15/04/2026
ENVIRONMENTAL HEALTH: A MISSING PIVOT IN NIGERIA'S NATIONAL PRIMARY HEALTH CARE DEVELOPMENT AGENCY
By OSUNBODE Olawale
The National Primary Health Care Development Agency (NPHCDA), established in 1992, is mandated to strengthen Nigeria’s primary health care (PHC) system, ensure equitable access to essential health services, and coordinate national health programmes. Over the past three decades, the agency has recorded notable achievements in immunization coverage, polio eradication, and maternal and child health. However, despite these gains, a critical gap persists in its operational framework—the inadequate integration of environmental health as a core pillar of PHC. This omission undermines the preventive foundation of PHC and contributes significantly to Nigeria’s persistent disease burden.
Environmental health, as defined by the World Health Organization (WHO), encompasses all aspects of human health determined by environmental factors, including water quality, sanitation, air pollution, waste management, and housing conditions (WHO, 2018). Its primary focus is prevention—identifying and controlling environmental risks before they result in disease. Globally, environmental risk factors account for approximately 24% of the disease burden, with even higher estimates in developing countries such as Nigeria (WHO, 2019). These realities underscore the centrality of environmental health to any effective health system.
The philosophical and operational basis for PHC was established in the Alma-Ata Declaration, which emphasizes universal access, equity, community participation, intersectoral collaboration, and appropriate technology (WHO & UNICEF, 1978). Environmental health aligns seamlessly with these principles. For instance, PHC elements such as safe water supply, basic sanitation, prevention of endemic diseases, and health education are inherently environmental in nature. Interventions like waste management, vector control, and water sanitation are essential to preventing diseases such as cholera, malaria, typhoid fever, and diarrheal illnesses.
Despite this alignment, environmental health remains marginal within the NPHCDA framework. Institutionally, there is no clearly defined department or division dedicated to environmental health within the agency’s structure (NPHCDA, 2025).
Programmatically, the agency’s focus is heavily skewed toward vertical interventions such as immunization and disease-specific programmes, reflecting a selective rather than comprehensive PHC approach. While these interventions are crucial, they do not address the root environmental determinants of health.
The consequences of this gap are profound. In Nigeria, environmental risk factors contribute to nearly 29% of the national disease burden, with millions lacking access to safe water and sanitation (WHO, 2019). Approximately 47 million Nigerians still practice open defecation, increasing vulnerability to waterborne diseases. Poor environmental sanitation has been identified as a major driver of communicable diseases, including cholera and diarrheal illnesses (Federal Ministry of Environment, 2025). These conditions disproportionately affect children under five, reinforcing cycles of morbidity and mortality.
The WHO framework on environmental health further highlights the need for integrated, multisectoral action. Environmental health responsibilities include monitoring environmental risks, enforcing regulations, promoting safe water and sanitation, controlling pollution, and addressing climate-related health threats (WHO, n.d.). These functions require strong collaboration between health, environment, water, and urban development sectors. However, within the NPHCDA, such coordination remains weak or fragmented, limiting the effectiveness of PHC interventions.
This gap also extends to the PHC workforce. Environmental health officers—key actors in implementing sanitation, hygiene, and environmental safety measures—are significantly underrepresented, constituting only a small fraction of PHC personnel (University of Ibadan, n.d.).
Additionally, challenges such as inadequate training, removal of environmental health tutors from formal schemes of service, and irregular remuneration further weaken this cadre (Tribune Online, 2022; Environmental Health Council of Nigeria, 2025). The marginalization of these professionals reflects a broader systemic undervaluation of environmental health within Nigeria’s health system.
Furthermore, the lack of environmental health integration contradicts the PHC principle of intersectoral collaboration. Effective PHC requires coordinated efforts across sectors such as water resources, sanitation, housing, and agriculture. Initiatives like Nigeria’s One Health approach demonstrate the potential for such collaboration, yet they remain insufficiently embedded within NPHCDA’s core programming. Without institutional mechanisms to support these linkages, environmental health challenges persist unchecked.
Importantly, environmental health interventions are highly cost-effective. Preventing disease through improved sanitation, clean water supply, and pollution control is far less expensive than treating illnesses after they occur. By under-prioritizing environmental health, the NPHCDA risks increasing long-term healthcare costs and undermining progress toward universal health coverage.
To address this critical gap, several strategic actions are necessary. First, the NPHCDA should establish a dedicated Environmental Health Division to oversee sanitation, water quality, and environmental risk management. Second, environmental health indicators should be incorporated into PHC monitoring and evaluation systems to guide evidence-based decision-making. Third, the environmental health workforce must be strengthened through training, recruitment, and improved welfare. Fourth, genuine multisectoral collaboration should be institutionalized, linking the health sector with environmental and sanitation agencies. Finally, community-based environmental health education should be expanded to promote sustainable behavioral change.
In conclusion, environmental health is not a peripheral concern but a central pillar of effective primary health care. Its limited integration within the NPHCDA represents a significant structural and programmatic weakness in Nigeria’s health system. Aligning WHO-defined environmental health responsibilities with PHC principles and elements is essential for reducing preventable diseases and achieving sustainable health outcomes. Re-centering environmental health within the NPHCDA is not only necessary but urgent for advancing health equity and national development.
*References*
Environmental Health Council of Nigeria. (2025). 12 months unpaid salary: Collapse of preventive health care system looms. The Authority News.
Federal Ministry of Environment, Nigeria. (2025). Minister prioritizes environmental health, sanitation over vaccines. Naturenews.africa.
National Primary Health Care Development Agency (NPHCDA). (2025). The mandate. https://nphcda.gov.ng�
Nigeria Health Watch. (2022). WASH in PHCs – How fulfilling evidence gaps contributes to improved policy and practice.
Tribune Online. (2022, May 19). Experts raise concern over possible dearth of environmental health professionals. Nigerian Tribune.
University of Ibadan. (n.d.). Health manpower availability in PHC facilities in FCT, Nigeria.
World Health Organization (WHO). (2018). Preventing disease through healthy environments: A global assessment of the burden of disease from environmental risks. Geneva: WHO.
World Health Organization (WHO). (2019). Global strategy on health, environment and climate change. Geneva: WHO.
World Health Organization (WHO). (n.d.). Health and the environment.
World Health Organization (WHO), & United Nations Children’s Fund (UNICEF). (1978). Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR.
The National Primary Health Care Development Agency (NPHCDA) is a parastatal of Nigeria’s Federal Ministry of Health.
