NAME:

ALEXSI
MIYUWAFULA

I
NTERNSHI
PCENTER:
NAI
ROBICOUNTY

I
NTERNSHI
PSTATI
ON:
RUARAKASUBCOUNTY

I
NTERNSHI
PPERI
OD:
FROM MAY2019TOMAY2020

I
NTERNSHI
PDURATI
ON:
ONEYEAR

SUBMI
TTEDTO:
PUBLI
CHEALTHANDTECHNI
CIANCOUNCI
L

DATEOFSUBMI
SSI
ON:
12/
05/
2020

1
TABLEOFCONTENTS.
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.2
Backgr
oundi
nfor
mat
ion………………………………………………….
.………………………………5
Acknowl
edgement…………………………………………….
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…………………………………….
6
Li
stofabbr
evi
ati
on………………………………………………….
.………………………………….
7
Oper
ati
onal
def
ini
ti
on………………………………………….
…………………………………………8
CHAPTERONE1:
COMMUNI
TYHEALTH…………………………………………….
.9
I
dent
if
yHeal
thSt
ruct
uresSy
stem &Ser
vices…………………………………………………………9
Communi
tydi
agnosi
s………………………………………………………………………….
……….
10
Compr
ehensi
veschool
heal
thpr
ogr
am……………………………………………………………….
.11
Nut
ri
ti
on/
Diet
aryAssessment
………………………………………….
…………………………….
.12
Communi
cabl
eandNoncommuni
cabl
eDi
seases…………………………………………….
.……12
Communi
tyHeal
thBasedPr
ogr
ams………………………………………………………………….
.13
Pestv
ect
or,
ver
minandpar
asi
tes…………………………………………………….
.……………….
14
Occupat
ional
Heal
th&saf
ety(
OHS)……………………………………………………………….
.16
CHAPTERTWO2:
PUBLI
CHEALTHENGI
NEERI
NG………………………….
.….
17
Wat
er,
Sani
tat
ionandhy
gienepr
ogr
ammer
s’……………………………………….
……………….
17
Wat
ersuppl
yandqual
i
tycont
rol
…………………………………………………………………….
18
Li
qui
dwast
emanagement……………………………………………………………………………19
Sol
i
dwast
emanagement(
SWM)…………………………………………………….
……………….
20
I
nfect
ion,
Prev
ent
ionandcont
rol
(IPC)……………………………………….
.………………………21
Conser
vancysy
stem …………………………………………………………………………………….
21
Hazar
dousWast
emanagement(
HWM)…………………………………………………………….
.22
Env
ironment
ali
nspect
ion.
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.….
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23
Env
ironment
ali
mpactassessment/
Audi
t……………………….
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..
……………………….
24
St
rat
egi
cEnv
ironment
alAssessment…………………………………………….
.………………….
25
Pol
l
uti
onPr
event
ionandCont
rol
…………………………………………………………………….
26
Cl
i
mat
eChangeandHeal
th……………………………………………….
………………………….
26

2
Chapt
erThr
ee3:
Bui
l
tEnv
ironmentandHeal
th……………………….
.…………………28
Desi
gnanddr
awi
ngofbui
l
dingpl
ans……………………………………………………………….
28
Landdev
elopmentandset
tl
ementManagement……………………………………………………28
Appr
oval
ofbui
l
dingpl
ans……………………………………………………………………………29
Dr
ainageandpl
umpi
ng……………………………………………………………………………….
29
Sani
tat
ionofconst
ruct
ionsi
tes………………………………………………………….
……………31
Regul
ari
zat
ionofbui
l
dingpl
ansf
orcompl
i
ance……………………………….
……………………31
Vent
il
ati
onandl
i
ght
ing……………………………………………………………………………….
32
I
ssuanceofoccupat
ioncer
ti
fi
cat
es……………………………………………………………………33
Vi
si
ttoi
nfor
mal
set
tl
ement
s……………………………………………………….
……………………33
I
nspect
ionf
oruse/
changeofuse……………………………………….
.…………………………….
33
Pr
event
ionMai
ntenance.
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.….
..
34
Bui
l
dingr
egul
ati
ons/
Standar
dsandcodes……………………………………………………………35
CHAPTER FOUR 4: FOOD I
NSPECTI
ON, HYGI
ENE AND QUALI
TY
CONTROL……………………………………………………………………………………………36
Rout
inei
nspect
ionf
orhy
gieneoff
oodpr
emi
ses.
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.….
..
36
I
nspect
ionoff
oodf
ori
mpor
tsandexpor
ts.
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…..
.37
I
nspect
ionoff
oodpr
emi
sesf
orl
i
censi
ng………………………………….
………………………….
38
Exami
nat
ionoff
oodhandl
ers…………………………………………………………………………39
Foodsampl
i
ngandAnal
ysi
s……………………………………………………………………………40
Foodepi
demi
cinv
est
igat
ion…………………………………………………….
.……………………40
Enf
orcementoff
oodl
aws(
cap254)………………………………………….
……………………….
41
I
nspect
ionofmeatandmeatpr
oduct
s………………………………………………………………….
42
CHAPTERFI
VE5:
GENERALPUBLI
CHEALTH…………………….
.…….
……….
44
Por
theal
thser
vices…………………………………………………………………………….
………44
HumanResour
cesManagement……………………………………………………………………….
46

3
Per
for
manceManagement………………………………………….
..
………………………………….
47
Publ
i
cHeal
thPr
osecut
ion……………………………………………….
………………………………47
Heal
thEducat
ionandPr
omot
ion………………………………………………………………………48

4
APENDI
CES
APENDI
X1…………………………………………………………………………………….
MOH505
APENDI
X2…………………………………………………………………………………….
MOH503
APENDI
X3…………………………………………………………………………………….
.MOH502
APENDI
X4…………………………………………………………………DI
SINFECTI
ONPROCESS
APENDI
X5……………………………………………………………………………HANDWASHI
NG
APENDI
X6……………………………………………………………………….
.…SEI
ZURFORM ‘
A’
APENDI
X7………………….
..
………………………………………………….
…SEI
ZUREFORM ‘
B’
APENDI
X8…………………………………….
..
..
BACTERI
OLOGI
CALANALYI
SQUESTI
ONARE
APENDI
X9…………………………………………………………EXPORTHEALTHCERTI
FICATE
APENDI
X10………………………………………………………….
…POORHYGI
NICCONDI
TION
APENDI
X11……………………………………………………………….
..
LABARATORYSAMPLES
APENDI
X12……………………………………………………………………….
.I
NDEMNI
TYFORM
APENDI
X13……………………………………………………….
IMPORTHEALTHCERTI
FICATE
APENDI
X14…………………………………………………….
..
…LI
QUI
DWASTEMANAGEMENT
APENDI
X15……………………………………………………….
.……HANDWASHI
NGFACI
LITY
APENDI
X16………………………………………………………….
.NEMAI
MPROVEMENTFORM
APENDI
X17………………………………………….
..
STANDARDSFOREFFLUENDDI
SCHARGE
APENDI
X18………………………………………………………………………….
.CHVSTRAI
NING
APENDI
X19…………………………………………OCCUPATI
ONALCERTI
FICATECHECKLI
ST
APENDI
X20…………………………………………….
.……TRAVELLERSSURVEI
LANCEFORM
APENDI
X21……………………………………………………………….
..
.FOODSAMPLI
NGFORM

5
 BACKGROUNDI
NFORMATI
ON
Nai
robi
Count
yisoneoft
he47count
iesi
nKeny
a.I
tist
het
hir
dsmal
l
esty
ett
hemost
popul
ousoft
hecount
ies.I
tisappr
oxi
mat
ely696km2wi
thapopul
ati
onof4,
397,
073t
hati
s
2,
192,
452men,
2,204,
376womenand245i
nter
sexi
naccor
dancet
othe2019census.Nai
robi
Count
ywasf
oundedi
n2013ont
hesameboundar
iesasNai
robi
prov
inceaf
terKeny
ans8
pr
ovi
nceswer
edi
vi
dedi
nto47count
ies.Nai
robi
Count
yhasexper
iencedoneoft
hemostr
api
d
gr
owt
hsi
ntheur
bancent
res.Thi
sisunl
i
kel
ytosl
owdownsoonbecauset
hepopul
ati
oni
n
Keny
aincr
easesatanav
eragespeedof3%.Thecount
yiscomposedof17par
li
ament
ary
const
it
uenci
es(
sub-
count
ies)t
hati
ncl
udeWestl
ands,
Dagor
eti
nor
th,
Dagor
eti
sout
h,Lang’
ata,
Ki
bra,
Roy
sambu,
Kasar
ani
,Ruar
aka,
Embakasi
sout
h,Embakasi
nor
th,
Embakasi
cent
ral
,
Embakasi
east
,Embakasi
west
,Makadar
a,Kamukunj
i
,St
areheandMat
har
e.

