World Health

Organization

Regional Office

for the

Eastern

Mediterranean

503 91FI

Final Reportof AGFUNDand CEHACollaboration

World HealthOrganization

The HashemiteKingdom of Jordan

HRH Prince TalalChairman of AGFUND

HRH Crown Prince Hassan,The Hashemite Kingdom of

Jordan

Dr. Hussein A. GezairyRegional Director

World Health OrganizationEastern Mediterranean Region

"It is quite clear that without this substantial (AGFUND)grant, and the thoughtful hospitality of the HashemiteKingdom of Jordan the much needed work of the (CEHA)Centre would not have been possible"

CEHA Premises, Amman - Jordan

1. Introduction

CEHA is the WHO Regional Centre for Environmental Health Activities, a technical centreestablished in 1985, in Amman, Jordan, by the World Health Organization, EasternMediterranean Regional Office (WHO/EMRO).

The Arab Gulf Programme for the United Nations Development Organizations(AGFUND) had extended a generous grant of US$ 1,000,000 to WHO for establishingCEHA within an agreement concluded in December 1984.

In January 1985, another agreement was reached between the Government of Jordanand WHO for the hosting of CEHA in Amman, and for support to the installation andoperation of the Centre.

With the generous grant from AGFUND and the thoughtful hospitality of theJordanian Government, CEHA began its operations in July 1985 in temporary premisesprovided by the Ministry of Health. In December 1988, CEHA moved to its presentpermanent premises, a three-storey building with an area of 617m2 providing ample spacefor offices, a conference hall, a library and documentation unit, and a laboratory.

Five years have passed since CEHA began its activities. During this period CEHAhas acquired significant capabilities and experience, and has rendered a broad variety ofservices to Member States for the the promotion of environmental health andstrengthening of national programmes and institutions. This report summarizes thoseachievements as a result of the fruitful cooperation and partnership between Jordan,AGFUND and WHO.

,09 AD Thea. .,., ;, oxt

2. Environmental Health Concerns inWHO Eastern Mediterranean Region(EMR)

While the twenty-two member countries (twenty-three before May 1990) of WHO EasternMediterranean Region have much in common, at the same time they are diverse in theirgeographies, their economies, their health status, and the nature of their environmentalhealth problems.

With urban and industrial growth come environmental health problems of water andair pollution, solid waste management and a variety of hazards and ecologicaldeterioration impacting both health and economic resources.

In several countries of the Region, many people do not have access to safe watersupplies and sanitation facilities. Table 1 shows an update of population coverage ofthese services, indicating the persistent poor conditions in rural areas. Because of theseconditions, communicable diseases remain the major cause of morbidity and mortality ina number of countries of the Region.

Table 1Status of Water Supply and Sanitation in the Eastern Mediterranean Region

ITEM

Water Supply coverage

Urban: Pop'n, 106(%)

Rural: Pop'n, 106(%)

Sanitation coverage

Urban: Pop'n, 106(%)

Rural: Pop'n, 106(%)

1980

92.221(84)

53.812(31)

58.187(53)

13.887(8)

1988

137.594(89)

56.336(28)

116.828(76)

19.171(10)

1990(estimate) •

148.937(90)

56.967(27)

131.448(79)

20.493(10)

1990(target)

162.805(98)

139.434(67)

124.596(75)

54.109(26)

Reference: The Work of WHO 1986 - 1989, Biennial Report of the Director - General of the World Health Organization, Geneva, 1990.

4

Figure 1 illustrates the distribution of Infant Mortality Rates (IMP). Extrapolatingfrom the figure, it may be estimated that about 75% of the Region's total population (ofabout 350 million) have an IMR of 50 and higher.

Catastrophies, both natural and man-made, and the resulting refugee problems,have exacerbated the disease situation and have also impeded remedial measures.

For these reasons, and in line with the requirements of the AGFUND Grant, specialemphasis was placed by CEHA on water supply and sanitation programmes. Moreover,environmental health management in emergencies and refugee settlements is emergingas a priority area in the Region, where the refugee population is estimated to exceedeight million.

