WATER GLOBAL PRACTICE POLICY NOTE Reviewing Sanitation in Uganda to Reach Sustainable Development Goals Jim Gibson, Kathy Eales, and Chris Nsubuga-Mugga JUNE 2018 MAIN MESSAGES • Low household incomes constrain investment in sanitation improvement. Targeted subsidy options, therefore, should be carefully considered to support universal access to services. • Funding to local governments needs to be increased, to enable them to fulfil their sanitation mandate. • Community mobilisation programs should be expanded with sustained follow-ups, to stimulate demand for improved sanitation, to all districts. • A major investment program is needed, along with ongoing funding support, to improve schools’ sanitation. • Investment is needed to improve sludge and wastewater treatment capacity in urban areas. • A comprehensive and integrated national capacity building program that gives emphasis to supporting implementation by local government of its sanitation responsibilities needs to be developed. Introduction the country. The ultimate objective of the assignment is to define possible measures to reach the national This policy note draws upon information col- objectives of meeting the Sustainable Development lated during a diagnostic study report to assist the Goals (SDGs). Government of Uganda (GoU) to make a comprehen- sive review of the state of household and institutional The diagnostic study identified several areas of com- sanitation in rural and urban areas, and assess the promised effectiveness of government spending on barriers and drivers of improvement of sanitation in sanitation. Underfunding can result in wasteful 1 expenditure where funds are inadequate to achieve entrenches the cycle of poverty and disease (for the stated aims, and investment in stand-alone infra- instance, cholera, typhoid, stunting, lowered immunity structure can be wasted where the supporting service to malaria, tuberculosis and human immunodeficiency linkages are not in place. Given the scale of competing virus [HIV] arising from worm infestations), slows demands for limited public funds, it is vital to target development, entrenches slums, as well as makes cities investments strategically to deliver the benefits less attractive places to work, live, and invest in. Girls required efficiently and effectively. not completing their schooling because of inadequate The research for the diagnostic study was conducted provision for menstrual hygiene management is also a between September 2016 and February 2017. consequence of poor sanitation. Conversely, better san- Preliminary findings and an interim report were pre- itation practices play a significant role in driving sented to the National Sanitation Working Group improvements in people’s standards of living and qual- (NSWG) on January 25, 2017. A draft of this report was ity of life, and ensuring those improvements can be presented to the NSWG on March 30, 2017, and com- sustained into the future. ments were incorporated into a revised report. To date, the GoU has given strong emphasis to eradicat- Good sanitation matters for many reasons, but particu- ing open defecation, and to encouraging people to larly for human dignity, public health, and environ- invest in safe containment systems. Grant funding, to mental protection, especially water. Poor sanitation local governments to support community-led total sanitation (CLTS) and home MAP 1. Major Towns Where Research Was Conducted for this Assessment improvement campaigns, is spur- ring sanitation improvement on a significant scale. But as the pace of urbanization picks up in the country and the scale and density of urban settlements rise, local authorities and the ministries that support and service these areas will need to give greater attention to safe management of wastes beyond the on-site facilities of individual users. The SDGs shift the sanitation sec- tor’s goal posts significantly. The sanitation targets go well beyond a measurement of how many peo- ple have access to an adequate toilet (coverage) and define out- comes in terms of safe manage- ment of human wastes across the whole service chain, from con- tainment, through emptying and transport to treatment and final 2 Reviewing Sanitation in Uganda to Reach Sustainable Development Goals FIGURE 1. The Entire Service Chain Reuse/ Containment Emptying Transport Treatment disposal Note: Beyond household toilet facilities, the concept of a wider chain of sanitation services shows the scope of the Sustainable Development Goals to which Uganda has committed itself. Where there is room to contain waste on-site and cover and close an old pit when it is full, the service chain beyond containment is not relevant. But even in small rural growth centers there is now growing demand for services and infrastructure to preempt open dumping of sludge. Open dumping is tantamount to open defecation on a vast scale, and frequently results in severe water pollution. disposal or reuse, and in all settlement contexts along beyond an emphasis on mobilizing households to the rural-urban continuum. What the Millennium increase toilet coverage and adopt practices that enhance Development