Thecount
ypubl
i
cheal
thdepar
tmenti
slocat
edwi
thi
ntheNai
robi
cent
ral
busi
nessdi
str
ictat
ci
tyhal
lof
fi
cesandi
sheadedbyt
hecount
ypubl
i
cheal
thof
fi
cer
.Ruar
akasub-
count
yhas
sev
enpubl
i
cheal
thof
fi
cer
sser
vingMat
har
e,Babadogo,
Utal
i
i,andKor
ogochowar
ds.Thecor
e
f
unct
ionoft
hepubl
i
cheal
thdepar
tmenti
ncl
ude:
-
 Reduceheal
thr
isksar
isi
ngf
rom i
nadequat
ehy
gieneandsani
tat
ion
 Pr
otectconsumerheal
thbyensur
ingwat
ersaf
ety
 Pr
otectpeopl
eagai
nsti
l
lheal
thar
isi
ngf
rom dai
l
yact
ivi
ti
esi
nthewor
kpl
aces
 Pr
otectconsumer
sheal
thbyensur
ingt
hatf
oodpr
oduced,
dist
ri
but
ed,
mar
ket
ed,
and
consumedmeet
sther
equi
redst
andar
dsoff
oodsaf
etyandqual
i
ty-
fooddr
ugsand
chemi
cal
actcap254.
 Reducef
act
orst
hatcont
ri
but
etopoorhousi
ngandenv
ironment
alpol
l
uti
on.
 Ensur
econt
rol
ofal
ldi
seases,
vect
orandv
ermi
ninv
essel
s,househol
dsandt
he
env
ironmenti
nli
newi
thcap242

6
 ACKNOWLEDGEMENT
Tobegi
nwi
th,It
hankt
heal
might
yGodf
orhi
slov
e,car
eandpr
otect
iont
hroughoutmy
i
nter
nshi
pper
iod.Muchgr
ati
tudeal
sogoest
omyf
ami
l
yandf
ri
endswhohav
ebeenv
ery
suppor
ti
vef
inanci
all
yandemot
ional
l
ythr
ought
hei
rendl
essandsi
ncer
eencour
agement
s.

Ir
eal
l
yappr
eci
ateNai
robiCount
ythr
ought
hepubl
i
cheal
thandt
echni
ciancounci
lforgi
vi
ng
meanoppor
tuni
tyt
opr
act
ical
l
yengagemy
sel
fint
hisi
nter
nshi
ppr
ogr
am andi
nthepr
ovi
sion
ofpubl
i
cheal
thser
vices.Iwoul
dli
ket
oacknowl
edget
hedeput
ydi
rect
orofpubl
i
cheal
thDr
.
Wi
l
sonLagat
,Ruar
akasubcount
ypubl
i
cheal
thof
fi
cerMr
.Pet
erKamuy
u,al
lthepubl
i
cheal
th
of
fi
cer
sinRuar
akasub-count
yandal
ltheheal
thwor
ker
satMat
har
eNor
thheal
thCent
ref
or
t
hei
rgui
dance and suppor
thence enabl
i
ng me achi
evet
he i
nter
nshi
p pr
ogr
am and t
he
obj
ect
ivest
her
ein.

Last
ly,
Iwoul
dli
ket
othankmyf
ell
owi
nter
nsf
ort
hei
rev
ery
daymot
ivat
ion.

Godbl
essy
oual
l
!

7
LI
STOFABBREVATI
ONS

CBO’
S-Communi
tyBasedOr
gani
zat
ion

CHVs-
Communi
tyHeal
thVol
unt
eer
s

CHW-
Communi
tyHeal
thWor
ker

CLTS-
Communi
tyLeadTot
alSani
tat
ion

EI
A-Env
ironment
alI
mpactAssessment

HACCP-
Hazar
dAnal
ysi
sCr
it
ical
Cont
rol
Poi
nt

MCH-
Mot
herChi
l
dHeal
th

MOH-
Mini
str
yofHeal
th

NAWASCO-Nai
robi
Wat
erandSewer
ageCompany

NEMA-
Nat
ional
Env
ironment
alManagementAgency

NGO’
S-Non-
gov
ernment
alOr
gani
zat
ion

ODF-
OpenDef
ecat
ion

OHS-Occupat
ional
Heal
thandSaf
ety

PHO-Publ
i
cHeal
thOf
fi
cer

PPE-Per
sonal
Prot
ect
iveEqui
pment

8
 OPERATI
ONALDEFI
NATI
ON

Communi
cabl
edi
seases-ar
edi
seasest
hatcanbespr
eadf
rom per
sont
oper
sont
hrough
v
ari
ousway
ssuchascomi
ngi
ntocont
actwi
thi
nfect
edbodyf
lui
dsorbl
ood,
insectbi
teor
br
eat
hingi
nanai
rbor
nev
irus.

Heal
theducat
ion-i
str
ansl
ati
onofwhati
sknownaboutheal
thi
ntodesi
rabl
eindi
vi
dual
,fami
l
y
andcommuni
tybehav
iorpat
ter
nsbymeansofeducat
ionpr
ocess.

Hy
giene-i
sthepr
act
iceofkeepi
ngonesel
fandone’
ssur
roundi
ngcl
ean,
especi
all
yinor
dert
o
pr
eventi
l
lnessort
hespr
eadofdi
seasee.
g.f
requenthandwashi
ngwi
thsoap.

Knowl
edge–f
ami
l
iar
it
ygai
nedbyexper
ienceandt
rai
ning
Negl
ect
edt
ropi
cal
diseases-
Vir
al,
par
asi
ti
candbact
eri
adi
seasest
hatmai
nlyaf
fectt
hewor
ld
poor
est
Noncommuni
cabl
edi
sease–Ar
enotspr
eadbycont
actbecausemostar
enotcausedby
ger
ms.I
nst
eadt
heyar
ethebr
eakdowni
nbodycel
l
sandt
issues.

Pr
act
ice–somet
hingdoner
egul
arl
yorof
tenasahabi
t,t
radi
ti
onorcust
om.

Pr
eval
ence-Ref
erst
othenumberofcasesofadi
suset
hatar
epr
esenti
npopul
ati
onatagi
ven
t
ime
Sani
tat
ion-t
hesci
enceofpr
event
ingandr
educi
ngdi
seasest
hroughv
ari
ousst
rat
egi
essuchas
awar
enesscr
eat
ion,
goodhousi
ngandpr
ovi
dingacl
eanenv
ironmenti
nwhi
cht
oli
ve;
measur
e
t
obr
eakt
hecy
cleofdi
seases.

9
 CHAPTERONE:
COMMUNI
TYHEALTH
I
dent
if
icat
ionofHeal
thSt
ruct
ures,
Syst
emsandSer
vices
TheKeny
anheal
thcar
esy
stem canbespl
i
tint
othr
eesubsy
stems,
bei
ngt
hepubl
i
csect
or,
commer
cial
pri
vat
esect
orandf
ait
hbasedor
gani
zat
ions(FBOs)
.Thepubl
i
cheal
thsy
stem
consi
stoff
ourt
ier
swhi
char
e;
1.Ti
er1:
Communi
tyl
evel
-Thi
slev
elcompr
isesal
lcommuni
ty-
baseddemandcr
eat
ion
act
ivi
ti
es,
thati
s,t
hei
dent
if
icat
ionofcasest
hatneedt
obemanagedathi
gherl
evel
sof
car
e,asdef
inedbyt
heheal
thsect
or.

2.Ti
er2:
Pri
mar
ycar
elev
el-Thesear
ethedi
spensar
ies,
heal
thcent
ersandmat
erni
ty
homesf
orbot
hpubl
i
candpr
ivat
epr
ovi
der
s.

3.Ti
er3:
Count
ylev
el-Thesear
ehospi
tal
soper
ati
ngi
nandmanagedbyagi
vencount
y
andconsi
stoft
hef
ormerl
evel
fouranddi
str
icthospi
tal
sint
hecount
yandi
ncl
ude
publ
i
candpr
ivat
efaci
l
iti
es.

4.Ti
er4:
Nat
ional
lev
el(
Ref
err
als/
teachi
ng)–Thi
sist
heapexoft
heheal
thcar
esy
stem
pr
ovi
dingsophi
sti
cat
eddi
agnost
ic,
ther
apeut
icandr
ehabi
l
itat
iveser
vices.Thet
wo
nat
ional
ref
err
alhospi
tal
sar
eKeny
att
anat
ional
hospi
tal
inNai
robi
andMoi
and
t
eachi
ngr
efer
ral
hospi
tal
inEl
dor
et.Theequi
val
entpr
ivat
eref
err
alhospi
tal
sar
eNai
robi
hospi
tal
andAgakhanhospi
tal
inNai
robi
.