Depending on the degree of economic development, urbanization andindustrialization, some Member States are encountering environmental health problemsbeyond the water supply and sanitation needs. These problems include environmentaldegradation, depletion of resources, poor housing conditions, environmental pollution,chemical hazards and food safety. In collaboration with EMRO, CEHA has begun toaddress these problems, and is expected to expand its activities in this regard.

Figure 1Infant Mortality Rates in the Eastern Mediterranean Region

Infant motality rate(per 1000 live births)

| | less than 20

[——| 20 to 49

50 to 99

100 to 149

•I 150 and over

| | no data available

WHO/HST Atlas of map-linked data bases Source: WHO global indicators data base

r Reference as given in Table 1.

Control ofEnvironmental

HealthHazards(CEH)

CommunityWater Supply

andSanitation

(CWS)Environmental

HealthIn Rural and Urban

Developmentand Housing

(RUD)

CEHATECHNICAL

AREAS

FoodSafety(FOS)

EnvironmentalHealth

inRefugee Camps

andEmergencies

(RCE)

Health RiskAssessment

ofPotentially

ToxicChemicals

(PCS)

National,Intercountry

and RegionalTraining

Programmes

TechnicalCo-operation

CEHABASIC

FUNCTIONS

InformationExchange

(CEHANET)

Researchand

AppliedStudies

3. Regional Centre for EnvironmentalHealth Activities (CEHA)

The primary mission of CEHA is to provide technical and scientific cooperation to EMRMember States for the solution of environmental health problems. To fulfil this mission,CEHA supports the implementation and strengthening of environmental healthprogrammes; collaborates with countries in human resources development (HRD)including planning, training and management of manpower; promotes and participates inapplied environmental health research, and acts as a Regional information and referencecentre to foster the dissemination of scientific and technical knowledge.

The establishment of CEHA was authorized in a resolution of the Thirtieth Session ofthe Begjonal Committee of WHO in 1983, and became operational in 1985, acting as atechnical arm of the Environmental Health Division of EMRO. It is guided in its work by aTechnical Advisory Committee (TAG) which meets every two years.

CEHA's services to Member States are described by a matrix of activities andtechnical areas as given in Figure 2. Resources for performing CEHA activities are shownin Figures 3 and 4.

Figure 2CEHA Activities and Technical Areas

Trainingas a component ofHuman Resources

DevelopmentHRD

• Communitywater supply

and sanitation• CEHANET

• Food safety• Rural and Urban

Development & Housing

.nformation \ ' S^SfS' I Institution..Exchange refugee camps ^ 0 Strengthening

Figure 3 • CEHA Resources

1. CEHA STAFFING (1990) EMRODirector

Environmental HealthAlexandria, Egypt

Technical Staff

CEHACoordinator

Amman, Jordan

Support Staff

Training & ResearchAdviser

Info. & Tech. TransferAdviser

Information ScientistCEHANET

DocumentalistCEHANET

Secretary

Typist/Clerk

Typist/Clerk

Driver/Messenger

2. PHYSICAL FACILITIESFigure 4Sources of CEHA Funds

Premises

617 m2 for offices, conference hall, library,documentation unit and laboratory.

Equipment

Two photocopiers, five microcomputers,lazer-jet printer, three proprinters, threeRogul Printers one quietwriter.

Software

Ventura , Mu l t imate , CDS/ISIS,Dbase 111+ , Cardbos + , Lotus 123,Samna, Advancelink, George, Foxbase,Harvard graphics, Displaywrite, Crosstalk,etc.

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"o<nc.o

1.91.81.71.61.5-1.4

1.31.21.1

10.90.80.70.60.50.40.30.2Oil

0

£3 AGFUND

LJ Non-Agfund

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1985 1986 -1987 1988 -1989 1990 -1991

4. Focus on Training in Water Supply andSanitation

During the period 1985-1989 the main focus of CEHA's human resources developmentactivities was training in the area of water supply and sanitation, in keeping with thegoals of the International Drinking Water Supply and Sanitation Decade (1981 -1990) andWHO'S target of Health for All by the Year 2000.

An impressive number of national environmental health personnel (see Table 2),spanning a wide range of levels and responsibilities in community water supply andsanitation, participated in both Regional meetings and national courses.

