The draft Swaziland National Environmental Health Policy, 2002This is the draft Swaziland National Environmental Health Policy and as such is a working document and not a formal policy document. It should not be interpreted as the policy of the Government of Swaziland until it has been finally agreed and adopted. 1 ANALYSIS OF EXISTING SITUATION CHAPTER 11.0 ANALYSIS OF EXISTING SITUATION1.1.0 INTRODUCTIONThe bases and principles for the declaration of a National Environmental Health Policy for the Government of the Kingdom of Swaziland are detailed below. 1.1.1 The National Health Policy was developed by the Ministry of Health and approved by Government in July 1983 with commitment to the World Health Organization goal of "Health for All" by the year 2000. The main objective is to improve the health status of the Swazi people by providing preventive, promotive, rehabilitative and curative health services which are relevant, socially acceptable, affordable and accessible to all. The strategy to achieve this goal is to mobilize All for Health in the development of a comprehensive Primary Health Care system. Specifically, the basic elements of the system are:-
1.1.2 The National Health Policy placed emphasis on health promotion and disease prevention. While it is necessary to care for individual health problems through curative interventions, it is generally recognized that preventive programmes can have a long-term and broad impact on the health status of the population, and these programmes are key priorities. They focus on assuring the provision of potable water supplies, the development of basic sanitation facilities and health education. 1.1.3 In September 1999, the Ministry of Health and Social Welfare published the draft Policy on National Health and Social Welfare Sector. Further revision of the National Health and Social Welfare Policy was effected in May 2000 so as to align it with new developments in health sciences and for the purpose of enhancing the ability of the Ministry of Health and Social Welfare to effectively deal with emerging health challenges. While the Policy places priority on the delivery of health care it nevertheless recognizes that health promotion is an inter-sectoral effort. In this respect the MOHSW has indirectly favoured delegation of functions and responsibilities of environmental health and sanitation matters to other sectors of the Government Agencies (Stakeholders). The situation is further compounded by the fact that the stakeholders have not been adequately equipped with environmental health expertise to address effectively and efficiently the environmental health problems of the population. 1.1.4 The draft Policy, National Health and Social Welfare Sector, September 1999 do not address adequately the areas that affect environmental health issues. Given the enormous environmental health problems of the rural areas where over 80% of the population live, there is a dire need to reexamine the Sector Policy to reflect a comprehensive environmental health policy within the framework of Primary Health Care and "Health for All" in the 21st century. 1.1.5 The environmental health policy has to be an addendum or an adjunct to the National Health and Social Welfare Policy. The availability of the Health and Social Welfare Policy has been the starting point for the preparation of the environmental health policy. However, while the National Health and Social Welfare Policy has adopted the PHC approaches as the impetus and energy to progress towards "Health for All", the environmental health policy must additionally recognize that sustainable development, environment and health are in consonance with the 1992 Earth Summit – The United Nations Conference on Environment and Development (UNCED) in Rio de Janeiro, Agenda 21 – an international programme of action for the 21st century. 1.1.6 Swaziland has machineries for development of rural water supplies and sanitation programmes through the Department of Environmental Health of the Ministry of Health and Social Welfare, the Rural Water Supply Branch of the Ministry of Natural Resources and Energy, and NGOs. The Water Services Corporation provides water supplies and sewerage and sewage treatment services for urban areas. For the peri-urban areas there are still problems in the provision of water and sanitation services although there has been effort to provide services by the Swaziland Water Services Corporation. A national environmental health policy will take into account the relevant Acts of the rural water supply and sanitation, the Water Services Corporation Act No. 12 of 1992, the Water Bill 2000, and the Public Health Act.. 1.1.7 A national environmental health policy has an essential advocacy role and must recognize the sole responsibility of the Ministry of Health and Social Welfare to exercise the mandate for the promotion of personal health and environmental health, as well as detail out the delegated functions and responsibilities of other ministries and stakeholders, as contained in the Public Health Bill No. 6 of 1999. 1.1.8 The Government and the people of Swaziland have the rights and responsibility to deal and resolve their environmental health issues. Government has over the years utilized the existing machineries to address the myriads of socio-economic problems including environmental health issues. There is advocacy in the policy document for a review of the existing machineries in order to merge them if necessary and create new ones for the achievement of the environmental health goals of the people of Swaziland. 1.2.0 CONTEXT - ENVIRONMENTAL HEALTH SITUATION1.2.1 The land-locked 17,364 square kilometers Kingdom of Swaziland has a population of 929,718 (1997) with annual growth rate of 2.9%, half of which is made up of children below 15 years of age, while women of childbearing age constitute 23%. The crude birth rate is 43 per 1000 population, crude death rate 8.4 per 1000. Life expectancy is 60 years for females and 58 years for males. Infant mortality rate is estimated to be 68 per 1000 live births. Fertility rate is about 5.8. 1.2.2 The King is the Head of State. He appoints the Prime Minister, the Ministers and Regional Administrators. The Prime Minister assisted by the Cabinet Ministers run the government on behalf of the nation. There is a legislative Parliament and a Judiciary. The approach to democracy is through the 55 "Tinkhundla" Local Government Centers (Constituencies) spread throughout the four regions of the country – Hhohho, Manzini, Lubombo, and Shiselweni. 1.2.3 Understanding environmental health discipline is limited in Swaziland and ministerial portfolios are divided between the Ministry of Health and Social Welfare and other Ministries – Ministry of Tourism & Environment, Ministry of Housing & Urban Development, Ministry of Natural Resources & Energy, and other stakeholders. 1.2.4 Environmental health discipline is dynamic. The following components are considered to constitute environmental health issues in Swaziland:-
