Authors : Issa Wone, Fatou Kiné Sylla
Affiliated organization : WaterAid West Africa
Site of publication : washmatters.wateraid.org
Type of publication : Report
Date of publication : February 2021
Call to action
Based on this report’s findings, we call for governments in West Africa to:
- Urgently and significantly increase their investment in hygiene infrastructure and promotion.
- Increase political commitment to prioritise and implement hygiene policies.
- Scale-up sustainable and inclusive water supply and sanitation provision.
- Stronger monitoring and accountability processes to ensure that hygiene policies are clearly prioritised, implemented effectively and sustainably, supported by clear national investment plans.
- More efficient sector coordination mechanisms, including all key stakeholders and encouraging greater innovation.
Access to hand washing facilities is exceptionally low
The proportion of people with access to adequate handwashing facilities in West Africa remains very low, rarely reaching 40% of the population. The situation is more serious in Liberia, where just 1% of the population have access to basic hygiene.
Lack of good hand hygiene practices enables disease transmission and outbreaks, causing missed work days, preventing children from attending school and increasing hospital admissions. It is integrated and cross-cutting to all other areas of hygiene: open defecation, food hygiene, menstrual hygiene and excreta disposal.
The current pandemic has highlighted on a global scale the critical role this intervention can play in reducing and preventing the spread of disease.
However, despite the recent increase in awareness, certain limitations were identified by the stakeholders relating to the dissemination of policies and programmes. Stakeholders are still dissatisfied with the integration of this specific aspect into their policies and strategies at country level. Furthermore, handwashing is routine in some public services, but still insufficient within the community.
Lack of access to safe water is a central barrier
Supply of safe water remains a severe challenge across West Africa, with almost 30% of the population still without access to at least basic drinking water, forcing millions to drink untreated, unsafe and contaminated water, significantly increasing the risk of disease.
Lack of good hand hygiene practices enables disease transmission and outbreaks, causing missed work days, preventing children from attending school and increasing hospital admissions. It is integrated and cross-cutting to all other areas of hygiene: open defecation, food hygiene, menstrual hygiene and excreta disposal
However, a further breakdown in data shows the rural areas being hit the hardest. In Togo, the consumption of surface water is four times higher in rural areas (32% compared to 8%).
Several sectors and ministerial departments are responsible for drinking water infrastructures across the region. The stakeholders view this management model as highly problematic. At domestic level, due to the lack of adequate mechanisms and the low impact of educational activities, the situation is considered unsatisfactory.
Open defecation and poor waste disposal are still prevalent
The elimination of open defecation improves dignity, reduces risks to children’s nutrition, and leads to improved health and productivity of affected communities. In West Africa, open defecation is more common in areas of economic disadvantage and rural areas.
Moreover, latrinisation and the installation of adequate excreta disposal facilities is implemented unevenly, depending on the region or province, in the different countries. The maintenance of equipment is also a problem.
Latrinisation programmes, particularly in rural areas, have been implemented for a long time in various West African countries, with varying degrees of success. Insufficient consideration of the school environment and inadequate monitoring of interventions remain the main factors hampering these strategies.
Taboos and barriers are blocking progress on menstrual hygiene
Menstrual hygiene management (MHM) remains a neglected issue in West African countries. Nevertheless, many initiatives, in partnership with UNICEF and certain NGOs, are emerging in these countries.
Effective MHM must include women and girls understanding the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear.
However, menstruation remains a taboo subject across many societies in the region and is often regarded as a disease or a form of uncleanliness. These taboos prevent many young girls from having access to the information that would allow them to adopt healthy hygiene practises.
Food hygiene efforts are ineffective
Poor food hygiene can contribute to stunting, diarrhoea, malnutrition and poor health. In the absence of specific data, stunting and mortality among children can often indirectly reflect the food hygiene situation in a country.
Stunting prevents children from reaching their physical and cognitive potential and levels are particularly high in West Africa, with the latest data showing the prevalence of stunting is 27.7%, which is higher than the global average of 21.3%.
Only four countries out of the 12 surveyed reported having specific hygiene policies, covering the three expected levels : Ghana, Guinea, Liberia and Mali. Policies are incomplete in Nigeria and Senegal, Togo and Burkina Faso, and significantly incomplete in Niger and Côte d’Ivoire.
Effective MHM must include women and girls understanding the basic facts linked to the menstrual cycle and how to manage it with dignity and without discomfort or fear
However, these policies are often obsolete and/or poorly implemented; they incorporate guidelines but remain very general.
A recent report by Sanitation and Water for All identifies large financing gap as one of the greatest barriers to achieving hygiene. Even within limited WASH budgets, hygiene comprises a global average of just 4%. In West Africa, accessible data on funding is often minimal and incomplete, making it difficult to get a clear and accurate picture across the region.
The World Bank has estimated that to meet SDG targets 6.1 and 6.2 globally, capital financing would need to triple to US$ 114 billion per annum, and operating and maintenance costs need to be considered in addition.
Hygiene coordination models
Generally speaking, several ministerial departments are involved in hygiene management, including the ministry in charge of health, on an on-going basis. This fragmentation has been criticised by the actors and is considered a source of inefficiency.
With regard to the coordination of hygiene activities, several models emerged from the analysis:
- A centralised model, based on the administration and its components. This model is found in countries such as Mali, Senegal and Niger.
- A management model which is more ‘open’ to civil society and NGOs, particularly in The Gambia and Liberia.
- A federal management model, as in Nigeria, where there is a coordination mechanism for these different bodies through the National Task Group for Sanitation (NTGS).
- An ‘in crisis’ model, as in Togo or Sierra Leone. In Sierra Leone, there is a lack of coordination between the NGOs, and between the NGOs and the Government.
- The Ghanaian model could be described as hybrid. In order to manage hygiene, public and environmental health at the decentralised level, 16 municipal councils, also called metropolitan, municipal and district units (MMDA), were created in addition to ten regional health and sanitation units.
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