National Environmental Health Policy

WATER AID 2.cdr GOVERNMENT OF MALAWI MINISTRY OF HEALTH AND POPULATION August, 2018 NATIONAL ENVIRONMENTAL HEALTH POLICY Preface ...................................................... vi ACKNOWLEDGEMENT ....................................... viii LIST OF ABBREVIATIONS ....................................... ix 1.0 INTRODUCTION ........................................... 1 1.5 Linkages Between EH Policy and Other Development Frameworks and Sectoral Policies ..................................................... 4 1.6 Challenges .............................................. 4 2.0 BROAD POLICY DIRECTIONS ................................. 4 2.1 Vision ................................................. 4 2.2 Mission ................................................ 4 2.4 Overall Goal ............................................. 6 2.5 Objectives .............................................. 6 3.0 POLICY THEMES .......................................... 6 3.1 Food Safety and Hygiene ..................................... 6 3.1.1 Introduction .......................................... 6 3.1.2 Goal ............................................... 6 3.1.3 Policy statements ....................................... 7 3.1.4 Strategies ....................................... 7 3.2 Water, Sanitation and Hygiene ................................. 8 3.2.1 Introduction .......................................... 8 3.2.2 Goal ............................................... 8 3.2.3 Policy statements ....................................... 8 3.2.4 Strategies ............................................ 8 3.3 Health and Safety .......................................... 9 3.3.2 Goal ............................................... 9 3.3.3 Policy statements ....................................... 9 3.3.4 Strategies ............................................ 9 3.4 Vector and Disease Prevention and Control ........................ 10 3.4.1 Introduction ......................................... 10 3.4.2 Goal .............................................. 10 3.4.3 Policy statements ...................................... 10 3.4.4 Strategies ........................................... 10 3.5 Emergencies, Climate Change and Human Health .................. 10 3.5.2 Goal .............................................. 11 3.5.3 Policy statements ...................................... 11 3.5.4 Strategies ............................................ 11 4.0 IMPLEMENTATION ARRANGEMENTS ......................... 12 5.0 IMPLEMENTATION PLAN .................................. 14 2. Monitoring and Evaluation ..................................... 14 5.2 Roles and Responsibilities of Different Levels of Environmental Health .... 15 5.2.1 National Level .......................................... 15 5.2.2 District Level .......................................... 15 5.2.3 Enterprise Level ......................................... 16 5.2.4 Community Level ..................................... 16 5.3 Roles and Responsibilities for Stakeholders In Environmental Health ...... 17 ANNEXES 1 TO 4 STRUCTURE OF ENVIRONMENTAL HEALTH ........... 20 2. Central Hospitals ............................................ 22 3. District Level .............................................. 23 4 Health Centre Level ......................................... 24 ANNEX 5 STRATEGIC PLAN (2017 – 2022) ......................... 25 ANNEX 6 MONITORING AND EVALUATION FRAMEWORK ............ 38 FOREWORD The Government of Malawi recognizes that Environmental Health services have a greatest impact on people whose health status is already at risk; therefore environmental health must address the societal and environmental factors that increase the likelihood of exposure to hazards and diseases. Environmental health has been recognized as one of the most important functions in a drive to improving human health. Maintaining the health environment is central to increasing quality of life and years of healthy life. Globally, 25% of all deaths and 52% of total disease burden can be attributed to environmental health factors. Environmental health factors are so diverse and include: exposure to hazards substances in the air, water, soil, and food, natural and technological disasters, physical hazards, the built environment, nutritional deficiencies. The goal of this National Environmental Health Policy is to guide and articulate, among others: National vision on Environmental Health hinging on five key thematic areas of Sanitation & Hygiene, Disease Control, Food safety and Hygiene, Health & Safety, and Human Health and Climate Change including Emerging issues as stipulated in the Public Health Act 1968; Policy Goals and Objectives for Environmental Health Management in Malawi; Principles, Strategies and Institutional Framework for effective management of critical Environmental Health matters and issues, including capacity building; education, training and public awareness; the polluter pays principle mechanism; reduction of emissions from automobiles hence lessen air pollution; adaptation and mitigation in natural and built environments, Waste management both industrial and domestic, water quality surveillance, and disaster impact mitigations emanating from climate change effects. This is also in line with Malawi’s National goals, as outlined in Malawi’s Growth and Development Strategy II and Vision 2020. The policy will achieve this through better adaptation to mitigation measures against environmental health risks and hazards with key focus on sanitation and hygiene, food safety and hygiene, disease control, health and safety provision for Malawi’s citizens. This Environmental Health Policy will create an environment for the development of a country- wide, coordinated and harmonized approach, which attends to the needs and concerns of all sectors of society, while ensuring continued sustainable development. This Environmental Health Policy, is intended to guide actions that reduce environmental health risks to human health and further guides harmonized approaches by different sectors and institutions towards implementation of Environmental Health Services. The policy will also guide Malawi to benefit from the global financial, technical and technological opportunities arising from the desire of the international community towards Health People 2020 Environmental Health agenda. Examples of technological opportunities iii National Environmental Health Policy include investment in recycling of generated wastes and composting biodegradable wastes for manure production. The policy lays out a number of principles, and outlines an institutional framework, to guide Malawi in the application and the implementation of adaptation and mitigation. Translating this policy into action will prepare the country to overcome the challenges of Environmental Health hazards and embrace the opportunities to lay a solid foundation for a sustainable and prosperous Malawi. The Government of Malawi therefore commits to fully addressing Environmental Health through implementing this policy in line with the current Malawi growth and Development Strategy and previous strategies such as vision 2020. Hon. Atupele Muluzi, MP Minister of Health and Population iv National Environmental Health Policy The Government of Malawi is concerned about the high disease burden that the country is experiencing. Most of these diseases are attributable to avoidable environmental risk factors. HMIS Reports, (2017) indicate that 52% of all out patient’s attendances in all health facilities and 25% of morbidity was due to sanitation and hygiene related diseases. The Ministry of Health has set out most of these as priority diseases in the Essential Health Care Package as outlined in the Health Sector Strategic Plan (HSSP)2017-20226. The challenge therefore is how to reduce the disease burden through environmental health interventions as one way of reducing pressure on the scarce health and national resources as outlined in outcome three of HSSP. Environmental health encompasses the assessment and control of all physical, chemical and biological factors that can potentially affect the health of individuals. It is targeted towards preventing diseases and creating a health supportive environment. This Environmental Health policy is aimed at providing guidance on implementation of environmental health interventions. The policy ought to achieve the following: · To increase the coverage of environmental health interventions in Malawi. · To increase public awareness of environmental health issues in Malawi. · To improve coordination and collaboration between various stakeholders in the implementation