Even before the COVID-19 pandemic, a majority of citizens say they went without needed medical care and clean water at least once during the previous year, a significant increase compared to 2017, the latest Afrobarometer survey shows.
Only a minority of citizens live in zones with piped water and sewage systems. Among those who had contact with a public clinic or hospital during the previous year, significant proportions report difficulties in accessing health care or having to pay a bribe to obtain the needed care, a troubling finding that has been fairly consistent over the past four survey rounds.
The survey also shows that citizens’ approval ratings for the government’s performance in providing water and sanitation services and improving basic health services, already low, have declined further.
The findings on inadequate access to water, sanitation, and health care point to priorities for urgent action, particularly in the face of the COVID-19 pandemic.
Only three in 10 Nigerians (29%) live in zones served by a piped water system, and even fewer (18%) have sewage systems their homes can access (Figure 1). Two-thirds (65%) live within walking distance of a health clinic.
Fewer than one in 10 citizens (8%) get their water from pipes in their dwelling place or compound. For most (65%), the main source of water is boreholes or tubewells (Figure 2).
Three in 10 respondents (30%) do not have a toilet or latrine in their home or compound.
Close to six in 10 Nigerians (57%) say they went without enough clean water at least once during the previous year, a 17-percentage-point increase compared to 2017 (Figure 3).
Two-thirds (65%) of Nigerians say they went without needed medical care at least once during the previous year, a 22-percentage-point increase since 2014.
Among respondents who had contact with a public health facility during the previous year, about four in 10 (38%) report difficulties in obtaining care, and two in 10 (21%) say they had to pay a bribe (Figure 4).
Only about one-third (36%) of Nigerians say the government is doing “fairly well” or “very well” on improving basic health care, and even fewer (27%) approve of the government performance in providing water and sanitation services (Figure 5).
Afrobarometer is a pan-African, nonpartisan survey research network that provides reliable data on African experiences and evaluations of democracy, governance, and quality of life. Seven rounds of surveys were completed in up to 38 countries between 1999 and 2018. Round 8 surveys in 2019/2021 are planned in at least 35 countries. Afrobarometer conducts face-to-face interviews in the language of the respondent’s choice with nationally representative samples.
The Afrobarometer team in Nigeria, led by NOIPolls, interviewed 1,599 adult citizens of Nigeria in January-February 2020. A sample of this size yields country-level results with a margin of error of +/-2.5 percentage points at a 95% confidence level. Previous surveys were conducted in Nigeria in 1999, 2002, 2005, 2007, 2008, 2012, 2014, and 2017.
Figure 1: Presence of health, water, and sanitation infrastructure | by urban-rural location | Nigeria | 2020
Survey enumerators were asked to record: Are the following services present in the primary sampling unit/enumeration area: Piped water system that most houses can access? Sewage system that most houses can access? Borehole or tubewell? Are the following facilities present in the primary sampling unit/enumeration area or in easy walking distance: Health clinic (private or public or both)? (% “yes”)
Figure 2: Main source of water for household use | Nigeria | 2020
Respondents were asked: What is your main source of water for household use?
Figure 3: Went without enough clean water or medical care at least once | Nigeria| 2012-2020
Respondents were asked: Over the past year, how often, if ever, have you or anyone in your family gone without: Enough clean water for home use? Medicines or medical treatment? (% percentage who say “just once or twice,” “several times,” “many times,” or “always”)
Figure 4: Difficulty and bribe-paying in obtaining medical care | Nigeria| 2012-2020
Respondents who said they had contact with a public clinic or a hospital during the previous year were asked: How easy or difficult was it to obtain the medical care you needed? (% who say “difficult” or “very difficult”) And how often, if ever, did you have to pay a bribe, give a gift, or do a favour for a health worker or clinic or hospital staff in order to get the medical care you needed? (% who say “once or twice,” “a few times,” or “often”) (Note: Figure excludes those who had no contact with public clinics)
Figure 5: Approval of government performance in providing water/sanitation services and improving basic health services | Nigeria | 2012-2020
Respondents were asked: How well or badly would you say the current government is handling the following matters, or haven’t you heard enough to say? (% who say “fairly well” or “very well”)
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