Climate change is the biggest threat to public health, GCHA urges action

International Health experts, the Global Climate and Health Alliance (GCHA), have added their voice to the climate action movement, arguing that the health risks posed by a global temperature rise are too grave to ignore. The health professionals are basing their argument on the UN’s Intergovernmental Panel on Climate Change's (IPCC) Fifth Assessment Report on climate change, which was released on Monday to intense global interest. 

The IPCC's ‘Climate Change 2014: Impacts, Adaptation, and Vulnerability’, affirms that humans are responsible for the earth’s warming which is having a devastating impact on communities globally. According to the United Nations’ World Meteorological Organization (WMO) the period from 2001-2010 was found to be the hottest decade on record.

People in the developing world are disproportionately affected by this rise in world temperature, with lower crop yields resulting in rising levels of under nutrition. This climate induced problem stunts child growth and inhibits full development. Similarly, weather disasters such as last year’s Typhoon Haiyan have had a severe and resoundingly negative impact on local communities, with significant numbers of casualties left in their wake.

Drawing on the IPCC’s data, the Global Climate and Health Alliance (GCHA) has developed a briefing report to highlight the precise health implications of climate change. Sue Atkinson, Co-Chair of the Climate and Health Council describes the rise in temperatures as the “biggest threat to public health” and notes that without “urgent action to curb emissions, both by individuals and organisations, the impact on the health of many will continue to increase”.

The GCHA believes the UNFCCC conference in Paris 2015 presents a key opportunity for tackling this alarming problem, and urges political leaders worldwide to commit to a binding and ambitious climate treaty. However, the health coalition also emphasize that small-scale actions such as increased use of bicycles can tackle greenhouse gas emissions effectively while also having a significant health benefit for individual cyclists.

Gary Cohen, President, Health Care Without Harm, has stressed that those in the medical profession must demonstrate climate leadership by “by anchoring the community response to extreme weather events, leading by examples in mitigating its own climate footprint and becoming powerful messengers for climate policies that will improve the health of our communities and the planet.”

Mark Kenber, CEO, The Climate Group, responded to the GCHA's report by drawing attention to the threat climate changes poses to international water security: "It is very encouraging to see such eminent international health experts lend their voices to the campaign for action on climate change. Climate scientists have predicted that the rise in global temperature will have a significant impact on drinking water both in terms of quantity and quality."

Borrowed from http://www.theclimategroup.org/what-we-do/news-and-blogs/if-human-health-is-to-be-protected-climate-change-must-be-tackled-global-health-leaders-urge-leaders-to-act/

Water Bill 2014 will enhance Water Sector gains

The CoK 2010 provided for opportunities that were meant to equally distribute resources and make services more accessible to citizens. It created devolution which placed water services delivery and storm water management in the hands of County Governments, entrenched citizen participation and broadened the bill of rights to explicitly espouse the right of access to safe water in adequate quantities. There was therefore need to align the water sector to these realities. The ongoing alignment process therefore provided an opportunity for sector institutions, the public, CSOs and development partners to move to a more targeted and integrated sector governance approach.

The Water Act 2002 has made great gains: The water sector has attracted more resources which confirm commitment and confidence by government and development partners respectively to the reform, there has been socially responsible commercialization of water services sector which has been successful in urban areas, there is more stakeholder participation and gender mainstreaming, there is improved ring-fencing of revenues, water resources increasingly receiving the desired attention as their management is more delegated to the grassroots and the sector is nowadays receiving manpower of varied skills. The Water Bill 2013 upholds the basic tenets of the Water Act 2002 and if correctly implemented could preserve and extend these gains made since 2002 hence improved accountability and transparency in water governance.

The Bill establishes bodies to be in charge of water resources, services, financing and disputes resolution; Water Resources: Are national assets belonging to all Kenyans. The Cabinet Secretary in charge of water affairs sets policies. The Water Resource Regulatory Authority (WSRA) sets and monitors rules and regulations.  Basin Water Resource Boards (BWRB) prepares and implements strategic basin water resource plans. Counties are represented on the BWRB; possibly on a rotational basis in a situation where the number of counties concerned exceeds the available seats. Water Resource Users Associations (WRUAs) with their current functions are established at the level of sub-basins and catchment areas. The Bill establishes the National Water Storage Authority (NWSA) responsible for national water works.

Water Services: Is primarily the responsibility of the county and inter-county governments, with the latter handling water supply systems covering several counties. The Bill upholds ring-fencing and regulation, i.e, what is paid for the water is used for water. Water Service Providers (WSPs) are licensed by the Water Service Regulatory Commission (WSRC). County Governments can take up water service provision instead of contracting companies. On the other hand, Water Works Development Boards (WWDB) plan and develop national water service works in consultation with the counties concerned. There are also Water Consumer Groups (WCGs), which provide for citizen participation in water service delivery. Currently, there are eight Water Action Groups across the eight Water Service Boards in Kenya.

