Skip to main content
Top
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

Descending the sanitation ladder in urban Uganda: evidence from Kampala Slums

Authors: Japheth Kwiringira, Peter Atekyereza, Charles Niwagaba, Isabel Günther

Published in: BMC Public Health | Issue 1/2014

Login to get access

Abstract

Background

While the sanitation ladder is useful in analysing progressive improvements in sanitation, studies in Uganda have not indicated the sanitation barriers faced by the urban poor. There are various challenges in shared latrine use, cleaning and maintenance. Results from Kampala city indicate that, failure to clean and maintain sanitation infrastructure can lead to a reversal of the potential benefits that come with various sanitation facilities.

Methods

A cross sectional qualitative study was conducted between March and May 2013. Data were collected through 18 focus group discussions (FGDs) held separately; one with women, men and youth respectively. We also used pictorial methods; in addition, 16 key informant interviews were conducted. Data were analysed using content thematic approach. Relevant quotations per thematic area were identified and have been used in the presentation of the results.

Results

Whether a shared sanitation facility was improved or not, it was abandoned once it was not properly used and cleaned. The problem of using shared latrines began with the lack of proper latrine training when people do not know how to squat on the latrine hole. The constrained access and security concerns, obscure paths that were filthy especially at night, lack of light in the latrine cubicle, raised latrines sometimes up to two metres above the ground, coupled with lack of cleaning and emptying the shared facilities only made a bad situation worse. In this way, open defecation gradually substituted use of the available sanitation facilities. This paper argues that, filthy latrines have the same net effect as crude open defection.

