Sunday Times 2
LG elections and making a healthier Colombo
With the Local Government election round the corner it gives the citizens an opportunity to elect members who would stop the fast deteriorating environmental health and sanitary situation in the city. During the former regime Colombo became somewhat clean and beautiful overnight after years of seeing piles of garbage even in the central areas of the city. The triangular area between Fort, Bambalapitiya and Colombo 7 underwent a massive re-construction and beautification phase that people also became reactive to that process in a positive manner and in turn became health conscious and became part and parcel of that same process. The residents in that area also kept their houses and gardens clean, did not dump garbage on the streets, enjoyed the fresh air and started walking, running to improve their personal health. Amazingly this was an area known for dengue fever attacks and as I recall with development work not a single dengue fever patient was found within that triangle for about a year. Most of that was due to the cleaning process that was installed and the new drainage lines that were placed. The illegal slums in this area were removed with a promise of giving the residents space in high rise buildings. How far that has moved is not known as the government changed and I didn’t hear about this anymore. In came the Megapolis project and I hope it will be given enough funds for the improvements of the infrastructure.
The area around the Arcade shopping mall at Independence Square given a facelift.
Today the city has many issues that have to be solved. These are housing, land tenure, water supply and drainage, solid waste management, pollution, education, transport, health care service delivery, space for recreation and sports etc.
In the past, many attempts have been made to implement community development programmes in some locations by the Colombo Municipal Council by using its own funds or through projects funded by the UNICEF, UNCHS, UNDP, GTZ, British ODA etc. Except for the first, these were small scale or pilot projects which didn’t create much of an impact. The UNICEF’s project on providing basic water and sanitary facilities coupled with health education improved the lives of the people in under-served areas ie. in slum and shanty areas. Although many government agencies are involved in providing services to the inhabitants, the Colombo Municipal Council (CMC) provides the following basic services: water supply and drainage, solid waste management, road maintenance, traffic control, urban planning, library service, curative and preventive medical services, maternal and child care, health education and community development, disease control, food safety, sports and recreational facilities and maintenance of parks, cemeteries and open spaces etc.
Most of the attempts have been to implement development projects “globally”, on a large scale which made them fail due to lack of resources and funds and others were merely demonstration projects which failed to replicate in other areas of the city. Hence, the Healthy Cities Programme concepts are vital to approach city development with a fresh angle at this juncture as here the approach is development for sustainability through the creation of healthy settings with the support of the residents to improve the living conditions of the people.
After the LG elections a Healthy Colombo Project should be started based on the following characteristics: A strong political commitment for creation of healthy settings; involvement of grass-root politicians, inter-sectoral collaboration; coordinated efforts by CMC officials with other stakeholders and residents in solving issues and creation of healthy settings; urban development with integration of a municipal Environment Health Improvement Plan (EHIP) in it and recognition of health impacts due to urban development and opportunities of health improvements; innovative action to promote health in different settings and effective healthy public policies that create healthy settings.
The aim of the programme will be to create healthy living conditions in the city of Colombo with the municipal authorities playing a leading role supported by other agencies in the process to achieve that status. The programme should receive political commitment by the highest in the country which will facilitate inter-sectoral collaboration, community participation and support from all stakeholders.
The objectives of such a programme should be:
1. To create awareness of health and environment issues among the citizens at large, relevant officials of the CMC, ministries, corporations, Non-Governmental Organisations (NGOs), private sector organisations, Community Based Organisations (CBOs), etc.
2. To collaborate efforts of all like-minded individuals and organisations and in a mutually beneficial and supportive manner to achieve better living conditions in the city.
3. To develop a Colombo Health and Environment Improvement Plan (HEIP) with the participation of all stakeholders including the community at large and institutionalise the plan in the Colombo Municipal Council for implementation.
4. To improve the living conditions of the people by creation of healthy settings in which all aspects such as physical, social, economical environment and improvement of the mental status of the people are considered.
5. To increase the capacity of officials, politicians in addressing the solutions to health and environment issues.
6. To create managerial mechanisms that will be increasingly sensitive to the needs of the community and the implementation of the project objectives.
Once the elections are over the Colombo Municipal Council will have around 110 members. Their strengths, commitment and community links should be harnessed. Once the Standing Committees of Health and Sanitation, Works, Solid Waste Management etc are formed they should take a leading role in making Colombo a healthier place to live and work. Accent should be on developing the underprivileged areas. The idea of the programme should be sold to the members to get the support of the politicians in higher bodies. Through it, support will be sought creating a network of supportive politicians. Relevant CMC officials will be also approached to sensitise and also seek support for the project. The support and advice of leading citizens who have been involved in advisory capacities with the CMC will be also sought in the initial phase.
