a fellowship program is also a critical component. In addition, these activities will support programs to increase the number and elevate the status of ER practitioners who engage in competency-driven continuing education and training.

Conclusion

In today’s world, efforts to ensue or maintain high levels of EH status in addition to traditional concerns need to take account of the broad development agenda as well as a number of often complex processes or phenomenal. In doing this, it is time governments at all levels stop paying lip service to ER matters. It must be appreciated by all that no nation can ache desirable level of development without proper EH delivery Government the people, the professionals and all other stakeholders must champion a course in ensuring a healthy environment in Nigeria and for Nigerians.

References

1. USAID (2003). Environmental Health in USAID. USAID, Publications.
2. Osaki Carl (2003). Community Environmental Health Assessment: Challenges and Successes in WA State. WA State Board of Health, Seatle, WA.
3. Anderson Henry (2000). Environmental Health in Wisconsin-Challenges for 21^st Century. Wisconsin Medical Journal, vol.
4. WHO (2003). Five Decades of Challenges and Achievements in Environmental Sanitation and Health. WHO Geneva, 2003.
5. NAP (2001). Grand Challenges in Environmental Sciences. National Academies Press.
6. UGA (2005). Environmental Health Science. College of Public Health University of Georgia in Athens
7. Healthweb (2005). Environmental Health. University of Michigan
8. Environmental Health Competency Project: Recommendations for core competencies for Local Environmental Health Practitioners, Appendix C, Page 16.
9. Robinson, P (2001) EHOs: A Species Under Threat. Environmental Health News, Vol: 16, No: 24. London, UK.
10.  Faertein Brain (2004). Resurrecting Equity Protection, challenges to environmental inequity: A deliberately indifferent opportunistic approach. Jnl. of constitutional Law. No. 561:7.2.

PRIVASTISATION OF WASTE DISPOSAL: ISSUES AND PROSPECTS

BY Abiodun Peter Bamigboye [now late], presented at the Environmental Health Officers Association of Nigeria annual scientific conference in Lagos, 2003

1.0     Introduction

          The failure of succeeding governments at various levels of Nigeria to effectively manage Municipal solid wastes (MSW) has remained a national embarrassment and a cause of concern. Waste management deficiencies remain one of the major health and development problems in the country. It is also a major cause of mortality especially of vulnerable population groups in the country as it exposes people to disease causing organisms and various pollutants from water and the physical environment. A strong association has long been established between the spread of communicable diseases and poor refuse management system. A look at most of the urban towns and villages in the country pictured a grossly deficient system of waste collection management and disposal-a sharp departure from what obtains in most developed countries of the world. The problem has thus become a complex one in Nigeria which requires urgent attention at all levels of policy initiation and implementation. The lack of capacity on the part of government and/or its agency has largely been responsible for this ugly situation.

In recent times, there has been lots of speculation as regards the intention of government to privatize waste management in Nigeria. Experts and professionals have continue to wonder on the viability of the idea while would be contractors have started their lobby to get involved in the business of waste management although without having much knowledge of its workability. It must be said at this juncture that Private Sector Participation (PSP) in waste management is not stately that should be implemented in haste. There is need for extensive knowledge and capacity building of the part of governments, professionals and the operators so that the benefits would be realizable. The choice of this topic and its target audience is therefore considered timely for addressing a pressing problem confronting our nation.

2.0     WASTES AND WASTE MANAGEMENT

Waste has been defined as a resource in the wrong place (Adewumi, 2001). Waste refer to lack of use or value or useless remains. It is a by-product of human activities. Solid waste encompasses diverse nature and constituents. It is generally classified as household, market or commercial, industrial, medical, construction, etc. All these could either be wet or dry in nature. It has therefore being advocated that the best way to deal with wastes is to restore value to it (Adewumi, 2001) to the point at which it ceases to be a waste. The lack of value in many cases can be related to the mixed and in many cases unknown composition of wastes which also compound management problems. The provision of municipal solid waste services is a costly and vexing problem for local authorities everywhere.