Table 2Number of Participants in CEHA Training Events

Year

1985

1986

1987

1988

1989

Total

No. of Events

ParticipantsRegional Meetings

—

55

—

79

108

242

15

ParticipantsNational Meetings

42

150

113

259

117

536

25

Total

42

205

113

338

225

923

40

The training events covered a wide spectrum of water supply/sanitation-relatedsubjects and dealt with both urban and rural aspects such as: policies and strategies,planning and appraisal of projects, institutional development, low-cost appropriatetechnologies, environmental health in refugee settlements, community participation andhealth education including field surveys and environmental monitoring. Twenty-onecountries benefited from these activities.

WHO staff, supported by consultants and temporary advisers, carried out more thantwo hundred country missions in connection with the organization of the trainingcourses, seminars, workshops and conferences.

10

The development of drinking water quality monitoring and control systems isreceiving high priority in many countries of the Region. A seminar programme at thecountry level was launched on the promotion of drinking water quality standards, in 13Member States. The focus of the seminars was the introduction of the 1984 WHODrinking Water Quality Guidelines for possible adaptation by national authorities. WHOHeadquarters staff participated actively in this programme.

In addition to the thirteen national seminars mentioned above, CEHA furthersupported national training events as shown in Table 3.

Table 3

National training events supported by CEHA

1985 Management Development Workshop

Biennium 1986/1987 1. Training Course on Sanitation and Health Education.

2. National Course on Sanitary Engineering Design and Practice.

3. Refresher Course for Sanitarians.

Biennium 1988/1989 1. Training Course for Sanitarians and Health Inspectors.

2. National Course on O & M of Wastewater Treatment Plants u p e r i n t e n d e n t s .

3. Training Course for Drinking Water Quality LaboratoryT e c h n i c i a n s .

4. National Course on O & M for Wastewater Treatment PlantOperators.

5. Training Course on O & M of Rural Water Supply and SanitationFacilities (2).

6. Training Course on Rural EH Emphasizing Sanitation (2).

Training materials were prepared for the training events. These were and still areuseful, not only for the participants but also for other professionals and technicians.Such materials are kept in the CEHA library and are available on request. In addition,CEHA has collected training and learning materials from other sources, mainly in thefield of water supply and sanitation, for use in future training activities.

11

5. Information Exchange and Networking(CEHANET)

Access to information is a basic prerequisite for the development of the environmentalhealth sector in the Region. CEHA has therefore given high priority to the development ofa comprehensive information unit which acts as the heart of the Environmental HealthRegional Information Network (CEHANET), collecting, processing and disseminatingtechnical information. The Information Exchange Programme of CEHA has been able toachieve the following:

1. Appraisal and technical cooperation missions to eight Member States were mounted to study theirinformation exchange capabilities and assist them to establish their own environmental healthinformation system;

2. CEHANET was established as a formal information system among six EMR countries which signedthe Memorandum of Understanding.

3. The International Reference Centre for Community Water Supply Interwater Thesaurus was arabizedfor use as a bilingual basic information storage and retrieval tool;

4. A CEHANET Procedures Manual (English/Arabic) was developed to facilitate information exchange/networking on a Regional scale.

5. Other manuals were prepared for the selection of materials and library collection development;

6. A number of bibliographic databases were developed including a Regional Bibliography and a list ofenvironmental health journals;

7. A number of non-bibliographic databases were developed including Regional environmental healthinstitutions and professionals directories, a CEHA mailing list and a database of CEHA consultants;

8. As part of developing the information exchange capabilities of national institutions, CEHA held itsfirst Regional workshop on CEHANET procedures.

9. CEHA has been able to establish on-line links with other national and international informationsystems, for example in Jordan, Egypt and WHO/Headquarters (Geneva);

10. CEHANET services of various kinds, have been able to reach all Member States of the Region.Reference services in response to enquiries from professionals of the Region undertake literaturesearches and provide answers to specific technical questions and referrals.

11. Current awareness services which CEHANET provides to professionals in anticipation of theirinformation needs and to keep them up to date include the following:

12

(a) four issues of the CEHA newsletter have been published and distributed to over1000 professionals;

(b) bimonthly current contents of CEHA journals are distributed regularly to about 700professionals and institutions in EMR;

(c) document delivery services: as a back-up service to «CEHA contents», photo-copies of articles requested by professionals have been supplied. CEHANET hasbeen overwhelmed by demand for photocopies; thus the number of articles hashad to be limited to four. Details of information exchange services are shown inTable 4.

