The incessant outbreak of communicable diseases has become a recurring issue in Nigeria. Attributable to widespread environmental sanitation infractions coupled with the near ‘non-existence’ of environmental health officers, GBENGA AKINFENWA writes that this health challenge can be tackled through the return of sanitary inspection scheme whose impact and effectiveness were popular across the nooks and crannies of Nigeria in the 70s and 80s.

From Lassa fever to Ebola and Dengue, the outbreak of communicable diseases across the country in the last 10 years is posing serious health risks to Nigerians, especially children and young adults, who are most vulnerable.

Only recently, the outbreak of Cholera in the country provoked the need for reintroduction of sanitary inspectors to tackle environmental sanitation challenges.

Experts, who spoke to The Guardian in the face of cholera outbreak, said the reintroduction was necessary to ensure that houses and surrounding compounds were kept clean and tidy.
 
As at weekend, no fewer than 37 people have been declared dead and others hospitalised across the states, with Lagos, accounting for the bulk of the fatal cases, with 21 from 401 cases. 
 
The Lagos State Commissioner for Health, Prof. Akin Abayomi, had raised the alarm, noting the laboratory tests confirmed a strain, which is highly aggressive and contagious, with potential for widespread infection.
 
 According to the World Health Organisation (WHO), cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.  Cholera can cause severe acute watery diarrhea and the severe form of the disease can kill within hours if left untreated.
   
The Nigeria Centre for Disease Control and Prevention (NCDC) reported that as of June 11, 2024, over 1,141 suspected cholera cases had been recorded across 30 states, since January 1, 2024.

The 10 states that recorded 90 per cent of the cases are mostly located in the South – Bayelsa, with over 400 cases, Lagos, Abia, Cross River, Delta, Imo states, with some situated further North – Katsina, Nasarawa, and Zamfara states.
 
According to the Global Health Security (GHS) Index released in 2020, Nigeria was rated average on all indices of health care delivery when weighed against developing and developed countries alike.
 
The GHS Index is a project of the Nuclear Threat Initiative and the Johns Hopkins Centre for Health Security meant to spur measurable changes in national health security and improve international capability to address one of the world’s most omnipresent risks – infectious disease outbreaks that can lead to international epidemics and pandemics.
 
The first-of-its-type project, spanning April 2017 to July 2019, launched on October 2019, rated Nigeria poorly on three of the six categories – providing sufficient and robust health system to treat the sick and protect health workers; preventing the emergence or release of pathogens; and overall risk environment and country vulnerability to biological threats.
 
Nigeria, however, ranks average in three areas comprising rapid response to and mitigation of spread of epidemic; early detection and reporting for epidemics of potential international concern; and commitments to improving national capacity, financing and adherence to norms.
 
A breakdown of the country’s GHS Index rating in terms of early detection and reporting for epidemics of potential international concern shows that Nigeria ranked 78th (a tie with Panama) out of the 80 countries ranked for the category, achieving 44.6 per cent.

The current threat posed by these diseases and many others, either reported or under-reported, has exposed the country’s inadequacies in the area of sanitation, hygiene practices, and access to clean water.

According to public health experts, many Nigerians are exposed to life-threatening environment owing to poor sanitation and lack of potable water. This portends danger for the actualisation of the eighth item on the Sustainable Development Goals (SDGs) which targets to “Ensure availability and sustainable management of water and sanitation for all.”

Checks showed that public spaces have been converted to dump sites while streets are now a ‘safe’ haven for open defecation. These spaces are found in many communities across the country, which expose residents to diseases such as cholera. It is common to see food vendors and shops doing businesses near some of these locations.

This development brings to the fore, the role of environmental health officers and inspectors in schools and communities in time past to achieve a cleaner and healthy environment’.

It is on record that these environmental health officers always ensure that homes and workplaces are safe, hygienic and healthy. These inspectors were always on a routine visit to schools to check if pupils were properly dressed and ensure that the school environment is hygienic enough for studying.

They were also present in streets to help enforce sanitation by residents and as a result ensure the environment remained clean and conducive to live in. But they have disappeared from the scenes and residents now have a field day desecrating the environment.

The Guardian checks revealed that efforts have been made in the past by government, non-governmental organisations, as well as international donors and stakeholders to address the issue.

Despite the observance of the monthly and weekly environmental sanitation exercises in states aimed at tackling the challenge, it is disheartening to note that major streets, communities, road sides, markets and other public places have become dump sites of debris.