Solid waste management involves distinct operations: storage, collection, transfer and transportation, resource recovery, recycling and final disposal. Effective management of waste therefore aims at ensuring that waste does not in any way constitute danger to health and safety or man and the environment at every stage of its handling. Waste management from time immemorial has become an essential part of Public Health service management which is expected to benefits all residents of the community. The service is no-exclusive (i.e. benefiting all sections of the society), and non-rivaled, meaning that any resident can enjoy the service without diminishing the benefits of others (Dillinger, 1988). As a result of these characteristics, Solid Waste Management (SWM) thus become a public good to which local metropolitan government is typically responsible. Constitutionally, responsibility for the disposal of waste in Nigeria rests on the Local governments. It is however clear that Local Government Areas (LGAs) presently seem to be incapable of handling the situation either due to:

1. Lack of expertise or resources
2. Poor planning
3. Lack of proper understanding of the various issues involved in the handling and management of municipal.

The need for other levels to play key role thus become inevitable. Various approaches have been explored in other countries to address the problems presented by poor waste management. One of the which is allowing private firms to be involved on all or selected aspects of waste management. Many countries have moved towards privatization in the last decade but only few have done it successfully.

2.1.1  Problems of SWM in Nigeria

The problems of SWM in Nigeria present a situation that is difficult in a way to clearly understand the complexes. This is because so many factors compound the problem from place to place. The factors include organizational, finance, climatic and ecological. Generally speaking, the followings are features of the SWM services in most places in Nigeria.

1. d.    Low Service Coverage: In some places the public financed system covers only a little section of the population and as such other places especially the rural areas have no organized form of waste disposal
2. e.      Substantial inefficiencies: This is most cases in characterized by high costs but low quality services and also labor intensive but low labor productivity giving  rise to mountains of refuse in many places
3. f.      Insufficient resources in which there is little or no cost recovery and a near total dependence on general revenues or transfers. Thus whenever money fail to come from the central sources no service is provided.
4. g.     Widespread uncontrolled dumping especially in market places of major towns and entirely in the rural areas.
5. Unorganized collection methods
6. i.       Inconsistent policy characterized by lack of commitment
7. j.       Problem posed by poor urban planning and poor road infrastructure complicating problems of collecting and transporting wastes to disposal sites
8. k.    Inadequate data on per capital waste generation making planning cumbersome and unrealistic
9. l.       Problem of waste segregation/sorting which increases the proportion that goes final disposal.

3.0     PRIVATE SECTOR PARTICIPATION IN SWM

          One proven ways of obtaining efficiency gains in solid waste management is through the involvement of the private sector-that is when key success factors of competition, transparency and accountability are present (Cointreau-Levine, 1994, Cointreau-Levine et al, 2000). As a matter of fact there is a growing interest in the participation of private companies in solid waste management. Most times this is driven from failures of municipal systems to provide adequate services, and some time by pressure from national governments and international agencies. It is a system that has recorded success in the US, Canada, Hong Kong, Morocco, Ecuador, Ghana and other places (Cointreau-Levine et al, 2000) and its being experimented in various places in Nigeria including, Lagos, Ibadan, Akure, Onitsha, and a few other places (Ogunwolere, 2000).

PSP in itself is not panacea but a possible opportunity in solid waste management. There are important questions which needs to be answered and these are: whether and how to involve the private sector in the provisions of municipal solid waste services. It should be looked at as a strategic management option where existing management options for services delivery are either too costly or inadequate. It should be seen as a means of enhancing efficiency thus lowering cost and mobilizing private investment thereby expanding the resources available for urban infrastructure. PSP like other business require planning and direction both in the long and short term otherwise it is bound to fail.

3.1.    Approaches to PSP in Nigeria

3.1.1  Contracting

Contracting has become a viable means of securing as long as it is possible to adequately described outputs anticipated from the contract. Of all the methods opened to PSP in waste management, contracting waste collection to private firms offers the greatest opportunity for effective management. It theoretically offers the opportunity for a less costly service than the public service which makes it well suited for discrete activities within the solid waste system. This opportunity is bet harnessed through solid waste collection.

An important issue in this regards is the absence of barriers to entry. This service involves low economies of scale, technological simplicity and moderate investment costs (Ogunwalere, 2000). This is feasible for local firms with modest financial resources to enter into the business. Findings from the Latin America showed that most of the firms were small-to-medium sized, indicating that there were no barriers to entry, (Bartone et al, 1991). Similar situation also exist in Korea. In most places in Nigeria, Particularly in Lagos, less than 10% of the contractors has 1 or 2 collection vehicles as most of them depend on government vehicles.