It will be important to sell the idea that this is a new approach and a workable one. Healthy settings such as markets, schools are workable and the examples of the already successful projects are to be brought to the notice of the public at large.
CMC and other stakeholders will work on an effective public health policy and action plans which will be circulated to members of the Healthy Colombo Steering Committee for their observations. The CMC Health and Environment Improvement plan will be formulated. The steering committee will be used to get support for the project from outside agencies by expressing political support for this effort and also to negotiate with them in getting funds for planning and implementation and divide tasks between agencies. A draft of the CMC Health and Environment Improvement plan will be published and it will be also available as a web page of the council inviting ideas.
This plan will cover major areas: 1) Preventive and Curative Health Services 2) Environmental Health and Health Engineering 3) Housing development 4) Park and recreational area development 5) Road Development, 6) Poverty Reduction and Care 7) Mental and Spiritual Health 
Industrial and Commercial Health. 9) Safe and quick movement of passengers 10) Improved air quality etc. Key issues, main activities, indicators, targeted durations, responsible departments and responsible persons for each activity will be identified.
The programme will finalise the action plans after conducting several meetings. These action plans along with the public health policy will then be the core of the CMC Health and Environment Improvement plan, which will be decided by the steering committee and finally approved by the council. The plan can draw best practices from other healthy cities initiatives around the world.
An organisational phase will be needed to create awareness about the need to have healthy settings in different areas of work or activity in order to create healthy living in Colombo. The steering committee by taking the ownership of the project can also help in getting necessary approval from the municipal council for project implementation. It will also create a task force.
An initial meeting of the Healthy City Task Force should be held to discuss the concepts, characteristics, scope and brief on situational analysis of the environment in Colombo. A brief summary of the proceedings will be sent to the steering committee. Thereafter an advocacy meeting should be held to get the support of the group, community, university, UDA, NHDA, Megapolis, other relevant ministries, public and private sectors, NGOOs, CBOs etc. by inviting key officials and/or representatives. The task force will appoint sub-committees to look into issues with regard to urban services in general or services at a setting. They will gather information, identify solutions, possible partnerships in solving the problems, decide on indicators to monitor progress of work and prepare reports which will be eventually submitted to the steering committee through the HC Task Force for approval and further action.
In order to facilitate the work of the above committees the programme office will work out the responsibilities giving out the terms of reference for each sub-committee, the frequency of meetings (which is expected to be once a fortnight for the main committees at the beginning to keep the momentum), and procedures adopted to get approval for various sub-projects which will be carried out by various NGOs, CBOs and groups outside the council. All these committees will come out with one joint final plan.
This CMC Health and Environment Improvement Plan (HEIP) is to be printed and distributed widely. Extensive media coverage should be sought in printed and electronic media to create an interest among the public, donor agencies, private sector organisations so that they could be approached for outside funding for some elements in the plan.
A baseline assessment will be done before the implementation of the HEIP and present data on indicators will be recorded to find out the impact the project might have on the health of the people in the future.
Proposed healthy setting areas
- n Healthy Homes
- Healthy Settlements (for under-served areas)
- Healthy neighbourhoods (for housing estates)
- Healthy schools
- Healthy markets
- Healthy parks
- Healthy sports and recreational centres
- Healthy and safe roads
- Healthy libraries
- Healthy work places
- Healthy hospitals, clinics, maternity homes
- Healthy and safe transport services
- Healthy canals and canal banks
- Healthy beach fronts
It may not be possible to carry out all these projects at once but those interested in working in these areas will be encouraged to do so.
Expected outputs
The general output that is expected from project is improved health and environment conditions at settings that will eventually create a healthy Colombo city. Such outputs may be improved sanitation, street drainage, solid waste management, good air quality, upgraded housing with adequate space, safe drinking water, healthy working conditions, increased recreational facilities, better transport – a standee-bus service within the city for quick access, less air pollution, improved physical, mental and social health, better health facilities, creation of awareness of issues and solutions among the public, community participation in finding solutions, increased capacity among all stake-holders and better information sharing among stakeholders through networking for maximum efficiency.
Implementation phase: A steering committee should directly involve itself with monitoring the activities. Monthly meetings should be held to monitor activities and annual monitoring and evaluations must be carried out. Strong links with the community should be maintained and as much as ‘community contracts’ should be given out create a feeling of ownership and bonding. Such work had been already carried out by the community under the guidance of the CMC officials before and we can build on that experience. During the implementation period one important factor that should thought of is improving the social and mental health status in the city. Creating healthy settings itself will improve mental health, peace and stability of the city and bring in a sense of team spirit and camaraderie among the stakeholders and residents at large.
(The writer is a former Chief Medical Officer of Health.)