Hygiene Sanitation Strategies in Uganda How to

Hygiene & Sanitation Strategies in Uganda How to Achieve Sustainable Behaviour Change? 31 st WEDC Conference 31 st October 2005, Kampala, Uganda Anthony Waterkeyn WSP / Mo. H (EHD)

New Opportunities for HP&S An Enabling Environment v Poverty Eradication Action Plan (PEAP Revision) v Sector Wide Approach to Planning (SWAP) v National Concern over very high Infant & Maternal Mortality Rates (Ministry of Finance) v Health Sector Strategic Plan (2005 – 2010) v Mo. H emphasising PREVENTION ahead of CURE v Fiscal Decentralisation Strategy – More District autonomy for budget allocations v New Environmental Health Policy & Legislation v More concern to educate the Girl-Child and improve school sanitation 2

New Opportunities for HP&S New Focus on Hygiene Promotion v Sanitation involves Behaviour Change v Hygiene Promotion is NOT just about building latrines v No point in building unwanted (mis-used) Toilets v Our Challenge: - How to break the faecal : oral routes of disease transmission? v Conversion vs Coercion (carrot or stick)? 3

Primary Prevention (The F diagram) Blocking the “Faecal Oral” Route 56% Latrine/Toilet Faeces Fluids Water Quality Fields Food Flies Fingers New Host Water Quantity Hand Washing 4% ? 4

Best Practices in Uganda Development Emergency v Busia v Mo. H v District Leadership v Integration of existing resources v Carrot & Stick v Regulation v Gulu IDP Camps v NGO (CARE / HIDO) v Demonstration Model (Community Health Clubs) v Peer Pressure v Behaviour Change 5

Home Improvement Campaign in Busia v v v v v Competition Targets Prizes Fines Baseline survey Monitoring Key role of DDHS Health Assistants Coverage 40 -90% 6

Community Health Clubs in IDP Camps v 15 IDP Camps Gulu 4 months Dec – Mar 05 v 15, 522 Health Club members (42% coverage) 116 CHCs v Weekly Health Promotion sessions (20 topics) v House to House monitoring v Sanitation Committee v Baseline survey & monitoring v >120, 000 direct beneficiaries v Constr. 8, 583 latrines (up from 1, 700) 7

Holistic Sanitation in Busia and Gulu v Clean, hygienic latrine / toilet v Hand-washing facility with water & soap that is used v Clean, swept compound (all children’s faeces deposited in latrine) v Fenced rubbish pit v Pot drying rack v Clothes line v Fuel efficient stove v Safe drinking water in clean covered container with ladle v Properly ventilated rooms v Prevention measures against malaria v Control of rodents, flies & mosquitoes 8

Way Forward v Treat HP&S holistically v “Total Sanitation” to break F-O route v Community Health Clubs build cohesion, peer pressure & positive behaviour change v Start with Model Homes and Model Villages… build on success v Demonstration Models : “seeing is believing” v Support health extension staff (ensure mobility and incentives) 9

Revitalising HP&S : 1 Recent Progress v National Sanitation Working Group v Sanitation Best Practice Workshops (Busia Story) v Improved Advocacy for HP&S : e. g. AMCOW, some District Leaders, Mo. H Ministers and now, President Museveni v Improving Integration within some districts (Water, Health, Education, Gender, NGOs and CBOs) v Establishing District Water & Sanitation Co-ordination Committees (DWSCC) v “Total Sanitation” concept is beginning to spread 10

Revitalising HP&S : 2 Lessons from Test Models for Best Practice in HP&S v Model Homes Model Villages Model Parish Model Sub County Model S/County Model District (League Tables) v Concentrate on just ONE Sub-County per year and achieve Total Sanitation in that Sub-county v Within about 5 -6 years a whole district can be completely changed v Model Village concept can influence advocacy and budgetary support from District (e. g. CAOs) v Seeing is Believing = Budgetary Support ! 11

Health & Water Sector UNDERTAKINGS v Annual Joint Sector Reviews v Past 3 years: Undertakings for Sanitation v Past week: President = major breakthrough “PHC Guidelines to be reviewed to encourage expenditure of up to 10% of the District PHC Grant on Hygiene Promotion and Sanitation Campaigns”. v Elections: “NO LATRINE – NO VOTE”! 12

The Objective: Healthier children 13