The Guardian learnt that the sanitary inspectors played very crucial roles during the colonial and post-independence era to wipe out filth and squalor.

Known as ‘Wole-wole‘ among the Yoruba people, ‘Nwaole-ala‘ among the Igbos and ‘Duba-gari‘ among the Hausas, sanitary inspectors are government officials saddled with the responsibility of overseeing the sanitation of houses and neighborhoods in every part of Nigeria. The office of the sanitary inspector was established back in the colonial era of Nigeria. At the dawn of their establishment, they were known as sanitary attendants because their primary function then was to serve as helping hands to colonial masters (sanitary inspectors) who execute sanitary duties themselves. On a clearer note, colonial masters who oversaw sanitisation were called ‘sanitary inspectors’ while Nigerians who worked under them were referred to as ‘sanitary attendants’.

The sanitary attendants handled meagre duties such as marking tall or bent trees, noting dilapidated buildings, pasting announcement or warning bills, interpreting for colonial masters, etcetera. Gradually, the sanitary attendants were assigned more professional functions such as daily sanitary inspection, collection of water samples, noting mosquitoes’ breeding sites and so on.

As time went on, these sanitary attendants improved in the level of their education and thus earned more recognition for their office. They began to execute functions such as felling tall trees that were close to residential buildings, identifying infectious disease cases, disinfection and disinfestations, liaison between the colonial masters and villagers, verification of notices issued by their colonial masters (sanitary inspectors), retention of daily, weekly and monthly returns and others.

As at this period, the sanitary inspectors were dreaded by all and sundry, even more than the then colonial police officers, because breaching their orders was breaching the system and thus, people avoid getting into their trouble net by tidying up their environments.

They noted that the sanitary inspectors, who normally carry out house-to-house sanitary inspection, would ensure that all houses, especially in rural areas have toilet facilities to discourage indiscriminate open defecation.

The experts said the sanitary inspectors were also expected to control indiscriminate dumping of wastes in the state capitals and other major towns in the country.

A retired teacher, Chief Titus Oludele recollects that at that time, everybody dreaded the sanitary inspectors even more than the ruthless colonial police officers, because breaching their orders was breaching the system and thus, people avoid getting into their trouble net by tidying up their environments.

He reminisced with nostalgia that the fear of sanitary inspectors then was the beginning of wisdom, as they provided the necessary practical solution to all environmental problems, as their order was law.

The reverberation of their boots as they enter any neighbourhood is enough to instill fear in the minds of the unruly and the dirty, as their presence signals a doom day, as there would be no respite for them. They bring order and sanity to bear in the environment.

They are the uniformed men and women that combed the nooks and crannies of communities ensuring everywhere was clean. They are the no-nonsense officers who handed out fines for dirty gutters and disgusting refuse heaps; and kept residents scrambling to tidy up their surroundings.

Indeed, the factor that improved the status of the sanitary inspectors was the establishment of the World Health Organisation (WHO) in 1948 as people with higher level of education joined the profession.

But in 1988, the name of the profession was changed to Environmental Health Officers in line with the internationally accepted name of practitioners of the profession and also to accommodate members of the profession who graduated from the university with a degree in public health, environmental health and epidemiology.

However, currently, reverse is the case. Since the name change, their performances and efficiency have changed. Though their status was enhanced and their monthly emoluments positioned almost at par with medical doctors, yet, their service delivery drops drastically, which public health analysts rated below average.

It is disheartening to note that the present situation of the sanitary inspectors in the country has deteriorated drastically as little or no regards are accorded them and their functions.

The Guardian observed that with the sanitation situation of Lagos, which earned it the sobriquet of the dirtiest city in the world, it confirms the near non-existence of the environmental health officers in the state and beyond.

The state of sanitation in some parts of the state, especially Lagos Island, the epicenter of the current cholera outbreak, Mushin, Agege, and other major communities, including markets, shows that the state is actually a breeding centre for diseases.

Aside from the issue of open defecation, indiscriminate dumping of refuse and littering of drainages, which has become a common place in the state, it has been confirmed that many houses that lack septic tanks are throwing their wastes directly into the drainage system without any sanction from necessary authorities.

For instance, a trader, Madam Idowu Olurebi, who resides at Sadiku Street, Ekoro, Abule-Egba, told The Guardian that a bungalow at Ona-Ara Bus Stop, close to her residence has been discharging bathing water and other wastes into the main street.

