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OPEN DEFECATION: A WORSENING HEALTH CHALLENGE

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OPEN DEFECATION: A WORSENING HEALTH CHALLENGE

The recent report that listed Nigeria among the top five open defecation countries in the world is not surprising but lamentable. The worrying aspect remains the disclosure that the country is set to overtake India in this inglorious health index, ISIOMA MADIKE, reports

 

The campaign “Clean Nigeria, Use the Toilet,” is the latest effort of President Muhammadu Buhari to end open defecation in the country by 2025. The president is said to be prepared to launch the campaign at a date yet to be announced. This follows the disturbing report of Nigeria being listed among the top five open defecation countries in the world.

The country, according to the reports, rose from its 5th position in 2003 to 2nd place in 2015 behind India. Also worrisome is the disclosure by the Minister of Water Resources, Suleiman Adamu that Nigeria is set to overtake India in this inglorious index. Adamu, according to reports, said Nigeria is set to become world’s leader in open defecation.

The minister, who spoke at the 3rd Founder’s Day ceremony of Edo University, Iyamho, recently, observed that the country was unable to attain the Millennium Development Goals (MDGs) targets for water supply and sanitation because of poor investments, low capacity and other challenges not limited to rural areas.

The President had in November 2018 launched National Action Plan for Revitalising the Water Supply, Sanitation and Hygiene (WASH), where he also declared a state of emergency on water and sanitation sector in Nigeria. An important aspect of the plan is for Nigeria to be open defecation free.

The National Plan of Action is a significant political milestone towards achieving the United Nations Sustainable Development Goal 6 to reach everyone, everywhere with clean water and decent sanitation by 2030. Adamu said Nigeria has developed a road map, 2016-2025, to end open defecation.

He added that out of the 774 local government areas, only 10 are open defecation free. Adamu said: “10 out of 774 local governments is very dismal but it is work in progress. But we have also made some progress as 20 to 21,000 communities in the country today are open defecation free.

The problem is we still have 47 million people practicing open defecation and Nigeria has been moving up the ladder since 2012 from being number four or five in the world to having the ranking of number two. “India is number one but India has been working to end open defecation, in the last four years they have taken over 500 million out of open defecation. And India plans to declare itself open defecation free by October 2019. Once that happens, Nigeria will become the number one country in the world that practices open defecation. You will all agree with me that this is an honour we do not want to have.

“So council approved a number of measures including the fact that Mr. President will launch the Clean Nigeria Campaign on a day to be decided. So, our campaign is ‘clean Nigeria, use the toilet.’ The president and cabinet members are to become ambassadors of clean Nigeria campaign by providing the needed leadership and commitment for successful implementation of the campaign.

“We also hope to create a clean Nigeria movement and to harmonize ministerial activities so that we have a seamless approach regarding sanitisation in the country. We are also requesting for annual budget of N10.6 billion to be approved, this is not money that will be taken out of budget alone, we will also have contributions from development partners, corporate world including leveraging on corporate social responsibility, grants and to mobilise Nollywood, youths, children and women.

“It will come with an executive order to give effect to the clean Nigeria campaign. All ministries are to establish specific budget lines and work plans to implementing their sector specific activities to end open defecation and improve sanitation in the country. The campaign will also involve state governments and households. We intend to use community-led sanitation and hinging more on behavioural change rather than doling out money.”

The World Bank’s recent statistics, according to reports, show that regions with high rates of open defecation experience catastrophic waste management problems. Unfortunately, the warnings by the World Health Organisation (WHO) that open defecation can lead to cholera, typhoid, trachoma, diarrhea, stomach upsets and poor overall health, have not been heeded, according to experts. These opinions have also said that the environment suffers as a result of open defecation because it introduces toxins and bacteria into the ecosystem in amounts that it cannot handle at a time.

This, they said, leads to build-up of filth. The load of microbes, they also said, can become so much that, in the end, they end up in aquatic systems thereby causing harm to aquatic life. But there are known solutions to tackle the menace. To overcome this problem, the government needs to invest more in WASH.

The United Nations Children’s Fund (UNICEF) has said that about N95 billion will be needed per year to eliminate open defecation in Nigeria. It also advised that the country could achieve economic gains as high as N359.1 billion ($US 1.026 billion) annually from the N455 billion it loses due to lack of sanitation.