Goals regarded as improved sanitation is their health and hygiene, to a recognition of the broader now considered just basic sanitation if there is no systems that support (or undermine) safe management proper management of waste beyond the  toilet of wastes across the full-service chain. In Uganda where (UNICEF/WHO 2015). The SDGs will also require track- percent of the population relies on on-site more than 90 ­ ing of how much wastewater is treated safely. The tar- facilities, and where the supporting services for empty- gets set call for safe sanitation for all by 2030, giving ing, transporting, and treatment are poorly developed, particular attention to the needs of women and girls. far too much sludge ends up in the environment, with a This requires a more extensive focus on how best to wide  range of serious impacts on public health, water ensure no one is left behind. quality, and environmental pollution. Tackling the implications of the SDGs requires a Sanitation improvement in Uganda is being supported by far-reaching change in thinking that will need to go an extremely wide range of initiatives. Most Ugandans Sludge discharged directly to drainage channels in Kampala. These pictures were taken in several locations and are representative of any of a growing number of towns, notably Mukono, Wakiso, and Masaka. Reviewing Sanitation in Uganda to Reach Sustainable Development Goals 3 live in rural settlements, and the clear majority of san- Development Goals (MDGs), reported “little or no itation improvement initiatives focus on building progress” in Uganda towards achieving the sanita- household demand in rural villages for sanitation tion MDGs (UNICEF/WHO 2015). Many current and  hygiene improvement through awareness and people at risk of hygiene practices continue to put ­ sensitization campaigns that promote good  hygiene, exposure to disease-causing pathogens. practical home improvements, and an end to open The role of households in achieving sanitation defecation. Sanitation promotion is just as import- improvement remains decisive as they will remain ant  in urban areas, but is not being addressed the primary agents of change. But tackling safe beyond  ­ limited nongovernmental organization ­ management of wastes beyond containment requires (NGO)-led projects. far greater engagement by public authorities, There is little understanding of the scope of the ser- primarily local governments. This will have signifi- ­ vice chain for on-site sanitation, and the need to cant implications for the quantum of funds required develop safe and affordable services for desludging and the strategies to be adopted if Uganda wishes to and sludge treatment. There is a clear need to make achieve the improvements that it has signed up for. significant additional investments across the service A  realignment of sector activities and resources is delivery chain in all villages, towns, and cities. needed to achieve the required progress against Interventions need to identify and address each pos- the  new performance indicators Uganda will be sible source of sanitation-relation pollution, and ­measured against. include promotion of responsible sanitation prac- tices, enforcement of relevant laws, and the creation Key Sanitation Sector Developments of infrastructure where needed. The uniqueness of context, practices, and outcomes requires that priori- Rural Sanitation Improvement tization occurs at a local level. Grand plans that do not Uganda’s largest sanitation initiatives currently are take adequate account of the local context will be community (community-led total sanitation) and inefficient, or even fail. home improvement campaigns led by district health and water officials, supported by village health teams. Many are delivering good results with very Progress Remains Disappointing: New Approaches Needed A wide range of sanitation improvement activities are under way across Uganda which tackle various aspects of the country’s challenges. The Ministry of Water and Environment’s (MoWE) 2016 Sector Performance Review presents evidence of a wide range of positive developments: Despite this, there is concern among sector role-­ players that Uganda’s progress in achieving improved sanitation is inadequate, in as far as the interventions being undertaken are not “moving the needle.” The international Joint Monitoring Mbarara District has one of the most effective community-led total sanitation programs in the country. It combines the eradication of Programme (JMP) that tracks and reports the per- open defecation with integrated home improvement. This voluntary formance of countries against the Millennium sanitation activist has upgraded both her toilet and her kitchen. 