RESEARCH

National Policy, Standards, Legislation & Enforcement

WORKSHOP ON THE ROLE OF MINISTRIES OF HEALTH AND ENVIRONMENT: NATIONAL AND STATE

Dr. Henry Falk, Mr. William Nitze, Dr. S. Cummings, Dr. V. Jagadeesan, Dr. R.K. Chandoke, Dr. M.Z. Hasan, Dr. B. Sengupta, Dr. Yasmin von Schirnding

This workshop was aimed at addressing major issues involved in developing and implementing a national plan for the elimination of childhood lead poisoning in India.

The participants recognized that developing a plan for the elimination of childhood lead poisoning requires the participation of different government agencies and other stakeholders, as well as strong coordination of activities between the federal government and the state and local levels.

Participants also acknowledged the necessity to compile existing information on the use of lead in India, particularly industrial usage at macro and micro levels (cottage industries), as well as data on known sources of lead exposure and results of blood lead survey. A document containing such information would provide the basis for a risk assessment of lead in India and help to define gaps for further data gathering. Participants also felt that the cost effectiveness of strategic choices made by other developing countries to address childhood lead poisoning is valuable information and should be considered and evaluated.

From the discussion, the following elements were identified as major issues to be considered in developing the plan:

1. The Identification of all Stakeholders

Ministries, government agencies at the federal, state and local levels, and other stakeholders that would be involved in developing and implementing the plan need to be identified. The definition of their roles, areas of involvement and responsibility, and tasks need to be clearly established in the early phase of the plan’s development.

2. The Important Parts of the Plan
  • Capacity building and human resource development for health and environmental/occupational assessment, health service delivery, and local program capacity. This includes strengthening existing federal, state and local agencies in a mutually supporting approach.
  • Development and/or strengthening of laboratory facilities, including quality control and quality assurance programs
  • Assessment of the extent of the lead problem in India
  • Promotion of public awareness and health education
  • Regulation and law enforcement
  • Control of lead sources
  • Evaluation of the control program

3. The Importance of Agency Coordination

There was a consensus on the need for an interagency advisory committee, which will coordinate the activities of the plan and periodically evaluate its performance. This solution appeared more viable than having only one government agency dealing with the entire lead problem in addition to its other priorities. Also, given that different ministries and agencies have to be involved, it seemed that an interagency committee would be better able to develop the overall policy to guide the activities of each participating agency, define the needs for implementing and managing the plan, and evaluate periodically the impact of control strategies. However, one government agency will have to assume a leadership role within the committee.

4. Standards and Regulation

Participants emphasized the need to revise or establish environmental and occupational standards and regulations. This implies that some of the sources of lead are already known (e.g. lead in gasoline) and that environmental monitoring provides the information needed to regulate specific media. Once some lead sources have been identified and regulated, there is a need to enforce and control compliance with the standards through periodic environmental monitoring, incentives, and fines.
  1. Public Awareness and Health Education

Community involvement is a key to the success of the plan. Participants emphasized that the public’s awareness about lead issues needs to be raised on an ongoing basis. One participant suggested planning a national campaign in year 2000. This campaign would inform the public about lead issues and provide basic measures to decrease people’s risk for exposure. Educational materials should be developed for the general public and for school curricula.

Participants also acknowledged that health professionals (physicians, nurses, and other health workers) needed further education on environmental issues, in particular lead, in order to diagnose, treat, and provide adequate advice to the public.

Educational materials also need to be aimed at policy makers so that they will understand the need to allocate resources and support control measures aimed at reducing the public’s exposure to lead.

6. Linkage to Other National and International Activities in the Health Sector

Many health activities and plans are already taking place in India, particularly in the area of nutrition. It would be very important and cost effective to use the health infrastructure already in place for the implementation of the lead plan and to develop an intersectorial approach. This approach would include activities such as building capacity and strengthening institutions, conducting biological and environmental surveys, and promoting public awareness and health education.

7. Formulation of a Plan with Specific Activities, Responsible Agencies, and Time-line

All participants in the plan should know what their responsibilities are. It is important to define objective tasks and responsible agencies within a time line. This needs to be done for short-term, as well as long-term activities to allow for a better follow-up plan, readjustment, and evaluation. Feedback is also important in order to encourage the process. Participants emphasized that the plan needs to have clear objectives and tasks, focus on the major aspect of childhood lead poisoning, and have an appealing packaging.

8. Budget

The consideration of cost is important if a realistic plan is to be developed. Many activities can be conducted to address the lead problem in India; however, it is necessary to have some information on the major contributing sources to lead poisoning and the relative effectiveness and cost of control measures in order to focus on the most cost-effective measures. It is also important to consider the potential sources of funding and which element of the plan is most likely to be funded.

Although many of the major issues were raised during the discussion, it is clear that further discussion and planning is needed. In a general framework, the following are the most relevant questions to ask when developing an integrated plan: (1) What is there to do? (2) Who is to do it? (3) How will it be done? (4) What are the resources? (5) What incentive should be used? (6) Who are the beneficiaries? (7) What are the needs for decision making and evaluating strategic choices?