The Challenges of Implementation of Open Defecation Policy in Nigeria

The Challenges of Implementation of Open Defecation Policy in Nigeria

CHAPTER ONE

Objectives of the Study

The study has the following objectives:

1. To examine the attitude of the Sabon-Gari LGA people towards the practice of open
2. To establish the level of peoples ‘awareness about the dangers associated with open
3. To identify the implementation strategies deployed by the Primary Healthcare Department of Sabon-Gari Local Government Area of Kaduna State in tackling open
4. To determine the effectiveness of these implementation strategies in the campaign against open defecation in Sabon-Gari
5. To identify effective implementation strategies to improve environmental sanitation and discourage open defecation practice in local communities in Nigeria especially within the study location.

CHAPTER TWO

Review of Related Literature

 This chapter reviews literature that are related to the discourse of Health Communication, curative and preventive Communication, Behaviour Change Communication, the role of media in communicating health issue, Communication Primary Healthcare Delivery, Caregiver-Patient Communication, preventive and curative communication, the state of Primary Healthcare in Africa and empirical studies on Primary Healthcare in Nigeria. This chapter also consists of the theoretical frameworks used to underpin the study.

Health Communication

Health, according to World Health Organization (WHO) is ―a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity‖ (1974:2). However, the World Health Organization (WHO) definition gives us the three global classification of health which is known as the Health triangle (Physical health, mental health and social health). However, several criticisms have rendered WHO‘s definition ineffective because of the realities of the day. There is high prevalence of chronic diseases which can only be managed therefore, WHO definition becomes counterproductive as it declares people with chronic diseases and disabilities definitively ill. It minimizes the role of the human capacity to cope autonomously with life‘s ever changing physical, emotional, and social challenges and to function with fulfillment and a feeling of wellbeing with a chronic disease or disability. Machteld Huber et al (2011) propose changing the emphasis towards the ability to adapt and self-manage in the face of social, physical, and emotional challenges. This is done through vivid explanation of the health triangle.

Several dimensions of health can be identified in the social domain, including people‘s capacity to fulfill their potential and obligations, the ability to manage their lives with some degree of independence despite a medical condition, and the ability to participate in social activities including work. Health in this domain can be regarded as a dynamic balance between opportunities and limitations, shifting through life and affected by external conditions such as social and environmental challenges (Huber, Machteld et al. 2011:2).

In the physical domain of health, when an organism is confronted with physiological stress, a healthy organism is able to mount a protective response, to reduce the potential for harm, and restore an (adapted) equilibrium. If this physiological coping strategy is not successful, damage (or ―allostatic load‖) remains, which may finally result in illness (  McEwen J.B, 2003).

In the mental domain, Antonovsky (1984) describes the ―sense of coherence‖ as a factor that contributes to a successful capacity to cope, recover from strong psychological stress, and prevent post-traumatic stress disorders. The sense of coherence includes the subjective faculties enhancing the comprehensibility, manageability, and meaningfulness of a difficult situation. A strengthened capability to adapt and to manage self often improves subjective wellbeing and may result in a positive interaction between mind and body. For example, patients with chronic fatigue syndrome treated with cognitive behavioural therapy reported positive effects on symptoms and wellbeing (Antonovsky 1979, 1984). This implies that the word health is complicated and its definition can be viewed from different perspectives. For the purpose of this study, health is defined as a situation whereby human environment is free of open defecation practice and its manifest consequences.

Communication is defined as a means of passing messages across from one person to another. The basis of communication process as postulated by Berlo‘s formula (1960) is the SMCR which means the SENDER+ MESSAGE+ CHANNEL+ RECEIVER. From the above, Berlo‘s formula, SMCR, connotes that someone has to be in charge of sending the message through a designated channel or medium and such message must get to another person who in this case is the receiver. The message however must be understood. It is an age-long concept from a Latin word- COMMUNIS, which means common or shared understanding. Communication is at the heart of who we are as human beings. It is our way of exchanging information. Communication therefore is a purposeful effort to establish commonness between a source and receiver (Schramn 1965:1).