Competition play an important role in getting low cost solid waste service from private collectors. In 1984 after many years of private collection system, the San Jone city in California re-examined the prices they were paying and dedicated that they might lower their waste management costs by activity increasing competition. They thus focused on helping a competitive waste management firm develop a new landfill. This approach waste found to have resulted in saving lot of contract costs to the tune of between US$25-$31 million in five years (Leite, 1991).

Some form of contracting involve a mix of public and private service. This approach was implemented in Bangkok where competition between private and public contractors led to the streamlining of the roles of the public service by 30% (Cointraneau, 1992). In Minneapolis where the approach experienced initial high cost than those of the private contractors, the public costs dropped towards the level of private contractors after five years (Bartone, 1999). This approach has the natural tendency to make both types of providers more accountable while it motivates the public service to be more efficient and on the part of the contractors it makes them realize that the city cannot be held hostage of cartels, monopoliers or collusion. This kind of approach is not yet organized to a level where the gains of competition could be maximized in Nigeria. However some form of collaboration exists between the private and the public service providers. The Lagos State Waste Disposal Board in 1985 (now Lagos State Waste Management Authority-LAWMA, divided the city of Lagos into zones and awarded contracts of refuse collection to selected private contractors to collect industrial and commercial wastes from large generators. 60% of user charges being collected by LAWMA was paid to the contractors while 40% was retained to cover their own cost of administration, billing and disposal in this form of contracting that was introduced at that time (Ogunwalere 2000).

3.1.2  Franchise

This is the method in which local government that is in charge of waste collection and disposal or any other agency so charged with the responsibility givers exclusive right to a qualified private firm for the responsibility to provide service to customers within a zone. In return for the right, the private firm pays a license to the government. The firm subsequently charges her customers appropriate fees to cover the cost of the service. Ceiling fixed by the government agency through ordinance may regulate the fees charged monitoring of the performance of the private firm having franchise agreement with government rests on the government agency. It is also their responsibility to regulate user charges.

An important advantage of franchise over contracting for government is that the private firm bears the cost of billing and collection of user charges. However it has the disadvantage of not usually resulting into the same low cost as contracting because of the cost of billing due to non-payment and late-payment (Cointraneau, 1992). However, there is need to make for a guaranteed lower cost than the public service. In doing this it is important to have a well defined contract performance measures, initiate enforceable contract sanctions, arrange for vigilant contract monitoring and cost accountability. There is also the need for the government agency to arrange for a means of receiving and managing complaints from residents about solid waste service.

Franchise has become a popular method of PSP in most places in Nigeria. It is being implemented in Ibadan, Lagos, Onitsha, Kano among others. Franchise if properly managed has the potential to enhance better efficiency and control. One major compliant from residents of Ibadan is that they were not given free choice to select their designated company and indeed some of the companies turnout not to be reliable (Cointraeau, 1992).

3.1.3  Informal Sector Waste Collection

In many developing countries, the informal sector provides waste collection services to low-income neighbourhood. While the formal sector is based on basic activities, the informal sector consists of non-basic services. This is common to see wastes being carried in carts being pulled by donkeys or carts being pushed by people. A major feature of this practice is the indiscriminate dumping of refuse by these cart pushers resulting from their lack of necessary equipments to haul wastes to official landfills. This practice has been reported to be predominant in Colombia where more than 600 clandestine dumps exist which were created by the informal sector using mainly donkeys (Coaintraeau 1989). The need to organize these collectors into a cooperative and developing a franchise arrangement whereby the rights and responsibilities of the informal sector collectors are defined has been suggested (Cointraeu, 1989). Community participation could be a very necessary tools in this wise in which the people are involved in the section of such informal refuse collectors in their neighborhood and negotiate the means of disposing the refuse with them. A high level of community organization would be a useful tool in achieving this. In doing this, a local leader may be put in charge of collecting fees from residents to fully cover costs of and also initiate actions to keep the neighborhood system self-sustaining.

3.1.4  Micro-Enterprise

Apart from this direct involvement of the sector in waste management, another form of PSP is through the incorporation of micro-enterprises and informal waste recycling cooperatives in the municipal solid waste management system. Research has shown that the promotion of micro-enterprises has proven to be an effective way of extending services to poor urban communities (Arroyo et al, 1999). The promotion and development of recycling cooperatives also provides a way of upgrading the living and work standard of informal waste pickers, resulting higher incomes for them and greater self esteem (Haan et al, 1998). Formalising the activities of scavengers would help in better organization of their services.