of environmental health interventions. The policy has been developed in line with international declarations which Malawi is a signatory of and these are: Libreville Declaration on Health and Environment, held in Libreville in 2008, Ethekwini Declaration on Hygiene and Sanitation, 2008, Africa Health Strategy (of the African Union), 2007-2015, UN Millennium Declaration and subsequent Millennium Development Goals, 2000, Rio Declaration on Environment and Development, 1992 and the Alma-Ata Declaration on Primary Health Care, 1978. The development of this Environmental Health policy demonstrates Malawi commitment towards these global declarations. Environmental health activities are being implemented in the country by different partners. These activities have been implemented without proper guidance and direction. This has, all along, even affected monitoring of the services since there have been no standards for implementation of the activities. The policy has therefore set out the core functions of environmental health which should guide every institution; governmental or non- governmental, that is rendering such services at all levels. It is my sincere hope that all stakeholders in the country will use this policy in order to contribute to the reduction of disease burden thereby improving SDGs 3 and 6 ; enhancing economic development and so contributing to the overall reduction of poverty at all levels in the country. PREFACE v National Environmental Health Policy This policy was developed after extensive consultations with Government Officials, Civil Society, Academia, NGOs, Experts and Development Partners. Amongst the consulted stakeholders included: UNICEF, WHO, Redcross, Wateraid, CPAR, Ministry of Agriculture, Irrigation and Water Development, University of Malawi (Polytechnic), Malawi Law Commission, Malawi Bureau of Standards, Ministry of Labour, World Vision Malawi, Malawi Environmental Health Association, Malawi College of Health Sciences, Medical Council of Malawi, Department of Environmental Affairs, Ministry of Education, Ministry of Labour, Ministry of Trade and Industry, World Bank, Department of Disaster Risk Management. The consultations ranged from meeting relevant stakeholders in their offices, sharing the draft policy with relevant stakeholders and holding consultative meetings with the relevant stakeholders. The policy will be guided by principles set out in the Malawi Constitution, the United Nations Framework, Convention on Environmental Health and the Ethekwini Declaration on Hygiene and Sanitation, 2008. The principles include protection of human rights and freedoms, gender equality, sustainable development, equitable development, the polluter pays principle, the precautionary principle and informed stakeholder besides community participation Dr. Dan Namarika Secretary for Health and Population vi National Environmental Health Policy ACKNOWLEDGEMENT vii National Environmental Health Policy The Government of Malawi, through Ministry of Health and population would like to sincerely thank World Health Organisation for providing financial and technical support during the development of this policy. A special vote of thanks should also go to stakeholders that were involved in the consultation stage of the development of this policy and to WaterAid for financing printing of this policy. Lastly special thanks to the team in Ministry of Health and Population that worked tirelessly in the development of this policy. ARI Acute Respiratory Infections CAMA Consumer Association of Malawi DODMA Department of Disaster Management EIA Environmental Impact Assessment EAD Environmental Affairs Department EHP Essential Health care Package EHS Environmental Health Services FSH Food Safety and Hygiene HACCP Hazard Analysis Critical Control Point HCWM Health Care Waste Management HIA Health Impact Assessment HIV/AIDS Human Immuno Virus/Acquired Immuno-Deficiency Syndrome HMIS Health Management Information System JMP Joint Monitoring Programme MBS Malawi Bureau of Standards MDG Millennium Development Goals MDGS Malawi Growth and Development Strategy MDIS Ministry of Defence and Internal Security MICS Malawi Indicator Cluster Survey MOAIWD Ministry of Irrigation and Water Development MOH Ministry of Health MOLGRD Ministry of Local Government and Rural Development MOJ Ministry of Justice MOL Ministry of Labour MRA Malawi Revenue Authority NGO Non-Governmental Organisations NSO National Statistical Office ODF Open Defecation Free SCT Sanitation Core Team STI Sexually Transmitted Infections UNICEF United Nations Children’s Fund WASH Water Sanitation and Hygiene WHO World Health Organisation LIST OF ABBREVIATIONS viii National Environmental Health Policy 1.0 INTRODUCTION 1.1 Environmental Health Policy The Environmental Health Policy provides policy direction on implementation of environmental health interventions. The policy has been developed in line with the Malawi Growth and Development Strategy (MGDS III), an overarching development plan for Malawi that recognizes that a healthy and educated population is essential if Malawi is to achieve sustainable socio-economic growth. This policy has also been developed in line with the overall national health policy that aims at improving the health status of all people of Malawi by among other things reducing environmental health risks as spelt out in the Health Sector Strategic Plan (HSSP) 2017-2022 under outcome number three, that pose serious threats to all people in Malawi. The Environmental Health Policy will be implemented through the following priority areas: Food Safety and Hygiene; Health and Safety; Vector and Disease Prevention and Control; Water, Sanitation and Hygiene; Emergencies, Climate Change and Human Health. The Policy will be implemented between 2018 and 2023. 1.2 Background Malawi like many other rapid developing countries is faced with a number of environmental health issues and problems that affect the human health and environment. The Environmental Health risks result in 52% of the disease burden in Malawi (HMIS Reports, 2017). These diseases occur due to poor sanitation and hygiene, food contamination, inadequate disease surveillance, occupational health risks and poor environmental management leading to climate change and subsequently subjecting people to the effects such as disaster like floods and droughts. The climate of Malawi coupled with poor environmental management practices favours the breeding of vectors e.g. mosquitoes, houseflies, tsetse flies that are responsible for transmission of diseases from one person to another. The vectors and vermin are on increase and are resulting in a rise in related diseases like malaria, diarrhoeal, lymphatic filariasis, onchocerciasis, eye, and skin infections (Emerson et al, 2004). Diarrhoeal diseases account for 37% of the disease burden; 83% roundworms; 41% hookworms; and malaria 48%. Thirty percent reduction in Trachoma prevalence would be achieved where there is improved sanitation and hygienic practices coupled with safe water supply (HMIS 2017). Occupational health and safety standards in institutions are generally poor. Most of the work environments are not safe either because there is no adequate personal protective equipment (PPEs) or else policy enforcement has lacked. This has resulted into an increase in occupational health related conditions, incidents and diseases, (Esrey, 2011). Management of hazardous industrial, health care wastes, electronic wastes is inadequate and in most cases, these are discharged into the environment without pre-treatment. All border posts into the country (air, water and land) are prone to transmission of diseases from other countries. Nevertheless, these borders lack equipment, infrastructure and worse still the manpower is not provided with adequate capacity to manage such functions. The community knowledge of environmental health issues such as waste management, sanitation and hygiene, food safety and hygiene, disease control is at minimal level hence participation in environmental health interventions has been very low. 1 National Environmental Health Policy Ministry of Health and Population in addressing environmental health issues faces a challenge of weak coordination with key sector stakeholders that include: Ministry of Local Government and Rural Development; Ministry of Agriculture Irrigation and Water Development; Department of Environmental Affairs; Ministry of Labour; Ministry of Industry and Trade; Ministry of Tourism, Wildlife and Culture and other Nongovernmental Organisations. 