80% of Ugandaâ€™s disease burden is related to poor hygiene and sanitation
By Conan Businge
AS DARKNESS blankets Natondome village in Mbale, an elderly woman slowly emerges from a thicket with a small jerrycan in one hand and a hoe in the other. She climbs a mile-long hill to her hut.
For the last five years, Sarah Nangobi has been cleaning the village well alone.
â€œGone are the days when we had serious chiefs who enforced community work. No one cares these days,â€ Nangobi says.
Although she takes time to clean the well, her home is a shambles. It comprises a kitchen and a hut. She does not have a pit-latrine, compost pit, bathroom nor a rack for utensils. Her bathroom is made of a torn sisal sack hung over a stick. Nangobiâ€™s home is not different from many other homes in this village.
Of the estimated 30 million people in the country, only 59% can access proper sanitation. â€œThis is a worrying trend because in 1960, access to sanitation was at 88%. It terribly declined to 22% in 1980,â€ notes Dr. Paul Luyima, an assistant commissioner in the health ministry.
Luyima was speaking at a workshop for the Water Sanitation and Hygiene for All Coalition Group in Kampala recently.
Access to sanitation refers to the share of the population with at least adequate excreta disposal facilities that can prevent human, animal and insect contact with human waste. Suitable facilities range from pit latrines to flush toilets with a sewerage system.
According to the Sanitation Working Group in Uganda, about 80% of Ugandaâ€™s disease burden is related to poor hygiene and sanitation.
Poor waste disposal
At 59%, the latrine coverage is far below the expected UN Millennium Development Goals target of 72%.
Poor disposal of human waste has led to the contamination of water sources, soil and food. This causes diarrhoea, the second largest killer disease among children in developing countries.
Dr. Kenya Mugisha, the director of health services, says of every five people that die, at least one dies of diarrhoeal diseases. He said many people, especially in villages, do not dispose of faeces in latrines, do not wash their hands after using the toilet and before handling food.
In June, at least 31 people died of cholera and over 290 were infected in Butaleja, Mbale, Pallisa and Manafwa districts in eastern Uganda. The health minister, Dr. Stephen Mallinga, attributed the infections to the contamination of River Manafwa.
Mugisha said water-borne diseases like cholera, typhoid, trachoma and hookworms, are one of the countryâ€™s most significant health problems.
The World Health Organisation (WHO) estimates that 85 to 90% of the diarrhoeal illnesses in developing countries can be attributed to unsafe water and inadequate sanitation and hygiene practices.
Dr. Lucy Korukiiko, a health consultant, says safe human wastes disposal reduces diarrhoea risk by 30%.
Kampala City Council chief health inspector Mohammed Kirumira says about 62% of households in Kampala lack toilets. About 48% of city dwellers also use contaminated water.
The ministry of health says that less than 10% of the people in rural areas wash their hands properly after using the toilet.
Dr. Luyima attributes the declining access to sanitation to the breakdown in the community leadership structures, declining positive attitude towards sanitation and negating of by-laws.
Samuel Watulatsu, a social entrepreneur in eastern Uganda, says: â€œThe problem is with peopleâ€™s attitude. Do you need someone to tell you that you need a latrine? Whoever has common sense should know that disposing of human waste carelessly is a threat to life.â€
Ronald Kawuma, the chief of Wakisi sub-county in Mukono says elective politics is one of the reasons community work is failing. â€œFor example, if you try to mobilise the masses and even use force to involve them in community work, the political leaders will oppose you because they want to protect their voters,â€ he says.
Kawuma adds that the reduction in local revenue also led to the failure of community work. â€œDue to the scrapping of Graduated Tax, you realise that sub-counties have got little resources to fund programmes like bulungi bwansi,â€ he says.
His colleague in Mubende agrees: â€œIt is better to sensitise the people than to forcefully ask them to improve their sanitation,â€ says Paul Musasizi a Gombolola chief in Mubende.
Sarah Muthoni, a housewife in Kasese, argues that due to HIV/AIDS, there is a missing generation of adults in every homestead, village, and country in general that would have passed on the values.
But Mwalimu Musheshe, a community worker in Kibaale, says: â€œAs of now, the people are so much into attending the free education and the rural areas are deprived of the youth to do the work. But as years go by and the people are educated, they will resume community work.
James Okello, a medical doctor, attributes the problem to corruption. â€œThe health inspectors can nowadays ignore a collapsing toilet because they have been bribed,â€ he says.
The director general of health services, Dr. Sam Zaramba, says that the Government is strengthening the implementation of the Public Health Act, as a way of improving access to sanitation. This is in addition to the Kampala Declaration on Sanitation, on which all district chairpersons became signatories in 1997.
The Declaration assigns responsibilities to people from family to district level, to improve health.
Through the health ministryâ€™s public health department, plans are also underway to establish committees of nine people; at all health centre one facility.
â€œThey will offer home-based knowledge on health, distribute nets and visit homes,â€ Zaramba said.