Global statistics show that about 2.6 billion people lack access to improved sanitation, the majority of them living in sub-Saharan Africa and Asia. Out of that alarming figure, 2.5 billion people do not have a clean toilet and 1.1 billion people defecate in the open. According to research, investing $1 in sanitation can generate a return of $5 in socio-economic benefits.
The humble toilet is a stepping stone to a healthy life, greater human dignity, freedom, equality between women, men, girls and boys, and finally, a catalyst to the development of communities and countries.
Uganda's ministry of health acknowledges that 75 percent of the disease burden in Uganda is preventable through improved hygiene and sanitation, vaccination against such child killer diseases as cholera, good nutrition and other preventive measures such as use of condoms and insecticide treated nets (ITNs) for malaria. Evidence suggests that improving sanitation can reduce diarrhoeal diseases by 30-40 percent and child mortality by 50 percent (WSP, 2000).
It is critical to promote good health through education and strategies for disease prevention, uptake and use of services, care seeking and referral. Other players in service provision and promotion include the media, civil society organisations (CSOs) and community structures such as village health teams (VHTs).
Meeting the Millennium Development Goal (MDG) for sanitation in developing countries requires about $142 billion, and to maintain the existing sanitation services requires about $216 billion (Hutton and Bartram, 2008).
Lack of access to improved sanitation continues to contribute to increased mortality and morbidity, which is much higher in children less than 5 years of age.
On average, each slum dweller in Uganda’s capital city Kampala, spends the equivalent of $10 a month on sanitation-related diseases.(Pers.comm.Plumm 2008).
Inevitably, Uganda, and in particular, the city slums are largely prone and grossly affected by poor sanitation and the associated problems. Three years ago, Patricia Namulindwa and her neighbors were grappling with the management of poor sanitation problem in their living environment in Kamwokya Kifumbira slum, one of the most congested informal settlements in Northern Kampala city.
“The sanitation situation was appalling; with both solid and liquid waste posing a potential threat to our livelihood. Urine, faecal matter, polythene waste products were being disposed off carelessly,” Namulindwa said.
Thanks to the intervention of Sustainable Sanitation and Water Renewal Systems (SSWARS) a local non governmental organisation. There is remarkable progress in improvement of sanitation in Kifumbira slum. In a survey conducted by SSWARS in Kamwokya, through random sampling, Namulindwa and two of her neighbours were selected to benefit from a home improvement loan facility.
According to Horst Alexandra, one of the researchers working with SSWARS, the selected beneficiary households were required to contribute a piece of land where the toilet was constructed as well as signing a memorandum of understanding which among others specified the mode of repayment the home improvement loan facility.
A two-stance improved sanitation loan facility constructed by SSWARS costs 2,600,000 million Uganda shillings ($968). Besides providing a piece of land, the beneficiaries were required to cost share by contributing 500,000 Uganda shillings for the toilet facility.
“In our loan repayment strategy, we resolved raise 32,000 Uganda shillings per month which will enable us to complete repayment of the loan within a period of 18 months," Namulindwa said.
With regard to the impact of the toilet facility, Namulindwa contends: “We are now living in a much cleaner environment than previously. This is reflected in remarkable reduction in diarrhoea, cholera and malaria infection in our area”.
Community members usually consult me for detailed information about acquisition of this kind of toilet facility. This has provided me with the opportunity to market this product through learning, experience sharing and possibilities for replication.
SSWARS organised and conducted orientation training covering good sanitation practices and effective management of the toilet facility by the beneficiaries.
Namulindwa hails the cooperation of her neighbors in acquisition, maintenance, and management of the toilet facility.
However, she cited the need for piped water for use especially for hand washing after using the toilet. She is confident and optimistic that after repayment of the loan, they will be able to sustain the toilet facility especially in terms of meeting the costs of a cesspool emptier.
The highly congested and extremely poorly drained and flood prone Bwaise industrial area in Kawempe Division is another beneficiary of sanitation marketing (sanimark). As opposed to a domestic facility built for Namulindwa, a commercial four-stance toilet was built in Bwaise through a public-private partnership arrangement.
This involves participation of Crest Tank a business agency that deals in hardware products, which provides a loan package comprising of durable plastic hardware materials used in construction of the toilet. According to proprietor Florence Nakamya, use of durable plastic materials provides a unique advantage of regular clean up using water and soap detergents.