1.3 Rationale The environmental health policy has been developed to guide the implementation of Environmental Health interventions which will help to mitigate the risk factors thereby reducing the sanitation and hygiene related disease burden that is already high. The resources used to treat these conditions will be saved and used to address other activities hence improve the general health status of all people of Malawi. 1.4 Statement of the problem For many years, the environment health services have been implemented without a guidance of a policy resulting into challenges in addressing poor waste management; sanitation and hygiene; food safety and hygiene; occupational health and safety; vector and disease control and emergencies; and climate change and human health. 1.5 Purpose of the policy The environmental health policy therefore seeks to seek to provide direction in the implementation of environmental health services. 2.0 LINKAGES WITH OTHER RELEVANT POLICIES Linkages Between EH Policy and Other Development Frameworks and Sectoral Policies The National Environmental Health Policy shall mirror other relevant policies and legal instruments such as Malawi Vision 2020, Malawi Growth and Development Strategy (MDGS) 2017-2022, Health Policy 2008, National Sanitation policy (2008), National Decentralisation Policy (1998), National Water Policy(2005), Health Sector Strategic Plan (HSSP) 2017-2022, Environmental Policy(1997), Social Disability Polic y (2005), The government of Malawi, with financial support from World Health Organization, through the Environmental Health section in the Ministry of Health and Population has developed this Environmental Health Policy. This is in line with Malawi's international commitments and national strategies. The policy responds to a number of international declarations to which Malawi is a signatory such as: Libreville Declaration on Health and Environment (2008), Ethekwini Declaration on Hygiene and Sanitation (2008), Africa Health Strategy of the African Union (2007-2015), UN Millennium Declaration and subsequent Millennium Development Goals (2000) Rio Declaration on Environment and Development (1992) and the Alma-Ata Declaration on Primary Health Care (1978). 2 National Environmental Health Policy HIV/AIDs Policy(2012) Disaster Risk Management Policy (2015), National Gender Policy (2011), National Health Communication strategy (2015) 2.3 Guiding Principles The policy shall be guided by the following principles: 3.0 BROAD POLICY DIRECTIONS 2.1 Vision A healthy Malawi, free from environmental health risks 2.2 Mission To improve the health status of all people in Malawi by providing efficient, effective, equitable and sustainable environmental health services. Coordination, partnership and consultation within the Ministry of Health, multilateral organisations, relevant government agencies, non-governmental organisations and communities. and in-service training, in collaboration with academic and consulting Institutions for effective implementation of Environmental Health services 2.3.6 Design, manage and operate our establishments to maximize on safety, efficiency and protect the environment 2.3.2 The delivery of national integrated environmental health service shall be based on 2.3.4 Promote man power development in Environmental Health through pre-service 2.3.1 A legal framework shall provide an enabling environment for implementing Environmental Health interventions. 2.3.3 Adequate and necessary financial, human and material resources shall be mobilized and allocated for effective and efficient implementation of the environmental health services at all levels. 2.3.5 The Policy shall address the needs of the target groups based on the evidence and analysis of data and information products through monitoring and evaluation appropriate cost effective technology and local innovations shall be adopted to promote the prevention and control of environmental health problems and their effects on health. 2.3.7 International and Regional Instruments and Protocols shall be complied with, when implementing Environmental Health services after adaptation and adoption. 2.3.9 Ensure that all community members and stakeholders are aware of their roles and responsibilities in the fulfillment and sustenance of environmental health and safety management systems. 2.3.8 There shall be equitable deployment and distribution of EH staff and services, respectively, so they are accessible to everyone living in Malawi, including the marginalised. 3 National Environmental Health Policy 2.4 Policy goal To achieve the highest possible level of health and well-being for every Malawian by reducing morbidity and mortality resulting from environmental health risks. 2.5 Policy oobjectives 1. To protect the consumer against unsafe, impure and fraudulently presented food that may be injurious to health. 2. To improve water quality, sanitation and hygiene at household level, public and private institutions 3. To protect workers and the general public from impacts of unsafe and poor working environment 4. To prevent and control the transmission of communicable diseases 5. To reduce impacts of public health emergencies and effects of Climate Change on Human health The policy has the following as priority areas that require attention and intervention to promote Environmental Health services: 1. Food Safety and Hygiene. 2. Health and Safety 3. Vector and Disease Prevention and Control. 4. Water, Sanitation and Hygiene. 5. Emergencies, Climate Change and Human Health 3.1 Food Safety and Hygiene 3.1.1 Introduction Food borne diseases in Malawi are on the increase due to contamination of food through biological, chemical and physical agents.The implementation of Food Safety and Hygiene interventions will not only contribute to the reduction of the incidence of these diseases, but also, present an opportunity for the country to expand both domestic and international trade through compliance with set standards. Policy statements: a. Government shall ensure National Food Safety and Quality Control systems are in place Strategies: · Establish and strengthen Food Control Authority · Strengthen and enforce appropriate food laws and regulations · Strengthen the monitoring of food at different points in the food chain 4 National Environmental Health Policy 3.2 Water, Sanitation and Hygiene 3.2.1 Introduction Malawi`s access to safe water is relatively high. According MICS (2014), access to improved drinking water sources in Malawi is at 86.2%, however, 27.8% uses untreated water. 40.6% owns and uses improved sanitation and only 4.2% uses hand washing facilitie s, the open defecation free (ODF) status in Malawi is at 44.6% (MOH Report, 2018). This low coverage is leading to high prevalence of water and sanitation related diseases. Strengthening of interventions will contribute to the reduction in these diseases and conditions hence improve the general health of the people of Malawi. This also contributes to saving of finances that can be used for other health services. 3.2.2 Policy statements 3.2.3.2.1 Government shall promote proper management of solid and liquid wastes at all levels (households, institutions, rural and urban communities). 3.2.4 Strategies 3.2.4.1 Strengthen water quality monitoring from source to user-end. 3.2.4.2 Promote sanitation facilities that are gender and disability friendly 3.2.4.3 Promote proper management of liquid and solid waste at all levels 3.2.4.4 Promote Open Defecation Free (ODF) communities. 3.3 Health and Safety 3.3.1 Introduction Health and safety focuses on environmental health factors that disproportionately affect the health of people especially the disadvantaged populations due to unsafe and poor working environment. Health and safety priority problems include: respiratory infections including tuberculosis; sexually transmitted infections (STIs) including HIV and AIDS; Eye, Ear and Skin (EES) infections, common injuries and other work related conditions such as stress and mental disorders. Most of these problems and challenges could be address by environmental health interventions. Policy statements: a. Government shall ensure that there is compliance with health and safety requirements in the design, siting and construction of buildings. Strategies: · Establish mechanisms for health impact assessment during EIAs. · Establish mechanisms for health and safety in construction of new structures and demarcation of new settlements. b. Government shall ensure that there is health and safety in all work places. 