Health  

Still a long walk to environment without open defecation

Public toilets

“Pay for shit? I cannot try that.” These are the exact words of Abdul when he was queried by The Guardian for practising open defecation. Abdul is a motor boy that fled his home when herdsmen attacked his village. He found succour on the Apapa-Oshodi Expressway, now turned trailer park. According to Abdul, he left home since 2016 living on the streets of Lagos before he got himself a job as a motor boy. Abdul said they spend weeks on the road thereby making it difficult for them to take care of their hygiene properly.

Abdul claimed he is not aware of the public toilet facilities at Mile 2. However, he said it made no difference because he would not stress himself looking for a public toilet when he could openly do his ‘business’. Abdul said many others like him openly defecate too.

When The Guardian visited Second Rainbow, FESTAC first gate, Mile 2 down to Coconut bus stop, it was observed that open defecation is a norm; they make use of items like nylon bags, tins, and takeaway plates to defecate and dump them it by the roadside.

Open defecation is the human practice of defecating outside rather than into a toilet. People may choose fields, bushes, forests, ditches, streets, canals or other open space for defecation. They do so either because they do not have a toilet readily accessible or due to traditional cultural practices.

According to statistics from the United Nations Children’s Fund (UNICEF), about 892 million (12 percent of the global population) are still practising open defecation. Of those who still practise open defecation, 90 per cent of them reside in rural areas of three regions: sub-Saharan Africa, Central Asia, and Southern Asia.

However, the UNICEF noted that there is a drop in the number of people practising open defecation, except for sub-Saharan Africa where Nigeria has 47 million people defecating in the open and ranks second in the world and the highest in population in Africa practising open defecation.

To change the narrative, concerted efforts are being made by the federal government of Nigeria and the UNICEF to end open defecation by 2025 and achieve universal access to safely manage sanitation by 2030.
Health implications

Consultant, Public Health Physician, Nnamdi Azikiwe University, Awka, Anambra State, Prof Ifeoma Modebe, said the scourge of open defecation necessitated the most recent effort “Make Nigeria Open Defecation Free by 2025 National Road Map”.

She said that excreta-related diseases include viral hepatitis, poliomyelitis, cholera, dysenteries, typhoid, paratyphoid, trachoma, hookworm, and ascariasis.

“These diseases are not only a burden on the community in terms of sickness, mortality and low expectation of life but a basic deterrent to social and economic progress,” Modebe added.

She continued: “Diarrhoea and other problems associated with the ingesting and exposure to human waste affect children under the age of five years the most since they are very susceptible to diseases. This exposure is because most of the open defecation happens next to waterways, drainage systems, and rivers.

“Such areas are often preferred because open defecators have a belief that the water washes away their waste. What they seem to forget is that most of such areas are not properly empowered to treat the water to remove human waste and the microbes that move with it.”

Modebe said the saddest fact about disease transmission caused by open defecation is the cyclic nature of problems.

“With diarrhoea, people cannot make their way to distant places due to the urgency of their calls of nature, so they pass waste close to where they have their bowel attacks. This leads to more people catching diseases and fewer people using the facilities. The result of this is more sick people and more opportunities for the disease to spread,” she added.

The expert said open defecation also leads to vector-borne diseases.

“When human waste collects into heaps, it attracts flies and other insects. These flies then travel around the surrounding areas, carrying defecate matter and disease-causing microbes, when they then land on food and drink, people go ahead and ingest unknowingly. In such cases, the flies act as direct transmitters of diseases such as cholera,” Modebe added.

The public health expert said that a proper disposal of human excreta, therefore, is a fundamental environmental health service without which there cannot be any improvement in the state of community health.

She added that exposure to excreta-related diseases, which are passed on due to the lack of proper sanitation, and hygiene leads to loss of fluids and lack of appetite for food.

Modebe noted that it is worsened by intestinal worm attacks passed through the human refuse.

She continued: “Altogether, these problems lead to stunted growth weakened immune system susceptibility to other diseases such as pneumonia and tuberculosis.”
Environmental and ecological implications

Founder, Friend of the Environment, Joanna Maduka said that open defecation is very unsightly, it smells and it is nasty. The product destroys the ecosystem where it is passed. “All shrubs and low growing plants are completely destroyed!”

