of Emerging Trends Economics and Management Sciences (JETEMS) 3(3): (ISSN: )

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1 Journal of Emerging Trends in Economics and Management Sciences (JETEMS) 3(3): Scholarlink Research Institute Journals, 2012 (ISSN: ) Journal jetems.scholarlinkresearch.org of Emerging Trends Economics and Management Sciences (JETEMS) 3(3): (ISSN: ) A Study of the National Rural Water Supply and Sanitation Programme Aimed at Achieving Millennium Development Goals in Eradicating Water Borne Diseases in Nigeria Olusegun Adegoke Adewusi Department of Economics, School of Management and Information Technology, Federal University of Technology, Yola. Abstract The study examines the Water Borne Diseases (WBDs) eradiation programmes of the Federal Government as stipulated by the Framework, with a view to achieving the Millennium Development Goals. The study is significant in the sense that the findings will guide the authorities in the choice of the appropriate strategies to be adopted in the eradication of water borne diseases (WBDs) in Nigeria. The study makes use of secondary data obtained from National Bureau of Statistics affiliated office in the Federal Government Secretariat, Yola and secondary data from the National Rural Water Supply and Sanitation Strategic Framework which was obtained through the internet. The secondary data obtained from these sources are used in establishing the reported case of Water Borne Diseases and notifiable diseases in Nigeria in year 2002 (pre-intervention year and year 2007) (post-intervention period). The comparison of 2007 data on WBDS with data on same for 2002 reveals that WBDs declines by 5.75 percent. The study recommends that a search should continue for a better, potent and result-oriented intervention that will rid Nigeria of WBDs. Keywords: water, disease, notifiable, approach, eradication INTRODUCTION The water supply and sanitation sector engages in the provision of services essential to the life and human development. To this end, Federal Government of Nigeria has directed sector efforts at achieving access to safe water and improved sanitation and hygiene practices by the population. This is hardly a surprise because most under-five mortality in Nigeria results from diseases that in one way or another are related to unsafe water supply, inadequate sanitary facilities and unhygienic behaviour (NPC/UNICEF, 2001). In Nigeria, the inadequacy of safe water and improved sanitation services is manifested in the prevalence of water and sanitation related diseases. Diarrhea, which results from poor sanitary/hygiene habits and consumption of water of poor quality is the second main cause of infant mortality after malaria and the third main cause of under-five mortality. The prevalence of diarrhea is higher in the rural than urban areas and in the northern zones than in the south. An estimated 150,000 to 200,000 diarrhea-related deaths occur among children below 5 each year (National Rural Water Supply and Sanitation Strategic Framework, 2004). Certain sector-borne diseases, such as onchocerciasis (River blindness) and dracunculiasis (Guinea worm) are transmitted by two insects that are associated with water, the black fly and Cyclops flea respectively (NPC/UNICEF, 2001). Dracunculiasis, which causes morbidity more than mortality, remains an important 272 health concern with multiple adverse effect on health, education and economic activities, especially in the rural areas. Onchocerciasis, caused by the black fly commonly found around fast moving streams of the savannah and forest zone is highly endemic in Nigeria with 40 million people exposed to the disease. Of this number, 22 million are infected and about 120,000 are estimated to be blind from the disease (National Rural Water Supply and Sanitation Strategic Framework, 2004). Schistosomiasis is a parasitic disease transmitted through active penetration of the human skin by the snail vector. The snails live in slow moving and stagnant water that is commonplace in Nigeria. Schistosomiasis causes morbidity in the rural areas of Nigeria. The high morbidity and mortality rates and the impact of these diseases are due to a combination of inadequate water supply and sanitation services and unhygienic practices. In acknowledgment of this fact, the drive to poverty reduction in Nigeria recognizes water supply and sanitation as an important component. The National Poverty Elimination Programme (NAPEP) views the Ministry of Water Resources as one of 14 key government agencies, relevant to the elimination of absolute poverty. Water supply and sanitation cuts across and affects several sectors, including agriculture, rural infrastructural development, education, industrial development and indeed all the sectors of development that require the use of water and the management of sanitation for the benefit and

