EHJ October 2002, pages 300 - 303 Recent industrial and economic development in Botswana has brought with it a new set of environmental and health problems that urgently need addressing. Bontle Mbongwe explains

Botswana, a semi-arid landlocked country, is situated in the Kalahari basin in southern Africa and shares boundaries with South Africa, Zimbabwe, Zambia and Namibia. The country has a population of about 1.7 million, on a land area of about 581,730 Km2, with about 80 per cent of the population concentrated in the east.

Although Botswana has experienced a healthy economic growth pattern, there are still some communities that cannot afford basic amenities as national wealth is unevenly distributed.

Unemployment/underemployment and natural disasters, such as drought, tend to aggravate the socio-economic disparities, thereby adversely affecting living conditions and health status. However, the Botswanan Government has developed sound policies on national wealth distribution and has, over the years, developed infrastructure in a bid to empower the population to participate in national economic growth.

Like many other rapidly developing countries, Botswana is faced with a number of environmental hazards that affect human health and the environment. The sanitary disposal of human waste is one indicator in which Botswana has not performed well in comparison with the global target. On the other hand, the diversification of the economy by increasing manufacturing growth, promotion of agricultural practices, expansion of tourism, expansion of the mining sector and business sector, as well as the accelerated population growth - especially in the urban fringes - all point to increased and diversified environmental health problems and challenges. Consequently, pollutants and hazardous substances from atmospheric pollutants, noise, clinical wastes, spent oil and heavy metals, and waste water pollutants are on the increase.

In Botswana, environmental health manpower is thin on the ground and monitoring of the environment is highly limited. Environmental health officers at middle level (diploma holders) are trained locally, with an average output of about 12 graduates a year. Specialised training is conducted outside the country and the opportunities for sponsorship are limited because of competing priorities. Lack of specialisation in the environmental health field contributes to the institutionalisation of different environmental health functions in institutions where relevant manpower is available.

IMPLEMENTATION OF ENVIRONMENTAL HEALTH

Responsibilities for environmental health in Botswana are currently shared among several ministries and agencies. However, being the overall custodian of health, the Ministry of Health has a responsibility to monitor the status of environmental health in the country. In addition, the Ministry of Health has continued to provide technical support and guidance to local authorities, private and other agencies. Its functions include:

• formulating public health and environmental health-related legislation and standards in partnership with related sectors;
• developing policies and strategies with regard to the management of chemicals, water supply and sanitation, air pollution, radiation control, housing and habitat, port health, waste management and tobacco control for purposes of protecting human and environmental health;
• providing technical support and guidance to local authorities and other government and non-governmental organisations/agencies on all matters affecting environmental health;
• formulating and developing public education strategies with regard to health and environment in order to build up positive behaviour, attitudes and promote community participation;
• establishing and strengthening links with essential sector ministries, agencies and institutions involved in health and environment matters for effective co-ordination; and
• promoting research and developing approaches that utilise state-of-the-art dose-estimation methods in both risk analyses and epidemiological investigations concerning potential environmental hazards with regard to radiation, chemicals, tobacco, etc.

Some of the major environmental health problems in Botswana include waste management, pollution of water resources, legislation and a lack of resources.

WASTE MANAGEMENT

Indiscriminate dumping of waste and widespread littering have become serious environmental problems in Botswana. Metal waste, cans, used tyres and batteries, and waste oil, are despoiling towns, villages and the once pristine countryside:

Used oil:
Oil sales in Botswana are projected to grow to 12.7 million litres by the year 2005, with the corresponding recovery of 6.3 million litres. The disposal of waste lubricants is proving difficult for the oil industry as customers, including the Government, look to the oil companies to offer solutions.

Paper, glass and packaging waste:
Consumption of paper and cardboard products and the corresponding generation of waste has been estimated at 38,000 tonnes a year (18,600 tonnes for packaging material; 7,100 tonnes for writing and printing, including newspapers, and 13,000 tonnes miscellaneous paper).

Glass:
In 1996, waste glass accounted for approximately 93 tonnes. Products on the market are either bottled in Botswana or imported as ready-packed goods. Over and above liquid products, glass packaging for other uses make up a considerable portion of waste glass. Significant quantities of waste glass are also generated when a new production line for new labels and bottle shape is introduced. For instance, in 1997 alone, 20,000 bottles were destroyed and recycled due to labelling failures and other deficiencies.

Medical/clinical waste:
The source of medical waste is primarily hospitals, clinics, laboratories, and veterinary and vaccine institutions. In addition, small amounts of waste arise from funeral undertakers and those engaged in acupuncture, chiropody, cosmetic piercing, tattooing, accident scenes, private dwellings, home-based care and private medical practitioners within residentially designated areas. It has been difficult to quantify clinical waste produced in health facilities due to the shortage of staff and the lack of weighing facilities. While some health facilities segregate clinical waste, most do not, and this results in mixed waste ultimately finding its way to landfill.

POLLUTION OF WATER RESOURCES

Botswana is a semi-arid country with scarce water resources. This, coupled with increasing demands for consumptive water uses (such as domestic, mining, industrial, commercial and agricultural water) makes it a very valuable commodity that requires careful planning for its sustainable utilisation and conservation. Ground water is the main source of potable water supply in the country.

