For decades, the symbols of national progress have been easy to recognize: highways, airports, power stations, hospitals and universities. But Sunday Sam Egon, a doctoral researcher in Environmental Engineering at the University of Central Florida, says one of the most important foundations of modern development is far less visible — safe water and sanitation infrastructure.

Egon argues that the public-health transformation of Europe and North America cannot be separated from the engineering systems that delivered treated drinking water and carried sewage away from homes. In the United States, historical research estimated that filtration and chlorination accounted for nearly half of the decline in mortality in major cities during the early twentieth century, with even greater effects on infant and child mortality.

That history, he believes, carries an important lesson for West Africa.

The challenge is not simply whether people have access to water. A community may have boreholes, wells or public taps and still face health risks if those sources are exposed to contamination from poorly managed septic tanks, pit latrines, waste dumps or untreated wastewater.

The same applies to sanitation. Building toilets is only the beginning. Human waste must also be safely collected, transported, treated and disposed of without contaminating groundwater, rivers or communities.

The health consequences can be serious, although poor water and sanitation are certainly not the only causes of disease in the region. WHO estimates that unsafe water, sanitation and hygiene contributed to at least 1.4 million preventable deaths globally in 2019, with diarrhoeal diseases accounting for most of that burden. In Nigeria, UNICEF continues to identify contaminated drinking water, poor sanitation and open defecation as major public-health concerns.

For rapidly growing West African cities, this challenge is becoming harder to ignore. Lagos, Accra, Abidjan and other urban centres continue to expand, placing greater pressure on water supply, drainage and wastewater systems. During heavy rainfall, stormwater can mix with sewage, solid waste and contaminated surface water, turning an infrastructure weakness into a public-health problem.

Egon believes this is why governments must look beyond hospitals when discussing preventable illness.

Hospitals, medicines and healthcare workers remain essential. But sanitary engineering works earlier in the chain. A functioning water-treatment plant, protected distribution system, effective drainage network and properly managed wastewater system can reduce exposure before a person ever becomes a patient.

The solution, however, is not to copy Western sewer systems blindly.

West African countries need infrastructure designed around their own population density, climate, finances and settlement patterns. Centralized sewer networks may be appropriate in dense urban areas, while decentralized wastewater treatment, properly designed septic systems, community facilities and organized fecal-sludge management may be more practical elsewhere. The World Bank has similarly emphasized citywide sanitation approaches that combine different technologies rather than assuming one solution will serve every community.

Maintenance must also become part of the development conversation.

A new treatment plant attracts attention when it is commissioned. But safe water depends on what happens five or ten years later. Pumps must work, leaking pipes must be repaired, treatment chemicals supplied, laboratory instruments maintained and operators properly trained.

Without long-term funding for operation and maintenance, expensive infrastructure can gradually become ineffective.

Egon also sees an important role for modern technology. Real-time sensors, geographic information systems, satellite observations and predictive models can help water utilities detect problems earlier and direct resources where they are most needed. But technology cannot replace basic engineering. A sophisticated sensor connected to a failing treatment system does not produce safe water.

The larger question, he argues, is how African countries measure development.

The WHO-UNICEF Joint Monitoring Programme reported that in 2024, about 2.1 billion people worldwide still lacked safely managed drinking water and 3.4 billion lacked safely managed sanitation.

West African governments should therefore ask questions alongside the usual statistics on roads, electricity and economic growth: Can citizens confidently drink water from their taps? Where does wastewater from growing cities go? Is septic waste actually treated? Can drainage systems withstand increasingly severe rainfall? Will today’s water-treatment plant still function properly a decade from now?

These questions may not create dramatic ribbon-cutting ceremonies, but they may reveal more about the health and resilience of a society than many highly visible projects.

The lesson from Western development is not that sanitation alone created prosperity. Rather, safe water and proper waste management helped create the environmental conditions in which healthier and more productive cities could grow.

West Africa does not need to repeat that history exactly. But it cannot afford to ignore its lesson.

Editor’s Note:Sunday Sam Egon is a doctoral researcher in Environmental Engineering at the University of Central Florida. His research focuses on water infrastructure, water quality, and emerging contaminants in water, with particular interest in how engineering, monitoring and predictive approaches can improve the protection and management of water resources.