The open secret to high latrine coverage in Kamwenge

Of every ten households in Kamwenge District, eight have a functioning, clean and safe latrine with a roof and a door. The district also soars above the national average on pupil-stance ratio and school access to hand washing facilities. For a district that hosts over 68,000 refugees and a native population of primarily subsistence farmers, how is this possible? 

“We are fully aware of the critical contribution of basic hygiene and sanitation to public health so we integrate best practices in every sector.” The results are evident. Whereas the national latrine coverage is 80%, in Kamwenge it is 86%. Additionally, Kamwenge’s pupil stance ratio of 53:1 is better than the national average of 71:1. In January 2019, the district leadership intensified a Community Led Total Sanitation (CLTS) approach, with support from UNICEF. The CLTS approach, which is being applied in six more districts in western Uganda, engages communities to take the lead in personal and collective sanitation by utilizing locally available materials and is overseen by local leadership.

Triggering Community Response

On the initial visit to Rwebiikwato 1 village in Kahunge Sub County, a team comprising UNICEF staff and the district health team converge a meeting to tackle the first element of sanitation and proper waste disposal. In a process known as ‘triggering’, the village members participate in identification of open defecation spots and the resultant contamination of food and water sources. When the first mound of waste is found less than 100 meters from the meeting point, the shame, disgust and fear is vivid. Some members spit, others shake their heads, one runs back to the meeting venue exclaiming “things have to change”!  Within fifteen minutes from the start of the ‘triggering’ session, the village has a Sanitation Committee charged with overseeing the implementation of a time-bound action plan being developed to tackle the situation. 

According to Gertrude Kengonzi, the Kahunge Sub-County Health Inspector, triggering has so far had a 100% success particularly because of the visual self-appraisal, communal problem identification and solution finding. After every triggering session and a maximum of five follow up meetings, every village becomes open defecation-free. “It is like a matchbox in a petrol station,” Gertrude elaborates, “The communities are so fired up by the gravity of their situation and the need to change, that all we do is provide standards.”

At the border of Rwamwanja Refugee Settlement, Mutwe village demonstrates the impact of triggering. Every single homestead has a mud and wattle pit latrine complete with a hand washing tippy tap, a dish drying rack made of logs, and a shrub bath enclosure. Mutwe is one of 77 villages declared open defecation free in 2019 alone.

Hygiene in Schools

In Kamwenge, 62 per cent of have access to hand washing facilities; nearly double the national average of 35 per cent. At Damasiko Primary School in Nkoma Katalyeba Town Council, there five latrine blocks, and each has a tippy tap that is a crucial element in the hand washing component of sanitation. In the Primary Seven class, 13-year-old Herbert*  demonstrates how to make a tippy tap and in ten minutes there it is; a simple device that can reduce the risk of contracting diarrhoea by over half, and respiratory infections by 35%. Suspended from a rectangular shaped log pegged to the ground, a small plastic jerry can with water hangs next to a small piece of soap dangling from a metal wire. A smaller stick acts as a foot pedal which, when stepped on, causes the jerry can to tilt and water pours out through a small hole at the front. One can thus wash hands often, without recontamination through touching the jerry can. Herbert is just one of the numerous school children who have become champions for tippy tap usage, teaching their parents how to build and use them.

Partnership making strides

The UNICEF Water, Sanitation and Hygiene (WASH) Specialist Hodaka Kosugi is a well-known face in Kamwenge, particularly in the schools and villages that have achieved open defecation free status. He explains that whereas UNICEF is supporting the triggering of at least one village in every sub county in the whole district, the ultimate aim is behavioural change and sustainability. Although the communities immediately respond to sensitization by using locally available material to construct latrines, sustainability is hinged on using stronger, higher quality materials that can withstand bad weather, termites and collapsing soils. However as quality usually comes with cost, even more partnership is required so as to achieve not just model homes and villages but a model WASH region.

A leadership on its feet

With a vibrant district health office, multiple village health teams and communities actively utilizing local resources to enhance sanitation; it would appear that the entire district is ready to take Kamwenge to the top of the sanitation ladder. Aggrey Natuhamya, the Kamwenge District Chairperson, is himself a ‘hand washing with soap’ champion. Having achieved latrine coverage of 86 per cent, the district leadership has now set a target of totally eliminating open defecation by December 2020. With 675 villages, including one refugee settlement, open defecation-free status is a big target by any standard, and according to Dr. William Mucunguzi, the District Health Officer, “This target makes us run instead of walking.”

In December 2020, Kamwenge may yet have another secret to share; How to achieve Open Defecation-Free status within two years.