Table 4Summary of Information Exchange Services Supplied to Member Statesduring 1985/1989

Country

Afghanistan, Rep. ofBahrainCyprusDemocratic YemenDjibouti

EgyptIran, Islamic Rep. ofIraqJordanKuwaitLebanonLibyan Arab JamahiriyaMoroccoOmanPakistanQatarSaudi ArabiaSomaliaSudanSyrian Arab RepublicTunisia

United Arab EmiratesYemen

Total

AddressesAvailable

on MailingList

33

39

40

39

12

89

114

155

192

86

29

35

38

71

224

36

109

42

151

125

42

14

41

1756

Copies ofCEHA

Contents

1120

4

21

9

45

36

71

68

20

14

10

30

27

81

16

19

47

9

60

37

6

20

681

Copies ofCEHA

Newsletter

14

28

13

28

6

53

79

119

151

70

23

13

36

59

187

25

78

16

78

89

28

10

31

1234

Distribution ofArticles

No. of, Users

3

14

5

8

17

19

92

93

9

4

25

14

38

3

16

1

16

40

8

5

3

433

No. of

Articles

18

44

10

33

70

60

187

250

36

16

91

36

128

4

43

2

65

97

20

16

6

1232

Distribution of

Document

No. ofDocuments

25

35

26

31

2

42

15

74

400

58

20

4

8

50

201

9

11

7

51

76

45

5

4

1199

No. of

Users

5

10

7

9

2

23

12

20

45

16

6

5

8

14

28

7

6

4

1819

15

2

6

287

Distribution is bimonthly

13

6. Strengthening of National Programmesand Institutions

To give visibility to environmental health and enhance the capability of national healthauthorities are difficult tasks in many countries of the Region. The problem is twofold.Within health ministries, the environmental health departments frequently haveinsufficient trained staff, low budgets and little influence on policy. Moreover, the healthministry itself may be isolated from the resources management agencies. As a result, theenvironmental health implications, as well as the adverse environmental impacts ofproposed development projects, may be neglected.

All CEHA activities, including training and information exchange, are designed tolead to the improvement of the performance of the agencies concerned. In addition to«general support" services, CEHA mounts technical cooperation missions in order to giveadvice to national institutions in solving specific problems. These consulting missionsare frequently followed up by material assistance or further investigations with a view toimplementing consultants' recommendations. Another approach in providing directsupport to institutions is to sponsor applied research projects which seek answers totechnical, managerial, or socio-economic issues facing environmental healthdepartments.

Table 5 Regional meetings which were examples of "general support» to institution-strengthening:

Table 5Meetings providing general support to institution-strengthening

Biennium 1986/1987 Biennium 1988/1989

1. Regional Seminar on Preventive Maintenance of PipedWater Supply Systems

2. Regional Short Course on Planning and Appraisal ofWater Supply and Sanitation

3. Regional Workshop on Management of HazardousWastes

4. Inter-Country Workshop on Low Cost Water Supply andSanitation Options

5. Regional Seminar on Water Resources and WaterQuality Management.

6. Regional Seminar on Urban Water SystemsManagement.

7. Regional Conference on Development, the Environmentand Health.

8. Consultation Meeting on Regional Strategy for FoodSafety.

9. First Regional Workshop on CEHANET Procedures.

10. Regional Seminar on Reuse of Treated Effluents.

11. Regional Workshop on Development of Chemical SafetyProgramme.

12. Regional Consultation Meeting on Control and Disposalof Hazardous Wastes.

13. Regional Workshop on Environmental HealthManagement in Emergencies.

14. First Consultative Group Meeting on CEHANET.

14

Direct technical cooperation provided by CEHA for strengthening institutions andprorammes included the following:

1. Advisory services provided to the Paramedical Schools in Amman and Irbid, Jordan,to review training programmes for sanitarians and to evaluate the needs for trainingmaterials and laboratory equipment.