2 welfare of human beings (National Rural Water Supply and Sanitation Strategic Framework, 2004). But, why do water and sanitation-related diseases continue to constitute a threat to the national aspirations and development? The answer to the question cannot be far-fetched. Except for the joint Federal Government of Nigeria and UNICEF Water and Environmental Sanitation (WES) programme, which has consistently been implemented, most of other programmes and projects that have been conceived to address the menace of water and sanitation-related diseases were interventionist, shortlived, pilot or demonstrative in nature. The purpose of the study is to establish the reported cases of Water Borne Diseases as a component of notifiable diseases in Nigeria; and to explore means of reducing its menace in the short-run and its total eradication in the long-run in line with the Millennium Development Goals (MDGs). Other specific objectives of this study are summarized as follows: The study examines the National Rural Water Supply and Sanitation (NRWSS) Strategic Framework as it affects the eradication of water borne diseases (WBDs) in Nigeria, using two major indicators. The two indicators are: the reported cases of notifiable diseases and the reported cases of water borne diseases (WBDs). The study, in addition, identifies approaches adopted by the Federal Government of Nigeria for the eradication of WBDs before the introduction of NRWSS strategic framework. Besides, the study underlines the new policy directions encapsulated by NRWSS strategic framework in eradicating WBDs. The study also assesses the new policy directions in order to establish its effectiveness or otherwise. Consequently, the study is focused to answer the following questions: i. Which approaches were adopted by the federal government of Nigeria for the eradication of water borne diseases (WBDs) before the introduction of NRWSS strategic framework? ii. Which policy directions were encapsulated by the NRWSS strategic framework for the eradication of WBDs in Nigeria? iii. How effective are the policy directives as encapsulated by NRWSS strategic framework? LITERATURE REVIEW The two indicators are defined as follows: Notifiable Diseases: - These are diseases so dangerous and serious that it must be reported officially to the authorities (Oxford advanced learners dictionary, sixth edition pg 798). Included in this category of diseases are: water borne diseases, chicken pox, lassa fever, yellow fever, small pox, meningitis, paralytic poliomyelitis, leprosy and many others (social statistics in Nigeria, 2007). Water Borne Diseases (WBDs):- These are the diseases spread or carried by water (Oxford advanced learners dictionary, sixth edition, pg. 1347). Included in this category of diseases are cholera, diarrhea, dysentery, dracunculiasis, typhoid and paratyphoid, onchocerciasis and schistosomiasis (social statistics in Nigeria, 2007). Approaches Adopted for the Eradication of Water Borne Diseases (WBDS) Before the Introduction of NRWSS Strategic Framework Two-pronged approach was adopted for the eradication of water Borne diseases (WBDs) before the introduction of National Rural Water Supply and Sanitation Strategic Framework early in the century. The approach was rooted in the water borne diseases preventive practice between 1981 and 1990, a decade that was christened as interventional drinking water supply and sanitation decade (IDWSSD). That decade was characterized by isolated water supply interventions, aimed at prevention of WBDs. The two approaches adopted are: i. qualitative approach ii. quantitative approach Qualitative Approach The focus of the qualitative approach was to improve the quality of water supply to forestall its contamination and by so doing prevent the water supply from being infected with water borne diseases (WBDs). A lot of well disinfection techniques were introduced and implemented to safeguard the wells from exposure that could lead to the contamination of water contained there-in. Emphasis of the intervention was placed on water quality laboratory equipment that would enable water supply to be tested in order to establish its suitability for human consumption. Water quality analysis was frequently undertaken to determine the susceptibility of water supply to water borne diseases. Water consumers were to be discouraged from patronizing water supply that failed quality assurance test and would thus be saved from being infected with WBDs. Another policy thrust of qualitative approach was the emphasis on the use of chemicals for water treatment prior to its consumption. Chemical bacteriological assessment were frequently undertaken to determine the capability of the various chemicals to subdue the bacteria that are carriers of WBDs. In addition, water quality guidelines were stipulated to the suppliers of water from different sources and authorities forbade the supply of water that failed quality assurance test. Quantitative Approach In contrast to the qualitative approach, the policy thrust of the quantitative approach emphasized on capacity building and other related measures that could enhance water supply coverage from various sources. If the policy thrust of qualitative approach was to address the menace of WBDs by improving 273