1.2.5 Environmental health issues and concerns in Swaziland are multi-sectoral and are institutionalized with different sector agencies of the Government, city councils, townships, parastatals with distinctive values and perspectives. The Ministry of Health & Social Welfare has clear governmental responsibility for environmental health issues without which the health of the Swazi people would be in shambles. Consultations and dialogue with the Ministries and Stakeholders have to be continuously carried out so that duplication of institutional functions and responsibilities can be reduced to a minimum. 1.2.6 The vision and mission in the Health and Social Welfare Policy is that Government through the Ministry of Health & Social Welfare seeks to improve the health and social welfare status of the people of Swaziland by providing preventive, promotive, curative and rehabilitative services that are of high quality, equitable, affordable and accessible. By the year 2015, the Sector shall have developed into an efficient and effective service and shall have given rise to a manageable population of a people that live longer, healthier and socially fulfilling lives. A high level of environmental health by the Swazi people is one of the most important ways for the pursuit of other legitimate national socio-economic objectives. Environmental health is therefore important among the objectives and values of most Swazi people and they expect Government through the vision statement to pursue policies that will afford them the opportunity to enjoy proper environmental health quality. 1.2.7 Swaziland like many other rapidly developing countries is faced with a number of environmental health issues and problems that affect human health and the environment. Poor sanitation – contaminated water sources, unsanitary excreta disposal, poor knowledge and behavioural practices regarding basic cleanliness and hygiene. Safe drinking water is available to about 50% of the rural population, and adequate excreta disposal facilities are available to less than 45% of the rural population. The urban population is reasonably covered with environmental health services. Improvement in the abatement of environmental health conditions will result from inputs of many sectors and stakeholders, not just the services provided by the MOHSW. The inter-sectoral collaboration, equity and community involvement are important in finding solutions to the environmental health issues. 1.2.8 In Swaziland, the post independence era has brought about rapid expansion of health services provided by the State, the Missions, industrial companies, private medical practitioners and traditional healers. The five types of health facilities existing in the country are the Outreach Sites, Health Centres, Hospitals, and Public Health Units. Government health facilities constitute 30% of the total in Hhohho, 39% in Lubombo, 29% in Manzini, and 85% in Shiselweni. Environmental health services have received minimum attention. Consequently environmental health services have been supported by other governmental agencies with the provision of various Acts, Bills, and Regulations, but with no elaboration of responsibilities. 1.2.9 The environmental health services in Swaziland have expanded greatly in terms of infrastructure – rural water supplies, peri-urban and urban water supplies have covered practically the population at large; sanitation and wastes management, food control and safety programme, human settlement and housing, environmental management, and control of environmental health diseases like diarrheal (cholera}, malaria, schistosomiasis (bilharzias), tuberculosis to mention a few are all being attended to in the country. The expectations of the Swazi people are continuously growing and the MOHSW has not been able to provide all the services because of its limited capacity and resources. 1.2.10 Policies, Strategies, Action Plans and Services aimed at individuals, families and communities are important. The provision of inputs of all stakeholders in the attainment of such a state of environmental health is a joint responsibility of the individuals, the families, the communities and the government. The provision of environmental health services will depend on the resources available to the four parties mention above. The MOHSW has the unique function to promote the personal health and environmental health within Swaziland as reflected in the Public Health Bill No. 6 of 1999. To this end the MOHSW will collaborate and co-ordinate all activities of environmental health with other stakeholders for achieving this task. 1.2.11 The Office of the Deputy Prime Minister is mandated to carry out the implementation of decentralization under its political and technical/administrative structures in the four regions of Hhohho, Lubombo, Manzini, and Shiselweni; each region having a regional administrator and regional secretary. Through the 55 "Tinkhundla" – Local Communities, the Office of DPM oversees the extensive network of services delivery. 1.2.12 The Ministry of Housing and Urban Development through several Acts, Bills, and Regulations is responsible for the delivery of healthy housing and urban services with the mission statement to provide a climate and infrastructure that will progressively maximize the quality and security of life of the people of Swaziland and make the best use of the country’s natural and human resources. The Ministry through its Department of Housing, Project Co-ordination Unit, Town and City Councils have major objectives to raise the environmental health standards among low income, mobilize common resources and encourage community participation, promote investment in urban employment opportunities, improve efficiency and equity in urban management, introduce permanent status and concept of the peri-urban growth. 1.2.13 The Swaziland Water Services Corporation is a parastatal under the Ministry of Housing and Urban Development empowered by the Water Services Corporation Act No. 12 of 1992 to provide water services (water supply and sewage treatment and disposal) and to control abstraction of raw water from boreholes in those areas for which it is responsible. The mission statement to provide services through sound management policies, strategies and improving technology has enhanced the Corporation’s role in poverty alleviation. In this respect the Corporation provides good quality water services that are both affordable and accessible to the urban poor. 1.2.14 The Ministry of Tourism and Environment through the Department of Environment supervises the Swaziland Environment Authority established under the Swaziland Environment Authority Act No. 15 of 1992. The main thrust of the Authority is to monitor trends in the state of the environment, promote environmental education to increase public awareness and participation, regulate development of policies and legislation, monitor and control pollution of the air, water and land, and promote research on environmental matters. The Authority is the focal point of all international and regional environmental treaties, conventions, and agreements, and the coordinating agency for all national environmental issues. 