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Our attention is drawn to an open letter to Ministry of Health that appeared in page 20 of the Daily Nation Newspaper of 3rd November 2016 from the County Government of Bomet regarding the state of solid waste disposal in the county. It’s worth to appreciate the efforts put by the County Governments across the country in allocating resources to operationalize waste management and general sanitation. This is surely a worthwhile effort towards improvement of service delivery and reduction of healthcare associated infections among healthcare workers and the general population. However, the expansion of the health infrastructure as well as the growth of our urban and trading centers, towns and cities have increased challenges in health sector, notably in the areas of solid and liquid waste management. Through a meeting chaired by the Cabinet Secretary for Health at Afya House on the 26th October 2016,  it was agreed in the presence of Hon. Governor Isaac Ruto and Hon. Ronald Tonui that the two levels of governments work together to address the challenges of Solid Waste Management in the County. In this regard, the Ministry on 2nd November 2016 sent a technical Team to assist in addressing the issue. The press release of 3rd

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November has therefore been overtaken by events as the matter is already being addressed.


Public Health and Sanitation Policy Management

The Kenya constitution under the “Bill of Rights” Article 42 provides that “every person has a right to a clean and healthy environment”. Additionally, Article 43 provides for the highest attainable standards of health. The constitution also under Article 70 (I) further provides for direction for redress to any person whose such right has been denied, threatened, infringed, and or violated. Furthermore, the Constitution under schedule 4, has devolved the function of waste management to County Governments, and powers and authority for enforcement have been provided for under The Public Health Act Cap 242 and other relevant legal statutes.


In discharge of its mandate, the Ministry through Executive Order No. 2 of 2013 is responsible for Management of Public Health and Sanitation policy among other related duties. The Ministry has developed various policies, guidelines and standards on sanitation, health care waste management and general waste. These policies include but not limited to the following: Environmental Sanitation and Hygiene policy, Strategic framework, Prototype county bill and   Kenya Open Defecation Free 2020 framework; the Healthcare Waste Management Strategy; Healthcare Waste Management Guidelines; Healthcare Waste Management Standard Operating Procedures; the National Healthcare Waste Management Plan (2016 -2021); the National Infection Prevention Control Policy and the National Infection Prevention Control Guidelines.

Other related policy documents include Environmental Management and Coordination Act (Waste management (NEMA) regulation 2006) and Environmental Impact Assessment regulations and the Occupational Safety and Health Act, 2007.


In line with the Constitution 2010, the Ministry continues to review some of these policy instruments as well as formulating new ones.We continue with dissemination of these policies as well as training the Counties in waste management in order to build the capacity of Counties   workforce. To this end, the national government has trained over 7500 personnel on waste management in the country.


Moving forward, the Ministry of Health and related national Ministries and agencies are not responsible for allocating land for solid waste disposal but only gives policy and technical direction on siting of such land.  It is worth to note therefore that it is the responsibility of the County Governments to acquire land for such utility as provided for under the devolved County health, lands and environment functions.


The State of Waste Management in the country

The appalling state of solid and liquid waste management in the country is a big concern for the Ministry and the country.We can attribute thesecond wave of cholera outbreaks in the country which affected over 30 counties to poor state of waste management and general sanitation. This wave began on 26th December 2014 and continues sporadically to date. It is alarming that as of30th May 2016 cumulative total of 15,681cases and 250 deaths of cholera have been reported.


Contraventions and low levels of implementations of legal and policy instruments including even those enacted by respective County Governments is a common practice in our country. The poor state of general waste management in our country is a serious risk to public health and environment. Counties being the duty bearers in services delivery as outlined in schedule 4 part 2 (g) of our Constitution have a responsibility to ensure sound management of such wastes.

The poor state of waste management is noticeable in the way a number of service areas are seemingly below par in terms of service provisions and management.

Some noticeable observations are as follows;

  1. The scattered uncollected wastes or poor open burning gives rise to offensive smell and dangerous gases, thus is a nuisance and serous risk to public health and a source of air pollution and disease in the long run
  2. The surroundings of dwellings or premises within the jurisdiction of majority of counties are dirty and below par that they pose dangers to public health of the occupiers and integrity of the environment. These harbor disease-causing reservoirs.
  3. Treatment of health care waste and other hazardous waste including e-waste is a challenge.
  4. The dismantled or destroyed wastes receptacles and inappropriately positioned receptacles across many of our towns and cities is a common eyesore.
  5. Indiscriminate scattering of waste and inappropriate dumping in riverine and wetlands is a dangerous source of pollution to the environment, thereby compromising public health in the long run. Our rivers are choking with wastes and dangerous pollutants.
  6. The overflowing sewage in most urban and cities settings has become a common nuisance in our country. Management of this liquid waste is a big problem across all major towns and cities that urgently need interventions.


Our Call

To address the poor state of both solid and liquid waste in the country, the Ministry is calling upon the counties to act with urgency to rectify the problems. The Ministry in exercise of powers conferred to it by part II section (13-14) of the Public Health Act Cap 242 and in the spirit of implementing article 43 and the requisite sections in schedule 4 of the constitution as well as the executive order No. 2 of 2013 in the management of Public health and sanitation policy do hereby bring to your attention that we as a country are contravening part IX section 118 of the Public Health Act among other provisions of relevant legal instruments.On the issue of accumulated waste around residential dwellings, we advise counties to take immediate measures to restore cleanliness and aesthetic value of the towns and cities environment. In the case of not having standard waste treatment infrastructures and lack of designated waste disposal sites, the Ministry urges counties to appropriately provide land and standard infrastructure to safely treat and dispose of wastes. Towns and cities that have permanent rivers running through them must take appropriate measures to clean up the buildup pollutants in the rivers, repair their sewage lines and ensure standard treatment of sewage is practiced.

In view of the foregoing, counties are therefore called upon to put in place appropriate laws and implementation strategies while ensuring consistency with the National Policies on management of public health and sanitation in the country. To this end, the Ministry is therefore calling upon the counties to initiate and facilitate efforts to set aside funds to institutionalize and operationalize waste management and general sanitation.




Kepha M. Ombacho, MBS, PhD