World Health Day 2023 - Health for All

By Chrispory Juma

World Health Day 2023 focuses on the theme, ‘Health for All,’ marking the 75th anniversary of the World Health Organization (WHO). It is a global health awareness day celebrated every year on 7 April, under the auspices of WHO and other related organizations. The date of 7 April marks the anniversary of the founding of WHO in 1948.

WHO’s 75th anniversary year is an opportunity to look back over 7 decades of collective public health achievements, thanks to science-driven learning and collaboration across countries and cultures, and to motivate action to tackle future health challenges for improved well-being and longer, healthier lives for everyone. 

Global public health awareness days help in raising the importance of healthy lifestyle and well-being among general population. Every year, many organizations and communities actively take part in promoting and supporting many world health days observed globally. These days are focussing on particular health problems and medical conditions.

World Health Organizations (WHO) and The United Nations urge everyone including individuals, organization and communities worldwide to take active part and educate others with real scientific data related to health issues.

Every individual should take part in this observance to help in promoting healthier lifestyle. Educating others related to the alcohol and smoking deadlier effects on the body, donating blood every year, healthy food habits and other public health measures can make a healthier world.

The writer is a Public Health Officer in the private sector. 

Kenyans are not ready to embrace plastic ban

By Chrispory Juma

The government may be ready in terms of structures and policies to implement this very positive plan for our environment but ordinary Kenyans are not prepared yet to forget about their most available and cheapest means of packaging just like that. NEMA ought to have learnt lessons on why previous attempts in 2007 and 2011 failed. As we had been mark-timing for another attempt this year, enough ought to have been done in the space available to educate and prepare the nation in adopting more environment-friendly methods of packaging. It is interesting that just a few days to effecting this ban, NEMA is organizing an event in Nairobi to show stakeholders available alternative innovations. National awareness, which includes such shows, ought to have picked up immediately an implementation plan was ready, with the utmost involvement of county governments and local communities.

The planned ban seemed to have picked up in the public domain just three months ago, leaving Kenyans confused and asking a number of questions. Where will an ordinary village trader get where to package his milk? What happens to the thousands of Kenyans employed in plastic-making industries? How available in the market are the alternative means against the huge demand? Can the state tell the nation what it has done to cushion Kenyans against the effects of this ban?

As it happens with most government initiatives, public engagement is assumed or superficial and the state relies mainly on its machineries to effect penalties such as fines and jail terms to insure such bans are implemented. But the strategies create illegal defiant creations for survival such as black markets. The big question that NEMA should ask itself is, ‘Have we done enough over time to change Kenyans’ attitude to embrace a clean environment?’ The answer would be NO, as it hopes for Kenyans and the industry to adapt to this ban along the way. We remain to watch if this time we’ll succeed.

Mr. Juma is a Public Health Specialist.

Concerning Professional Regulation, the Public Health Council must heed to Key Stakeholders’ concerns

By Chrispory Juma and Camlus Odhus

Public Health as a profession has been existence for a long time. Some authors have dated the founding age of public health to around 400 BC when the Hippocrates published his book titled Airs, Waters and Places. Since then, Public Health Officers have been involved in disease control, health promotion, epidemic preparedness and investigation, and health education. In Kenya, Public Health Officers and Technicians are tasked with safeguarding the health of the public, including ensuring food safety, promoting basic sanitation and hygiene, educating the public on various health risks, planning diverse population health interventions, and enforcing a vast array of public health laws. To do this, health officers must adopt multidisciplinary and collaborative approaches, work with integrity and professionalism, and emphasize equity and prevention for a healthy population.

Thus in 2013, the Ministry of Health saw through a law known as the Public Health Officers (Training, Registration and Licensing) Act, which made provision for the professionalization, training, registration and licensing of Public Health Officers (PHOs) and Public Health Technicians (PHTs) in Kenya. The Act established the Public Health Officers and Technicians Council (PHOTC), whose purpose is to exercise general supervision and control over the training, practice and employment of public health officers and technicians in Kenya, and to advice the government and Ministry of Health on matters of public health governance. Over the past two years, the Council has done its level best to put its house in order, including setting up training regulations and curriculum for Kenyan institutions that train the Public Health workforce including Universities and other colleges; putting up measures for internship and registration of graduates; setting up an online information portal, among other achievements.