Conclusion

Whereas most sanitation campaigns are geared towards provision of improved sanitation infrastructure, these findings show that mere provision of infrastructure (improved or not) without adequate emphasis on proper use, cleaning and maintenance triggers an involuntary descent off the sanitation ladder. Understanding this reversal movement is critical in sustainable sanitation services and should be a concern for all actors.
Appendix
Available only for authorised users
Literature
1.
2.
go back to reference Un-habitat: State of the World’s Cities 2010/2011: Bridging the Urban Divide. Bridging the Urban Divide. 2010, Routledge Un-habitat: State of the World’s Cities 2010/2011: Bridging the Urban Divide. Bridging the Urban Divide. 2010, Routledge
3.
go back to reference Isunju JB, Schwartz K, Schouten MA, Johnson WP, Van Dijk MP: Socio-economic aspects of improved sanitation in slums: a review. Public Health. 2011, 125 (6): 368-376. 10.1016/j.puhe.2011.03.008.CrossRefPubMed Isunju JB, Schwartz K, Schouten MA, Johnson WP, Van Dijk MP: Socio-economic aspects of improved sanitation in slums: a review. Public Health. 2011, 125 (6): 368-376. 10.1016/j.puhe.2011.03.008.CrossRefPubMed
4.
go back to reference Harvey D: Reshaping economic geography: the world development report 2009. Development and change. 2009, 40 (6): 1269-1277. 10.1111/j.1467-7660.2009.01602.x.CrossRef Harvey D: Reshaping economic geography: the world development report 2009. Development and change. 2009, 40 (6): 1269-1277. 10.1111/j.1467-7660.2009.01602.x.CrossRef
5.
go back to reference Montgomery MA, Jamie B, Menachem E: Increasing functional sustainability of water and sanitation supplies in rural sub-Saharan Africa. Environ Engineering Science. 2009 , 26 (5): 1017-1023. 10.1089/ees.2008.0388.CrossRef Montgomery MA, Jamie B, Menachem E: Increasing functional sustainability of water and sanitation supplies in rural sub-Saharan Africa. Environ Engineering Science. 2009 , 26 (5): 1017-1023. 10.1089/ees.2008.0388.CrossRef
6.
go back to reference Chambers R: Going to scale with community-led total sanitation: reflections on experience, issues and ways forward. IDS Practice Papers. 2009, 1: 1-50.CrossRef Chambers R: Going to scale with community-led total sanitation: reflections on experience, issues and ways forward. IDS Practice Papers. 2009, 1: 1-50.CrossRef
7.
go back to reference Tumwebaze IK, Orach CG, Niwagaba C, Luthi C, Mosler HJ: Sanitation facilities in Kampala slums, Uganda: users’ satisfaction and determinant factors. Int J Environ Health Res. 2013, 23 (3): 191-204. 10.1080/09603123.2012.713095.CrossRefPubMed Tumwebaze IK, Orach CG, Niwagaba C, Luthi C, Mosler HJ: Sanitation facilities in Kampala slums, Uganda: users’ satisfaction and determinant factors. Int J Environ Health Res. 2013, 23 (3): 191-204. 10.1080/09603123.2012.713095.CrossRefPubMed
8.
go back to reference Abimanyi JK, Atuhaire M: Inconvenience in the Places of Convenience; Kampala Uganda. 2012, Kampala: Uganda News; Daily Monitor-Monday Abimanyi JK, Atuhaire M: Inconvenience in the Places of Convenience; Kampala Uganda. 2012, Kampala: Uganda News; Daily Monitor-Monday
9.
go back to reference Günther I, Alexandra H, Christoph L, Hans-Joachim M, Charles BN, Tumwebaze IK: Where do Kampala Poor “go”? Urban Sanitation Conditions in Kampala’s low –Income Areas. 2011, Zurich, Switzerland: ETH Günther I, Alexandra H, Christoph L, Hans-Joachim M, Charles BN, Tumwebaze IK: Where do Kampala Poor “go”? Urban Sanitation Conditions in Kampala’s low –Income Areas. 2011, Zurich, Switzerland: ETH
10.
go back to reference Günther I, Alexandra H, Christoph L, Hans-Joachim M, Charles BN, Innocent Tumwebaze IK: When is Shared Sanitation Improved Sanitation? The Correlation Between Number of Users and Toilet Hygiene. 2012, Zurich, Switzerland: ETH Günther I, Alexandra H, Christoph L, Hans-Joachim M, Charles BN, Innocent Tumwebaze IK: When is Shared Sanitation Improved Sanitation? The Correlation Between Number of Users and Toilet Hygiene. 2012, Zurich, Switzerland: ETH
11.
go back to reference UNICEF: Progress on Drinking Water and Sanitation: Special Focus on Sanitation. 2008, Geneva, Switzerland: WHO/JMP UNICEF: Progress on Drinking Water and Sanitation: Special Focus on Sanitation. 2008, Geneva, Switzerland: WHO/JMP
12.
