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Government Must Establish More Environmental Health Training Institutions And Upgrade Existing Schools of Hygiene To Degree Level As A Matter of Urgency To Help Tackle Poor Environmental Health and Sanitation in Ghana

The training of professional public health inspectors (currently Environmental Health Officers/Practitioners) started around 1925 during the colonial

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The training of professional public health inspectors (currently Environmental Health Officers/Practitioners) started around 1925 during the colonial days at Ajabeng in the Accra Metropolitan Area (AMA). The establishment of the Schools of Hygiene (SOH) under the Ministry of Health (MOH) then, was primarily the only recognized tertiary institution to train qualified public health inspectors with certification from the Royal Society of Health (RSH), London, United Kingdom. After Ghana gained independence, the West African Health Examination Board (WAHEB) took over the certification of these health professionals. Later, Ghana Health Examination Board (GAHEB) also came into the picture as the certificate awarding body. However, there has been a reversal of the certificate awarding body back to the West African Health Examination Board (WAHEB) through the Ghana Chapter of the WAHEB.

During the colonial era, upon the successful completion of a two and three year Certificate in Public Health Inspection and Diploma in Public Health Inspection programmes respectively, candidates were posted to work as Health Inspectors under the Ministry of Health (MOH). Moreover, along their practice and with the need for change to reflect current trends, the name Health Inspector was changed to Environmental Health Officer (EHO).

Currently, the only Environmental Health Training Institutions (EHTIs) that trains professional Environmental Health Officers and Assistants (EHOs/EHAs) are, the Three Schools of Hygiene (SOH) located in Accra, Ho and Tamale which still trains only Certificate and Diploma graduates and these schools are affiliated to the Kwame Nkrumah University of Science and Technology.

In Ghana currently, Environmental Health Professionals’ training and practice is regulated by the Allied Health Professions Council of Ghana (AHPC) under the Health Professions Regulatory Bodies Act, 2013 (Act 857) , and therefore they are registered and licensed before they can practice as applies to other health professionals such as Nurses, Medical Doctors, Medical Laboratory Scientists, Pharmacist etc.

What then is Environmental Health? It 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 present and future generations. It is noted however that, Environmental Health also addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments.

The objects of the Environmental Health Profession are;

to assess, correct, control and prevent those factors in the environment that can potentially affect adversely the health of present and future generations;
to preserve, protect, and improve the quality of life for human beings;
to control those elements of the environment which cause, or may cause deleterious effects to the health and well-being of human populations or to the food and drink, lands, waters, atmosphere, shelter and other resources upon which humanity is dependent for survival;
to prevent and control infectious, communicable and non-communicable diseases which have afflicted humankind through the centuries.
Who is then an Environmental Health Officer? An Environmental Health Officer is a person who is trained in the sanitary sciences, biology, chemistry, geology, physics, mathematic etc. and operates as an inspector or health official in the public sector or private industry, reviewing programmes and enforcing laws to protect public health. He or she is also a public health professional whose responsibilities may include food sanitation and safety; air, water, and environmental protection; inspection of well-water and sewage-disposal systems; control of insect pests, and animals; disease control and epidemiology; housing, occupational; and institutional safety and sanitation and nuisance control.

According to Section 19 of the Public Health Act, 2012, (Act 851), an Environmental Health Officer is a health professional who is involved in health promotion, education and who controls activities that have adverse consequences on the environment, public health and safety. Environmental Health Officers (EHOs) play a significant role in all stages of disaster or pandemic management due to their many and varied areas of expertise. These health professionals are well-placed to assess the impact of pandemics and disasters on populations and conduct evaluations of responses due to their population and community-based focus and holistic approach to their work in protecting public health and safety among the Ghanaian populace.

Amongst the duties and responsibilities of Environmental Health Officers (EHOs) are; they inspect, controls, and manages sanitation in public places, assists in community-based environmental sanitation campaigns and public education, educate the public on environmental health issues and regulations and enforces environmental health laws and policies. These duties are performed through routine premises inspection (house to house), health education and promotion activities, sitting of household latrines for households, labour supervision of sanitary labourers and orderlies, market sanitation, inspection of public eating premises e.g. (restaurant). Also includes waste management, school health education programmes, slaughterhouse and abattoir duties (meat inspection), food safety (inspection of expire date of food items such as canned foods), vector control activities such as mosquito control, through disinfestations or fumigation.