1.2.15 The Swaziland Environment Authority has published the Swaziland Environment Action Plan (1997) with sections on human settlements and environmental health in which issues of diarrheal diseases, air pollution, water pollution, solid wastes (refuse) disposal, inadequate housing and overcrowding, and gender-related matters are covered. The Authority has produced the Environment Management Bill 2000 presented by the Minister to Parliament and awaiting the King’s accent. The Act provides for and promotes the enhancement, protection and conservation of the environment and where appropriate, the sustainable management of natural resources. Indeed if the environment is not taken care of, contagious and infectious diseases will be rampant. 1.2.16 The Ministry of Natural Resources and Energy administer the Water Act 1967 to be repealed and replaced by the Water Bill No. 7 of 2000. The Bill establishes the National Water Authority (Department of Water Affairs, Rural Water Supply and Sanitation Branch) and the Water Apportionment Board. The Rural Water Supply and Sanitation Branch has published the National Plan of Action 1999/00 – 2001/2 in January 1999 that assembled 18 planning elements for the development of water supplies and sanitation in rural areas of Swaziland. The plan calls for an increase in the share of maintenance costs borne by communities, consistent with the newly developed sector policy and strategy guidelines: henceforth communities will be responsible for at least 50% of the cost of replacing major system components. 1.2.17 The Ministry of Agriculture & Co-operatives through the Plant Control Unit has the responsibility for the protection of crops from pests and disease damage as well as protection of human being from pesticides poisoning. The Department of Veterinary Services in the same Ministry is involved with animal health and Meat hygiene. However a veterinary health services has yet to be established in the Meat Section of the Department. 1.2.18 The Ministry of Enterprise & Employment through the Factories Inspectorate of the Department of Labour undertakes inspections (boilers, elevators, etc.), approval of factories, training of workers and employers, and improvement of occupational safety and health standards. The Ministry has published the Occupational Safety and Health Bill passed already by Parliament in 1999 and is awaiting the King’s accent. 1.2.19 Other Stakeholders involved in environmental health issues and interventions are recognized in the environmental health policy. Among the Ministries are Education; Finance; Public Works &Transport. No discussion on environmental health sector involvement will be complete without mentioning the role of NGOs – C.A.N.G.O. and Baphalali Swaziland Red Cross. 1.2.20 There is acute shortage of environmental health practitioners in Swaziland due to brain drain, attrition and inadequate training support programme. The number of posts is not enough. These officers are the cornerstones on which the effective execution of environmental health services rest. Diploma training for environmental health officers is provided at the Faculty of Health Sciences (Environmental Health Sciences Department), University of Swaziland. The Diploma Course has been upgraded to university degree level. The Ministry of Health and Social Welfare will consider supporting the activity of redeveloping the curriculum in order to redirect it for accreditation by the University of Swaziland. 1.2.21 In provision of environmental health services the Ministry of Health and Social Welfare – Environmental Health Unit, Malaria Control Unit, Bilharzia Control Unit, Emergency Preparedness & Response Unit, and the CDD Programme Unit interact with many international, regional and national organizations and departments (both private and public). The MOHSW is permanent member of many national standing committees that attend to a wide variety of environmental health issues. The list of the committees is growing and is continuously being revised. 1.2.22 Inadequate financing of the Health Sector has affected implementation of environmental health programmes and this has been identified in the National Health and Social Welfare Sector Policy (September 1999). The budget of the MOHSW is shared between government and the subsidized Mission health institutions. The decline in revenue collection resulted in decline in allocation to the Health Sector from 9.4% to 7.6% of the total government budget in 1998. The shortage of funds, changes in environmental health technological options coupled with other factors have made it difficult to provide environmental health services. All these factors necessitate the need to define an explicit environmental health policy, so that capability can be understood to be a factor in determining which environmental health services can be provided to the Swazi people and what the users/consumers can provide in return. 1.2.23 It is very important to emphasize the role of Government through the Ministry of Health and Social Welfare as policy maker, professional guide, facilitator and supervisor of health care and environmental health in its entirety in Swaziland without prejudice to the stakeholders (Ministries, NGOs and others) as providers or institutions. This is essential irrespective of ownership or source of funding by the stakeholders and provider institutions. 1.3.0 CONSEQUENCE AND IMPLICATIONS OF THE ENVIRONMENTAL HEALTH SITUATION1.3.1 The National Plan of Action 1999/00 – 2001/2 for the development of rural water supply and sanitation in Swaziland has stressed the sectoral goal to extend access to safe drinking water and sanitary excreta disposal to the entire rural population by the year 2020. Rural water supplies and sanitation facilities are basic developmental needs necessary for the improvement of health and living conditions and should remain fundamental components in the long-term rural development programmes in Swaziland. The low levels of coverage for water supply (50%) and for sanitation (45%) are of great concern and require priority attention. In the wake of the cholera epidemic (2000) provision of water is needed to reduce the burden of time devoted to carrying water by rural women and children, and limiting water- and excreta-related diseases that have very high prevalence rates in the country. 1.3.2 The "Tinkhundla" are in varying status of development in the four regions of Hhohho, Manzini, Lubombo, and Shiselweni. The Rural Water Supply and Sanitation Branch, and the Swaziland Water Services Corporation in particular provide environmental health services to rural, peri-urban and urban populations. However many of the water supplies and wastewater disposal systems lack maintenance or are inadequate for the population being served. As a result, sewer overloads, blockages and spills of obnoxious sewer materials in residential areas is common occurrence. There is thus serious lack of capacity to provide adequate safe water supplies that exposes especially the peri-urban and urban residents to the risks of communicable diseases and can seriously compromise their health. 