Rescue from diseases through water, sanitation, hygiene

It promises to reduce the incidence of water borne diseases, improve personal hygiene, stop open defecation and empower rural communities in Yobe, Kano, Jigawa, Osun, Cross River and Anambra. But only about 20 per cent of the communities are benefitting leaving the remaining 80 per cent at the mercy of cholera, gastroenteritis, diarrhoea, typhoid fever and other communicable diseases due to absence of safe water and toilet facilities, which leads to people using the same stream of water for bathing, washing, defecation, cooking and drinking. The Guardian visited some of the Water Sanitation and Hygiene (WASH) and Community Led Total Sanitation (CLTS) projects in Anambra state, which were commissioned by the United Nation Children Fund (UNICEF) with support from European Union (EU). The Guardian investigation revealed that the WASH programme and CLTS are very good and have reduced water borne diseases as well as met targets. But not without challenges of inadequate funding, ‘hard’ geology of most communities in Anambra state where you have to dig over 1,300 metres to get water, delay in maintenance of the water projects, absence of WASH departments at the local council level, and lack of political will and funds to take the projects to the whole state.

TWENTY-THREE year-old Nkechi Nwoye was passing watery diarrhea and vomiting. This resulted in dehydration and grayish-bluish skin. Nkechi, a native of Anam in Anambra West Local Council of Anambra State, had cholera. 

        Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae.

     She had been drinking water from the Omambala River. The river is the major source of water for the villagers. They defecate, bath, wash their clothes and personal items, and drink water from the Omambala River. 

      Indeed, Nkechi had been drinking water or eating food that has been contaminated by the feces (waste product) of an infected person, including one with no apparent symptoms.

     The diarrhea and vomiting led to rapid dehydration and electrolyte imbalance, and death of Nkechi within 24 hours. 

      Nkechi is one of the eight persons that died of cholera penultimate week in Anambra West Local Council of Anmabra state. 25 others were also admitted in various hospitals across the state with symptoms of cholera.

    Until now, the primary treatment for cholera is oral rehydration therapy, typically with oral rehydration solution, to replace water and electrolytes. If this is not tolerated or does not provide improvement fast enough, intravenous fluids can also be used. Antibacterial drugs are beneficial in those with severe disease to shorten its duration and severity.

     But it has been shown that cholera and other water and food borne diseases can be prevented by the provision of safe drinking water and observing high level of hygiene.

     Anambra West is one of the 19 local councils in Anambra state that are not benefitting from the Water Sanitation and Hygiene (WASH) and Community Led Total Sanitation (CLTS) projects. The United Nation Children Fund (UNICEF) with support of the European Union (EU) is implementing the WASH and CLTS projects in five of the 24 local councils of the state.

      According to UNICEF, the WASH programme aims to create safe water sources and sanitary facilities in communities and schools and provide hygiene education. Water, hygiene and sanitation ensure optimal child health and survival and also boost school attendance rates – especially girls.

      The overall objective of UNICEF in the area of WASH is to contribute to the realization of children’s rights to survival and development through promotion of the sector and support to national programmes that increase equitable and sustainable access to, and use of, safe water and basic sanitation services, and promote improved hygiene.

       CLTS is an innovative methodology for mobilising communities to completely eliminate open defecation (OD). Communities are facilitated to conduct their own appraisal and analysis of OD and take their own action to become open defecation free (ODF).

     At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches to sanitation prescribed high initial standards and offered subsidies as an incentive. But this often led to uneven adoption, problems with long-term sustainability and only partial use. It also created a culture of dependence on subsidies. Open defecation and the cycle of fecal–oral contamination continued to spread disease.

     In contrast, CLTS focuses on the behavioural change needed to ensure real and sustainable improvements – investing in community mobilisation instead of hardware, and shifting the focus from toilet construction for individual households to the creation of “open defecation-free” villages. By raising awareness that as long as even a minority continues to defecate in the open everyone is at risk of disease, CLTS triggers the community’s desire for change, propels them into action and encourages innovation, mutual support and appropriate local solutions, thus leading to greater ownership and sustainability.

      Indeed, rural communities in Aguata, Idemili South, Nnewi, and Anambra East are living testimonies to the benefit of WASH and CLTS. UNICEF through Rural Water Supply and Sanitation Agency (RUWASSA) in Anambra State intervenes basically in the rural communities.

     The Guardian visited WASH and CLTS projects in Umueleke village Achina and Umuchina Ekwulobia both in Aguata local council.

     Programme Manager of WASH at RUWASSA, Anambra State, Mr. Victor Ezekwo, told The Guardian: “… The concern of UNICEF through WASH is to ensure increase in access to safe water supply to rural communities, increase in access to adequate sanitation facilities and good personal hygiene in rural communities. So ordinarily UNICEF through RUWASSA intervenes basically through the rural communities. 

