PESTICIDES HEALTH POLICY AND PRACTICE: A Review of the Role of Environmental Health Officers in Sout

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PESTICIDES HEALTH POLICY AND PRACTICE A Review
of the Role of Environmental Health Officers in
South Africa

• Hanna-Andrea Rother, Tracey Prinsloo Leslie
  London
• Occupational Environmental Health Research Unit
• University of Cape Town, South Africa

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THE POLICY - PRACTICE GAP

• Health and safety is recognised in the legal
  framework for pesticides in South Africa -
  registration, applications, pollution, etc.
• Yet, these mechanisms fall short in practice
• Example Environmental Health Officers (EHOs) in
  South Africa
• Analysis aims to offer recommendations for
  putting policy into practice

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SITUATION ANALYSIS

• Extensive pesticide use in South Africa
• - agriculture public health pest control
  
• operators domestic plague control
• Lack of reliable data on quantities
• Pesticides poisonings under reported

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Pesticide Poisoning Notifications in South Africa
gtAbout 100 to 150 cases per year
gtUnder-reporting 5 to 20 hospitalised cases
reported gtBrunt of poisoning falls on most
marginalised
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EHO Legislated Responsibilities

• Under Health Act medical notifiable condition
  ? notification form
• Triggers investigation
• ? Complete toxicological form
• ? Follow-up poisoning cases
• Provide safety instructions for future poisoning
  prevention

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ASSUMPTION

• Because pesticide poisoning is a notifiable
  medical condition under Health Act (63 of 1977)
• Health inspectors (EHOs) actually do follow-up
  of poisoning cases
• EHOs educate farmer farm worker for prevention
• EHO at grass roots level - aware of circumstances
  - best equipped for role

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PROJECT AIM

• Study aim was to
• evaluate the role of the EHO in promoting
  pesticide safety in the Western Cape of South
  Africa and
• evaluate strategies for strengthening their
  contribution to the public health control of
  pesticide poisoning.

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METHODS

• Qualitative Methods
• --gt Focus groups run with
• - EHOs
• - Farmers
• - Farm workers
• - Doctors
• --gt Individual interviews
• Quantitative Methods
• --gt record review of all poisoning cases
• --gt farm audits

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RESEARCH SITES
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Pesticide poisoning - Blaming the victim

• Local studies, based on these records, show that
  ignorance is the main cause of pesticide
  poisoning in South Africa. This is followed by
  suicide, accidents and lastly negligence. It is
  clear that very few people are aware of the
  toxicity of pesticides. ...The urgent need for
  very specific training and education is reflected
  in the 'ignorance factor' taking on such a
  dominant role.
• Source Department of National Health and
  Population Development, 1992, authors emphasis

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DIFFERENCES IN CONCEPTION OF OCCURANCE OF
PESTICIDE POISONING

• The study findings showed some very important
  differences in the way pesticide poisoning was
  conceived by different parties affecting the way
  in which cases where reported, addressed and
  followed-up.
• Conception of cause of poisoning plays a
  significant role in how policy is applied in
  practice.

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Environmental Health Officers perceptions of
circumstances of pesticide poisoning
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Environmental Health Officers

• Linear, uncontextualised narratives
• "... the house was sprayed for fleas and flies
  and the people were not thoroughly informed about
  the use of the house after it was sprayed, so it
  is ignorance."
• " ... he knew that he must ... wear an
  overall, he was wearing boots, he has all these
  things, but he did not wear the gloves. Because
  it was too hot."

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Farm workers perceptions of circumstances of
pesticide poisoning
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Farm Workers (I)

• Narratives contextualised in wide range of
  conditions
• Identify both direct and indirect exposures
• we spray in the wind and this must not be
  because that vapour makes you so terribly
  nauseous, immediately you have heart burn.
• take my wife for instance she does not
  come close to the insecticides, but every year
  when the spraying season starts, then her skin
  breaks out again a rash, as if she is allergic
  to the insecticides

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Farm Workers (II)

• Identify explicitly PPE problems
• "We have gloves but it's these old plastic
  things. It's just so two, three days, then the
  finger tips are broken. Then the poison comes
  through it the torn glove."
• " ... you may as well spray without those things
  protective clothing then you do get wet from
  the poisons as you do from the sweat underneath
  that clothing"
• " ... the tractors are not working, the spray
  pumps leak, the men have not even started
  spraying yet and they are already wet, and all
  that stuff must be fixed ..."

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Pesticide poisoning - A wider web

• Victim blaming leads to focus on individual
• Wider understanding needed
• Non chemical pest control or IPM
• Build on workers knowledge, experience

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KEY FINDINGS

• EHOs Training
• theoretical not practical -
  limited instruction on pesticide poisonings and
  pesticide safety issues in general no IPM
• - limited understanding of pesticide poisoning
  circumstances
• role models NB

• EHOs Role
• reactive - dependent on notified cases
• limited proactive -
• lack capacity other than inspections
• not educational - blame not train

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RECOMMENDATIONS

• To strengthen EHO capacity to control pesticide
  poisonings
• 1. Improve input to EHO curriculum
• 2. Budget for EHO capacity building for
  
• viable effective prevention
  
• intervention programs
• 3. Improve on surveillance mechanisms
  Proactive, and Effective interventions!

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CONCLUSION

• An efficient pesticide policy is needed to
  protect human health and the environment - but
  this policy requires practical support.
• Support can be
• Financial capacity
• Human resource capacity! Build capacity in terms
  of training and curriculum development of policy
  implementers (e.g. inspectors).
• Systems approach