ANALYSIS: Sub-Saharan Africa must pay more attention to Water, Sanitation, Hygiene

A well used to illustrate a story
A well used to illustrate a story

Water, Sanitation and Hygiene (WaSH) are the most crucial elements of development.

Historically, achieving improved drinking water supplies, adequate sanitation and sound hygiene had been part of the development agenda of the western industrialized countries.

One must have heard of John Snow’s success in reducing the scourge of cholera in Soho, London (1854), having successfully identified and removed the handle of a water pump in Broad (now Broadwick) Street as the source of the disease.

This, however, laid the foundation for subsequent efforts that culminated in the sanitary revolution of the 19th century. Unsafe drinking water, inadequate sanitation and poor hygiene are still a major challenge in developing countries.

Available statistics for sub-Saharan Africa (SSA) continues to haunt our development efforts through avoidable deaths and diseases. For instance, of the global deaths, from the one billion people without access to treated drinking water and 2.5 billion lacking adequate sanitation, over 83 per cent is concentrated in SSA.

The Ebola and other infectious diseases outbreaks are much related to our inability to get the WaSH act right, and there is high likelihood the COVID-19 pandemic may be complicated by poor access to WaSH among the vulnerable segment of the population.

The Nexus WaSH has diverse dimensions. Water (quantity & quality), for instance, is associated with the transmission of water-washed, water-borne, water-based and water-related diseases arising from inadequate supply, poor quality, hosts to some aquatic invertebrates and the spread of diseases agents respectively.

So, the sources of water we drink, the storage medium and the way we manage water are fundamental. Sanitation and hygiene carry several elements including personal hygiene, domestic and environmental cleanliness, waste disposal, handwashing, food hygiene, menstrual hygiene, child hygiene, maternal hygiene, care of the sick and vulnerable, safe disposal of human excrements, control of wastewater, care of those who are infected, safe handling of solid wastes, among several issues.

Several diseases linked to inappropriate WaSH practices include COVID-19, cholera, diarrhoea, dysentery, hepatitis, malaria, intestinal worms, guinea worms, trachoma, HIV/AIDs, typhoid, among many others.

Water-sanitation-hygiene-public health-development are clearly interlinked. One can validate this by quantifying the amount of time devoted per day to look for water; the cost involved (even if you run a borehole, you still spend money on energy and related services to make water available when you need it); the cost incurred in treating WaSH related diseases and sicknesses; the impact on children and women who spend so much of their time and energy to secure water for drinking at the expense of engaging in other productive/study activities; the cost on low-income earners (who spend a significant proportion of their income in securing drinking water through commercial channels).

In some rural areas of Benin, studies have shown that girls aged 6-14 spend an average of one hour a day collecting water compared with 25 minutes for their brothers. In Malawi, women have been reported to spend four to five times longer than men on water collection.

In Tanzania, a study found school attendance higher by 12 per cent for girls in homes located 15 minutes or less from a water source than in homes one hour away. Children carry the main responsibility for collecting water, with girls under 15 years of age being twice as likely to carry the responsibility as boys under 15 years.

In Africa, it is estimated that 90 per cent of the work of gathering water for the household and for food preparation is done by women. It is also estimated that women and girls in low income bracket spend 40 billion hours a year collecting water-the equivalence of a year’s worth of labour by the entire workforce in France;

The importance of WaSH in securing and sustaining improved socio-economic development cannot be overemphasized-you can connect and relate some of the stated facts to the actual and potential impact on the Gross Domestic Products (GDP).

The Sustainable Development Goal (SDG) reserves a special chapter for clean water and sanitation (Goal 6). Goal 6 intersects with several other elements of the SDGs directly or indirectly including, good health and well-being (Goal 3).

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It is also indirectly related to the goal of eliminating poverty (goal 10), securing gender equality (goal 5), and promoting economic growth (goal 8). But how can we reconcile our guest for development with our inability to secure improved access to clean water and sanitation across public and private places in sub-Saharan Africa, including schools, markets, public agencies, hospitals, motor parks, abattoir, streets, ports and our domestic arena, among several others?

Indeed, WaSH challenge in SSA is complicated by the existence of layers of socio-cultural and religious beliefs, attitudes and values across geographies, religion and socio-demographic and economic groups.

Scientific and practical biological and epidemiological logics and approaches to understanding the dynamics and transmission pathways to WaSH related diseases have helped the developed world through behavioural improvements and biomedical solutions. However, our greatest problem is our inability to disentangle WaSH matters from socio-cultural behaviours and religious beliefs, which, in some cases, are reproduced in the policy arena.

The major challenge of our times not only rests on our poorly developed WaSH policy environment and other forms of institutional arrangements; it also lies in our inability to connect our domestic WaSH policies with local science and environmental contexts.

In other words, why is it difficult to develop and sustain evidence-based policies in the WaSH sector? So much knowledge is produced, but much less knowledge synthesis happens in the WaSH sector.

Most of the local and policy tools in the WaSH sector are either drawn from the available colonial sources or prescriptions of major multilateral organisations, international NGOs and some scientific literature produced from a different contextual environment.

More so, the political commitment to solving the WaSH sector problem hardly exists. It is important to state here that the WaSH sector in SSA straddles several ministries and agencies including water resources, environment, health, agriculture, rural development, power, works and housing, transports, mining and steel.