Thest
ruct
uresi
nheal
thcar
eser
vicedel
i
ver
yar
easf
oll
ows:

 Communi
tyl
evel
-Thi
slev
elcompr
isesal
lcommuni
tybaseddemandact
ivi
ti
es,
thati
s
t
hei
dent
if
icat
ionofcasest
hatneedt
obemanagedathi
gherl
evel
sofcar
easdef
ined
byt
heheal
thsect
or.Act
ivi
ti
esatt
hisl
evel
incl
ude:
-
1.Pl
an,
i
mpl
ementmoni
tor
,ev
aluat
eandgi
vef
eedbackonact
ivi
ti
es
2.Mobi
l
izeandmanager
esour
ces
3.Under
takeheal
thpr
omot
ion,
hygi
eneandcar
eseeki
ngi
nit
iat
ivepr
imar
ycar
e
ser
vices
 Di
spensar
iesandheal
thcent
ers-
Theyf
ormf
ir
stl
evel
cont
actwi
tht
hecommuni
ty.
Thesear
ethedi
spensar
ies,
heal
thcent
ersandmat
erni
tyhomesf
orbot
hpubl
i
cand

10
 pr
ivat
epr
oduct
s.Thi
slev
elf
ormst
hemai
nli
nkagebet
weent
hecommuni
tyandt
he
heal
thsy
stem.Act
ivi
ti
esunderi
tincl
ude:
-
1.Pl
an,
impl
ement
,ev
aluat
eandpr
ovi
def
eedbackonl
evel
ofser
vices
2.Mobi
l
izer
esour
cesf
ordev
elopmentoft
heheal
thf
aci
l
iti
esaswel
lassuppor
ti
ng
out
reachandr
efer
ral
act
ivi
ti
es
3.Faci
l
itat
eregul
ardi
aloguebet
weent
hecommuni
tyandt
heheal
thser
vicepr
ovi
der
s
basedonav
ail
abl
einf
ormat
ion
4.Pr
omot
eint
er-
sect
orcol
l
abor
ati
on
5.Or
gani
zet
hecommuni
tyf
orheal
thact
ions
6.Faci
l
itat
epl
anni
ng,
budget
ingbudgetcont
rol
andaccount
abi
l
ityt
oensur
eav
ail
abi
l
ity
ofr
esour
cesneededf
orl
evel
oneser
vices.
 Count
yref
err
alsandSubCount
yHospi
tal
s-Theycoor
dinat
eandasr
efer
ral
sforsmal
l
er
uni
ts.Theyhav
eresour
cesandpr
ovi
decompr
essi
veandmedi
cal
andsur
gical
ser
vices.
Theyar
emanagedbymedi
cal
supr
etendant
s.Thesub-
count
yhospi
tal
hast
heMOHas
t
heheadofal
lheal
thf
aci
l
iti
esunderi
t.Thehospi
tal
ref
ersi
tspat
ient
stot
hecount
y
hospi
tal
sandi
thast
hef
oll
owi
ngdepar
tment
s;OPD,
inpat
ient
,labor
ator
y,phar
macy
,
t
heat
re,
mat
erni
ty,
MCH,
VCT,
x-r
ay,
heal
thr
ecor
ds,
subcount
yPHO,
hospi
tal
admi
nist
rat
or,
nut
ri
ti
onandki
tchen.Car
eser
viceact
ivi
ti
esatt
hisl
evel
incl
ude:
-
1.Pl
an,
impl
ement
,moni
tor
,ev
aluat
eandpr
ovi
def
eedbackonact
ivi
ti
esf
orcont
inuous
i
mpr
ovement
.
2.St
rengt
henheal
thboar
ds
3.Coor
dinat
einputofdev
elopmentpar
tner
si.
e.NGOsandCBOs.
4.Pr
ovi
det
rai
ningandsuppor
ti
vesuper
visi
on
5.Coor
dinat
e,col
l
abor
ate,
net
wor
k,exchangear
easandpool
resour
ces.
 Nat
ional
ref
err
als-
Bei
ngt
heapexoft
heheal
thcar
esy
stem i
nKeny
a,t
heypr
ovi
det
he
f
oll
owi
ng
1.Dev
elopi
ngst
rat
egi
cpl
ansandi
mpl
ement
ati
onpl
ansf
orl
owerl
evel
act
ion
2.Ensur
ingmul
tisect
orandf
ormercoor
dinat
ioni
nheal
thandr
esour
ceal
l
ocat
ion.
3.Pr
ovi
dingcompl
excur
ati
veser
vices
4.of
fer
ingt
eachi
ngandt
rai
ningser
vices
5.Ensur
ingheal
thi
nfor
mat
ioni
spassedt
oal
ltheKeny
anpopul
ati
on.

11
 Communi
tyDi
agnosi
s
Communi
tydi
agnosi
sist
hepr
ocessofi
dent
if
yingf
act
orst
hataf
fectt
heheal
thofa
popul
ati
onanddet
ermi
net
heav
ail
abi
l
ityofr
esour
ceswi
thi
nthecommuni
tyt
oadequat
ely
addr
esst
hesef
act
ors.
Weconduct
edacommuni
tydi
agnosi
sinRuar
akasub-
count
y,Mat
har
ewar
d,powerv
il
laget
o
assesst
heav
ail
abi
li
tyandusageoft
oil
etsamonghousehol
ds.

-
Wor
kpl
an;t
hisi
nvol
vedmappi
ngt
hev
il
lagewhi
lecount
ingandl
abel
li
ngeachhousehol
d
usi
ng uni
quenumber
sthendi
vi
dingour
sel
vel
vesi
ntosmal
lergr
oupst
ocol
lectdat
a
f
rom t
hehousehol
dsmember
sandcompi
le.

-
Att
endancel
ist
;thr
oughar
esponsi
bleadul
tineachhousehol
d,t
heypr
ovi
dedt
henumber
anddet
ail
s(namesandage)ofi
ndi
vi
dual
sli
vi
ngi
nthehousehol
d

-
Met
hodol
ogy
;Icar
ri
edoutasur
veyt
oensur
ethatal
lthemar
kedhousehol
dswer
ereached
andr
ecor
ded

-
Dat
acol
lect
iont
ool
s;Iusedobser
vat
ionast
hemai
nwayofcol
lect
ingdat
abyl
ooki
ngatt
he
av
ail
abi
li
tyoft
oil
etsathousehol
dsandt
hei
rsani
tar
ycondi
ti
ons

-Fi
ndi
ngsandr
ecommendat
ions;asi
gni
fi
cantmaj
ori
tyofhousehol
dshadt
oil
etsbuti
na
poorhy
gieni
cst
atet
huswer
ecommendt
hecont
inuoussensi
ti
zat
ionont
hebestWASH
pr
act
icesi
nthev
il
lage.CLTSpr
ogr
amsshoul
dal
sobei
ntr
oducedi
nthev
il
laget
oensur
e
pr
operdi
sposalofhumanwast
e.

Compr
ehensi
veSchool
Heal
thPr
ogr
am (
CSHP)
Ipar
ti
cipat
edi
nar
out
inei
nspect
ionofsev
eral
school
sinRuar
akaSubCount
ywhi
chi
ncl
uded
Mat
har
enor
thpr
imar
yschool
inmat
har
ewar
d,Damascussecondar
yschool
inKor
ogocho
war
dandDr
ivei
npr
imar
yschool
inmat
har
ewar
d.Thecondi
ti
onst
oputi
nmi
nddur
ing
i
nspect
ioni
ncl
udedt
hei
nspect
ionofcl
asses;
forpr
operl
i
ght
ingandv
ent
il
ati
on,
sizeoft
he
cl
asst
opupi
l
/st
udent
srat
io,
thecondi
ti
onoft
hebui
l
dingsi
nter
msofbui
l
dingandpai
nti
ng,
numberofpi
tlat
ri
nesandt
hei
rcondi
ti
on,
andwat
ersuppl
y.I
not
herschool
swher
efoodi
s
pr
epar
edf
ort
hest
udent
s,t
heki
tchenwasi
nspect
edf
orl
i
ght
ingandv
ent
il
ati
on,
foodsur
face

12
pr
epar
ati
onar
ea,
utensi
l
ssour
ceofwat
er,
andi
tspal
atabi
l
ity
.Ial
socheckedf
orcooks
medi
cal
cer
ti
fi
cat
esandt
hei
rper
sonal
hygi
eneandi
fthet
eacher
sint
heschool
sar
eTSE
r
egi
ster
edIal
soconduct
edheal
theducat
ioni
nvar
iousschool
sonhandwashi
ngandpr
oper
hy
giene.

Nut
ri
ti
on/di
etar
yassessment
/sur
vey

Anut
ri
ti
onassessmenti
sani
ndept
hev
aluat
ionofbot
hobj
ect
iveandsubj
ect
ivedat
arel
ated
t
o ani
ndi
vi
dual
’
sfood and nut
ri
enti
ntake,l
i
fest
yleand medi
calhi
stor
y.Led byMadam
Mar
gar
etatt
henut
ri
ti
ondepar
tmentatmat
har
enor
thheal
thCent
re,Icar
ri
edoutdi
etar
y
assessmentofpat
ient
sand gr
owt
hmoni
tor
ing ofchi
l
dren.Par
ent
swi
thchi
l
drenhav
ing
abnor
malgr
owt
hcur
vewer
eref
err
edt
onut
ri
ti
oncounsel
l
ingandt
her
apy
.It
ookpar
tint
he
nut
ri
ti
onal
assessmentt
hrought
hef
oll
owi
ng:
-

 Cl
i
nical
hist
ory
-phy
sical
obser
vat
ionofsi
gnsandsy
mpt
omsofmal
nut
ri
ti
on,
muscl
e
wast
ing,
edemaandski
npi
nchi
ngamongchi
l
drenAnt
hropomet
ry.
 Cal
cul
ati
onofbodymassi
ndex(
BMI
)andi
ntegr
ati
ngt
heBMIchar
tforadul
tandMUAC
measur
ementf
orchi
l
dren.
 Di
etar
yint
ake:
Prov
isi
onofdi
etar
ysuppl
ement
ssuchasi
onandf
olat
e(I
FA)f
or
pr
egnantwomen,
vit
ami
nAf
orchi
l
drenunderf
ivey
ear
sandpl
umpynut
ssuppl
ement
s
t
othemoder
atel
yandsev
erel
ymal
nour
ishedchi
l
dren
 Bi
ochemi
cal
assessment
:measur
ingofl
evel
sofi
ron,
zinc,
cal
cium,
iodi
deandsugari
n
bl
oodandur
ine
Mal
nut
ri
ti
oni
sani
mpor
tantpubl
i
cheal
thi
ssuepar
ti
cul
arl
yfort
hechi
l
drenunderf
ivey
ear
s
whohav
easi
gni
fi
cant
lyhi
gherr
iskofmor
tal
i
tyandmor
bidi
tyt
hanwel
l
-nour
ishedchi
l
dren.
Usi
nghechi
l
dren’
scl
i
nical
books,
Iwasabl
etodet
ermi
net
hegr
owt
hpat
ter
nfr
om t
hei
r
pr
evi
ousv
isi
ttot
hecl
i
nic.Mot
her
swhodel
i
ver
edatmat
har
enor
thheal
thCent
rewer
e
encour
agedt
oensur
ethatexcl
usi
vebr
eastf
eedi
ngf
orsi
xmont
hswasadher
edt
o.
Nut
ri
ti
onsuppor
tismanagedbyhousehol
dmember
s,communi
tymember
sandCHWs.
Househol
dmember
sar
eingener
alact
ivel
yinv
olv
edi
npr
event
iveheal
thcar
e.Theyal
so
of
tenmanaget
hecl
i
nical
car
eoft
hecl
i
nical
l
yandchr
oni
cal
l
yil
l
.

