Tuesday, December 12, 2006

The Public Health Approach Towards the Unsanitary Collection and Disposal of Municipal Waste in the Monrovia Metropolitan Area – Geraldine Pierre-Kaba

INTRODUCTION-BACKGROUND

Monrovia is the capital city of Liberia which is located on the West Coast of Africa. For the past 14 years, the country has experienced a civil war that has resulted in the degradation of all of the fundamental infrastructure and basic health services. Particularly, the lack of capacity to provide sanitary and efficient municipal solid waste services to the Monrovia Metropolitan Area (MMA) city residential 1.6 million population has caused tremendous health and environmental challenges. According to a recent United Nations study, municipal workers and scavengers manage to collect less than 20% of the city’s 780 metric tons of daily refuse generation (UNEP Desk Study 2004).

Today the MMA once a beautiful, striving metropolitan city in the West African region, is now an eye-sore of pothole-ridden streets and garbage-clogged alleys that dot the city (http://www.analystliberia.com/i_am_shamed_disgusted_and_concerned_nov23.html). Solid waste is currently dispose of by means of a variety of inadequate and unsanitary methods such as open air burning; open dumping on byways or in vacant lots by the MMA residents. Petty garbage traders/contractors haul refuse to ad hoc collection sites that also accumulate into heaps of untreated and uncollected waste throughout the MMA. These accumulated heaps result in clogged drains and serve as a breeding ground for disease vectors such as mosquitoes, flies, and rodents posing major threats to the public health and to the deterioration of the health quality of life in the MMA (DucorWaste, July 2006). Accumulated heaps of untreated and uncollected waste, also affect ground and drinking water which is responsible for the prevalence of major water borne diseases like cholera and typhoid. Untreated municipal solid waste produces offensive odors that pollute the air and generally add to the numerous environmental public health hazards that currently exists in the MMA communities.

Prior to the 14 years of civil war, 85% of the Metropolitan Monrovia industrial and solid waste was collected and effectively disposed of by the municipal city corporation (http://www.humanitarianinfo.org/Liberia/infocentre/donors/index.asp). The system was further improved by the introduction of a private waste collection system to assist the city’s existing program (UN DESK Study 2004). However, the ravages of the war destroyed all facilities and equipment and affected the psyche of the citizenry and their behavior towards community hygienic practices. The lack of a structured waste management system and the need to have waste disposed of in ways that will not adversely affect the environment have been emphasized by both the local public health officials and the international communities and a knowledge generally accepted within the MMA communities (http://www.liberiandaily.com/environment.html). So, the question here to ask is, if there was an effective waste management system prior to the civil war, then why has there been no movement towards implementation of at least a semblance of a prewar system or some working intervention program? One would think with a preexisting waste management plan, it would be very easy to dust it off its shelves and resurrect the plan. Apparently this seems to not be as easy as it sounds. What about the various workshops addressing the waste problem conducted by the international community in collaboration with local public health officials? What about the newspaper and published articles again extensively addressing the problem? Is no one getting the message? What really is the message? The answers to these questions hopefully should give some insight as to some of the fundamental causes of why this dreadful problem of developing an effective waste management program continues to persist in the MMA communities. Why, in the 2 years of postwar activities and the seating of a newly elected government a comprehensive sanitary waste management intervention program is still non existent despite the many futile attempts at addressing the problem.

APPROACHES TO THE SOLID WASTE PROBLEM

The many attempts at tackling the problem of the unsanitary collection and disposal of waste in the MMA have been ineffective, unsuccessful and basically flawed as evidenced by the lack of a structured intervention program or system. Thus, the approaches need to be revised to be more effective so that in the final analysis, this process produces a workable system. The major stakeholders, the local Public Health officials including the municipal authorities, the international community and the MMA communities each bring a unique approach that could help resolve this problem. One critical approach mentioned above has been the reluctance of the local officials to capitalize and improve the prewar waste model system. The model poses a tremendous advantage for the local public health practitioners and municipalities in engaging international counterparts for support for revitalization and improvement of the plan. To date, there has been no available resource recommending this approach. Another method used by the public health officials is the ineffective use of waste management workshops and the media. The message these outlets are trying to convey is unclear. The outcomes of these activities should produce clear public health campaign messages that directly provide information on what the public needs to do to combat the waste problem in their communities. Promotion of mass hygiene campaigns should be the key message of these venues, but such is not the case. Instead, published articles and media houses fill news spaces with worthless workshop information that derive no beneficial outcome. Another stakeholder, the municipal authorities have a unique opportunity here to make the case to the international community and aggressively engage donors for funding, logistical and manpower support for a waste management project. The foresight to engage the international community more effectively and aggressively is completely lacking. The use of an aggressive media advocacy program to combat the tolerance of piles of waste and garbage in the communities can be approached from that perspective emphasizing the utmost importance of a disease free community. However, the current behavior and attitude of the MMA residents towards their environment leave much to be desired. A major problem that the public health and municipal authorities will face is the development of an effective approach towards an appropriate intervention program that directly addresses the behavioral changes and perceptions of the community.

