IFEH ISSUE 6 - International Federation of Environmental Health

national development programmes and projects, mobilise the resources needed to support and
strengthen these activities, promote community-based local initiatives in the area of environmental
health and coordinate interventions related to the management of environmental health activities
(WHO 1998a).
The Southern African Development Community (SADC) Health Protocol reaffirms the importance of
improving environmental health conditions of communities especially in rural and under-developed
areas. The WHO has also committed itself to the Health for All in the 21st Century framework which
makes explicit three goals (WHO 1998b): (i) an increase in life expectancy and improvement in the
quality of life for all; (ii) improved equity in health between and within countries and (iii) access for
all to sustainable health systems and services. While not encompassing all the actions, environmental
health falls clearly in the interface between health and development and is therefore critical to the goal
of “making health central to human development” (Thomas et. al., 2002; Cairncross et. al., 2003).
Malawi is a country located in Southern Africa, east of Zambia and shares borders with Mozambique
and Tanzania. The country is one of the poorest nations in the world. Two out of five people live on
less than US$1 per day and three quarters of the population on less than US$2 per day. Within SADC,
only Angola and Mozambique have a human development index value less than that of Malawi
(Chunga et. al., 2004). It is categorized within the lowest human development category. Despite the
financial challenges facing the country, the academic institutions in collaboration with the
environmental health profession are striving to produce graduates, at different levels, to improve the
health of the nation. Here, we present the first of two papers on the challenges facing the profession
and academia reviewing the past, present and future of the profession and academia in the country.
THE PAST
The environmental health profession in Malawi dates back to the early 1950s when the Government of
Malawi established the Likangala School of Hygiene in Zomba. The school trained an Environmental
Health cadre popularly referred to as ‘Sanitary Capitaos’ (Sanitary Inspectors). At this time they were
mostly engaged in nuisance inspection and control duties e.g. inspecting liquid and solid waste
disposal facilities (Chunga et. al., 2004). Later in 1980 the course for this cadre was moved to a newly
opened college called Lilongwe School of Health Sciences (LSHS) run by the Ministry of Health.
LSHS offered a two year certificate course and produced a cadre of graduates now known as Health
Assistants (HAs).
Supporting the Sanitary Capitaos in the early days were the Public Vaccinators (PVs) whose role and
responsibility was to vaccinate people against smallpox. These PAs travelled the length and breadth of
the country vaccinating people and were immensely successful and their mission. In 1972 Malawi
together with other countries under World Health Organization auspice was declared smallpox free in
1978 (Ntopi, 2010). In 1973 Malawi experienced its first cholera outbreak in Nsanje District and HAs
and PVs played a pivotal role in stemming the outbreak by promoting village sanitation and water
hygiene. As a result the PVs became entrusted by the Government as they had demonstrated that they
had the necessary skills and knowledge base undertake the duties associated with preventing and
controlling cholera outbreaks. As a result they were renamed Cholera Assistants. Today Cholera
Assistants are known as Health Surveillance Assistants due to the increased nature of their duties.
They now undertake a range of preventative and medical health activities at community (village) level
and are located primarily at the community (village) level within health posts and report to the District
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