5 National Environmental Health Policy · Strengthen inspection of work places and institutions. · Improve the management of HCW in health facilities. · Establish advocacy mechanisms for management of radioactive, toxic and injurious substances. · Strengthen mechanisms for prevention of air pollution for both in door and out door. · Strengthen proper industrial waste management 3.4 Vector and Disease Prevention and Control 3.4.1 Introduction In Malawi communicable diseases related to environmental health risks such as Malaria, acute respiratory infections (ARI), Diarrhoeal diseases and Bilharzia remain the major causes of morbidity and mortality. These diseases occur due to poor sanitation and hygiene, food contamination and poor environmental management. Policy statements: Government shall promote appropriate control measures of vector and vermin: Strategies: · Strengthen port health services. · Strengthen prevention of vaccine preventable diseases · Strengthen reporting of notifiable and emerging diseases · Strengthen sustainable vector and vermin control measures · Strengthen collaboration in prevention of zoonotic diseases · Enhance Information, Education and Communication of all communicable diseases including notifiable, emerging diseases and events 3.5 Emergencies, Climate Change and Human Health 3.5.1 Introduction Climate change poses a serious threat to Malawi’s development agenda. In the short to medium term, climate change will significantly affect the functioning of natural ecosystems, with serious repercussions on weather-sensitive sectors, such as health, agriculture, forestry, water resources, energy, fisheries, and wildlife. There is occurrence of some diseases such as malaria, diarrhoea and malnutrition correlate with changes in climatic conditions such temperature, rainfall and humidity. Impacts of disasters/emergencies such as floods and drought have already severely hit the well-being of many people in the country; smooth and effective delivery of health services has also been badly affected. 3.5.3 Policy statements Government shall ensure that there are strong and resilient public health systems and programmes to respond to emergencies and disasters, and address effects of climate change on human health 3.5.3.3 Ensure that there is capacity building of Human Resource both for Health workers and community on health and climate change issues and emergencies. Strategies: 6 National Environmental Health Policy Strategies: · Strengthen environmental health hazard identification, mapping and risk reduction mechanisms at all levels. · Strengthen preparedness for response, during and after emergencies and disasters. · Promote research on climate change impacts and adaptation. · Strengthen and operationalize the health components of disaster risk reduction and management plans. · Strengthen core national and district capacities that shall facilitate development of strong and resilient public health systems and programmes to respond and address effects of climate change to human health. · Establish and strengthen a surveillance system that will integrate health and climate change information for early warning and emergency preparedness and planning. · Strengthen adaptation and mitigation measures for climate change sensitive diseases and conditions such as malaria, diarrhoea and malnutrition based on seasonal variations of climatic variables and disease incidences. · Strengthen and promote multi-sectoral collaboration on health and climate change. · Strengthen governance structures for the management of emergencies and climate change effects on health. · Establish a mechanism for monitoring emergencies, health and climate trends. 4.0 IMPLEMENTATION ARRANGEMENTS 4.1 INSTITUATIONAL ARRANGEMENTS There are many stakeholders that need to be engaged in the implementation of this policy. Coordination and leadership across these players is critical to achieving success. The Ministry of Health shall be the coordination office and shall lead implementation at all levels. The prime goal of this leadership is to convene, facilitate and guide rather than to command and direct so that an integrated approach towards the common goals and objectives of this policy can be achieved. Key stakeholders include: government, non-governmental organizations and civil society, the private sector, academia, development partners, local communities and other marginalized groups. 4.2 Government coordination At government level, the current cabinet committee on Health and Environmental shall report all issues pertaining to Environmental Health to cabinet. Similarly, the Parliamentary Committee on health and environment shall, report all issues pertaining to Environmental Health to Parliament. The Cabinet Committee will enable all arms of government to coordinate their actions. The Parliamentary Committee will serve to provide good governance oversight of environmental health interventions and services in Malawi. 7 National Environmental Health Policy In order for government to efficiently and effectively reach out and engage with communities, a National Environmental Health Committee shall be established. This committee shall monitor progress, and provide advice on strategies and actions of its implementation. It shall also ensure that prescribed standards of services provided are adhered to. This National Environmental Health Committee shall include Environmental Health professional representatives from: civil society including the marginalized groups, government line ministries, and academia, media and development partners. The National Environmental Health Committee, including its roles, shall be replicated at district level. The head of Environmental Health Services shall serve as secretary to the District Environmental Health Committee. 5.0 IMPLEMENTATION PLAN Government, through the Ministry of Health and Population in conjunction with the key stakeholder s a s outlined in the institutional framework shall develop a national strategic plan to take forward this national environmental health policy. 1. Incorporation of environmental health into relevant Sectoral and Partners’ Strategic Plans The structures established in the institutional framework will promote the incorporation of environmental health into all relevant Sectoral and partners’ strategic plans. 2. Monitoring and Evaluation Regular review of progress in the implementation of the national environmental health policy and advice on how to take the policy forward shall be provided by the bodies established in the institutional framework. Observing change, in environmental health interactions and disease trend alike, can only be achieved by monitoring key indicators and communicating hazards, risks and trends to those who can take action for addressing them. The Malawi Government affirms to the need to monitor and evaluate env ironmental health interventions both on short term and long term besides climate change impacts such as floods, droughts, earthquakes, cyclones. This will enable environmental health practitioners to make evidence based decisions and to plan and respond effectively to environmental health risks and hazards including other emerging issues. 4.3 National and District Fora 8 National Environmental Health Policy The Ministry of Health and Population, through the Environmental Health section, shall be the secretariat of the National Environmental Health Committee. This Committee shall establish a technical working group to tackle issues in all Environmental Health Thematic areas. This technical working committee shall be chaired by the Deputy Director responsible for Environmental Health. Monitoring and evaluation also provides a mechanism for institutional transparency and accountability. Progress with international and national developmental goals such as SDGs, the MGDS II, HSSP, and Vision 2020 can also be assessed. The Ministry of Health and Population in collaboration with other stakeholders, shall develop appropriate indicators. The ministry shall also report on regular basis on performance of those indicators. The relevant regulatory bodies and associations shall play a vital role in regulating professional conduct and career development of its environmental health practitioners. For instance, regulatory bodies shall ensure that all practitioners who implement the environmental health activities are qualified by training from recognized institution by Malawi government. The Ministry of Health and Population through Environmental Health Organizational structure shall provide overall guidance, coordination, monitoring and evaluation of the national environmental health policy (see annex 3). 5.2 Roles and Responsibilities of Different Levels of Environmental Health 5.2.1 National Level The department for the Environmental health in the Ministry of health and Population shall be responsible for the following: 5.2.1.1 Initiate the review and development of legislation, policies, and standards and guidelines on environmental health 5.2.1.2 Establish mechanisms for sectoral and inter-sectoral co-ordination. 