Unclogging Uganda's Rural Sanitation Crisis

Waterborne Diseases are Rampant in African Country, but Local Approaches May Offer Solutionto Crisis

On the beach in this fishing village nestled on the shores of Lake Victoria, a rickety sign reads, "Bathing, defecating or urinating in the water: fine 20,000 [Ugandan shillings]" — about $7.80, a week's wages. The sign does not seem to be much of a deterrent, however. Just a few meters away, dozens of people go about their daily business in the lake — children splash, women fill up plastic canisters, a man washes a motorcycle. Water is at the center of life here.

But water is also a source of disease. A stone's throw from where the village's residents wash and gather water, bobbing green reeds line the shore. This semiprivate area serves as a toilet for many of the villagers. The result is that waterborne diseases, including diarrhea, scabies, trachoma and schistosomiasis, abound. In fact, in the local language, the name "Walumbe" means death, as the area was once plagued by tsetse flies carrying sleeping sickness.

The health and sanitation problems facing Walumbe are common across much of Uganda, a largely rural country. Poor sanitation and hygiene are contributing factors to three-quarters of the diseases found here, according to Julian Kyomuhangi, assistant commissioner for environmental health at Uganda's Ministry of Health.

Only about 34 percent of the population has access to hygienically constructed toilets, according to the World Health Organization. (The Ugandan government, which uses broader criteria than the WHO, asserts that the figure is more than twice that. Western foreign-aid officials familiar with the issue suggest this is a highly inflated number). According to the World Bank's Water and Sanitation Program (WSP),poor sanitation costs the country an estimated $177 million per year(equivalent to about 1.1 percent of GDP) because of premature deaths due to diarrhea, malnutrition and diseases like malaria and measles. Each year, diarrhea alone takes the lives of 19,700 Ugandan children under 5 years old. It's a vicious cycle: Poor communities cannot afford good sanitation, so people get sick, and fall deeper into poverty.

While some sub-Saharan African countries, such as Rwanda, have made important strides in sanitation, Uganda's progress has been clogged by various obstacles— an impoverished and poorly educated population, shaky governance and high-level government corruption —that are common in many nationsin the region. In Uganda's case, though, they are especially pronounced. While the country is a large recipient of international aid and was once considered a model of good governance, in recent years the government of President Yoweri Museveni has been mired in mismanagement and corruption scandals.

Parasitic worms

One of the most devious of Walumbe's common diseases is schistosomiasis. When people suffering from the disease go to the bathroom outdoors, close to Lake Victoria, tiny worms in their feces and urine called blood flukes find a host in water-dwelling snails. The snails release larval forms of the worms that burrow into unbroken skin, where they take up residence in the blood vessels and reproduce until their offspring are again excreted, and the process repeats.

Community solutions

So if the central government can't be relied on, what's the solution? Foreign aid officials working on sanitation in Uganda say the most effective model they've found is one that shifts the burden to local communities. Developed in Bangladesh in 1999, the method, known as Community Led Total Sanitation, or CLTS, is a low-cost, low-tech approach that has been embraced by the U.S. Agency for International Development, the World Bank and other aid agencies because it is cheap, relatively quick and demonstrates powerful results — at least in the short term.

The program, loosely administered by local health officials, is being rolled out slowly and hasn't yet reached Walumbe. But in Kibuku district, in the eastern part of the country, which has a population of 183,844, it appears to have spurred dramatic gains. Sanitation coverage in the district has gone from 47 percent to 84 percent since the CLTS program began in 2011, according to Paul Mulomi, secretary for health education for the district.

The CLTS approach incites so-called behavior change by triggering a"sense of disgust or shame." The community then passes a bylaw at the health workers' encouragement: Within three weeks, everyone must dig a latrine.

Source: America Aljazeera

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• Water & Sanitation
• Sanitation & Hygiene