Maduka said that the environment also suffers as a result of open defecation because it introduces toxins and bacteria into the ecosystem in amounts that it cannot handle or break down at a time, which leads to building up of filth.

She noted also that load of microbes can become so great that in the end, they end up in aquatic systems thereby causing harm to aquatic life.

“It can contribute to the formation of algal blooms that form disgusting scum on the surface of the waterways which disturb aquatic life underneath the water by preventing oxygen and light diffusion into the water. It carries any infection, it can affect humans badly especially if there is any contact with the faeces. Faeces become toxic when it dries thus affecting both human and other living beings in the areas,” she added.

The environmentalist said that heaps of human faeces or just the sight of it cause an eyesore and nauseate anyone who is close, stressing that the odour emanating from the refuse is also highly unappealing and pollutes the surrounding air making such places to attract large swarms that make the area completely unattractive for the eye.

She continued: “For all those unfortunate to see the regions affected, it creates a sorry sight and reduces the dignity of all those living in the squalor of those regions. The smells augment the problem by disgusting those who live within the affected regions making life awful.”

Challenges
According to findings, a lack of improved toilets facilities is a major cause of this menace. Nigeria needs to add two million toilets per year between 2019 and 2025 to achieve the target of universal basic sanitation. However, Nigeria’s current delivery of improved toilet is approximately 160,000 per year.

Modebe said that poverty makes it a challenge to build latrines coupled with lack of government support providing such facilities.

The expert added that cultural issues related to sharing toilets among family members and pleasure in using toilets that is filthy or not clean is fueling the menace.

Elsewhere
As a result of strong political commitment from the Indian government, the country, between 2014 and 2019, has reduced open defecation from 550 million people to less than 100 million people. The government committed about $20bn to aid the fight against open defecation. Indian tagged the campaign Swacch Bharat Mission (SBM). Also, Indonesia has dropped from the second position to fourth. Bangladesh has from the seventh position moved to an open defecation free country and Nigeria has climbed from the sixth position to second and it is expected that Indian will hand over to Nigeria the first position by October 2, 2019.

Cost implications
Nigeria loses about N455 billion of Gross Domestic Product (GDP) annually due to poor sanitation as a result of illness, low productivity and loss of learning opportunities.

Studies have shown that frequent episodes of Water Sanitation and Hygiene (WASH)-related diseases cause absence from school or work, as affected people take time off to heal and some to take care of a sick relative. Also, there is reduced school enrolment and attendance due to time lost in the search for water and frequent episodes of WASH-related illness.

According to UNICEF, open defecation results in loss of dignity, increased risk of insecurity and violence against women and children. It noted that one in four children under the age of five exhibit severe stunting, while one in 10 is wasted due to frequent episodes of diarrhoea and other WASH related illness.

According to UNICEF, more than 100, 000 children under five years of age die each year due to diarrhoea, of which 90 per cent is directly attributed to unsafe water and sanitation and Nigeria is the second country with the highest children deaths due to diarrhoea.

Burden
According to WASH National Outcome Routine Mapping (NORM) survey, 64 per cent of Nigerians have access to basic drinking water services, 42 per cent have access to basic sanitation, and 24 per cent practice open defecation. The report noted: “20 per cent have fixed lace for hand washing with soap and water, six per cent school have gender sensitive WASH services, five per cent of health facilities have basic gender sensitive WASH services, 12 per cent markets, and motor parks have basic WASH services, 11 per cent suffered diarrhoea in the past six weeks, 76 per cent are children under five.”

The WASH-NORM survey was conducted by the National Bureau of Statistics in collaboration with UNICEF.

The reality of open defecation across the geopolitical zones showed that North Central is 53.9 per cent, North East 21.8 per cent, North West 10.3 per cent, South East 22.4, South-South 17.9 per cent, and South West 28.0 per cent. This implies that one out of every four Nigerians defecate in the open, while one in two persons defecate in the open in north central. Out of 774 local government areas only 13 are open defecation free.