Financing: The mandate of the WSTF (Water Sector Trust Fund) would extend to community initiative for water conservation. Communities in hard it Counties such as Kitui, Marsabit and Garissa should now be able to initiate community owned water supply projects.

Dispute resolution: The Bill establishes the Water Tribunal as a sub-ordinate court within the judiciary along the Land & Environmental Court mandated by the CoK. This should handle water related issues like the cross-county conflicts that have surfaced between Nairobi and Murang’a Counties.

With Devolution now fully running and various County Governments rolling up their sleeves to fully serve citizens, it would be great to finalize the enactment of the Bill for smoother transition. The pressure is already building up on many of them to find both short and long-term solutions to insistent low water coverage. Counties like Homa Bay and Siaya continue to have acute water shortages inspite of being close to World’s second largest fresh-water lake and surrounded by many permanent rivers. Counties now need a national framework to guide their processes of formulating county-based water laws which would inform investments and budgetary priorities; of course water is top priority for many Counties.

With many unmet objectives under the millennium development goal on water, a new water law would create a good environment even as we begin discussions on the post-2015 goals on water. More than  40% of Kenyans still do not have water and sadly, some Water Companies like the Nairobi City Water and Sewerage Company (NCWSC) plan to make water more expensive inspite if its scarcity and quality questions. This in itself is not in line with the Jubilee Government’s manifesto on water which went ahead to promise Kenyans piped tap water at their doorsteps by 2020.

The Commission for the Implementation of the Constitution (CIC) has uploaded the Bill on its website and there is still window for sector players’ inputs. Non State Actors such as Kenya Water and Sanitation CSOs Network (KEWASNET) and Water and Livelihoods Network (WALINET) have since 2012 engaged partners in consolidating inputs through position papers and policy briefs to be presented to the CIC and The Directorate of Water Sector Reforms. The Bill has been officially gazetted and shall be presented to Parliament for debate.

The writer is a Kenyan Public Health Officer based in South Sudan (chrispory.juma@gmail.com).

Why unemployment is a a public health time bomb

Kenya, a developing country, should take keen interest in the WHO review on effects of unemployment and education on public health in Britain, a member of the G10. It states that young people who are not in employment or education in Britain are “a public health time bomb waiting to explode”. ‘Neets’ – or young people not in employment, education or training – were likely to have worse health than their employed counterparts and the Government needed to act to ensure health inequality does not become entrenched, the authors of a report by the organisation claimed.

The review also found that children and women would be better off living in many other European countries, including Eastern European states, than in the UK. “Unemployment may be falling in the UK, but persistent high levels of the number of young people over 18 not in employment, education or training is storing up a public health time bomb waiting to explode,” said Professor Sir Michael Marmont, who chaired the study.

"We are failing too many of our children, women and young people on a grand scale. "I would say to any government that cares about the health of its population: look at the impact of their policies on the lives people are able to lead and, more importantly, at the impact on inequality.

"Health inequality, arising from social and economic inequalities, are socially unjust, unnecessary and avoidable, and it offends against the human right to health." Across the UK there are are 1.09 million 16 to 24-year-olds in the ‘Neet’ category, or 15.1 per cent of the population in that age bracket, according to data published this year.

And death rates for under-fives in the UK - which stand at 5.4 per 1,000 live births and are linked to poverty - are higher than most countries in the east of Europe, the Review of Social Determinants and the Health Divide in the WHO European Region found. Children are more likely to live in poverty in Britain than many other countries in Europe including Iceland, Cyprus and Ireland, it said.

Sir Michael added: "Good quality early years provision must be a priority for all children. But childcare in this country is expensive and many people cannot afford to utilise it or go back to work after having children. "There needs to be a broad range of social policies, including improvements in every child's start to life, adequate social protection that can act as a buffer against low income over the life-course, and provide a minimum standard for healthy living." Female life expectancy in the UK is 83, behind Spain, France and Italy, where it is 85, and Cyprus and Germany, where is it 84.

This review has very serious resonance and semblance to Kenya where a large percentage of the youth are unemployed and lack formal training or education. A recent report by InfroTrack Research stated that only 3% of people in the coast region have at least a University Degree.

Kenya’s life expectancy averages 57 years with under-five mortality standing at 80 per 1000 live births. These damning health indicators may well show that we are more affected by poor investment in employment and training of our youth, doing worse in public health. The fact that the youth are still marginalized in terms of opportunities such as employment means that they stand to be the affected because they can not have the socio-economic power to make the right health choices. There is then every reason for our governments, national and county, to adopt this WHO report. 

