 I work for the Ministry of Health as an environmental health practitioner. I've been doing this work for the last 25 years. I look very young I know but I have the experience. I did 15 years at community level and I've been with the policy formulation aspect within the last 10 years so I think we can. I'm here just to take you through what actually the liberal declaration is and what is all about and what informed the liberal declaration and why the concern and they ended up being the liberal declaration in 2008. Like you all know environment is one of the primary determinants of health. Individual and community health for that matter and when you talk about the environment you're talking to the physical, the chemical, the biological, the chemical and the biologic risks in the environment that can harm human health and then like you all know that data has shown that nearly a quarter of all that's in Africa are reportedly due to environmental causes and this is from the WHO and I just wanted to share with you this picture just to show you how the environment actually impacts human health and the issues that we actually look at when you talk environmental determinants of health and you talk we talk to issues of air pollution in adequate water and sanitation and hygiene issues chemicals including biological agents, radiation, community to noise, occupational risks that the labor aspect, agricultural practices including pesticide use, water reuse and thereof built environments, housing and roads and climate change so those are some of the impacts it's not all of them they're not this is not an exhaustive list but this is just to give guidance on what isn't that we talk about we talk about the environmental determinants of health because if you break down all these elements you'd realize there's so much more actually within each component right from air pollution down to climate change that you need to take into consideration as you assess issues of environmental determinants of health and then that this is just to show you the impact globally of the environmental disease burden it's at 24 percent and this is information from the 2022 2022 global strategy on health environment and climate change as developed by WHO and you can see that as the Africa region we are at at least 2.5 million people die from environmental disease burden annually um the liberal declaration um the liberal declaration was conceptualized in 2008 by UNEP and WHO and it was led by the african ministers of health and environment taking to cognizance the effects that the environmental determinants of health have on the ultimate health of the people and like I've already said before most of the issues that we're battling with were what you call infectious diseases like I said that other slides or the the pictogram that I showed do not actually was not included did not indicate issues of infectious disease or communicable diseases as we talk as we discuss them and when you talk infectious or communicable disease we include zoonotic diseases so that is how we discuss it from the health perspective and then the other issues are like what we we know the traditional issues and other issues like air pollution, tobacco smoke and chemicals are driving the disease burden when it comes to SCDs nowadays and estimated 28 percent of all prematureness attributed to environmental um factors in the african region and that is why the ministers of health and environment specifically got together to say what is it that we can do what strategy can we come up with to actually manage the health and environment uh risks and the other thing that was quite pivotal in the establishment of the the declaration was that 60 percent of the vital ecosystem ecosystem services of the planet are being degraded hey or are being subjected to excessive prejudice that is the services that maintain the quality of life i mean the quality of air land and water resources were actually being impacted and these are the top 10 courses of death from the environment um and that and this is in the african region we can see that it's ischemic um ischemic heart diseases and here we are talking issues of which are which are which are contributed by air pollution and then chronic respiratory diseases it's also issues of air pollution here as well and then the various cancers i mean we use a lot of pesticides a lot of chemicals uh irradiation exposures you can name it those are some of the contributing factors to cancers and then your unintentional injuries especially within the labor sector or occupational health um issues and um respirator infections we know we talk about tb people usually assume that tb it's not environment related but the how part of the how you live how you survive um the alias speakers talk to issues of health going beyond just just about the physical aspect but it's more about the environment that one lives in so you find that diseases such as the tv is promoted primarily about where the one person resides or the kind of housing structure that that person lives in that real disease we know that it's it's it's um it's my mainly contributed to by issues of water sanitation and hygiene malaria vector bond diseases the neglected tropical diseases that were being discussed earlier diabetes is an ncd where people live uh realize that they don't even have space to actually any physical activity so those are some physical activity and they don't even have a small patch of land where they are able to grow their own food for survival or to keep healthy if i'm important that way and then the neonatal conditions here we are talking issues of um uh in in certain environments we'd realize that there's what you call klepsiola in the hospital settings and it's been found that most neonatal conditions are caused by this particular um pathogen which is as a resultant from poor uh hygienic conditions within the hospital settings and liberal deterioration itself had 11 action points and in conceptualization which was establishing health and environment strategic alliances that is taken to cognizance the institutions existing institutions within country to see how best can we ensure that even though these institutions exist how do we bring them together to ensure that they fit back i must i must each other and then those development of the national frameworks development or strengthening is other you develop as a country you strengthen what is that is existing to close their gaps um poverty reduction through national environment program because we know that in the africa region we are hard hit by poverty and we cannot ignore it when we discuss issues of health and environment