13
 Communi
cabl
eandNon-
Communi
cabl
eDi
seases
Communi
cabl
edi
seases
Theyar
einf
ect
iousdi
seasest
ransmi
ssi
ble(
from oneper
sont
oanot
her
)bydi
rectcont
act
wi
thani
nfect
edi
ndi
vi
dual
orhi
s/herdi
schar
geort
hroughi
ndi
rectmeans(
vect
or)
.Themost
commoncommuni
cabl
edi
seasesar
emal
ari
a,t
uber
cul
osi
s,HI
V/AI
DS,
hepat
it
isBandCand
mostr
ecent
lyCOVI
D-19pandemi
c.Amongt
het
opt
endi
seasesatMat
har
enor
thheal
th
Cent
rear
eURT,
tonsi
l
li
ti
s,di
arr
heaandpneumoni
a

Noncommuni
cabl
edi
seases
Theyar
econdi
ti
onsmai
nlycausedbyl
i
fest
yleandt
heyi
ncl
udedi
abet
esmel
l
itus,
hy
per
tensi
on,
cancerandst
roke.
I
nci
dencei
stheoccur
rence,
rat
eorf
requencyofadi
seasei
napopul
ati
onwi
thi
naspeci
fi
c
per
iodoft
imeandpr
eval
encei
sthenumberofnewcases.
Thecausesandt
her
iskf
act
orsandcausesofcommuni
cabl
eandnon-
communi
cabl
e
di
seasesi
ncl
ude:

 Cl
i
mat
eespeci
all
ythecol
dseasons

 Poorper
sonal
hygi
ene.

 Smoki
ng

 Unbal
ancedf
ooddi
et

 Thr
oughcont
act

 genet
ics

Dat
acol
l
ect
iont
ool
s(MOHf
orms)usedar
e;

MOH502–i
ntegr
atedcasesur
vei
l
lancef
orm commonl
yusedwhent
aki
ngsampl
esf
or
ant
hrax,
measl
es,
T.Tandy
ell
owf
ever
.

MOH503–l
i
nel
i
sti
ngf
orm,
usedi
ncaseofanout
breakf
oral
lcont
act
sforeasyt
raci
ng.

14
MOH504–mont
hlyr
epor
tdi
seasesur
vei
l
lance

MOH505–Weekl
yrepor
tdi
seasesur
vei
l
lance

Communi
tyBasedHeal
thPr
ogr
amme
Communi
tyst
rat
egyi
sthemechani
sm t
hroughwhi
chhousehol
dsandcommuni
ti
est
ake
act
iver
olei
nheal
thandheal
thr
elat
edi
ssueswhi
chr
elat
edt
otheappr
oacht
arget
ingmaj
or
heal
thandheal
thr
elat
edpr
obl
emsaf
fect
ingal
lcohor
tsatcommuni
tyandhousehol
dlev
el.I
par
ti
cipat
edi
nacommuni
tybasedheal
thpr
ogr
am f
undedbysav
ethechi
l
drenatmat
har
e
nor
thar
eaandobser
vedt
hatacommuni
tyuni
tismadeupofappr
oxi
mat
ely1,
000househol
ds.
I
tmustbeal
i
gnedt
oanadmi
nist
rat
iveuni
t(subl
ocat
ion)
,ser
vedbyar
ound50CHWswi
th1
CHW ser
ving20househol
ds.Hav
ingaf
unct
ional
communi
tyuni
thel
pst
hePHOt
oeasi
l
y
i
ntegr
atewi
tht
hecommuni
ty.
St
ruct
ureofacommuni
tyuni
t
 Househol
d
 Vi
l
lage
 Communi
tyheal
thcommi
tt
ees
 Heal
thf
aci
l
itymanagementcommi
tt
ee(
FMC)
 Di
vi
si
onal
heal
thst
akehol
der
’sf
orum (
DHSF)

Tof
orm acommuni
tyuni
t,keypeopl
eint
hecommuni
tymustbecont
act
ed.Thear
eachi
efi
s
t
obecont
act
edf
ir
st,
dat
eandav
enuei
ssetf
orcommuni
tymeet
ing.Local
leader
sshoul
dbe
usedf
ormobi
l
izat
ion.
Repor
ti
ngt
ool
s

 MOH513-
househol
dregi
ster
 MOH514-
Communi
tyheal
thwor
kerser
vicedel
i
ver
ylogbook
 MOH515-
communi
tyheal
thext
ensi
onwor
kersummar
y
 MOH516-chal
kboar
dout
sideheal
thf
aci
l
iti
es.
 MOH100-Ref
err
alt
ool
s.
Pest
,Ver
minandPar
asi
tes

15
Themanagementofi
nsectpesti
sav
eryi
mpor
tantconsi
der
ati
onwhendeal
i
ngwi
thpubl
i
c
heal
thandhy
giene.Thepr
esenceofi
nsect
ssuchasf
leas,
cockr
oach,
fleasandant
sin
commer
cial
anddomest
icpr
emi
sesespeci
all
ywher
efoodi
spr
epar
edi
sundesi
rabl
e.Pest
cont
rol
isr
equi
redi
ndomest
ic,
hot
els,
hospi
tal
s,publ
i
cbui
l
dingsandcommer
cial
est
abl
i
shment
swher
efoodi
shandl
ed.Ther
efor
ethecont
rol
ofpest
sini
ndust
ri
al,
domest
ic
andcommer
cial
premi
sesi
sver
yimpor
tantandshoul
dbev
ari
edoutbyat
rai
nedof
fi
cer
.
I
nsect
sofpubl
i
cheal
thi
mpor
tancei
ncl
udel
i
ce,
fli
es,
bugs,
fleas,
cockr
oaches,
rat
sand
l
ocust
s.Thev
ect
orcont
rol
met
hodsi
ncl
ude:
-
 Decont
ami
nat
ion-
aimedatt
reat
mentoft
heenv
ironmentsot
hatpest
scannot
sur
viv
ether
ein.
 De-
rat
ti
ng-speci
fi
cal
l
yai
medatr
odentcont
rol
.
 Di
si
nfect
ion-
speci
fi
cal
l
ytar
get
sdi
seasecausi
ngagent
sandpar
asi
tes.
 Di
s-i
nsect
ion-
speci
fi
cal
l
yai
medati
nsectcont
rol
Mosqui
toescanbecont
rol
l
edby
;
 I
nsect
ici
det
reat
mentnet
s
 Useofi
nsect
ici
des
 Scr
eeni
ngofhouses
 Dr
aini
ngofst
agnantwat
er
 Useofbi
ologi
cal
means
Cockr
oachescanbecont
rol
l
edby
;
o Useofchemi
cal
s(i
nsect
ici
des)
o Adequat
eli
ght
ing
o Cl
eanness
Rodent
sconst
it
uteofasi
ngl
egr
oupofmammal
ssuchasr
atsandmi
ce.Commont
ypesof
r
odent
sincl
ude;
a)Commonr
at-
rat
tusnor
vegi
cus
b)Shi
prat
-r
att
usr
att
us
c)Housemouse-
musmuscul
us
Economi
cimpor
tancet
opubl
i
cheal
thi
ncl
udes:
 Rodent
sdest
royf
oodi
nthef
iel
ds,
war
ehouse,
fact
ory
,housesandr
est
aur
ant
s.
 Rodent
scauseal
otofdamaget
owoodwor
k,wat
erpi
pes,
elect
ri
ccabl
esandar
ti
cles

16
 suchassoap
 Rodent
scancausef
ir
e
 Rodent
str
ansmi
tdi
seasessuchaspl
aqueandl
ept
ospi
rosi
s
 Rodent
scauseal
otofnui
sancebecauseoft
hei
rbi
tes,
droppi
ngsandnoi
se
Cont
rol
ofr
atsi
nvol
ves;
 Useofbai
ts
 Useofchr
oni
crodent
ici
des
 Acut
epoi
soni
ng
 I
Vpr
event
ionofent
ryi
ntobui
l
dingsbyscr
eenwi
ndowsandv
ent
il
ati
onwi
thnet
ti
ngor
gaugewi
re.
 Seal
hol
esi
nwal
l
swi
thst
rongcementmor
tar