The writer is a PHO based in Nairobi (e-mail: chrispory.juma@gmail.com)

Graduate PHO Interns must not be forgotten

The Public Health Officer (PHO), or Bora Afya (in Kiwashili) is the guy who spearheads disease surveillance, hygiene and sanitation, building plans approvals, health education and promotion, community mobilization over all health issues including having a first-hand contact with epidemics where they arise, and enforcing legislations related to environmental health. In essence, the PHO is the custodian and pillar of Kenyans’ health, ensuring that any or many of them are not admitted in hospitals, or fall sick at all; yes, the PHO is the benchmark of preventive health care.

Preventive health care has gained a lot of traction in government as well as in the NGOs sector. However, financing it has never gained the same tracking and most activities geared towards prevention are under-resourced (mortalities due to preventable deaths still high).  Only recently, the government began putting some efforts to support prevention through the community strategy by employing CHEWs (Community Health Extension Workers). However, the CHEWs (lab tech, pharmacy technicians, etc) employed through the ESP program were not directly relevant to Community strategy and had to be reassigned in most districts. To date the biggest undoing of community strategy is lack of funds as it is still donor-funded with many donors having their own priorities.

This brings to fore the whole question of how adequate Public Health Professionals, particularly PHOs, are for the Kenyan Public. The number of PHOs in Kenya is approximately 20,000, with those in government at around 10,000. Majority of those in Government are diploma and certificate holders and only about 200 are graduate degree holders. We are talking of a ratio of 1 PHO for every 2,000 Kenyans.

A cadre of PHOs which seems to be forgotten in this Public Health Human Resource circus is the Graduate PHOs Group, which just like any other health cadre, is required to undergo a mandatory 1 year internship to be considered for absorption by the government. The interesting thing about the health care system in Kenya is that it is very much in the hands of the government thus opportunities for health professionals largely depend on government provisions.

Internship is undoubtedly a good professional development platform, more so for those with health backgrounds. But how convenient and motivating is the PHO Graduate Internship? Is there anything that can be done better? Upon completion of studies, graduate PHOs interested in future MOH job considerations are required to choose an internship station of their choice, apply and volunteer there for one year, without any motivation or stipend.

Upon completing this, absorption is not guaranteed. Frustrated graduate PHOs have had to wait for more than 3 years now for a word from the MOH. The most affected are the Environmental Health Graduates. The last time MOH did a meaningful absorption of PHOs was in 2009, where more than 150 PHOs were employed. Many PHO graduates have had to run to NGOs which have Public Health Programs, and have found their skills and experiences relevant and hugely in demand. Others have had to diversify their career paths into unlikely fields such as banking and insurance.

As one of the creamiest professions for university entrants, many people always have huge expectations when they enroll for it. But the loud silence from MOH on the fate of PHO interns, with many of them graduating from Universities each year, always makes them wonder if academic investment in Public Health is worth it, in the absence of many NGOs which have absorbed a number of them.

While we are talking of laws to introduce stipends for unemployed graduates or stipends for best performing form four leavers, what has made it difficult to have stipends for PHO graduates? Is it about our laws, now that the Public Health Act Cap 242 and Public Health Officers/Technicians Act do not mention PHO interns? Can’t we include PHO interns in the PHOs’ Schemes of Service (SOS)?

With health care largely devolved, any hopeful PHO is looking up to the county governments to create more opportunities. This being a service delivery profession, the government continues to be our sole bread-winner and the silence has even wider effects on the growth of the Public Health Profession in the Country.  The Constitution of Kenya, in the Bills of Rights, expressly provides not only the right to health for every Kenyan but also the need for everyone to be treated equally, with an equal right to employment and related benefits. When the government selectively targets one cadre of health workers to be compensated during internship and not the other one, it is a violation of the other’s human rights and propagating professional discrimination in the health sector. As such, by the PHO Interns asking the government to look better into their welfare, it is not a request for a favour but a demand for what is justifiably right.

(The writer is a PHO working as a Program Officer for Water and Livelihoods Network (WALINET). He is the convener of Public Health Officer Interns-Kenya, E-mail: chrispory@walinet.org)

Imported solid wastes adding more salt to injury

The Environmental Management and Coordination Act (EMCA) of 1999 gives rights and confers duties to individuals to safeguard and enhance the environment. It guarantees every Kenyan a clean and healthy environment. These provisions also envisage protection of the environment for the benefit of the present and future generations as also envisioned  in Kenyan Vision 2030 and the constitution 2010.

However, more often than not, urban dwellers have to make do with living amid solid wastes despite the health risks.  Here is where slums and streets are littered with solid wastes and bus parks and ocean/lake shores serve as dumpsites. It is common to come across slum children playing with plastic bags full of feaces that had been thrown away the previous night.