4 Reviewing Sanitation in Uganda to Reach Sustainable Development Goals FIGURE 2. Extent of Sewered Sanitation in Uganda 10,000 9,000 8,000 7,000 6,000 Customers 5,000 4,000 3,000 2,000 1,000 0 a le lu ra a ro ra e ga la ro a le ti di al nj ak bb m ba pa Gu ra Li ro ba ro so an in rt Ji oi as te ba To M So m Po Ki as Ka Ig H M En Ka M M rt Fo Source: The National Water and Sewerage Corporation. Note: The number of customers connected to sewered systems around the country is very low. Due to the reluctance of customers to connect to the systems, there is not much planned in the way of extensions to the existing networks. modest spending. The Ministry of Health (MoH) bud- serving as good role-models for behavior, for motivat- gets on the basis of an assumed cost of U Sh 1.6 ­ million ing change, and for being willing to take a hard line (US$440) per village, but based on the outcome against those who persist with anti-social behaviors. of  District Investment Planning initiatives in the Northern region, districts maintain that a more Urban Sanitation Initiatives realistic ­ figure of three times that amount, Urban settlements have accelerated rapidly over the U Sh 4.7 million (US$1,295) is required per village to past two decades, and more attention is now being achieve lasting impacts, even with volunteers. The given to the challenges they pose. There are fewer than challenge, however, is how to sustain the gains and 10,000 sewer connections in Kampala, serving less prevent backsliding. than 10 percent of the capital’s night-time population; Areas having the greatest success in achieving and sus- a far smaller number is served in 15 smaller towns taining ODF status tend to be in areas where median where sewer networks were developed, in some cases, rural household incomes are higher than the national more than four decades ago. There are significant chal- average, where local household toilet coverage before lenges for sanitation improvement, but a growing the intervention was above 65 percent, and where a number of partners are supporting town administra- combination of mobilization and support approaches tions to explore options, develop improvement plans, are used. The stance of local leaders is pivotal in and test innovations. Reviewing Sanitation in Uganda to Reach Sustainable Development Goals 5 Universal inclusion requires greater attention to pro-poor approaches that may not be commercially ­ viable. Private sector operators are motivated by a desire for profit, and they are unlikely to offer safe sanitation service in markets where there is no viable trading proposition. Additional public funding is needed to address public health and safety, and to ensure a clean living environment. Sanitation Supply Chain Development Several NGOs have given particular emphasis to devel- The new sludge drying beds in Ntungamo, dedicated to fecal sludge deliveries. oping the supply chain for sanitation goods and ser- vices to meet household demand. One illustration of progress is that over 20,000 Satopans, or “flappers,” Most urban sanitation initiatives are currently focused have been sold through over 350 hardware outlets on Kampala, where the Kampala Capital City Authority nationally. This simple easy-to-clean plastic pan with a (KCCA) is working with a number of partners to tackle counter-weighted flap at the base, provides a barrier to sanitation challenges that are compounded by exten- flies and odors and offers a simple route to achieving sive settlements in swampy areas and flood plains. improved sanitation at relatively low cost. A  range of initiatives aim to expand access to improved sanitation facilities, and address fecal WASH loans: WASH loans have been suggested as a sludge management across the service chain. way of assisting poor households to build or improve Approaches being developed in the KCCA are not their facilities or invest in lined pits to enable empty- ­ necessarily replicable in smaller centers where local ing. Many options are currently available: individual government capacity is more limited, populations are loans from institutions such as Postbank, or savings poorer, and where affordability constraints mean that and credit cooperatives (SACCOs), or through groups formal sector desludging services providers cater lending by Postbank to SACCOs. primarily to institutional and commercial customers. ­ Semi-mechanized pit emptiers: Water for People has trained a number of would-be entrepreneurs to enter the gulping business, but the attrition rate is high. There are now five entrepreneurs offering such services in Kampala using Gulpers and other ­ equipment. However, simply securing a trading ­ license constitutes a significant barrier to entering formal sector markets. Only two of the five have trad- ing licenses. The cost—U Sh 475,000 per year—is significant, but the greater challenge is assembling ­ the requisite paper trail of audited financial state- ments and other documents. There is an evident need to offer guidance and support to those who know limited English, and those who are not aware of the ­ Covered drying beds at the NWSC’s Lubigi works, where the NWSC produces compost for sale to market gardeners and farmers. benefits of having a trading license. 