BY Musediq Aderemi BASORUN


The poor living in rural communities are generally vulnerable to water borne diseases because of uneven coverage of projects providing clean drinking water and even worse provision of improved and safe sanitation.
Water and sanitation surveys conducted in Nigeria, have shown that a significant number of rural communities have only a limited or no access to reliable and safe drinking water supply. To meet their daily water needs, rural communities draw water from unprotected water sources. The Idi-Iya community of Oyo State faces the largest backlog in water and sanitation services in the country.

Cholera is spread by contaminated water and food. Sudden large outbreaks are usually caused by drinking contaminated water from unprotected sources (WHO, 2000). The communities most at risk from water-related diseases are those who are poor, those with poor or no sanitation services who are forced into bush toileting – often along the banks of rivers, and those who rely on untreated water directly from rivers for their drinking water and for washing purposes. The cholera bacterium therefore spreads by people drinking contaminated water.


Lack of access to basic water supply and sanitation facilities is one reason for most state in northern Nigeria suffering by far the highest infant mortality and water-related disease rates in all of Africa. 18 000 people in Nigeria die from diarrhea or dysentery every year It costs the country approximately billions of naira every year to treat and cope with the effects of water borne diseases (Rural Development Services Network, 2000). Even where there are community water supply projects there are problems encountered by poor families accessing the minimum water consumption (25 litres per person per day) set out in regulations.

In the rural areas individual consumption daily rarely reaches this level except where there are yard connections. Reasons for low or no clean drinking water consumption include issues of affordability at either the flat rate contribution or metered water supply, and an unwillingness to pay for communal standpipes (RSDN, 2000). This has now been partially alleviated by the provision of free basic water, but there are still continuing problems of other kinds in Idi-Iya Community which predominantly is occupied by farmers. Prominent among these problems is the problem of communicating of relevant information to prevent in the first instance, the outburst of cholera, prevention of its spread or provision of information that leads to a favourable attitude change among rural dwellers in the west particularly in the aforementioned are.


Cholera is a disease largely of absence of sanitation and is closely associated with deep impoverishment and poor service delivery. The bacteria is spread mainly by contaminated water and food, attaches to intestinal wall, multiplying to produce a poisonous chemical which prevents the body processing water. Up to 14 litres of diarrhea can be passed in one day and it can lead to death in 24 hours. The disease has caused terror to populations and in the 19th century has devastated first world cities where it has been described as ending in mort de chien, a dog’s death, in agonizing cramps, diarrhea, and exhausted death. It can be eradicated by fairly elementary public health measures such as provision of sanitation, clean drinking water and encouragement of hand washing. Reports of outbreaks to the WHO show that cholera, which was previously widespread in the former colonial regions generally is increasingly limited to the African continent.

Nigeria is one of the most developed states in Africa and the incidence of cholera was something of a surprise. In the post-apartheid period has given priority to the delivery of water and sanitation to rural areas, was subject to a substantial outbreak of cholera in the period 2000-2001. An outbreak in August 2000 in the northern part of Nigeria gave rise to more than 100 000 cases a year later and there were continuing outbreaks in this and other provinces. According to WHO statistics this was the biggest outbreak in Africa for that period, all in all, the Nigeria outbreak accounted for 80 percent of all cases worldwide in the reporting period (IRIN, 2002?). It was both significant continentally, internationally and in terms of its policy implications locally.

According to Bongi and David (2004.1), the question arises why Nigeria which has a high profile policy of water services delivery should suffer such a prolonged and widespread epidemic. The outbreak of cholera appeared to indicate a considerable gap between the promise of basic municipal service delivery and the reality of unsanitary social environments mostly in rural, but possibly more acutely in peri-urban areas and slums. It is evident that the disease is closely associated with deep levels of poverty where people are vulnerable to lack of publicly provided sanitation. In the inception of the epidemic debate focused on impediments to public access to clean drinking water through rigorous cost recovery measures in the northern areas. As the epidemic advanced the relationship between poverty, backlogs in water and sanitation provision and health conditions was very actively debated. Was cholera the result of a low level of service delivery or precipitated by the emphasis on cost recovery and payment for water services?

The second question relates to the extent and persistence of the epidemic which pointed to problems with the public health messages and interventions led by the Department of Health and supported by other departments, the military and local agencies. Questions have been asked about the effect of the messages being communicated. To what extent were the messages put over in print, radio and television effectively communicated and having the result envisaged? It is not clear whether the health messages and campaigns have had the desired result. During and following the epidemic there was a particular focus on ‘anti-cholera’ strategies in accelerated water and sanitation delivery and were these measures sustained?

Two questions arise from these phenomena: why were the public health messages relatively ineffective in stemming the tide of the epidemic and what were the problems encountered in securing effective departmental coordination. The effectiveness of messages on sanitation and hand-washing is assessed in the schools which as the one state controlled and directed institution in the rural areas should operate as models of hygienic practice. It was found there were poor standards of sanitation and no facilities for hand washing.