Modebe continued: “Women are often at more risk of experiencing violence and multiple health vulnerabilities. Women with poor sanitation facilities are more susceptible to hookworm infestation resulting in maternal anemia, which in turn is directly associated with adverse pregnancy outcomes. They suffer from diarrheal diseases, a leading cause of under-nutrition among women during their reproductive age.

She added that the interaction between disease and under-nutrition could further uphold the vicious cycle of worsening infection and deterioration of women’s health, particularly in pregnant women.
Efforts

To address the scourge, UNICEF organised a media dialogue on sanitation tagged “Clean Nigeria: Use the Toilet” to equip journalist on the necessary tools to canvass and drive the needed awareness to end open defecation.

Also, the Federal Government of Nigerian recently declared a state of emergency on open defecation. Moving forward, ‘Clean Nigeria: Use the Toilet’ campaign launched its website on March 22, 2019, www.cleannigeria.ng. The campaign is an initiative to address the issue of open defecation in Nigeria and develop a strategy to end open defecation in Nigeria by 2025.

Acting Coordinator, Clean Nigeria: Use the Toilet Campaign, of the Federal Ministry of Water Resources, Chizoma Opara, noted that the Federal Executive Council (FEC) approved the Clean Nigeria campaign with a secretariat to drive the campaign and also constituted a technical working group for the Clean Nigeria Campaign.

She said the ministry planned and sent delegates to India to understudy the SBM on how India was able to move more than 400 million out of open defecation. Opara stated that strong and high-level politics played a crucial role in the implementation of the SBM.

According to her, the SBM focused more on behaviour change than on latrine construction with the huge government financial commitment of $20billion to the campaign.

The Acting Director added that communication strategy was developed which guided implementation of the behaviour change campaign.

She called for the development of a proposal, policy, coordination, advocacy and communication, programme implementation, monitoring, evaluation, finance and resource mobilization.

Opara said that when the team came back to Nigeria, a National Stakeholder Retreat was held to discuss and adopt a national proposal in which the recommendations from the retreat are being incorporated into a strategy for the implementation of the Clean Nigeria campaign.

She said the campaign requires leadership and commitment at the highest political level with development partner’s support.

Mobile toilets

Opara continued: “This is a transformational movement; it is what we want to use and tackle the issue of open defecation in Nigeria. 47million Nigerians still defecate in the open and Nigeria is second behind Indian. Indian is working towards ending open defecation and Nigeria is still saying we cannot take that position. We want to also end open defecation so that we will not end up there and the first step we have taken is to find out how they (India) did it within a short time. Within four years, they were able to move more than 400 million people from open defecation and also what are the structures they put in place to be able to do that.

“We sent a memo to the FEC on the 8th of May and there was approval given to actually push the ‘Clean Nigeria: Use the Toilet’ campaign and part of the approval is that the president will launch and flag off the campaign.”

Furthermore, she said that on May 27, 2019, they also had the official opening of the secretariat, which is at number 3 Benghazi Street Wuse Zone 4.

She added: “What we also discussed in that retreat was for states to link to the whole campaign. There would also be a unit within the states that will be linked to the federal so that we have good reporting on the progress being made. The website has been open and that will also make the public to actually follow the progress that is being made to end open defecation in Nigeria.”

She added that the India government was building toilet for households. Opara explained: “But for us here, there are models that we have piloted, we have seen good results, and the community-led total sanitation, which has been implemented within the few Local Government Areas (LGAS).

“They have been piloted, 13 of them are Open Defecation Free (ODF), and this is an indication that it is doable. All we need to do now is to scale up, have more campaign and awareness creation and everybody be on board.

“UNICEF led a focal discussion sometimes and when that happened in a few states, many people were not even aware of 47million who are defecating in the open. What we actually need is awareness creation. Let people know that it is a habit that Nigerians need to stop.”

“In some of ODF LGA, they all try to work together to achieve that including the issue of homeless people. In the case of mad people, they have families. Chain your mad people or face the consequence. Looking at the homeless let us mount our campaign and have legislation and sanctions. We are just starting I know we would get there,” she added.