1.3.3 In line with decentralization policy, community participation is a strategy for undertaking environmental health programmes. The communities are somewhat aware of the various environmental health problems, yet their attitude and practices are still limited. Diseases such as cholera, malaria and schistosomiasis (Bilharzia) are not only worsening in their incidences and prevalence rates but also showing naturalistic resistance to environmental health interventions. Serious and professional adoption of the environmental health policy will entail considerable re-orientation in the methods of management techniques and in administrative training and support to ensure effective community participation through Participatory Hygiene and Sanitation Transformation (PHAST) methodologies. 1.3.4 Solid wastes (refuse) disposal systems in Swaziland are rudimentary and practices include dumping of refuse in borrow-pits, on plain land and banks of rivers. The pollution of groundwater, springs as well as surface waters is an unavoidable consequence. This situation is further compounded by the lack of adequate progress towards safeguarding the quality of the available water resources. There are at present no national drinking water quality standards. The Water Resources Laboratory, the Rural Water Supply Branch Laboratory, and the Swaziland Water Services Corporation Laboratory use different guidelines for physical, chemical, biological and radiological examinations and analysis that have to be consolidated and upgraded to conform to WHO – International Drinking Water Quality Guidelines. 1.3.5 Most of the Town Boards and Town Councils have inadequate resources to tackle the problems of refuse collection, storage, transportation and disposal. Refuse removal vehicles are largely old, unreliable and often not suitable for the hygienic removal of refuse. This has resulted in accumulation of refuse on the street verges and at collection points, because refuse removal schedules cannot be adhered to. Cases of proliferation of rats and mice are many and worrying and can lead to an epidemic of bubonic plague. 1.3.6 Industrial and medical wastes are considered as hazardous solid wastes that require proper management because they are usually allowed into the environment or into the general refuse disposal systems. A clear policy on disposal of hazardous solid wastes (industrial and medical) needs to be formulated and regulations promulgated. 1.3.7 Air pollution both indoor and outdoor have resulted in high incidence of bronco-pneumonia in Swaziland. Problems of occupational health and industrial hygiene due to local ambient air contamination are identified to be serious. Problems of the uses of hazardous substances (chemicals, pesticides and radioactive materials) that contaminate the environment are of increasing concern. Government machinery to address these issues is fragmented, and co-ordination, collaboration and networking by stakeholders are weak. Consequently duplication of programmes by Ministries and Stakeholders does not allow for adequate financing of projects. 1.3.8 The present staffing for the environmental health section in the Ministry of Health and Social Welfare is 44 health inspectors and 74 health assistants serving national population of 929,718 (1997). The national coverage for environmental health practitioners to the population is 1: 7,880. WHO staffing norm is 1 post to 5,000 persons. Using the ratio of the Ministry of Health & Social Welfare there is therefore considerable deficit and shortage of environmental health practitioners to address the problems of environmental health in the country. Because of inadequate provision of budgetary allocation and shortage of manpower and other inadequate logistics (transport), environmental health practitioners in the Government Services have not been able to adequately attend to environmental health problems at all levels. 1.4.0 THE NEED FOR A POLICY DOCUMENT1.4.1 In the absence of a Policy document that lays out the role of Government and other stakeholders in environmental health services, the Ministry of Health and Social Welfare is constrained in carrying out some of the functions, especially those of policy maker, professional guide, facilitator, and supervisor of all environmental health services. 1.4.2 This Policy document is therefore to make the people of Swaziland aware of Government policy on environmental health focusing mainly on the following issues:- 1.4.2.1 Delivery of environmental health services by the Ministry of Health and Social Welfare in relation to available resources (financial and technical expertise). 1.4.2.2 The relationship of the Ministry of Health and Social Welfare with other Ministries, Stakeholders and Providers of environmental health services. 1.4.2.3 The duties and rights of the Ministry of Health and Social Welfare as provider of environmental health services. 1.4.2.4 The functions of "Tinkhundla" as environmental health services providing agencies under co-ordination and supervision by the Office of the Deputy Prime Minister. 1.4.2.5 The duties and rights of individual, family and community as users/consumers of environmental health services. 1.4.2.6 The powers and role of both the Ministry of Health and Social Welfare and the Office of the Deputy Prime Minister as policy makers, co-coordinators, professional guides, facilitators and supervisors to the "Tinkhundla". 1.4.2.7 The powers and roles of the core Ministries – Health & Social Welfare, Tourism & Environment, Housing & Urban Development, Natural Resources & Energy, Ministry of Agriculture & Co-operatives , Ministry of Enterprise & Employment and others as policy makers in issues of health, environment, and sustainable development. 1.4.2.8 Involvement of other stakeholders including NGOs as partners in provision of environmental health services. 1.4.3 It is essential that all stakeholders adopt this Policy and accept it in order that environmental health services can be provided adequately in the country. There are several Acts, Bills, and Regulations that clearly spell out the roles, functions and responsibilities of some of the stakeholders in relation to environmental health issues. What is required is the willingness for effective co-ordination, collaboration and networking. 1.4.4 This environmental health Policy document is meant to address the identified deficiencies and gaps. CHAPTER 22.0 THE NATIONAL ENVIRONMENTAL HEALTH POLICY2.1.0 TITLE2.1.1 This Policy will be known as The National Environmental Health Policy. 