Apart from insecurity, food insecurity and other issues affecting Nigeria, cholera has become one of the diseases that claim the lives of Nigerians. This year alone, 22 states and the FCT are affected by cholera as 816 deaths have been reported in these states. Cholera has become a recurrent disease in Nigeria with the outbreak having occurred several times previously.
Cholera is a water-borne disease that can lead to a sudden death due to dehydration. It is transmitted primarily through contaminated food or water and through contact with the feces of an infected person. Through open defecation, food and water can be contaminated.
Nigeria has the second highest number of people who practice open defecation worldwide after India. India has over the years taken drastic steps in making sure more toilets are constructed. The ‘Clean India’ policy has reduced the number of open defecation considerably; about 110 million toilets were built in five years and 600 million people gained access to them. UNICEF in its Making Nigeria Open Defecation-Free by 2025 report states that, “About 46 million people in Nigeria defecate in the open, of which another 56 million people are estimated to be added.” This means that a total of 102 million people should have access to toilets and use it.
Open defecation is the practice of defecating openly in gutters, open places, in waterways, open trenches, bushes without any proper disposal of human feces. Open defecation affects human health and is classified as a sanitation and environment problem. Poor sanitation increases poor health and spread of diseases. When people defecate into running water from a point, there is a possibility that at another point, the water is regarded as drinking water. Lack of clean water causes cholera, diarrhea, and other forms of bacterial and viral infections that may lead to more life threatening health challenges. It could lead to stunted growth in children, malnutrition and can increase mortality rate in children.
Open defecation is an issue that affects everyone, women, especially pregnant women and children who are often at more risk of experiencing multiple health vulnerabilities.
It is often assumed that rural dwellers indulge more in open defecation because they may lack access to good toilet systems. It is not fully so. Open defecation is practiced in the cities, semi urban areas as well. Where there is no adequate public toilet system, people are left with the choice of defecating in the gutters, water channels and even in farms. Open defecation is also practiced in many institutions of learning in Nigeria where the toilet facilities are not adequate and properly managed.
The United Nations recognized that access to safe and clean drinking water and sanitation is a human right. It says that health implications linked to lack of access to clean water, poor sanitation and open defecation are clear breaches of human rights.
However, the UN asserts that sanitation has to be measured in terms of human dignity. This is because open defecation leaves people vulnerable to all forms of abuse and violence as well as shame and this is seen as infringement to human dignity and it should be considered a human rights issue.
Reducing open defecation and improving sanitation can reduce the recurring outbreak of cholera in Nigeria.
Having access to toilet and hygiene promotion is a cost effective health intervention. Open defecation is yet to be defeated. The Nigerian government could adopt the toilet revolution of India while engaging in mass awareness of the implications of open defecation, poor sanitation and hygiene. Efforts towards changing such culture should be geared towards providing more public toilets, and ensuring its use and its cleanliness. This is to restore public health, human dignity while also looking at the economic benefits.
Many medical practitioners are fleeing Nigeria
The way a country finances its health care system, determines the quality of the healthcare rendered to the citizens. At the ‘Abuja Declaration’ held in 2001, African leaders signed a declaration to award at least 15% of the budget to the health sector but in 2021, Nigeria merely budgeted about 5% of the annual budget. Jacob Lew wrote that, “Budget is not just a collection of numbers, but an expression of our values and aspirations.” The budget allocation to the health sector barely funds the health sector and the medical practitioners. Whereas the president and the political elites do not have faith in the country’s healthcare system, prompting them to seek medical treatment abroad, Nigeria’s health sector is bleeding and a lot of medical practitioners are seeking refuge in other countries.
The Nigeria Medical Association (NMA) had said that about 2000 medical workers leave Nigeria annually to other countries for work and improved income while the ones in Nigeria are overworked and their wages owed, making them go on strike often.
Where are this country’s values and aspirations? Is it about draining Nigeria of good healthcare or becoming a hub for medical tourism just as India has worked hard to achieve? As it seems, the political leaders do not care as the medical practitioners continue their exodus so long they receive medical assistance from other countries.