3 the quality of water supply, the policy thrust of quantitative approach was to make water available to the larger percentage of households. The contention of the quantitative approach was that availability of water to rural dwellers from various sources would provide rural households with variety of choice which would prevent them from patronizing infected sources of water. The focus of the quantitative approach was on the water yield and the provision of different types of handpumps in the rural locations. It also involved a clear-cut arrangement for the maintenance of rural wells and the introduction of new drilling techniques. All these called for the constant rehabilitation of rural wells in order to guide against their deterioration. Quantitative approach also embraced the training of well drillers and household water system managers. Besides, the approach recommended the provision of motorcycles and bicycles to the mechanics to enhance their mobility within the rural locations of their primary assignment. Had qualitative and quantitative approaches made positive impact on WBDs reduction in Nigeria? To answer the posted question, it will be useful to examine the constituent of WBDs in the reported cases of notifiable diseases in Nigeria. In order to avoid confusion and to distinguish between notifiable diseases, definitions of the two categories of diseases were given in the introduction. Information contained in table 1 reveals to us the reported cases in absolute and relative terms and it constituted 0.05 percent of the reported cases of notifiable diseases in year But, could different approaches, other than qualitative and quantitative approaches, result in greater reduction of WBDs? A study conducted by Esrey (1996) on impact of water, sanitation and hygiene on diarrhea reduction, answered in the affirmative. Esrey (1996) discovered that intervention, involving qualitative approach reduced reported cases of diarrhea by 15 percent; intervention involving quantitative approach reduced reported cases of diarrhoea by 20 percent. On the other hand, intervention targeted at improved hygiene and safe excreta disposal reduced reported cases of diarrhea by about 35 percent and 37 percent respectively. The outcome of Esrey s findings is presented in figure 1. Percent Table 1: Reported cases of Water Borne Diseases (WBDs) and Notifiable Diseases in Nigeria in Diseases Reported cases WBDs as a % of Notifiable Diseases Cholera 23, Diarrhea 793, Dysentery 424, Dracunculiasis 2, Typhoid and 104, paratyphoid Onchocerciasis 5, Schistosomiasis 14, Total WBDs 1,368, Total Notifiable Diseases 4,726, Source: NBS: - Social Statistics in Nigeria (2007) Table 1 reveals that reported cases of WBDs in year 2002 were 1,368,141 which constituted percent of the reported cases of the notifiable diseases in the year. Diarrhea which results from poor sanitary/hygiene habits and consumption of water of poor quality was the most prevalent of the WBDs in the year. Reported cases of another type of diarrhea (dysentry) were 424,021. This constituted 9 percent of reported cases of notifiable diseases in the year. Another water borne disease that gave a cause for concern is typhoid and paratyphoid, the reported cases of which were 104,154. This constituted 2.2 percent of reported cases of notifiable diseases for the year. The remaining WBDs appeared to be less threatening as they constituted less than 1 percent of the reported cases of notifiable diseases, individually. Dracunculiasis attracted the least reported cases of Improved water quality Improved water quantity Improved hygiene practices Safe excreta disposal Figure 1: Impact of water, sanitation and hygiene on diarrhea reduction (% reduction in diarrhea by intervention) Source: Esrey (1996) In the face of this incontrovertible proof, Esrey concluded that isolated water supply interventions (qualitative or quantitative) are not effective in the prevention of WBDs and that sanitation related intervention alone has a larger impact on WBDs than does water related interventions. METHODOLOGY OF THE STUDY The study covered all the thirty-six states of the Federation and the Federal Capital Territory. It was conducted with the aid of secondary data obtained from the social statistics in Nigeria. The two indicators examined by the study are the reported cases of Water Borne Diseases (WBDs) and Notifiable Diseases in Nigeria. Secondary data on these indicators for year 2002 were collected. For the purpose of comparison, year 2002 is noted by this study as the pre-intervention period. Secondary data, pertaining to the interventions aimed at curtailing the menace of WBDs in Nigeria were also obtained from the internet. The author understudies the application