The acting coordinator said the roadmap has already been launched by the Minister of Health in 2016, “In terms of coordinating policies, incidentally, the Honorable Minister has started something, the Minister had a dialogue with fellow Honorable ministers like Education, Health, Environment, Budget, and Planning, he has been discussing with them on how to move the WASH sector forward and achieving the Sustainable Development Goal (SDG) goals. We hope when the new ministers come on board, they will continue in that direction,” she said.

She harped on Public-Private Partnership (PPP) saying, “Looking at the PPP arrangement, we believe it will also go a long way. You are aware if we build toilets and there is no maintenance, nobody will use them, and for it to be maintained, it means some form of stipend can be paid to ensure that somebody cleans the toilet and that person is paid from there.

“That is the angle we are looking at it from. That is more sustainable than government; having provided toilet still put somebody there to maintain it. We have started discussion with some private organisation to see how they can take up the WASH as some form of Social Corporate Responsibility because we know the government cannot do it alone. We are also calling on individuals to assist the government.”

In terms of awareness creation she added: “We have started creating more awareness and the federal government has started building public toilets to be handed over for proper management. We are also exploring the sanitation marketing whereby individuals can build toilets and make money out of it. Sanitation marketing is building up; we have sanitation marketing under the projects that are being supported by UNICEF.

“We have in Jigawa, Katsina, Benue and Bauchi where sanitation marketing has actually picked up and the entrepreneurs are doing well. With the sensitisation, in most of the places where the open defecation practices were thriving, the people are now triggered to action, and some of them have gone into the sanitation marketing, ensuring that their community is open defecation free.”
Going forward

WASH specialist, Bioye Ogunjobi said that the focus for the Clean Nigeria campaign is to get 47million Nigerians to use the toilet, stop open defecation and increase access to improved sanitation especially in the rural communities.

Ogunjobi highlighted that the approach was community-led total sanitation, sanitation marketing, sanitation financing, WASH in institutions and schools, PPP for public places.

He said the clean Nigeria drive should prioritise sanitation on federal and state governments’ agenda/budget, the release of WASH funding, make laws that promote safe hygiene, implement ODF roadmap at the state and LGAs levels as well as call for behaviour change through community dialogues, and information dissemination through the mass media and other available channels. Increase investment in sanitation and Invest in sanitation market/corporate social responsibility.

The WASH specialist stressed the importance of those things like ODF documentary, radio jingles, and video skits-promoting safe defecation, KabuKabu series to entertain while educating the public on the importance of improved sanitation.

He stressed the need for strong political commitment in leadership at all levels to improve sanitation and end open defecation and increased budgetary allocation. Ogunjobi also recommended increased support from the media for dissemination of behavior change, institutional advocacy and increased coverage of human interest story on sanitation. He also called for increased collaboration among development and civil society organisations working to improve sanitation and end open defecation, improve private sector engagement through business investment and corporate social responsibility, and sanitation and hygiene awareness creation through branding and promotion.

Similarly, Deputy Director, Head, Child Right Information Bureau, Federal Ministry Of Information And Culture, Olumide Osanyinpeju, said open defecation is incredibly dangerous, as contact with human waste can cause diseases such as cholera, typhoid, hepatitis, polio, diarrhoea, worm infestation and undernutrition.

He said that is why UNICEF has been at the forefront of ensuring that we have access to safe drinking water supply, adequate sanitation and proper hygiene in our environment and communities.

Osanyinpeju noted that the government recently declared a state of emergency on WASH Nigeria and launched an ODF campaign strategy to jump-start the country’s journey towards ending open defecation.

He explained that the campaign is one of the most ambitious behaviour-change campaigns in Nigeria with a strong citizen public engagement component.

“The campaign against open defecation is a key initiative that will reach many underserved populations. Leveraging on what is currently working in the states with Local Government Areas’ certified ODF. This campaign mode will create a national movement with elements of policy advocacy, public advocacy, grassroots mobilisation, and private sector engagement,” he added.

The Deputy Director said sanitation is essential to the survival and development of children because it reduces the severity and impact of malnutrition.

He continued: “It can also help in reducing the spread of intestinal worms, as well as promoting dignity and boosting safety, particularly among women and children. Sanitation standards are intended to ensure that people do not suffer adverse health effects that could occur if toilets are not available when needed.

