Situational Analysis and Needs Assessment (SANA)
- Download the executive summary [PDF]
- Download the full report [PDF] (individual sections available are below as separate downloads)
The draft of this initial SANA was compiled in June 2013 and addresses the GEOHealth three key areas of research as well as related policy and organizational frameworks. The report was developed based on a literature review including peer-reviewed journals, government reports and unpublished research, as well as stakeholder interviews from key regulatory and governmental authorities.
The final report will be available to download on this page in the near future.
- Air Pollution & Health
- Occupational Safety & Health
- Climate Change & Health
- Policy, Regulatory & Organizational Framework
Air Pollution & Health
This theme distinguished between two types of air pollution: ambient or outdoor air pollution which is caused mainly by industries and vehicles; and indoor air pollution contributed by biomass fuel used in households. The relative contribution of indoor air pollution seemed to be bigger compared to that of ambient outdoor air pollution, although the latter is on the rise, reflecting the growing intensity of industrialization and urbanization. Biomass fuels emit harmful gases, vapors and smoke that are known to affect the respiratory organs and cause acute and chronic respiratory diseases including cancer.
The levels and health effects of both indoor and outdoor air pollution have not been comprehensively studied in Ethiopia.
Results are available from a few small studies that used NO2, CO, particulate matter to evaluate levels of indoor air pollution in households and refugee camps. These studies are geographically limited to Addis Ababa, Tigray, Oromia, and Southern regions. These limited studies have found that the levels of indoor air pollution exceeded limits that have been recommended by regulatory agencies such as the US EPA and by the WHO guidelines. However, such limited studies do not appear to have either adequate spatial coverage or enough temporal resolution to fully characterize the actual burden of air pollution on human health and its potential impact on the eco system in the country.
The monitoring and management of air pollution were found to be critical areas of concern in this assessment. There exists a conducive policy structure for management and control of air pollution as mandated to the Ethiopian Environmental Protection Authority (EPA). EPA has proclamations and regulations dealing with the management of air pollution. However, the capacity to evaluate and monitor the levels of urban air pollution has not resulted as yet in tangible accomplishments. Limited resources as well as limits in technical and training capacity appear to be major bottlenecks to the progress of air pollution management.
The problem of air pollution due to vehicular movement is likely to be a major concern, especially in major urban centers such as Addis Ababa. Although the level of traffic air pollution is not extensively evaluated, the growing on-road vehicular density and the limited road infrastructure are likely indicators of potential health hazards.
In general, there is currently inadequate information on levels of air pollution in Ethiopia. Improving the national capacity to conduct effective monitoring and evaluation of indoor and outdoor air pollution and to assess the health effects of air pollution, through well planned and targeted research and training in these domains would be timely and is highly recommended.
Occupational Safety & Health
This theme focused on exploring the level of industrialization in Ethiopia its impact on the health and safety of the workforce, in addition to health effects of agricultural exposure. Ethiopia is a primarily agrarian country and only about 5% of the total employed workforce is engaged in manufacturing, construction, and mining sectors. Males predominate as workers in all sectors. The occupational hazards in the work place depend on the nature of the industry and the production process. Generally, major safety issues include accidents that result in injuries; and a wide variety of health hazards with major concern on chemicals and physical agents. Workplace hazards are closely linked with the growth of industries and increasing urbanization that have led to a rapid expansion of the construction industry.
The organization and availability of health services in work places widely varies depending on the scale of the enterprises. Standalone health facilities and contract-based public health services were the two modes of provision. In most of the cases, the provisions of health services did not appear to have a strong link with the monitoring and prevention of hazards.
The current labor proclamation is the basis for all current activities and practices on the delivery of OSH services. There exists an operational guideline (OSH directive) that outlines detailed procedures, and provides standards or cut offs for hazard prevention. There is a concern that the existing regulatory documents do not address emerging issues related to new and booming industries due to the recent economic development such as those in the construction industry and floriculture. It is worth noting, however, that a national OSH policy envisaging new economic developments has been submitted to the Council of Ministers for consideration and approval.
The theoretical concept of hazard management through its avoidance, reduction or isolation may be currently ineffective in the Ethiopian setting due to various factors such as the widespread use of obsolete machines, poor accountability by employers, poor knowledge of and awareness by workers of work place risks, and limited training on safety issues. Risk management at the person level through the provision of personal protective devices is a common practice, but of little efficacy. Hazard signs are not properly identified by employees because of limited training.
There is severe shortage of properly trained OSH inspectors in Ethiopia. Close to 95 % of all available OSH inspectors are found in four regions (Addis Ababa Tigray, oromia, Amhara). Many of the OSH inspectors lack basic professional training. The Addis Ababa Bureau of Occupational safety and Health is a pioneer, by Ethiopian standards, in the organization and use of OSH instrumentation for the monitoring of known occupational hazards. However, even this Bureau is in dire need of assistance and further development in terms of basic professional training on the handling of existing monitoring instruments and enhancing the quality of monitoring instrumentation.
