Nine million Ugandans practising open defecation

Imagine having to get up before sunrise in order to find a deserted piece of land on which you feel safe enough to ease yourself.

Yet this is what at least 8.8 million Ugandans have to go through daily. According to the 2020 Ministry of Water and Environment sector performance report, 8.8 million Ugandans are practising open defecation.

This brings significant health risks such as diarrhoea, cholera and typhoid, which may lead to death.

Both rural and urban Open defecation, the practice whereby people go in fields, bushes, forests, open water bodies, or other open spaces to defecate, is pervasive throughout Uganda.

The practice is persistent in both rural and urban areas.

The population that practised open defecation in 2019/2020 reduced to 22% from 22.8% in the 2018/2019 financial year. The percentage of rural population having access to safely managed sanitation, experienced a slight decline from 7.1% to 7% in the 2019/2020 financial year.

This means that the other segment of the population, 93%, was either accessing basic sanitation, sharing sanitation facilities or practising open defecation.

In urban areas, access to safely managed sanitation services increased slightly from 37.4% to 38.9%.

Absence of facilities Eng. Felix Twinomucunguzi, the assistant commissioner in charge of urban water supply and sanitation at the water ministry, said: "In slums, there are no facilities, while in urban areas toilets are closed during the night.

This leads to people easing themselves in the open." This is evident in Kampala, where most both public and private toilets are closed at night. The few private and public facilities that exist charge up to sh300 per use of a toilet, which sometimes is not affordable.

Cultural beliefs Twinomucunguzi also cited cultural beliefs, especially in rural areas, where some members of the community do not use toilets. "There is a cultural aspect where in certain places it is a taboo for children and pregnant women to go to the latrine.

This makes it a challenge to end open defecation," Twinomucunguzi said. Poverty blamed Twinomucunguzi added that because of poverty, some people are unable to construct appropriate latrines.

"You cannot compel someone to have a nice toilet when they cannot afford a good house," Twinomucunguzi said. More than 892 million people defecate out in the open around the world.

In Uganda, 8.8 million people defecate in the open, compared to 2002, when there were five million of the 24.4 million Ugandans without a toilet facility.

Broken systems Dr Julian Komuhangi, the commissioner in charge of environmental health at the health ministry, blamed the persistent practice on breakdown of systems that would have helped people change their behaviour.

"Systems in local governments have broken down; health assistants and health inspectors are not active. They are no longer pro-people but are just after money," Komuhangi said.

"We need to sit with the community and become part of them and show them why open defecation is dangerous," she added. Central and eastern regions are better off compared to their counterparts in Karamoja and West Nile regions where latrine coverage is still low. "When you have a bad toilet where faeces are exposed, it is open defecation. This is because flies will take it to the community. When it rains, the faecal matter will mix with water," Komuhangi said. "There is need for enforcement in some areas where people are stubborn. The bylaws need to work where other means have failed," she added.

Way forward The sector report calls for promotion of hygiene and sanitation programmes coupled with provision of sanitation and hygiene infrastructure if Sustainable Development Goal 6.2 on sanitation and hygiene is to be attained.

According to the World Bank water and sanitation programme study of 2012, Uganda loses $177m annually due to poor sanitation.

Approximately, 23,000 Ugandans, 19,700 of whom are children under five, die each year from diarrhoea. Some 90% of these deaths are directly attributed to poor sanitation and hygiene. Fred Mulyaba, the principal environmental health officer at the health ministry, said the figures are embarrassing and should awaken everyone to take action.

"It is dehumanising and embarrassing to see this practice happening in the 21st century. Using a toilet should be everyone's responsibility," Mulyaba said.

With the implementation of the sanitation programmes by different sector players, national latrine coverage has increased from 49% in 1997 to 79% as of 2018. National hand-washing coverage increased from 14% in 2007 to 36% in 2018.

The sector performance report indicates that access to hand-washing with soap at household level increased by 2% from 36% in 2019 to 38% in 2020 in rural areas, while in urban areas leapt to 61.1%.

The increase in coverage is attributed to COVID-19 response messaging, which has resulted in positive behaviour change among the population towards hand-washing with soap.