Consider this: the world is urbanizing at an unprecedented rate, with the migration of millions of individuals to cities and urban centres bringing enormous pressure to bear on inhabitants, politicians, city managers, urban planners and policymakers.^[1] In a stark dichotomy, in Nigeria, access to piped water through household connections has decreased in urban areas, and the post-construction functionality of water points and schemes remains low.^[2] It can be easy to dismiss the profound significance of water in socioeconomic development, yet the reality of it is clear: across Nigeria these issues have a huge impact on health, education, livelihoods and well-being.

Amongst the gloom, there is hope in unsung heroes. Rita Momoh entered the world of healthcare from an early age, starting her nursing education at Adamawa State College in north-eastern Nigeria. After three years at the college and graduating, she then moved to the city of Jos in the Middle Belt of the country and began working as a nurse at an orthopaedic hospital where Rita laid the foundations of her medical and health practice for a year. Following this, Rita returned to education at the local Our Lady of Apostle School of Midwifery, where she undertook the 18-month-long midwifery post-basic education course, which she completed before taking on a role as a midwife at another hospital for five years.

While Rita loves what she does, there are inherent frustrations in her day to day which create obstacles on the road to excellent work. She mentions a constant lack of basic resources, including running tap water from a safe source, medical items such as forceps, gloves and syringes as well as a systemic entrenchment of unfair practices. These practices include reluctantly having to ask patients to fund their own supplies and provide basic items to facilitate Rita’s work with them. Across Nigeria, this is often the case, with only 31 percent of public health care facilities having access to a basic, functioning hand hygiene station.^[3] The indicators for access to improved sanitation are not only low, but also suggest that the sector is in an alarming state of dilapidation. Rates of open defecation may be low nationally, but less than one-third of citizens have access to improved sanitation, and approximately 94 percent of the population lack sewerage connectivity.^[4] These figures are alarming, nonetheless Rita finds great joy and pleasure in what she does, providing sustained care and support to pregnant women, from preparation in pregnancy, to the healthy delivery of a baby by a healthy mother in a healthy environment which can be sustained over time.

Rita therefore finds great solace and passion in being able to provide a continuous cycle of care for pregnant women who come to her MamaCare classes, led by Wellbeing Foundation Africa, which provide a continuous partum of care by creating a partnership between midwife and pregnant women to give them necessary support, care and advice during pregnancy, birth, and the postpartum period. When asked what is missing from her daily practice, Rita points to the availability of basic instruments which would enable for a more efficient, sanitary and holistic treatment for the women she is caring for as the top priority. An aim of the MamaCare programme, throughout its duration since 2015, has been bridging this identified gap between reality and achieving best outcomes, by making the mother a premium partner in her own decision-making, through education and awareness in birth preparedness. The MamaCare birth preparedness programme of antenatal and postnatal education and financial inclusion, using tools such as Emergency Obstetrics and Newborn Care (EmONC), client-held Personal Health Records (PHRs) and Respectful Maternity Care (RMC) empowers the mother by engendering health information and education during that key eleventh month (antenatal and postnatal) nest and nurture period. Still, there is much to be done and Rita has not been resting on her laurels. There are still low levels of facility-based delivery, skilled attendance at birth and use of modern contraceptive methods across Nigeria, which all contribute to a high new-born mortality ratio with 37 new-born deaths for every 1000 live births and 42 of every 1000 pregnancies resulting in stillbirths. When it comes to access to key water and sanitation facilities, Rita comments:

“Both midwives and mothers need WASH in each healthcare facility, because currently, in most facilities there are no running taps and this leads to an environment which is more conducive to spreading infections rather than reducing them.”

 She goes on to specify what happens in the occurrence of an outbreak:

“When there is a spread of disease, such as dysentery, Lassa fever or Ebola, the outbreak could be stopped at the source with preventive lessons on hand-washing and hand-washing stations. Still, most times, basic infections such as diarrhoea will spread in hospitals due to a lack of a good water source.”

With MamaCare currently running in 29 locations in Kwara, Lagos and Abuja States with a cumulative daily attendance of at least 2,000 women per state and over 200,000 repeated contacts, progress is in the air and Rita feels it. The delivery of 10,000 Mamakits to healthcare facilities since 2015 has seen Rita experience firsthand the amelioration of the key issues related to a lack of sufficient resources for midwives and pregnant mothers, yet she sees this just as the beginning. There is an urgent need for running taps not just in rural areas, but as aforementioned, in urban areas as well. Furthermore, behavioral restraints are often a leading impediment to better practices and Rita believes more enlightenment on hygiene and sanitation across Nigerian society needs to be done. Rita will continue to push for access to more resources and education so that there is greater coverage within and across facilities and, in her view, the government should secure WASH facilities and equipment as a public good while a model of service provision through midwives, nurses and other health care workers will lead the way to make WASH work. So, as is the case with a majority of unsung heroes, Rita continues her work in earnest and is diligent that, while the road ahead remains long, it is ever-more worthwhile.

[1] UN Chronicle, August 2018, “Promoting Sustainable Human Settlements: Its Relevance to the 2030 Agenda”, Link: https://unchronicle.un.org/article/promoting-sustainable-human-settlements-its-relevance-2030-agenda

[2] World Bank, 2017, “A Wake Up Call: Nigeria Water Supply, Sanitation, and Hygiene Poverty Diagnostic”, p. 85. Link: http://documents.worldbank.org/curated/en/566381502379018228/pdf/118241-WP-PUBLIC-WASH-series.pdf

[3] World Bank, 2017.

[4] ibid