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1 Introduction

Urban sanitation constitutes an urgent environmental problem facing African urban communities and authorities. The urban population today is incomparably larger than 50 years ago, so without huge up-scaling, the centralized old urban environmental infrastructures are grossly inadequate to service all contemporary urban residents efficiently and effectively. Even maintaining and managing these existing infrastructures and services efficiently is a challenge for the local authorities in East Africa, let alone expanding them to those not yet served. However, the local urban authorities seem also unable to put in place alternative plans and regulations for physical environmental infrastructure development and their management that do cover the entire urban population. Main obstacles to substantially increase sanitation to communities in the EAC region are political instability, rapid population growth and low priority given to sanitation issues (Anschütz 1996; MoFPED 2004; WHO/UNICEF 2004). Access to sanitation in the East African urban centres ranges between 20% and 30% (UN-Habitat 2005).

Inefficient and inequitable sanitation provision is an obvious cause of the outbreaks of diseases and environmental degradation (Carr 2001). Low sanitation coverage, dilapidated waste water treatment system and prevalence of waterborne and water-related diseases were reported throughout East-Africa (East African Community 2004; LVEMP 2002; MWE 2006; Stephens and Harpham 1992; UN-Habitat 2005). The predominance of unsanitary conditions among the urban poor and neglect from urban authorities are exacerbated by the prevailing ignorance and poverty (Ababio 1992). For instance, wastes dumped by local population in storm-water drains, streams, rivers and other water points intensify environmental problems which can escalate into disastrous disease epidemics that can be a major cause for loss of productive capacity especially among the urban poor and in many instances loss of lives as well. Climate change has also been implicated in outbreaks of diseases such as cholera and diarrhoea (Hales et al. 2003).

This chapter presents an urban sanitation scenario for Uganda by identifying opportunities for the inclusion of the urban poor in waste management and sanitation. The authors claim that there are opportunities for including the poor in urban environmental service provision by developing closer connections between the conventional centralized and recently introduced decentralized systems.

This chapter begins with a general description of urbanization and sanitation in Uganda followed by an explanation of the methods used to collect data for the compilation of this chapter. The central problems in urban environmental service provision in Uganda are discussed in Section 4.3. Section 4.4 presents the policy, legal and institutional dimensions for environmental management in Uganda and innovative ways to address the problems in waste management and sanitation. After discussing aspects of funding in Section 4.5, and social and cultural issues in Section 4.6, this chapter draws some conclusions on the way forward in the final Section 4.7.

2 Urbanization and Sanitation in Uganda

2.1 Urbanization in Uganda

Uganda is a land-locked country in Eastern Africa and its current population is about 29.6 million (UBOS 2006). The country’s GDP for the budgetary year 2004/5 was about 8.3 billion US$. The growth rate of its GDP was 6.2% per year signifying a per capita GDP growth of 0.2 US$ during the same budgetary year 2004/5 (UBOS 2006). The average per capita income was 280 US$ for the year 2005 (World Bank 2006). Uganda is a tropical country, located along the equator. Except for the north-east region, the country receives an annual rainfall of more than 500 mm while the temperatures are normally around 25°C throughout the year. These warm and wet conditions in many months during the year exacerbate urban waste management and sanitation problems.

During the past two decades, Uganda experienced an increase in rural-urban migration and its urban population rate stands at 14.9% in the year 2007 (UBOS 2008). This rapid growth was not commensurate with a well-planned growth in urban services. The structure of urban communities in Uganda is complex, where the rich stay in planned housing zones but most of the poor in slums, while combined formal-informal settlements exist for the middle class. This complex structure coupled with intricate settlement patterns places serious stress on the available planning capacity and material resources, undermining the prospects for equitable and sustainable environmental service provision. Urban planning and management in Uganda is complicated by the lack of reliable data on social, economic, cultural and environment/ecological trends, leading to uninformed decisions. Local governments seem unable to effectively charge for services resulting in severely reduced financial resources (MoFPED 2004; UN-Habitat 2005) forcing local authorities to resort to external support. Financial assistance comes mainly from the central government, Non-Governmental Organizations (NGOs), Community Based Organizations (CBOs), and international donors (MoLG 2007). Such external financial support is in most cases conditional and directed towards a particular sector, whereby funding for sanitation is often not prioritized (Section 4.3) compared for example to water provision. Sanitation services are unbalanced with regard to the social classes and the spatial segments within the cities served. Hence, the urban poor living in the (peri-)urban slums do not receive adequate sanitation services from local governments while they are constrained by their limited capacity to secure these services themselves.