There are only a handful studies for Ethiopia that assessed the type and magnitude of relevant health outcomes and respective occupational risk factors. Exposure measurements in the work place were only available in some studies and these focused on cotton dust, noise, and cement dust. Work place exposure was characterized subjectively in many studies through the use of operational definitions of the research questions. The few available studies appear to be neither comprehensive nor nationally representative.
The current organization of hazard surveillance and monitoring of accident/ injury does not appear to be based on a systematic process. Shortage of monitoring instruments and poor quality of existing monitoring instrument is a major constraint. Lack of basic training on the operation of instruments is a big challenge in M & E activities. Capacity building efforts in areas of research, training, policy development, regulation, and organizational aspects are much needed.
Climate Change & Health
Climate change currently represents one of the greatest development and health challenges in Ethiopia. The current stage of research on climate change and health is rudimentary; research findings and other activities tend to appear largely fragmented and uncoordinated. As a result, there are only few spatially detailed, methodologically consistent climate impact studies available for the country.
Ethiopia has been identified as one of the most vulnerable countries in the world impacted by the adverse effects of climate change. Climate change is of critical importance to Ethiopia. Human-induced climate change is expected to bring further warming over the next century at unprecedented rates. Climate models suggest that Ethiopia will see further warming in all seasons between 0.7°C and 2.3°C by the 2020s and between 1.4°C and 2.9°C by the 2050s.
Some impacts of climate change occur as a result of anomalies in temperature and rainfall that have been demonstrated through the analysis of climate data for 1961-1990. In Ethiopia, there have been repeated droughts, floods, agricultural failings with malnutrition, extreme temperature events (extreme heat and cold), and re-emergence of climate-sensitive diseases. Increased environmental survival of pathogens and creation of new ecological niches for vectors to propagate diseases are also observed. The major health effects include under-nutrition due to variability in agricultural production and food security; increasing incidence of climate sensitive diseases such as malaria, meningitis, and diarrhea; and other adverse health impacts due to scarcity of water and natural disasters such as floods and droughts. Malaria in the highlands is likely to occur in the very near future. Soil transmitted helminthic infections like hookworm may increase because of warming. Diarrhea is expected to be a frequent health risk due to the rainfall and flooding that contaminates drinking water. Zoonotic infections will be emerging because of the changes in parasite or pathogens to host relationship favored by climate change. Malnutrition not only among under-five children, but even among adult population will be a significant concern because of food shortage posed by anomalies of climate change. While the impact of climate change on health and other related issues is recognized by various governmental stakeholders, the specific actions and responses have had very little oversight to date.
This assessment identified the existence of insufficient collaboration between different organizations on the planning and execution of climate change and health activities, lack of trained professionals that can independently perform climate change and health-related research and activities at various levels. The SANA also revealed lack of a well-organized structure in the different organizations and poor inter-sectoral collaboration, poor coordination and communication among different stakeholders, lack of policies and programs who independently target climate change and health, inability of the existing policies to consider the gender and community dimensions of climate change, and weak monitoring and evaluation efforts on climate change and health activities at various organizations.
Policy, Regulatory & Organizational Framework
This theme addressed the foundation of policy and organizational contexts that play a role in the management and control of health impacts of air pollution exposure, occupational safety, and climate change.
Results of the SANA showed that there are a number of major constraints in addressing the public health challenges arising from air pollution exposure, occupational safety, and climate change.
While there are many policies and regulatory provisions already in existence, in the majority of cases there is a lack of persistence in implementing the policies/strategies and enforcing the regulatory provisions.
The results of the situational analysis indicated that there are cross-cutting gaps in the different sectors. Among these, shortage of skilled personnel is an urgent priority. Most of the stakeholders appear to be suffering from acute shortage of professionals and poor retention mechanisms.
Research activities in the health impacts of air pollution exposure, occupational safety and climate change currently appear to be at the most minimal level.
Consequently, evidence based decision making and monitoring and evaluation is hampered.
The findings from the SANA on all of the three themes discussed above are characterized by the complexity of the challenges and by their multi-sectoral nature. However, mechanisms for coordination and integration are mostly on paper and not practically functional in reality. Lack of such mechanisms reduces the engagement of the different stakeholders mandated by the government.
The linkage between universities and concerned ministries indicates a mismatch between what the training institutions are producing and the specific skills required by the ministries. It is also shown that the level of awareness of the challenges posed by environmental, occupational and climate change related issues is currently very low. Furthermore, the outcomes of the minimal monitoring and evaluation activities in progress are compounded by poor documentation. The need for training and research capacity building, development of clear implementation guidelines, and building effective inter-ministerial coordination mechanisms should be highlighted as some of the most important findings from this assessment. The development of a full GeoHealth Hub would be of great benefit to Ethiopia.