6 Reviewing Sanitation in Uganda to Reach Sustainable Development Goals Abandoned toilets in a school near Lira. BOX 1. Innovation to Support Better Fecal Sludge Management An NGO, Water for People, is pioneering innovation in several areas to support better fecal sludge man- agement. In the Northern Region it has worked with local and international partners in an attempt to develop viable service chains to small scale sludge treatment works in Lira and Kitgum. In Lira it has recruited, trained, and supported local youths to develop a small manual sludge emptying business using a Gulper, and provided a pedal tricycle to haul filled barrels to a small treatment site 10 km west of the town. Construction of small sludge treatment works on this scale may well provide more afford- able options to increasing the number of safe sludge disposal sites nationally, rather than the more capital intensive works evident in Ntungamo and Buwama. A small sludge treatement plant developed by an NGO, Water for People, outside Lira. box continues next page Reviewing Sanitation in Uganda to Reach Sustainable Development Goals 7 BOX 1. Innovation to Support Better Fecal Sludge Management (continued) In an impressive commitment to addressing the need for commercial viability, Water for People has invested in equipment to make charcoal briquettes from the dried sludge, to generate a revenue stream to offset the costs of treatment. However, converting latent demand for pit emptying services into a viable enterprise requires a certain minimum scale of operation and achievable, practically imple- mentable operational tasks. FIGURE 3. Funding of Local Government Ratio (Local Govt : Line Ministry) 35 30 25 20 Percent 15 10 5 0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Financial year (ending) Source: MoFPED. Institutional Sanitation Schools sanitation  is a primary focus of most WASH Schools: The provision of sanitation facilities in schools construction of school latrines is supported NGOs, and ­ requires priority attention. There are nearly 9 million by a wide range of NGOs and faith-based organizations. pupils in over 18,000 primary schools in the country and 86 percent of these are in public/­government-aided Sanitation for Refugee Settlements schools. Because children spend a significant amount There are a growing number of refugee settlements in of time in and around their schools, the state of school northern, western and south-western Uganda, but the sanitation facilities has a significant impact on biggest are in the north. In March 2017 an estimated their wellbeing, and p ­ rovides important opportunities 2,800 people were arriving in Uganda each day from for entrenching ­ life-long attitudes and behaviors. South Sudan. 8 Reviewing Sanitation in Uganda to Reach Sustainable Development Goals Providing adequate sanitation in a context of rapid in the absence of programs designed to stimulate arrival of displaced people can be extremely challeng- demand for sanitation. ing, and the risk of disease outbreaks can be high. • Chronic underfunding of local governments which, Providing safe alternatives to open defecation is the in turn, severely limits their ability to drive sanita- priority. tion improvement campaigns, develop and operate public toilets, enforce compliance with the law, and develop facilities for safe sludge management. Local The Diagnostic and Challenges governments are the critical implementation agen- While statements are made at high level about the cies for driving sanitation improvement, but are importance of sanitation, this importance is not severely underresourced. reflected in budget allocations. Advancing sanitation improvement systematically and sustainably requires • A shift in the government’s spending priorities away a fundamental shift from reliance on externally-funded from water and sanitation, as well as health and project-based approaches, to a sustained focus on sanita- education, in favor of investment in sectors that will tion by local governments, with dedicated funding from stimulate economic growth and the attainment of central government to address their sanitation man- middle income country status. date on an ongoing basis. Without the enabling envi- These points have been made repeatedly in various ronment that this funding backbone will provide, the studies. They remain fundamentally relevant. The cur- impacts of externally-driven sanitation projects will rent rate of progress in the sector reflects what can be continue to be short-lived. achieved with this quantum of funding. The sector is It seems there is a view in national government that currently stuck in a low-level equilibrium, and pros- sanitation does not warrant additional resourcing, that pects for achieving different sanitation outcomes with it is a personal responsibility of households, and all the same resources are limited. that is needed is promotion through CLTS. There is lit- Some additional key themes that arise from the diag- tle awareness of just how meager the available resources nostic are: are and how thinly they are spread, relative to the chal- lenge. Data presented in the 2016 MoWE Sector • Household incomes fundamentally shape what is Performance Report suggest that total sector spending possible. The challenge is how to mobilize ordi- on sanitation improvement in 2015/16 by government, nary citizens to undertake the improvements and development partners, and CSOs for both hardware changes that sector