…Sanitation, self-respect, and the silent health crisis we pretend not to see
Drive through many cities across Africa at dawn or dusk. You will see something so normalised that many people no longer react.
- A man stands by the roadside, facing a wall, relieving himself openly.
- Another walks casually into a bush beside a busy street.
- Occasionally, a woman shields herself behind a parked vehicle or building.
In some markets, defecation occurs in hidden corners before traders begin their day.
Cars pass. Pedestrians avert their eyes. Life continues. The behaviour has become so common that it rarely shocks anyone anymore. So let us ask the question, directly and without politeness:
What is wrong with us?
When did public urination and defecation become an accepted feature of urban life? When did our streets, gutters, bushes and abandoned plots become informal toilets? And perhaps even more troubling: Why do many of the same individuals who relieve themselves in public return minutes later to handle food or sell items by the roadside without washing their hands?
The disturbing rise of plastic bag defecation
If roadside urination and bush defecation were not disturbing enough, another troubling phenomenon has emerged in many African communities. People now defecate into plastic bags and throw them into gutters, bushes, empty plots, or roadside drains. These plastic bags often sit quietly along pavements and drainage channels until rain arrives. When the rain comes, the bags burst open, spreading human waste into drainage systems and waterways. In some areas, this practice has acquired a disturbingly casual name. They are called “flying toilets.” Human waste wrapped in plastic and thrown into the public environment.
Imagine a visitor from another continent trying to understand why human waste in plastic bags has become a normal feature of our streets.
NyansaKasa (Words of Wisdom): “When shame disappears, danger multiplies.”
Interpretation:
When society normalises degrading behaviour, the consequences extend beyond dignity and become serious public health risks.
The health crisis we refuse to see
Public urination and open defecation are not simply unpleasant sights. They are serious public health threats. Human waste contains bacteria, viruses and parasites capable of spreading cholera, typhoid, dysentery and numerous gastrointestinal infections. Flies land on exposed faeces and then land on food. Rainwater washes contamination into drainage systems and water sources. According to global health data, poor sanitation remains one of the leading causes of preventable diarrhoeal diseases, which continue to claim hundreds of thousands of lives globally each year. In many African countries, sanitation-related diseases remain among the leading causes of childhood illness. Yet we walk past these scenes daily as if they are minor inconveniences rather than a public health emergency.
NyansaKasa (Words of Wisdom): “Filth does not discriminate.”
Interpretation: Poor sanitation eventually harms everyone regardless of wealth or social status.
Is it only about lack of toilets?
Yes, infrastructure gaps exist. Many urban areas lack sufficient public toilets. Some facilities are poorly maintained or inaccessible. But let us be honest. The behaviour cannot be explained solely by the absence of toilets. There are places where toilets exist but remain underused. In other places, small user fees are avoided in favour of convenience. The issue is not only infrastructure. The issue is also mindset.
NyansaKasa (Words of Wisdom): “Convenience without discipline breeds chaos.”
Interpretation: Infrastructure alone cannot solve sanitation problems without civic responsibility.
A stark contrast with other regions
In most European cities, public urination carries immediate fines. In many American cities, law enforcement intervenes quickly when public indecency occurs. In Japan, public cleanliness is deeply embedded in culture. Streets remain spotless because citizens feel responsible for shared spaces. Singapore has turned sanitation discipline into a national identity. Children in these societies are taught early that public cleanliness reflects personal dignity and respect for others. Africa also has sanitation laws. But laws without enforcement become suggestions.
NyansaKasa (Words of Wisdom): “Rules ignored eventually disappear.”
Interpretation: A law that is not enforced gradually loses its authority.
The culture of tolerance
Perhaps the most troubling aspect of the problem is how easily society tolerates it.
- People walk past public urination without comment.
- Plastic bags containing human waste appear in gutters, and people step around them.
- Food vendors operate beside contaminated drains, and no one questions the hygiene risks.
We have gradually become comfortable with behaviour that would cause outrage in many other societies.
NyansaKasa (Words of Wisdom): “Normalising wrong makes it permanent.”
Interpretation: Repeated tolerance eventually transforms unacceptable behaviour into accepted culture.
The impact on children
Children learn from observation. What message do we send when they see adults relieving themselves openly in public spaces? When they see plastic bags filled with human waste in drainage systems? If children grow up believing this is normal, they will repeat it.
