By Timeyin Uwejamomere
Several comments have been expressed with respect to the way the various governments in Nigeria – Federal and States have responded to the advent of the corona virus infection. Some people feel the response is not adequately home grown, that the level of poverty in the country and the desire to meet our food needs will flush people into the streets. Others have suggested the need to strengthen the distribution of palliatives to ensure it reaches those who truly need it, particularly the 70% of Nigerians considered poor, as well as those missing out on their daily income opportunities. Charles Soludo, former Governor of Nigeria’s Central Bank, recently revealed statistics from a 2007 study he conducted, showing that only 8% of the bank accounts had balances of NGN300,000 (then over $2,500) and above, accounting for 95% of total deposits, while adding that a more recent study revealed that only 2% of bank accounts had NGN500,000 (about $1,300) and above[i]. With some 80% of the African population “living from hand to mouth on daily toil and hassle”, the Professor of Economics and a member of President Muhammadu Buhari’s Economic Advisory Team suggested a relaxation of the lockdown. Thankfully the Federal Government has taken advice on this matter and has announced a gradual relaxation of the lockdown from Monday, May 4, 2020. We shall find out about the efficacy of this decision in the next few weeks.
We have also heard of the dilemma before citizens, who live without running water, being bombarded with TV and social media messages urging them to wash their hands at critical times for at least 20 seconds under running water. In a country where 51 million Nigerians drink directly from unsafe surface water sourced from ponds, stagnant streams, rivers, or even unprotected water holes, and shallow hand dug wells, and only 7% of Nigerians (12 million people, just about half the current population of Lagos) actually have access to the treated water supply from the various State water boards on their premises as at 2015, handwashing under running water is impractical. A recent World Bank study in rural Nigeria established that handwashing practice is positively correlated with availability of water supply. Simply put, about the same number of Nigerians, without safe water supply, does not practice handwashing. Very closely related is the fact that just about this number of Nigerians does not have safe places to defecate, 112 million persons. In fact, about 47 million Nigerians defecate in the open.
These statistics are worrisome and sit right in the epicenter of, and drive, the corona virus trajectory. Findings from a recent study in China, adds a new mix into the handwashing debacle. Chief of these findings is that the corona virus, after it has been killed and eliminated from the lungs or respiratory system, lives on in the human digestive system and can be present in the faecal waste of former patients for up to three (3) weeks. The report stopped short of confirming that after discharge from the isolation or treatment centers, former corona virus patients can infect people through their poo. As we intensify contact tracing, we await a confirmation of the first faecal-oral transmission case, either of former patients or their close neighbours. Something we know however is that former COVID-19 patients can also be re-infected, as recently confirmed by the World Health Organization (WHO).
Faecal-oral transmission of infections has always been a global heath burden, particularly to developing countries’ governments who unfortunately seem unperturbed by it. At least not as much as developed countries’ governments who have shown more concern for issues of safe water, safely managed sanitation and hygiene (WASH), as the proven remedy to faecal-oral transmitted diseases. For instance, before you finish reading this piece, over five children would have died from diarrhea in Nigeria alone. The latest figure from the Nigerian Bureau of Statistics[v] is that 200 children under-5 die every day in their mothers’ arms, without the paparazzi or media blitz that COVID-19 enjoys. COVID-19 has killed 35 persons in Nigeria, in the 6 weeks after the first index case arrived in Nigeria. In that time, 8,400 children and 4,900 adults, a total of 13,300 Nigerians would have died from diarrhea. Yet, no Presidential Task Force. No special budget. No private sector-led coalition working to address the water and sanitation issue. Why? Diarrhea is a poor persons’ disease? Mostly poor mothers, who in our rural communities or urban slums, cry alone burying their children. Just to make it further clear, 200 children every day amounts to over 70,000 children every year. When you add on the adult population, we have over 117,000 deaths from diarrhea in Nigeria every year.
I have gone to this length to make one central point; in the long term, the COVID-19 pandemic can only be substantially managed by one thing – a focused attention to improved water supply, sanitation and hygiene. Together, these basic services provide the best remedy and protection against the virus, in combination with social distancing and the use of mask. Vaccine will help with stemming the virus but ultimately sanitation and hygiene will be the game changer, for developing countries. As we have been told, vaccines are necessary; however variants of the corona virus will emerge in future and require further new vaccines. As we have seen with diarrhea, the most effective solution is to cut out the four (4) faecal-oral routes of infection – our fingers, fluids, flies and fields, by establishing improved safe water supply, adequate sanitation and hygienic practices such as handwashing.