To increase accessibility of the poor and strengthen sustainability, the introduction in urban development strategies of a Modernized Mixtures MM (Spaargaren et al. 2006) approach should be welcomed. The MM approach (Oosterveer and Sano 2008) stands for an integrated approach, taking the best from both existing sanitary strategies (centralized and decentralized) in order to better fit the particular local situations in both social and technological respects (see Chapter 2). Decentralized sanitation and Resource Reuse (DeSaR) systems look promising especially for the poor communities that can subsidise their expenditures by growing their own food (urban agriculture) and closing the water and matter loops. In exploring the potential of alternatives, not only the physical infrastructures should be covered but the relevant political, social and institutional arrangements, as well.

In this chapter the results from a study on sanitation systems in urban centres of the four administrative regionsFootnote 1 of Uganda are presented. These urban centres include Kampala City, the municipalities of Lira, Arua, Soroti, Mbale, Masaka, Kabale and Fort Portal, and Mayuge Town Council (Fig. 4.1).

Fig. 4.1
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Map of Uganda showing the major urban areas (http://www.idrc.ca/openebooks/189-2/f0032-01.gif)

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Urban centres in Uganda include cities, municipalities and town councils, whereby the grading is based on the number of inhabitants. A town council must have a population of more than 25,000 inhabitants, a municipal council more than 100,000 inhabitants and a city council a population of more than 500,000 inhabitants (Local Government Act 1997, Schedule 3, Article 32-1).

2.2 Study Methods

The findings reported in this chapter are based on field research and a review of existing literature aimed at identifying and assessing the sanitation provision mechanisms and the problems related to their implementation in the urban centres of Uganda. Both quantitative and qualitative data collection methodsFootnote 2 were used in the field study. The methods include community surveys through the administration of questionnaires to randomly sampled households to acquire information about the sanitation condition and on the relevant social and economic factors (yielding both qualitative and quantitative data). In addition, focus group discussions (FGDs) were performed with local government authorities and staff, and with NGOs on problems related to sanitation and waste management in urban areas (yielding qualitative data), observations were made on the existing sanitation facilities determining type, location, operational conditions, environmental impacts and opportunities for improvement (qualitative data). These findings were supplemented with document reviews (generating both qualitative and quantitative data). The lead researcher together with trained enumerators administered the questionnaires and conducted FGDs from January to April 2008.

3 Central Problems in Urban Environmental Service Provision

The provision of sanitary services and the related challenges are discussed here while distinguishing different social groups found in the urban centres of Uganda. The principal two distinct groups are the (peri-) urban slum dwelling poor staying in unplanned high-density communities and the affluent class staying in well-planned residential areas. These (peri-) urban communities consist of a mixture of almost all the tribes of Uganda and this cultural mix results in a complex social structure (Okot-Okumu 2008). Among the low-income poor households in these slums there is lack of water and sanitation (15-45 persons per latrine) and solid wastes are in most cases left to rot uncollected. Contrary to water projects, solid waste and sanitation facilities in these neighbourhoods are less utilized and less well-maintained except when the communities accept them based on culture, cost and technology (see Section 4.6). This is because water is a basic necessity of life and as communities are immediately strained without it, this is therefore their first choice. A poor community even if aware of the linkages between good sanitation, environmental pollution and human health will show lower priority to waste management and sanitation compared to other basic necessities. However, many inhabitants of poor neighbourhoods do not clearly perceive the connection between latrine usage and health (Cairncross and Feachem 1993). The desire for privacy, convenience or social status is usually more effective in generating demand than health concerns. At the same time sanitation laws in Uganda are deficient and the implementation is weak.

Although in this study local government staff rated solid waste management and sanitation first and second respectively as the major urban environmental problems, urban authorities give these issues low priority in their planning and resource allocation (MoLG 2007; Okot-Okumu 2008). This is because the technical staff does not determine or significantly influence resource allocation. Rather resource allocation is influenced by the executive staff that in many cases lacks appreciation of the importance of community sanitation and its relevance for welfare and productivity.