Proper sanitation facilities promote health because it allows people to dispose of their waste appropriately,”

Osanyinpeju said the Partnership for Expanded Water, Sanitation and Hygiene (PEWASH) programme was formulated and launched in 2016 in direct response to the challenges affecting the rural WASH sector, with the aim of achieving 100 percent WASH coverage in rural areas. The Federal Ministry of Water Resources with support from UNICEF, in partnership with Inter-Ministerial Agencies, Civil Society Partners, the Private Sector, and the people of Nigeria is currently leading the ODF campaign to end open defecation in the country by 2025, and achieve universal access to safely manage sanitation by 2030.

He continued: “There is a need to increase awareness about the impact of open defecation in Nigeria. Media is a strong vehicle to communicate the message. End ODF and WASH programmes were integral parts of SDG 6. It is, Therefore, critical, to intensify efforts in tackling them. The Nigerian Government has made some progress towards achieving the SDG 6 and eliminating inequalities in the WASH sector.

“It is against this backdrop that the process recognised that there is dire need to constantly leverage on media alliance in this process because the media is a critical partner in achieving success in the WASH and End ODF programmes.”

Osanyinpeju said the media dialogue on sanitation and the campaign to end open defecation, therefore, is aimed at creating awareness about “Clean Nigeria: Use the Toilet” campaign, and mobilize resources to sustain the national movement.

He called for its behavior change and policy reform through the community, dialogues to raise public awareness by setting agenda for children issues within the framework of child rights stating that it also creates a deeper understanding of the needs of children among people, government and institutions, while defining the role of the society in meeting those needs.

The deputy director added: “As journalists being presented with facts of data on the status of sanitation in these areas, I enjoin you to use the medium at your disposal to educate the populace with the sanitation situation in Nigeria, with particular reference to child development. You are to ensure that children issues are reported in a way that would elicit responses from different levels of stakeholders, causing them to meet their obligations to children as duty bearers. You should respect, protect, project and fulfill the rights of children, as you are equally duty bearers to set agenda, use narratives and give voice to issues concerning children.

“You are also to use your expertise to increase the knowledge among community members to upgrade Local Government Areas’ WASH Units, and Departments, and strengthen the capacity to implement rural WASH projects. You will be required to review and generate human-interest stories for publication, create visibility for WASH interventions, and donors. It will go a long way in realizing the objective of UNICEF in realizing the rights of all children to help them build a strong foundation and have the best chance of fulfilling their potential. On this note, therefore, I wish to urge you all to sustain actions beyond the meeting, to aggressively create more awareness on Sanitation issues, “Clean Nigeria: Use the Toilet” to bring about the desired change intended for this course.”

Maduka tasked Government and Civil Society Organisations (CSOs) to take it as a major issue the problem of open defecation.

She said The CSOs must do a lot of advocacy to convince a community with the government financing the projects that will end this nasty practice.

“Interestingly, I was involved with a community where everybody used to do what they called ‘short put.’ After encouraging them to build toilets, it became an uphill task to make them use the facilities as habits die-hard. When the people got used to the facilities, they became healthier and the environment became much cleaner,” she said.

Maduka continued: “However, attention must be paid to the rest of the sanitation chain especially water supply, maybe by proving borehole facilities. The terrible air pollution due to the smell of the defecation became a thing of the past.”

Modebe called on the need for the action of individuals and intervention of the government to address the cultural, economic and social challenges in tandem.

She said that due to poverty, government and Non Governmental Organisations (NGOs) could help communities in constructing toilets.

“Governments should establish incentives for people to build their own toilets by providing subsidies and putting up public toilets in strategic locations and by creating government programs that encourage sanitation and personal hygiene, individuals must be involved and forced to take up the responsibility of enhancing their hygiene as well as overall health,” Modebe added.

She noted that through such programmes, people could get to learn the importance of their environments and work towards ensuring that they do not harm themselves by partaking in open defecation because it eventually reduces healthcare burdens on the government and lessens the number of those who practice open defecation, as it will be seen as a terrible activity.

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