Fixing environmental health will reduce Nigeria’s disease burden – EHORECON registrar

BABA YAKUBU MOHAMMED is the Registrar/CEO of the Environmental Health Officers Registration Council of Nigeria (EHORECON), a specialized professional body under the Federal Ministry of Environment established to primarily regulate the practice of environmental health in Nigeria. In this interview with BusinessDay’s BASHIR IBRAHIM HASSAN, Mohammed highlights the roles the Council is playing in keeping Nigeria’s environment healthy. He also reveals how Nigeria can maximize the potential of environmental health officers to drive economic growth, tackle the age-long problem of open defecation, curb several disease burdens and other environmental concerns, including building collapse.

The law gives you the authority to regulate environmental health in the country. Our abattoirs are in very unhygienic conditions, waste management is also a very serious challenge, with major cities like Kano and Lagos overwhelmed by waste. How is this organization taking the lead in its responsibility of changing this narrative?

I would like to draw your attention to chapter five of the Constitution of the Federal Republic of Nigeria that gives power to ensure sanitation and enforcement of sanitation laws to the local government. You and I know how incapacitated our local governments are. So, the numerous issues that you have mentioned fall under the purview of the local government.

Now, I want to ask you this question: does the local government really see the need to recruit the type of professionals that can handle environmental sanitation challenges? The answer is no. They don’t even see the value of recruiting the range of professionals required..One more thing about this profession is there is no investment that brings dividends more than in the environmental services.

Let me give you a scenario. When you go to our major cities like Kano, you’ll realize the truism of the adage “Whatever you give to the environment, that’s what you get in return.” And you also know that we are undergoing a vicious cycle of stretching our health facilities. You will contract a disease today, go to the best hospital in Nigeria, get the best care in that hospital; but you will return to the same environment where you contracted the disease. How can we break this vicious cycle?

Let me highlight another scenario. Do you know that all of us are paying trillions of dollars in malaria tax? Why am I saying this? Epidemiology 101 says that if you want to eliminate any disease, attack the vector. But our health policies say we are rolling back malaria. But, as we are rolling back malaria, malaria is not going anywhere. So the reality is that everybody in Nigeria bears the burden of malaria, like a tax burden, because there is nobody in Nigeria who doesn’t contract malaria at least thrice in a year. The cost of malaria treatment is about N1000, which amounts to N3000 annually per person. The projected population of Nigeria is 220 million. So multiply 3000 by 220 million. This is what we are paying for a disease that is related to environmental sanitation, a disease that can be eliminated.

Let me also tell you that 98% of the diseases that are causing hospitalization in Nigeria are sanitation-related diseases.

And the solution is simple – bring back the environmental health officers, give them the necessary equipment to work with. Environmental health work is a noble profession, because even during Nigeria’s Amalgamation (of the Northern and Southern Protectorates to form what became Nigeria), the chief sanitary inspector was already well known by people.

So, where did things start to go wrong? We are investing a lot of money on training medical doctors and building hospitals. But let me tell you, building more toilet facilities is better than building 100 hospitals. Environmental health is a response to a public health challenge. If one person defecates openly, water washes out the faecal matter into the river. Even those living in Asokoro cannot escape the consequences of this action, because we buy from the same market; our farmers are using the same contaminated water to grow our vegetables. When you see a vegetable that is being irrigated with faecal matter, it looks very enticing to everyone. Indeed, it’s difficult for somebody suffering from cholera in Asokoro to understand where they get the cholera. They don’t even know the food chain system.

There is a Water, Sanitation and Hygiene Services (WASH) programme supported by the World Bank through the Federal Ministry of Water Resources that seeks to eliminate open defecation. What’s the nature of your Council’s involvement in the programme? How come we still find people engaging in open defecation?

You see, you can’t give what you don’t have. You only give what you have. The issue of (elimination of) open defecation or Water, Sanitation and Hygiene Services (WASH) is not within the mandate of Water Resources. The mandate of Water Resources is to provide water. Sanitation is solely the responsibility of the Federal Ministry of Environment. That’s why the gap is there.

When you go to the Federal Ministry of Water Resources, there is not a single sanitation officer. So who can give the policy direction for the states to buy in? Who can give policy direction for the local government to buy in? In Water Resources, the programme is managed by engineers. The job of an engineer, even if you are a sanitary engineer, is to design, not to take on actual implementation and enforcement.

Let me use this opportunity to appreciate and sincerely thank President Muhammadu Buhari for issuing order number 09, which has set the target for Nigeria to achieve open-defecation free status. I also want to give kudos to my boss, the Honourable Minister of Environment, Barrister Mohammed Abdullahi, who has seen the gap and is now working closely with the Ministry of Water Resources to co-chair the programme to be able to implement the order number 09 issued by the President.

We have also developed a programme for our members to specialize for mandatory professional development on water sanitation and hygiene technology to be able to contribute to the attainment of order number 09 by the President

Do you think that if this council had been assigned to spearhead the programme to eliminate open defecation, the country would have made much more progress than it has?

Of course, because like I mentioned earlier, it requires a lot of enforcement. The Ministry of Water Resources cannot enforce the issue of sanitation. It is the responsibility of the environmental health officers to enforce such laws.

The federal government has invested a lot on the water and sanitation project. But the state and local governments are not buying in. But I believe that with this new arrangement of co-chairing, the environment sector has a lot to bring to the table to complement what the water resources have done to be able to attain the targets of order number 09.

Q: 98% of the diseases that are causing hospitalization in Nigeria are sanitation-related diseases

What have been your achievements since assumption of duties in regulating the practice of environmental health?

In 2015, we amended and upgraded the National Environmental Health Practice Regulation. The then Minister of Environment also issued that regulation in 2015. So that regulation has been the instrument that the practitioners are using today.

Another modest achievement that we have achieved as a Council is that we have issued about 17 guidelines that cut across various aspects of the practice; from sanitation in the aviation industry, guideline for accreditation of our programmes in the training institutions, guideline for school sanitation and we also opened up the profession to the private sector. There is a guideline where we allow the private sector to come in.

We also opened a register and approved five practice areas in environmental health –inspection of premises; public health pest and vector control; waste collection; air quality monitoring and healthcare waste management. So, these are the areas that we have opened up for the private sector to come and invest in. We have issued guidelines where people can come and invest.

Another modest achievement recorded by this council is the issue of the merging of our licences. When we started, all environmental health officers were using the single licensing protocol. But since the profession has grown, we have now de-merged our licensing. Those that have PhDs and professors are called environmental health specialists, and we issue them license as such. The licensing is bi-annual, but the licensing comes with additional responsibility. By law, you cannot be signing some professional documents when you are not at a certain level. This was intended to bring sanity to the practice.

As a young environmental health officer, you have a limit to what you can do in the field; you have to subject your work to the scrutiny of a superior. And that’s why we only give seals to consultants and upward. And for aspiring consultants in the field of environmental health, you must have a minimum of a master’s degree.

Last year in 2021, we were able to host the first National Environmental Health Summit, and one of the outcomes of that Summit was that we were able to come up with the roadmap for environmental health. This roadmap is what we are going to follow religiously to be able to move the profession of environmental health to the global standards.

What legacy do you hope to leave behind?

The only legacy that I want to leave behind is to move environmental health from an analogue profession to a digital profession, and we are on the right course to move the environmental profession.

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