Uganda Sanitation and Hygiene 2005 Rapid Situation Assessment

EHD (MoH), PS (MoES) and DWD (MLWE) in collaboration with WSP (2005)

Review of policies, strategies and practices

A review of the present policies, strategies, and practices indicated, for urban areas, need for fine-tuning of the Memorandum of Understanding (MoU) between the ministries responsible for water, health, and education to take account of integrated urban development projects. Again for urban areas, the tariff setting for the sewerage served areas should ensure that the poorly served areas are not subsidising the better served areas. Continuous policy level discussion is needed on the trade-offs between pro-poor and economic growth strategies.

For rural areas, it was observed that districts are at different levels in terms of latrine coverage and other hygiene practices. A district based rather than a national based effort could be more successful. Enforcement is an important tool in the effort to improve sanitation and hygiene promotion but it is only useful where other favour factors co-exist e.g. political stability, presence of effective technical solutions to latrines and handwashing. On-budget modalities mean that sanitation and hygiene promotion now have to compete on an equal footing with other priorities. The main strategy for the DHI and others is to influence local work plans rather than hope for project-like approaches. Strategies need to be developed that encourage private sector participation, options include tax reduction on sanitation related equipment or good.

In schools, greater attention is needed to providing officials with the monitoring information to measure value for money. There are opportunities for greater participation of parents and teachers in contract management, leading to a more cost-effective use of public funds and the by-products of increased local ownership and greater technology awareness.

Assessment of the district-based practices indicated the following:

• Political leaders were not supportive of improved sanitation and hygiene (ISH) promotion.
• Funds allocated to Improved Sanitation and Hygiene were limited, largely as a result of sanitation not being a priority area.
• There is lack of clarity concerning institutional mandates and responsibilities. Where they are functional, the designated coordinating bodies, the District Water and Sanitation Committees are weak, biased towards water, and less understood by other stakeholders.
• Few districts reported having the necessary baseline data for advocacy or for a more rational evidence-based planning for ISH.
• There is lack of replicability and sustainability of Best Operational Practices reported by NGOs.
• There was need for research on viable, affordable technical options that take account of the special needs of differing environments as well as special needs groups such as AIDS patients.
• The sub-county and parish levels faced more extreme versions of the same problems faced at district level with specific reference to political will and inter-sectoral collaboration creating a need for a coordination forum at sub-county and parish levels.

Reviews of the central practices indicated weak linkages between the centre (Environmental Health Division, Ministry of Education and Sports, Ministry of Gender, Labour, and Social Development) in terms of co-ordination, supervision, and guidance. There is need to shift the centre of ISH gravity back to the Ministry of Health so that the positive rhetoric of the health and poverty documents is vested in strategic reality.

The study indicated that NGOs have found it easier to direct their efforts towards ISH. In some districts NGOs have been asked to implement ISH on behalf of the district authorities as in the case of WaterAid and partners in Mpigi and Katakwi districts.

Financing Sanitation and Hygiene

The main sources of on-budget financing for sanitation and hygiene promotion include Primary Health Care (PHC) grant, Schools Facility Grant (SFG), Water and Sanitation Conditional Grant (WSCG). Main sources of off-budget financing of sanitation and hygiene promotion include household investment in sanitation facilities, user charges/tariffs, micro-finance available to communities and consumers (minor in practice), NGO and donor projects (grants and loans), and Investments by the private sector with the aim of securing a return on the investments.

Public sector subsidies are only available for hygiene promotion, for school facilities and for public sanitation facilities. All other expenditure is carried at the household level apart from some NGO and donor projects that still provide direct construction subsidies

National Baseline and Targets

• There was a certain amount of confusion about rural data with considerable variation by source. Some of the National Baseline include the following:
• According to the Water and Sanitation Sector Performance Report (2004), an estimated 440 children die of diarrhoea in Uganda every week. Infant Mortality Rate increased from 81 to 88 deaths per 100 births between 1995 and 2000. Diarrhoea alone accounts for approximately 19% of infant mortality in Uganda. There are high morbidity and mortality rates as a result of poor hygiene and sanitation conditions in the IDP camps.
• According to the annual Health Sector Performance Report for FY 2003/04, national latrine coverage stood at 57% in June 2004, with figures varying considerably throughout the country from 94% in Rukungiri to 2% in Kotido. There are wide variations in latrine coverage between and within districts. The North-eastern districts have very low coverage of less than 4% compared to the western districts (over 80%). Available data however relates to the existence of facilities and not on the use or state of these facilities.
• Urban latrine access ranges widely by location and depends also on the criteria used to define ‘adequate sanitation’. In Mbarara and Kampala, it was reported to be as high as 90%. The pit latrine is the main household sanitation type in the Rural Growth with sanplat coverage averaging below 30%. Only 12 towns have a sewerage system with only 8% of the population connected to the sewerage system. Latrine coverage in IDP camps was 1 stance to 360 people contrary to SHERE Guidelines that recommend 1:20
• The limited information available on handwashing practice indicates that only 4% of the households in rural areas and 6% in urban have a basin, soap or ash and water available for handwashing. According to the Sector Performance Report (2005) this picture seems to have improved considerably with rural access to a handwashing facility reported to be 25% and urban access to be 40%.
• According to the MoES data, the overall trend in the average number of primary school students per latrine stance has improved from 325 in 1997 to 64 in 2002, with significant variations from 26:1 in Kalangala District to 118:1 in Yumbe District

National ISH Targets

The main target setting document is the SIP 15 (2000- 2015) which defines overall sector target as ‘Sustainable safe water supply and sanitation facilities, based on management responsibility and ownership by the users, within easy reach of 77% of the rural population (95% of the urban population) by the year 2015, with an 80%-90% effective use and functionality of facilities.’

Although targets are important at a national level, their significance increases when it comes to district planning, priority setting, and resource allocation.

Specific environmental health activities to be in place and implemented by 2010 include:

• Integrated district plans for domestic and school sanitation and hygiene promotion, based on best practice,
• Integrated vector management strategy,
• Food Safety Strategic Plan,
• Regular drinking water surveillance and related safe water chain activities.

Since performance varies widely between districts, it is expected that district based targets for gradual achievement (or in some cases over achievement) of the national targets are needed. In line with international agreement, a sanitation MDG has been adopted which is to halve the proportion of those without access to safe sanitation by 2015.

For more information visit:

NETWAS Uganda Documentation centre

P.O.Box 40223, Kampala

Plot 28 Chorley crescent street Luzira

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