It would be essential therefore, in taking a long term view, to consider the multiplier effect of adequate water supply, safely managed sanitation and hygiene practices can have on focusing the lessons of the over four weeks of humanitarian work of the Presidential Task Force and informing the discussions and emerging plans under the Stabilisation Committee and the proposals expected from the Minister of Finance on how the proposed investment of NGN500 billion earmarked for responses to COVID-19 should be applied. The third Presidential Address on April 27, 2020 gave some hope when President Buhari said the government had reviewed how we can reopen the economy or send children back to school but stopped short of telling us if the government has considered how we would make water and sanitation available to Nigerians. Hence it did not give us an indication of any attention being paid to this dire need of getting people running water and safe sanitation to ensure the virus does not get into our mouths, noses and eyes.
Our focus on the humanitarian response to the pandemic is excellent. My take is that we need both the humanitarian response and the more development-based response of improving the supply of safe water, safely managed sanitation and hygiene practices. The humanitarian response should, as is already the case in some quarters, include such interventions as the provision of handwashing infrastructure and soaps; facilitation of handwashing practices in public places including offices, markets and hospitals; social responsibility interventions from private sector partners for slums and rural areas; public education and palliatives targeted at those at the bottom of the economic pyramid; and a coordination platform involving all major stakeholders in the WASH Sector – FMWR, CSOs, INGOs/Development Partners, private sector, individuals/consultants. No doubt, this government has shown the highest level of leadership for improving water, sanitation and hygiene (WASH) than any other previous governments in Nigeria, with President Muhammadu Buhari launching, on November 8, 2018, the National Action Plan for the revitalization of the water supply, sanitation and hygiene sector. This indicates a foundation for a more development focused response to COVID-19. The challenge is in how to fully implement the National WASH Action Plan as a strategic response to COVID-19.
The dilemma with improving WASH services is not only that you have to make the investments and build the infrastructure, but that it involves two other equally important and reinforcing activities – one, being the building and strengthening of systems and the other being the promotion of behaviour change. Now that we have had a global and, more relevant for us, a national campaign to change our hygiene behaviour, we must ensure we take advantage of the momentum to strengthen our systems and make the commensurate budget and investments available to build and expand our WASH infrastructure. The rest of this paper will address these two issues.
To build and strengthen systems, we must go back to States and Local Governments (i.e. if we still have what we can call local governments). The chain is as strong as its weakest link they say. Nigeria’s greatest challenge in the delivery of water and sanitation services has been the sub-national governments, particularly the States governments. Many of our Governors have failed to take the bull by the horn, be responsible and do right with respect to providing basic water and sanitation infrastructure. Nigerians must also agree that we have not held the governors accountable on this matter, or on any matter in fact.
Under the Federal Constitution, states have the responsibility for water supply, sanitation and hygiene. Unless our State Governors act up, we shall never meet the dream of providing safely managed sanitation and water supply to every Nigerian by 2030 and eliminating open defecation by 2025, a global commitment Nigeria signed up to under the Sustainable Development Goals and for which the National WASH Action Plan articulates a strategy for implementation, as approved by the Federal Executive Council.
As a matter of urgency, States must review their water and sanitation delivery systems and realign these to present day realities, making them fit for purpose. The State Ministries, Departments and Agencies responsible for these services must be overhauled. Systems-strengthening involves several key building blocks as identified by a variety of approaches. These include baseline measurement and data for planning, capacity building, adequate investments, district-wide planning, water resources planning, infrastructure development and asset management, and regulation, accountability and annual performance monitoring.
This list, where adequately pursued has transformed the performance of the WASH sector in several developing countries and was a major trigger in the development trajectory of the Asian tigers. A focus on district-wide planning, investments in WASH and housing infrastructure and capacity building unleashed development and triggered economic prosperity in Singapore, South Korea, Malaysia and Thailand[vii]. A similar trajectory is taking place in Ghana, Ethiopia, Kenya and Senegal.
We cannot use the same public utilities and work force which has been held back for over 20 years to achieve this goal. At the least, we will need to retrain, reorient and infuse the current public utilities with fresh knowledge and modern techniques and capacities. A recent study in one water utility found the average age of public utility staff to be over 50. Very few competitive recruitments have been conducted for the leadership of Nigerian utilities in many years. An attempt to do this in the said utility didn’t end well. Political interference must stop. Where a Governor is willing, and their Commissioners are undermining the process is not helpful and vice versa.