2.2.0 INTERPRETATION2.2.1 In this document unless the context otherwise requires – ‘Authorized Officer’ means and includes an officer of the Ministry of Health and Social Welfare who possesses requisite technical and professional qualifications in environmental health discipline. ‘Collaboration’ means the overall interaction between agencies/stakeholders involved in environmental health issues. ‘Co-ordination’ means the principal mechanism for effecting collaboration within the sector of environmental health. ‘Council’ means township council, or city council. ‘Dwelling’ means any house, room, shed, hut, homestead, cave, tent, vehicle, caravan, remains of structure or any other structure or place whatsoever, any portion used by a human being for residing or sleeping or in which any human being uses for dwelling. ‘Environment’ means surroundings, surrounding objects or conditions, region or circumstances. It is totality of all social, technological, physical, chemical and biological elements that compose the surrounding of man. Its scope can range from the ocean depths to the atmospheric ozone layer. ‘Environmental Health’ as defined by WHO is "The factors 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 the present and future generations". ‘Environmental Health Issues’ means in Swaziland components that include : rural water supply; peri-urban water supply; urban water supply; rural excreta disposal; peri-urban excreta disposal of dry and wet systems; urban sewerage and sewage treatment; hazardous liquid wastes management; solid wastes management (domestic and commercial); hazardous solid wastes management (industrial and medical); occupational health and safety; occupational epidemiology; vector and vermin control; pesticides control; toxicology; control of dangerous and hazardous chemical substances; control of dangerous radioactive materials and articles; food hygiene and safety; meat hygiene; milk, dairy and dairy products; community participation and hygiene education (PHAST plus IEC); environmental health impact assessments; risk assessment; port health activities; air pollution; noise pollution; water pollution; healthy housing; environmental health manpower development and management; control of communicable disease outbreaks and epidemics; environmental health legislation; education of public on environmental health issues; advise to local authorities on environmental health issues; mental hygiene; emergency preparedness and response. ‘Environmental Health Practitioners" includes environmental health officers, environmental health assistants, health inspectors and health assistants qualified and registered as such. ‘Environmental Health Services’ means all services that are provided to address environmental health issues/interventions. The services are operated and financed by Swaziland Government (Ministry of Health and Social Welfare), "Tinkhundla" – Local Government Administrative Centers, township councils, city councils, other Ministries and Stakeholders, organizations and parastatals assisted financially by Government, private corporations/companies and non-governmental organizations (NGOs). ‘Establishments’ means establishments requiring environmental health services inspections that may vary, such as supermarkets, manufacturing industries etc. ‘Food or "article of food’ includes any animal product, fish, fruit, vegetables, dairy produce, milk, milk products, condiments, confectionary, beverages, and any other thing or article whatsoever, other than drugs, in any form, state or stage of preparation which is intended or ordinarily used for human consumption. ‘Government’ means public sectors excluding parastals. Some of the key/core Ministries of Government recognized under public sectors include the Office of Deputy Prime Minister, Ministry of Health & Social Welfare (Department of Environmental Health); Ministry of Tourism & Environment (Swaziland Environment Authority); Ministry of Agriculture & Co-operatives (Plant Control Unit, Department of Veterinary Services);. Ministry of Housing & Urban Development (Department of Housing, Project Co-ordination Unit, Swaziland Water Services Corporation, City Council of Mbabane, City Council of Manzini); Ministry of Enterprise & Employment (Department of Labour, Factories Inspectorate); Ministry of Tourism & Environment (Swaziland Environment Authority); Ministry of Natural Resources & Energy (Department of Water Affairs, Rural Water Supply Branch, Water Resources Laboratory, Rural Water Supply Laboratory); Education - University of Swaziland (Environmental Health Sciences Department of the Faculty of Health Sciences). These key/core Ministries have primary responsibilities for health, environment and sustainable development in Swaziland. ‘Health’ means "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity". ‘Industrial hygiene’ means the environmental health measures applied in the work situation to protect the health of workers. ‘Local Authority’ means township council, city council, or any other body or authority, or mission, or chiefdom designated as such in terms of this Policy by the Minister of Health and Social Welfare. ‘Minister’ means the Minister of Health and Social Welfare. ‘Ministry’ means the Ministry responsible for Health and Social Welfare. ‘Public Health’as commonly defined is the art and science of preventing diseases, prolonging life, promoting physical health and efficiency. ‘Recognized standards’ means guidelines, standards etc., which are internationally or nationally recognized. ‘Sanitation’ means a set of independent factors, such as hygiene practices, faecal and solid waste disposal, safe water use and management, healthy housing, and maintenance of a healthy surrounding that reduce health risks and increase well being. ‘Sanitation Services’ means disposal on-site or off-site of human excreta, the collection of sewage, excluding untreated toxic waste and storm water from residential, commercial or industrial sources, or the treatment and disposal of wastewater. ‘Sewage’ means soil water, wastewater or manufacturing or trade effluent. ‘Stakeholders’ means other related sector agencies of the Government, international agencies, and non-governmental organizations (NGOs), as well as individuals, families and community groups and private organizations. 2.3.0 PHILOSOPHY OF THE ENVIRONMENTAL HEALTH POLICY2.3.1 The Environmental Health Policy in Swaziland shall be based on the principles of Comprehensive Primary Health Care System contained in the National Health and Social Welfare policy (May 2000); the International Drinking Water Supply and Sanitation Decade 1981 – 1990; Agenda 21 on ‘Health, Environment and Sustainable Development’ in Rio de Janeiro in 1992; ‘Africa 2000 initiative on an international programme for water supply and sanitation’ WHO Regional Meeting of Africa Ministers of Health, Brazzaville in 1993; and the Pretoria Declaration on Health and Environment in Africa in 1997. 2.3.2 The Government shall ensure that sustainable development is put among the priority programmes when planning environmental health activities. 2.3.3 Government shall ensure that there are special environmental health intervention measures in respect of the peri-urban and urban, rural population and special groups such as children and workers in farming, mining, factories, hospitals and others whose profession justifies such measures. 