Community-Based Initiatives Improve Sanitation and Health in Waru, Nigeria

 {Photo credit: Dr. Saddiq Abdulrahman}Dr. Tali Butkap addresses community members during a sensitization meeting in Waru.Photo credit: Dr. Saddiq Abdulrahman

Waru is an underserved and hard-to-reach indigenous community in the Federal Capital Territory (FCT) of Nigeria. Until recently, this community did not have a safe waste disposal system and the majority of homes did not have toilets. Residents often dumped their garbage in open fields and defecated in bushes. This haphazard disposal of human waste and garbage caused Waru’s water sources and environment to become contaminated and, in turn, many residents suffered from diarrhea, cholera, intestinal worms, malaria, and typhoid.

Dr. Tali Butkap, deputy director for disease control at the FCT Department of Public Health, was aware of these sanitation challenges in Waru and eager to explore solutions. In March 2012, the PEPFAR-funded USAID Program to Build Leadership and Accountability in Nigeria's Health System (PLAN-Health), led by Management Sciences for Health (MSH), awarded Dr. Butkap the PEPFAR Health Professionals Fellowship to help him tackle these challenges in Waru.

During his six-week fellowship training, Dr. Butkap acquired new problem-solving and leadership skills, which equipped him to implement a community-based health volunteer system to address Waru’s sanitation problem. To start, Dr. Butkap recruited a team of 20 volunteers and trained them to conduct preventive health activities including community-based advocacy events, public health discussions, and sensitization sessions. These activities helped residents understand the health risks associated with poor sanitation and brainstorm ways to reduce these risks in Waru. Eventually, community members were inspired to work with the volunteers to identify and prepare designated dumpsites in the community.

In addition to community activities, the volunteers conducted household visits to educate residents about the importance of personal hygiene and keeping their environment clean. During these visits, the volunteers taught residents how to construct toilets in their homes and safely dispose of their waste and garbage. Residents also learned to wash their hands regularly, especially after going to the bathroom, before eating, and after returning home.

Dr. Butkap’s interventions have improved sanitary conditions and reduced disease incidence in Waru. Community members now understand the health risks of dumping refuse and human waste around the community. By the end of January 2013, residents in 15 households had constructed toilets and residents from another 15 homes were in the process of digging their toilets. Most residents now leave their refuse at the designated community dumpsites and both children and adults have started washing their hands after using the toilet and prior to meals. Community members are so invested in these improvements that they recently requested refuse bins from FCT’s Environmental Control Department.

“This is the first health program to sustain our community for a long period of time. We now know what to do to keep our environment clean and, as a result, malaria, cholera, diarrhea, and other diseases have reduced in our community," said Ishaya Dodo, volunteer project manager.

“We don’t go to the bush to defecate any longer, we don’t throw our refuse just anywhere, and our children wash their hands all the time,” said a community member.

With support from PLAN-Health’s technical staff, Dr. Butkap is now training community health volunteers from five additional communities within FCT.

James Ayodele is strategic communications analyst for the USAID PLAN-Health project and communications consultant for MSH Nigeria.