Local Public Health and Municipal Officials

The local municipal authorities in the MMA spend a majority of their time planning and conducting collaborative workshops in conjunction with international partners to address the waste and environmental problems especially in the city. The environmental workshops are inadequately structured and flawed producing no measurable outcome. For example, these workshops do not address who the target and intended audiences are. It is important to emphasize that in order to have a successful outcome, there needs to be a clear identification of who will effectively convey the public health message and to whom this message will be received. Media outlets have to be identified that will effectively convey this and efforts channeled to get the most support to achieve the intended goals.. Most of all, local public health and municipal officials must understand the dynamics of the current political era to succeed with an effective public health message. Take for example the key participants at an environmental workshop last spring in Monrovia where the goal was to address and establish a public awareness campaign on major environmental issues including the sanitary waste problem. The list included all of the governmental units on natural and mineral resources, agriculture, and transportation among others (http://www.liberiaenvironmentalwatch.org). The target audience should be a narrow list of key stake holders who will be able to receive the ultimate message from the workshops and implement the message.

Another example of how the workshops are inadequately structured and flawed is the use of a common result oriented approach called “train the trainer to train” approach (http://www.liberiaenvironmentalwatch.org). These workshops fundamentally assume that there is an existing common community belief system and that the community built on these “assumed’ beliefs are homogeneous. The concept of “trainer to train” works only in community settings where a level of educational, socio-economic status, perception of social norm and a general attitude is consistent across the community spectrum and continues to persist regardless of other external factors. Each community is made up of unique societal and cultural norms and general perceptions of how to tackle specific problems in their communities. The trainer must be able to tap into that concept and use a multi level behavioral model approach to possibly address this.

Because of the complexities of the socioeconomic groups with the communities, the messages must be able to be effectively structures and be appropriately conveyed by the public health officials who conduct these workshops and conferences. Trainers are characteristically from developed countries and tend to not have a complete grasp of the best approach to developing a sustainable training program nor the right tools to guide the trainees after they depart the country.

A major flaw in the approach of the workshops in addressing the sanitary problem is the message that the workshops are trying to convey. Most workshops state goals of addressing some particular public health problem. To tackle a problem such as sanitary waste in the MMA, the public health official and the municipalities must understand that sufficient support from the community must be available. The approach used is based on the assumption that the communities do not understand that having piles of garbage and sewage waste right under their windows is serious. The local public health officials in planning and conducting these workshops do not effectively convey the message of the health risk of exposed garbage and waste and the environmental effects of open air burning. Instead, workshops spend exhaustive days on useless problem identification and recommendations for unrealistic solutions on waste disposal and other environmental issues. The health message addressing the public health concerns get lost in the process and as a result, the workshops do not yield any tangible and significant outcome. The workshops need to change this approach to conveying the message. If the stated goal was to address the sanitary waste public health problem and train the trainer to train in their communities, then the outcome and results should reflect the original goal and message and have a follow up plan to evaluate. The approach should have more emphasis on the effect on health and the link to welfare. The message addressing the problem is weak and need a stronger approach. One stronger approach would be for the trainers to conduct these workshops on sites with varying sanitation conditions. This approach will directly address the problem and stress the enormity of the problem of untreated exposed garbage. Workshops need to change their current approach and concentrate on reevaluating the existing prewar waste management plan and extensively address the fundamentals cause of the community indifference towards their unsanitary environment. At the end of the workshops, typical recommendations advocate for more governmental support. These so-called results/ financial aid request for support are then published in news daily and reported on local radio stations instead of having a conclusive public health statement as to how to tackle this problem. Because the approach to tackling this problem is flawed, the message is flawed and in essence the public health community has failed to appropriately develop any kind of waste management system to alleviate the problem in the MMA. This vicious cycle of continuous workshops with baseless agenda help to make communities disillusioned and demoralized and thus persist with the indifferent attitude and behavior. There needs to be change in the approaches to this problem in order to have an effective assessment and intervention program. In short, the public health officials need to evaluate the messages they are trying to convey to the government and the community leaders need to have a forum to be able to merge with their local public health official in effectively framing and transmitting their messages toward a better disease free environment. Public Health practitioners must endeavor to change their approach to tackling this problem from the community level. They will have to approach the behavioral change from a concept of perceived behavioral control over opportunities, resources, and skills which have been found to be necessary skills that are critical to the process of behavior change (http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html).