go back to reference United Nations. Department of Economic affairs: The Millennium Development Goals Report. 2008, New York: United Nation Publications United Nations. Department of Economic affairs: The Millennium Development Goals Report. 2008, New York: United Nation Publications
13.
go back to reference Morella E, Vivien F, Sudeshna GB: Climbing the Ladder: The State of Sanitation in sub-Saharan Africa. Background Paper 13. 2008, Washington, DC: World Bank Morella E, Vivien F, Sudeshna GB: Climbing the Ladder: The State of Sanitation in sub-Saharan Africa. Background Paper 13. 2008, Washington, DC: World Bank
15.
go back to reference Lüthi C, Jennifer M, Elisabeth K: Community –based approaches for addressing the urban sanitation challenges. Int J Urban Sustainable Dev. 2010, 1 (1–2): 49-63.CrossRef Lüthi C, Jennifer M, Elisabeth K: Community –based approaches for addressing the urban sanitation challenges. Int J Urban Sustainable Dev. 2010, 1 (1–2): 49-63.CrossRef
16.
go back to reference Dawson S, Manderson L, Tallo VL, Mutharayappa R, Farkas JI, Hogan DP, Kurien PA: A manual for the use of focus groups. Man in India. 1993, 73 (1): 17-27. Dawson S, Manderson L, Tallo VL, Mutharayappa R, Farkas JI, Hogan DP, Kurien PA: A manual for the use of focus groups. Man in India. 1993, 73 (1): 17-27.
18.
go back to reference Silverman D: Doing Qualitative Research: A Practical Handbook. 2013, London: SAGE Publications Limited Silverman D: Doing Qualitative Research: A Practical Handbook. 2013, London: SAGE Publications Limited
19.
go back to reference Bryman A: Social Research Methods. 2008, Oxford: Oxford University Press, 3 Bryman A: Social Research Methods. 2008, Oxford: Oxford University Press, 3
20.
go back to reference Graneheim UH1, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24 (2): 105-112. 10.1016/j.nedt.2003.10.001.CrossRefPubMed Graneheim UH1, Lundman B: Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004, 24 (2): 105-112. 10.1016/j.nedt.2003.10.001.CrossRefPubMed
21.
go back to reference Kondracki NL, Wellman NS, Amundson DR: Content analysis: review of methods and their applications in nutrition education. J Nut Educ Behav. 2002, 34 (4): 224-230. 10.1016/S1499-4046(06)60097-3.CrossRef Kondracki NL, Wellman NS, Amundson DR: Content analysis: review of methods and their applications in nutrition education. J Nut Educ Behav. 2002, 34 (4): 224-230. 10.1016/S1499-4046(06)60097-3.CrossRef
22.
go back to reference Wolff MF: Ethics a social practice: introducing the debate on qualitative research and ethics. Forum Qual Social Res. 2005, 6 (1 Art.9): 25-30. Wolff MF: Ethics a social practice: introducing the debate on qualitative research and ethics. Forum Qual Social Res. 2005, 6 (1 Art.9): 25-30.
23.
go back to reference Rwabukwali CB: Ethics in social research: the Uganda context. Mawazo, J Faculties Arts Soc Sciences. 2007, 8 (2): 111-118. Rwabukwali CB: Ethics in social research: the Uganda context. Mawazo, J Faculties Arts Soc Sciences. 2007, 8 (2): 111-118.
24.
go back to reference Gorad S: Ethics and equity; pursuing the perspective of non-participants. Soc Science up-date. 2002, 39 (Winter): 16-20. Gorad S: Ethics and equity; pursuing the perspective of non-participants. Soc Science up-date. 2002, 39 (Winter): 16-20.
25.
go back to reference Black RE, Morris SS, Bryce J: Where and why are 10 million children dying every year?. Lancet. 2003, 361 (9376): 2226-2234. 10.1016/S0140-6736(03)13779-8.CrossRefPubMed Black RE, Morris SS, Bryce J: Where and why are 10 million children dying every year?. Lancet. 2003, 361 (9376): 2226-2234. 10.1016/S0140-6736(03)13779-8.CrossRefPubMed
26.
go back to reference Rujumba J, Byamugisha R: Publishing operational research from ‘real life’ programme data: a better form of accountability. Trop Med Int Health. 2011, 17 (1): 133-134.CrossRefPubMed Rujumba J, Byamugisha R: Publishing operational research from ‘real life’ programme data: a better form of accountability. Trop Med Int Health. 2011, 17 (1): 133-134.CrossRefPubMed
27.
go back to reference Hardoy A, Schusterman R: New models for the privatization of water and sanitation for the urban poor. Environ Urban. 2000, 12 (2): 63-76. 10.1177/095624780001200206.CrossRef Hardoy A, Schusterman R: New models for the privatization of water and sanitation for the urban poor. Environ Urban. 2000, 12 (2): 63-76. 10.1177/095624780001200206.CrossRef
28.
