Dengue prevention:
How to obtain human resources
for a massive campaign


By Dr. Pradeep Kariyawasam,
Deputy Municipal Commissioner (Health), Colombo Municipal Council

 A fogging programme in progress (file photo)

The City of Colombo, like many other cities in the developing world was growing rapidly posing many complex problems to its city Council. Rapid development work is going on these days mainly to upgrade the housing stock, improve infrastructure in the city with regard to drains, roads sewerage etc. Therefore, the Municipal Council together with Urban Development Authority have taken up the challenge to improve living standards to ensure adequate health in all dimensions to the citizens in general and to the urban poor in particular through improved management efficiency. The vision of all should be to create an Eco-friendly environment in the city by reducing the unhealthy environment-borne diseases.

Dengue and other mosquito-borne diseases have become a major urban health problem in the city mainly due to lack of appropriate management of solid waste by all concerned. The bi-annual monsoon periods in May-July and November-January create heavy rains and result in floods and spread of diseases. The rain pattern has changed nowadays and as a result dengue fever outbreaks are evident even during inter-monsoonal periods. It causes the government and the municipality to spend a large amount of resources on medication and corrective actions. In addition, it causes loss of productivity among city dwellers particularly among the urban poor, majority of whom are daily-wage earners, forcing them get in to the vicious cycle of poverty, which eventually destroys the poor environment further causing more problems.

Even though Dengue fever has existed in the city for over 50 years with major out breaks occurring periodically every 3 to 5 years in the beginning, over the recent past the numbers of patients getting dengue fever has increased and in 2012 the worst epidemic occurred. The numbers have gone up steadily in Sri Lanka and globally. All efforts to control it have not worked out and the main problem has been sustainability of the programme and the capacity to carry out such programmes.

The Public Health Department, Colombo Municipal Council was controlling the outbreaks of mosquito-borne diseases through these routine operations by paying attention to inspection of land parcels and clearing the ‘containers’ in which mosquitoes breed and spraying roadside drains, ultra-low volume spraying of residences and institutions with BTi in dengue high-risk areas, fogging of underground drains and open thick spaces where rank vegetation was observed. Therefore, any attempt to reduce and finally eradicate the incidence of Dengue and other vector controlled diseases in the city will not be comprehensive unless concurrent action for solid waste and storm water drainage management in large drains and canals go hand in hand with this social mobilization and education initiative. The CMC mobilized this concurrent action assisted by legal threats as the municipalities are usually blamed and not the individual homeowners, government and private organizations. Therefore, over the years the Municipal Officials took a decision that homeowners from high, middle and lower income groups should join hands with the municipality to eradicate this menace from society. The only way to curb the epidemic is to clear dengue mosquito breeding sites in these homes and private lands.

Hence, the Public Health Department of the Colombo Municipal Council came up with an innovative idea fourteen years ago on my directive, of house-to-house inspection and issuing of a ‘Green Star Home’ sticker to homes compliant with the six criteria, which are necessary to eradicate mosquito-breeding sites inside homes and, in gardens.

Under this project, the Colombo Municipal Council (CMC) aimed at getting health related Departments of the Council, other state related organizations, the private sector and the community involved through a participatory process whereby homeowners and the authorities together fight the dengue and other mosquito-borne diseases epidemic before it affects the city.

Public, Private and NGO sector partnerships

It was our belief which is proven time and again that the health sector alone cannot win the war against dengue epidemics. During the programme staff of several health related departments worked as volunteers to carry out the project. The programme also had the services of the youth from the NGO sector, the Rotarians, and volunteers from universities and schools. The officers of the four divisions of the Public health Department and staff of other departments got an insight into aspects of Environmental Health and Sanitation. This same force can be engaged in similar health or environment improvement campaigns in the future. The enthusiasm shown by the public was overwhelming in the beginning and there was competitiveness among the neighbours to win the Green Star sticker, which they proudly displayed on their walls or gates. The Mayors of Colombo participated in the launchings of programmes and this helped building of public relations between the Council and the ratepayers.

Improved information collection to increase awareness.

Staff members were mobilized to visit households with volunteers and student and advise citizens on preventative action and making their homes mosquito-free. It is essential that field resource personnel provide more information regarding the epidemic itself and collect information about the situation in each land plot and check on the home environment. Today most of the Medical Officers of Health of the Ministry of Health in other towns use this concept of House to House inspections initiated by us in their work. Social mobilization and mass-education efforts of these programmes generated supportive actions at the community level.

To be continued tomorrow

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