3.1.5  Concession

This is an arrangement under which the private sector finances and owns solid waste management facilities. This ownership is usually for a period of time sufficient to depreciate investments and provide a reasonable return to the investors. Concession agreement could specify performance standard, methods of judging performance, penalties for delay or non-performance, risk assignment, insurance requirements, dispute resolution and standard for workers’ safety and health environmental protection.

Concession components include building, owning, operating and sometimes transferring of facilities through long-term contractual agreements. Some components that are commonly referred to are:

1. Built, Own, Operate and Transfer (BOOT): This involves the building, owning, operating and after a specified period the transfer of the infrastructures. It provides a means of having the private sector financed facilities whose ownership will eventually be transferred to government.
2. Built, Own and Operate (BOO): This involves building, owning and operating waste management through contracting by a private firm. Such facilities can provide solid waste services such as transfer, disposal or resource recovery. BOO is widely used in many developed countries like the USA, Germany and Canada (Cointraneau, 1989).

3.1.6  Private Subscription

This involves each household and commercial establishment hiring private collection firms and paying the user fee charged by the firm. This brings in opportunity for open competition. This methods has been known to have some disadvantages including:

1. Higher costs than those incurred by government contracting with private firms
2. Usually more costly than the public service.

Collusion has always being an issue when open competition is practiced. Association of private refuse collectors exist in a number of cities in Nigeria especially Lagos, Ibadan, Akure and other places.

4.0     KEY ISSUES

4.1.1  Factors Influencing Private Sector Participation in Solid Waste Disposal

Privatizing solid waste management in developing countries requires elaborative consideration of all the issues involved and arriving at realistic decision as to whether to privatize a specific aspect or portion or the entire aspect of the service. In deciding whether to have PSP, many factors needs to be analyzed such as cost recovery, efficiency, public accountability, management, finance, economies of scale, legislation, institution and cost (Cointraneau, 1994). For each situation therefore, governments needs to weigh the economic risks associated with the political manipulation including payment, environmental regulations, tariff regulation, inflation and other associated factors. Cost factors in particular should be analyzed separately for the different components of solid waste service collection, cleansing, disposal and transfer.

However, some factors are worth considering in making decision to involve private sector in the service. These include:

1. Efficiency: The need to know the political realities constraining government from providing efficient service is required. These realisties include, cost accountability, labour tenure, government wage scales, labour practices, personnel benefits, work arrangement, bureaucratic procurement procedures and hiring and firing procedures. Also important is the need to find answers to questions like.
2. Where these constraints could be removed
3. Where same constraints could characterized the involvement of the private sector
4. If there are economies of scale.
5. Capability: Certain questions need to be addressed as regards to capability. These are:
6. Does the government recognize that expertise is essential for competent and low-cost solid waste management?
7. What are the differences between government and the private sector in technical and financial resources required to build or buy, operate and maintain waste management facilities
8. Can performance be effectively monitored?
9. Costs: The cost of running the public service must be compared vis a vis the cost of maintaining PSP. There must exist an accounting information to determine whether PSP would offer solid waste services delivery at a lower cost. The need to have a strategic planning and good feasibility study as relates to efficiency of technology and equipments is very important.
10. Accountability: There is need to assess whether PSP will disportionately benefit an elite, wealthy class with control over private capital or whether market opportunities will be available to small and middle sized business which would eventually lead to some redistribution of income and power

aa. Competition: PSP as matter of necessity must allows for healthy competition among firms on the hand and between firms and government on the other hand. Government policy on PSP must be made in such a way to facilitate this and appropriate provisions made to ensure that at all time the required atmosphere is created to make it work.

1. Risk: There must be a regulatory framework to protect the private sector against risks due to environmental damage, currency adjustments and inflation, political changes etc, so that the prices of services are not unduly burdened with hidden costs for risk protection. Signing contract for a minimum length of time to allow for full investment depreciation and economic of scale would reduce risk.

