GLOBAL AND NIGERIA’S CASE STUDIES IN WASH IMPLEMENTATION

Global Case Studies

1. Sato Pan Introduction: Launched in Bangladesh in 2012, the Sato Pan is an innovative toilet solution designed for low-income communities. Its counterweighted trapdoor minimizes insect and odor exposure while using less than one liter per flush. By 2014, over 800,000 units had been installed, and the initiative had expanded to 45 countries, benefiting over 68 million people.
2. WASH FIT Implementation: The Water and Sanitation for Health Facility Improvement Tool (WASH FIT) has been adopted in countries like the Philippines, Indonesia, Kenya, and Mali. This tool enhances WASH services in healthcare facilities, leading to improved patient outcomes and facility hygiene standards.

Nigerian Case Studies

In Nigeria, access to WASH services remains challenging. According to WASHNORM (2021), approximately 67% of the population has access to basic water supply services, but only 13% are classified as “safely managed.” There are approximately 33,000 Primary healthcare Care (PHC) facilities,  but half of them lack clean water, and 88% lack basic sanitation amenities; FCT is no exception. Several organizations, including WHO, UNICEF, and local Non-governmental organizations (NGOs), are working to improve WASH facilities in Nigeria. These include:  2 

1. UNICEF, in collaboration with the Nigerian government, has constructed and rehabilitated over 1,700 solar-powered boreholes across multiple states, including the FCT. Examples of these are:

1. Benue State Uikpam IDP Camp: In November 2021, UNICEF commenced the construction of a 12,000-litre motorized solar-powered water borehole, along with two blocks of five-compartment toilets and five-compartment bathrooms, to serve approximately 27,227 Internally Displaced Persons (IDPs) in the Uikpam IDP camp, Guma Local Government Area.8
2. Kano State Fadisonka Community: In Fadisonka, Wudil Local Government Area, a solar-powered borehole was installed around 2013 by the Rural Water Supply and Sanitation Agency in partnership with USAID and UNICEF. This borehole serves as the primary water source for the community.9

2. Programs like the WaterAid Nigeria’s Hygiene for Health campaign have played a crucial role in promoting proper sanitation and hygiene within PHCs, contributing to improved patient safety.

3. The World Bank’s SURWASH program is a notable initiative providing WASH services to healthcare facilities, including in Nigeria, to ensure sustainable access to clean water and sanitation. An example is the development of Performance Improvement Action Plans (PIAPs) for urban sanitation in several states. For example, in Gombe State, the program aims to strengthen and expand access to WASH services, improve management and sustainability, and address institutional development and capacity gaps within implementing agencies.

WASH IN FCT: Current Situation and its Health Implications 

Despite Abuja being the capital city of Nigeria, many primary healthcare centers (PHCs) in the FCT lack a consistent water supply and proper  WASH facilities. Over 40% of rural PHC’s face water scarcity, leading to inconsistent water quality and compromised hygiene practices.^5. Ensuring WASH in FCT healthcare facilities is not just an infrastructure issue; it is a fundamental human right and a public health necessity. The failure to meet basic and improved WASH services in the FCT health facilities undermines progress in healthcare delivery and sustainable development goals (SDGs), particularly SDG 3 (Good Health & Well-being) and SDG 6 (Clean Water & Sanitation).

Field surveys conducted by the Author in areas like Karu, Kuje, and Bwari Town showed that both water availability and quality are compromised under various settings. Water quality parameters such as phosphate, total coliform, Salmonella, and E. coli often exceed acceptable limits and global standards set by WHO. The inadequate WASH services in these towns have significantly burdened healthcare workers by making infection and prevention control (IPC) challenging. Without access to clean and improved WASH services, medical procedures such as childbirth and surgeries become high risk, increasing the chances of postoperative infections. Healthcare workers are subjected to outsourcing water from unsafe alternatives, heightening the risk of hospital-acquired infections and complicating medical procedures. This reality highlights the urgent need for systemic improvements in WASH infrastructure across FCT healthcare facilities.

Furthermore, the health implications of insufficient WASH facilities in FCT are alarming, especially to vulnerable groups such as infants/children, pregnant women, the elderly, etc. This causes the spread of waterborne diseases, Skin and Respiratory Infections, and malnutrition,  hindering child development and survival. Sepsis, a life-threatening infection, remains a major concern for pregnant women and newborns in PHC’s without proper sanitizing stations⁷. Surgical operations, childbirth, and other critical healthcare services become riskier without reliable water and sanitation. Many newborn deaths in Nigeria are linked to infections acquired in health facilities due to poor hygiene practices ¹. The article “The Urgent Need to Address Infant Mortality in Nigeria” highlights that Nigeria records over 250,000 neonatal deaths annually, averaging about 700 daily, making it the highest in Africa and second globally. Key contributors include infections (36% of neonatal deaths), birth complications, low birth weight, and limited healthcare access, especially in rural areas. The piece underscores the necessity for enhanced healthcare infrastructure, skilled birth attendants, and comprehensive maternal and child health programs to mitigate these alarming mortality rates. 

Additionally, inadequate waste management in some FCT health centers increases the likelihood of environmental contamination and disease outbreaks. Healthcare-associated infections (HAIs) are two to three times higher in low-resource settings where WASH infrastructure is inadequate.

Research has shown that ensuring access to clean water and improving sanitation conditions can significantly reduce neonatal and maternal mortality rates. Also, antibiotic resistance is on the rise due to excessive reliance on antibiotics to combat infections that could have been prevented with proper WASH services.⁴