In line with its mandate to ensuring that all public health professionals within its jurisdiction meet an acceptable level of competence before they begin to practice, the PHOTC has gazette a raft of guidelines. This level of competence is measured by assessing the applicant’s knowledge, skills and professionalism. It is in this regard that the Council has decided on annual examinations, where graduates who have successfully completed their internships undergo written and oral interviews before being issued with a License to Practice. The Council set registration examination fees at Kshs. 20,000 and Kshs. 15,000 for degree and diploma graduates, respectively. The seemingly high fees have created a raging controversy among the graduate fraternity with them calling for the fees to be revised to reasonable levels, and streamlined with other professional bodies’ fees. Others have called for the scheduled exams to be called off all together until the grievances are addressed, in line with sound stakeholder engagement mechanisms.

Graduate PHOs go through a mandatory one-year unpaid internships without any allowances or benefits, at times even without any supportive supervision from the national government. As if that is not enough, interns are expected to pay Kshs. 1000 for the internship. Even after this, their absorption into the Public Service is not guaranteed, at both the County and National levels even as the Higher Education Loans Board expect many of these graduates to start repaying university loans, amidst the tough economic times. The graduates are, therefore, asking where the council expects them to get the exorbitant Kshs. 20,000 to pay up for the examinations. They would also like to know the criteria which used to arrive at the figures, yet other profession’s examinations are much affordable. Doctors undergo paid internships and for those in public service, have to part with Ksh. 8,000 for Board registration. Nurses pay up less than Kshs. 5,000 for their professional examinations to the Nursing Council. While PHOTC have a mandate to set fees among other regulatory roles, the decision processes need to be open, fair, objective, participative and reasonable.

Public health professionals across Kenya have also questioned the list of graduates who have already been lined up for the test. Core to this discussion is the question regarding how holistic a professional’s training should be. While board examinations have been used the world over as filters, societies are increasingly weary of prohibitions, and regulators should instead adopt facilitative processes in for holistic development of any profession. Needless to say, Kenyans will pass exams through hook or crook but passing a first-past-the-post exam is neither indicative of a qualified professional nor should it assure members of the public regarding integrity and professionalism. The PHOTC is well advices to enlarge its focus beyond exams and unreasonable fees, and to train their lenses on institutions that are non-compliant with admission and training standards.

Until a proper system is put in place to monitor and enforce training standards, administering entry exams does not assure the public that quacks and half-baked officers will not be the ones tasked with promoting and safeguarding their health. And in a country that suffers from gross inequality, questions must be asked regarding whether profession of Public Health is now on sale to the highest bidder? We must guard against a culture that dishes out opportunities to those that can afford irrespective of their competence and qualifications, at the expense of many that could be deserving, yet cannot afford. Are the right candidates selected to join the right institutions? What is the quality of training at the respective institutions? Is there enough effective oversight on the training of health officers? What procedures are in place to go beyond an exam-based filter to a competency-based professional grounding?   How is PHOTC going to systematize continuing professional development, given that public health has one of the largest specialization options of any career? Employers, although not specifically about public health, have continued to note the poor quality and employability of job-seekers from local institutions of higher learning, despite such applicants holding impressive academic qualifications. The challenge is for PHOTC to find a balance between evolving employers’ needs, the country’s health aspirations, and current socio-economic realities, and to feed these back into the training standards and ongoing initiatives for professional development.  

