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THE ROLE OF FEDERAL, STATE AND LOCAL GOVERNMENTS IN NIGERIA TOWARDS SUSTAINABLE ACHIEVEMENTS IN ENVIRONMENTAL HEALTH
INTRODUCTION
Environmental factors play an important role in health and disease. 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. 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 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.
During the 1990s, 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. Apart from the general environmental health duties which had hitherto been mentioned this cadre of health officers have been very useful in the implementation of primary health care services at all levels of government: federal, state, and local governments respectively. These should therefore educe the consciousness of Government at all levels to intensify efforts towards sustainability of the gains recorded in Environmental health. This paper brings to fore the role of Government in Nigeria towards sustainable achievements in Environmental Health.
THE SCOPE OF ENVIRONMENTAL HEALTH
Meaning of Environmental Health
The World Health Organisation defines Environmental Health as the control of all factors in man’s physical environment, which exercise, or may exercise, deleterious effects on his physical development, health or survival. Environmental health, therefore, takes account of the various aspects of human health, including quality of life, which is 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 these factors that can potentially affect adversely the health of present and future generations.
Agency for Toxic Substances and Disease Registry, US, defined environmental health “as branch of public health that protects against the effects of environmental hazards that can adversely affect health or the ecological balances essential to human health and environmental quality.
Components of Environmental Health Services
The key components of environmental health in Nigeria include waste management; food hygiene and control; pest and vector control; environmental health control of housing and sanitation; epidemiological investigation and disease control; air quality management; occupational health and safety; water resources management and sanitation; noise control; protection of recreational environment; radiation control; health control of frontiers, air and sea ports and border crossing; pollution control and abatement; educational activities (health promotion and education); promotion and enforcement of environmental health quality standards; collaborative efforts to study the effects of environmental hazards (through research); environmental health impact assessment (EHIA) and the management of emergency situations (disasters, flooding, disease outbreaks) etc. (EHORECON:2007).
Improving Environmental Health Management Tools
In addition to political commitment, there are practical prerequisites for developing and
implementing environment and health strategies. Many countries urgently need to create or improve the main tools available to decision-makers for environmental health management.
To be effective, this requires a shift from the traditional approach (involving the separate
consideration of, say, water, air and food quality control and of waste management) to an
integrated approach that, consistent with those endorsed at the Lucerne Conference and in
the EU’s Fifth Environmental Action Programme, improves the ways and means of preventing and controlling environmental hazards and favours actions directed at controlling the sources of these hazards.
Such tools require an administrative framework that reflects the partnership between
authorities in environment and health and other relevant sectors at all levels of management. Partnership with finance departments is particularly important, since it permits the use of economic and fiscal instruments.
The main environmental health management tools are: an environmental health information system; the identification and assessment of environmental health hazards and risks; a framework of enforceable legislation; additional control measures, including economic and fiscal instruments; environmental health services; professional education and training; public information and health education; public participation; research and technological development.
NATIONAL HEALTH DECLARATION
The following extract from the National Health Policy document gives a good revelation of the intention of the Government of Nigeria to better quality healthcare for all Nigerians.
“The Federal, State and local government of Nigeria hereby commit themselves and all the citizens by year 2000 and beyond that is a level of health for all that will permit them to lead socially and economically productive lives at the highest possible level.
All government of Federation are convinced that the health of the people contributes to better quality of lives and to sustained economic growth of the country as a whole.
That the people of Nigeria have the right to participate individually and collectively in the planning and implementation of their health care.
That primary healthcare is the key to achieve the goal health care for all the people of Nigeria. These principles of social justice and equity and the ideals of fairness and freedom have been captured in the National HealthCare Policy and equally affirmed in the constitution.”
The Constitution assigns to local government councils certain functions which are essential elements of primary health care; environmental sanitation; provision and maintenance of health services; as well as the provision and maintenance of primary education.
“With the general guidance, support and technical supervision of State Health Ministries, under the aegis of Ministries of Local Government, Local Government Councils shall design and implement strategies to the Constitution, and to meet the health needs of the local community.
Motivation of the Community: The Local Government Councils shall elicit the support of formal and informal leaders, traditional chiefs, religious and cultural organizations as well as other influential persons and groups in support of community action for health.” This is a clear statement of delegation of roles and responsibilities to various tiers of Government.
ENVIRONMENTAL HEALTH POLICIES AS PROJECTED BY WHO
The attainment of sustainable development by creating friendly environment conducive to health can only be realized through the enhancement of an environment that is free from biological, chemical and physical hazards emanating from local, national and international sources. In this regard, environmental health plays a pivotal role in the endeavor to create and foster an environment that is safe to work, recreate and live. It is in fact one of the most essential elements and preconditions for development. The primary and principal step deemed imperative in the effort to deliver environmental health services is the development and formulation of comprehensive and sound policy in the sector.
The Environmental Health Policy (EHP) programme aims to assist countries in their endeavor to realizing the achievement of sustainable development by creating an environment conducive to health through the development and formulation of Environmental Health Policy and strengthening/development of their capacities to render sound Environmental Health Services.
The main areas of focus of EHP include:
- Providing technical support to countries in the African Region in development/review of National Environmental Health Policies and development/strengthening National Capacities.
- Assisting countries in the formulation of Environmental Health Policies to realize the implementation of the Regional Strategy for Health and Environment adopted during RC 52.