      “RUWASSA is an agency with the mandate of UNICEF established by states in order to implement WASH programme in the rural community. There is no state in Nigeria that is benefitting from UNICEF support without RUWASSA. For UNICEF to work with any state or partner with them in terms of water, sanitation and hygiene, that is WASH, they must establish RUWASSA in their state. So RUWASSA was established by an edit to implement WASH activities in the rural communities.     

      “Now over time we have been able to support communities in terms of portable water supply. Before now, we provide hand pumps but the geology of Anambra state is not friendly to give hand pumps in some places like Aguata, you cannot take hand pumps there because the hydrogeology there is a problem. Now they have moved from hand pumps to motorized borehole powered by the generator. 

      “Because of climate change and the effect of burning diesel to the climate we now move to using solar energy. Of course that is the global trend now, having cleaner energy and cleaner environment and also to alleviate poverty because it was observed over time that when you provide these water schemes with generator or electricity, sometimes the community will not be able to manage it because to provide diesel for daily operation of the scheme is a concern. Now to help them surmount that poverty issue we now opt for solar. Now all our schemes in the rural communities are solar driven. We have recorded tremendous stories in respect to that. 

      “In Aguata, Idemili South, Nnewi, and Anambra East we have so many water boreholes in the last four to five years running. That does not mean we do not have challenges. There are some places where these lackadaisical attitude about public utilities and maintenance culture. It is still a concern in some rural communities. But we are trying our best to strengthen the structure we normally establish. 

      “Prior to the establishment of water scales to rural communities we normally do some preliminary assignments like formation of a structure called Water Sanitation and Hygiene Committee (WASHComm). This body their responsibility is basically to implement the WASH programme in their communities, maintaining of the water project, ensuring that they have water in their communities, ensuring that good hygiene practice is maintained in the communities. It is the duties of the WASHComm. It is the same role and responsibilities for WASH departments in Local Government Areas (LGAs) just like RUWASSA. So you have structures at various levels that help in driving the WASH activities.” 

    Ezekwo said there are other structures within the communities that promote these WASH activities. He explained: “There is these group we call volunteer hygiene promoters. Their role is to carry out the personal and environmental hygiene work in their communities. We have this other group even though they are natural leaders, in respect to CLTS.

     “There is an approach the global community has identified to be kind of the easiest means of achieving the sanitation component in terms of Millennium Development Goals (MDGs) delivery. Now government and UNICEF going about providing toilet do not sound so good. They can provide for public places but the household is a concern. If you move around our streets, remote areas, even on some high ways you see feces around. People defecate, as they like because our sanitation here is household sanitation and not environmental sanitation. It is respect to having access to safe excreta disposal. 

     “UNICEF with the other UN agencies found out that the usage of a particular model called CLTS could help the world to achieve that goal in respect of sanitation attainment under MDG. The idea is to mobilize the communities, trigger them. We call it CLTS triggering. We trigger them and on the other way round sensitise them on the dangers of defecating in the open, defecating along the water bodies or the advantages of having toilets in their homes and the benefits.

     “ Initially, implementing the CLTS was a challenge. When you call people you start telling them, stop going to the bush to defecate, build your own toilet. You find out that in some communities people don’t bother about building their own toilets. Some call it Ama, some call it all sort of names. But that approach over time, maybe in the last five years have really helped us to sensitise the people to stop defecating anyhow. 

     “Like the cholera outbreak we have now in the Anambra West. These are people when you call them to sensitise them on CLTS, ‘that the shit you defecate say one kiolometre away, you are drinking it here.’ They don’t understand it and those they can easily get diarrhoea diseases from drinking such water that is polluted. They always tell us, ‘our forefather drank it. They defecated here and nothing happened to them and so nothing will happen to us.’ 

     “We saw all these things as behavioral problems. That change is always a concern. They will tell you, ‘no you don’t defecate in the house, and it must be in the open.’ To them they grew up with it. So telling them otherwise must be like a fairy tale.”

     Ezekwo who is also a geologist said the impact so far in terms of proper sensitization and proper education in terms of having personal toilets is gaining ground in the WASH sector. He further explained: “In fact most communities today are now embracing CLTS as the best way of getting people to understand the importance of having their toilets. Now in communities we have facilitators but outside the facilitators we have what we call natural leaders. It is just like volunteers hygiene promoters. People that take it upon themselves that in their communities they must make sure that people stop defecating in the bushes, in the path ways, in the farms is working. We have such structures and from time to time we call them for workshops in Abuja and Calabar to build up their capacities. So these are the areas we intervene in respect to WASH.”

