Written by Ijeoma UKAZU

Tackling Under 5 Mortality Through Safe Water, Sanitation

Water is essential commodity in everyday affair and should be suitable for drinking, hence, both rural and urban dwellers deserve clean and hygienic water as well as a healthy environment.

In Nigeria, the need for improved water source in rural and urban areas to avoid water-borne diseases especially for children who are the most vulnerable is urgent and imperative.

But certain external factors could easily make water unsafe to drink and these factors include; presence of septic tank in the vicinity of the water source, borehole or well might make the water unsafe as sewage could seep through the soil strata to the water source and contaminate it.

According to the Multiple Indicator Cluster Survey (MICS), 2017 carried out by Nigeria Bureau of Statistics (NBS), in partnership with United Nations Children's Fund (UNICEF), indicates that 90 percent of households in Nigeria consume water contaminated  with fecaes and E.coli which shows that only 10 percent of Nigerians have access to suitable water for drinking.

Worried by the MICS survey, the Chief Water and Sanitation Specialist, UNICEF, Zaid Jurji said "this is very alarming. Approximately 88 percent of deaths due to diarrheal illness worldwide are attributable to unsafe water, inadequate sanitation and poor hygiene. Diarrhea is the second killer disease amongst children under age five despite being easily preventable. An investment of $1 in Water, Sanitation and Hygiene, (WASH) will yield an average return of more than $25 in good health, productivity, learning amongst others."

Jurji said for us to understand why this is happening, we need to know the underlying causes. “It is important to know, that good quality water is not enough, but also improved sanitation and hygiene. They go hand-in-hand,” adding that improved water sources coverage in Nigeria is only 64 percent (55% in Rural) which means that one third of the population which is about 60 million people have no access to clean water.

According to him, one of the underlying problem to having suitable drinking water in Nigeria is Open Defecation (ODF), and this is practiced by roughly 25 percent of the population which is more than the population of Canada by 20 percent, revealing that defecation contaminates water sources when practiced near or around.


He however added that exposure to external factors like dirty containers or even unwashed hands (after using latrines or changing nappies of babies) could make water contaminated as he urged communities and individuals to be aware not to allow this to happen.

"There are precautionary, cost-effective measures to reducing contamination of water and likelihood of becoming sick like using aquatabs for disinfection or boiling water that is used for drinking purposes."

The WASH chief added that "the North Eastern Nigeria situation is the same if not worse especially when we talk about the displaced population living in camps about 600,000 people. This has resulted from the humanitarian crisis as there was an outbreak of cholera in summer of 2017 that claimed the lives of 61 people and affected more than 5,000 people. The region has attracted the attention of the concerned authorities and the humanitarian actors.

"Following the cholera attack, there was an upscale of activities that aimed at improving water quality and promotion of personal hygiene which UNICEF in 2017, supported blanket chlorination for all urban water facilities during the raining season reaching 4.5 million people."

On increasing access to improved water, sanitation and hygiene, he called on government to make water a priority for it citizens, stating that "it is the right of every human. Secondly, improved services have positive impact on health, attendance of children to schools, work and economic productivity of individuals to name a few. It is also a collective effort by the government and the people to make it work."

He advised that, while it is the responsibility of the authorities to provide water systems, it is the responsibility of people to pay for the service to ensure that it works, adding that a tariff system not only allows for a sustainable service but also conserves and perpetuates the capital investments that have been made to establish the systems.


The Water Specialist said, "For example, wealth divide is clear in WASH accessibility. The richest 20 percent of Nigerians have  more than 90 percent access to water and sanitation. While the poorest 20 percent have access to less than 30 percent in water and 12 percent in sanitation. Also, 37 percent of rural population have to travel two hours to get water from an improved source. The tradeoff between getting water and work will always tilt to work and this brings health hazards and undernourishment to people and children.

"It is worth mentioning that close to half of children of families with the poorest 40 percent of Nigerians are stunted (low weight for age. An indication of malnutrition which is a big problem in Nigeria). Thus, there is need to focus on the poor and on rural areas to address a critical equity element.

"There is need for quick and big action especially in sanitation, otherwise, with a slow progress, water accessibility will always be beaten by the increase in population. Also with a Federal government setup, there will always be need in incentivize the States so that they equally make water and sanitation as their state priorities."

Jurji also revealed that globally, the private sector has been found to deliver better services if properly regulated. In an ideal environment, government agencies should limit themselves to the function of regulation and leave the operations and management of water systems to the private sector.

"In Kenya, agencies similar to water boards in Nigeria award the contract of managing water supply schemes to "Service Providers". Now the service providers could be an NGO, a Private contractor or a formally registered Community Organization. Following a competitive process, the management contracts are issued to these "Service Providers".

"These service providers provide service, following an agreed criteria (such as hours of operations, quality of water, tariff charged to poor and well-off). The Water Board regulates these service providers and ensure that good quality services are provided against the agreed criteria. This is one good way forward for Nigeria as well. The approach reduces the burden on the government, results in better quality services to people and at a more affordable and competitive price.

"On the other hand Rural Water and Sanitation Agency (RUWASA), and Water Boards could continue serving the unserved areas by constructing more water points through private sector. Thus RUWASAs capacities are not over stretched and they remain effective and efficient with time."

In his reaction, Pharm. Edwin Oyoma Akpotor, Senior Program Officer, Pharmaceutical Society of Nigeria (PSN), and also involved in the Partnership for Advocacy in Child and Family Health (PACFaH), project, called on stakeholders to know that clean water and sanitation is vital to safeguarding the health and wellbeing of children who are most vulnerable to water and hygiene diseases such as Diarrhea, Cholera and Pneumonia, adding that proper WASH and hand washing is the most potent “vaccine” for the prevention of childhood killers diseases.

He said, according to the most recent findings by Nigeria Demographic and Health Survey (NDHS 2013), shows that for every 1000 live birth in Nigeria, more than 180 of these innocent children won’t live to see their fifth birthday as Water, Sanitation and Hand washing preventable diseases such as Diarrhea, Cholera and Pneumonia accounts for more than half of these (180/1000) preventable diseases.

Akpotor urged the government of Nigeria to take the lead in ensuring Nigerians especially those in the rural hard-to-reach communities have access to clean water, hand washing services, sanitation and live in hygienic environment as he also called on development partners, traditional and religious leaders as well as other stakeholders to support the government to achieve the aforementioned goals as it will help to drastically reduce children deaths due to these diseases.

Also speaking, a member of the Association of Community Pharmacists of Nigeria (ACPN), Lagos, Mr. Steven Nwaozuzu said, "the issue of water source and supply is a major concern. In our practice we see a lot of water borne disease cases in particular, diarrhea.

"As it is seen today, everybody is digging borehole and we don't know how healthy it is. People drink all sort of water and end up with diarrhea. Once a child has diarrhea, ORS and Zinc is given to replace the lost fluid in the system. This will help control the diarrhea. In a week, we can have like five people who come to purchase ORS and Zinc in my pharmacy. I urge the government to take safe water supply to its citizenry seriously."


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