role-players regard as necessary. and software was well below US$10 million, with sec- Structurally, improvement in the sector relies heav- tor partners beyond government contributing the bulk ily on investment by individual households, and of those funds. This reality helps to explain why so few progress is constrained by modest aggregate house- sanitation initiatives are more than finite projects. The hold incomes. The cost of replication without exter- lack of adequate funding for sanitation by local govern- nal funding is greater than households are willing or ment represents a massive inefficiency for the govern- able to fund and, thus, motivation and momentum ment as a whole. is lost. Three main factors seem to be holding back Uganda’s • Inadequate sanitation funding leaves local authori- progress in achieving sanitation improvement: ties dependent on the projects of external partners. • Low median household incomes, which constrain Achieving the level of desired improvement required investment in sanitation improvement, particularly calls for a change in the roles of local governments, Reviewing Sanitation in Uganda to Reach Sustainable Development Goals 9 the Ministry of Local Government, and the quantum absent handwashing facilities, no soap, dry taps, of funds available to local governments. Districts unsafe water supplies (MoES 2016)—compromises rely on central government transfers for well over the school environment and exposes learners to 90 percent of their income. Compounding their several health risks. The MoES now requires new financial constraints is the fact that budget transfers school toilets to be lined, to enable emptying. But are not being revised to keep pace with population only 17 percent of the schools surveyed in the map- increases. Some districts receive funds from devel- ping exercise had ever been emptied (MoES 2016) opment partners to run specific programs around due to a lack of safe emptying options, or because sanitation or HIV prevention—but with the with- the school was unable to raise the funds required. drawal of key partners, even these sources of fund- Universal Primary Education and School Facilities ing are reducing. Grants are inadequate to support decent school sanitation. • Market-driven approaches are necessary but not suf- ficient. Approaches that encourage the private sec- • Regulation in line with the law is underresourced tor to provide sanitation services on a commercial and inadequately supported by political leaders. basis are proving valuable in expanding the range Uganda has excellent public health legislation with of service options available to those who can afford the scope to achieve good sanitation, but enforce- them. The number of formal service providers ment is comprised by weak penalties, a shortage of offering desludging is growing steadily. However, health inspectors able to focus on sanitation-related universal service coverage—which requires greater regulation, and interventions by politicians who attention to pro-poor approaches that may not allegedly do not want their voters alienated. One be commercially viable—cannot be addressed area requiring urgent attention is regulation of land- solely through purely commercial models run by lords, who are being allowed to externalize the costs entrepreneurs. of providing no, or poor-quality, toilet facilities to their tenants. Sanitation promotion campaigns will • Neglect of sanitation is resulting in a severe disease increasingly need to target landlords specifically, burden, with high curative health costs and lost pro- and engage local and national political leaders, to ductivity. Cholera, typhoid, dysentery, and diarrhea enforce existing health and building regulations are well known consequences of poor sanitation. more assertively. Less widely recognized is the importance of good sanitation in combatting stunting in children. Poor • The sanitation sector needs a leader. It is gener- ally understood that the Ministry of Health is the health affects school performance in childhood sector leader for sanitation in Uganda, but sector years, as well as job prospects and life-long earning policy and legal documents do not specify this potential in later years. clearly. Sanitation needs an overall leader with the • Poor sanitation is compromising Uganda’s schools mandate and authority to call other role-players and education goals. Children spend a significant to account. It is, therefore, important that sector amount of time in and around their schools, and the leadership is assigned formally, with policy docu- state of school sanitation facilities has a significant ments and legislation stating clearly which minis- impact on their wellbeing. It provides important try takes the lead on sanitation, what its role and opportunities for entrenching life-long attitudes obligations are as leader, and what the roles and and behavior. Yet the dire state of sanitation facili- obligations of other ministries are concerning san- ties in many schools—dysfunctional or dirty toilets, itation in Uganda. This clarification is particularly 10 Reviewing Sanitation in Uganda to Reach Sustainable