5.2.1.3 Identify major environmental health issues for priority interventions 5.2.1.4 Establish environmental health indicators for monitoring and evaluation of the effectiveness of the policies and strategies. 5.2.1.5 Provide supplementary financial and material resources for the management of environmental health at district level. 5.2.1.7 Define responsibilities and lines of authority of EHOs at different levels 5.2.1.8 Ensure equitable distribution of Environmental Health Officers 5.2.1.9 Establish a training programme for Environmental Health Officers. 9 National Environmental Health Policy 5.2.1.10 Promote international collaboration and cooperation on EH issues. 5.2.1.11 Promote coordination with other ministries and organisations that provide environmental health services 5.2.2 District Level The department of Environmental health in the district shall be responsible for the following: 5.2.2.1 Implementing, monitoring and evaluation of environmental health programmes. 5.2.2.2 Conduct education and information campaigns to promote environmental health. 5.2.2.3 Maintain a data-base and information net-work on environmental health. 5.2.2.4 Ensure timely response to emergencies and management of epidemics. 5.2.2.7 Enforce and ensure compliance with statutory regulations and standards on environmental health 5.2.2.8 Promote inter-sectoral collaboration and co-operation 5.2.2.10 Prepare periodical reports on the state of environmental health in the district 5.2.2.11 Promote community participation in the formulation of strategies for assessment, monitoring and evaluation of environmental health interventions. 5.2.3 Enterprise Level 5.2.3.1 Formulate institutional environmental health policy and procedures 5.2.3.2 Ensure compliance with all statutory regulations and standards on environmental health 5.2.3.4 Establish training and information programmes for workers and surrounding communities 5.2.4 Community Level 5.2.4.1 Establish community-based Development and Management Committees for environmental health programmes 5.2.4.2 Promote inter-sectoral co-operation and involvement 5.2.4.3 Participate in policy decisions to identify and determine local priorities in resources, developmental projects and services in environmental health 10 National Environmental Health Policy 5.2.4.4 Participate in the planning, implementation, monitoring and evaluation of environmental health programmes. 5.2.4.5 Support and participate in public information campaigns of the national environmental health policy and programmes 5.2.4.6 Develop plans and mobilise the community for timely response to emergencies and management of epidemics 5.2.4.7 Mobilise the community to plan, implement and evaluate EH services 5.3 Roles and Responsibilities for Stakeholders In Environmental Health The strategies stipulated in this policy cuts across different sectors. This section is clarifying the roles and responsibilities for different stakeholders in Environmental Health field. Ministry of Health and Population v Water quality monitoring and sanitary surveys v Promotion of water point sanitation and hygiene v Water treatment at household level v Promotion of sanitation and hygiene in cities and communities using relevant approaches such as CLTS and PHAST v Promotion and enforcement of proper waste management at both households and commercial sites v Conduct Environmental Health Impact assessment v Promotion and enforcement of food safety and hygiene at household, informal and formal food establishments. v Certification of exported and imported foods that meet food safety and hygiene standards v Monitoring and enforcement of food fortification at ports of entry, commercial and household levels v Medical examinations of food handlers from informal and formal establishments v Coordination of food safety and hygiene activities at all levels v Coordination of disease prevention and control including vector and vermin v Planning, implementing and evaluating of disease prevention and control measure/interventions including vector and vermin v Management of port health services at all ports of entry v Planning, implementing and coordinating of health interventions during disaster and emergency v Planning, implementing and coordinating of health and climate change interventions Ministry of Agriculture, Irrigation and Water Development v Provision of water sources v Water quality monitoring before commissioning of new water sources v Facilitation of water sources management v Water treatment at water facility 11 National Environmental Health Policy Malawi Bureau of Standards v Setting and monitoring standards of environmental health related services and products v Certification of environmental health related services and products Department of Environmental Affairs v Monitoring of water pollution v Conduct Environmental Impact assessment v Conduct environmental education and public awareness v Enforcement of environmental standards, laws and regulations v Reporting on state of environment. v Issuing of certification for effluents to be discharged into water bodies v Monitoring of radiation Water Boards v Provision of urban and peri urban piped water supplies v Water treatment v Water catchment conservation management Local Authorities v Plan, implement and coordinate environmental health services. v Provision of sanitation and hygiene facilities in public places e.g markets v Solicit funding for implementation of environmental health services v Formulate and enforce of Bye laws, statutory regulations and standards on Environmental health. v Promote awareness on environmental health issues v Prepare periodical reports on the state of environmental health in their areas. v Promote intersect oral collaboration and co-operation Non-Governmental Organisations and Civil Societies v Assist in community sensitisation in environmental health issues v Encourage the community to manage water and sanitary facilities. v Assist Government in implementing environmental health activities v Advocacy on health and safety measures Training institutions v Undertake capacity building in environmental health issues v Promote and conduct research in environmental health v Develop low cost technologies for advancement of environmental health issues Development Partners v Provision of technical and financial resources v Capacity building 12 National Environmental Health Policy Ministry of Labour v Conduct inspection in work places. v Formulate and review laws regulation codes of practice on occupational safety and health v Creating awareness to employees and employers on occupational safety and health Department of Relief and Disaster Management v Coordination of disaster risk management. v Mobilising resources for disaster and emergency management v v Coordination of development of disaster risk management plans Ministry of Home Affairs and Internal Security Enforcement of laws Media v Creating awareness on environmental health issues Malawi Revenue Authority v Support in regulating importation and exportation of food and other materials. v Collaborating with port health officers in their duties. Ministry of Education, Science and Technology v Collaborate in planning, implementing and evaluating school environmental health services. v Maintain environmental health issues in school curriculum. Ministry of Gender, Community Services and Social Welfare v Support community mobilisation for Environmental Health Services (EHS). 