Besides, the government’s Open Defecation-Free Roadmap, experts said, should be more than a plan to eliminate the nuisance by 2025, it should, according to them, also put into consideration the N234 billion needed to attain open defecation-free status in its annual budget.

Moreover, the 774 local governments should be involved in the campaign to end open defecation in the country. And bills should equally be initiated to promote sanitation and take urgent action to implement Open Defecation-Free Roadmap. Available statistics revealed that access to sanitation has been on the decline from 30 per cent in 2010 to 28 per cent in 2015 while open defecation has been on the increase in Nigeria.

The 2018 National Outcome Mapping Report has also shown that 47 million Nigerians defecate in the open, while the country loses N455 billion (US$1.3b) annually due to poor sanitation. Last year, the findings by the Brookings Institute, based on a projection by the World Poverty Clock, indicated that Nigeria had overtaken India as the country with the largest number of people living in extreme poverty, with an estimated 87 million Nigerians believed to be living on less than $1.90 a day. The link between poverty and poor sanitation is very thin, intertwined and tenuous.

In reality, most Lagos outskirts, are known to be dangerous slums. Across Nigerian urban communities, the story is not different. And beneath the relentlessly slummy surfaces of these communities lie a kind of moral discomfort. The drainage ditches are frequently blocked with faeces, which often overflows during the rainy season into houses and streets, such that most paths are wholly composed of human waste. Some have also described it as a shame to find human faeces litter public places such as railways, motor parks, filling stations, footpaths, highways and playing grounds across the country.

Incidentally, lack of safe water and toilet system, have contributed to this menace in recent time. This may be the reason why experts continue to harp on improving access to potable water and toilet facilities which, they believe, will largely reduce open defecation.

Curbing this nuisance, they also noted, will check morbidity, avoidable diseases and improve the quality of life. Sadly, efforts by government to provide public toilets and enforce sanitation habits have been vitiated by ignorance and inability to adapt to change by some Nigerians. At the Kosofe-Ketu community recently, a young man dashed out of his room with clenched teeth, pulled open his zippers, took a quick look to his right and left, retired to a small bush by the school building, and dropped off lumps of smelly faeces.

His action surprised no one, for it is a tradition of sort in this part of the mega city. In virtually every open space in and around the neighbourhood, heaps of faeces literally jostle for space with human beings. From the homes, they are wrapped up in newspapers and launched from windows, scattering into a spatter mess.

It piles the streets as though they are articles of ornament. Yet, no one seems to bother about it. “This is how we do it here. You can hardly find a toilet in most homes and where you find one, it is untidy; not good for any decent use. Most times, what you find is a makeshift toilet in which wooden plank platform are constructed with buckets under it.

The sight of such is quite disgusting. For all these, we consider it convenient and comfortable doing it in the open, and since it suits us, it should not be anybody’s headache,” said an elderly man, who declined to give his name. He added: “This practice is common in this community, especially in places where toilet facilities are a luxury. When nature calls, everyone responds differently.” The old man’s excitement, many believe, is simply a collective adaptation to extreme hardship. He, like many others in the Kosofe community, were born and bred in that ghetto.

Though, he and his likes seem to have a fascination for defecating in public places and in bushes, they are not alone in this act and Kosofe is definitely not an isolated case. It is a common practice in the city of Lagos. But, such behaviour, according to some, clearly portrays the level of helplessness and frustration in most Nigerian communities. Just like Kosofe, the Island end of the mega city also presents an interesting twist. The bridges that connect it to the mainland are looping ribbon of concretes. Most of them were built in the 1970s.

Parts of a vast network of the bridges, cloverleaves, and expressways intertwined to them were intended to transform the districts and islands into an efficient modern metropolis. As the bridges snake over sunken piers just above the waters of Lagos Lagoon, they passes a floating slum: thousands of wooden houses, perched on stilts a few feet above their own bobbing refuse, with rust-coloured iron roofs wreathed in the haze from thousands of cooking fires. Fishermen and market women paddle dugout canoes on water as black and viscous as an oil slick.