“Residents and other people working in Bwaise industrial area are very appreciative of this venture. A person pays 200 shillings for each visit to the toilet. I collect an average ranging between 20,000 and 40,000 shillings daily” Nakamya said.
Nakamya is paid a daily allowance of 4,000 shillings for managing this facility. The main challenge encountered is that at night, bad people wishing to illegally use the toilet facility vandalise, break and damage door bolts and padlocks.
These are some of the testimonies that came out during a learning journey organized by the National Sanitation Working Group (NWSG). The learning events are facilitated by the Network for Water and Sanitation (NETWAS) with the objective of exploring successful initiatives and approaches in the sanitation sub sector since 2005. RUDMEC is a member of this resourceful network.
NETWAS hosts the Water Sanitation and Hygiene (WASH) resource centre, which isspearheading learning and knowledge management in the sector. WASH is a learning initiative that builds on innovations in the sector for knowledge exchange at different platforms. Learning journeys are such platforms. The learning journey was organized under the theme: “Home led sanitation and private sector involvement promotion in urban slums”.
The learning journey focused on demand creation as an approach to improve sanitation in peri-urban and urban areas. Kamwokya Kifumbira and Bwaise industrial area are some of the beneficiaries of sanitation marketing a collaboration initiative of the Germany Society for International Cooperation (GIZ) in partnership with Kampala City Council (KCC), Kawempe division and SSWARS. The partners are promoting a home-led sanitation investment finance concept, involving partnerships with private companies to supply sanitation products and a home improvement credit scheme aiming at improving toilet coverage in informal urban settlements in Kampala District.
Charles Nuwagaba working with SSWARS, is one of the promoters of Sanimark and a member of the research team that conducted a study on Urban sanitation conditions in Kampala’s low-income areas (November 2010), said that before introducing sanimark intervention, an estimation of the latrine coverage in Bwaise 1 and 11 parishes which form part of the project area was found to be only 50 percent.
Results of the survey conducted by Nuwagaba and others further revealed that despite the widespread accessibility to sanitation, the conditions of many facilities are unsatisfactory due to the generally large numbers of users per stance.
This leads to low hygienic standards and waiting times for toilet users. As a result, disposal of faecal matter wrapped in polythene bags named “flying toilets” is a common practice among the urban poor and many toilets are abandoned after a relatively short time, questioning the true level of sanitation access in Kampala’s low- income areas.
Sanimark was carried out using house to house visit, road drive shows, drama, story tale booklets for school children, information, education and communication (IEC) materials including posters, fliers, stickers and branded items (pens, pencils, rulers, T-shirts). Forms of credit acquisition through banks and micro finance institutions were explored as well as sanitation acquisition through installment purchase. The possibility to run sanitation as a business was equally explored.
The total number of sanitation (including) water facilities constructed in Bwaise 1 and 11 parishes comprise of 42 slabs, 18 latrines comprising of 39 stances, 10 water storage tanks, 10 hand washing basins, three wonderloos and one ecopan.
These facilities were built at household level, at religious institutions (two churches and one mosque), in four primary schools and in one business establishment.
The project benefited directly 2000 people with an additional 3000 indirectly. The latrine coverage increased from 50 percent to 63 percent. The possibility to run sanitation as a business was found profitable in one public latrine visited daily by 100 people. Nuwagaba said that the owner could recover the total loan cost of the latrine in 2.5 years.
Kampala’s urban poor sanitation facts at a glance
- 70 percent of Kampala’s urban poor are tenants living in one room with 4 people and using a shared public toilet.
- Among the shared public toilets, one stance is on average used by 30 individuals or seven households.
- Private toilets are a privilege of homeowners
- Only 47 percent of sanitation facilities are clean enough to be used properly.
- 45 percent of sanitation facilities are abandoned after 5 years because they are full or have broken down.
- The cost of an improved sanitation facility exceeds the annual per capita income.
(Source: Study: Where do Kampala’s poor “go”? Urban sanitation conditions in Kampala’s low income areas, Nov. 2010. The study was jointly conducted by Makerere University, the Swiss Federal Institute of Technology and Swiss Federal Institute of Aquatic Science and Technology.)