13 National Environmental Health Policy A N N E X 5 IM P L E M E N T A T IO N P L A N ( 20 18 – 20 24 ) Sp ec i c go al O ut co m e St ra te gy A ct iv it y Im pl em en ti ng p ar tn er s T im ef ra m e To pr ot ec t th e co ns um er ag ai ns t un sa fe , im pu re a nd fr au du le nt ly pr es en te d fo od t ha t m ay b e in ju ri ou s to th e he al th of th e co ns um er . R ed uc ed in ci de nt s of fo od bo rn e di se as es St re ng th en fo od i ns pe ct io n an d pr em is e au di tin g C on du ct fo od in sp ec tio ns M oH P, M B S, M in is tr y of T ou ri sm , M O L G O ng oi ng Pr oc ur e eq ui pm en t a nd su pp lie s M oH P, U N IC E F, W H O 20 18 an d on go in g T ra in E H s ta ff in fo od in sp ec tio ns M oH P, T ra in in g in st itu tio ns O ng oi ng C on du ct s ta ke ho ld er s m ee tin gs M oH P, O ng oi ng T ak e an d re vi ew in ve nt or y of f oo d pr em is es M oH P, , T ra de , M O A , M O T , C ou nc ils , M B S O ng oi ng D ev el op st an da rd s fo r co nd uc tin g fo od in sp ec tio ns a nd p re m is e au di tin g M oH P, M B S, W H O , M O A 20 18 St re ng th en m ed ic al ex am in at io n fo r fo od ha nd le rs R ev ie w g ui de lin es f or m ed ic al e xa m in at io ns M oH P, L oc al G ov er nm en t 20 18 C on du ct ro ut in e m ed ic al ex am in at io ns fo r fo od h an dl er s Pr oc ur em en t of r ea ge nt s an d eq ui pm en t fo r te st in g of fo od h an dl er s M oH P, M B S, C ou nc ils M oH P, O ng oi ng O ng oi ng 20 18 14 National Environmental Health Policy E st ab lis hm en t of ce rt ifi ca tio n m ec ha ni sm s D ev el op he al th ce rt ifi ca tio n gu id el in es fo r lo ca l, ex po rt ed an d im po rt ed fo od s an d co rr es po nd in g ce rt ifi ca te s M oH P, M O IT , M R A , M B S St re ng th en m ec ha ni sm s fo r fo od te st in g D ev el op f oo d te st in g gu id el in es ( sa m pl in g, tr an sp or ta tio n, s to ra ge ) M oH P, M B S 20 18 T ra in E H s ta ff in fo od te st in g gu id el in es M oH P, M B S, tr ai ni ng in st itu tio ns 20 18 Pr oc ur e eq ui pm en t a nd s up pl ie s M oH P, W H O , U N IC E F 20 18 T ra in la b pe rs on ne l i n fo od te st in g M oH P, 20 18 St re ng th en in ve st ig at io n an d do cu m en ta tio n of fo od bo rn e di se as es an d co nd iti on s D ev el op gu id el in es on in ve st ig at io n an d re po rt in g of fo od bo rn e di se as es an d co nd iti on s M oH P, 20 18 T ra in in g of E H s ta ff o n th e gu id el in es M oH P, W H O 20 18 R ai se aw ar en es s an d ed uc at e co ns um er s on fo od s af et y an d hy gi en e C on du ct I E C o n FS H p ra ct ic es a t ho us eh ol d le ve l M oH P, C A M A O ng oi ng D ev el op IE C m es sa ge s an d m at er ia ls o n FS H M oH P, W H O 20 18 15 National Environmental Health Policy St re ng t he n th e m on ito ri ng of fo od at di ff er en t po in ts in th e fo od ch ai n, in cl ud in g ra w ag ri cu ltu ra l pr od uc ts , pr oc es se d fo od s, ge ne tic al ly m od ifi ed fo od s, st re et fo od s, fo od s se rv ed i n fo od se rv ic e es ta bl is hm en t, fo rt ifi ed fo od s an d at ho us eh ol d le ve l D ev el op t ra in in g m at er ia ls o f fo od p re m is es ow ne rs a nd f oo d ha nd le rs M oH P, M B S 20 18 T ra in fo od p re m is e ow ne rs in F SH M oH P, M B S 20 16 H ar m on is e gu id el in es fo r fo rm al fo od es ta bl is hm en ts A da pt c od ex /W H O g ui de lin es i n in fo rm al fo od e st ab lis hm en ts in F SH M oH P, M B S M oH P, M B S 20 16 20 16 T ra in in g of f oo d ha nd le rs a nd i ns pe ct or s in H A C C P M B S, M oH P, T ra in in g in st itu tio ns O ng oi ng St re ng th en a nd R ev ie w th e av ai la bl e fo od la w s an d M oH P, M O J, M B S, M O A FS 20 18 16 National Environmental Health Policy en fo rc e ap pr op ri at e fo od la w s an d re gu la tio ns re gu la tio ns 20 18 20 18 O ng oi ng D is se m in at e th e fo od la w s an d re gu la tio ns D ev el op fo od c on tr ol A ct M oH P, M B S, M O J M oH P, M B S, M O J E nf or ce m en t o f f oo d la w s an d re gu la tio ns M oH P, M O L G , M O T , M R A , M D IS , M B S, M O J T o en su re av ai la bi lit y of s af e w at er , sa ni ta ry fa ci lit ie s an d im pr ov ed hy gi en ic pr ac tic es R ed uc ed in ci de nt s of W A SH re la te d di se as es St re ng th en of w at er qu al ity m on ito ri ng fr om s ou rc e to th e us er T ra in in g of E H O s in w at er q ua lit y m on ito ri ng M oH P, M O IW D , T ra in in g in st itu tio ns O ng oi ng Pr oc ur em en t of e qu ip m en t an d su pp lie s fo r w at er q ua lit y m on ito ri ng M oH P, U N IC EF O ng oi ng St re ng th en w at er t re at m en t at p oi nt o f us e C on du ct IE C o n w at er tr ea tm en t M oH P, P ar tn er s O ng oi ng L ob by fo r a va ila bi lit y of c hl or in e pr od uc ts Pr ov id e ch lo ri ne M oH P, M oH P, P SI O ng oi ng O ng oi ng St re ng th en su rv ei lla nc e of W A SH re la te d di se as es . T ra in in g of H SA s an d co m m un ity s tr uc tu re s in W A SH d is ea se s. M oH P, P ar tn er s O ng oi ng 17 National Environmental Health Policy Pr om ot e hy gi en e at ho us eh ol d le ve l D ev el op IE C m es sa ge s an d m at er ia ls on sa ni ta tio n an d hy gi en e. M oH P, P ar tn er s 20 18 C on du ct c le an v ill ag e co m pe tit io n M oH P, Se ns iti ze co m m un iti es on co ns tr uc tio n of dw el lin g ho us es t ha t m ee t m in im um h ou si ng st an da rd s M oH P, Pr om ot e O pe n D ef ec at io n Fr ee T ri gg er co m m un iti es fo r O D F us in g ap pr op ri at e ap pr oa ch es s uc h as C L T S M oH P, Pr om ot e fo r pr ov is io n of sa ni ta ry fa ci lit ie s an d ha nd w as hi ng In sp ec tio n of s an ita tio n in v ill ag es , p ub lic a nd pr iv at e in st itu tio ns M oH P, L oc al c ou nc ils O ng oi ng C on du ct IE C o n sa ni ta tio n an d hy gi en e M oH P, P ar tn er s O ng oi ng C on du ct I E C o n sa ni ta tio n an d ha nd w as hi ng at c ri tic al tim es M oH P, P ar tn er s O ng oi ng Pr om ot e th e us e of su st ai na bl e sa ni ta tio n te ch no lo gi es C on du ct IE C on su st ai na bl e sa ni ta tio n te ch no lo gi es M oH P, P ar tn er s O ng oi ng D oc um en ta tio n of s us ta in ab le te ch no lo gi es M oH P, P ar tn er s O ng oi ng Fa ci lit at e co ns tr uc tio n of w at er a nd s an ita tio n fa ci lit ie s th at ar e ge nd er an d di sa bi lit y fr ie nd ly M oH P, Pr om ot e pr op er m an ag em en t of liq ui d an d so lid w as te at al l le ve ls Fa ci lit at e co ns tr uc tio n of s ta nd ar d liq ui d an d so lid w as te f ac ili tie s M oH P, Fa ci lit at e pr oc ur em en t of liq ui d an d so lid w as te c ol le ct io n ve hi cl es M oH P, 18 National Environmental Health Policy In cr ea se d co lla bo ra tio n an d co or di na tio n St re ng th en in g se ct or al an d in te r se ct or al co or di na tio n an d co lla bo ra tio n C on du ct s ta ke ho ld er s m ee tin gs i n th em at ic ar ea s M oH P, M oH P, P ar tn er s O ng oi ng O ng oi ng C on du ct jo in t v is its to p ro je ct a re as In cr ea se d us e of da ta in de ci si on m ak in g St re ng th en E H in fo rm at io n m an ag em en t sy st em D ev el op in di ca to rs f or E H th em at ic a re as M oH P, P A R T N E R S 20 18 E st ab lis h da ta b as e fo r E H th em at ic a re as M oH P, 20 18 Pr od uc e an d su bm it re po rt s on E H t he m at ic ar ea s M oH P, O ng oi ng D is se m in at e in fo rm at io n in E H th em at ic a re as M oH P, O ng oi ng Im pr ov ed ev id en ce ba se d de ci si on m ak in g Pr om ot e re se ar ch an d te ch no lo gy de ve lo pm en t in E H th em at ic ar ea s C on du ct re se ar ch in E H th em at ic a re as M oH P, P ar tn er s O ng oi ng A da pt a nd a do pt i nn ov at iv e te ch no lo gi es i n E H th em at ic a re as M oH P, P ar tn er s O ng oi ng To pr ev en t an d co nt ro l th e tr an sm is si on of ot he r co m m un ic ab le R ed uc ed in ci de nc es of ot he r co m m un ic a bl e di se as es St re ng th en p or t he al th s er vi ce s D ep lo y E H p er so nn el in b or de r p os ts T ra in in g of b or de r s ta ff M oH P, M oH P, M R A 20 18 R en ov at io n an d co ns tr uc tio n of h ea lth o ffi ce s 19 National Environmental Health Policy di se as es an d di se as e ou tb re ak s an d m ag ni tu de of o ut br ea ks in b or de rs M oH P, M R A , W H O M oH P, W H O M oH P, W H O M B S, M oH P, M R A M oH P, M oH P, M O L G 20 18 20 18 20 18 O ng oi ng O ng oi ng O ng oi ng Pr ov id e ne ce ss ar y va cc in at io ns to tr av el le rs Pr oc ur e eq ui pm en t an d su pp lie s fo r po rt he al th o ffi ce s C ol la bo ra tio n w ith b or de r S ta ke ho ld er s C on du ct d is ea se s su rv ei lla nc e at b or de r po st s C on du ct c ro ss b or de r m ee tin gs o n di se as e pr ev en tio n an d co nt ro l St re ng th en di se as e su rv ei lla nc e an d re sp on se fo r co m m un ic ab le di se as es an d ev en ts T ra in h ea lth w or ke rs i n di se as e su rv ei lla nc e an d re sp on se M oH P, W H O M oH P, V H C s O ng oi ng O ng oi ng C on du ct su rv ei lla nc e of di se as es in co m m un iti es a nd h ea lth f ac ili tie s St re ng th en re sp on se to di se as e ou tb re ak s an d ev en ts Pr oc ur e an d di st ri bu te s up pl ie s fo r re sp on di ng to o ut br ea ks M oH P, P ar tn er s W he ne ve r re qu ir ed C on du ct o ut br ea k in ve st ig at io ns a nd r es po nd M oH P, W H O , U N IC E F W he ne ve r re qu ir ed 20 National Environmental Health Policy St re ng th en re po rt in g of no tifi ab le an d em er gi ng di se as es Fo rm an d re va m p ep id em ic m an ag em en t st ru ct ur es M oH P, O ng oi ng C on du ct s ta ke ho ld er m ee tin gs o n ep id em ic s M oH P, L oc al c ou nc ils St re ng th en su st ai na bl e ve ct or an d ve rm in co nt ro l m ea su re s E nh an ce in fo rm at io n, ed uc at io n, an d co m m un ic at io n fo r al l co m m un ic ab le di se as es in cl ud