These are weighty issues that many do not expect the regulator to have sorted out in its brief existence. But public health professionals are watching to see that a solid foundation is set for the sustainable development of the profession in the country. Most importantly, and as anticipated by the Constitution, what public consultative mechanisms have PHOTC put in place to ensure effective stakeholder engagement? It would be important for the regulator to put in place effective stakeholder engagement strategies, backed by a sound communications plan to ensure ongoing exchange of information in a non-confrontational manner. Sadly, on this facet, the regulator is found wanting. Although backed up by an Act of Parliament and having the benefit of a fully constituted board, PHOTC should seek to gain the confidence of her stakeholders, and work collaboratively with genuine member-driven associations rather than wave statutes at the slightest interrogation. Unless the regulator has a thousand-strong secretariat and adequate finances to police the profession, it is well advised to forge cooperative alliances while remaining above board. As we have witnessed with other regulators, laws are not enough to maintain sanity, and public participation and support for policy actions are key ingredients for success. We want the Council to succeed wildly, for we, the members of the public health profession and the public - whose health we are here to safeguard - will be the ultimate beneficiaries of such a success, but we are also ready to scrutinize how it conducts business because we have a legitimate right to do so, both as citizens and as corporate members.

A strong council would need all PHOs and PHTs of all calibers to move along with it, regardless of their stature in the society. It would be in naïve, in bad faith, unjust and arrogant to go ahead with the planned examinations without properly responding to concerns raised. We expect it to have a special sitting to deliberate on the exorbitant examination charges, because if this is not done, professionals will need a rethink. The Council must be fully supported in its efforts to restore integrity in the Public Health sector, but that support can only be effective with participatory decision making on its governance roles. Kenya needs strong institutions to move towards national, regional and global development goals, including the new Sustainable Development Goals related to public health, and PHOTC must not disappoint.

Disclaimer: The writers are Kenyan Public Health Practitioners. Views in this article do not necessarily reflect those of their affiliate organizations. Chrispory Juma is a MPH Student and Community Mobilization Expert (chrispory.juma@gmail.com); Camlus Odhus is a post-graduate Commonwealth Public Health Scholar (codhus20@gmail.com)

5 Ways to Celebrate World Water Day 2015

Today Sunday is World Water Day, a United Nations initiative to celebrate clean water and bring attention to those who don’t have enough of it. Every 22^nd March, the world, under UN Water, seeks to reflect on the value and future of water in our society being the centre of our food, driver of our industries and the balance of human equality. A new report released ahead of World Water Day warns about a looming shortage, and centers on this year’s theme: water and sustainable development. Here are five ways to celebrate World Water Day:

1.       Learn about poop water

First charcoal juice becomes a thing, and now poop water? Hey, Bill Gates drinks it—thanks to a new machine called the Omni-processor that literally transforms waste into water through a steam engine. On his blog, Gates writes about drinking a “delicious” fresh glass of it and marvels at the possibilities to improve sanitation in low-income countries. “The processor wouldn’t just keep human waste out of the drinking water; it would turn waste into a commodity with real value in the marketplace,” Gates writes.

2.       Take a break from meat

Showering and hydration are hardly your main uses of water—but food is. The average American uses 7,500 liters of water each day, according to the U.N. If you’re eating meat, your water usage shoots way up; a steak dinner for two requires 15,000 liters of water for the meat alone. Eating more meat and dairy has been the single greatest factor for water consumption in the past 30 years, says the group—so going vegetarian, even temporarily, can make a difference.

3.       Wash your hands the right way

Sounds gross—and it is a public health hazard, according to UNICEF, organizers of Global Handwashing Day, another water-related holiday worth celebrating. “Handwashing with soap prevents disease in a more straightforward and cost-effective way than any single vaccine,” supporter UNICEF writes.

4.       Support a future female farmer

Most of the world’s hungry are women, says the U.N.’s new report, and most don’t own land—or even have time to make an income, since 25% of their day is spent collecting drinking water. “With equal access to resources and knowledge, female farmers, who account for the majority of all subsistence farmers, could produce enough additional food to reduce the number of the world’s hungry by 150 million,” the report says. Investing in water and sanitation actually helps improve equality, which helps stimulate the economy—every dollar invested yields between $5-28, the UN estimates.