2.3.4 Environmental health services shall be structured and carried out in such a way that the services shall be linked to the principles of health, environment and sustainable development and together with available resources shall be managed in such a way as to derive maximum socio-economic benefits with minimum waste. 2.3.5 Co-operation with all sectors whose activities have impact on environmental health status of the Swazi people shall be encouraged and fostered. 2.3.6 The participation approach shall be gender sensitive in health, environment and sustainable development is vital and beneficial as it gives women a sense of ownership, empowerment for longer-term social sustainability. 2.3.7 Effective community participation through Participatory Hygiene and Sanitation Transformation (PHAST) methodologies in the planning, execution, operation and maintenance of environmental health facilities shall be encouraged and supported. 2.3.8 Information, education and communication tools shall be promoted and utilized and communities encouraged to change attitude and practices that will promote good environmental health conditions. 2.3.9 Training and research in appropriate and affordable technologies in environmental health is important and to this end the health social welfare sectors shall encourage and support the involvement and participation of stakeholders and the community at large. 2.3.10 Government shall take the primary responsibility of training environmental health practitioners in local training institutions especially at the Environmental Health Sciences Department, Faculty of Health Sciences, University of Swaziland. In this respect the Ministry shall support the redevelopment of the curriculum for the training of environmental health officers from the present Diploma course to B, Sc. Degree programme to be approved by the University of Swaziland. 2.3.11 All employers shall provide refresher, on the job, and continuing and distant education to environmental health practitioners in order to ensure the maintenance of their basic skills and introduce them to new approaches in the discipline. 2.3.12 Environmental health discipline shall be practiced and supervised only by authorized officers in their respective cadres. CHAPTER 33.0 ENVIRONMENTAL HEALTH POLICY STATEMENTS3.1.0 MISSION AND VISION OF THE MINISTRY OF HEALTH & SOCIAL WELFARE (DEPARTMENT OF ENVIRONMENTAL HEALTH)3.1.1 The Environmental Health Policy statement is in line with vision of the National Health and Social Welfare Policy (May 2000) and seeks to ensure a safe environment, health and sustainable development for the promotion and sustenance of good health and improved quality of life of all Swazi people whatever their own financial resources or place of domicile. By the year 2015 the environmental health sector shall have been developed into an efficient and effective services delivery for the people of Swaziland. 3.1.2 To achieve the goal of the Policy statement the Ministry of Health and Social Welfare (Department of Environment Health) has the portfolio responsibility to formulate, adopt, promulgate, regulate, interpret and co-ordinate as well as supervise and monitor the implementation of policies, strategies, and activities relating to environmental health. The primary aim is to ensure safe environment, health and sustainable development. 3.2.0 RIGHTS OF USERS/CONSUMERS OF ENVIRONMENTAL HEALTH SERVICES3.2.1 Access to environmental health services shall be a basic human right. 3.2.2 The rural population in Swaziland are beneficiaries of environmental health programmes that invariably they must contribute to either by self-help or contribution in kind. In this respect community participation is obligatory in planning, operation and maintenance of the schemes. 3.2.3 Users/consumers in the rural areas shall avail themselves of the Participatory Hygiene and Sanitation Transformation (PHAST) methodologies, and the Community Level Operation and Maintenance (CLOM) mechanisms, for managing the environmental health schemes. 3.2.4 The users/consumers in the peri-urban areas must take initiatives to invest in the improvement of their environmental health facilities in order to prevent the deterioration and total collapse of the systems provided. 3.2.5 The urban population in most environmental health programmes will pay for the provision of services (water supplies, sewage treatment and disposal, refuse collection etc.). In some cases, some segments of the urban population are is provided for, on a subsidized basis by Government (Swaziland Water Services Corporation and Ministry of Health & Social Welfare) and other Stakeholders. 3.2.6 Persons that use environmental health facilities shall respect the rights and susceptibilities of other clients/consumers. 3.2.7 Users/consumers must observe all rules concerning the organization, operation and management of the environmental health facilities/services. 3.2.8 Appropriate bodies, committees, co-operative associations in the Communities responsible for representing and defending the interest of users/consumers will be established and must be made functional to look after the interest of users/consumers of environmental health facilities/services. 3.2.9 Users/consumers, producers, manufacturers, retailers and importers of hazardous substances and articles including chemicals and radioactive materials, pesticides and others that discharge wastes pollutants, must abide by the respective laws, and conform to acceptable recognized standards and conventions. 3.3.0 RESPONSIBILITIES OF THE MINISTRY OF HEALTH AND SOCIAL WELFARE AS POLICY MAKER, PROFESSIONAL GUIDE, FACILITATOR AND SUPERVISOR3.3.1 The Ministry of Health and Social Welfare shall be responsible for the formulation, adoption, promulgation, regulation, interpretation, co-ordination and supervision of this Environmental Health Policy. 3.3.2 Government recognizing the interdependent nature of the environmental health sector on a global basis, assumes its responsibilities accordingly with recognition of, and support for established regional and international environmental health organizations, in particular the International Federation of Environmental Health, the World Health Organization (WHO), the United Nations Children Fund (UNICEF), the United Nations Environment Programme (UNEP), the Food and Agriculture Organization (FAO), Habitat, Focal point of CODEX Alimentarius, and of benefit to Swaziland to co-ordinate its policies therewith. 3.3.3 Government through the Ministry of Health and Social Welfare shall ensure that all stakeholders are provided with information and guidelines of environmental health issues particularly the quality standards for drinking water, waste disposal etc. recommended by WHO. 3.3.4 The Ministry of Health and Social Welfare shall ensure that standards adopted for providing environmental health services conform with such internationally recognized standards; and shall through its facilitating and supervisory activities see to it that the environmental health services providers have established appropriate quality surveillance and control systems for adhering to the recognized standards. 