Chemi
cal
susedt
ocont
rol
pest
sincl
udedi
odr
inef
orbat
s,py
musf
ormosqui
toes,
sodi
um
chl
ori
def
ordi
sinf
ect
ingsur
facesandker
osenemi
xedwi
thdustbanordi
azol
eforbees.Some
oft
heappar
atusi
ncl
udesknapsackspr
ayer
,pr
essur
epump,
handpump,
andbl
owpump.
Occupat
ional
Heal
thandSaf
ety
Occupat
ional
heal
thandsaf
etyi
samul
ti
-di
sci
pli
nar
yfi
eldconcer
nedwi
tht
hesaf
ety
,heal
th
andwel
far
eofpeopl
eatwor
k.Iv
isi
tedqwet
uconst
ruct
ionsi
teaccompani
edbyMadam Jane,
t
hePHOi
nchar
geatbabadogoar
ea,
wher
eal
lwor
ker
swer
einPPEl
i
ke,
over
all
,hel
met
,nose
masks,
andsaf
etyshoeheadscar
famongot
her
s.Ial
sov
isi
tedHansel
ImpexCompanyand
par
ti
cipat
edi
nOHSi
nspect
ion.Icheckedf
ort
heav
ail
abi
l
ityoff
ir
eext
ingui
sher
sandwhen
t
heywer
elastser
viced,
thepr
esenceoff
ir
esaf
etysi
gnageandawel
l
-equi
ppedf
ir
stAi
dki
t,t
he
cl
eannessoft
hesani
tar
yfaci
l
iti
esandt
heuseofPPEs.Thecompanyhadoccupat
ional
heal
th
pol
i
cieswhi
chwer
erev
iewedwi
tht
imei
faneedar
oseandt
heoccupat
ional
off
icer
swer
e
pr
esentt
ohandl
ecasest
hatoccur
redatt
hei
rwor
kpl
aces.Ial
sohadheal
theducat
ionwi
th
t
hosewhower
enotcompl
i
antatt
heHansel
impexcompany
.
Occupat
ional
heal
thandsaf
etyact2007pr
ovi
dest
hat
:
 Gener
aldut
yoft
heoccupi
erst
oensur
esaf
etyi
nawor
kpl
ace
 Dut
ytopr
epar
easaf
etyandheal
thpol
i
cyst
atement

17
 Pr
ohi
bit
sdi
scr
imi
nat
ionagai
nstempl
oyees
 Est
abl
i
shmentofsaf
etyandheal
thcommi
tt
ee
 Dut
ynott
ochar
geempl
oyeesf
ort
hingsdoneorpr
ovi
ded
 Saf
etyandheal
thaudi
ts,
dut
iesofsel
f-
empl
oyedper
sonsanddut
iesofempl
oyees
 Dut
iesofdesi
gner
s,manuf
act
ures,
impor
ter
swi
thr
egar
dst
oar
ti
clesandsubst
ances
f
oruseatwor
k
 Not
iceofacci
dent
sanddanger
ousoccur
rences

18
 CHAPTERTWO:
PUBLI
CHEALTHENGI
NEERI
NG
Wat
er,
Sani
tat
ionandHy
gienePr
ogr
amme
Washpr
ogr
amspr
ovi
desexper
ti
seandi
nter
vent
ionai
medatsav
ingl
i
vesandr
educi
ngi
l
lness
byi
mpr
ovi
nggl
obal
accesst
oheal
thandsaf
ewat
er,
adequat
esani
tat
ionandi
mpr
oved
hy
giene.Ipar
ti
ci
pat
edi
nvar
iousCLTSpr
ogr
amsi
nKwar
e,Dampi
ngsi
te,
Mat
openi
and
Pi
pel
i
nev
il
lagesi
nMat
har
enor
thwar
dandf
oll
owedt
hest
epsi
nvol
vedi
nbehav
iorchangei
.e.
t
ri
gger
ing,
moni
tor
ingandf
oll
ow-
up.Thest
epsi
nvol
vedi
ncommuni
tyt
ri
gger
ingar
e;
1.Pr
e-t
ri
gger
ing
2.Keyel
ement
soft
ri
gger
ing
3.Def
ini
ti
onofODF
4.ODFt
hir
dpar
tycer
ti
fi
cat
ion
Pr
e-t
ri
gger
ingi
nvol
vesmobi
l
izat
ionandset
ti
ngt
ri
gger
ingdat
es.Faci
l
itat
orsf
rom t
he
communi
tyar
eident
if
ied.Thi
smayi
ncl
udecommuni
tyl
eader
s,womeny
out
hleader
s,r
eli
gious
l
eader
s,CHWsandCHEWsheal
thpr
omot
ers,
heal
thst
aff
,washof
fi
cer
samongot
her
s.
Tr
igger
ing-ef
fect
ivet
ool
sforcommuni
cat
ingbehav
iorchangei
ncl
ude:
 Rappor
tbui
l
ding
 Soci
almappi
ng
 Tr
ansectwal
k
 Shi
tcal
cul
ati
on
 Fdi
agr
am (
usef
uli
ndi
scussi
nghandwashi
ng,
reduct
ionoff
li
esandsmel
l
,sol
i
dwast
e)
 Medi
cal
expensesandl
ossoft
ime/unpr
oduct
ivi
ty
 Par
ti
cipat
orycommuni
tyact
ionpl
ant
owar
dsODF
 Par
ti
cipat
orycommuni
tymoni
tor
ing
Def
ini
ti
onofODF
Noexposedhumanexcr
etawi
thi
nthehousehol
d/communi
ty(
compl
eteabsenceofexposed
f
ecal
mat
tert
hatcanbeaccessedbyhousef
li
es,
whet
heri
ntoi
l
etf
aci
l
iti
es,
chamberpot
s,
sur
roundi
ngbushes/shr
ubsorr
efusedumps.
ODFt
hir
dpar
tycer
ti
fi
cat
ion
Ther
epor
ti
ng,
ver
if
icat
ionandcer
ti
fi
cat
ionshoul
dbedonebyasepar
atebody
/agencyt
o
ensur
erel
i
abi
l
ity
.Fact
orst
obeconsi
der
edandsuggest
iveof
fi
cial
sandagencyt
hatcar
ryout

19
t
hespeci
fi
cfunct
ionsi
ncl
udecommuni
tysel
f-assessmentpr
ocess,
ver
if
icat
ion,
andODF
cer
ti
fi
cat
ion.
Forpr
operunder
standi
ngoft
hedanger
sofOPD,
thecommuni
tymember
sar
egat
her
edf
ora
demonst
rat
ion.Awhi
tedemar
cat
ioni
sdr
awnont
hegr
oundt
omar
ktheboundar
iesoft
he
communi
tyuni
t,abl
uepowderi
sdi
str
ibut
edi
npat
chest
omar
kthedi
ff
erentwat
ersour
cesi
n
t
hecommuni
tyandal
soy
ell
owpowderi
susedt
oshowt
heopenf
ecesi
nthecommuni
ty.
st
onesar
eputi
npl
acet
oshowt
hehousest
henoneexpl
ainshowwheni
trai
nst
hef
ecesi
s
sweptawaybysur
facewat
ert
othewat
erpoi
ntst
husshowi
nghowt
hecommuni
tymember
s
consumet
hei
rownf
ecesl
eadi
ngt
odi
seaseout
breaks.Af
tert
ri
gger
ing,
thecommuni
tyel
der
s
t
aket
hei
nit
iat
ivet
osur
veyt
hosewhohav
etoi
l
ets,
eval
uat
ioni
scar
ri
edoutt
odet
ermi
net
he
i
mpactoft
ri
gger
ingphaseandt
hosewhof
ail
toconst
ructt
hel
atr
inesar
efacedbyl
egal
act
ion.

Wat
erSuppl
yandQual
i
tyCont
rol
Thewat
err
ecei
vedandt
reat
edatKabet
etr
eat
mentpl
ant(
oneoft
hef
ourwat
ert
reat
ment
f
aci
l
iti
esoper
atedbyNai
robi
Cit
yWat
erandSewer
agecompany
-NSWASCO)or
igi
nat
esf
rom
Rui
rudam whi
chi
sabout29km f
rom Kabet
etr
eat
mentpl
ant
.Rui
rudam i
slocat
edi
n
Gi
thungur
i,Ki
ambuCount
yandl
i
eswi
thi
ntheAt
hir
ivercat
chment
.
Thei
ncomi
ngr
awwat
erf
rom Rui
rudam makesent
ryi
ntot
hepl
antv
iat
hreepi
pes;
16i
nch,
12
i
nchand9i
nchdi
amet
er.Thei
nletwor
kshast
wochamber
swher
esomeaer
ati
ont
akespl
ace.
The16and12i
nchpi
pesf
eedsi
ntoonechamberwher
eal
umi
num sul
phat
e(Al
um)sol
uti
oni
s
addedwhi
l
ethe9i
nchpi
pesf
eedsi
ntoanot
herchamber
.Wat
erf
rom bot
hchamber
spasses
t
hroughchannel
about30m l
ongby0.
9m wi
deby1.
1m deep,
alongwhi
chbaf
fl
esar
epl
acedt
o
cr
eat
etur
bul
encei
nor
dert
omi
xthewat
erwi
thal
um sol
uti
on.Thewat
erent
ers
sedi
ment
ati
ont
anks,
tot
hef
il
ter
s,t
other
eser
voi
rthent
othecommuni
tywher
eitsuppl
i
est
o
Kabet
e,Dagor
eti
,andut
hir
uwar
ds
Thecommuni
tymember
sal
souser
ainwat
erhar
vest
edandst
oredi
nst
oraget
anks.Wat
er
t
reat
menti
sdoneusi
ngchl
ori
ne,
andboi
l
ingofdr
inki
ngwat
er.