There were no radio jingles relating to the cholera epidemic or hygiene practice in the classrooms and it was unclear the extent to which hygiene and water and sanitation featured in the curriculum. In short the schools practice showed that the departments of education, health and water affairs were ineffective in getting messages to the youth and ensuring they were reinforced.

The public health intervention was founded and managed on the basis of an emergency strategy which, for the first time in Nigeria history, employed the Disaster Management Act of 2002 for a health problem. Emergency strategy lead to concentrated focus on anti-cholera coordinated activities and succeeded finally in bringing the epidemic under control (although not its elimination). It did, however, raise issues in relation to its relationship to the longer term social question of service delivery and responsible government.


According to Moemeka (1981.27), the media, especially radio, can not only reach people and areas otherwise inaccessible, but also serve as a direct instrument of education. He say they are agents of social change because they help in the county’s transition to new practices, which to him, in turn, leads to changes in attitudes, beliefs and skills, without which there can be no substantial community development.

Moemeka, in his work, Local Radio: Community Education for Development: Alternative Approach emphasizes the importance of radio in development by citing the media approach to community education as experimented in Ghana’s Rural Broadcasting Unit- Radio Rural Forums, Tanzania’s civic education through radio study groups, Senegal’s Radio Education Rurale and Colombia’s Accion Cultural Popular. Describing them as successful, he posits that they have shown that the mass media can to a large extent, offset many of the disadvantages of the face-to-face approach while making the best use of its advantages.

The media approach to Moemeka, has enabled the literacy to be crossed, and distance to be eliminated, it has made the services of the few experts available to everyone, for through the media one teacher can teach everyone. According to him, it has also helped to remove the problem of ‘dragging’ people out of homes and familiar surroundings to attend classes. The believe here is that if radio with its numerous potentials can be used to achieve the feat in he aforementioned countries it can do more in Nigeria if effectively put into use.


The theoretical frame-work for this is based on Two-Step-Flow Theory of the media. The theory postulated by Lazersfeld and Merton (1948), cited in Folarin (1981), posit that ideas often flow from the mass media (radio, television or newspaper) to the opinion leaders in society who then pass this information via interpersonal channels to their followers- or the less active sections of the population. According to Kartz (1960), individuals are not social isolates but they belong to groups that interact with other people.

The implication of this in development communication delivery is that the potentials of group dynamics among rural dwellers remain a viable option for effective information dissemination in rural development process.

The theory states that the first step in the flow consists of active information seekers who are generally well-educated, have access to media resources, are influential on others and act as sources of guide to others. Therefore, the paradigm of innovation-diffusion in rural community requires the services of opinion leaders. Since they play an active role in adoption process, they need full integration into the information exchange network of development programmes. They are well-informed people. They pass their information to others in the second stage through informal or interpersonal means.

Therefore, personal influence becomes an in-built process intervening between the media’s direct message and the audience’s ultimate reaction to media messages. As every other communities, Idi-Iya also has some that could be referred to as opinion leaders whose influence could determine the success of any media messages such that has been received by the people thus, if the messages are favourable to the leaders, they tend to spread the information among the less informed who are looking up to their approval of any intending actions. If it is contrary, then, the message may not achieve the purpose the communicator expects of it.


Strategy for intervention

The strategy for intervention employs advocacy to raise resources and political and social leadership commitment for developmental goal; social mobilization for wider participation and ownership; and programme communication for bringing about changes in knowledge, attitudes and practices among specific participants in programs. These are the three main strategies in communication for development which is crucial for social transformation. This may as well be regarded as participatory development.

Advocacy and Communication

Mobilizing the communities, local, regional and national as well as political and religious leaders to play an active role in cholera control and ensuring proper understanding of the core interventions by the population and promoting positive change of behaviours is the major purpose of advocacy and communication as part of the cholera control strategy. Here, the stakeholders opinion leaders, the community people, the donors and the communication experts are brought together to debate and dialog on issues of development that bothers the development partners this affords every partners the opportunity of being involved in the developmental process. This process creates opportunity for a two-way communication between the partners.

The general objective of this work is:
To design a communication intervention programme that is aimed at creating a favourable atmosphere for a positive change of attitude towards preventing and eliminating the deadly effects of cholera in Idi-Iya community of Oyo State.

The ‘Besette Approach’ was employed in the designing of the intervention. According to Arokoyo (2011), the Besette step is a regular development plan and it is a participatory approach used for various development interventions.


Efforts were built on the existing structures such as the Ward and Community Development Committees to engage communities and families in playing an active role in cholera prevention as well as to increase correct treatment behaviours.


