Water, Sanitation, and Hygiene (WASH): An Essential Component for Improved Health Outcomes
Safe drinking water, sanitation, and hygiene (WASH) are crucial to human health and wellbeing and form the Sustainable Development Goal 6 of the United Nations (UN, 2023). Safe WASH is not only a prerequisite to health but contributes to livelihoods, school attendance, and dignity and helps to create resilient communities living in healthy environments (Word Health Organization, 2023). Health and WASH are intrinsically related and must be recognized as both preconditions for and outcomes of sustainable development. Lack of joint action on WASH and health over past decades has resulted in poor progress on agreed international targets, including maternal, newborn, and child health (Action for Global Health and WaterAid, 2015). Women and girls suffer disproportionately from the lack of adequate WASH services. They bear the burden of water collection over long distances, which is associated with adverse effects on wellbeing, school attendance, and a higher risk of gender-based violence (GBV) (World Bank, 2021). Access to WASH can impact years of schooling by freeing up time that children spend collecting water to attend school, reducing the prevalence of diseases that can keep them out of school, and contributing to a safe and healthy learning environment while at school. Frequent episodes of WASH-related ill-health in children contribute to school absenteeism and malnutrition (UNICEF, 2023).
Water, Sanitation, and Hygiene (WASH) is a vital yet complex sector, with three distinct subsectors that involve daily interaction between authorities at the federal, state, and LGA levels; service providers; contractors and entrepreneurs on the one hand; and the population on the other. Poor access to improved water and sanitation in Nigeria contributes significantly to high morbidity and mortality rates among children under five. Using contaminated drinking water and poor sanitary conditions increase vulnerability to water-borne diseases, including diarrhea, which leads to the deaths of more than 70,000 children under five annually (UNICEF, 2023). 73% of the diarrheal and enteric disease burden is associated with poor access to adequate water, sanitation, and hygiene (WASH) and is disproportionately borne by more impoverished children. Achieving Sustainable Development Goal 6 by 2030 requires extraordinary efforts. According to World Bank estimates, Nigeria must triple its budget or allocate 1.7% of the current Gross Domestic Product to WASH. The ambition is highest for rural sanitation, where the gap for improved services is 64.1 percent. Funding for the sub-sector is weak, and significant household contribution is needed to eliminate open defecation despite low family incomes. (UNICEF,2023).
Although Nigeria has made considerable progress in the Water Supply, Sanitation, and Hygiene (WASH) sector, access to high-quality, reliable, and sustainable services still needs to be improved. In 2018, Nigeria’s Water, Sanitation, and Hygiene (WASH) sector was declared to be in a state of emergency by the Government –due to the deplorable state of the sector. Approximately 60 million Nigerians were living without access to essential drinking water. Eighty million people had no access to improved sanitation facilities, while 167 million couldn’t access basic handwashing facilities (World Bank, 2021). In another Federal Ministry of Water Resources report, only 61% of citizens can access improved water.
Furthermore, only 41% of the population has access to improved water within 30 minutes round-trip of their premises, and only 31% have access to improved water on premises. Even fewer, 7%, possess piped water on premises. The sanitation sector is in critical condition, and current data reflect this reality: only 29% of Nigerians have access to unshared improved sanitation sources. National estimates of open defecation rates indicate that open defecation remains pervasive across the country (Federal Ministry of Water Resources, 2018). Research also carried out by the Enyenaweh Foundation found that there’s a high prevalence of open defecation in Abuja, despite being the country’s capital, due to the unavailability, affordability, and accessibility to essential WASH services (Ikumapayi et al., 2022). These shortcomings include inadequate infrastructure, a lack of required human capital, poor investment, a deficient enabling regulatory environment, performance of water agencies, water points, and water distribution schemes (Federal Ministry of Water Resources, 2018; World Bank, 2021). Almost half of the existing water points and schemes are nonfunctional. This multidimensional failure has fueled mounting water stress in the country and created a poverty trap by adversely affecting poverty and human development outcomes.
In recent years, the Government of Nigeria has strengthened its commitment to access to WASH services, with the government launching the National Action Plan (NAP), a 13-year strategy for the Revitalization of Nigeria’s Water Supply, Sanitation, and Hygiene (WASH) Sector aimed at ensuring universal access to sustainable and safely managed WASH services by 2030, commensurate with the Sustainable Development Goals. (Federal Ministry of Water Resources, 2018). Similarly, the World Bank Group implemented a project in Nigeria titled National Water Sector Reform Program (NWSRP) outlined several objectives, including sector reform, water utility sustainability and commercial viability, infrastructure improvement, service reliability, and performance enhancement, and increased access to quality piped water networks in urban areas nationwide. (The World Bank, 2017)
In addition, health promotion and public enlightenment should be carried out periodically in communities and through the media to promote attitudinal change toward eradicating open defecation and other unhygienic habits in Nigeria. Efforts towards community-led interventions such as the Community-Led Total Sanitation in rural, peri-urban, and rural areas should be strengthened and revitalized. Monitoring, evaluating, and assessing all projects and interventions should be carried out periodically to assess impact and sustainability.
Achieving SDG 6 by 2030 will require a quadrupling of current rates of progress in safely managed drinking water, sanitation, and essential hygiene services. A WHO study in 2012 calculated that for every US$ 1.00 invested in sanitation, there was a return of US4 5.50 in lower health costs, more productivity, and fewer premature deaths (Global Health Observatory, 2023). Therefore, the government at all levels and all significant stakeholders should not relent in their efforts towards providing equitable, affordable, and accessible WASH services to Nigerians.
Action for Global Health (AfGH) and WaterAid (2015). Making Health a Right for all: Universal Health Coverage and Water, Sanitation and Hygiene. Available at: https://plan-uk.org/file/afgh-wateraiduhc-and-wash-papermarch-20rgb-pdf-for-general-usepdf/download?token=44fihGSL
Federal Ministry of Water Resources (2018). National Action Plan for Revitalization of Nigeria's WASH Sector. Available at https://www.wateraid.org/ng/sites/g/files/jkxoof381/files/nigerias-national-action-plan-for-the-revitalization-of-the-wash-sector.pdf
Global health observatory (2023). SDG Goal 6 Ensure availability and sustainable management of water and sanitation for all. Available at: https://www.who.int/data/gho/data/themes/topics/sdg-target-6-ensure-availability-and-sustainable-management-of-water-and-sanitation-for-all Accessed 1 March 2023
Ikumapayi, J., Abutu, V., Onuoha, J., Obado-Joel, J., and Arthur, A. (2022), Open Defecation in the Abuja Metropolis, Enyenaweh Research, 2022. Available at: https://www.enyenawehafrica.org/post/open-defecation-and-public-health-in-abuja-research-report
The World Bank (2017). National Sector Water Reform Project. Available at: https://ieg.worldbankgroup.org/sites/default/files/Data/reports/ppar-nigeriawater-07122017.pdf
UNICEF (2023). Water Sanitation and Hygiene Nigeria. Available at: https://www.unicef.org/nigeria/water-sanitation-and-hygiene
United Nations (2023). Ensure availability and Sustainable Management of Water and Sanitation for All. Available at: https://sdgs.un.org/goals/goal6
WHO (2023). Water Sanitation and Hygiene. Available at: https://www.who.int/health-topics/water-sanitation-and-hygiene-wash#tab=tab_1 Accessed 1 March 2023