- Assisting countries in the elaboration and review of their policies on the sector.
- Assisting countries in developing Policy Implementation Strategy for proper and effective implementation of the policy.
- Developing and disseminating technical guidelines and other promotional materials related to policy formulation, implementation and capacity building.
These policies include but not limited to:
- Policy Guidelines on Market and Abattoir Sanitation
- Policy Guidelines on Solid Waste Management
- Policy Guidelines on excreta and sewage management
- Policy Guidelines on School Sanitation
- National Environmental Sanitation Policy
- Policy Guidelines on Pest and Vector Controls
- National Erosion and Flood Control Policy
- National Drought Preparedness Plan
- Renewable Energy Master plan
HISTORICAL ACHIEVEMENTS IN ENVIRONMENTAL HEALTH
This cadre of public health workers came into existing during the colonial era, their statutory function was purely sanitary inspection then as sanitary assistants to the colonial masters.
In the 19th century, the colonial masters who executed the sanitary duties of our environment in Nigeria were known as sanitary inspectors while the African/Nigerians attached to them were known as sanitary attendants. These attendants acted as aides to their masters to discharge various sanitary inspection activities like marking of tall trees, service of abatement notice etc. under their masters’ directives and close supervision.
As time went on these sanitary attendants were given more responsibility such as routine sanitary inspection, collection of water samples, survey for breeding places of mosquitoes, as well as acting as guides and interpreters.
During the early 20th century, with improved educational background, these attendants gathered enough experience from their colonial masters, they were assigned duties such as cutting down tall trees that were close to the residential buildings, identification of infectious disease cases, disinfection and disinfestations, liaison between the colonial masters and villagers, verification of notices issued by their colonial masters (sanitary inspectors), retention of daily, weekly and monthly returns.
Dr Isaac Ladipo Oluwole brought about changes in the status of Nigeria health workers. In the 1920s, when Dr. Isaac came back from Britain as public health physician, he was the first African Medical Officer of Health (MOH) in the Lagos colony. He pioneered with vigour, school health services using the then sanitary attendants, including inspection of schools and vaccination of schoolchildren in their school. He started the first Nigerian School of Hygiene at Yaba Lagos in 1920, where qualified persons from all over the Nigeria trained as sanitary inspectors and obtained the Diploma of the Royal Institute of Health (RIH) London, which was later, changed to Royal Society of Health (RSH).
The first problem that faced the modern day Nigerian sanitary inspectors as early as the 1920 was the outbreak of bubonic plague in 1924. The practice of the profession which was introduced into Nigeria by the colonial government due to their determination to ensure a safe environment for the colonial government proved its usefulness. The impact of your predecessors manifested in the eradication of some of the major communicable diseases of the 1950’s and 60’s such as Yaws, Plague and Small Pox and these efforts were well appreciated by the Nigerian people. Other communicable diseases spread by filthy environment such as cholera, Malaria, typhoid etc were equally kept at bay. The older generation of Nigerian still remember with nostalgia the effectiveness of the then Sanitary Inspector. The professional was actively involved in the control of the plague epidemic. Dr. Oluwole revamped Port Health Duties and made sanitary inspection a vital instrument for the control of communicable diseases using entirely the Nigerian sanitary inspectors.
All these brought recognition to the sanitary inspectors among other cadre of health workers in Nigeria . They were referred to as “Wole-wole” among Yoruba’s, “Nwaole-ala” among the Igbo’s and “Duba-Gari” among the Hausas. They were a force to reckon with in that colonial era in the area of preventive health services in Nigeria.
In the 1930s, the educational qualification and training of sanitary inspectors had greatly improved. Thus, the colonial government assigned them the following statutory functions. Routine sanitary inspection of houses, markets, schools and communities; Waste disposal and environmental sanitation, pollution control and industrial sanitation; Water sampling and sanitation; Port health duties (air, land and seaports); Control of communicable disease (infectious diseases). Other duties were, Building and urban planning ; Vector and pest control e.g. Malaria control; Prosecution of public health offenders in the court; Meat and food inspection; The disposal of the dead (corpses); Occupational health and factory inspection; Vaccination/inoculation of both schoolchildren and adults; Health education on personal and public hygiene was also included.
The establishment of the World Health Organization in 1948 brought about changes in the profession, thus many people with Higher Educational Qualification were recruited into the profession and enhanced curriculum to accommodate the need of the society.
“This was evidenced in their immense role in the eradication of Yaws and Smallpox in the late 1940s and early 1970s respectively.
In 1988, the name of the profession was changed to environmental health officers in line with the internationally accepted name of practitioners of the profession and also to accommodate members of the profession who graduated from the university with a degree in public health, environmental health and epidemiology.
Apart from the general environmental health duties which had hitherto been mentioned this cadre of officer has been very useful in the implementation of primary health care services in the country at all level of government (Federal, State, and Local Government).
ROLE OF FEDERAL, STATE AND LOCAL GOVERNMENTS IN SUSTAINABLE ACHIEVEMENTS IN ENVIRONMENTAL HEALTH
Water Supply and Sanitation
Access to safe water and sanitation is a serious challenge for Nigeria. Little progress was made up to 2005 but improvements since then have brought the proportion of the population accessing safe water to 58.9 per cent and the proportion accessing improved sanitation to 51.6 per cent. Nigeria’s Vision 2020 is an integrated development plan with one of its three pillars dedicated to ensuring safe water sustainability.