3.3.5 Authorized officers shall at all reasonable times have access to any establishments (schools, supermarkets, food premises, farms, manufacturing industries, etc.) providing environmental health services for the purpose of supervision of the compliance with provisions laid down or decisions made pursuant of national policy, legislation, regulations and recognized standards. 3.3.6 Authorized officers when exercising supervisory duties may require and if so shall be provided with any information and samples concerning environmental health services offered by any establishment to users/consumers, and may inspect or obtain samples for laboratory examinations as required to control and supervise the activities of such establishment. 3.3.7 Where the work or activities of any establishment is considered to be harmful or potentially harmful to the users/consumers or not up to recognized standards, an authorized officer may order remedial measures, which order shall be complied with at the earliest reasonable opportunity. 3.3.8 The Ministry shall establish standard operational procedures for inspections and reporting on investigation of outbreaks of communicable and environmental health related epidemics such as cholera, typhoid, bubonic plague, etc. 3.3.9 The Ministry shall pursue its facilitating and supervisory role by means of advice, dialogue and consultation, and other mechanisms for intersectoral collaboration, coordination and networking. 3.4.0 PROVISION OF ENVIRONMENTAL HEALTH SERVICES3.4.1 The environmental health services shall comprise the facilities/services operated by government/stakeholders, Tinkhundla or those supported by parastatals and non-governmental organizations, and include such establishments as water companies, refuse collection ands disposal enterprises, medical and toxic wastes management companies, and others. All facilities shall be run in accordance with relevant legislation, Acts, Bills, and Regulations. 3.4.2 The responsible Ministry and Communities shall set users/consumers fees for those environmental health services they provide and revise them periodically after consultations with other stakeholders. 3.4.3 The responsible Ministry shall directly administer those environmental health services operated by Government; the Communities shall administer those services in their areas of responsibilities. Other stakeholders shall administer the environmental health services operated by them. All these components shall co-operate that they can so far as possible function as a coherent system. 3.4.4 All providers of environmental health services, whether public or private shall ensure that their activities are planned, constructed, operated and maintained in accordance with generally accepted technical and professional standards with existing legislation and the responsible Ministry may from time to time issue such guidelines. 3.4.5 The Communities in consultation with the Ministry’s environmental health management teams at both central and regional levels shall be responsible for planning and provision of environmental health services for the population in their areas in accordance with Government policy and any guidelines issued by the Ministry. Such primary focus includes Water & Sanitation; Environment Pollution; Meat & Food Safety; Occupational Health; Safe Habitat, and Port Health Activities. 3.4.6 Environmental health officers, environmental health assistants and others shall be appointed to be the authorized officers for the enforcement of environmental health laws, and regulations of the Public Health Bill. 3.4.7 Tinkhundla should ensure that they have in their employment environmental health officers, environmental health assistants and others to provide an efficient environmental health services. 3.4.8 In the spirit of decentralization the Ministry through its regional environmental health practitioners shall assure effective management of environmental health programmes of the Communities being executed by Regional environmental health workers. 3.4.9 An appropriate database on environmental health shall be developed for use by all environmental health departments in Swaziland. 3.5.0 INTERACTION BETWEEN THE MINISTRY OF HEALTH AND SOCIAL WELFARE AND STAKEHOLDERS3.5.1 The Environmental health practitioners shall administer and enforce the environmental health issues reflected the relevant Acts, Bills, and Regulations concerning Public Health and Health Promotion. 3.5.2 Environmental health issues are also reflected in many other Acts and By-laws. These are enforced in part by the Ministry with shared responsibilities by other stakeholders. The implementation of the National Environmental Health Policy is indeed a complex multisectoral activity involving the Ministry of Health & Social Welfare, other stakeholders and the communities. All tiers and agencies of Government, the communities and NGOs shall be actively involved in a complementary manner. 3.5.3 Providers and Communities have developed significant policies, strategies and action plans on environment, health, and sustainable development being administered by the core Ministries and stakeholders. The Ministry shall continue to interact with them as equal partners and develop the modality of collaboration to ensure that environmental health issues are considered and taken on board by the specific providers and Communities. 3.5.4 The Ministry will develop the modality of collaboration with various stakeholders to ensure that environmental health issues are considered in their programmes. Some of the issues may include – Water & Sanitation; Environmental Pollution; Meat & Food Safety; Occupational Health; Safe Habitat; Port Health Activities, and Communicable Diseases Prevention & Surveillance. 3.5.5 Non-Governmental Organizations and partners are involved with environmental health programmes in Swaziland. The programmes vary - water supply and sanitation, appropriate technologies research options. These NGOs and partners will be encouraged, to continue to support environmental health programmes and collaboration with them shall be effected and assured by the Ministry. 3.5.6 The Ministry may from time to time elaborate any component of the Environmental Health Policy in more detail as circumstances demand. Such elaborations will as much as possible be made after consulting the Communities, Councils, Regional, Administrative Authorities through established consultative channels with stakeholders, if the regulations directly relate to their environmental health operations. 