NyansaKasa (Words of Wisdom): “Children imitate what they see, not what they are told.”
Interpretation: Civic behaviour is learned through example more than instruction.
The economic opportunity we ignore
Sanitation should not be viewed merely as a cost. It can also be an economic opportunity. Public toilets can be built and managed through public-private partnerships. Well-maintained sanitation facilities create jobs, generate revenue and improve public health. India launched major sanitation initiatives that significantly reduced open defecation through infrastructure investment and behavioural campaigns. Rwanda has transformed Kigali into one of the cleanest cities on the continent through strict enforcement and civic discipline. Singapore’s commitment to urban cleanliness has become part of its global brand.
NyansaKasa (Words of Wisdom): “Clean cities attract clean investment.”
Interpretation: Urban hygiene influences tourism, investor confidence and international reputation.
The food safety danger
One of the most alarming consequences of poor sanitation is the impact on roadside food vending. Individuals who relieve themselves in public without washing their hands sometimes handle food immediately afterwards. This creates a direct pathway for disease transmission. Foodborne illnesses spread quietly. Outbreaks occur. Public trust erodes.
NyansaKasa (Words of Wisdom): “Unwashed hands feed invisible enemies.”
Interpretation: Neglecting hygiene allows disease to spread silently through food handling.
Why do we always wait?
Many African societies react to sanitation issues only after crises occur. A cholera outbreak leads to temporary enforcement. A viral video sparks outrage. Government directives appear briefly. Then attention fades and behaviour returns. Why must tragedy occur before discipline begins?
NyansaKasa (Words of Wisdom): “Prevention is cheaper than mourning.”
Interpretation: Proactive sanitation policies cost far less than responding to disease outbreaks.
Accountability – government and citizens
- The government must provide adequate sanitation facilities and enforce regulations.
- Urban planning must integrate public toilets into markets, transport hubs and busy streets.
- Food vendors must receive hygiene training and licensing requirements must be enforced.
- But citizens must also accept responsibility.
Personal discipline cannot be legislated fully.
NyansaKasa (Words of Wisdom): “Cleanliness begins where excuses end.”
Interpretation: Infrastructure cannot compensate for cultural indifference.
The bigger question
Perhaps the most uncomfortable truth is this:
- We know better.
- We understand hygiene. We understand disease transmission. We understand dignity.
- Yet behaviour often contradicts knowledge.
What is wrong with us that we compromise dignity for convenience?
Conclusion – From indifference to integrity
Europe enforces sanitation laws. Asia embeds hygiene discipline into culture.
America penalises public indecency. Africa often debates but hesitates to enforce. Toilet infrastructure must improve. Enforcement must become consistent. Civic pride must rise. The next time you see public urination, bush defecation, or plastic bags filled with human waste in gutters, do not simply walk past.
Ask yourself:
- Is this the standard we accept?
- Is this what we want our children to inherit?
- Is this how we want our cities to be remembered?
NyansaKasa (Words of Wisdom): “A clean city reflects a clean conscience.”
Interpretation: Urban dignity mirrors societal values.
Sanitation is not merely about cleanliness. It is about self-respect, public health and national pride. So the question remains unavoidable: What is wrong with us? And perhaps more importantly: What will we do differently tomorrow morning? Because dignity is not expensive. Indifference is.
>>>Ing. Professor Douglas Boateng is a globally recognised governance and industrialisation strategist, known for advancing long-term, institution-focused leadership across Africa. A chartered engineer and boardroom governance authority, he works at the intersection of policy, board leadership, and economic transformation. He is the Convenor of the Boardroom Governance Summit, one of Africa’s leading platforms for chairs, CEOs, regulators, and policymakers to shape governance practice for generational impact. His work champions governance as national infrastructure—arguing that strong institutions, not strong personalities, drive sustainable development.
Professor Boateng is a leading voice on industrialisation, supply-chain strategy, board effectiveness, and generational leadership, with advisory roles across public and private sectors. He is also the creator of NyansaKasa, a widely followed series of reflective governance and life proverbs circulating across Africa and the diaspora. His writing blends insight, satire, and moral clarity to challenge comfortable thinking, urging leaders to govern for the unborn and to measure success not by applause, but by the strength of the institutions they leave behind.