Effective mainstreaming environmental management in the urban policies and plans is still lacking (MoLG 2007; Okot-Okumu 2008). Therefore, since 2005, there is ongoing training in environment and natural resources management organized by the Ministry of Local Government (MoLG) for all local governments in Uganda. An important aspect of this training is the mainstreaming of environment, gender and equity issues in policies and plans for districts and urban centres (Okot-Okumu 2008). In addition, the MoLG produced in the year 2007 environmental management information sheets and posters for the local governments. The training and other awareness-raising materials are developed for skill development of the LG’s technical staff while information sheets and posters are specifically designed to target the community. The environmental management training and information materials however all do lack the key issue of partnership which is vital for community involvement.

Currently the official coverage of improved sanitation for the Ugandan population is 92% in urban and 62% in rural areas (MWE 2007; NEMA 2005). This estimated coverage is based on access to latrines and hand-washing at the household level, which overestimates effective access to safe sanitation. More elaborate studies, such as Mubiru (2000) and MoWLE (2004), indicate safe coverage at an average of only about 30%. Many of the latrines are shared by large numbers of people (MWE 2007) whereby management responsibilities are not very clear, making them dirty and structurally poor in terms of health and safety (Table 4.1).

Table 4.1 Conditions that make sanitation facilities unsafea
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The sewage network in towns is very small and covers only 7% of the national urban population (see Letema et al., Chapter 9 in this volume). These networks are restricted to the central business districts of the larger cities and to affluent residential areas close to the centre of these towns. The sewer networks have never been expanded to the newly built residential areas where septic tank-soak pits are necessarily used by the richer populations. The septic tanks are emptied by cesspool emptying trucks that transport the waste to sewage treatment points. Large housing estates in (peri-) urban areas use sewage lagoons or maturation ponds that drain into the environment, usually adjacent wetlands.

No attempts have ever been made to connect the (peri-) urban slum areas where most of the poor live because of fear that cost recovery will fail as the poor residents lack the means to afford these services. There are however many smaller towns including the secondary towns close to Lake Victoria that do not have sewer lines at all (UN-Habitat 2005). On-site sanitation systems that include septic tank-soak pit systems, traditional pit latrines, improved pit latrines (e.g. VIP, slabs, sanplats, etc), and some flush toilets account for 90% of the sanitary facilities in these urban centres (Fig. 4.2). However, on average only about 30% of these facilities are managed hygienically. LVEMP (2002) noted that very poor sanitation and solid waste management in secondary towns in Ugandan results in a 20% effective latrine coverage only. Most human waste in these locations is discharged directly into the environment.

Fig. 4.2
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Percentage distribution of types of sanitation facilities in Ugandan urban centres (Okot-Okumu 2008)

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The existing urban sanitation infrastructures are in most cases in a state of disrepair. Traditionally, managing the sanitary infrastructures and services was the responsibility of the municipal authorities, in particular the Department of Public Health. The recently created Department of Environment coordinates and supervises environmental management at local government level, but has little practical influence on waste management and sanitation because the Department lacks the necessary resources (e.g. staff, funds, equipment). Waste and sanitation was generally not considered a high priority and revenues were regularly used to fund other ‘more urgent’ expenditures (UN-Habitat 2005). Therefore little or no money is spent on the maintenance or invested in the expansion and renewal of infrastructures. In combination with the growing presence of silt, the lack of proper maintenance, misuse of toilet facilities and indiscriminate disposal of solid wastes are causing degradation of existing infrastructures and local flooding and environmental pollution. This is the scenario in most urban areas of Uganda.

A reform study for urban water and sanitation was done between September 1999 and December 2000. The resulting reform in water and sanitation was a clear effort to offset the negative institutional weaknesses whereby services have now been commercialized and assets are held by separate (parastatals) entities while all stakeholders are represented to ensure an integrated approach in management. In Uganda this approach is spearheaded by the National Water and Sewerage Corporation (NWSC) in 18 towns. NWSC is mainly concerned with sewer line provision, which is not affordable to the urban poor.

The integrated approach is however being practiced well only at the central government level. The strength of this integrated approach dwindles as one moves down the ladder towards the lower government levels where the poor communities can be found. Community involvement in waste management is discussed in depth by Muller and Hoffman (2001) and can be adopted for sanitation programmes as well. To be successful, however, all aspects of management - technical, environmental, financial/economic, socio-cultural, institutional and policy (including political) - should be included.