3.5.7 There is advocacy for a consultative technical committee on environmental health matters between the Ministry of Health & Social Welfare(Department of Environmental Health) and the Core Ministries - Tourism & Environment (Swaziland Environment Authority); Agriculture & Cooperatives(Plant Control Unit, and Department of Veterinary Services); Housing & Urban Development (Swaziland Water Services Corporation); Enterprise & Employment (Factories Inspectorate); and Natural Resources & Energy (Rural Water Supply Branch) for exchange and collaboration. Members of the Committee shall be nominates by the Ministries from time to time. CHAPTER 44.0 INSTITUTIONAL FRAMEWORK4.1.0 INSTITUTIONAL AND ORGANISATIONAL STRUCTURES4.1.1 A National Environmental Health Advisory Board/Committee shall be established in the Ministry of Health and Social Welfare and will be empowered with legislative mandate to co-ordinate and advice the Minister on all matters of sustainable development, environment, and health among all stakeholders. The Board/Committee shall be serviced by Secretariat – the Department of Environmental Health. In order for the Board/Committee to perform its functions effectively, adequate resources in finance and personnel shall be provided through its Secretariat – the Department of Environmental Health. 4.1.2 The organizational structures of the Ministry of Health and Social Welfare are shown in Figures 1, 2, and 3. Within the organizational structures the cadre of the environmental health technocrats have been included to contribute to the integrated approach of dealing with the delivery of health care and environmental health services. 4.1.3 At the central level the Principal Health Inspector gives policy decisions and guidelines in the field of environmental health supported by other environmental health officers with specific programmes responsibilities. At the Regional level, the regional environmental health officers carry out the policy decisions with the collective support of environmental health practitioners within the Tinkuhdla health management teams. 4.1.4 At the Community level the environmental health activities are carried out from the health centers by the environmental health workers. The in-house services are curative, preventive and promotive mainly in waterborne diseases, diarrhea infections, bilharzias control and malaria control. The outreach activities cover in addition sanitary inspections, refuse and solid waste, food inspection and health education. The environmental health assistants take care of all environmental health programmes supported at community level by community based health workers. 4.1.5 Environmental health services in Swaziland are not the sole responsibility of the Ministry. There are many stakeholders involved. However the aspect of co-ordination a key function of the Ministry is lagging behind and as a result there is fragmentation of policies both within the Ministry and among other sectors as well. The collaboration, coordination and networking of environmental health activities with some of the existing coordinating inter-ministerial committees are not well defined. This Policy reaffirms the Ministry as the major player in policy formulation, planning and co-ordination in terms of environmental health. 4.1.6 Manpower resources development and management for environmental health workers have lagged behind. The complex nature of environmental health services and the interrelationship with the physical, biological, chemical, social and psychosocial appreciation and understanding all point of advocacy for the Ministry and co-operating partners to support a degree programme in environmental health sciences. Mechanisms to set up undergraduate and postgraduate programmes in the Faculty of Health Sciences of the University of Swaziland shall be actively set up. 4.1.7 Through the processes of consultation, workshops, seminars and meetings national policies, strategies and action-oriented plans have been developed by national responsible officers. This Policy Document formulation is a result of such organization and management procedures. A consensus (building) workshop to be convened will present and seek adoption on the policy by all stakeholders. 4.2.0 LEADERSHIP4.2.1 The success of the National Environmental Health Policy is vital in the achievement of the national goal of sustainable development, a safe environment, and the sustenance of good health for the people of Swaziland. The embrace of the Policy for use and application by all is advocated. 4.2.2 The Environmental Health Policy affects every aspects of the socio-economic, sustainable development and aspiration of the Swazi people. It requires the political will, support and participation of all our leaders in the chiefdoms and Tnkhundla. These include Political Leaders, Religious Leaders, and Traditional Elders of the Communities. CHAPTER 55.0 MONITORING AND EVALUATION5.1.0 STRATEGIES AND ACTION PLANS5.1.1 The Ministry of Health and Social Welfare will develop effective strategies and action oriented plans in line with activities already identified in the organizational structures for the environmental health cadres for the monitoring and evaluating the implementation of this Environmental Health Policy. 5.1.2 Developing Strategies for environmental health issues must be based on the needs, studies and consultations with stakeholders on the ways in which environmental health programmes could be directed in order best to respond to these needs, bearing in mind the constraints to be faced in terms of staffing, finance, supplies and equipment. 5.1.3 The Ministry must consider specific strategies that will enable it carry out its environmental health functions and for the achievement of environmental health goals. These would include capacity building, working with the existing structures of the Ministry, information education and communication, intersectoral collaboration, management of information system and use of national prominent and traditional leaders. 5.1.4 The National Environmental Health Policy identifies a wide range of environmental health issues to be addressed for the achievement of the overall environmental health gains and improvement of quality of life of the Swazi people. The draft Policy will be given wide distribution among all stakeholders in the country for review, comments and contributions. 5.2.0 AREAS OF CONCERN5.2.1 The draft National Health and Social Welfare Policy highlights the need for monitoring and evaluation and propose measures to be made of interventions, and the broad process of evaluation, reasons for evaluation and indicators to be determined. All components will enable efficient monitoring and evaluation of comprehensive Primary Health Care Systems. 5.2.2 The components of environmental health issues compiled after exhaustive technical sessions and consultation meetings and face-to-face interviews with national officers underscore the challenges and the need for radical changes in this Policy direction for strengthening the capacity of the Environmental Health Unit – office of the Principal Health Inspector through improving the staff capacity in order to be able to address the national environmental health issues. 5.2.3 The Ministry shall review this Policy from time to time to bring it in line with prevailing conditions in the country. This page was last updated on 08 February 2005 |