in g no tifi ab le , em er gi ng di se as es an d ev en ts E st ab lis h en to m ol og ic al la bo ra to ri es M oH P, 20 18 Pr oc ur e ve ct or co nt ro l eq ui pm en t an d su pp lie s M oH P, P ar tn er s O ng oi ng C on du ct o pe ra tio na l r es ea rc h on e nt om ol og y M oH P, P ar tn er s O ng oi ng Pr om ot e IE C on da ng er s an d co nt ro l of ve ct or s M oH P, P art ne rs O ng oi ng Pr om ot e in se ct ic id e re vo lv in g fu nd in iti at iv e M oH P, P ar tn er s O ng oi ng M ob ili se c om m un iti es in v ec to r a nd c on tr ol ( h ea lth y vi lla ge s et tin gs ) M oH P, P ar tn er s O ng oi ng C on du ct re se ar ch o n ve ct or c on tr ol m et ho ds M oH P, P ar tn er s O ng oi ng St re ng th en co lla bo ra tio n C on du ct m ea t i ns pe ct io n V et er in ar y, M oH P, O ng oi ng 21 National Environmental Health Policy in pr ev en tio n of zo on ot ic di se as es C on du ct co m m un ity se ns iti sa tio ns on zo on ot ic d is ea se s M oH P, V et er in ar y O ng oi ng St re ng th en pr ev en tio n of va cc in e pr ev en ta bl e di se as e C on du ct im m un is at io ns fo r ot he r im m un is ab le d is ea se s C on du ct m as s sc re en in g fo r s om e co nd iti on s C on du ct m as s tr ea tm en t i n co m m un iti es M oH P, W H O M oH P, P ar tn er s M oH P, P ar tn er s W he ne ve r re qu ir ed W he ne ve r re qu ir ed W he ne ve r re qu ir ed To p ro te ct th e w or ke rs a nd ge ne ra l p ub lic fr om ha za rd ou s en vi ro nm en ta l fa ct or s. R ed uc ed ha za rd ou s en vi ro nm en t al fa ct or s in w or kp la ce s an d ge ne ra l co m m un ity St re ng th en in sp ec tio n of w or k pl ac es U pd at e lis t o f w or kp la ce s R ev ie w gu id el in es an d ch ec kl is t fo r in sp ec tio ns C on du ct in sp ec tio n of w or k pl ac es M O L , c ou nc ils , M B S M oH P, M O L M oH P, M O L 20 18 20 18 O ng oi ng St re ng th en H C W M in al l he al th es ta bl is hm en t R ev ie w tr ai ni ng m an ua ls fo r H C W M C on du ct tr ai ni ng of he al th w or ke rs on H C W M C on du ct i ns pe ct io n of H C W M f ac ili tie s in he al th in st itu tio ns M oH P, W H O M oH P, M oH P, E A D 20 18 20 18 O ng oi ng 22 National Environmental Health Policy E st ab lis h m ec ha ni sm s fo r he al th an d sa fe ty in co ns tr uc tio n of ne w st ru ct ur es an d de m ar ca tio n of ne w se ttl em en ts D ev el op g ui de lin es i n he al th a nd sa fe ty i n si tin g, de si gn in g an d co ns tr uc tio n of bu ild in gs . T ra in E H O s in th e he al th an d sa fe ty gu id el in es Pa rt ic ip at e in co un tr y an d to w n ph ys ic al pl an ni ng m ee tin gs a t a ll le ve ls M oH P, P hy si ca l p la nn in g M M oH P, P hy si ca l p la nn in g M oH P, C ou nc ils 20 18 20 18 O ng oi ng St re ng th en he al th im pa ct as se ss m en t du ri ng E IA s D ev el op gu id el in es fo r he al th im pa ct as se ss m en t T ra in H ea lth p er so nn el in H IA s A dv oc at e fo r p ar tic ip at io n in E IA s C on du ct h ea lth a ud its o f p ro je ct s M oH P, E A D M oH P, E A D M oH P, M oH P, E A D 20 18 20 18 20 18 20 18 St re ng th en m ec ha ni sm s fo r pr ev en tio n of a ir p ol lu tio n fo r bo th i nd oo r an d ou td oo r C on du ct a dv oc ac y on in d oo r a ir p ol lu tio n M oH P, E A D 20 18 23 National Environmental Health Policy St re ng th en in du st ri al w as te m an ag em en t C on du ct in du st ri al au di ts on w as te m an ag em en t M oH P, E A D , L oc al c ou nc il 20 18 St re ng th en co re na tio na l ca pa ci tie s th at en ab le he al th sy st em s to pr ep ar e fo r an d eff ec tiv el y re sp on d to cl im at e ch an ge th re at s to hu m an h ea lth · C on du ct r eg ul ar e nv ir on m en ta l he al th au di ts in al l ca tc hm en t ar ea s to es ta bl is h cl im at e ch an ge i m pa ct s th at m ay li ke ly o cc ur · E st ab lis h ea rl y w ar ni ng sy st em s of cl im at e ch an ge im pa ct s at a ll le ve ls · Pr ov id e ca pa ci ty to al l ex te ns io n w or ke rs t o su pp or t co m m un iti es o n en vi ro nm en ta l sa fe gu ar ds co ns tr uc tio n · Pr om ot e re si lie nt co ns tr uc tio n te ch no lo gi es to m iti ga te cl im at e ch an ge im pa ct s · T ra in h ea lth w or ke rs a nd s ta ke ho ld er s in c lim at e ch an ge im pa ct s m iti ga tio n M oH P, M et er eo lo gi ga l d ep ar tm en t 20 18 Pr om ot e re se ar ch on cl im at e ch an ge im pa ct s an d ad ap ta tio n · In te ns if y us e of e vi de nc e ba se d da ta to pl an in te rv en tio ns ai m ed at ad dr es si ng c lim at e ch an ge im pa ct s · C on du ct r es ea rc h on c lim at e ch an ge im pa ct s an d th ei r re sp ec tiv e m iti ga tio ns · C ol la bo ra te w ith a ca de m ia in tr ac ki ng tr en ds o f c lim at e ch an ge im pa ct s M oH P, U ni ve rs ity o f M al aw i, L ua na r, W H O 20 18 St re ng th en a nd op er at io na lis e th e he al th co m po ne nt s in · E st ab lis h eff ec tiv e pl an s an d in co rp or at ed i n th e na tio na l, di st ri ct im pl em en ta tio n pl an fo r pr op er M oH P, D oD M A , W H O 20 18 24 National Environmental Health Policy di sa st er ri sk re du ct io n pl an s co or di na tio n pu rp os es · Pr ov id e bu dg et ar y es tim at es to D oD M A ev er y ye ar to as si st in re sp on di ng to d is as te r i m pa ct s · C on st itu te e m er ge nc y he al th t ea m s to re sp on d to d is as te r ri sk s To pr om ot e pr ev en tiv e, m iti ga tio n an d ad ap ta tio n m ea su re s re ga rd in g he al th im pa ct s of em er ge nc ie s an d cl im at e ch an ge is su es . St re ng th en en vi ro nm en ta l he al th ha za rd id en tifi ca tio n, m ap pi ng an d ri sk re du ct io n m ec ha ni sm s at al l l ev el s T ra in h ea lth p er so nn el in h az ar d m ap pi ng C on du ct h az ar d an d en vi ro nm en ta l h ea lth r is k m ap pi ng C on du ct se ns iti sa tio n m ee tin gs on ha za rd m iti ga tio n C on du ct ro ut in e do cu m en ta tio n of a ll ha za rd s M oH P, L oc al c ou nc ils M oH P, L oc al c ou nc ils M oH P, L oc al c ou nc ils M M oH P, L oc al c ou nc ils 20 18 20 18 20 18 20 18 25 National Environmental Health Policy A N N E X 6 M O N IT O R IN G A N D E V A L U A T IO N F R A M E W O R K O u tc om e O u tp u t In d ic at or B as el in e T ar ge t M O V F re q u en cy T im el in e R es p on si b le of  ce r H E A L T H A N D S A F E T Y R ed uc ed h ea lt h ri sk s in w or kp la ce s in sp ec ti on o f w or k p la ce s st re ng th en ed % o f w /p la ce s w it h sa fe o r no n ha za rd ou s w or ki n g co nd it io ns U nk no w n D is tr ic t re po rt s S ur v ey s Q ua rt er ly A nn ua ll y O ng oi ng O ng oi ng C E H O he al th an d sa fe ty st an da rd s re vi ew ed A va il ab il it y o f re vi ew ed st an da rd s on oc cu p at io n al he al th a nd s af et y C op y of re vi ew ed st an da rd s O nc e 20 16 C E H O R ed uc ed h ea lt h ri sk s du ri ng em er ge nc ie s an d di sa st er s re sp on se to em er ge nc ie s an d di sa st er s st re ng th en ed N o. o f d is as te rs w he re re sp on se w as t im el y U nk no w n D is as te r re po rt s W h en ev er re qu ir ed C E H O R ed uc ed ri sk of in fe ct io ns an d in ju ri es fr o m he al th ca re w as te s H C W M in he al th f ac il it ie s im p ro ve d % o f fa ci li ti es w it h re qu ir ed H C W M * U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng oi ng C E H O 26 National Environmental Health Policy O u tc om e O u tp u t In d ic at or B as el in e T ar ge t M O V F re q u en cy T im el in e R es p on si b le of  ce r R ed uc ed ri sk of in fe ct io ns an d in ju ri es fr o m de ve lo p m en ta l pr oj ec ts H ea lt h im pa ct as se ss m en t du ri ng E IA s st re ng th en ed H ea lt h au di ts st re ng th en ed % o f pr oj ec ts w hi ch h av e p as se d H IA s % of pr oj ec ts pa ss ed a ud it s U nk no w n U nk no w n D is tr ic t re po rt s D is tr ic t re po rt s Q ua rt er ly Q ua rt er ly O ng oi ng O ng oi ng C E H O C E H O Im p ro ve d h ea lt h an d sa fe ty in se tt le m en ts H ea lt h an d sa fe ty m ea su re s in se tt le m en ts an d bu il di ng s st re ng th en ed % o f ne w se tt le m en ts de si gn ed in co m p li an ce w it h he al th an d sa fe ty gu id el in es U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng oi ng C E H O R ed uc ed h ea lt h ha za rd s fr o m ex po su re in ju ri ou s an d ha za rd ou s su b st an ce s m ec h an is m s fo r re du ct io n of ex po su re ha za rd ou s an d in ju ri ou s su bs ta nc es M ec ha ni sm s in pl ac e P op ul at io n ex po se d S ur v ey A nn ua ll y 20 17 20 17 C E H O C E H O 27 National Environmental Health Policy es ta bl is he d R ed uc ed h ea lt h ri sk s fr o m i nd oo r ai r p ol lu ti on A dv oc ac y on pr ev en ti on o f in