Tackling Sanitation and Hygiene Challenges beyond Policies

Omolabake Fasogbon in this report, writes about individual’s quota to the quest to hygiene and sanitation challenge and expedite the attainment of Sustainable Development Goal six in Nigeria

With Water, Sanitation and Hygiene (WASH), status in Nigeria abysmally low, it is that obvious that efforts have to be more than doubled by all stakeholders to reach a commendable height.

This is particularly important where the United Nations Sustainable Development Goals (SDGs), which hygiene and sanitation is a crucial item, inches close to the 2030 deadline.

The 2030 UN Agenda recognises the centrality of sanitation and hygiene in the progress of other sectors of the economy, including health, education and poverty reduction.

As a matter of fact, SDG six which places premium on access to WASH for all, is considered a key driver of economic growth, which also provides leverage for existing investments in health and education.

Afterall, it is being said that health is wealth, just as the World Health Organisation (WHO) has conditioned good health as the prerequisite for sustainable development.

Sadly, WASH status in Nigeria has followed a retrogressive pace between 2018 and now, judging from the Water, Sanitation and Hygiene National Outcome Routine Mapping (WASH -NORM ) report.

The WASH -NORM survey being conducted by the National Bureau of Statistics in collaboration with the Federal Ministry of Water Resources and United Nations says only 11 per cent of Nigerian population have access to complete basic WASH services in 2018.

In 2019, the percentage dropped further to nine percent, a situation which experts believed posed a great risk to public health.

In 2018, a state of emergency was declared in the Nigerian WASH sector, which as a result attracted a number of interventions to the sector. Inspite of this support, the sector is still begging for attention.

For instance, the federal government came up with several initiatives to improve access to water and sanitation, which included construction of over 2,300 additional water points as well as 6,546 sanitation compartments and hygiene facilities across the country.

Most recently is the approximately $10 million donation that the United Nations Children’s Fund (UNICEF), received from the United States Agency for International Development (USAID), in support of Nigerian government’s initiative to improve WASH services in three Nigerian states, namely Kebbi, Sokoto and Zamfara.

According to UNICEF, 46 million Nigerians do not have access to proper sanitation while access to safe hygiene facilities nationwide is extremely low at 16 per cent.

This situation is interestingly sad given the era of COVID-19 that has reinforced the importance of adequate and safe water, basic sanitation and proper hygiene practices to stem the tide of the disease in the country.

Poor access to WASH services has been reported to be the major cause of diarrheal morbidity and mortality in Nigeria, which is also associated with at least 70,000 deaths in children under five each year.

But beyond government actions and or inactions, experts say more can be done at individual’s corner to support government’s efforts and expedite the attainment of the SDGs on sanitation and hygiene.

They recognise proper hand washing and effective toilet usage &cleaning as cheap and effortless exercise to deal with the demands of sanitation and hygiene.

Experts say individuals observing these with discipline at their private corner would avert a lot of emergency health issues, save cost for developmental projects and consequently bolster economic performance.

Specifically, the WHO noted that proper hand washing and toilet hygiene which are usually taken for granted are important aspects of life that will speed up the attainment of SDGs.

94 Percent Nigerians do not Practice Proper Handwashing – UNICEF

Relevant reports have shown a decline in how Nigerians observe proper hand washing. The most recent report from UNICEF says 94 percent of Nigerians do not wash their hand properly. This further puts the country at a disadvantaged position as far as WASH is concerned.

While lack of access to water has becomes a major hitch to fulfilling handwashing precaution, report says that those with access to adequate water are equally guilty.

Acknowledging lack of running water in most Nigerian homes as a fall back to proper hand washing measure, Consultant Pediatrician, Dr. Efunbo Dosekun, noted that a special bucket with a tap at the bottom comes as a good alternative.

She said, “If clean, running water is not accessible, as is common in many parts of the country, use soap and available water but you must not wash your hands in one bucket. If soap and water are unavailable, use an alcohol-based hand sanitiser that contains at least 60 per cent alcohol to clean your hands.”

According to her, the hands are the most exposed part of the body where germs are concerned, which when properly washed will yield a 40 per cent reduction in Acute Respiratory Infections, ARI, especially amongst children and prevent many other diseases including the ravaging COVID-19.

Quoting the Centre for Disease Control, CDC, Dosekun enlightened on five steps involved in proper hand-washing and they include “Wet your hands with clean, running water (warm or cold) and apply soap; Rub your hands together to make lather and scrub them well; be sure to scrub the backs of your hands, wrists, between your fingers, and under your nails; Continue rubbing your hands for at least 20 seconds. If without a timer, it advises you hum the “Happy Birthday” song from beginning to end twice; Rinse your hands well under running water; Dry your hands using a clean towel or air dry them; and After washing your hands properly, the CDC advises you use a fresh cloth or paper towel to dry your hands completely. Then use the towel as a buffer between your clean hand and the tap to turn off the water.”

A General Practitioner, Dr Safiyaat also recommended that hands should be washed after defecation and after almost every activity for good hygiene.

Diseases from Dirty Toilet Kill Women Every 40 Seconds – Water Aid

Indeed, Nigeria has since suffered inadequate toilet facilities to the extent that it was tagged the number one open defecation nation globally, after which is India. Report says over 10 million households or 50 million Nigerians still defecate in the open.

More worrisome is poor sanitation practices or toilet usage that put Nigerians, especially women
at risk of toilet diseases and other infectious ailments. According to WHO, two in three people in the world are in danger of disease because they don’t have access to a clean and safe toilet.

