Harnessing Local Governments for Environmental Sanitation & Public Health

Transcription

1 Harnessing Local Governments for Environmental Sanitation & Public Health Monica Das Gupta, Dilip Ghosh, KK Datta, and Subhra Chakrabarti Development Research Group, The World Bank & the State Institute for Panchayats and Rural Development, W.Bengal

2 Outline of presentation 1. What are some of the key issues in environmental sanitation and public health? 2. What roles can local governments play in this? 3. What organizational strengthening do local governments (esp. PRIs) need for this? 4. What do they need from line agencies (esp DoH) for this? 5. Conclusions

3 Outline of presentation 1. What are some of the key issues in environmental sanitation and public health? 2. What can local governments do about this? 3. What organizational strengthening do local governments (esp. PRIs) need for this? 4. What do they need from line agencies (esp DoH) for this? 5. Conclusions

4 What is involved in environmental sanitation for protecting public health? Various tasks related to reducing exposure to disease, e.g. providing basic civic amenities e.g. waste management, drainage controlling rats & mosquitoes implementing sanitary & public health regulations Example: recent dengue outbreaks from stagnant water The costs of neglect Outbreaks (plague, dengue, avian flu) take toll on labour productivity, costs of health care & outbreak control. Implications for: Poverty reduction National economic growth (including investment attractiveness) Global costs (e.g. avian flu, slowing polio eradication)

5 Atrophy of interest in these issues In international dialogue, little attention to local governments role in public health (e.g. DCPP). Narrow focus on medical interventions In India, atrophy of sanitation and public health services since colonial era. So: Lack of coherent public health perspective, e.g. programmes which bring in water without drainage Shortage of manpower trained in implementing sanitation and public health services (have to be met from states own budgets, unlike family planning). But now PRIs constitutionally mandated for these tasks Of the 5 core functions of PRIs, 4 pertain to sanitation & public health: Health and sanitation Provision and maintenance of basic civic amenities: drinking water, roads, maintenance of community assets

6 Outline of presentation 1. What are some of the key issues in environmental sanitation and public health? 2. What roles can local governments play in this? --- many roles that only local govts can play 3. What organizational strengthening do local governments (esp. PRIs) need for this? 4. What do they need from line agencies (esp DoH) for this? 5. Conclusions

7 Provision and maintenance of basic civic amenities to assure sanitation e.g. drainage, solid waste, water supply, removing overgrown vegetation Implement sanitary / public health regulations e.g. market hygiene, license food vendors with training and typhoid shots Assure intersectoral and interjurisdictional coordination, e.g. Irrigation dept leaves canal half-finished, generates mosquito breeding Defective sewerage can generate cholera for own and neighbouring districts. Need for oversight and residual responsibility Mobilize citizens for assuring sanitation e.g. govt cannot possibly monitor each flower pot for stagnant water Posting GP schedule of activities can help public monitoring & support Support DoH in disease control efforts PRIs can add much to DoH service outreach, e.g. for monitoring diseases, prevention measures and outbreak control. Because of their grassroots presence, and their position as converging point for line agencies and citizenry. And diseases without vertical programs, e.g. zoonotic diseases.

8 The costs of neglecting local governments roles in public health: illustration from endemic malaria district Irrigation Dept s half-built canal breeding mosquitoes DDT spraying without supervision, and no effort to ensure community compliance Larvivorous fish programme ineffective without community participation Health situation monitoring & rapid response Personal protection measures Sharp contrast with Vietnam vector control programme: strong collaboration between health workers, local govts and communities (Note: Vietnamese local govt setup very similar to PRIs)

9 Outline of presentation 1. What are some of the key issues in environmental sanitation and public health? 2. What roles can local governments play in this? 3. What organizational strengthening do local governments (esp. PRIs) need for this? 4. What do they need from line agencies (esp DoH) for this? 5. Conclusions

10 General constraints to PRI functioning as local govt: Functions delegated without adequate administrative, technical, and financial support Insufficient clarity in activity mapping, so confusion about responsibilities of different levels of govt, and between PRIs and line agencies. Clarity about roles and accountabilities esp important for sanitation and health Uncertainties of fund flows (little point receiving vector control funds after vector breeding season begins) Performance management (e.g. standards, sanctions) For public health, also need mechanisms for PRIs to assure: intersectoral coordination (to PREVENT, not just control outbreaks). Coherent composite public health delivery mechanism. Involve all key depts in policy decisions, follow-up mechanism, technical inputs to PRIs. HIA interjurisdictional coordination collaboration between line agencies and PRIs

11 Outline of presentation 1. What are some of the key issues in environmental sanitation and public health? 2. What roles can local governments play in this? 3. What organizational strengthening do local governments (esp. PRIs) need for this? 4. What do they need from line agencies (esp DoH) for this? 5. Conclusions

12 Public health stewardship from MoH & DoH: Technical and policy inputs e.g. guidelines, technical backstopping, health information systems, health planning frameworks (some inputs also from others e.g. PHED, EPA) Legal and regulatory framework for public health action (e.g. updated regulations, model bye-laws). E.g. Karnataka Interface between DoH and PRI public health staff and activities: Assure minimum network of public health staff at each PRI level, whether of DoH or PRIs --- jointly accountable to DoH and PRIs Staff job descriptions, training, performance management protocols, etc. Re-orientation towards stewardship roles. E.g. West Bengal has built close interface between DoH and GPs, but currently DoH uses GPs to implement their own vertical programmes rather than supporting GPs in implementing their environmental sanitation and other activities to reduce exposure to disease. Public health communication & advocacy e.g. S. Indian rural elites more likely to have drains than non-elites, but no difference in how clogged the drains are

13 Outline of presentation 1. What are some of the key issues in environmental sanitation and public health? 2. What roles can local governments play in this? 3. What organizational strengthening do local governments (esp. PRIs) need for this? 4. What do they need from line agencies (esp DoH) for this? 5. Conclusions

14 Conclusions Enormous gains from investment in public health Critical roles of local govts in public health --- Neglect has led to serious inefficiencies in disease control Local govts now mandated to fulfil these roles but need organizational strengthening and public health stewardship Strong grounds for more direct central govt involvement: Directly finance key public health staff and activities (as in family planning) because of externalities --- no point in having poorer or less capable states spread diseases to others Benchmark states and districts performance, offer rewards Most ingredients already in place for improving public health outcomes, need creative effort to use these ingredients coherently

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