Ipar
ti
cipat
eint
hecol
l
ect
ionofv
ari
ouswat
ersampl
esf
rom v
ari
oushousehol
dsf
orchemi
cal
andbact
eri
ologi
cal
exami
nat
ions.Thecol
l
ect
ionpr
ocedur
eweusedi
sasf
oll
ows;

Usi
ngcot
tonandspi
ri
tbur
nthewat
ert
apf
orsomemi
nut
est
oav
oidcont
ami
nat
iont
henal
l
ow

20
wat
err
unt
ocl
eant
hemi
croor
gani
sms

 Opent
hebot
tl
eandf
il
li
twi
thwat
erandl
eav
eal
i
ttl
espace.

 Cl
oset
hebot
tl
e

 Label
thesampl
i
ngbot
tl
ewi
thspeci
men

 Fi
l
lthewat
ersampl
i
ngf
orm

 Taket
hesampl
est
othegov
ernmentchemi
stf
oranal
ysi
s

Reasonsf
orwat
ert
reat
menti
ncl
ude;

 Remov
alofphy
sical
impur
it
iese.
g.si
l
t,l
eav
es,
stones

 Remov
alofchemi
cal
impur
it
iese.
g.sal
t

 Remov
alofbi
ologi
cal
impur
it
iese.
g.f
ungi
,bact
eri
a,pr
otozoa

Bact
eri
ologi
cal
anal
ysi
s

Gr
ade1-100ml
wat
erwi
thni
lE.col
iandcol
i
for
ms

Gr
ade2-100ml
wat
erwi
th2col
i
for
m andni
lE.
col
i

Gr
ade3-
100ml
wat
erwi
th24col
i
for
msandni
lE.
col
i

Gr
ade4-100ml
wat
erwi
th1E.col
ii
rr
espect
iveofnumber
sofcol
i
for
ms(
unsui
tabl
efor
dr
inki
ng)

Wat
erActof2016pr
ovi
dest
her
egul
ati
ons,
managementanddev
elopmentofwat
ersour
ces,
wat
erandsewagesser
vices.

Li
qui
dWast
eManagement
Thepr
imar
yobj
ect
iveofl
i
qui
dwast
emanagementi
stopr
otectt
hepubl
i
candt
heenv
ironment

21
f
rom pot
ent
ial
har
mful
eff
ect
sofwast
ewat
er.I
nci
ti
es,
li
qui
dwast
eiscar
ri
edawaybymeans
ofsewage.Thewast
ewat
erneedst
obet
reat
edbecauseofv
ari
ousi
ssuessuchast
he
unaest
het
icandunpl
easantnat
ureofexcr
eta.
Iv
isi
tedt
heDandor
aSewageTr
eat
mentPl
anti
nRuai
andl
ear
nedaboutt
hewat
ert
reat
ment
pr
ocess.Thepl
anthasacapaci
t 000m3perday
yof160, .Thewat
ert
reat
mentpl
anti
nDandor
a
i
sdoneusi
ngt
wodi
ff
erentpr
ocesses.
1.Themechani
cal
process.
2.Bi
ologi
cal
process.
Themechani
cal
processi
nvol
vesv
ari
ousst
agesoft
reat
ment
.
 Coar
sebarscr
eeni
ng-
ithas100mm spacesconnect
edt
oanaut
omat
icr
aki
ngmachi
ne
t
hatr
emov
esupt
o50kgsofwast
e.
 I
nter
medi
atescr
een75mm scr
eenandcupscr
eenswhi
cht
akest
hewast
etoat
rai
l
er
f
ordi
sposal
.
 Gr
itt
rap-
wor
ksusi
ngcent
ri
fugal
for
cewhi
chr
otat
esandt
hesi
l
tset
tl
eatt
hebot
tom.
Thesi
l
tist
henpumpedandt
akenoutusi
ngscr
ewconv
eyor
s.
Bi
ologi
cal
treat
mentt
akespl
acei
npondsandi
thappensaf
termechani
cal
treat
menti
s
compl
etewhenonl
yli
qui
dwast
eisl
eft
.Ther
ear
ethr
eet
ypesofponds:
-
 Anaer
obi
cpondswhi
char
ethedeepest(
5met
ers)whi
char
ethr
eear
rangedi
nser
ies
andhasa5day
sret
ent
ionper
iod
 Facul
tat
ivepondsmeasur
es750by500met
ersandar
e1.
7met
ersdeephav
inga
r
etent
ionper
iodof35day
s
 Mat
urat
ion/aer
obi
cpondswhi
char
etheshal
l
owestandt
oal
l
owt
hepenet
rat
ionof
ul
tr
avi
oletr
ays.Theyar
ear
rangedi
nser
iesof3andhav
ear
etent
ionper
iodoff
ivet
o
si
xday
s.Theymeasur
e500by500met
ersandt
heyar
e1.
2met
ersdeep.Fi
shar
e
i
ntr
oducedher
etodet
ermi
nei
fthewat
erhasenoughoxy
gent
osuppor
taquat
icl
i
fe.
Oncet
reat
menti
scompl
ete,
thewat
eri
stest
edf
orBODbef
orebei
ngr
eleasedi
ntot
heNai
robi
Ri
ver
.Ot
herl
abor
ator
ytest
scar
ri
edoutt
oconf
ir
m qual
i
tyofwat
eri
ncl
ude;
PH,
temper
atur
e,
E.
col
i
,andnut
ri
ent
ssuchasammoni
a,chl
ori
desandphosphat
es.
Sol
i
dWast
eManagement
Sol
i
dwast
eist
hemat
eri
alor
igi
nat
ingf
rom v
ari
oushumanact
ivi
ti
esnor
mal
l
ysol
i
dsorsemi
-
sol
i
dsconsi
der
edt
obeusel
essorunwant
ed.Sol
i
dwast
emanagementai
msatr
educi
ngt
he

22
har
mful
heal
thandenv
ironment
ali
mpact
sofwast
e.Thi
sisachi
evedt
hrough;
 Pr
event
inggener
ati
onofwast
e.
 Pr
omot
ingr
euseofwast
e
 Pr
omot
ingbi
ologi
cal
recov
eryofwast
eandr
ecy
cli
ngmat
eri
al
 Pr
omot
ingener
gyuseofwast
enotsui
tedf
orr
ecy
cli
ng
Wast
ecol
l
ect
edi
nthehospi
tal
skepti
nahol
dingar
eawher
efur
thersegr
egat
ioni
sdone.The
gener
alwast
eist
akent
oadumpi
ngsi
tewhi
l
ethei
nfect
iouswast
eandshar
psar
ebur
nedi
n
t
hei
nci
ner
ator
.Thei
nci
ner
atorbur
nsat750degr
eest
o1000degr
eesmaxi
mum att
hei
gni
ti
on
and1000degr
eest
o1200degr
eesatt
heaf
terbur
ner
.Theaf
terbur
nerbur
nssmokeandash.
Thi
sensur
est
hatt
hesmoker
eleasedi
ntot
heenv
ironmenti
ssaf
eenoughnott
ocausehar
m
t
othepubl
i
c.I
nNai
robi
,thecount
ygov
ernmenti
staskedt
ocol
l
ectandmanagei
tswast
eand
al
sogoesaheadt
ocont
ract
ingpr
ivat
ecompani
est
ocol
l
ectandmanagesol
i
dwast
eint
he
count
y.Mat
har
enor
thr
esi
dent
sdonotsegr
egat
ethei
rwast
eathousehol
dlev
el.Thewast
e
pr
oducedbyt
her
esi
dent
sisbr
oughtt
oget
heri
nonecol
l
ect
ionpoi
ntbyy
out
hswi
thasmal
lfee
t
heni
t’
sloadedt
othecount
ywast
ecol
l
ect
ingv
ehi
clesati
nter
val
sandt
akent
oDandor
a
dumpsi
te.
Ther
ear
esi
xfunct
ional
component
sofwast
emanagementsy
stem asout
li
nedbel
ow:
-
a)Wast
egener
ati
on-
ref
erst
oact
ivi
ti
esi
nvol
vedi
nident
if
yingmat
eri
alswhi
char
eno
l
ongerusabl
eandar
eei
thergat
her
edf
orsy
stemat
icdi
sposal
ort
hrownaway
.
b)Onsi
tehandl
i
ng,
stor
ageandpr
ocessi
ng-ar
eact
ivi
ti
esatt
hepoi
ntofwast
egener
ati
on
whi
chf
aci
l
itat
eeasi
ercol
l
ect
ion.Forexampl
ewast
ebi
nsar
epl
acedatt
hesi
teswhi
ch
gener
atesuf
fi
ci
entwast
e.
c)Wast
ecol
l
ect
ion-
acr
uci
alphaseofwast
emanagement
,incl
udesact
ivi
ti
essuchas
pl
aci
ngwast
ecol
l
ect
ionbi
ns,
col
l
ect
ingwast
efr
om t
hosebi
nsandaccumul
ati
ngt
rash
i
nthel
ocat
ionwher
ethecol
l
ect
ionv
ehi
clesar
eempt
ied.
d)Wast
etr
ansf
erandt
ranspor
t-
aret
heact
ivi
ti
esi
nvol
vedi
nmov
ingwast
efr
om t
hel
ocal
wast
ecol
l
ect
ionl
ocat
ionst
other
egi
onal
wast
edi
sposal
sit
einl
argewast
e
t
ranspor
tat
ionv
ehi
cles
e)Wast
epr
ocessi
ngandr
ecov
ery
-ref
erst
othef
aci
l
iti
es,
equi
pment
’sandt
echni
ques
empl
oyedt
orecov
erbot
hreusabl
eandr
ecy
clabl
emat
eri
alsf
rom t
hewast
est
ream and
t
oimpr
ovet
heef
fect
ivenessofot
herf
unct
ional
element
sofwast
emanagement
.

