1. INTRODUCTION
A Health Center is a fore-front unit in echelon of public health adminstration, that is responsible among others for implementation of environmental sanitation programmes in a community. Its role as a bulwark against diseases has been given more and more recognition.
When one is preoccupied with daily routines, however he is most likely to lose sight of the goal previously laid down, and therefore it may be necessary to review the objectives of the environmental sanitation programmes and to evaluate the accomplishments in the light of these objectives.
This report is an outcome of ´a survey on various facets of emvironmental sanitation activities performed by 166 health centers throughout the country during the year of 1967. An effort has been made to collect, analyse and summarize various data of sanitation activities and to define potential problems that may have been encountered in the course of the implementation of the programmes. For comparison, similar data available from other countries were entered wherever deemed appropriate.
Ⅱ. DISCUSSION
The report deals with six sub-fields of environmental sanitation; namely, water sanitation, sewage disposal and stream pollution, human excreta and refuse disposal, insect and rodent control and other environmental pollution control. Each subject is looked upon as a separate treatise. Some of the points on discussion are as follows:
In the subject of water sanitation, the importance of providing safe water in sufficient quantity can not be too strongly emphasized, from the view of public health point. Water quality standards are reviewed and the role of health centers in bringing in the community plenty of wholesome and safe water was discussed. The urban and rural water supplies were reviewed and the extent to which the-health centers participate in the project of developing and improving community water supply systems was considered.
In the subject of sewage disposal and stream pollution control, attention was called to perceptable degradation of stream water quality due to urbanization and industrialization. Analytical data on stream water samples taken at various points along the stretches of several of important rivers were presented. The minimum required water quality standards should be established with due regards given to the expected present and future use of the water. Co-operation among authorities concerned with abatement of stream pollution seems to be essential in carrying out a successful water quality management program.
In the subject of human excreta and refuse disposal, potential hazards caused by these wastes were discusand as a permanent and surest measure to cope with the problems created by insanitary handling and disposal of these wastes, it is suggested that the watercarriage systems reinforced with adequate sewer construction and maintenance and with sewage treatment where needed shall be introduced for urban communities. Methods of collecting, transporting and final disposal of garbage and other housefold refuse are briefly described. As to the proper storage of refuse at households, including provision of sanitary garbage bins and etc., intensive health education programmes should be depended on.
III. CONCLUSIONS
Environmental sanitation is the prevention of diseases by means of controling or eliminating the environmental factors that form links in the chain of transmission, and the success (and the failure too) of the programmes depends largely on determined devotion the sanitation workers will have demonstrated to the programmes.
The primary functions of a health center, so far as environmental sanitation is concerned, may be stated as follows:
1) It is the health center whose responsibility it is to plan overall environmental sanitation programmes for the community for which it is intended to serve. It acts as a co-ordinating agent among such a diversified. group of, authorities and organizations as water works, sewerage works, street cleaning, city planning and etc., each doing its share of contribution either directly or indirectly to the promotion of sanitation !standards of the community.
2) The health center is in most cases an agent that promotes health of the community by means of actively creating and maintaining sanitary facilities in the community, specially in rural areas. Among the facilities are public wells, small piped water supply systems, public toilets, and other excreta disposal facilities. Continuous surveilance on these facilities as well as general conditions of the community shall be undertaken by the health center, too, and any defects shall be remedied.
The followings are some of findings from this evaluation study:
1) Safe water supply seems to be of less concern to a urban health center than rural one. Visits to water works and inspection of water supply systems by health authorities were not done in many part of the urban communities.
2) About half of the rural type health centers surveyed has some programmes leading to improvement of rural water supply schemes.
3) Health centers are found to show very little, if any, interest in the community sewerage works and proper treatment and disposal of spent water. There seems to be lack of understanding in health centers, of the significance of proper waste water disposal upon the overall effect of health of the community.
4) More intensive programmes for improvement of such basic sanitation as toilet construction, composting etc. shall be emphasized in health centers.
5) Sanitation labor teams shall be organized in each health center and they should carry out systematic insect and rodent control programmes The importance of community organization for this program also has been overlooked.
6) Much time and energy have been spent by the most health centers inspecting various business premises such as food establishments, inns, hotels, bath houses, barber shops, and beauty parlors. Number of inspections on these so called licensed business places exceeded that laid down by regulation as the minimum.
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