At the point of entry in the communities, there were clear absence of toilets in Durunmi 3 and Ruwan Fulani. Open defecation was the other of the day. Residents defecate and fling same through their window because of the absence of toilet facilities. On entry into Durunmi 3, what you see is a waste heap that may have existed for ages. It was a den of flies with feaces and other waste adorning the heap. The only toilet in the community was located close to a borehole where they get water. Attenuation may not be possible with the closeness of the water to the toilet. As a result, dysentery, cholera, malaria were regular health issues in the community. So also was Ruwan Fulani but unlike Durunmi 3, there was no heap of refuse. Theirs was open defecation with contaminated stream water as drinking source. At Kuyizhi Community, the baseline findings were not remarkably different. Only one household had toilet out of 34 household. Occupants’ of houses defecate in the surrounding which flows into their drinking water sources (streams) during the rains. Hygiene was a big issue. People defecate and do not bother to wash their hands after defecating. Oral feacal transmission was rampant, causing Malaria, typhoid fever etc.

All of these started changing during the triggering session in the intervention were the residents realized that they were eating their own feaces. They accordingly developed their action plans and initiated activities that brought changes and the attainment of Open Defecation Free status.

The social target of governments, international organizations and communities across the World is the attainment by all peoples of the world a level of health that will permit them to lead a socially and economically productive life. Primary health care was identified as the key to attaining this target. Despite this, the tale in Nigeria primary health care institutions and including those in Anambra State has been largely a tale of underperformance, a reason the project was conceptualized.

PHCs facility assessment was undertaken to ascertain the actual status of facilities at the PHCs. Centre LSD developed a checklist based is expected in every Primary Health Centre in terms of water and sanitation. As technical lead, Centre LSD developed the checklist with the agencies including JDPC Nnewi and Community Empowerment Network (COMEN), as part of the process for sills transfer. The checklist guided and paved way for a seamless engagement of the assessment process.
The outcome of which, enabled the development of a terms of reference for the researcher on PHC policy review in Anambra State.