Development Goals necessary in the light of the SDGs, as coordination role-players to longer term and sustained engagement. and collaboration is needed across a wide range of The job will never be finished. role-players. Sanitation improvement needs to be addressed at a senior strategic level within the government, in view Recommendations of  its wide-ranging impacts on the citizens and The recommendations and action plan outline inter- economy of Uganda. It is recommended that the ­ ventions that should form part of an ongoing pro- Office of the Prime Minister (OPM), responsible gram. The proposals are informed by representative for coordinating the activities of all ministries, takes sector costing benchmarks, but are not costed in an active role in giving strategic direction to the detail. sector, working in conjunction with the National ­ Sanitation Working Group. The aim would be to set Achieving safely managed sanitation across the entire the direction, develop strategy, and allocate resources service chain will require concerted effort on all fronts. in a way that takes account of national priorities At present the levels of investment are pitifully low, and aspirations, beyond the operational level of the with the bulk of district sanitation funding coming various ministries. The most important role for the from the Uganda Sanitation Fund, and reaching only a OPM, in collaboration with the Ministry of Finance, minority of districts. Planning and Economic Development (MoFPED), is to ensure that the national budget provision for sanita- There is a clear need to make significant additional tion is increased steadily to enable each government investments across the service delivery chain in all vil- role-player in the sector to fulfil its mandate. In turn, lages, towns, and cities. These increased investments the respective ministries with a sanitation mandate need to be mainstreamed into the day-to-day activities should lobby the OPM and MoFPED actively for sector of all actors and role-players to sustain improved per- funding. Each ministry should be able to articulate formance over the long term, and provide a conducive their funding needs for activities and outcomes, pri- environment for individual projects. oritized on the basis of evidence from monitoring and research. Interventions need to identify and address each ­ possible source of sanitation-related pollution, and In addition to improved coordination by OPM, the sec- include promotion of responsible sanitation practices, tor should focus on: enforcement of relevant laws, and the creation of • Strengthening the sector policy environment: infrastructure where needed. Each settlement has dif- ferent challenges, requiring different types and combi- • Explore the feasibility of targeted subsidies to nations of interventions. The uniqueness of context, support universal access to affordable services practices, and outcomes requires that prioritization across the service chain; and occurs at a local level. Grand plans that do not take • Assess urban sanitation policy gaps. adequate account of the local context will be ineffi- cient, or even fail. • Measuring activities and performance in the sector: These recommendations outline interventions that • Track sector expenditure through the “chart of accounts”; and should form part of an ongoing program. Certain ele- ments of each initiative may be implemented on a proj- • Select performance indicators can shed light on ect basis, but there needs to be a commitment from all where interventions are needed. Reviewing Sanitation in Uganda to Reach Sustainable Development Goals 11 • Developing infrastructure: • Make better decisions based on evidence from innovation and knowledge projects. • Develop additional regional sludge treatment capacity; • Ensuring sector capacity development: • Refurbish and upgrade existing waste water treat- • Build sector capacity to drive sanitation improve- ment facilities; and ment across the service chain. • Expand and improve sewer networks to limit pollution Action Plan and Cost Estimate The sanitation sector in Uganda is diverse; there are • Improving school sanitation facilities to support a many initiatives and actions being undertaken, and healthy learning environment: many contextual considerations that result in qualita- • Ongoing investment in the building and tive differences. It is not possible here to list each one maintenance of school latrines should be ade- ­ of these and describe a course of action to achieve quately funded on a continuous basis through the improvement. That is a task that must be executed at a MoES. local level by people who have deep knowledge of the specific contexts. The recommendations presented • Using scheduled, co-funded emptying of facil- here attempt to begin a process of mobilizing the ities  at schools and hospitals to provide viable resources required for such local decision making and business opportunities for pit emptiers beyond ­ implementation. Kampala. The budget takes into consideration what may realisti- • Reducing OD through provision of additional public cally be mobilized over a five-year period. The