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CHAPTER THREE

RESEARCH METHODOLOGY

Research Design

Research instruments were tools used by researcher to collect valuable data. The essence of research instrument is to enable the researcher gather pertinent data that will be used to answer the research questions. This study therefore utilized the following research design and instruments for data collection:

1. Key Informant Interview
2. Focused Group Discussio
3. Questionnaire

Key Informant Interview 

The key informant interview method of collecting data involves presentation of oral- verbal stimuli and reply in terms of oral-verbal responses. This method can be used through personal interviews and, if possible, through telephone interviews. Key Informant Interview method requires the interviewer to ask questions generally in a face-to-face contact to the other person, or persons – as the case may be. (At times the interviewee may also ask certain questions and the interviewer responds to these, but usually the interviewer initiates the interview and collects the information.) This sort of interview is direct personal investigation in which the interviewer has to collect the information personally from the sources concerned. He has to be on the spot and has to meet people from whom data have to be collected.

Meanwhile, the researcher used this instrument to interview the Deputy Director, Disease Prevention and Control unit and seven (7) health officers that are directly in charge and managing the Primary Healthcare offices in Sabon Gari Local Government Area. This enabled the researcher to get first-hand information on the activities of the PHC especially on open defecation and disease prevention and control.

Focused Group Discussion 

A focus group discussion (FGD) is a small group of seven to ten people led through an open discussion by a skilled moderator. The group needs to be large enough to generate rich discussion but not too large that some participants are left out. The focused group moderator nurtures disclosures in an open and spontaneous format. The moderator‘s goal is to gather a minimum number of different ideas and opinions from as many different people in the time allotted (Berko, Wolvin and Curtis, 1993 cited in Athena, 2005:349).

Focus group discussions are structured around a set of carefully predetermined questions which are usually not more than 10 but the discussion is free-flowing. Ideally, participants‘ comments will stimulate and influence the thinking and sharing of others. Some people even find themselves changing their thoughts and opinions during the group chat. A homogeneous group of strangers comprises the focus group. Homogeneity levels the playing field and reduces inhibition among people who will probably never meet after the discussions.

CHAPTER FOUR

DATA PRESENTATION AND ANALYSIS

Demographic Data of the Selected Population.

Key: Figures in parenthesis are in percentages

The above table represents the age and sex distribution, household population and educational status of the respondents. The data generated was analyzed below.

Age Distribution of Respondents 

Table 1 shows the respondents‘ age bracket. 238 respondents between age 15 and 30, representing 68.8% had the highest frequency followed by 75 Respondents between age 31 and 49 representing 21.7%, while 33 respondents with 50 and above representing 9.5% were the least. However, the average age of the respondents for this study is 31. This implies that themajor population of respondents is youth and also suggests that they are likely to be the highest precursor of open defecation. If these people could be properly reached, it can go a long way in curbing open defecation. Again, it connotes that any communication intervention that will effectively curb open defecation must involve the community youth.

CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

Summary

This dissertation evaluates the implementation strategies against open defecation practice in Sabon-Gari local Government of Kaduna State using Bassawa, Bomo and Chikaji wards as sampled population. The study pays critical attention to the communication structure viz-a-viz the attitudes of the people towards open defecation practice as indicator for measuring its effectiveness or otherwise. Relevant literatures were reviewed and the principles of Health Belief Model and Participatory Communication Theory were used as premise and rationale for analyzing the Local Government Implementation strategies. The survey research approach was employed to gather data using qualitative and quantitative methods. The instruments include Questionnaire, Key Informant Interview and Focused Group Discussion.

In this study, 400 questionnaires were distributed across the three wards selected while 346 were returned, analyzed and presented in tables, charts and percentages. Data derived from 35 FGD discussants across the wards and KII response from the 8 environmental health officers across the local Government including the Deputy Director, Disease Control of Sabon-Gari LGA primary healthcare department, were descriptively analyzed and interpreted using triangulation.