 5.       Give better water to the world

A new report from WaterAid America found that one in five babies born in the developing world dies during its first month of life because of a lack of clean water. And 35% of facilities in middle- and lower-income countries didn’t have water and soap for hand-washing, another report from the World Health Organization found

Adapted from http://time.com/3753021/world-water-day/

(The writer Chrispory Juma is a Public Health Officer and Community Mobilization Expert based in South Sudan. Email: chrispory.juma@gmail.com)

Parents and Guardians need to fully support the Condoms for Teens Campaign

Everyday 20,000 girls under the age of 18 give birth, and 95 percent of these pregnancies occur in the developing world. For these young women, the results can be devastating. They not only face increased risk of maternal death and other pregnancy complications, but are less likely to remain in school, which can limit their economic and other opportunities. Of married adolescents in sub-Saharan Africa, 26 percent want to avoid pregnancy, but are not accessing modern contraceptives.

In Eastern and Southern Africa, some 2.7 million people aged 15 to 24 years live with HIV, more than half of all HIV-positive young people globally with the risk of infection is higher among young girls. Back home in Kenya, every two minutes, a youth is infected with HIV from unprotected sex with the average HIV/AIDS prevalence rate standing at 3%. For sure, young people are evidently at risk from unprotected sex and this sad fact cannot be assumed any longer.

In the global debate site, www.debate.org, the question of whether to give teens condoms or not is the most answered one, with proponents for condom use leading with a massive 80% and the general point about their support is that with an increase in reported sexually transmitted diseases (STDs), including HIV/AIDS, among adolescents, teenage pregnancies, communities must take action to protect their youth. One proven method is to provide comprehensive sexuality education along with school based programs that make condoms available to sexually active youth.

Numerous nations in the developing world have already adopted this strategy, notably South Africa with very positive results, and Kenyan parents must not appear to be any conservative to deny this campaign the much needed support to reduce adolescent mortalities from particularly HIV/AIDS. Kenyan parent’s fears are understandable, they want total control of their children’s sexual and reproductive health and rights and most have a strong feeling open introduction of their children to condoms will lead to rampant immorality. Many contend it will rubber-stamp a system failure of the society to reign in on their children to abstain.

But we need the parents and guardians to accept and adopt this global UN campaign fully and support in the HIV/AIDS Prevention strategy of Behavior Change Communication (BCC). At a time when it is frequently difficult for parents to talk with teenagers, that condom opened up avenues for us to discuss AIDS and birth control. When young people feel unconnected to home, family, and school, they may become involved in activities that put their health at risk. However, when parents affirm the value of their children, young people more often develop positive, healthy attitudes about themselves. Although most adults want youth to know about abstinence, contraception, and how to prevent HIV and other sexually transmitted infections (STIs), parents often have difficulty communicating about sex. Nevertheless, positive communication between parents and children greatly helps young people to establish individual values and to make healthy decisions.

Adolescent are not going to be given condoms to promote sex, rubberstamp ABC prevention matrix or parental failure. It is going to promote safe sex due to an extremely high rate of sexually transmitted diseases and teen pregnancies. This is a health issue; if it wasn't then there wouldn't be this launch with massive international support. It needs be clear again to parents that if schools are going to give out condoms to students, its going to be after a proper discussion about sex education and sex practices, and they are going to have a right to accept or refuse to let their children partake the preventive and contraceptive tools. By statistical evidence, teenagers engaging in unprotected sex is a public issue that cannot be thrown under the carpet. The campaign is about availability, access and use for young people so that we can protect the safe ones and prevent the already infected ones from infecting others. Sex yes is an adult topic and behavior but obviously children are ‘acting’ like adults who must be taught to behave responsibly with their sex lives.

Parents in their religious or social groups, professional workplaces and family unions must be mobilized through vigorous sensitizations to embrace this campaign as the current best amongst many strategies meant to secure the future generation of leaders, workforce and key movers of the nation. Youth writer Mary Macleod once said, ‘We have a powerful potential in our youth, and we must have the courage to change old ideas and practices so that we may direct their power toward good ends.’ Parents must shift from conservative ideas and embrace globally appreciated progressive interventions that seek to protect their children.