4 Policy, Legal and Institutional Framework for Sanitation

4.1 Policy and Legislation

In Uganda, environmental policymaking remains the function of the central government, but implementation of its policies and regulations is passed on to the districts. This is in line with the general decentralization process that has been adopted by the country.

The constitution of Uganda (Government of Uganda 1995; clause 39) states that ‘every Ugandan has a right to a clean and healthy environment’ while at the same time every citizen is expected to play his part in creating such a situation (clause 17[j]) - ‘it is the duty of every citizen of Uganda to create and protect a clean and healthy environment’. The National Environment Management Policy (NEMP) of 1994 Section 3.9 sets the goal for the control of pollution in Uganda.

The policy of decentralization has allowed the devolution of state powers from central government to the Local Councils (LCs) at the level of districts and urban authorities. Environmental management and planning, including sanitation services and waste management, has become the responsibility of these districts and municipalities. Therefore local governments have the full mandate for solid waste management and sanitation and the legal authority to make specific ordinances and by-laws.

The National Environment Management Authority (NEMA) is empowered to establish environmental standards and regulations (e.g. sanitation and solid waste management regulations) and to coordinate and supervise environmental management in Uganda. The Public Health Act Cap 281 of 2000 requires local authorities to take measures for maintaining their area in a clean and sanitary condition at all times to prevent the outbreak of diseases and to safeguard and promote public health. While these regulations exist, so far no urban authority has implemented them effectively. Treatment of sewage remains inadequate or is completely absent while solid waste is disposed of indiscriminately, polluting the environment and causing health risks. There is lack of capacity for implementing sanitation policies and regulations. The presence of several policies relevant for the sanitation sector also causes implementation problems through duplication of activities within other sectors.

Some districts and lower level local governments lack up-to-date ordinances and by-laws to handle issues in sanitation and solid waste management. Community survey and focus group discussions found low levels of use of the regulatory documents by the local governments. It was stated that these documents are difficult to read or understand. In such cases an abridged version of these documents would be more helpful.

Political interference is a major problem in African countries impacting on environmental management as reported by Palczynski (2002) and Rotich et al. (2006). Politicians may interfere with environmental management projects by making statements that are contradictory to the official environmental management policy and encourage communities to refuse cooperation and contribution in sanitation projects. This interference weakens environmental management institutions’ ability to implement laws and regulations and makes the local community difficult to deal with.

When reviewing the existing policy and regulations we observe that despite the presence of many policy and legal or regulatory documents, urban centres in Uganda still experience very poor sanitation and waste management. The making and implementation process of these statutory instruments is failing particularly because not all relevant stakeholders are involved. These failures are most felt by the poor especially in the congested slums. It is therefore important to involve the most impacted community because every neighbourhood may have its unique and complex mixture (e.g. social, economic, cultural, and religious) that requires attention for policy and environmental regulations. The opportunity for the poor to participate in the making of policies and regulations is recognized in the existing Acts of parliament mentioned above but not fully implemented. To overcome this limitation the poor urban community should be involved in the revision of these statutory documents by engaging them together with local policy/legal experts in analysing their neighbourhood waste and sanitation problems and drafting their own vision on waste management and sanitation. Community views on improving policies and regulations on waste and sanitation should be submitted for consideration by the next higher level of local government. Abridged versions of the existing statutory documents should be produced for easy interpretation and use by all stakeholders. An example of this is the version of the National Environment Statute/Environment Act of 2005 termed ‘Popular Version’ that is more receptive for use by stakeholders.

NGOs should support the poor in making their own by-laws on wastes and sanitation. There is already a strong contribution from NGOs through partnerships in urban waste management and sanitation in Uganda (Tukahirwa et al. 2008). The policy and regulation making process should be opened up from the very beginning to enable effective community contribution and acceptance during implementation and to develop community responsive policies and laws on waste and sanitation.

4.2 Institutional Arrangements

The Ugandan National Environment Act (Cap 153) and the Local Government Act (Cap 243) specifically decentralizes environmental management to local governments to increase its cost-effectiveness and community involvement. Urban councils/authorities are responsible for decentralized services that include sanitation and waste management. The institutional framework for water and sanitation management in Uganda is displayed in Fig. 4.3.