A new analysis released by the international development organisation, WaterAid further puts it that diseases linked to dirty water and lack of safe toilets are the fifth biggest global killers of women.

According to the analysis, diseases from dirty toilet causes more deaths among women than diabetes, HIV/AIDS or breast cancer, taking a woman’s life every 40 seconds.

UNICEF further clarifies that not just lack of access to basic sanitation facilities, but poor hygiene practices has made diarrhoea, the second largest direct cause of childhood deaths in Nigeria.

Away from government roles, experts reckon that the function of a clean and hygiene toilet rests on individuals at home, schools, church and every other public place where government policy does not really interfere.

And just like handwashing, it is on record that many who have access to a toilet facility do not know the proper and ideal way to clean the toilet, such that meet the standard for safety and hygiene.

This knowledge gap alone has cost Nigeria up to N455 billion according to the Convener of Clean Up Nigeria Campaign, Adepeju Jaiyeola, who added that 70 million Nigerians live in pitiable sanitary conditions.

According to CDC, Feaces, either from people or animals is an important source of germs like Salmonella, E. coli O15 and norovirus that cause diarrhoea, and able to spread some respiratory infections like adenovirus and hand-foot-mouth disease.
It is also said that a single gram of human faeces can accommodate as much as one trillion germs, hence, the need for extra care of the toilet.

Towards Clean, Germ Free Toilet

In one of its publications, a house cleaning firm, Molly Maid enlightened on effective steps to toilet cleaning, using a toilet cleaner or vinegar to make it harmless and germ free.

It explained thus- begin by applying toilet cleaner to the bowl, and allow it to soak. If you’re using vinegar in place of toilet cleaner, simply pour a cup into the bowl. Quickly swish the cleaner around the bowl with a brush;

“While the cleaner soaks in, spray the exterior of the toilet with an all-purpose disinfectant. If the toilet is extra dirty, give it a preliminary wipe-down with paper towels and toss them in the trash;

“Next, use a scrub sponge to clean the exterior of the toilet. Pay attention to the base and floor around the toilet while you’re there. If you have a modern toilet with a quick-disconnect toilet seat, remove the seat and clean it separately;

“Once the exterior is clean, use a toilet brush to clean the bowl. If you have hard water rings or stains, use a pumice stone to remove these;

“You know the area underneath the rim where water pours out? Since this is out of sight, many people don’t scrub it. Don’t ignore this area! Use your brush or sponge to clean the underside of the rim.”

The Good Housekeeping Institute also advised that toilet be washed at least once a week. “But if there are people with bugs or small children around, then daily,” it suggested.

In doing this, experts cautioned against the use detergent to get rid of toilet germs and recommend toilet cleaner instead.

This is because in addition to toilet cleaner destructive ingredients, it also comes with a soap base (Surfactants) that aids washing. But also, an Hong Kong based Medical Doctor, Dr Ademola Adeoye warned against the idea of mixing toilet cleaner with bleach which has been a common practice amongst households lately.

According to him, the effect has proven counter productive and deadly to human health away from the intended benefits.

Adeoye informed, “Some toilet cleaners contain hydrochloric acid and ammonia. Mixing bleach and ammonia-based cleaners create gases called chloramines. Mixing acid-based toilet cleaner is also very dangerous, the action of NaOCl on these detergents will cause the release of chlorine gas. Chlorine gas mixed with water will increase the hydrochloric acid content which is quite dangerous, you should know the dangers of acid burns.

“Asides from that, the chlorine gas can irritate the mucous membranes of the nose and eyes and affect breathing. Death is far-fetched but the mixture is definitely harmful,” he said.

The use of toilet paper to clean the anus after defecation has also been widely condemned. Providing more clarification on this, a General Practitioner, Dr Safiya Ojo once said, “It is better to wash with water than use toilet paper after defecation because water washes completely without a trace, whereas toilet paper might not wash completely or properly.

“The paper particles can attach to the surroundings of the anus which can bring discomfort, while water washes off everything, leaving you clean and fresh.”

Bridging Knowledge Gap in Hygiene Practices

Government at different tiers have been advised to complement policies and initiatives with constant enlightenment on safe practices to aid the attainment of SDG six.

This safe practice is particularly advocated for sanitation and hygiene to curb diseases spread.

In the words of UNICEF’s Chief Officer in charge of WASH, Mr Kannan Nadar, “it is not enough to drive initiatives when the a larger percentage of the beneficiaries are oblivion of what and what not to do”. According to him, reaching the SDG target on sanitation requires that current efforts be multiplied by 15.

Nadar affirmed that there had been a gap between knowledge and attitude in hygiene promotion practice, hence, called for behavioural change in practices.

“Such situation could be reduced with proper hygiene promotion messages. Nigeria needs to scale up its hygiene promotion strategies to enable it become a social norm”, he said.

He added that stakeholders would need to develop simple, better and cost effective messages that would enable more Nigerians change their behaviours towards hygiene promotion.

The UNICEF chief also put it to private sector and academic institutions to make use of their platforms to promote safe hygiene messages and support WASH interventions in underserved communities.

In the same vein, the Country Director of WaterAid Nigeria, Chichi Aniagolu-Okoye worried that a lack of hand washing promote programmes have aided inequalities and place individuals at higher risk of contracting diseases with adverse impact on their health, education and livelihoods.

She said, “To accelerate to 2030 and leave no one behind, it is crucial that we move quickly from policy to practice. Ensuring access to hygiene facilities is necessary but not the only step.