“This has been going on for over a year. At a time, some tenants who were disturbed with the menace the smelly water constitute approached the environmental health officers at the Agbado-Oke Odo Local Council Development Area (LCDA) secretariat, Oja-Oba, to complain, but instead of swinging into action, they were demanding for money for logistics.

“Though they eventually came, almost two months after, issued warnings and the house stopped the emission but after few weeks, they continued discharging the water till now. To make the matter worse, a new house built beside the bungalow, which has no drainage has added to the water. Whenever they wash anything in the house, the water will flow directly into the street.

“The health inspectors know about this, but they have continued to look the other way. There are so many sanitation infractions going on around the area and beyond but they won’t see it, but when it comes to extorting innocent citizens they’ll act swiftly.”

Beyond this area, investigations showed that there have been reported cases of similar scenario, which can surreptitiously spark-off outbreak of contagious diseases in the state.

Another case in point is the dumping of dead bodies on the major roads, which has also become a common place in the state. Unlike in the past, dead bodies are no longer evacuated promptly until they began to decompose and oozing foul odours into the air.

For Ogun State, from Sango, a metropolitan city in Ado-Odo/Ota, which shares borders with Lagos State, through Ifo to Abeokuta, Mowe and Ibafo among others areas, which also has abundance of environmental health officers, it has also not feared better.

It was confirmed that dead bodies, faeces and other types of debris are indiscriminately disposed-off in major areas in the state. On several occasions, places such as the Sango bridge-edge, Panseke, Lafenwa market, Enu Gada, Brewery and some areas in the capital city are always littered with refuse. It is the same scenario around Mowe, Ibafo to Ijebu area and beyond.

Recently, the state Commissioner for Environment, Ola Oresanya, warned residents against indiscriminate dumping of refuse and open defecation on the multi-million naira Panseke pedestrian bridge, Abeokuta.

“We put a giant waste bin along the road going towards the market. We put another smaller one around the place where okada riders (commercial motorcyclists) park, so that they can put their waste in the bin, but every time we go there to clear the wastes, we find out that the bins contain faeces and dead babies.

“When their children die, they don’t bury them, they will just dump them in the bins. There is a major social problem in that area that needs special attention, and we are looking at it holistically.”

It is a similar scenario as reported across other states in the country, where it was reported that despite the huge pay received by the health officers, their productivity and efficiency is below expectation.

With the current hike in price of foods and other commodities, reports have it that sellers and producers are adopting dangerous and unwholesome practices in production and handling of consumable goods, especially in the markets.

There are reports of adulterated palm oil diluted with dye, stones added to beans, usage of rotten tomatoes and peppers by food peddlers used to cook the food they peddle. It was also reported that some locust beans merchants use urine and dusting powder in the production of the locust beans. Butchers use urine to preserve beef till the second day and many other unwholesome practices, which have resulted in food poisoning for many people.

There were also reports of illegal slaughters sited along stagnant rivers, which stinks, where butchers wash the carcasses before selling to unsuspecting consumers.

In Ondo State, it was reported that vegetables and fruits dealers are fond of washing them in a river within the Akure Shasha market very early in the morning before taking them to markets, to sell to innocent buyers.

The problem with the Shasha Market River is that it stinks, oozing strong stench, as people defecate and dump all sorts of dirt in it. According to public health experts, the market could be a channel for infectious diseases that could cause epidemic in the market.

These and many more have further heightened the clamour by many stakeholders and concerned citizens for the return of the sanitary inspectors of the ‘good old days’.

A Professor of Public Health and Community Medicine, Department of Community Medicine, Ahmadu Bello University, Zaria, Kaduna State, Prof. Alhaji Aliyu, who lend his voice to the reintroduction of the sanitary inspectors, said the problem started, when “the functions of the local councils were taken away by the states, just because of money.

“The environmental health officers are the same as the sanitary inspectors with same legal framework, but their functions as far as I am concerned have changed. They are more heard in Abuja than other places, that is the problem. The laws are there, it’s just to make them function and provide an enabling environment to make people do their work.

“The sanitary officers of yesteryears are issues that constitutionally are within the purview of the local councils, but we know what is happening in the local councils. Currently, the Federal Government is in the court on the finances of local councils and the states, and as long as the local councils are not doing what they ought to do constitutionally, it is going to be difficult to break this vicious cycle because even basic sanitations – the sweeping of the streets, market sanitation, and even environmental sanitation are all within the legal framework of the local councils, but the councils have been short-changed.