budgets toilets. have been deliberately structured as seed funding • Promoting ongoing sanitation improvement: for an ongoing program of action rather than as stand- alone projects. It is, however, important to continually • Expand demand creation approaches to all dis- consider each of the interventions from the perspec- tricts, with funding support for annual ­follow-ups; tive of how they integrate into the existing system that and is delivering service. This cost estimate has also given • Develop and implement sanitation promotion some consideration to what may be practically avail- approaches relevant for urban residents. able in the way of additional resources that could be deployed. • Enlisting financial support for local government’s sanitation role: The amounts presented represent the recommended investment in the first year of execution of the various • Increase sanitation grant funding to local programs. These amounts should be progressively government; increased over time, allocations should be adjusted to • Allocate increased funding to support com- continually strengthen and broaden the initiatives. The plementary services that support sanitation development of initiatives should be based on feed- improvement; and back on the successes and failures that are observed. 12 Reviewing Sanitation in Uganda to Reach Sustainable Development Goals TABLE 1. Action Plan and Cost Estimate Yearly cost estimate No List of actions Description Category Responsibility U Sh US$ 1 The Office of the Sanitation is elevated to an issue Policy OPM/MoFPED Part of ongoing Part of ongoing Prime Minister of national importance. activities activities and Ministry of Finance Planning and Economic Development take responsibility for ensuring increased resource allocation to the sanitation sector 2 Refurbish and A design check and evaluation Technical/ MWE/NWSC 22 billion 6 million upgrade existing of performance of each existing financial WWTW and sludge facilities is carried out, and the receiving facilities need for upgrade and a program of refurbishment and upgrade is implemented based on priorities identified against the probability and consequence of ongoing pollution. 3 Build new WWTW New treatment facilities are Technical/ MWE/NWSC 27.5 billion 7.5 million and sludge handling constructed on the basis of financial facilities prioritization and careful consideration of positioning and design to achieve maximum benefit for each investment. 4 Review policies and The existing policy provisions are Policy MWE/NWSC 1.1 billion 0.3 million strategies applicable revised to better align with the de to sewered sanitation facto sanitation practices in urban are revised areas. Analysis focuses on the current lack of commercial viability and the real ability to enforce practices on residents, particularly the poor. 5 Expand and upgrade Extensions are made to existing Technical/ NWSC 25.7 billion 7 million existing sewer networks based on expressed financial networks need, and capacity upgrades are implemented that are aligned to current overloading an anticipated demand. 6 Develop new sewer New sewer networks (and possibly Technical/ NWSC 18.3 billion 5 million networks decentralized treatment facilities) financial are developed in areas where commercial viability could be realistically achieved. table continues next page Reviewing Sanitation in Uganda to Reach Sustainable Development Goals 13 TABLE 1. continued Yearly cost estimate No List of actions Description Category Responsibility U Sh US$ 7 Accelerate school Additional resources are made Financial MoES 16.5 billion 4.5 million toilet building available to build more toilets at programs those schools identified as priority. 8 Subsidize the A subsidy program is designed Financial/ MoES/MoFPED 36.7 billion 10 million operation, and implemented to provide operational maintenance and assistance to schools to enable sludge management them to effectively manage the of school toilets functionality of toilets. This subsidy is applied in a manner that primarily supports schools in poorer and lesser resourced areas. This program is used to support the mergence of effective pit emptying service providers. 9 Accelerate building Public toilets are built at a Technical/ LG/MWE 16.5 billion 4.5 million of public toilets in greater rate in areas where open financial urban areas and rural defecation is problematic due to growth centers the lack of alternatives for day visitors. 10 Subsidize operation, The pricing of the service is Financial/ LG/MoFPED 36.7 billion 10 million maintenance, and reviewed and subsidized so as to operational sludge management not exclude the poor (User fees at public toilets and subsidies). 11 Build roadside public Funds are made available for Technical/ LG/MoFPED 16.5 billion 4.5 million toilets the building, O&M and sludge financial management of road side public toilets where open defecation is problematic due to the lack of alternatives for people traveling on national roads. 12 Scale up sanitation Additional funding is made Financial/ MoH/MoFPED/ 44 billion 12 million promotion to include available to expand the sanitation operational DPs/NGOs the whole country messaging (CLTS/HI/ODF+) program. 