Unfortunately and sadly, since time immemorial, Ghana has not been able to run a professional Bachelor of Science degree in Environmental Health for its Environmental Health Practitioners. Rather only Certificate and Diploma programmes in Environmental Health are on offer since 1925. It is therefore urgent and prudent for the H.E Nana Addo–Bawumia Government to establish more of the Environmental Health Training Institutions (EHTIs) to run professional B.Sc. Environmental Health programmes for Certificate and Diploma Holders in Environmental Health and Senior High School graduates to boost the human resources capacity of the Environmental Health and Sanitation sector in order for Ghana to achieved the cleanest cities in Africa as the President has promised and envisaged.

The decades absence of a professional Bachelor of Science degree in Environmental Health has uncharacteristically lead to the unfortunate recruitment of quacks (graduates) without professional Environmental Health background and requisite licenses into the MMDAs to work as Environmental Health Officers / Analysts.

Recently, the Local Government Service (LGS) has been recruiting graduates with first degree programmes in an unrelated disciplines/areas into the various Environmental Health Departments/Units under the MMDAs to work as Environmental Health Officer/Analysts to the extent of assuming Headship Positions over the professional Environmental Health Officers/Assistants registered and licensed by the Allied Health Professions Council of Ghana ( AHPC ) established by the Health Professions Regulatory Bodies Act, 2013 (Act 857), the only legal instrument that backs the practice of all health professions in Ghana, just because the LGS assumes and believes that the registered and licensed professional Environmental Health Officers/Assistants are not graduates with degrees.

However, according to the Health Professions Regulatory Bodies Act, 2013 (Act 857) and AHPC regulations, one can only practice Environmental Health in Ghana if that person was admitted and trained by recognized public or private institution that has been accredited by the Allied Health Professions Council with the School of Hygiene (SOH) inclusive.

Interestingly, the University of Health and Allied Sciences (UHAS) in Ho, Volta Region has started a Bachelor of Science degree programme in Public Health with an option in Environmental Health that is accredited by the AHPC for their graduates to practice as EHOs.

Moreover, according to the International Standard Classification of Occupations (ISCO–08), International Labour Office (ILO), 2012, Geneva. (Unit Group 2263, page 145) under Environmental and Occupational Health and Hygiene Professionals, EHOs has been captured and assigned with special codes such as Environmental Health Officer 2263; Health Inspector 3257; Sanitarian 3257; and Sanitary Inspector 3257.

Notably, amongst Laws/Acts enforce and/or implement by registered and license Environmental Health Professionals in Ghana with legal backing from the HPRBA, Act 857 and AHPC regulations are: Health Care Waste Management Policy, MOH, 2020; Public Health Act, 2012 (Act 851), Part One-Communicable Diseases, Part Four-Vector Control and Part Five -Environmental Sanitation; International Health Regulations (IHR), 2005 and the Criminal and Other Offences Act 29, 1960.

As the country is faced with dire consequences of selling of food under insanitary conditions, poor sanitation, vector borne diseases such as malaria etc., where we need the services of professionally trained and certified Environmental Health Officers with Masters and Ph.D. degrees in Environmental Health. The Local Government Service (LGS), recruiting graduates without Environmental Health background and the requisite license or credentials is neither the best option nor the solution. Sadly enough, these graduates are now learning on the job as my colleagues and I interacted with some of them.

To this end, as our dear President, H.E Nana Addo Dankwa Akufo-Addo passionately called on all Ghanaians to be “Citizens And Not Spectators” and as a good and patriotic citizen as well as a proud and concerned Environmental Health Practitioner and not a spectator, I would like to humbly call on the President, the Parliamentary Select Committee on Health and Sanitation as well as the Ministry of Sanitation and Water Resources (MSWR) to as a matter of urgency consider establishing more Environmental Health Training Institutions (EHTIs) in the country and also empower other Universities/Colleges to run professional Environmental Health programmes at Degree, Masters and Ph.D. levels to strengthen and modernize the preventive public health workforce in their readiness to handle emergent pandemics such as the current rampaging and deadly Coronavirus (COVID-19).

It is very ironic, funny, retrogressive and unproductive, that graduates who were not trained in professional Environmental Health and are not even qualified to be licensed by AHPC as such, are been recruited to practice as Environmental Health Practitioners and lead the Development and issuance of technical guidelines on Environmental Health Management and Services as well as provide technical advice for the formulation of Environmental Health policies, when the Government has the opportunity to establish more EHTIs as well as Upgrade the existing Schools of Hygiene (SOH) to Degree, Masters and Ph.D. levels.

BY SAMUEL YAW AGYEMANG-BADU, SAN., PHE, MAHPC, M.SC., Ph.D. CANDIDATE

The writer is a renowned and passionate Environmental Health Practitioner with both local and international experience.

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