Fig. 4.3
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The institutional framework for water and sanitation management. MoFPED: Ministry of Finance Planning and Economic Development, MoH: Ministry of Health, MWE: Ministry of Water and Energy, MoLG: Ministry of Local Government, MoES: Ministry of Education and Sports, MAAIF: Ministry of Agriculture Animal Industry and Fisheries, MGLSD: Ministry of Gender Labour and Social Development, NEMA: National Environment Management Authority, DWD: Directorate of Water Development, DWRM: Directorate of Water Resources Management Environment, NWSC: National Water and Sewerage Corporation

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At the national level there is the Water and Sanitation sector Working Group (WSSWG) that is comprized of the different relevant Ministries, the international development partners, NGOs and local governments. WSSWG has two sub-sector working groups and one of them is on sanitation. The role of WSSWG includes providing policy and technical guidance to the sanitation sector, preparation of medium term budget framework papers for the sector, preparation of annual sector performance reports and ensuring the implementation of Sector Wide Approach (SWAp) in the sanitation sector.

At the local level, also District Water and Sanitation Coordination Committees have been established to strengthen collaboration and coordination between the different policy areas (health, education, agriculture and social development), the private sector, NGOs, CBOs and civil society. NGOs and CBOs are very active in the provision of water and sanitation services, in particular through the construction of facilities, capacity building of local governments and community mobilization, hygiene promotion, advocacy and lobbying. Currently some 200 NGOs and CBOs are involved in water and sanitation activities in Uganda (MWE 2007).

Regional and international organizations that could contribute to further collaboration in the domain of water and sanitation in the East African region are UN-Habitat, the Lake Victoria Basin Commission (LVBC), the Nile Basin Initiative (NBI), the Lake Victoria Environment Management Project (LVEMP), the Lake Victoria Local Authorities Cooperation (LVRLAC) and the East African Communities Organization for the management of Lake Victoria (ECOVIC). Despite the presence of this large number of organizations, there is little effective cooperation and harmonization of water and sanitation efforts, although this could go a long way in addressing the many challenges.

4.3 Institutional Innovations in the Water and Sanitation Sector

In Uganda the management of urban water supply and sanitary infrastructures are closely linked and the planning is guided by one integrated policy document. In order to meet the targets of the Poverty Eradication Action Plan (PEAP), MoFPED (2004) initiated a reform of the water and sanitation sector. This is in line with the MDG No 7, targeting improved sanitation for the poor. The sector reform process in Uganda was developed through a participatory approach with strong links to the objectives of poverty alleviation. The water and sanitation reform process involved government lead ministries, civil society, NGOs and international donor agencies (e.g. DANIDA, SIDA). The Uganda Water and Sanitation NGO Network (UWASNET) is an umbrella organization and has played a great role in coordinating, strengthening information sharing and networking among the NGOs and CBOs operating in this domain and with the government. The aims of the sector reform were to ensure that water supply and sanitation services are provided with increased performance and cost-effectiveness, and to reduce the government’s financial burden without compromising the provision of equitable and sustainable services. To implement these objectives asset holding and development were separated from service provision and regulatory activities, while decentralization and devolution of responsibilities, improved transparency, reduced political interference and effective public-private partnerships would all contribute further.

The first step in the reform process was the enactment of the 1999 National Water Policy (NWP) to strengthen the regulatory framework and provide a basis for cost recovery, including the introduction of commercialized operations. Based on a sub-sector study in the year 2000, public-private partnership was recommended whereby the ownership of assets involved in urban water supply and sanitation is retained by the public sector and service delivery is done by private operators. For small towns both responsibilities remain with the local governments. While the larger towns (18) are guided by the NWSC, the smaller towns (48) are guided by the (national) Directorate of Water Development (DWD).

The reform process also generated a consensus on the importance of a sector-wide approach (SWAp), comparable to the strategy that was already adopted with some success by the Health and the Education sectors. Such a sector-wide approach aims at moving towards comprehensive programs that are well coordinated in funding and eliminate duplication of efforts. There is recognition by the government that as the reforms are being implemented there is an increasing need to co-ordinate its own efforts with those of its development partners.

We may observe from these findings that although the reforms generate positive results there are weaknesses in the decentralization and devolution processes because local governments often lack the capacity required to successfully take their responsibilities. Local governments still depend largely on the central government and external support (MWE 2007). This problem has resulted in the community not being well represented within the institutional structure even though this is provided for by law as displayed in Fig. 4.3. The existing institutional structures should be modified after consulting the community so that the poor are adequately and effectively involved in the planning and implementation of waste and sanitation programmes in their locality. Institutionalization of the roles of the community in the long-term plans for waste and sanitation should be done to enable their integration in the overall strategy, which may be expressed in the form of laws, regulations or relevant documents.