However, the study revealed that the implementation strategies deployed by the primary healthcare are not adequate due to the frequent occurrence of cholera outbreak in Sabon-Gari LGA. The study also discovered that the prevalent practice of open defecation among the people is an indication of an ineffective and failed implementation strategy. This is consequent upon the fact that the communication content does not include threat messages that is capable of changing the people‘s attitude and behavior towards open defecation. Whereas, the annual cholera epidemic where people lost their lives is a bigger threat to be domesticated and factored into the communication approach of the primary healthcare officers in Sabon-Gari LGA.

Furthermore, any communication structure that is designed to change peoples‘ unhealthy attitudes and traditional behaviour like open defecation must adopt a multiple communication media, especially interpersonal and alternative media that will target all members of the society in order to yield positive outcome which in this case were not considered.

Conclusion 

From the findings of this study on the evaluation of implementation strategies against open defecation in Sabon-Gari LGA, it is established that the Primary Healthcare‘s Communication Approach was able to mere awareness creation among the people, it was incapable of changing their attitude towards open defecation. Though the LGA‘s communication channels are indigenous to the people, still they do not involve the people in message design and dissemination except at the level of information.

In conclusion, the study identified multiple communication media especially the use of interpersonal and alternative media like Traditional Media, Social Media, Theatre for Development and Community Led Total Sanitation as panacea to successfully curb open defecation practice. If the Local Government can incorporate this media outlet with their existing ones, it will help in reducing the prevalence of open defecation in Sabon-Gari LGA.

Key Findings

Based on the field responses on the evaluation of implementation strategies against open defecation in Sabon-Gari LGA, the following findings emerged:

1. The data revealed that though 92% of the respondents have toilet facilities, those toilets in most households are meant for the female (male members find alternative means of defecating even if it means practicing open defecation).
2. The study identified house to house inspection‘, use of local announcer‘, health talk at various PHC centre‘, the use of mobile phones‘ and ‗radio‘ as the implementation strategies used by the Primary Healthcare in Sabon-Gari LGA in curbing open defecation
3. The study found out that the implementation strategies deployed by the Primary Healthcare in Sabon-Gari LGA are feeble, partially participatory and incapable of directing the people towards adopting a healthier
4. The study discovered that the people are not involved in the planning and dissemination of health communication messages against open
5. The study indicated that majority of the respondents are aware of the dangers associated with open defecation. This is reflected in 89.3% of the respondents who said they are aware of open defecation related
6. The study revealed that there are no PHC centres in Bomo and Chikaji wards as opposed to Bassawa ward that has a PHC centre.
7. Findings from KII and FGD revealed that inadequate toilet facilities, social reality, unconscious habitual practices and unhealthy cultural practices are significant factorsleading to open defecation, especially the Almajiri students who are major stakeholders that contribute to the prevalence of open
8. It was discovered that the people are not aware of polio as an open defecation related disease; meanwhile, Kaduna is one of the six states where polio is
9. The study found out that provision of public toilet, communicating sanitary laws and media campaign on open defecation related diseases are salient factors to be considered if positive result must be returned to their various home.

Recommendations 

In view of the aforementioned findings, the study recommends that:

1. There is the need for the LGA to conduct a baseline study on the cultural and behavioural factors responsible for non-compliance that is hampering their communication efforts that is aimed at curbing open
2. The LGA should deploy the use of multiplatform communication including the use of Theatre for Development and Community Led Total Sanitation which has proven to be highly effective. This will enhance adoption of healthy behaviour and, ultimately, a drastic reduction on the rate of open defecation
3. The Primary Healthcare should involve the people in the process of planning, designing and implementation of the message and create an atmosphere where individual can freely express themselves. In addition, members of the community should be trained as peer educators so that they can talk to their own people in the language they
4. The LGA should collaborate with the railway corporation, market and shop owners to construct public toilets that are free for all with apt The Mallams of the Almajiri should be sanctioned and given ultimatum to construct toilet for their students otherwise, they the children should be returned to their various homes.

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