In spite of Nigeria’s considerable resources and its leading role in uniting the African community for cholera control, the commitment of the political leadership in this community is still insufficient and something urgent need to be done to rescue the situation.



Community Entry

Advocating among State Governors, parliamentarians, politicians, religious and traditional leaders for a better understanding of as well as more financial and organizational support for cholera control will be the main strategy and will utilize up-to-date information provided by the Monitoring and Evaluation (M&E) unit of NMCP as well as professional communication strategies. Empowering the communities and thereby ensuring broad participation of the grass root level of society was the second strategic focus in this area.

• At the entry point, the opinion leaders in the community where met who in turn lead the programme experts to the Mai-Angwa, the politicians, the youth leaders, women leaders and other community members. The compound of the Mai-Angwa was used for the debate which lasted for several hours.
• The problems were debated on with the programme team leader serving as the moderator. Everybody was given equal opportunity for participation; useful contributions were recorded here as everyone was free to express him or herself. Dialog ensued after the issue was debated to the satisfaction of every partner. The discussion was participatory enough because it employed a two-ways communication process.
• The key points from the result of the discussion were integrated in the education agenda which was used to teach the participants on how to prevent the outburst of cholera in the community as well as to control its spread in the future.
• The teaching programme was recorded having taken permission from the development partners.
• A short drama on the health implication of cholera and the reason why it has to be prevented at all cost was staged. This was informative, educating as well as entertaining, it was also recorded.
• After this, the other stakeholders, the Local Government Chairman, CBO, NGOs and others whose interest are presumed crucial for the success of the programme were met to discuss finance and other logistics capable of making the programme to see the light of the day.
• The recorded lecture and drama are now to be used as part of the materials to be used to design radio programmes which shall be aired on the local radio station (AmuludunFM) at appointed time this will be used to reinforce the lesson learnt during the programme. The reason for this is to ensure that no part of the lecture is forgotten by the people, and it will also enhance programme exit.

Project Time Frame

This project is expected to be completed within 3months of commencement all things being equal.


It is assumed that at the end of this intervention programme, there would have being a great change in attitude of the people towards a favourable behavior to prevention of the endemic disease called cholera as every member of the community would have imbibe a new culture different from what obtains before the intervention.

Programme Communication for Behavioural Change

Recognizing the importance of the understanding and acceptance of the core interventions by the population and based on the past positive experiences in Nigeria, a nation-wide professionally designed campaign will be under taken using the established communication channel and strategies and using radio advertisement placement for dissemination of information of health facilities, the use of community radio drama performances as well as high profile annual events such as Africa Cholera Day that brought national visibility to cholera control efforts.
Preliminary assessment has been done regarding the current knowledge, attitudes and perceptions of community members in regards to cholera prevention and control and this will further be informed by planned operational research.


The programme was adduced to be successful and handed over to the community for sustainability and ownership.


At this juncture, this work concludes that cholera is a killer disease, but can be prevented through inculcation of simple sanitary measures which were often being taken for granted by most people especially the rural dwellers. But with proper education through participatory communication intervention, this people too can be encouraged to change their attitudes for better health living.


Based on these findings, the study recommends that:

– Government “should take its hands off radio” and a truly public service system should be put in place, funded partially by a fraction of the Petroleum Trust Development Fund (PTDF) and the Education Tax Fund (ETF);

– The second suggestion is that government should stop vacillating over the establishment of community radio, as the study shows that radio stations are alienated from the community and from listeners;

– Third, development planning and practice in Nigeria should be integrated, and there is a need to ensure that the tasks that radio is encouraging people to perform in its jingles and programmes are feasibly supported by existing infrastructure;
– The fifth step would be for government to support private stations in order for them to more effectively participate in development communication;

– Finally, the work suggests that Nigerian communication schools and colleges review their curricula to include topics on public journalism, also known as civic or citizen journalism. It says that public journalism seeks to put the citizens at the centre of news and reports. According to the study, if radio is to perform public service and engage development effectively, “we need producers and presenters who are citizen-conscious and citizen-loyal.”


Bongi, D., and David, H. (2004). Water Service and Public Health: the 2000-01 Cholera outbreaks in KwaZulu-Natal, South Africa. Being a paper presented at the 8th World Congress on Federal Environmental Healthin Durban; South Africa.

Folarin, B. (1981). Theories of Mass Communication, Ibadan; Stirling-Horden Publishers

Ministry of Health (2009). National Malaria Control Programme: Strategic Plan
2009-2013; Abuja; Nigeria.

Moemeka, A.A. (1981). Local Radio: Community Education for Development, Zaria; Ahmadu Bello University Press.

WHO. (2003). The Abuja Declaration and the Plan of Action. Geneva:World Health

Samb, B. et. al. (2009). An assessment of interactions between global health initiatives and
country health systems, Lancet.

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