The bridges then passes the sawmill district, where rain-forest logs sent across from the far shore, 30 miles to the east form a floating mass by the piers. Smouldering hills of sawdust landfill send white smoke across the bridges, which mix with diesel exhaust from the traffic. Beyond the sawmills, the old waterfront markets, the fishermen’s shanties, the blackened façades of high-rise housing projects, and the half-abandoned skyscrapers of downtown Lagos Island loom under a low, dirty sky. Around the city, faeces dumps steam with the combustion of natural gases, and auto yards glow with fires from fuel spills. All of these parts of the city seem to be burning and stinking.

For those, who are working on the Island or just visiting for the first time, the aquatic scenery of the lagoon ought to present an uncommon beauty to behold. But, it is not so for Christopher Awolo. His experience, according to him, is everything but pleasing. Driving through the Third Mainland Bridge en route for Obalende- CMS on Tuesday, Awolo saw several buttocks spewing shit into the lagoon; “it was quite disgusting,” he said, adding, “it’s awful seeing Lagosians defecate in the open as if they don’t have toilets in their homes.”

In a city with a population of over 21 million, the act could only be curbed by providing more public toilets for Lagosians, some have said. “There are adequate spaces in Lagos for people to have everything in their homes. No office or residential building should be without a good toilet.

Nigerian governments should provide more public modern toilets with the taxpayers’ money. In some countries, a good toilet is located for every five minutes’ walk. This is also possible in Lagos,” said Williams Appiah, a Ghanaian Urban and Town planning expert.

But Lagos is not alone in this disgusting act. In Ibadan, a public refuse dump site close to Yidi Agodi is also said to be packed always as early as 5am on a daily basis by individuals, who have found the area most convenient to defecate. This is in total disregard to a bold notice threatening ‘open defecators’ with arrest and huge fines.

What makes the site unique, according to those who use the place, is its closeness to a stream that empties into a major river. Flies around the area easily perched on uncovered foods; they fortify such meals with potentially harmful ingredients. This shameful act is replicated at major refuse dump sites across the city. In the other parts of the sprawling city, many, living in houses without identifiable toilets, are said to be compelled to defecate at open spaces such as dump sites and on the bank of slowly flowing streams and rivers.

This is partly because owners of such houses have come to believe that toilets would be an additional burden since money would be needed to keep it clean and usable. There are others in that neighbourhood, who also believe, though wrongly, that faecal material should incinerate or be allowed to decompose on such sites. Virtually all residents of the Federal Capital Territory suburbs suffer similar fate.

This, according to those who live there, has become a striking irony of Abuja. Behind the allure of expansive roads and rising buildings that make the Nigerian capital Africa’s most expensive and one of the world’s fastest growing cities, several poor communities in the suburb live without toilets.

“It’s bad; very terrible,” Ms. Augusta Nmakwe, one of the residents in Mararaba, said. Mararaba, a slump community of over 100,000 people is one of Abuja’s outskirt towns where residents struggle to find a space to build homes, much less toilets. For those without a toilet, the routine is simple: convert everything, from old sewage pipes to polythene bags, to one.

More than 60 per cent of the population living in other suburbs within the FCT is equally affected by shortage of toilets, making them to live with a very serious health challenge. At present, deaths from diseases such as cholera, dysentery, diarrhea, typhoid, as well as malaria, according to reports, are very rife within these communities. Sadly, women and children are the worst hit. Poor sanitary condition resulting from absence of proper human waste management facilities has haunted residents of many other communities around the country.

The low-cost settlement, a magnet for thousands of poor Nigerians and low-income earners, has all the compliments of a typical ghetto with most houses lacking toilets, water, electricity and other basic social amenities that make life worth living. It is, indeed, obvious that sanitation is a major challenge in the country. The evidence is everywhere.

Nigeria appears to be one huge field, where people defecate, without shame, and without putting into consideration the impact of their action on the health of others. Travellers are not left out of this “madness.” For anyone, who has travelled from Lagos to the East by road, knows that there are few rest areas with toilet facilities along the route. At stops in Ore or Benin City, pressed passengers hurry off into the bushes, gingerly skating around others’ faeces, in order to relieve themselves. Toileting in most villages are equally an awful experience.

In many rural communities, people still build houses without provision for toilets, or as the case may be, latrines where human waste can be emptied without others coming in contact with it. In many rural communities, people defecate in the bushes and other isolated places when they are pressed. They consider this a safer option to the city’s ‘Shot Put’ style where shameless people defecate in polythene bags or old newspapers and fling on the roadside and gutters. Yet, there are other villages where the act of defecating in the open has become almost a ritual and routine that some people indulge in at any time of the day.