4.1.2  Expectations from the Private Sectors (as part of their sector participation process)

1. Technological assessment studies
2. Public consultations
3. Environmental Impact Assessment
4. Design facilities and acquire permits.
5. Activities Expected from Government

4.1.3  Activities Expected from Government

1. Identification of the activities to be privatized and the development of a private sector policy strategy
2. Preparation of the privatization (including detailed cost analysis and potential restructuring) plan
3. An appraisal phase which basically consist of preparing the transaction itself
4. Implementation of the privatization policy
5. Maintaining a balance between private and public sectors to secure contestability (e.g. monitoring public provision over some waste collection zones).
6. Minimizing labour redundancy, health and safety risks
7. Monitoring performance based on well specified contracts
8. Considering willingness to pay in determining user charges
9. Defining equitable collection zones in order to minimize collusion and procurement irregularities
10. Defining clear contractual clauses and well-advertised, transparent, equitable and scheduled procurement
11. Ensuring that government has available financial means to comply with its constraining and to establish cost-recovery systems
12. Developing the capacity of public sector to regulate and monitor private service providers
13. Providing governmental support by changing national laws and policies and by providing guidance and setting norms.

4.1.3  General Issues

1. Extent of privatization-is government backing out?
2. How much planning has been made prior to privatization
3. How much waste is generated per capita, within different socio-economic group
4. Facilities available for disposal-location, capacity, efficiency etc
5. Making collection efficient-transportation, storage, transfer station etc
6. Capacity building (personnel for monitoring) in terms of training, retraining, research etc
7. Modifying the role or state environmental agencies
8. Recycling-strategies to minimize waste available for disposal
9. The software components-Health education, information, community organization, sorting at source etc.

5.0     PROSPECTS

Although PSP in solid waste management has failed in a number of few places, it has continued to gain prominence in many other places with recorded success. (STAT 2002). The private sector:

• Improves efficiency and lower costs by intruding commercial principles of:

-         Limited and well focused performance objectives

-         Financial and management autonomy

-         Hard budget constraint

-         Clear accountability to consumers and providers of capital.

• Has better financial and management autonomy, a hard budget constraints and clear accountability to both customers and providers of capital. This would help  in providing better equipment and services
• Provide new ideas, technologies and skills. The activities of scavengers has recently introduced into the Nigeria industrial sector re-cycliable materials that is already solving problem of supply of original raw materials.
• Mobiles needed investment funds especially for short-lived collection vehicles
• Job creation for various categories of staff
• Environmental beauty and protection
• Enhancement in health status and community hygiene

All which is expected to lead to lower cost and tariffs.

Ample evidence abounds from around the world to support these claims. Findings from the United State, Canada and the UK shows that in about 2000 cities surveyed, the services provided by public monopolies typically cost between 25-4% more than competitively contracted services (Bartone, 1999).

6.0     Conclusion

The problems of solid waste management in Nigeria demand a radical approach to finding effective solutions to address the various problems of confronting the sector. It is also very clear that with the abundant human and material resources and a vast enterprising market, PSP in solid waste management has a great potential in Nigeria. It cannot be out of place for government in Nigeria to explore the opportunity offered by a wide range of resources and to work out strategies to make PSP in waste management workable in Nigeria. In doing this there would be the need for a waste management sector reforms and a commitment on the part of governments to really address waste management problems. Effective planning is fundamental to its success and a commitment (both political and administrative) to implement plan if very central to PSP in solid waste disposal.

Public health not doctors' preserve

By Sani Garba Mohammed

Public health is a term that is eliciting concern from health professionals; for, as the name imply, it deals with the issues pertaining health be it preventive, curative, promotive or rehabilitative.

In Nigeria, the rivalry between health professionals is making the term to lose relevance as to what public health stand. It reaches a stage where by one profession corner the title and determines what goes in and out, leaving large chunk of other health professional onlookers.
This comment will look at what is public health, whether or not one profession should be alpha and omega, and the need of collaborative approach towards making public health better.

Permit me to quote WHO [1952] definition of public health which is “the science and art of preventing disease, prolonging life, and promoting health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for early diagnosis and preventive treatment of disease, and the development of social machinery to ensure for every individual a standard of living adequate for the maintenance of health, so organizing these benefits as to enable every citizen to release his birthright of health and longevity”.

Based on this, we can deduce that public health consist of environmental health services [it has 18 components], medical, nursing, laboratory, other health services, including other sectors relevant to health like agriculture, science and technology, power, communication, engineering, etc., that address the physical, mental and environmental health concerns of communities, and disease prevention technologies interventions designed to improve and enhance quality of life.
Considering the all-encompassing scope of public health, no any profession, be it medical, nursing, chemist, etc., can lay claim to be its only promoter, as it is obtainable in Nigeria where the mere mention of ‘public health’, direction will look at doctors only, not all health workers.

