An act as small as washing hands with soap and water, can stop microbes from travelling farther than we imagine. This was evident and encouraged during the COVID-19 pandemic, when this simple habit became a major frontline defence, helping to slow the spread of a virus that brought the world to its knees. However, the power of handwashing extends beyond the pandemic.
Today, handwashing remains a powerful tool in preventing many public health crises, including antimicrobial resistance (AMR), a growing global threat. In an interview with Niniola Williams, Managing Director of DRASA Health Trust, an organisation working to prevent AMR through awareness and capacity building, she explained that each time we wash our hands, we remove harmful microorganisms, thereby reducing the likehood of infections and the need for antimicrobial treatment.
The 2024-2028 AMR National Action Plan (AMR-NAP) also highlighs this priority identifying strengthened partnerships with immunisation and WASH stakeholders as essential to increasing the visibility of AMR within programmes as a key component of Infection Prevention and Control (IPC) measures. However, an estimated 60 million Nigerians still do not have access to clean water, and over 80 million do not have access to essential sanitation facilities.
Understanding the AMR threat in Nigeria
AMR has become one of the most pressing global concerns of the 21st century driven by the rapid growth of drug-resistant infections. According to the World Health Organization (WHO), AMR is responsible for an estimated 1.27 million deaths each year, with low- and middle-income countries at higher risk. The organization further noted that if left unchecked, it could cause 10 million deaths annually by 2050, surpassing cancer as a leading cause of mortality.
AMR occurs when microorganisms such as bacteria, fungi, viruses, and parasites evolve to become resistant to the medicines designed to kill them. When resistance can develop naturally, it is accelerated by repeated or inappropriate exposure to antimicrobial drugs in agriculture. As a result, once-treatable infections such as typhoid are becoming harder, and in some cases impossible, to cure.
In Nigeria, the threat of AMR is heightened by multiple risk factors. Antibiotics are often misused, purchased over the counter without prescriptions, shared among family members, or taken to viral infections such as the common cold. Between April and May 2025, Nigeria Health Watch conducted a community listening across Lagos, Kano, Niger, Ebonyi, Cross River, and Borno states to explore patterns of antibiotic-use, access adherence.
Findings revealed that nearly half of the 4,137 respondents obtained antibiotics through informal or self-prescription; 41% used leftover medicine or shared them with others; and 43% did not complete the prescribed course. Even more concerning is that about 13% could not identify the antibiotic they had used. These unsafe practices are entrenched fuelled by systemic challenges such as weak pharmacovigilance, poor regulatory enforcement, limited access to formal healthcare, inadequate provider training, and other structural gaps in Nigeria’s health system.
The overlooked power of hand hygiene for prevention
During the COVID-19 pandemic, widespread hygiene campaigns encouraged frequent handwashing, with public spaces equipped with handwashing stations, hand sanitisers freely distributed, and heightened caution around touching shared surfaces due to fear of contamination. However, as Williams noted, these practices have not been consistently sustained, despite their broader potential to prevent the spread of infectious diseases, “one of the things we need to think through is beyond the short-term infectious diseases, how do we tie them to some of these constant ongoing challenges like AMR which is not a time bound thing.”
Hand hygiene is a powerful preventative measure, yet its role in tackling AMR is often overlooked. “It is a very technical and difficult topic; people don’t always understand it because awareness and risk perception of AMR is low amongst most populations,” she explained.
Ensuring available, accessible and sustainable WASH systems is essential for sustaining a consistent hand hygiene culture. Williams stressees that raising awareness and conducting training alone are not sufficient. Adequate tools, infrastructure, and supplies must be available to enable proper hygiene practices.
She noted that among most AMR interventions, including new drug development, hand hygiene is the most feasible and can be implemented in the shortest time frame, offering a higher return on investment (ROI), provided there is genuine commitment. The WHO also reports that every dollar invested in water and sanitation yields a 4.30 dollar return by reducing healthcare costs for individuals and society. Yet, one in three people globally still lack access to basic sanitation services.
She also pointed out that, beyond communities, healthcare workers must uphold proper hand hygiene, as healthcare-associated AMR can spread in environments meant to prevent such infections; however, in many healthcare facilities across Nigeria, access to clean water, functioning toilets, and handwashing stations remains far from guaranteed.
The general state of Water, Sanitation, and Hygiene (WASH) in healthcare facilities is inadequate, with 26% without proper toilets/latrines on premises, and only 20% to 32% have basic hand hygiene services and hand hygiene stations with soap and water at points of care, respectively. Despite handwashing being one of the critical first lines of curbing the spread of microbes, 95% of all Nigerian healthcare facilities are at risk of becoming epicentres of diseases because of a lack of access to WASH.
Nigeria’s AMR conference — A turning point
In June 2026, Nigeria will host the 5th Global High-Level Ministerial Conference on Antimicrobial Resistance. The gathering will bring together stakeholders from human health, animal health, agriculture, and the environment, under the One Health approach to shape a unified, cross-sectoral strategy that addresses the escalating threat of AMR across sectors and borders.
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The conference marks a critical moment. As infections grow harder to treat and antimicrobial medications lose their effectiveness, Nigeria has a chance to lead Africa’s response by embedding robust and comprehensive WASH and encouraging something as simple as hand hygiene behaviour into the national AMR strategy.
As Professor Muhammad Ali Pate, Coordinating Minister of Health and Social Welfare, stated, “Nigeria is committed to leading the fight against AMR through coordinated action. This conference will strengthen accountability, secure sustainable funding, and promote effective innovations. We are proud to host the global community and showcase Africa’s leadership.”
Looking ahead to the Conference, the momentum should be built on actionable steps, and communities must be included. Niniola also buttresses that point. “The power of communities is often underestimated, not the community health workers or the traditional leaders, but the regular person on the road and in the homes. There is nothing like having a change agent in a place. It is great for sustainability. They are the ones [that can keep] such things active without external support.”