At times, they do it, religiously as if it is a spiritual exercise. A report from a workshop in Jos that preceded the Water Supply and Sanitation Sector Reform Programme (WSSSRP) funded by the European Union in Nigeria in 2002, pointed to traditional belief also.

At that meeting, a representative of one the LGAs in Plateau State stated that his community believes it is a taboo to excrete on another person’s waste. This in effect, supposedly does away with the use of toilets. Each morning, the report said, one would watch as scores of people line up along the rail line doing their own thing.

The story is not significantly different in the nation’s tertiary institutions as some campus communities also spread intense odour as many students, in the absence of clean toilets in the hostels, use any available space as convenience. Experts have consistently warned that when large numbers of people are defecating outdoors, it is extremely difficult to avoid ingesting human waste, either because it enters the food or water supplies or because it has to be spread by flies and dust. Just recently, UNICEF reported that about 34 million people in the country use the open fields, forests and bushes as well as bodies of water as convenience.

But the cost of these unhealthy living conditions – of indiscriminately polluting the environment – is expensive. According to the joint UNICEF and the World Health Organisation report, lack of toilets remains one of the leading causes of illness and death among children. The report said that diarrhea, a disease often associated with poor sanitary condition, and respiratory infections resulting from poor hygiene, kills about 400,000 children, under the age of five, annually. “These are largely preventable with improvements in water, sanitation and hygiene,” said Geoffrey Njoku, UNICEF Communication Specialist (Media and External Rela-tions) in Nigeria.

This is why the revelation of Adamu that Nigeria is set to overtake India in open defecation index is worrying. The minister’s statement is evident that the country had not made any appreciable progress in this regard. Indeed, the figure is suggestive that more Nigerians now use the outdoors to ease themselves. According to an official of UNICEF, Dr. Suomi Sakai, the unwholesome practice leads to the depositing of about 1.7 million tonnes of faeces into the environment annually. This statistics from West Africa most populous country paints a general picture for the region with respect to this problem.

However, lack of sufficient infrastructure has been identified as a contributory factor to the problem with the failure of governments to effectively address these in rural and urban settlements. Add to this, is the behavioural attitudes across communities, which play a major role in promoting this menace. Concepts of hygiene, cleanliness, purity, and beliefs about sanitation and disease are also deeply ingrained through religious and cultural beliefs. The UNICEF report was amplified by Dr. Michael Ojo, onetime Country Representative of Water- Aid to Nigeria, who brought the shame to almost every home.

He said that every seven in 10 women in the country have no access to a safe toilet, and more than 50 million Nigerian women and girls lacked safe and adequate sanitation, while 17 million do not have access to toilets at all. “Every year, over 85,000 mothers in Nigeria lose a child to diarrhea diseases caused by a lack of adequate sanitation and clean water,” said Ojo.

“Women and girls living in Nigeria without toilet facilities spend 3.1 billion hours each year finding a place to go to toilet in the open,” he added. As a result, former Commissioner for the Environment and Secretary to Lagos State government, Tunji Bello, has suggested that governments at all levels in the country, should, as a matter of necessity, increase its investments in the area of provision of sanitation facilities, new policies and enlightenment campaigns to tackle the cultural and religious beliefs that continue to be a setback in achieving better sanitation.

The failure to do this, he said, would see a Nigeria that is more disease ridden in the future and consequently even more unproductive socio-economically. In like manner, Abimbola Fashola, wife of former Lagos State governor, also said that the local governments, in particular, must ensure that toilets are built in the markets, village squares and open spaces that serve as recreation centres.

For Mrs. Sherifat Aregbesola, the government should deploy massive and sustained public enlightenment campaigns in Pidgin English and indigenous languages in both print and electronic media as well as other indigenous forms of communication in remote rural areas.

They all agreed however, that the authorities should equally enact laws to checkmate open defecation practice, and ensure its diligent enforcement. Such a law, according to them, would go a long way to halt the shameful and unhealthy practice. Above all, members of the public, they said, should imbibe attitudinal changes that would help make open defecation a thing of the past.

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