Kenya continues to face a myriad of challenges regarding solid waste management. Budgetary deficiencies, insufficient public awareness, poor enforcement of outdated legislations, less solid waste research and lack of skilled staff in waste management are making us stare in the face of a solid waste management time bomb. Collection systems are inefficient and disposal systems are not environmentally friendly. 30 to 40 per cent of all solid waste generated in urban areas is uncollected and less than 50 per cent of the population is served (Otieno, 2010). He states that up to 80 per cent of collection transport is out of service or in need of repair and argues that if the issue of sustainable solid waste management in Kenya is not considered urgently, all the towns in Kenya will be engulfed in waste. The politics of relocating the Dandora dumpsite, inspite of the obvious environmental health risks it predisposes us to, for instance, has been here with us for decades. Again, one would wonder, where will this dumpsite be rellocated with the current approaches? That remains another discussion for another day!

Nairobi, the most affected by the solid waste menace, produces approximately 3200 tonnes of solid wastes daily. This is enough for people who would want to draw recyclables, instead of resorting to importation as in the case last week of the 20 tonnes from Britain. But this, ashamedly, might just be a tip of the iceberg. Many more are getting in. But one would ask, why bother with the local content while we can not tell the exact amounts of types of solid wastes we produce daily as a nation?

This calls for the need for sustainable, economically and ecologically practical solutions to integrated solid waste management.  These simple and well known three bottom-line prerequisites need to guide us in the development of a solid waste management strategy that would protect our land and turn the solid waste management sector into a viable economy. This would call for the revision of the EMCA Act to be realistic with the changed face of the solid wastes sectors such as a viably inclusive private-public partnership in the major towns. This would facilitate a fruitful implementation of NEMA’s Waste Management Regulations 2006 which are yet to yield convincing fruits. It would also guide county governments on waste management. If this is not happening alongside other sector alignments, then where are headed to? 

The writer is a Public Health Officer practicing in Nairobi(Chrispory.juma@gmail.com)

How can young people end corruption in Kenya?

With Kenya ranked as one of the most corrupt in Africa and the youth accounting for more than 60% of her population, the fight against corruption can be well won if the youth actively participate in interventions against corruption or initiate innovations to help fight the vice. We must help effect Transparency International’s vision of a world in which governments, politics, business, civil societies and the daily lives of people are free of corruption.

We, young people, are undoubtedly the biggest victims of corruption. Youth unemployment is one of Kenya’s biggest headaches yet World Bank Reports show that more than 250,000 job are lost to corruption annually. Bribery, tribalism and nepotism shroud the job market such that competence and merit have been thrown to the bin. This in turn means that we remain poor and resort to retrogressive malpractices such as drug-abuse, moral degradation, violence and apathy that continue to affect our economic growth over time. The need for the youth to be involved in the fight against corruption can therefore not be over-emphasized. What then must young people do to end corruption?

We must provide servant leadership, at all levels. With our athleticism and energy, we must strive to influence the society to believe in us as the best agents of change and capable leaders. We must therefore lead by example while respecting existing authorities. In a society where politics is money-driven, we can use our numbers to propel ourselves into political offices and once there, we must be of integrity to serve as examples to others. Many youths now look up to Duncan Gutuanja (youngest county representative) and Kinoti Gatobu (youngest MP) to be shining leaders. The nation can never trust us with leadership when, in positions of power, we are the ring-leaders of corrupt deals and moral corruption. We need to be the luminaries of reforms and social accountability, providing leadership in condemning corruption loudest and reporting any cases to the relevant authorities, which we must always keep on check and ensure they serve the interests of citizens.

Young people must end total dependency on the government for jobs and wealth creation opportunities by coming up with initiatives that do not only help them, but create opportunities for others. To be prosperous in these wealth creation initiatives, we can seek mentorship from successful businesspeople who have always inspired generations over-time, such as Manu Chandaria and Chris Kirubi. The government provides loans to the youth. How many of us belong to youth groups that can apply for these loans? How many youth groups pay back their loans so that others can also benefit. If we can manage these funds well to have sustainable sources of income for ourselves, the government will be encourage to pump more into youth funds and we shall be politically and economically independent.

Corruption can not hold us back as we watch. In the words of Benjamin Disraeli, ‘We live in an age when to be young and to be indifferent can be no longer synonymous. We must prepare for the coming hour. The claims of the Future are represented by suffering millions; and the Youth of a Nation are the trustees of Posterity.’ I believe that with servant leadership and strive for economic independence, we’ll immensely contribute to securing a corruption-free future for our beloved country Kenya.

The writer is a Public Health Officer practicing in Nairobi (chrispory@gmail.com)