How a market-based approach is delivering durable toilets, safe water and healthier futures in Uganda’s refugee-hosting district
By Moses Sserwanga
In Uganda’s refugee-hosting district of Kamwenge, Byabasambu is a selected model village where a comprehensive programme to enhance sanitation and hygiene, and promote infection prevention and control (IPC) at community level, is being implemented with the support of UNICEF Uganda.
For the last five years, communities have been mobilized in cluster model villages and sensitized to abandon the long-standing practice of open defecation. Households are encouraged to construct modern, sustainable toilet facilities under the Water, Sanitation and Hygiene (WASH) programme, which has registered tremendous success in reducing the disease burden in this remote district.
Kamwenge, which has a large refugee population accounting for about half of the 552,000 residents, has hitherto faced many challenges, and access to social services such as safe water, health care and education remains limited in many hard-to-reach areas. In response to these challenges, the Government of Uganda through district leadership championed by the Local Council V Chairman, Joseph Kalungi, is implementing the Community-Led Total Sanitation (CLTS) outreach programme, which is now transitioning to a Market-Based Sanitation Improvement Approach (MBSIA) to address slippage and foster the construction of more durable and climate-resilient sanitation structures.
Getrude Kengonzi, an environmental health officer, explained that the new MBSIA is a facilitated approach of community collective action that encourages household investment in basic improved sanitation products such as toilets, delivered through a network model characterized by sales agents (sanitation promoters), linked with well-trained and capable masons.
At his home in Kamwenge District, Godfrey Mony demonstrates how he uses a tippy-tap made from locally available materials, part of community hygiene practices promoted through WASH interventions. All pictures by Zahara Abdul/UNICEF
Grace Bonabana and Godfrey Moni are among the hundreds of community members who have embraced the MBSIA programme in the remote village of Byabasambu, Lukunyu Town Council, Kyakanyemera Sub-County, Kamwenge District. Their clean, well-maintained homesteads were among those visited by a delegation of eight Swedish MPs who have been in Uganda on a fact-finding mission to assess firsthand the impact of Official Development Assistance (ODA) extended to Uganda by the Swedish Government.
The MPs, representing eight political parties in Sweden, included Katrina Tolgfors, Martina Johansson, Magnus Berntsson, Yasmine Eriksson, Joar Forsell, Janine Alm Ericson, Markus Kauppinen and Andreas Lennkvist Manriquez. They were accompanied by two staff members from UNICEF Sweden, Karin Strömstedt and Erik Windmar. In Kamwenge, they were joined by the UNICEF Representative to Uganda, Dr Robin Nandy; Chief of Child Survival and Development, UNICEF Uganda, Dr Yaron Wolman; and the Counsellor, Deputy Head of Mission and Head of Cooperation, Embassy of Sweden, Adam Kahsai Rudebeck.
Bonabana and Moni gave moving testimonies to the visiting Swedish MPs about how their lives have been transformed by the CLTS and MBSIA UNICEF-supported interventions.
“Very few homes had sanitation facilities in this village. People used to go to the bush to ease themselves. It was open defecation for many homesteads and families. Poor sanitation led to the spread of diseases like cholera and dysentery, a gastrointestinal infection that causes severe diarrhea with fever, abdominal pain and vomiting,” Bonabana told the Swedish visitors.
Moni said the situation has since improved. “We are much better now. Most households have climate-resilient and sustainable toilets, and the disease burden is reducing. Community members can now save money to take their children to school and improve their families’ welfare,” he said.
Both Bonabana and Moni showed the visitors their newly constructed smart toilets, raised drying racks for house utensils, handwashing facilities, home-based income-generating activities such as chicken and goat rearing, and well-maintained gardens where households plant nutritious foods for their families to improve their nutrition.
For Kengonzi, the CLTS and MBSIA initiatives have been a blessing for the people of Kamwenge. “A comprehensive capacity-building programme was conducted for extension workers and community leaders to enhance local sanitation management skills. 78 masons were trained and empowered to construct sustainable and climate-resilient sanitation facilities, thereby contributing to local economic development. The programme has also improved basic sanitation services for 27,600 households through the distribution of 1,000 sato pans and community education initiatives,” she revealed.
According to Dr William Mucunguzi, Kamwenge District Health Officer and UNICEF focal person, WASH infrastructure development has led to the construction of latrine facilities in three primary schools, including provisions for menstrual hygiene management. “Latrine facilities have been constructed in two healthcare facilities, and handwashing stations installed across all stations. Chlorine generators have been installed in three healthcare facilities to ensure a safe water supply, and 29 health workers and political leaders across 30 schools have been trained to foster a culture of hygiene and infection prevention,” he said.
Impact, scaling up and sustainability
Dr Mucunguzi noted that the interventions have yielded significant positive impacts on the community, schools and healthcare facilities. He observed that with CLTS and now MBSIA, the district has progressed from 86 per cent latrine coverage in 2019 to 95.3 per cent currently.
“Through the implementation of the MBSIA approach adopted in the past two years, six sub-counties have been supported reaching 121 villages, and 27,600 households now have access to basic sanitation services. This has led to improved health outcomes and reduced incidences of sanitation-related diseases,” he added.
Kalungi thanked the Swedish Government for its continued support to Uganda, noting that it has transformed the lives of many Ugandans including vulnerable communities such as refugees. “Uganda has an open-door policy when it comes to refugees. When services like education, health, sanitation and nutrition are offered to communities, we do not discriminate between nationals and refugees. These services are accessed by everyone in the community, including refugees," he said.
“WASH interventions have reduced sanitation- and hygiene-related illnesses, including diarrheal diseases and intestinal worms. This has had a ripple effect on child development with fewer sick days, reduced malnutrition and improved cognitive performance, especially in early childhood,” he added.
The creation and training of village sanitation promoters, sanitation entrepreneurs and VHTs has established a grassroots mechanism for ongoing hygiene promotion. The training of local masons and the active engagement of the community have fostered a sustainable approach to sanitation.
“The construction of latrine facilities and healthcare facilities in schools has elevated hygiene standards, promoting the health and well-being of students and patients. We have formed and trained water boards, and Kamwenge is now a district water authority. To ensure continuity and scaling up of services, district officials are also training mechanics in the operation and maintenance of water systems; training school health clubs in menstrual health and liquid soap making; and strengthening school management structures on WASH. We are encouraging the formation, training and transformation of masons’ associations into economic enterprises to ensure sustainability,” Kalungi said.
UNICEF-supported sanitation, therefore, have significantly improved the health, safety and dignity of children and communities in Kamwenge District. However, for the district to consolidate these gains and achieve universal access to basic sanitation, further investment and partnership will be essential. UNICEF’s catalytic role has demonstrated scalable impact and laid a strong foundation for sustainable WASH systems.
The writer is a Media and Communications Consultant/ Advocate of the High Court of Uganda
Editor;msserwanga@gmail.com
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