How lack of water undermines healthcare delivery, deepens sanitation challenges

In so many ways, Nigeria is a case study in contrasts. An ambitious middle-income country and Africa’s largest economy, Nigeria struggles to provide some of the most basic of services to its residents and it is curious how difficult it is for many of its citizens to access a facility as basic as water.

An estimated one third of Nigerians do not have access to clean water, and two thirds do not have safe private toilets. And one in three healthcare facilities does not have access to water, according to a World Health Organisation (WHO) landscape survey.

What this deficiency has succeeded in doing is impeding efficient healthcare delivery and deepening the country’s sanitation challenges which are made manifest by open defecation, especially in rural areas and the slum areas of the country’s big cities.

On Universal Health Coverage Day celebrated recently, environment experts saw the need to talk about why water, sanitation and hygiene must be included in the health conversation and Michael Ojo, WaterAid Nigeria’s Country Director argues that “if we are to achieve better health for everyone, everywhere, we need universal health coverage — the ability for all to have good health, and to get the healthcare they require, without incurring financial hardship”.

This, he explains, means looking at what underpins good health including their environment, the air they breathe, the food they eat, and whether they have clean, safe water to drink, a decent private toilet to relieve themselves in, and a way to keep themselves and their surroundings clean and hygienic. “At the moment, we are failing on this mission”, he notes.

Many health centres in the country lack these basic facility. At Zuba Primary Health Centre, in Gwagwalada, Abuja, Nigeria, there is no water supply so staff buy water for hospital use, including washing linen and instruments and flushing toilets. The clinic has been running for roughly 20 years and has 12 staff members, who deal with an average 30 to 40 outpatients each day. It runs antenatal and postnatal clinics, immunisations, laboratory services and services for the prevention of mother-to-child transmission of HIV/AIDS, as well as a delivery unit.

In some health centre, there are gallons of water in jerry cans lined up outside, purchased because the taps are dry. Lab technicians wash out samples of faeces or urine in a hospital sink using bottled water and And very ill patients or pregnant women with no choice but to use a single, fetid, overflowing squat toilet.

“This is the reality for healthcare staff in many health centres around Abuja, where WaterAid documented some of the realities of their working days trying to treat patients with dignity”, Ojo says, citing another instance of with Gwagwalada Township Clinic, Abuja, Nigeria where its 40–50 staff members deal with an intermittent water supply from the water board, and have to buy it from water porters when the main supply cuts out.

“We have a lot of challenges in terms of water and sanitation … the lack of constant water flow in the clinic, and we don’t have a borehole or a good well that will, at least, help us even if there is no other means of getting water from the water board”, reveals Umar Bako, 52, the newly appointed nurse in charge of the clinic.

Rukayyat Yahaya, 34, is a volunteer lab technician at the Garki Village Primary Health Centre, Abuja. Nigeria. The facility has two toilets and buys water daily, as it lacks a mains supply. “My lab is supposed to have a tap and sink, dustbin, fridge and a lot of space but it is too small… When I finish with the samples and my instruments for testing, I have to go into the toilet and wash them in the sink. Imagine excrement samples, urine and blood — it is not comfortable at all and I fetch the water from a big drum with the same hands”, Rukkayat lamented in an interview.

Compounding the risk for patients and healthcare professionals is Nigeria’s fast-growing struggle with antimicrobial resistance. Of the 10 million deaths from antimicrobial resistant infections predicted by 2050, an estimated 4.1 million would likely be in sub-Saharan Africa, where clean water, good sanitation and rigorous hygiene practices, which are critical to preventing infections, in the first place, are often lacking.

CHUKA UROKO