2. Cooperation provided to the Inter-Agency Committee, Jordan, for review of nationalwater quality standards.

3. Advisory services provided to the School of Hygiene and Environmental Sciences,Khartoum University, Sudan, for the strengthening of its environmental healthprogrammes.

4. Advisory services provided to the Royal Scientific Society, Jordan, the WaterAuthority of Jordan, on procedures for monitoring removal of nematode eggs fromwastewater.

5. Cooperation provided to assess the performance of the Al Samra WastewaterTreatment Plant, near Amman, Jordan.

6. A grant to the Royal Scientific Society, Jordan, for a special study on «Use and After-Effects of lnsecticides».

7. Advisory services provided to the University of Jordan for the strengthening andequipping of the Environmental Engineering Laboratory in the School ofEngineering.

8. Assistance provided to the Water Authority of Jordan for review of its monitoringprogramme on Water and Wastewater Quality.

15

7. Collaboration with other TechnicalOrganizations

Special attention has been given by WHO/EMRO and by CEHA to the forging of links withexternal support agencies and organizations with related concerns.

From the beginning it was clear that resources provided by WHO would have to becomplemented by extrabudgetary funds and that the growth of CEHA would have to rely,partly, on funds obtained through cooperative agreements with other UN bodies, bilateralagencies, development banks and funds and non-governmental organizations.

The generous support provided by AGFUND was instrumental in the developmentand consolidation of CEHA; it was the cornerstone for the founding of the Centre.

The successful negotiations with the Canadian International Development ResearchCentre (IDRC) made possible the implementation of the Environmental Health RegionalInformation Network (CEHANET).

CEHA has developed a working relationship with the Economic DevelopmentInstitute (EDI) of the World Bank and jointly sponsored a Regional Seminar on WaterResources and Water Quality Management in 1986 and a Second Regional Seminar onUrban Water Systems Management in 1988. More joint seminars are planned in theBiennium 1990/1991.

Through a cooperative agreement with the United Nations Environment Programme(UNEP), CEHA is carrying out a project with the United Nations Relief and Works Agency(UNRWA) for Palestinian Refugees in the Middle East, for the training of UNRWA'senvironmental health staff, and the development of a field manual on water supply andsanitation. The project began in February 1989 and will continue for two years.

16

8. Future directions

During its initial five years of service, CEHA has passed successfully through theestablishment phase of its development. It now exists as a viable institution, withdemonstrated capabilities and promising potentials. Its accomplishments provide abroad and firm foundation on which to build an institution of technical and scientificexcellence highly responsive to the needs of the countries of the Region.

Based on five years of experience in serving Member States, and with the guidanceof its Technical Advisory Committee (TAG), CEHA was able to improve its planningprocess. The result was the preparation of the workplan for the Biennium 1990/1991. Inorder to be responsive to the common as well as the specific needs of Member States, thefollowing directions and concepts are being considered:

1. Continued focus on water supply and sanitation, with emphasis on the needs of therural sector.

2. In cooperation with EMRO, promotion of activities on environmental healthmanagement in emergencies and refugee settlements.

3. Expansion of technical areas to include health impact assessment, prevention ofenvironmental pollution, emergency planning and food safety in cooperation withWHO/Headquarters and EMRO, as well as other concerned organizations.

4. Extension of CEHA's approach in human resources development (HRD) from trainingactivities to the full spectrum of HRD components of manpower planning, trainingand personnel management.

5. Fostering links with institutions and professionals in the Region to act as informalfocal points in HRD and other technical areas.

6. Expansion of CEHANET's geographical scope to cover all Member States.7. Seeking partnerships with more international organizations and concerned

agencies.8. Identification of relevant applied research areas in collaboration with Member States

and assisting institutions in securing support from interested international andbilateral agencies. Such applied research will, in part, guide technology transfer orthe development of appropriate systems for environmental health protection.

17

Top: Inauguration of CEHA premisesin Amman, Jordan, 10 December 1988Inset: Unveiling of the Inauguration plaqueBottom, left: CEHANET Regional ComputerData BasesBottom, right: CEHA Documentation Unit Library

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Top: Regional Conference on Development,The Environment and Health,Amman, 10-14 December 1988Bottom and Inset: Water and SanitationLaboratory which CEHA supported at theUniversity of Jordan's Faculty of Engineering

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