A key area for involving the community and the poor is the introduction of decentralized systems. DeSaR systems aimed at closing the water and matter loops and at turning waste into goods for the poor communities can be implemented because this is already supported by the decentralization policy. However, this model can only be successful if the community sees tangible benefits from the waste itself or from the waste management and sanitation activities. A study in Kampala by Niwagaba et al. (2008) used social marketing techniques to promote sanitation and was successful in developing awareness and skills among the community.

The community can also be involved through cooperatives or businesses (e.g. micro- and small-scale enterprises) as is ably discussed by Scheinberg (2001), which, apart from being an effective means of solving waste and sanitation problems, is also a job creator. Small-Scale Enterprises can take tasks such as waste collection, emptying latrines and septic tanks, composting and recycling. Recognition of these enterprises by the LGs is important and initial support by agencies like NGOs may be vital for these entrepreneurs to succeed.

5 Funding

The financial resources available to the urban authorities for managing water and sanitation originate from the central government, international donor agencies and the locally mobilized revenues. Section 81 of Local Governments Act 1997 provides that local governments may levy charges and collect fees and taxes, while the rates of these levies are regulated through the Local Government Rating Act (MoLG 2003). Suspension by the national government in 2005 of the Graduated Tax which was a major source of revenue for local governments has complicated their funding possibilities and they have not been able to raise adequate revenues. Moreover, the sector of sanitation and waste management receives even less funding from the local governments because this is considered a low priority. In the Financial Year 2006/07, less than 10% of the total municipal budget was used for waste management and sanitation by local governments in Uganda (MWE 2007). Most of the funding is therefore coming from international donors, NGOs and conditional government grants through the Local Government Development Programme. This is not a sustainable system of financing because it has no local resource base, while external funding sources (e.g. donors, NGOs, LGs) tend to have prescribed priorities which are not necessarily those of the poor. For sustainability significant funds must accrue from the community initiated activities.

It can be concluded that there is an opportunity for partnership in waste management and sanitation between the local authorities, NGOs and the community. The community can form neighbourhood waste and sanitation management associations that are initially supported financially by LGs or NGOs to provide a revolving fund. Some of the income-generating opportunities in the waste and sanitation sectors are solid waste sorting, collection, composting, reuse, recycling, briquette making, handicraft making from wastes and emptying of pit latrines and septic tanks. These activities are already taking place in Uganda especially in the larger urban areas like Kampala, Jinja and Entebbe. However, many projects collapse because of their failure to recover costs. Professional expertise within the LGs and NGOs could be used to boost the community potentials (technical, financial) and promote sustainability. Apart from improving on waste and sanitation management for environmental health this will also cut the funds required from external sources. Ownership of waste and sanitation projects by the community can provide the opportunity to involve the poor more effectively in waste management within their own neighbourhood. The tangible rewards can attract more poor individuals and the idea can also be easily duplicated in other neighbourhoods.

6 Social and Cultural Issues

Poor sanitation is exacerbated by several social and cultural factors. These factors include poor knowledge and awareness of the health and environmental implications of poor sanitary practices while particular cultural beliefs and practices can hinder the introduction of innovations in sanitation technologies, systems and practices. A general lack of community participation complicates the adequate inclusion of and response to these issues, slowing down the modernization process (Ajello 2006; Mubiru 2000). These social and cultural issues, in combination with the absence of sanitation facilities for the poor and the presence of congested housing in many cities, result in the adoption of bad practices like uncontrolled dumping of solid waste and faeces. This has probably caused the recent cholera and diarrheal disease outbreaks in slums and camps for internally displaced people (MoH 2007, 2008). There were cholera and diarrhoeal disease outbreaks in Pabbo camp in the north of Uganda in the year 2005, Bundibugyo, Hoima and Kibaale in western Uganda in the year 2006, and in Kampala’s (peri-) urban areas in the years 1997/98, 2006, 2007. These outbreaks were also linked to the onset of the rainy season and to floods.