(The writer Chrispory Juma is a Public Health Officer and Community Mobilization Expert based in South Sudan. Email: chrispory.juma@gmail.com, Twitter: ChrisporyKer)

Why Cholera struck Homa Bay County and what must be done

As a son of Homa Bay, born, bread and schooled within the County up-to Secondary level and a PHO who has spent most of his professional experience within the county, I think I understand it better. I wish to share why Cholera again struck Ndhiwa in Homa Bay, claiming 3 lives and more than 100 cases. I am very sure this will not be the last Cholera outbreak unless any miraculous public health and sanitation investment happens in the shortest time, and the issues I wish to express, well in the public domain, are not given the requisite attention. Any single confirmed cholera case, in any village is a sign of a very poor water, sanitation and hygiene situation. Why in this age would people die from a disease very preventable by mere proper washing of hands, proper cooking of food or proper environmental sanitation? We may mistake it as a matter of cultural negligence but I take it as the repercussion of poor public health governance.

The statistics on the ground do not lie. From report sources, only 2% of the more than 1.2 million residents of the County have access to clean and safe piped water. An average of 14% of residents lack basic sanitation and latrine coverage at its worst. Every day of our lives we live amidst serious danger of water-borne disease outbreaks. Homa Bay town must be having one of the most serious water shortages with the water service provider lacking the technical capacity to supply a growing population and improve its supply chain. The result is a lowering in the quality of life, reduced urban productivity, and increased burden of health care and unmitigated environmental pollution. The acute water shortage can get worse that people drink the raw waters of Lake Victoria. With a child-rich population with the 0-14 year age bracket accounting to 43%, there is clear linkage between the high child mortality rates to the ever present health hazards posed by poor water and sanitation.

In Homa Bay, we enjoy the largest section of Lake Victoria and boast of four rivers: Awach Tende, Awach Kibuon, Riana and Kuja. The argument has understandably been that tapping the Lake Victoria water with the incessant water hyacinth infestation has been expensive and problematic, and therefore we have just to live with the lake beside us. But what about the rivers? Why can’t we have a sustainable plan of connecting communities along the rivers with the available water? A comprehensive water supply plan from our immense fresh water sources is the way forward. It is never in drilling boreholes the way the Governor promised last week over 50 boreholes. South Nyanza ground water has quality issues, too salty and unsafe for human consumption. There is enough evidence from Pala in Karachuonyo to Pala in Koguta that the high fluoride levels in the ground water have serious public health risks.

Plan International, World Vision and other agencies have done tremendous work in Community Led Total Sanitation (CLTS) in Homa Bay County. But must NGOs fund CLTS any longer for our people? Even without CLTS, what energy or funds does it take to invest in low cost toilets, even for the urban poor? With good leadership, we can break away and run the County’s WASH like NGOs ourselves. What can stop us from running a Countywide CLTS Program to ensure all our villages are Open Defecation Free (ODF)?

The County Government is frustrating health professionals. Late payments and poor working conditions have demoralized many health workers to an extent the quality of their service delivery has been immensely affected. Challenges regarding transition of public health management and service delivery have immensely affected community health, with Community Health Extension Workers (CHEWS) and in extension the Community Health Workers (CHWs). Community disease surveillance, reporting, documentation and progress have back-tracked. The frequency of field visits and supervisions have reduced possibly even due to untimely fueling of their motorbikes; now all the funds are managed by the County Treasury. Local Health Centers are ill-prepared to handle Ebola cases, and Rongo Sub-County Hospital was far, and ended up being over-crowded by the patients. Many will tell you they avoided the Homa Bay County Hospital because no quality health care is offered there.

The County’s Ministry of Health must go back to the Homa Bay County Integrated Development Plan (CIDP) and borrow the insights therein regarding improving health care for the people of Homa Bay. It must hold full grip of our Public Health Management System, and get our Disease Surveillance, Community Health Strategy and Community Led Total Sanitation back to its feet.

The three main diseases that the government must give equal focus and responsive prevention strategies are AIDS, Malaria and Water Borne Diseases (Cholera and Typhoid). The burden of AIDS might have blocked our eyes from other real public health matters. This outbreak will once again put spotlight on our County and most like attract more NGOs into the WASH sector but we must offer leadership. I am hopeful that this will help the County’s Ministry of Health WASH Strategy, and Community Mobilization must be at the heart of it. Village Committees, Community Leaders and CHWs must be capacity built, motivated and tooled to mobilize very village to take personal hygiene and sanitation seriously.