4 of the interventions to water supply and environmental sanitation in the rural areas of Nigeria between year 2002 and Then, the author obtains fresh data on WBDs and notifiable diseases in Nigeria from National Bureau of Statistics publication, social statistics in Nigeria for the year 2007 and compares it with the figures on the two indicators for the pre-intervention year of 2002 in order to establish the effectiveness or otherwise of the interventions. In the process, other notifiable diseases are used as the control. New Policy Direction Encapsulated By the National Rural Water Supply and Sanitation Strategic Framework Esrey s findings were a cue to the formulation of WBDs-related part of National Rural Water Supply and Sanitation Strategic Framework (NRWSS). It pointed to the fact that improvement in the quality and quantity of water, if implemented together with effective sanitation and hygiene education programme would make a greater impact on WBDs reduction. Thus the NRWSS programme was formulated to pursue an integrated approach for the delivery of safe water supply and improved sanitation and hygiene services, targeting communities, health centres, schools and other public and private institutions in the rural areas of Nigeria. The main components of the new policy directions are: hygiene promotion and education, sanitation and water supply. Hygiene education is viewed by the NRWSS strategic framework as all activities aimed at encouraging behaviour practices that help to prevent water and sanitation related diseases. Hygiene promotion, on the other hand, creates awareness such that people recognize and understand diseases as well as their causes and prevention. Hygiene promotion was, therefore, designed to improve public health and personal well being, reduce the cost of curative health services and to improve productivity of school children and working people because less energy is lost from poor health illness. By combining hygiene promotion and hygiene education with water supply and sanitation, it was expected that there will be optimum use of safe water and sanitation facilities which will bring about a desired reduction in WBDs. It was also expected that water will be handled safely to prevent its contamination and that hygiene promotion and education related to sanitation will reduce WBDs because hygiene education will teach users to clean their latrines properly. The new integrated approaches also involve water, sanitation and hygiene promotion in schools, which include menstruation and menstrual hygiene. It is expected that through this aid, students in schools will understand menstruation, menstrual discomfort and management, menstrual hygiene practices and will be able to make menstrual hygiene messages. It was hoped that all these efforts would help in reducing poor sanitation and hygiene related diseases. DISCUSSIONS AND FINDINGS Esrey s study reveals that isolated water supply interventions (either qualitative or quantitative); isolated interventions on hygiene promotion and education and isolated interventions on sanitation will achieve varying degree of success. Esrey opined that the combination of these interventions into one would probably achieve greater success. Greater success in this context implies greater reduction on reported cases of WBDs. The integrated approach encapsulated by the NRWSS strategic framework was in consonance with Esrey s recommendation. The programme recommended the integration of intervention on hygiene promotion and education, sanitation and water supply to curtail the growth of WBDs in Nigeria. It was expected that the introduction of integrated approach would lead to a reduction in the reported cases of water borne diseases in Nigeria. How realistic is this expectation? The answer to the question is provided by the information contained in table 2. It is to be emphasized that data on the reported cases of WBDs and notifiable diseases for 2007 are presented in table 2 in order to establish the effectiveness or otherwise of integrated approach, which is the crux of the Framework. Table 2: Reported cases of water Borne Diseases (WBDs) and Notifiable diseases in Nigeria in 2007 Diseases Reported cases WBDs as a % of Notifiable Diseases Cholera 12, Diarrhea 1,069, Dysentery 424, Dracunculiasis Typhoid and paratyphoid NA - Onchocerciasis 9, Schistosomiasis na - Total WBDs 1,515, Total Notifiable Diseases 6,533, N.B: NA implies not available. Source: NBS:- Social Statistics in Nigeria (2007) In order to establish the impact of the integrated approach on WBDs reduction, it will be useful to compare information in table 2 with the information in table 1. It is to be emphasized that table 1 contains information on the reported cases of WBDs and notifiable diseases for the year 2002, that is before the adoption of integrated approach. A look at the two tables will reveal that WBDs had declined in relative terms. It declines from percent in 2002 to 23.2 percent in With regard to individual WBDs analysis, cholera declined from 0.5 percent in 2002 to 0.2 percent in 2007; diarrhea declined from 16.8 percent in 2002 to 16.4 percent in 2007; dysentery declined from 9 percent in 2002 to 6.5 percent in 2007; dracunculiasis declined from 0.05 percent in 2002 to percent in