13 Run ongoing media A long-term media campaign is Financial/ MoH/OPM/ 11 billion 3 million campaigns to developed and implemented to operational MoFPED encourage good inform people of the benefits of sanitation behavior improved sanitation practices and and practice the actions that each individual and household can take to support such outcomes. The message is to include information on containment infrastructure, emptying and transport practices, and personal habits and behavior. table continues next page 14 Reviewing Sanitation in Uganda to Reach Sustainable Development Goals TABLE 1. continued Yearly cost estimate No List of actions Description Category Responsibility U Sh US$ 14 Encourage innovation There is a need to continually Technical OPM/MoFPED/ 11 billion 3 million and research to support innovation, invention, DPs/NGOs strengthen sanitation and discovery within the sector. Breakthrough thinking, technology, and systems can make a big difference. This should be supported on an ongoing basis. 15 Strengthen solid Additional funding is provided to Financial/ LG/MoFPED 25.4 billion 7 million waste management local government (LG) so that they operational can more effectively manage the challenges created by the nexus of solid waste and fecal sludge management, especially where they overlap and the become indistinguishable from each other. 16 Review local A review and amendment of the Policy/legal LG/MoH/MWE 1.1 billion 0.3 million government by-laws policies and legal provisions for to improve alignment these two, often overlapping, of solid waste services. and fecal sludge management 17 Improve stormwater Areas where stormwater Technical/ LG 25.4 billion 7 million systems arrangements are adversely financial affecting sanitation outcomes are identified and addressed. 18 Subsidize fecal sludge Explore and implement subsidy Financial/ LG 36.7 billion 10 million management mechanisms to improve safe operational handling of fecal sludge in containment, emptying, transport, and treatment implemented. A market-based approach will never reach every household. This should be approached with care so as to not result in irreversible perverse outcomes. 19 Develop spatial plans At the root of many of the Technical LG 3.7 billion 1 million for urban settlements greatest sanitation challenges is the rapid unordered growth of settlements. The development of spatial plans in some of the most rapidly urbanizing areas should be supported as a first step in alleviating this problem. table continues next page Reviewing Sanitation in Uganda to Reach Sustainable Development Goals 15 TABLE 1. continued Yearly cost estimate No List of actions Description Category Responsibility U Sh US$ 20 Provide funding Local government is at the coal Financial LG 18.3 billion 5 million support to enable face of achieving good sanitation local authorities to outcomes. Their role in the play a more active management of solid waste and role in monitoring fecal sludge should be adequately sanitation practices funded to enable them to deploy and outcomes in the necessary human resources to urban areas. This achieve these objectives. will also include enforcement of the law, where appropriate. 21 Build sector Sanitation improvement requires Policy/ DLUDH/MWE/ 18.3 billion 5 million capacity to plan and the development of multi- technical/ MoH/DPs/NGOs manage sanitation disciplinary programs to equip operational improvement, urban managers and technical especially in urban professionals address the diverse areas sanitation challenges posed by rapid urban settlement. 22 Provide support Provide supporting resources Policy DLUDH/MWE/ 1.5 billion 0.4 million for engagement on for dialogue on urban sanitation DPs/NGOs urban sanitation policy between mayors, NLUDH policy improvement and relevant roleplayers, with between mayors, facilitation by AMICAAL NLUDH, and relevant roleplayers Total 400 billion 110 million References Performance Report 2016.” MoWE, Kampala, Uganda. http://envalert.org/wp-content/uploads/2016/09/SPR​ MoES (Uganda Ministry of Education and Sports). -2016_final.pdf 2016. WASH in Schools Mapping Report. Kampala, Uganda: MoES. UNICEF/WHO. 2015. Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment. MoWE (Uganda Ministry of Water and Environment). New York: UNICEF. 2016. “Uganda Water and Environment Sector ­ ank. Some rights ­ © 2018 International Bank for Reconstruction and Development / The World B reserved. The find- ings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, represent. The World Bank does not guarantee the accuracy its Board of Executive Directors, or the governments they ­ ­ ork. This work is subject to a CC BY 3 of the data included in this w (https://creativecommons.org​ ­ .0 IGO license ­ /­licenses​ by/3.0/igo). The World Bank does not necessarily own each component of the c /­ ­ ontent. It is your responsibility to ­ wner. If you have determine whether permission is needed for reuse and to obtain permission from the copyright o pubrights@worldbank.org. questions, email ­ All photographs are by Kathy Eales. 16  SKU W18023