The field study of Ugandan towns by the authors found that in some neighbourhoods cultural beliefs prevent the (effective) use of the available sanitary facilities, in particular among the poor in (peri-) urban areas. Some ethnic groups have taboos that prevent realizing the potential benefits from improved sanitation infrastructures and services. For example, some groups in Uganda do not allow in-laws to share latrines and even forbid pregnant women to use them at all (Mubiru 2000; see also Ajello 2006; Tanner 1995). In some cases, these negative attitudes and cultural taboos prevent particular groups and people to actively participate in public campaigns and other activities to improve sanitary infrastructure (Palczynski 2002). Higher levels of education and social status were found to have positive impacts on sanitation behaviour (Ajello 2006; Mpamize 1998; Mubiru 2000; Omer 2004). Innovative methods that could be used to involve the community better in sanitation management and ensure sustainability are summarized in Table 4.2. The table was constructed from data collected through questionnaires administered to the community, interview of key informants and focus group discussions. This table makes perfectly clear that concrete perspectives exist for engaging the local community in improving the sanitation sector in Uganda.

Table 4.2 Possible community-oriented innovative methods for sanitation programmes
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7 Conclusions

The rapid urbanization and population growth in Uganda together with increased influx from the rural areas is creating mushrooming (peri-) urban informal settlements. It is difficult to provide environmental services for such poor communities because of the weak or absent infrastructures. Traditional approaches to waste management and sanitation have their limitations, and consequently the suitability of the already implemented infrastructure to respond to current needs decreases (Scheelbeek 2006). In most cases traditional approaches do not respond to requirements expressed by the community or neighbourhood, resulting in rejection and improper use of the facilities and therefore to non-sustainability. Adopting the large-scale European or American centralized sewerage systems in African circumstances is often unsuccessful (LVEMP 2005; MoLG 2007; MWE 2007; Scheelbeek 2006; UN-Habitat 2005). These systems require financial means for construction and maintenance as well as planning and management capacities that go beyond the available resources. On the other hand, decentralized systems such as single household pit latrines or septic tanks that are ‘scattered’ around the neighbourhood cannot provide the answer either. These facilities saturate a neighbourhood with sewage collection points, thus increasing the risk of pathogen transmission compared with centralized systems that exhibit less human contact with waste flows. Decentralized systems also require the application of strict criteria in site selection and management to avoid seepage of contaminants into ground and surface water, and insect and rodent infection of home facilities. The resulting appalling waste situations in neighbourhoods cause pollution of water sources (Howard et al. 2003; Nasinyama et al. 2000; Nsubuga et al. 2004; Skoog 2004; Taylor and Howard 1995) when rain carries pollutants from wastes into water sources (Howard et al. 2003; Taylor and Howard 1995).

The official commitment of the national authorities offers a starting point for initiating community-based strategies and implementation practices. This official engagement should be expressed in creating an adequate institutional environment for pro-poor sanitation programs and create opportunities for investment in sanitation infrastructures and services. The interest in this domain from private entrepreneurs, NGOs, CBOs and international donor agencies should be capitalized upon. Ultimately this engagement will result in more diverse and flexible opportunities for sanitation, that better fit the conditions of the poor, in particular their limited ability to contribute, their illiteracy and absence of (a culture of) sanitation. Local authorities should be pressurized through local communities and national authorities to give priority to this policy domain and secure the necessary financial and administrative resources to address a problem that is already urgent and will only become more so in the future as a result of rapid population influx.

Involving the urban poor in improving waste management and sanitation should be approached in an integrated manner that considers other stakeholders (NGOs, CBOs, LGs, entrepreneurs) as partners and includes all the aspects (environment, technical, financial socio-cultural, institutional, policy) of waste management and sanitation. This chapter identified key entry points for the urban poor in waste management and sanitation, showing the possibilities in the policy (legal, political), institutional and funding domains to improve the level of performance and success. This illustrated the existence of opportunities for the involvement of urban poor in waste management and sanitation that are not yet adequately exploited. Already introduced local solutions have to be considered as part of larger systems that best fit the urban neighbourhoods and the urban area as a whole.

Targeting the Millennium Development Goal 7 and PEAP covering water and sanitation demands an integrated approach with strong community participation. Innovative concepts and strategies, such as the Modernized Mixture approach (Spaargaren et al. 2006), offer better perspectives to broadly consider the community, engage all stakeholders, acknowledge the specific local conditions and incorporate ecological sanitation. It is important for an African country, such as Uganda, to not only aim at providing sanitation services that deal with the problem of excreta disposal, but to also provide services that are sustainable in the long term as observed by Carter and Rwamwanja (2006).