Generally, if Cholera killed 9 people in two days you can imagine if it were an Ebola outbreak. In the end you realize that Africa's problem in disease surveillance and disaster response is uniform and the same from West to East: We are under-staffed, ill-equipped, unprepared, clueless, hypocritical and poor learners. The burden of disease is seriously taking tall on us and we look forward to our County leadership mobilizing every citizen so that we can be a model WASH County: Let us manage devolved health care properly, invest heavily in water supply and low cost latrine construction, re-energize community health workers and revive proactive management of Lake Victoria.

(The writer Chrispory Juma is a Public Health Officer and Community Mobilization Expert based in South Sudan. Email: chrispory.juma@gmail.com)

Pollution kills far more people than Malaria or Ebola in the Developing World

Diseases like Ebola, HIV, and malaria rightly get a lot of a headlines, because they can kill millions of people very quickly. But there's another problem that affects even more people, and it's not mentioned as much: pollution. In all, pollution kills 8.9 million people a year, according to a new report, and as many as 200 million people suffer pollution-related health problems, including brain damage from exposure to lead, mercury, and pesticides. From Kenya to Kyrgyzstan, there are still thousands of appallingly polluted places, from electronic waste dumps to toxic old factories where chemicals continue to seep into the ground. One 2013 study of 373 sites in India, Indonesia and the Philippines estimated that 8.5 million people were at risk of serious disease-the equivalent burden of malaria and outdoor pollution combined.

"Most of the countries that are struggling with this have very limited resources to tackle the problem," says David Hanrahan, senior technical advisor to the Global Alliance on Health and Pollution (GAHP), one of the groups behind the report. "In smaller, poorer countries, it may not amount to more than a few hundred thousand dollars. That's very, very little in comparison to what developed countries in Europe or North America spend, and it's also small compared to other international aid flows." The study comes from the Blacksmith Insitutte for Pure Health (a New York nonprofit), the Green Cross in Switzerland, and GAHP. It follows a similar report from last year that identified the world's most polluted places. In addition to drawing attention to pollution, it shows how relatively low-cost interventions can improve lives.

The groups list 10 projects that are "turning a corner on pollution" including one in Dong Mai, a village in Vietnam. The area is covered in lead from recycling and small-scale smelting. Working with local partners, Blacksmith covered the soil with a "geotech" fabric (a semi-permeable material) then placed new dirt over the top. Toxicity levels dropped 30% in three months, all for about $20 per villager. In another example, from Thiaroye Sur Mer, in Senegal, several international groups worked together to dig up the soil around areas where women recovered lead from old batteries (the soil was 20% lead). They took the dirt to a containment site and then provided villagers with hydroponic systems and training, so they could grow vegetables more safely. In a third example, from the infamous Agbogbloshie e-waste dump, in Ghana, cheap recycling machines have reduced the need for "pickers" to burn old equipment to get components out. That reduces their exposure to toxic fumes from plastics and other casing materials.

A fourth example is back home in Kenya, where we have seen Dandora dumpsite take years to relocate as neighbouring residents more-so their children complain of respiratory infections, Nairobi River is back to its old self, very polluted yet still used by people along it to brew illicit liquors and domestic consumption. The foam that formed a long Mbagathi way last year was a good example of how we continue to lose in environmental protection. Water resources are under pressure from agricultural chemicals and urban and industrial wastes, as well as from use for hydroelectric power. Kenya expects a shortage of water to pose a problem in the coming years. For example the damming of the Omo River by the Gilgil Gibe III dam together with the plan to use 30% to 50% of the water for sugar plantations will create huge environmental problems. It is estimated that up to 50% of the water capacity of Lake Turkana will be lost.

In the end, a keen look into these assaults on the environment and their long time health effects reveals that we keep losing more lives through environmental pollution and this largely contributes to lower mortalities in the developing world. And there seems to be less willingness to invest in clean energies for healthier citizens if for example the planned multi-billion Kenyan coal project is anything to go by.

The writer is a Public Health expert on community mobilization (chrispory.juma@gmail.com)