More so, these ministries and agencies are duplicated at sub-national and local government levels. Several other players and interests are also involved including multinational and non-governmental organizations, the private sector, legislative and executive interests, multilateral and regional organizations, among several others.

With these multitudes, one would not believe SSA should be grappling with several WaSH challenges.

The biggest challenge here is that each of the organisations and institutions seems to pursue separate interest without a common coordinative platform. The results, of course, would be inter-agency competition, parallel projects that hardly reflect practical needs.

The most troubling of all is that the WaSH policy sector seems to be driven by the neoliberal agenda of privatization/commercialization, internationalization, individualization, liberalization, deregulation and re-commodification.

This cannot, in any way, address the WaSH sector problem as most of the contents in the neoliberal agenda hardly reflect SSA peculiar socio-cultural realities, economic development needs and environmental circumstances.

Country performance reports speak to these gaps. For instance, roughly 42 per cent of Nigeria’s urban and semi-urban populations are estimated to have access to safe drinking water as compared with about 29 per cent of the rural dwellers.

Currently, only Abuja and limited areas in Lagos have a sewerage system. This means, no other urban locations have been able to sustain a functional sewage system for their population. Though Malawi believes it has achieved 86.2 per cent public water coverage for her citizens, it is estimated that between 30 per cent and 40 per cent of available facilities are not functional due to cultural, environmental and socio-economic related factors.

Viewed through the lens of the neoliberal norms, how would the WaSH needs of homeless people, persons with disability and street beggars, who may not afford the cost of patronizing privatized toilets at public places including the market be handled?

Within these contexts, the task of securing access to safe drinking water and sanitary services is transferred on to the ordinary citizens, who have to depend on all forms of unimproved sources mostly dictated by economic, social and environmental circumstances as well as religious and cultural beliefs.

What should be done

On November 8, Nigeria’s President, Muhammadu Buhari, declared a state of emergency in the WaSH sector, implying that available resources should be mobilised to concentrate efforts at solving the problem.

In his remarks, Mr President noted as follows: ‘access to piped water services which was 32 per cent in 1990 has declined to seven per cent in 2015; access to improved sanitation has also decreased from 38 per cent in 1990 to 29 per cent in 2015…our country now ranks number two in the global rating on open defecation as about 25 per cent of our population are practicing open defecation…’

WaSH services in the rural areas are unsustainable as 46 per cent of all water schemes are non-functional, and the share of our spending on WaSH sector has been declining from 0.70 per cent of the GDP in 1990 to about 0.27 per cent in 2015, which is far below the 0.70 per cent at the West African regional level…’

This represents an important first step to addressing the WaSH sector challenges. But there is need for more including ‘water-sanitation-hygiene-public health nexus literacy’, ‘strong legal and regulatory interventions’ as well as creating appropriate institutional domains for WaSH.

WaSH is never recognised as an important public health issue among the population. Sector policies and legislations excessively focus on drinking and productive uses of water. Sanitation and hygiene rarely command high policy priority, making it difficult to address problems holistically. ‘Nexus’ thinking is more likely to encourage integrated management, improved stakeholder relationship and coordination of sector plans.

The WaSH sector governance needs much strengthening in terms of coordination, legislative and regulatory intervention. In all ramifications, the sector is poorly governed across SSA. No clear governing domain for WaSH as the three elements of water, sanitation and hygiene straddle different ministries and agencies, often giving rise to inter-agency competition and poor coordination.

In Nigeria, for instance, the Federal Ministries of Water Resources and its Environment counterpart claim parallel WaSH sector governance authorities, often leading to conflicts during the implementation of sector plans.

Public authorities should do more in the areas of legal and regulatory interventions to improve WaSH services at public places and residential homes. More interest should be focused on guaranteeing toilet services at residential and public places to minimise incidents of open defecation.

Urban rental properties should, by law, have minimum sets of toilet facilities before they are leased out. Market places, abattoirs, motor parks, recreation centres, restaurants, etc should not be allowed to operate below a certain minimum of sanitation services. These should be in the realm of legislative and regulatory interventions.

It is also important to recognise the challenges posed by cultural beliefs and religious values that tend to work against behavioural changes and innovative practices in the sector. This explains why WaSH literacy and awareness campaigns are necessary.

WaSH literacy and awareness campaign will enhance citizens’ capacity to read, understand and engage in appropriate behaviours to improve their sanitary living. WaSH education should be strengthened at the elementary and secondary schools.

The Media and community-based organisations can help complement basic education and awareness on WaSH-public health literacy.

While the multilateral, bilateral and many non-governmental organisations have been critical to WaSH sector development and progress in sub-Saharan Africa, national, sub-national and local level governments should assume the driver seats during program implementation.

This is necessary to evolve home-grown, cost-effective and sustainable solutions that address local complexities. This emphasizes the necessities for developing mechanisms for funding and engaging local science and research to enhance context-relevant policies.

Emmanuel Akpabio is affiliated to the Department of Geography and Natural Resources Management, University of Uyo, Nigeria. He is currently an EU Marie Sklodowska Curie Fellow, Department of Geography & Environmental Science, University of Dundee, UK. Mobile: +447751629349, E-mails:,; Orchid:;


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