23
 f
) Di
sposal
-i
sthef
inal
stageofwast
emanagementandi
nvol
vesact
ivi
ti
esai
medatt
he
sy
stemat
icdi
sposal
ofwast
emat
eri
alsi
nlocat
ionssuchasl
andf
il
ls.
I
nfect
ion,
Prev
ent
ionandCont
rol
(IPC)
I
nfect
ionpr
event
ionandcont
rol
isasci
ent
if
icappr
oachandpr
act
ical
sol
uti
ondesi
gnedt
o
pr
eventhar
m causedbyi
nject
ionst
opat
ient
sandheal
thwor
ker
s.I
tpur
posest
oreducer
isks
associ
atedwi
thunsaf
einj
ect
ionpr
act
icesi
ncl
udi
ng:
 Tr
ansmi
ssi
onofi
nfect
ions:
inocul
ati
onofani
nfect
iousagenti
ntot
hepat
ient
’sbody
;
 Par
aly
sis:
inj
ect
ionofadr
ugi
ntoaner
vecanl
eadt
odamageoft
hener
ve;
thi
scan
r
esul
tinweaknessoft
hel
i
mb(
lameness)
.
 Dr
ugr
eact
ion:
abnor
mal
responseoft
hebodyt
oadr
ug.
 Abscess
 Tr
auma
 Deat
h
 Li
ti
gat
ion
AtMat
har
enor
thheal
thcent
erI
PCpr
otocol
sandst
andar
dpr
ocedur
esi
ncl
udeuseofcol
or
codedbi
nsandbi
nli
ner
stosegr
egat
ewast
e,useofPPE’
s,t
rai
ningst
aff
sonI
PCpr
ocedur
es,
cont
roloft
heenv
ironment
,respi
rat
oryhy
gieneandcoughet
iquet
te,i
nci
ner
ati
onofneedl
es
andbur
ningofpat
hol
ogi
calwast
e,chl
ori
ner
ati
o,handwashi
ng, andsaf
etyboxes.Post
exposur
epr
ophy
laxi
sisal
soav
ail
abl
eincasesomeonei
sinj
uredandi
satr
iskofi
nfect
ions.

Conser
vancySy
stems
Conser
vancysy
stem i
swher
eexcr
etaf
rom t
hebodyar
edeposi
teddi
rect
lyt
otheear
thwi
thout
t
heuseofwat
er.I
tal
soi
nvol
vesasy
stem wher
eexcr
etaar
est
oredt
empor
ari
l
ypendi
ng
di
sposal
.Sani
tat
ionpr
ogr
amsmai
nlyai
mtocont
rol
excr
etar
elat
edi
nfect
ions.These
i
nfect
ionscausemuchmor
bidi
tyandmor
tal
i
tyi
nmostdev
elopi
ngcount
ri
es,
mor
esoi
nthe
l
owi
ncomecommuni
ti
es.Exampl
esoft
heconser
vancysy
stemsar
e,t
radi
ti
onal
pit
,vent
il
ated
i
mpr
ovedpi
tandwat
ercl
oset
swher
east
heydon’
thav
emai
npl
ansdur
ingconst
ruct
ioni
.e.a
t
radi
ti
onal
pitcont
ainsapi
t,awoodenf
loorandasuperst
ruct
ure.i
nbabadogowar
d,t
he
publ
i
cheal
thof
fi
cer
sledbyMr
.Kamuy
uandt
heCHWsai
msmai
nlyonpr
event
inghuman
cont
actwi
thf
ecesast
her
ewasev
idenceofpi
tlat
ri
nesi
nsomer
esi
dent
ial
areaswi
thpoor
hy
giene.Sani
tat
ionsy
stemsai
mst
opr
eventhumanheal
thbypr
ovi
dingacl
eanenv
ironment

24
t
hatwi
l
lst
opt
het
ransmi
ssi
onofdi
seases,
especi
all
ythr
oughf
ecal
oral
rout
e.
Communi
tyl
eadt
otal
sani
tat
ion(
CLTS)appr
oachesar
eusedt
oaccel
erat
ethesani
tat
ion
cov
eragei
nthear
eabyf
ocusi
ngondesi
gnandsoci
ocul
tur
ali
ssues.
Hazar
dousWast
eManagement
Att
heNat
ional
Env
ironment
alManagementAut
hor
it
y(NEMA)headquar
ter
sinsout
hCar
ea,
Nai
robi
count
y,wedef
inedhazar
douswast
emanagementast
hecol
l
ect
ion,
treat
mentand
di
sposal
ofwast
emat
eri
alst
hatwheni
mpr
oper
lyhandl
edcancausesubst
ant
ial
har
mto
humanheal
thandsaf
etyort
otheenv
ironmenthazar
douswast
ecant
aket
hef
orm ofsol
i
ds,
l
i
qui
ds,
sludgeorcont
ainedgasesandt
heyar
egener
atedpr
imar
il
ybychemi
cal
product
ion,
manuf
act
uri
ngandot
heri
ndust
ri
alact
ivi
ti
escompani
espr
oduci
nghazar
douswast
ehav
eto
r
epor
ttoNEMAbef
orebegi
nni
ngt
hei
roper
ati
ont
oobt
ainper
missi
onandt
obedi
rect
edont
he
pr
inci
plesofhazar
douswast
emanagement
.Hazar
douswast
ecanbebi
ologi
cal
,chemi
cal
or
phy
sical
.Theyal
sohav
ethef
oll
owi
ngchar
act
eri
sti
cs
 Radi
oact
ive
 Expl
osi
ve
 Cor
rosi
ve
 Fl
ammabl
e
 Bi
ohazar
dous
 Al
l
ergi
c
 Toxi
corpat
hogeni
c
 Asphy
xiat
ing
 Oxi
dizi
ng
 Bi
ohazar
dous
Pr
inci
plesofwast
emanagementwer
easf
oll
ows;
 Gener
ati
on
 Segr
egat
ion
 Col
l
ect
ion
 Tr
anspor
tat
ion
 St
orage
 Tr
eat
ment

25
  Fi
nal
disposal
.
TheKeny
agazet
tesuppl
ementnumber69,
2006cont
ainst
her
egul
ari
zat
ionandpol
i
cies
concer
ninghazar
douswast
emanagement
.Ther
egul
ati
ongi
vesgui
danceon
 Appl
i
cat
ionandr
enewal
ofl
i
censet
oownadi
sposal
orwast
etr
eat
mentsi
te
 Appl
i
cat
ionandr
enewal
ofl
i
censet
otr
anspor
twast
eand
 Gui
del
i
nesf
orwast
emanagement
.
Heal
thcar
ewast
ecanbecl
assi
fi
edasi
nfect
ious,
anat
omi
cal
,shar
pswast
e,chemi
cal
wast
e,
phar
maceut
ical
wast
e,r
adi
oact
ivewast
e,genot
oxi
c(mut
ageni
c/car
cinogeni
c),
pressur
ized
cont
ainer
s,andwast
ewi
thhi
ghcont
entofheav
ymet
als.
Env
ironment
alI
nspect
ion
Anenv
ironment
ali
nspect
ioni
sani
nvest
igat
ionofei
theraper
cei
vednoncompl
i
anceora
compl
aint
,ort
hel
evel
ofcompl
i
ancewi
tht
heenv
ironment
alr
egul
ati
onorper
mit
.Ifapl
anthas
anenv
ironment
alper
mitofsomeki
nd,
theyar
einspect
edatsomepoi
ntdur
ingt
hedur
ati
onof
t
heper
mit
.Inspect
ioncanal
sobedonebef
oret
heper
miti
sissuedoraf
teri
thasexpi
red.Al
so
i
facompl
ainti
srai
sedaboutapl
antoper
ati
onsorenv
ironment
alcondi
ti
ons,
inspect
ioncan
bedone.
Thei
nspect
ionsmost
lyf
ocusoni
ssuessuchasCompl
i
ancewi
thper
mit
,Wat
erqual
i
ty,
or
Hazar
dousmat
eri
alet
c.
Thei
nspect
ionhad4mai
ngui
del
i
nes;
 Pl
anni
ngf
ort
hei
nspect
ion
 I
nspect
ion
 Repor
twr
it
ing
 Act
ionpl
an
 Gi
vi
ngt
hef
eedback
I
nspect
ionpar
amet
ersi
ncl
udeEI
Ali
cense,
li
censef
orai
rpol
l
uti
on,
not
ebooks,
pensand
camer
as.
St
andar
dsf
orsoundmoni
tor
ingi
ncl
ude35deci
bel
sdur
ingt
heni
ghtand85deci
bel
sdur
ingt
he
day
.

