A Public Health Perspective on Sierra Leone’s Monthly Cleaning Exercise

The newly elected president of Sierra Leone proclaimed an Executive Order instituting a monthly cleaning day in the country

Let me start by giving thumbs-up to our newly elected president of the Republic of Sierra Leone, Julius Maada Bio. In 22 years, his campaign messages proved convincing to the people of Sierra Leone and have given him another opportunity to rule, democratically this time. I must also commend the Sierraeye Magazine in Sierra Leone for organizing a national debate on the cleaning exercise-a topic many considered was “ very sensitive” to debate, and the Africa Young Voice (AYV) Media for providing its “cutting-edge” coverage that allowed this author to watch the debate live from Spain. Globalization indeed!

Freetown, Sierra Leone

Very recently the newly elected president of Sierra Leone proclaimed an Executive Order instituting a monthly cleaning day in the country. There is no doubt that a national monthly cleaning exercise could do much to raise the current sanitary state of the country, particularly in Freetown, the capital city. Regardless of how effective this initiative turns out to be, the inspiration behind such a Presidential Order is, to me, a reflection of good spirit and in line with countless best practices in public health and sanitation.

The mobilization of resources to clean the surrounding environment is a demonstration of political commitment to public and global health

The mobilization of resources to clean the surrounding environment is a demonstration of political commitment to public and global health. This is just one example of initiative where Sierra Leone stands to gain in terms of health impact: malaria is the single largest contributor to deaths in the country with stable transmission throughout the year and accounts for 40% of outpatient morbidity across all ages.

Many government ministers justify the Presidential Order with public health arguments, and in my view, that is why it remains crucial that public health indicators are used to assess the effectiveness of the measure. The trade-off between business as usual -i.e. the normal routine of city councils to ensure cities are clean-, and the Presidential Order (plus business as usual) should justify the use of taxpayers money on either approach.

First Lady of the Republic of Sierra Leone particulating during the monthly cleaning campaign. Photo: http://cocorioko.net

It remains crucial that public health indicators are used to assess the effectiveness of the measure

This raises a series of relevant questions: is/are there a specific indicator(s)/method(s) identified for impact assessment? Are there specific mechanisms that give autonomy to community structures and promote community ownership and sustainability rather than relying on monthly commitments from construction companies among others? How can we incorporate such a good idea into the work of line of the responsible ministries? How do we measure the cost effectiveness of the monthly exercise as compared to business as usual only? What innovations (including recycling systems) do we have in place to create employment from filth? Do we have a more efficient waste management strategy in place compared to business as usual? Finally, do we have clearly identified goals and objectives of the monthly cleaning campaign?

These are critical questions to consider when suggesting any public health intervention. The new government preached messages on “new direction” manifesto. I am sure Sierra Leoneans would not appreciate mindless utilization of their resources under the excuse of a nice sounding public health initiative.   

Another aspect worth considering is that the country is heading towards the rainy season. Huge piles of filth placed along the road waiting to be transported to landfills would be washed away by heavy downpour. The effect on sanitation and health could be more severe than when the filth is left untouched in the drainage.

In addition, some of these materials, particularly plastic, could burn for days, emitting hazardous pollutants/substances such as dioxin that are dangerous to human health and the environment. When plastics are burnt, harmful quantities of dioxin, a group of highly toxic chemicals are emitted. 

Photo: http://cocorioko.net

Mr. President sir, we don't want to address one public health issue that would lead us to a more severe public health issue. The chances of success of the presidential order could be increased by taking into consideration the following recommendations:

It is good to have the president and first lady leading campaigns but it is best that public health campaigns are designed with a goal and objectives that give leadership and place ownership at community level, such as has occurred in Zimbabwe. The authorities should put in place a strategic document that stems from community and private sector consultations.

Sierra Leone needs to adopt, adapt, and incorporate what I will refer to as the “public health implementation research” element into the national cleaning campaign strategy

Sierra Leone needs to adopt, adapt, and incorporate what I will refer to as the “public health implementation research” element into the national cleaning campaign strategy mentioned above. This would address issues such as: health impact assessment of a cleaning campaign backed with a Presidential Order versus business as usual without a Presidential Order, waste management issues which include innovation and recycling, community participation, community autonomy and  ownership, and cost effectiveness.  

Sierra Leone might be remembered for its “Alma Ata” approach that identifies sanitation as a major element for the attainment of “Health for All”, if it is able to recognise the relevance of a comprehensive strategy that clearly spells out the role of all stakeholders including the Ministry of Health Sanitation and other ministries. A blanket Presidential Order is not enough for improving public health.