The quality of ground water varies greatly throughout the country, with high salinity and excess levels of fluorides, nitrates and other harmful substances common in the western part of the country. Desalination plants are required in some places to treat water to portable standards. The main sources of pollution are industrial, domestic, and agricultural waste. In rural areas, pollution tends to be of a biological nature, ie pit latrines, cattle kraals, waste dumps and burial sites. Some well fields have been abandoned as a result of pollution from human waste from pit latrines.

FOOD HYGIENE AND SAFETY

The increasing demand for convenient and low-price food suppliers has led to "street food" becoming a major part of Botswana's urban scenario. While there are many positive aspects to street foods, there are also some negative issues, including encroachment on roadsides and pavements, hygiene and sanitation problems, potential disturbance in the lives of other citizens, and a possible contribution to the deterioration of the law and order within the city.

A situation analysis study on street food vending is needed, to develop integrated strategies for the management of street vended foods. Issues such as education and training, regulatory aspects of preparing and selling these foods, and capacity building should also be addressed.

CHEMICAL SAFETY

Botswana is faced with the increased environmental contamination as a result of industrial chemicals and pesticides. According to the 1995 annual economic report, the import of chemicals to Botswana (including rubber products but excluding fuels) constituted 9.5 per cent of all imports for that year.

A recent survey on public awareness of the use of chemicals in Botswana showed a lack of awareness on the safe management of chemicals by members of the public, industry employees and their managers, and identified a severe lack of disposal facilities for chemical wastes. Further, the lack of adequate monitoring capacity for radiation and air quality (especially indoor air quality) has become an issue of concern. Recently, serious radiation leaks have been detected in two of the government hospitals.

The lack of sufficient data and capacity to establish the proper linkages between these environmental hazards to specific diseases and public health problems has continued to cause conflict between development aims and environmental goals.

LEGISLATION AND POLICY

There are currently around 25 different pieces of legislation in Botswana concerned with health and environmental protection. This legislation is fragmented both in substance and in terms of implementation mechanisms. Thus, different pieces of legislation often fall under different government departments and authorities, creating both gaps and overlaps in its implementation.

Although the Ministry of Health has followed the primary health care strategy, health care policy development in Botswana has continued to focus itself on issues of accessibility to medical care. There is currently no policy on environmental health in Botswana. This has led to the slow development of environmental health in the country as a whole.

Due to inadequate capacity, which includes financial, technical and human resources, the Ministry of Health is not able to carry out its functions effectively and efficiently. There are currently no specific budgetary allocations for the development of environmental health programmes and activities, and as such, programme development is dependent on donor funding. The World Health Organisation (WHO) currently funds a few of the components of environmental health, such as water and sanitation, tobacco control and food safety. A programme on the management of chemicals has also been established with the assistance of the Danish Corporation for Environment and Development.

STRENGTHING ENVIRONMENTAL HEALTH

A clearly defined long-term vision is required to meet the challenges ahead, and some of the current developments aimed at improving environmental health in Botswana include:

Legislation:
The Ministry of Health has taken a leading role in developing relevant legislation and advocating for the revision of existing legislation on health and the environment in Botswana. This move is crucial in that it will set boundaries and provide guidelines for all those involved in health and environment issues.

The Public Health Act (1972) is currently being reviewed and a Chemical Substances and Products Bill, aimed at controlling the use of hazardous chemicals, is currently being developed. Along with this legislation is the development of standards on labelling and classifications of chemicals. In order to protect the public from the effects of environmental tobacco smoke the Ministry of Health is currently amending the Control of Smoking Act (1992) to accommodate a total ban on tobacco advertising and smoking in public places.

Environmental health policy:
A national policy on environmental health is currently being developed to ensure proper co-ordination and execution of environmental health services in the country.

Capacity building:
The Ministry of Health is currently undergoing a restructuring process. Proposals have been made to elevate the status of environmental health in the country, including the establishment of a public health laboratory, which will facilitate the assessment of risks to human health from airborne, soil, water, food and other environmental matrices. This will also facilitate the measurement, estimation and prediction of the incidences of exposure to substances in the environment.

Establishment of an environmental health information system:
The Ministry of Health, with the assistance of the WHO, is currently establishing an environmental health database, to enable clear management and planning and to facilitate rational decision-making.

PROMISING SIGNS

The formulation, planning, co-ordination and implementation of successful health and environment policies and activities depend on the institutional structures put in place. In Botswana, the activities and mandates of several departments and sections within different ministries impact upon health and the environment. Although there are some promising signs - not in terms of environmental improvement, but rather in the national development of policies and infrastructure to address the problems described above - the lack of financial, technological and human resources is a major deterrent to progress and needs to be addressed.

The Ministry of Health has an essential advocacy role to play in highlighting the links between health, environment, and sustainable development when future policies are developed and actions planned. The need for the ministry to strengthen its capacity on environmental health can therefore not be overemphasised. This is for the simple reason that, in order for external organisations to recognise the impact of health on the environment, the Ministry of Health must have adequate capacity to assess, monitor, and provide the necessary technical expertise.

Bontle Mbongwe, Botswana's chief EHO, is chair of the Botswana Environmental Health Officers Association.

This is an edited version of a paper presented at the CIEH annual conference, held in Harrogate in September. The CIEH Yorkshire and Humberside Centre announced its twinning with the Botswana Environmental Health Officers Association at the same meeting. For further details contact: Jill Barlow on tel: 01274 381662 or e-mail: barlow@anchor.org.uk