Doctors have now appropriates public health practice as their own only, and determine how it should be run, from federal ministry level down to local government level; and any attempt to do the right thing by the right professionals in what they have interest will not see the light of the day.

Nowadays it has become a norm that every minister of health is a doctor, the same with majority of states, also many position are now reserved for doctors only like headship of hospitals, national primary health care development agency, etc., which any health practitioner like pharmacist, medical scientist, environmental health officer, nurse can hold with the necessary managerial skills. These, give rise to a situation that very health policies, tend to be one-sided, from the prism of medical practice, with the exception of other sides which are equally important.

For instance, the effort to prevent/and or reduce the endemicity of malaria could not succeed, because the emphasis is based on curative approach that hinge on only provision of insecticide treated nets, provision of drugs, to the detriment of more effective control of environmental health management of our surroundings, which harbor the vector that causes it, because money is involved from donors.

Now doctors are penetrating in to many professions and forcing their thoughts on how to do or not do this and that; they are into radiography, laboratory science, pharmacy etc., but still want to usurp the role of those who start from degree level.
”Take a look at a scheme of service, from 2001” said Godwill Okara “ addressed to the minister for health, telling him of eleven schemes of service for professionals in the health sector, to be implemented. The then minister caused this letter to be circulated to all chief executives of hospitals for immediate implementation. Up till now, this scheme of service has not been implemented because doctors feel they are the ones to [lead]”, daily trust 3rd July, 2012.
He also added “There are laws: do your own, let me do my own. When people think that they are above the laws of the land, it is an open invitation to anarchy. And the kind of situation we see in the health sector, there could be no greater anarchy than it. Despite the immense human and material resources in Nigeria, the Nigerian health service is being rated 51 out of 53 in Africa. It’s a shame. Instead of facing these facts, they gang up, become partisan and want to protect the interest of their colleagues against all others”

The other area where other health professionals are being discriminated is their non-admission by many universities for Masters in Public health, which it seems is exclusive reserve of medical doctors; with the exception of few universities in the south-like federal university of technology, Owerri, University of Calabar, University of Port Hacourt, University of Uyo-all northern universities reject any non-doctor health practitioner from the programme, even if s/he has first class in his degree.

National Health Bill further creates another huge gap which if allows to be signed without the input of other health professionals, will do more harm than good, and public health services will suffer. “The new bill” according to Nigerian Health Watch “states that the "Executive Chairmanship of the proposed National Tertiary Hospitals Commission must be a Medical Director of the status of a Professor with a minimum of ten years working experience in a Teaching Hospital"

“This clause that limits the Executive Chairmanship to medical doctors in perpetuity has all the other health professions up in arms. Doctors argue that it is their traditional (read tribal) role to lead a medical team. The other health professions argue that they (their tribe) must also have a go at leading the commission.

“It is our contention at NHW, that this clause in the health bill is flawed, as it does not protect the best interests of Nigerians, and has placed tribal interests as belonging to a profession (a tribe of doctors), reaching an academic height (a tribe of professors) and having worked in teaching hospital (a tribe of public sector workers) - none of which ultimately guarantees a good leader and manager which the National Tertiary Hospitals Commission needs to fulfill its promise to the Nigerian people”.

I am not bringing this to castigate or blackmail my fellow practitioners, as I have many friend doctors, mentors, but just to highlight the issue at hand at its pertain the practice of public health, which are directly or indirectly affecting it delivery to the target beneficiaries, for no any profession is an island unto itself, as doctors needs pharmacist, radiographer, laboratory scientist, so also pharmacist need chemist, nurse, and other health practitioners. As a sanitarian [aka environmental health officers], I need police, lawyer, engineer, laboratory scientist, etc., to discharge my work accordingly, as such, public health services needs all of us to join hand and deliver, for, we own it up together.

So, for public health practice to prosper there should be no enmity, or feeling superiority of one over the other, we are all equal as all have undergone training of not less than 5 years. Let us join hands together if we are ever serious. Public health belongs to us not one of us. It is better late than never.

Sani Garba Mohammed, is of department of public health technology, federal university of technology, Owerri.