Deliverables and challenges

       The WASH programme manager at RUWASSA in Anambra state said the outcome is good. Ezekwo said: “Today I can tell you that the living standard and health of a lot of people in the rural communities where we are working is stabilized. Some don’t bother about spending money to buy water. You don’t smell shit anywhere around their communities. Some will tell you that in any function now that it is part of them that before they serve food to visitors they must ensure that first of all they get good water for people to wash their hands. 

     “So the intervention of WASH is positive all through but the limitations or the challenges is the coverage. About now we are getting support from EU and UNICEF to implement this programme, which is like pilot. Between 2006 and 2011 we have been able to implement WASH in five LGAs. For five years we supported five LGAs- Aguata, Anambra East, Idemili South, Nnewi North and Ogbaru, which is in Anambra East. After that pilot phase we did another one in Ogbaru alone, still WASH activity. 

     “Presently we are also on the same implementation activity for another five years, which started in 2012 and is ending in 2017. But this time around we are working in just two LGAs that is Aguata and Anambra East, which were self selected from the original five. Now the other 19 local LGAs in Anambra state are not benefitting from this programme now. So we still have a lot of work to do to carry this good message to the other 19 LGAs. Good a thing, the state government with their limited resources are doing something. 

      “Part of the plan of the programme is that the state should be able to replicate whatever is being done or were done in the pilot LGAs. But sometimes we do the proposal and sometimes we get favourable response and sometimes we don’t. The programme to reasonable extent are upstream, it has to do with training, sensitization workshop and all that. It is not something you see the outcome or the impact immediately. It is only when you talk about the works that is the water supply that you start seeing the impact immediately. So getting support to implement the programme like forming WASComms in all the rural communities or that you want to sensitise or do CLTS in the whole rural communities in Anambra state. 

    “If you do such proposal, the money will be too much and it will be queried, ‘what is the output here?’ But the output will come after the sensitization. But they will be looking at how many toilets will you be able to construct with this? But we are not going to build the toilets; the people are going to do it by themselves. You get them to do it and the only way you can do that is to train them, sensitise them, and inform them because information is key to everything. So it is a concern but sometimes our proposal for replication or for scale up are sometimes not funded.” 

     Ezekwo said it is still a problem getting adequate funding to replicate these WASH activities across the other 19 LGAs. “UNICEF and EU, their resources are also limited. We are still even scouting to see how we are going to get other donors to come in and support these rural communities because when they come in it is going to be the same model, the model is not going to change. Like we are trying to see how the African Development Bank (ADB) will support us in the provision of water in the rural areas,” he said.

    Secretary WASH Committee, Alexander Ezenwa, after an inspection of a solar powered water borehole at Umueleke village, Achina in Aguata LGA, told The Guardian: “The water project started two years ago. It is working but of late it has become not fully functional. The solar powered pumping machine is not working, as it should. You can see how people are waiting because the water the solar pump was able to pump into the tanks has been exhausted. 

     “In fact it does pump for more than two hours. This is also common around the dry season of December to March.  The solar panels are dirty and need cleaning for them to be able to trap enough solar energy to pump enough water. The water is good and people come from far and wide around this place to fetch water here. It is not for sale but to benefit the community.”

     The Guardian also visited an ongoing water project at Umuchina Ekwulobia in Aguata LGA. A member WASHComm who preferred anonymity said: “ The project is going on well. We have been able to pump the water and it flowed very well almost three days. It was open 7am in the morning and locked at 12 mid night.

      “We are about 22 members of the WASHComm both women and men. What we do is to make sure that the site manager builds everything to specification according to the instructions we were given.”

    The WASH coordinator at Aguata LGA, Peter Akwuobi, said: “The challenges have been with the interaction with the community. Sometimes selecting the sit becomes a problem for the community because of interest. But because of our coordination and explanation to them they now realize the importance of getting somewhere central. Like this one here is close to the health centre to serve it and the entire community.”

Gaps

     The geologist said: “When you compare the gap to the achievement, the ratio is like 80 to 20 or even 90 to 10. This because the coverage is small in just five LGAs then you have the other 19 LGAs that are yet to benefit in these WASH driven activities. There is a concern, the other LGAs even though they are getting support from the LGAs and they are getting from the state through the MDGs. Even though it is WASH facilities, the method of delivery is not the way we normally do with our partners like UNICEF. It is not the UN model. The WASH units at the LGAs are not being carried along and at the community level they don’t establish WASHComm. They just provide water and at the end of the day you see it won’t be functional. That is why I put it at 80:20 because even though they have all these things, they are not yet fully structured.”