do o r ai r po ll ut io n en ha nc ed % of ho us eh o ld s w it h sa ti sf ac to ry m ea su re s fo r pr ev en ti on of in do or a ir p o ll ut io n* U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng oi ng C E H O R ed uc ti on in he al th pr ob le m s du e to ex po su re to co n ta m in at ed en v ir on m en ts Im p ro ve d in du st ri al w as te m an ag em en t % o f in du st ri es w it h p ro pe r w as te m an ag em en t fa ci li ti es U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng oi ng W A T E R Q U A L IT Y , S A N IT A T IO N A N D H Y G IE N E O u tc om e O u tp u t In d ic at or B as el in e T ar ge t M O V F re q u en cy T im el in e R es p on si b le of  ce r R ed uc ed in ci de nc e o f W A S H re la te d di se as es W at er qu al it y m o ni to ri n g st re ng th en ed % o f w at er s am p le s by so u rc e te st ed ne ga ti ve fo r m ic ro bi al co n ta m in at io n U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng oi ng C E H O % o f w at er s am pl es m ee ti n g w at er st an da rd s in te rm s of ch em ic al an d bi ol og ic al a na ly si s U nk no w n S ur v ey A nn ua ll y O ng oi ng M O IW D 28 National Environmental Health Policy A dv oc ac y fo r w at er hy gi en e, sa ni ta ti on an d ha nd w as hi ng at ho us eh ol d le ve l e nh an ce d % o f w at er s am pl es fr o m ho us eh o ld s w it h re si d ua l ch lo ri n e. U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng oi ng C E H O % o f w at er s am pl es fr o m ho us eh o ld s te st ed co li fo rm ne ga ti ve U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng oi ng C E H O % of ho us eh o ld s ow ni ng an d u si ng im p ro ve d sa n it ar y fa ci li ti es * 40 .6 % im p ro ve d M IC S ,2 01 4 60 % im p ro ve d D is tr ic t re po rt s S ur v ey s Q ua rt er ly A nn ua ll y 20 17 C E H O % o f O D F v il la g es 29 % (M oH R ep or ts 20 15 ) D is tr ic t re po rt s Q ua rt er ly O ng oi ng C E H O % of pe op le ha nd w as hi ng w it h so ap 56 .2 % M IC S 20 14 60 % S ur v ey A nn ua ll y 20 17 C E H O O u tc om e O u tp u t In d ic at or B as el in e T ar ge t M O V F re q u en cy T im el in e R es p on si b le of  ce r W at er tr ea tm en t at po in t o f u se im p ro ve d % of w it h w at er sa m p le s fr o m ho us eh ol ds te st ed po si ti ve o n ch lo ri n e re si du al s U nk no w n S ur v ey A nn ua ll y 20 17 C E H O 29 National Environmental Health Policy A dv oc ac y fo r pr ov is io n of sa n it ar y fa ci li ti es in pu bl ic in st it ut io ns st re ng th en ed % of pu bl ic in st it ut io ns w it h ad eq ua te sa n it ar y fa ci li ti es U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng oi ng C E H O P ro m o ti on o f su st ai na bl e, ge nd er an d di sa bi li ty fr ie nd ly sa n it ar y fa ci li ti es en ha nc ed A va il ab il it y o f su st ai na bl e g en de r an d di sa b il it y fr ie nd ly sa n it ar y fa ci li ti es U nk no w n S ur v ey A nn ua ll y O ng oi ng F O O D S A F E T Y A N D H Y G IE N E R ed uc ed in ci de nc es o f fo od bo rn e di se as es F oo d in sp ec ti on st re ng th en ed N o. o f fo od it em s co nd em n ed N o. of in sp ec ti on s do ne un kn ow n D is tr ic t re po rt s Q ua rt er ly C E H O pr em is es au di ti ng st re ng th en ed % of sa ti sf ac to ry fo od p re m is es *. U nk no w n ( da ta fr o m M B S , ci ty ) D is tr ic t re po rt s Q ua rt er ly C E H O 30 National Environmental Health Policy O u tc om e O u tp u t In d ic at or B as el in e T ar ge t M O V F re q u en cy T im el in e R es p on si b le of  ce r M ed ic al ex am in at io n se rv ic es fo r fo od h an d le rs st re ng th en ed % o f fo od h an d le rs sa ti sf y in g m ed ic al fi tn es s * N o. of fo od es ta bl is hm en ts co m p ly in g w it h te st in g un kn ow n D is tr ic t re po rt s Q ua rt er ly C E H O F oo d ce rt ifi ca ti o n gu id el in es es ta bl is he d F oo d ce rt ifi ca ti on gu id el in es es ta bl is he d un kn ow n P re se n c e o f gu id el i ne s O nc e C E H O M ec ha ni sm s fo r fo o d te st in g es ta bl is he d F oo d te st in g gu id el in es i n pl ac e N on e G ui de li ne s Q ua rt er ly C E H O In ve st ig at io n of fo od bo rn e di se as e ou tb re ak s an d co nd it io ns st re ng th en ed N u m b er of fo od bo rn e d is ea se ou tb re ak s in ve st ig at ed un kn ow n D is tr ic t re po rt s Im m ed ia te ly up on oc cu rr en ce C E H O R ep or ti ng o f fo od bo rn e di se as es an d co nd it io ns st re ng th en ed % of di st ri ct s re po rt in g D is tr ic t re po rt s Im m ed ia te ly up on oc cu rr en ce C E H O A dv oc ac y on N u m b er o f un kn ow n S ur v ey A nn ua ll y C E H O 31 National Environmental Health Policy fo od S af et y an d H yg ie ne a t ho us eh o ld le ve l en ha nc ed ho us eh ol ds pr ac ti ci ng fo od sa fe ty a nd h yg ie ne re po rt F S H st an da rd co m pl ia nc e in fo rm al an d in fo rm al fo od pr em is es en ha nc ed % of fo rm al an d in fo rm fo od pr em is es c om pl yi ng w it h fo od s ta nd ar ds N ot k no w n R ou ti ne da ta Q ua rt er ly C E H O O u tc om e O u tp u t In d ic at or B as el in e T ar ge t M O V F re q u en cy T im el in e R es p on si b le of  ce r F oo d sa fe ty m an ag em en t sy st em s st re ng th en ed % o f fo od in du st ri es co m p ly in g w it h fo od sa fe ty m an ag em en t sy st em s U nk no w n S ur v ey A nn ua ll y F oo d la w s an d re gu la ti on s st re ng th en ed F oo d la w s de ve lo pe d 20 17 C E H O V ec to r an d D is ea se p re ve n ti on a n d c on tr o l T o re du ce in ci de nc es of ot he r co m m un ic ab le Im p le m en ta ti o n of in te rn at io na l he al th % of po rt s im p le m en ti n g al l co re c ap ac it ie s* U nk no w n D is tr ic t re po rt s A nn ua ll y C E H O 32 National Environmental Health Policy di se as es an d co nt ro l of d is ea se ou tb re ak s re gu la ti on s st re ng th en ed di se as e su rv ei ll an ce st re ng th en ed N o. o f ca se s de te ct ed N o. of de at hs de te ct ed D is tr ic t re po rt s Q ua rt er ly C E H O R es po ns e to di se as e ou tb re ak s st re ng th en ed N u m b er of fu nc ti on al co o rd in at io n co m m it te es A tt ac k ra te fo r ou tb re ak s C as e fa ta li ty ra te fo r ou tb re ak s D is tr ic t re po rt s Q ua rt er ly C E H O O u tc om e O u tp u t In d ic at or B as el in e T ar ge t M O V F re q u en cy T im el in e R es p on si b le of  ce r S us ta in ab le ve ct or co n tr ol m et ho ds pr om o te d % of vi ll ag es im pl em en ti ng su st ai na bl e ve ct or co nt ro l in te rv en ti on s* U nk no w n D is tr ic t re po rt s Q ua rt er ly C E H O 33 National Environmental Health Policy C on tr ol of zo on ot ic di se as es st re ng th en ed P re va le nc e of zo on ot ic d is ea se s U nk no w n D is tr ic t re po rt s O u tc om e O u tp u t In d ic at or B as el in e T ar ge t M O V F re q u en cy T im el in e R es p on si b le of  ce r E m er ge n ci es , C li m at e C h an ge a n d H u m an H ea lt h R ed uc ed h ea lt h ri sk s du ri ng em er ge nc ie s an d di sa st er s re sp on se to em er ge nc ie s an d di sa st er s st re ng th en ed N o. o f d is as te rs w he re re sp on se w as t im el y U nk no w n D is as te r re po rt s W h en ev er re qu ir ed C E H O In cr ea se d al lo ca ti o n o f re so ur ce s to w ar ds di sa st er ri sk s m it ig at io ns W el l an d eff e ct iv e co or di na ti on o f di sa st er m an ag em en t N u m b er of re so ur ce s an d st ak eh ol d er s co m m it te d to di sa st er ri sk s m an ag em en t D is tr ic t re po rt s W ee kl y O ng oi ng C E H O E nh an ce d ca pa ci ty fo r he al th s ys te m s to pr ep ar e fo r an d re sp on d to cl im at e ch an ge th re at s to hu m an W el l tr ai n ed w or kf or ce to pr ep ar e an d re sp on d to cl im at e ch an ge th re at s to hu m an he al th N u m b er of he al th w or ke rs tr ai ne d in cl im at e ch an ge im pa ct s m it ig at io n s U nk no w n D is tr ic t re po rt s Q ua rt er ly O ng in g C E H O 34 National Environmental Health Policy he al th pu t in p la ce S ci en ti fi c re se ar ch pr om o te d on cl im at e ch an ge im pa ct s an d ad ap ta ti on W el l co or di na te d re se ar ch on cl im at e ch an ge im pa ct s an d ad ap ta ti on m ec h an is m s N u m b er o f re se ar ch re po rt s pu bl is he d U nk no w n D is tr ic t re po rt s B ia nn ua ll y O n go in g C E H O 35 National Environmental Health Policy Page 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16 Page 17 Page 18 Page 19 Page 20 Page 21 Page 22 Page 23 Page 24 Page 25 Page 26 Page 27 Page 28 Page 29 Page 30 Page 31 Page 32 Page 33 Page 34 Page 35 Page 36 Page 37 Page 38 Page 39 Page 40 Page 41 Page 42 Page 43 Page 44 Page 45 Page 46 Page 47 Page 48