“Let’s go back to Lagos; the same Lagos has the Lagos Waste Management Authority (LAWMA) or Lagos State Environmental Protection Agency (LASEMA) – Lagos State, just for political patronage. In Abuja, you’ll hear Abuja Municipal Waste Management Agency, in Kano, you’ll hear Kano Municipal Waste Management Agency, in Kaduna, you’ll hear KEPA – Kaduna Environmental Protection Agency. So, the functions of the local councils have been taken away by the states, just because of money.”

Prof. Aliyu said when those things were being done at the council authority level, the law backs them to the extent that they can even go to houses when they see waste water is flowing out of “your house without proper drainage because that is environmental contamination. Your waste water must go into the septic tank, the same thing happened in those days you’ll see food inspectors coming to primary schools, coming to secondary schools, but more importantly primary schools because the primary schools are under the purview of council authority, to inspect food vendors, as part of food hygiene and school health service but gradually all; those things got eroded and some of us start wondering where did we missed the road.”

While speaking further, the don said: “The issue of cholera outbreak in Lagos, Port Harcourt, Rivers State and other places is not surprising in the sense that cholera is attached or associated with contaminated water supply and also poor sanitation. And that is why whenever we are talking about water supply, it also goes with basic sanitation; they are essential to life in the sense that without proper sanitation our water supply system can easily get contaminated.

“This is because when people go and defecate in the bush because of lack of sanitary facilities, especially now that we are in the raining season, the rain will wash away the fecal matter that is on the surface of the earth into the rivers, it washes it into our ponds, it washes it into our wells and those who don’t have their wells covered it goes into the well and when we consume this water domestically, especially that is contained of course we are going to end up with cholera outbreak.

“So, if we want to break that cycle, we must provide the communities safe and potable drinking water and also provide sanitary facilities. The immediate past administration said it would end open defecation by year 2025, which is next year, I doubt if we can achieve that at the rate we are going, especially in rural communities, where people don’t have basic sanitary facilities in their homes, they have to go into the bush to defecate.”

On his part, an environmentalist, who is a retired Deputy Director, Water Supply and Environment Sanitation Department, Abeokuta North Local Council, Ogun State, Mr. Vincent Akinsola, attributed the inefficiency of the environmental health officer to inadequate man-power in the sector.

“It is not that we don’t have sanitary inspectors in place currently; it is only in nomenclature that the name has been changed and transformed. One of the challenges is that we don’t have enough man-power in that sector. The WHO recommended one environmental health officer to 8,000 population (1:8,000), but what we have now is far from the recommendation.

“Another major problem hampering their productivity is absence of logistics and tools to work with. They don’t have public health tools to perform efficiently. If you can make your enquiry further, go to the council secretariats and see how many councils, especially, in Ogun State, have a single tipper-lorry to cart away refuse, they don’t have simple shovels and rakes. Even the complimentary staff they supposed to have like the health attendants – male health attendants, and male sanitary health attendants that supposed to be doing the physical jobs by taking away the refuse, loading it in the vehicle, offloading it, burying pauper and accompanying the health officers for routine inspections, they are not there, they don’t have them.”

While appealing to government at all levels to increase the number of the environmental healthy officers across the country by employing more hands to meet up with the requirement of the WHO standard, Akinsola suggested the need for government to create a community oriented policy on environmental health service whereby the Community Development Associations (CDAs) would be involved and every individuals will embrace the policy as theirs.

“Government can assist the sector by increasing their numerical strength and man power development including that of their supportive staff like sanitary health attendants and drivers; provide them with modern sanitary equipment to face environmental challenges such as refuse lorries/compactor designed to ply Nigeria hinterland roads, minor pail loader, refuse crushers, rakes, shovels, public health meters for reading the degree of pollutants suspended in the atmosphere; and intervention for enforcement by creating mobile court or special court to adjudicate on environmental health offences with dispatch.

“It may be true to an extent that some officers are taking bribe instead of doing their jobs, because from among the 12 disciples there would be one Judas. That’s the effects of poverty in our society because it takes two to tango. There is a disciplinary committee within the professional body that’s seriously curtailing this menace.

“It’s the duty of people like you to assist in fishing out such bad eggs for reprimand. By the time a new policy is enshrined, which must have taken care of that type of loopholes, we would have a saner attitude from our officers.”