5 Year Before we draw the final conclusion, it will be useful to examine the fluctuation, in relative terms, of the other notifiable diseases between 2002 and Information in table 3 will throw more light on this. We reiterate that the other notifiable diseases are used as the control for the study. Table 3: Fluctuation of the other notifiable diseases in Nigeria between 2002 and 2007 A B C D Total WBDs Total Notifable diseases Other notifiable diseases (A-B) Other Notifiable diseases as a percentage of total notifiable diseases ,726,227 1,368,141 3,358, ,533,306 1,515,475 5,017, Source: - Field Survey (2011) Information in table 3 reveal to us that reported cases of other notifiable diseases that were not involved in integrated intervention increased from 71 percent in 2002 to 76 percent in It is certain that an integrated intervention impacted positively on the reduction of WBDs within the period. In the face of incontrovertible outcome, one cannot do but agree with integrated approach which brought about reduction in reported cases of WBDs in Nigeria between 2002 and Federal Government of Nigeria has taken a prudent step for jettisoning isolated sanitation and water supply intervention in favour of an integrated interventions. CONCLUSION AND RECOMMENDATIONS Acute water supply and defective environmental sanitation pose a serious socio-economic problem to Nigeria. It not only inhibits or stops economic development, but also directly damage the health of the nation s people UNCHS, (1998). Its health implication is manifested in the prevalence of water borne diseases of varying degree of savagery, which had held Nigeria hostage for decades, defying all manners of intervention. Visible solution to the menace of WBDs commenced with International Drinking Water Supply and Sanitation Decade (IDWSSD). It is to the credit of the water supply and environmental sanitation strategists that the message of IDWSSD was not lost on the federal government of Nigeria. It was the message of that decade ( ) that stipulated the intervention options that could be adopted to reduce (in the short run) and to eradicate (in the long run) water borne diseases of different kinds. The ineffective isolated water supply and sanitation intervention options were the first choice of Nigerian government. The gains and the lessons learnt from those isolated interventions metamorphosed into integrated intervention as encapsulated by the National Rural Water Supply and Sanitation strategic frameworks. The introduction of integrated intervention appears to be rewarding. The application of this up-graded kind of intervention in Nigeria between 2002 and 2007 had reduced, in relative terms, reported cases of WBDS by 5.75 percent. It declines from percent (2002) to 23.2 percent (2007). On individual WBDs analysis, introduction of an integrated approach had reduced, in relative term, the reported cases of cholera from 0.5 percent (2002) to 0.2 percent (2007); diarhoea from 16.8 percent (2002) to 16.4 percent (2007), and dysentery from 9 percent (2002) to 6.5 percent (2007). With these remarkable reduction, it is safe to conclude that integrated intervention proved to be a better option as opposed to the isolated water supply and sanitation interventions. The outcome of this study is very cheering but it is recommended that the Federal Government, water supply and environmental sanitation strategists and indeed all the stakeholders should not rest on their oars. A search for more potent and results-oriented intervention option should continue until the time the nation is able to rid itself of the last vestige of WBDs. REFERENCES Esrey (1996) Impact of Water, Sanitation and Hygiene on Diarrhea Reduction as Reproduced in Framework (2004). Federal Ministry of Health (2002) Statistical Data on Notifiable Diseases in Nigeria. National Bureau of Statistics: Social Statistics in Nigeria (2007). NPC/UNICEF (2001) Situation Assessment and Analysis Children and Women s Right in Nigeria a Wakeup call. Framework (2004) Prepared by the Department of Water Supply and Quality Control, Federal Ministry of Water Resources (with Stakeholders input). Oxford Advanced Learner s Dictionary, Sixth Edition (Pg. 798; 1347). UNCHS (Habitat)/UNEP (1998) Sustainable Cities Programme (SCP). The SCP Process Activities. A Snapshot of What they are and How they are Implemented, Nairobi, Kenya. UN-Habitat (2003) Water and Sanitation in the World s Cities, Local Action for Global Goals, Earthscan, London. UN-Habitat (2003) United Nations Human Settlement Programme, Improving the Lives of 100 Million Slum Dwellers, Towards the Millennium Development Goals, Nairobi, Kenya. 276