Chasing SDG6: Progress towards scale, sustainability and new Frontiers in Uganda

Uganda's Ministry of Health Assistant Commissioner weighs in on the country's progress towards achieving SDG6

Access to safe water and sanitation and sound management of freshwater ecosystems are essential to human health and to environmental sustainability and economic prosperity. Achieving universal access to basic sanitation and hygiene; ending the unsafe practice of open defecation requires substantial acceleration of progress especially in rural areas where the majority of people without access live. SNV has been facilitating an email discussion on the topic “Chasing SDG6: scale, sustainability and new Frontiers in rural sanitation and hygiene” on its Rural Sanitation and Hygiene D group platform. The discussion was part of the activities prior to a learning event that was held in Ethiopia from the 23rd to 26th April 2018.

SNV Uganda had the privilege of interviewing Julian Kyomuhangi, the Assistant Commissioner in charge of Environmental Health Division -Ministry of Health who participated in the learning event about her take on the topic of the event. Below is an extract of the interview.

Where do we stand as a country on SDG 6 and will we be able to achieve access to adequate and equitable sanitation and hygiene for all and end open defecation (OD) by 2030?

To achieve Open Defecation Free (ODF) communities/ villages, you must first of all define ODF. However this cannot be defined without agreement on a common standard for latrines. A standard latrine is one that cuts off faecal – oral route for disease transmission. This is a latrine that is constructed with permanent materials or with locally available materials in the community, has washable or cleanable floor, non-leak roof, provides privacy / door shutter, a tight fitting drop-hole cover and a handwashing facility with soap and water. When you have such a latrine, the flies will not be able to access faeces and take it to the food or to any other material, to transmit disease causing germs / organisms to uncovered utensils, items and food.

The essence of having ODF is to have faecal oral routes sealed off. This kind of latrine is what we call basic or what is known as an improved latrine. Latrine technologies may differ across the country and this is not a problem because the focus is not on the technology per say but the attributes that I have listed above. Once households appreciate these attributes and invest in constructing such latrines then the journey towards ODF will have started.

From 2011 when we started the Uganda Sanitation Fund (USF) programme the number of villages attaining open defecation free status has been on the increase. By the end of 2017, we had over 7,900 villages declared open defecation free. We recruited field officers in each region where USF is being implemented and facilitated them so that they can efficiently and effectively carry out their work. These do not work in isolation but with the structures at the grassroots. We have very well defined structures at the grassroots. At the village level we have Village Health Teams (VHTs), Local Council I, then we have water sanitation and coordination committees at district and sub-county levels. Health assistants, community development officers, agricultural officers, health inspectors at the sub-county and district levels. These structures are not just for our use as government but for our partners as well. NGOs are supposed to strengthen and support the already existing structures and initiatives of government and not work in isolation because we need each other to achieve results at scale.

Despite the above results, we realised at the learning event that we need to aim higher. ODF declaration at the village level and village by village is not enough. If we are to achieve ODF at scale we must work towards achieving ODF not just at the village level but a whole district ODF and we can achieve that. Currently 80% of the population in Uganda have and use latrines. The quality of these latrines however is not uniform across the country so we have to go back to the drawing board and define what we mean by basic/ improved latrine to ensure that all stakeholders have a clear definition of a basic / improved latrine. A household that has a latrine but does not have a fitting drop-hole cover is still practising fixed point open defecation. They are as good as a person who is defecating in the open and leaves their faeces uncovered. Why? Because flies can access the faeces in both situations and transmit diseases through their legs carrying faeces with germs to food, utensils and other materials. The same applies to a household that does not having a handwashing facility with soap and water. When you defecate, clean yourself and do not wash your hands with soap and water, you are as good as a person whose food has been contaminated by flies from an open latrine.

Our rate of handwashing with soap and water is still very low (at 37%). Can we achieve 100% handwashing by 2030? Absolutely. We just have to work doubly hard to change people’s behaviours, attitudes and engage more in community dialogues to ensure that the messages of handwashing, sanitation and hygiene gets home. This will call for more investment in communication and dialogue with communities to understand their behavioural triggers and find the motivators that can cause behaviour and attitude change and sustain it. We have quite a task ahead of us, especially with handwashing with soap but I believe that we shall be able to achieve access to adequate and equitable sanitation and hygiene for all and end Open Defecation by 2030.

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What was the take home for you from the learning event?

The learning event was very successful. There was a lot to learn from each other especially from other countries that are also chasing the SDGs. Besides the need to scale ODF interventions beyond villages and sub-counties that I have already talked about, we learnt about the importance of being dynamic and work as teams if we are to sustain Open Defecation Free communities/ villages. We must consolidate the gains achieved in ODF and have active platforms and fora’s to address slippage in ODF. If we promote the basic latrine as described above, we will have less cases of slippage because these latrines can withstand rainfall and hard weather unlike the weak structures that can be eroded by slight rains.

Sustainability is attitude/ behaviour change. Sustainability is, even if the rains come and wash away your latrine, as long as you have the mind-set that you must have a latrine and use it and cut off the faecal oral route then you will sustain the good behaviour and construct another latrine.

We also learnt about monitoring. In Ethiopia, the community we visited had well-built monitoring structures in place. Each member of the ‘development committee was responsible for 30 homes and they met weekly to share progress reports and challenges. To strengthen this committee even further, they incorporated some of the brightest children, five of them who were excelling in class and could communicate effectively to monitor along with the development committee. You know children tell the truth and they considered children from the ages of 5 – 8 years. This was a very exciting lesson for me because we don’t have it and is something worth exploring. The way they systematically collected data, left no room for doubt and this data was authenticated at the health centre. For our context that means that data collected by the village health teams must go to parish level where it is verified by the Parish Development Committee (PDC) at the parish level. We can also incorporate pupils in the data collection as long as we describe what should be monitored.

I also liked the way they graded their ODF communities. A yellow flag meant not all households have latrines in that community. A green flag meant that all households had latrines and a white flag meant all households had latrines and there was also a communal latrine for passers-by and visitors to the villages.

I look at the quality of latrines we have, we are quite far up the sanitation ladder. We just need to define what we mean by basic/ improved latrine so that all stakeholders implementing Community Led Total Sanitation (CLTS) have the same definition and we can have uniformity in the quality of latrines across the country.