Government and the International Community

In recognition of the growing environmental problem and the lack of a national policy for addressing the environmental management needs of the country, the government of Liberia in 1999, through the instrumentation of the UN (United Nations) created the National Environmental Commission of Liberia (NECOLIB), that eventually evolved into a EPA. The NECOLIB was “charged with the executive authority over all program and activities relating to environmental management in the country”. One of the primary policy of this agency was to “ensure the improvement of the physical environment and the quality of life of the people” (http://www.liberiandaily.com/environment.html). The policies were very comprehensive and seem a good step towards the right direction of addressing the general environmental needs, but specifically recognizing the need for a sanitary waste management program as it relates to the general health of the community. The problem with the policy concept is that as representative of the people, the government had not implemented the policies since their inception for the effect to be felt by the communities. “In April 2000 the UNDP signed an Environmental Project document to provide technical and funding support for the evolution of the NECOLIB into the Liberian EPA” (UNEP Liberia Desk Study 2004). This funding would provide support coordination of sustainable environment management. Again like the NECOLIB setup, the objectives seemed very sound and achievable, however, we faced similar issue with no specific timeframe for implementation of these objectives and no reference to the ‘How’ this could be done i.e. an intervention program towards the collection of community waste. The only implementation program to date consistently carried out on a governmental level is a temporary clean up campaign in certain communities that are on the route of foreign nationals dignitaries when visiting the country. This is the wrong message the government and public health officials are sending to the MMA community. These factors form a major cause of the general indifferent attitude of the local community towards the solid waste problem in their environment. This indifference also stemmed from the structure of the prewar systems in which waste collection and disposal was the responsibility of the municipal government which most of the residents are familiar with and this body’s responsibility to provide such basic service to the community. However, given the current government’s postwar agenda of reconstruction, policy makers and the president have in no uncertain terms currently made it clear that due to the capital intensive and costly nature of tackling such a problem, that this is not a top priority for the government. The government has indicated that it is really the municipalities that should bear the responsibility of tackling this problem and has recommended a more aggressive approach by the municipal governments to collaborate with private entities as a means to get the necessary funding to support t this initiative
(http://www.analystliberia.com/i_am_shamed_disgusted_and_concerned_nov23.ht
ml).

It is extremely challenging to teach a community of people an alteration of their current lifestyle (Salazar: Comparison of Four Behavioral Theories). It is even more challenging to deal with a community of people whose level of decision making is completely influenced by their low psychosocial and socioeconomic status. Behavioral change which is needed here by the local public health officials will need to use a combination of approaches which will address small behavior patterns that makeup the overall complex behavior change that they sought.

In order to tackle this primary health issue, steps towards a modified behavioral change must be initiated (http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html). This initiation must be tackled by the public health officials and the approach to the municipalities and MMA communities for support. Thus, the message is clear from the government that the support once provided during the prewar era no longer exists and the tackling of this waste problem will have to be borne at the community level. A major hurdle local public health officials face with the shift in responsibility from government to the community is having to change the mindset that this is no longer someone else’s responsibility, but theirs.

CONCLUSION

The campaign to convey a message that having piles of garbage uncollected and exposed in local communities is a health hazard has to be effective using a combination of educative and re education approaches. The leaders must develop public health campaigns that directly link major infectious and familiar prevalent diseases with the familiar uncollected garbage that emphasize a disease free quality of life for their families. The public health approaches have been addressed as to why the public health community in the MMA has been unable to structure an effective public health campaign to tackle the waste management problem. All key players and stakeholders must commit and provide support to achieving this common but simple goal of having municipal solid waste properly managed by sanitary collection and environmentally safe disposal. The international community must assist in modifying the messages the workshops convey to emphasize more on health intervention programs and recommendations to test these policies in pilot communities. The government has no intentions of making this a fiscal priority therefore, this health problem of the uncollected waste is one for the public health officials and municipalities to tackle by directly appealing simultaneously to the international community who has the funding support. It is possible to do this, but the problem has to be framed in such a way that an effective and successful intervention program is developed that will directly appeal to the low psyche of the MMA residents. Developing health educational workshops and public health campaign without fundamental analysis of what the current health perceptions in the MMA communities, is a recipe for a continuous disastrous public health campaign as what currently exist today.

REFERENCES

1. United Nations Environment Programme (UNEP) Desk Study on the Environment in Liberia 2004 PP 29,70 ISBN 92-807-2403-7
2. Liberia Environmental Watch- on-line Newsletter July 2006 Volume 1, issue 1 pp1-4 http://www.liberiaenvironmentalwatch.org
3. Salazar MK. Comparison of four behavioral theories. AAOHN Journal 1991; 39:128-135
4. The Liberian Daily on-line newspaper- Draft Environmental Policy on Liberia –UNDP http://www.liberiandaily.com/environment.html
5. Jim Grizzell, MBA, MA, - Behavior Change Theories and Models- American College Health Association 9/29/2003 http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html
6. Nyandibo, Monrovia City Corporation, Rogers, MUSH, Hare, Oxfam- Appendix 4:Urban Managed Solid Waste http://www.humanitarianinfo.org/Liberia/infocentre/donors/index.asp
7. Nyepon, F. Ducorwaste Solid Waste Operations:Establishing a Solid Waste Management Operation in Monrovia July 2006 unpublished
8. The Analyst on-line newspaper: “I am Ashamed, Disgusted, Concerned” November 22, 2006
http://www.analystliberia.com/i_am_shamed_disgusted_and_concerned_nov23.html

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