The next key issue is funding. It is estimated that we need an investment of US$1.3 billion (2.5% of GDP) every year, over the next 10-12 years to deliver the National WASH Action Plan. The reality however is that the Federal Government’s investments in the sector has been falling, from US$607.5 million in 2006 to US$136.2 million in 2009. State Governments’ investments have shown a rise but not quite in expected dimensions to meet the gap, from US$411 million in 2006 to US$670 million in 2009[viii]. Although a substantial part of the expected rise in revenue must come from government budgets, citizens also have a role to play. A World Bank study[ix] shows that Nigeria’s state water boards (SWB) need an estimated US$600 million of investments annually but are held back from taking a substantial chunk of the US$700 million a year received in revenues by informal water vendors through a regime of bottlenecks imposed by State and political interference. When water supply is seen as political dividend and the operation of an efficient tariff and revenue collection systems is frustrated, utilities fail. State institutions – police, military and paramilitary barracks, government offices and establishments are in debt to water utilities to the tune of multiple billons, dating back decades. Only 18 of 35 SWBs (51%) were reported to issue bills to customers albeit with tariffs not reviewed in many years, according to the study.
We must build and build and build water and sanitation infrastructure. The development and construction of sanitation and water infrastructure must become a cross-party program. The challenge is bigger than one political tenure and must stretch across the states, just like COVID-19 has shown that infections know no boundary, WASH infrastructure must permeate the nooks and crannies of the country. It is a simple fact that the flies from your neighour’s poo soon arrives at your dinner table. To mitigate this reality, we need to build household and public sanitation infrastructure. For instance, to meet the goals of the Clean Nigeria: Use a Toilet Campaign launched by Vice President Yemi Osinbajo, on World Toilet Day in 2019, we need to build 2.4 million toilets every year, that is about 6,800 toilets a day, to meet the needs for a decent place to poo, for the current population, and another 1,500 toilets daily to meet the needs of the new households that will be formed over the next 6 years. This is a whooping 8,300 toilets to be built daily. Add to that about 10,000 wastewater / faecal sludge treatment plants. These toilets will have to be built in the States under the mobilisation of State Governments and supported by the National ODF Campaign Secretariat. I know we can do this. Well, how do I know? India built 95 million toilets in 4 years, to exit the position of the nation with the most open defecation in the world, establishing millions of new sanitation jobs and trades for women masons and youths, and generating huge financial flows in the process.
Building anything involves money. The investments needed by households, mainly the poor, can be supported by various efforts to reduce cost including micro-finance and self-help schemes and through government negotiations with materials producers for bulk supplies, such as cements, and plastic toilet basins like the innovative satopans and other toilet accessories. The national WASH Action Plan has also proposed a National WASH Fund, like the TETFund, to help trigger and support States and non-state partners in pursuing this national goal and expanding the local content in building water and sanitation infrastructure. The WASHFund has yet to be established. This is the time this fund is needed most. It should be established as a national priority, to provide the national backbone to prevent and withstand future environmental determined pandemics.
COVID-19 has come to remind us of our failings in preventative medicine. Yet we follow the herd in focusing on curative medicine, bidding time for vaccines to arrive and hoping to build more isolation tents / hospitals. Let us retrace our steps and make right our actions. Massively rolling out a credible water supply, sanitation and hygiene delivery program will release half of hospital beds held up by patients suffering from diarrhea and other water borne diseases. It will massively reduce needless deaths from these diseases, release our women and nursing mothers to pursue productive activities, and contribute to National economic growth through job creation as well as ensure adolescent girls stay in school rather than drop out as a result of the poor state of WASH in schools for menstrual hygiene management. This is the long-term solution to environment determined viral load and pathogens that attack our families and public health.
Timeyin Uwejamomere, an urban and regional planner, is a development specialist and former Country Director of WaterAid Nigeria. He was the Global Lead for urban water and sanitation at WaterAid UK for over a decade, before returning to Nigeria in 2016 to manage the USAID-funded Water, Sanitation and Hygiene Coordination Project as Chief of Party. He is the Managing Partner/CEO of Mangrove & Partners Limited, an Institutional Strengthening Consultancy firm