and then the capacity building of health and environment institutions or organizations this is one of the key action areas as well promote knowledge acquisition that is research around health and environment issues that's why we brought in academic and research institutions to actually facilitate or support this particular aspect to see what is it that they are doing and then establishment of and strengthening of health and environment surveillance systems we know that a lot of institutions do have surveillance systems but the instance the the surveillance systems don't actually fit back on each other you'd realize that health has its own surveillance system aggregate um what do you call it we call it agriculture back home so i'm used to i want to say animal health has its own surveillance system wildlife has its own surveillance system ecosystem health has its own surveillance system we never sit down together to say how best can we manage the issues that are emanating from the surveillance systems that we have or how do we fit back and that is why the liberal declaration kind of advocated for and then there was it also advocated for the establishment of national mechanisms for assessing compliance to conventions treaties and protocols for protection of human health here what actually happened was that the the the declaration takes cognizance of existing conventions treaties and protocols globally that talks to protection of the health and environment so we have to ensure that if countries are signatories to these protocols conventions and treaties that ensure that there is compliance to it how far are we as a country with regards to compliant to that and then there was establishment of this establishment or strengthening of national monitoring and evaluation mechanisms like i said earlier there are surveillance systems there are many systems within countries but the information is not shared amongst the sectors and then the where there was need there was need to establish systematic assessments for evaluation of health and environment risk layer for example i believe you are all aware of the environment environmental outlook reports i know that a lot of countries used to do them i don't know if you are most of the african countries are still doing but this is one way of as establishing the risks from this establishing the risks as outlined always guided by the liberal declaration and then it also advocated for development of partnerships and advocacy programming amongst these institutions these organizations and then ensuring establishment of budget allocations for instant intersectoral collaboration so if countries had always in place or if countries did a situation analysis needs assessment they would come with the appropriate national joint plan of actions to actually address these issues or a plan that would say going forward as Botswana as country acts this is how we are going to do it and then i'm just going to give you a Botswana perspective this is the country coordinating mechanism or the country coordinating team in Botswana it's made up of diverse departments organizations civil society civil society organizations uh academic institutions and you name it and it's coordinated by the ministry of health and the ministry of environment and commitment by these ministries was done at ministerial level like i said before and before we did anything we had to sit down and identify what you call or identify the environmental determinants of health or the environmental risks in Botswana that impacted on human health so as this team they we sat together we did that and and came up with our risks internal risks and rated them accordingly and then like i said there was an established country coordinating mechanism and it has about 35 members but we keep on adding where there is need we realize that there are gaps or areas which are not really and it's more of a whole of government approach it's a more of a whole of government approach it's not only limited to the ministry of health and the ministry of environment um we had like i said we identified the risk and then we brought in everybody concerned to help us drive the national plan of joint action and then the multi-sexual the team is multi-sexual and multi-sexual and multi-disciplinary team and the team developed its own terms of reference to say how are we going to be functioning what are the issues of consent which are informed by the situation analysis that was conducted progress so far in Botswana we undertook the situation analysis and needs assessment and that is the report that we did in 2013 and developed the national plan of joint actions and in 2022 the Africa region updated its strategy the liberal declaration updated that strategy so in 2023 we decided as a country that we are going to review our situation analysis and needs assessment so we are right now in the process of reviewing the situation analysis and needs assessment and that is 10 years later we are about to complete it uh we're in the middle last week to actually do this to do the review um and what are the opportunities or benefits it's effective actually for the management of environmental risk across sectors cost effectiveness it's much cheaper for government because you bring everybody who needs to be there together to actually make decisions whether it be in policy or not so ever and then there's no duplication of efforts use of collaboration and partnerships right now if you add all there's an issue you know exactly who to contact who to talk to in another sector within another ministry and then the benefits are obviously when you have a healthy environment you're looking at a healthy population challenges and limitations yes there are those that still don't understand the concepts and there are several approaches to certain health and environment issues and then we still have limited funding we are yet to have a appropriate funding mechanism because the whole essence of this liberalism is that it be anchored at the highest level like in the VP's office for example so that is what we are saying so we are yet to sign MOUs to ensure um all the members involved actually commit to what is that he said and it's currently being led at technical director's level and our hope and which it should is that we should be at the level of the VP's office and this is just to say in closing adoption of a one health approach which is a holistic cross-sectional and is highly recommended in the implementation of the liberalism to ensure effectiveness of the health and environment strategic alliance and this is a quote from the regional strategy for the africa region of 2022 thank you