Env
ironment
alI
mpactAssessment/
Audi
t

26
EI
Aisacr
it
ical
andsy
stemat
icexami
nat
ionofef
fect
sofapr
ojectt
otheenv
ironmentand
gi
vesmi
ti
gat
ionmeasur
esofi
mpactont
heenv
ironment
.
Thest
agesofEI
Aincl
ude;
 Pr
ojecti
dent
if
icat
ion
 Scr
eeni
ng
 Scopi
ngandconsi
der
ati
onofal
ter
nat
ives
 I
mpactpr
edi
cti
on
 Mi
ti
gat
ion
 Repor
ttodeci
si
onmaki
ngbody
.
 Publ
i
chear
ingandpar
ti
cipat
ion
 Rev
iewt
heEI
A
 Postpr
ojectmoni
tor
ing
Whenar
epor
tissubmi
tt
edt
oNEMAandt
hef
oll
owi
ngar
ecar
ri
edout
 NEMAsendsanacknowl
edgementl
ett
ert
otheexper
t
 Copi
esoft
her
epor
tar
esentoutt
oleadgov
ernmentagenci
esdependi
ngont
hepr
oject
underassessment
.
 I
nthecaseofaf
ull
EIAt
hegov
ernmentagenci
esar
egi
ven30day
stor
espondand14
day
sifi
tdoesnotr
equi
reaf
ull
EIA.
 Foraf
ull
EIAmember
soft
hepubl
i
car
enot
if
iedconcer
ningt
hepr
ojectsot
hatt
heycan
r
aiseanycompl
ainsorpr
obabl
econsequences
 NEMAr
evi
ewst
her
epor
tandmakesr
ecommendat
ionsonwhet
hert
oappr
ove,
rej
ect
ormakeamendment
stot
hepr
oper
ty.
 Al
i
censei
stheni
ssuedt
otheappr
ovedpr
oject
s.
Someoft
hei
ssuest
oconsi
deri
nenv
ironment
ali
mpactassessmentar
e;
a)Ecol
ogi
cal
consi
der
ati
ons
b)Soci
alconsi
der
ati
ons
c)Landscape
d)Landuse

St
rat
egi
cEnv
ironmentAssessment

27
St
rat
egi
cEnv
ironment
alAssessment(
SEA)i
sthepr
ocessbywhi
chenv
ironment
al
consi
der
ati
onsar
erequi
redt
obef
ull
yint
egr
atedi
ntot
hepr
epar
ati
onofpl
ansand
pr
ogr
amspr
iort
othei
rfi
nal
adopt
ion.Theobj
ect
ivesofSEAar
etopr
ovi
def
orahi
ghl
evel
of
pr
otect
ionoft
heenv
ironmentandt
opr
omot
esust
ainabl
edev
elopment
.Iti
sat
ool
anda
pr
ocessf
orev
aluat
ingef
fect
sofpr
oposedpl
ans,
tool
s,andpr
ogr
amsonsoci
al,
economi
c,
cul
tur
alcondi
ti
onsand,
nat
ural
resour
cesaswel
last
hei
nst
it
uti
onal
env
ironmenti
nwhi
ch
deci
si
onsar
emade.SEAt
her
efor
etakesawi
de/br
oadv
iew,
incl
udi
ngt
het
hreesust
ainabl
e
di
mensi
onsaswel
lasi
nst
it
uti
onal
issues.
Thest
ruct
ureofst
rat
egi
cenv
ironment
alassessmenti
sbasedont
hef
oll
owi
ngphases.
 Scr
eeni
ngwher
ebyi
nvest
igat
ionofwhet
herpl
anf
all
sundert
heSEAl
egi
slat
ion.
 Scopi
ngwher
eboundar
ies ofi
nvest
igat
ionassessmentandassumpt
ionsr
equi
red.
 Document
ati
onoft
hest
ateoft
heenv
ironment
.
 Det
ermi
nat
ionoft
hel
i
kel
yenv
ironment
ali
mpact
s.
 I
nfor
mingandconsul
ti
ngt
hepubl
i
c
 I
nfl
uenci
ngdeci
si
onbasedont
heassessment
 Moni
tor
ingoft
heef
fect
s.
ASEAr
epor
tshoul
dincl
ude;
 Thet
it
leoft
her
epor
t
 ASummar
yoft
hepot
ent
ial
signi
fi
canti
mpact
s
 Recommendat
ionf
ormi
ti
gat
ingmeasur
es
TheEnv
ironment
alAnal
ysi
sshoul
dpr
ovi
debasel
i
nei
nfor
mat
ionf
ocusi
ngonpar
ti
cul
arl
y
af
fect
ive
 Rel
evantr
egi
str
ati
onf
rameandr
elat
edpol
i
cydocument
 Summar
yofv
iewofkeyst
akehol
der
sconsul
ted
 Pr
otect
edi
mpact
soft
hepol
i
cypr
ogr
am orpl
an
 Al
ter
nat
ivepol
i
cyopt
ions&compar
isonagai
nstenv
ironment
ali
ndi
cat
ors:
 Ongoi
ngpr
oject&howt
heyf
iti
nthepr
oposedpol
i
cypr
ogr
am orpl
ans.

Pol
l
uti
onPr
event
ionandCont
rol
Measur
ementofpar
ti
cul
atemat
teri
ntheenv
ironmentandai
rpol
l
utant
sincl
udedust
,ash,
gas

28
f
umes,
smokecar
bondi
oxi
deet
c.At
omi
cpar
ti
cul
atemat
terordust
,Occur
sev
ery
wher
e
i
ndoorandi
nwat
ercausedbynat
ural
processes(
sheddi
ngofpol
l
engr
ainsormol
dspor
es
andal
sobyhumanact
ivi
ti
essuchasdr
ivi
ngcar
s,manuf
act
uri
ngt
hingsandev
enj
ustwal
ki
ng
orsoot
ypar
ti
cl
est
hatar
emost
lyt
oxi
cwhent
heyar
esmal
l10mi
crons.
Theai
rpol
l
utanti
ncl
udet
hef
oll
owi
ng
 Sul
furdi
oxi
de/
sul
fur
icaci
d
 Car
bondi
oxi
de
 Ni
tr
ogenoxi
de
 Di
esel
exhaust
 Pol
ycy
cli
car
omat
ichy
drocar
bons
Ther
ear
etool
susedt
omeasur
etheamountofpol
l
utant
sint
heai
rsuchast
hemobi
l
eai
r
sensor
s.Noi
sel
evel
sshal
li
ncl
ude60deci
bel
sdur
ingt
hedayand35deci
bel
satni
ght
.

Cl
i
mat
eChangeandHeal
th

Madam Mar
yMuneneatMat
har
enor
thdi
seasesur
vei
l
lancedepar
tmentt
ookmet
hrough
cl
i
mat
icchangeandnegl
ect
edt
ropi
cal
diseases.Theshi
ft
ingcl
i
mat
iccondi
ti
onsaf
fect
humansonmanyl
evel
s.Fori
nst
ance,
global
war
mingmaybr
ingsomebenef
it
sindi
ff
erent
ar
eassuchf
ewerwi
nterdeat
hint
emper
atecl
i
mat
esaswel
lasi
ncr
easedf
oodpr
oduct
ioni
n
ot
herar
eas,
theov
eral
lheal
thef
fect
sofcl
i
mat
ear
eov
erwhel
mingl
ynegat
ive.Cl
i
mat
echange
af
fect
senv
ironment
alandsoci
aldet
ermi
nant
sofheal
th-saf
edr
inki
ngwat
er,
cleanai
r,secur
e
shel
terandsuf
fi
ci
entf
ood.
Hi
ght
emper
atur
erai
sest
heozonel
evel
saswel
lasot
herpol
l
utant
sint
heai
rthati
ncr
ease
car
diov
ascul
arandr
espi
rat
orydi
seases.
I
next
remeheat
,pol
l
enandaer
oal
l
ergenar
ehi
gh.Theycant
ri
ggerast
hma.
Cl
i
mat
iccondi
ti
onshav
eanadv
erseef
fectonwat
er-
bor
nedi
seasesanddi
seasest
ransmi
tt
ed
t
hroughsnai
l
,insect
sandot
hercol
dbl
oodedani
mal
s.Changei
ncl
i
mat
ewi
l
lpossi
blyl
engt
hen
t
het
ransmi
ssi
onseasonsofv
ect
or-
bor
nedi
seasesaswel
lasal
tert
hegeogr
aphi
crange.
Someoft
henegl
ect
edt
ropi
cal
diseasesar
e;schi
stosomi
asi
s,ascar
iasi
s,hookwor
minf
ect
ion,
t
rachoma,
denguef
ever
,lepr
osy
,Af
ri
cansl
eepi
ngsi
cknesset
c.
Cl
i
mat
echangeaf
fectsoci
alandenv
ironment
aldet
ermi
nant
sofheal
th,
cleanai
r,saf
edr
inki
ng
wat
er,
suf
fi
cientf
oodandsecur
eshel
ter
.