go back to reference Burra S, Patel S, Kerr T: Community-designed, built and managed toilet blocks in Indian cities. Environ Urban. 2003, 15 (2): 11-32. 10.1177/095624780301500202.CrossRef Burra S, Patel S, Kerr T: Community-designed, built and managed toilet blocks in Indian cities. Environ Urban. 2003, 15 (2): 11-32. 10.1177/095624780301500202.CrossRef
29.
go back to reference Sheuya S, Howden-Chapman P, Patel S: The design of housing and shelter programs: the social and environmental determinants of inequalities. J Urban Health. 2007, 84 (1): 98-108.CrossRefPubMedCentral Sheuya S, Howden-Chapman P, Patel S: The design of housing and shelter programs: the social and environmental determinants of inequalities. J Urban Health. 2007, 84 (1): 98-108.CrossRefPubMedCentral
30.
go back to reference Fernandez A, Mondkar J, Mathai S: Urban slum-specific issues in neonatal survival. Indian Pediatr. 2003, 40 (12): 1161-1166.PubMed Fernandez A, Mondkar J, Mathai S: Urban slum-specific issues in neonatal survival. Indian Pediatr. 2003, 40 (12): 1161-1166.PubMed
31.
go back to reference Buttenheim AM: The sanitation environment in urban slums: implications for child health. Popul Environ. 2008, 30 (1–2): 26-47.CrossRefPubMed Buttenheim AM: The sanitation environment in urban slums: implications for child health. Popul Environ. 2008, 30 (1–2): 26-47.CrossRefPubMed
32.
go back to reference Checkley W, Gilman RH, Black RE, Epstein LD, Cabrera L, Sterling CR, Moulton LH: Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community. Lancet. 2004, 363 (9403): 112-118. 10.1016/S0140-6736(03)15261-0.CrossRefPubMed Checkley W, Gilman RH, Black RE, Epstein LD, Cabrera L, Sterling CR, Moulton LH: Effect of water and sanitation on childhood health in a poor Peruvian peri-urban community. Lancet. 2004, 363 (9403): 112-118. 10.1016/S0140-6736(03)15261-0.CrossRefPubMed
33.
go back to reference Fosto JC: Urban –rural differentials in child malnutrition: trends and socioeconomic correlates in sub-Saharan Africa. Health Place. 2007, 13: 205-223. 10.1016/j.healthplace.2006.01.004.CrossRef Fosto JC: Urban –rural differentials in child malnutrition: trends and socioeconomic correlates in sub-Saharan Africa. Health Place. 2007, 13: 205-223. 10.1016/j.healthplace.2006.01.004.CrossRef
34.
go back to reference Allen A: Environmental planning and management of the peri-urban interface: perspectives on an emerging field. Environ Urban. 2003, 15 (1): 135-148. 10.1177/095624780301500103.CrossRef Allen A: Environmental planning and management of the peri-urban interface: perspectives on an emerging field. Environ Urban. 2003, 15 (1): 135-148. 10.1177/095624780301500103.CrossRef
35.
go back to reference Khosla P, van Wijk C, Verhagen J, Francis J, Arce M: Gender and Water. 2004, International Water and Sanitation Centre (IRC) Khosla P, van Wijk C, Verhagen J, Francis J, Arce M: Gender and Water. 2004, International Water and Sanitation Centre (IRC)
36.
go back to reference Marmot M, Bell R: Health equity and development: the commission on social determinants of health. European Review. 2010, 18 (01): 1-7. 10.1017/S1062798709990081.CrossRef Marmot M, Bell R: Health equity and development: the commission on social determinants of health. European Review. 2010, 18 (01): 1-7. 10.1017/S1062798709990081.CrossRef
37.
go back to reference Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S: Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008, 372 (9650): 1661-1669. 10.1016/S0140-6736(08)61690-6.CrossRefPubMed Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S: Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008, 372 (9650): 1661-1669. 10.1016/S0140-6736(08)61690-6.CrossRefPubMed
38.
go back to reference Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, Koller T, Vega J: The commission on social determinants of health: tackling the social roots of health inequities. PLoS Med. 2006, 3 (6): e106-10.1371/journal.pmed.0030106.CrossRefPubMedPubMedCentral Irwin A, Valentine N, Brown C, Loewenson R, Solar O, Brown H, Koller T, Vega J: The commission on social determinants of health: tackling the social roots of health inequities. PLoS Med. 2006, 3 (6): e106-10.1371/journal.pmed.0030106.CrossRefPubMedPubMedCentral
39.
go back to reference Kjellstrom T, Friel S, Dixon J, Corvalan C, Rehfuess E, Campbell-Lendrum D, Gore F, Bartram J: Urban environmental health hazards and health equity. J Urban Health. 2007, 84 (1): 86-97.CrossRefPubMedCentral Kjellstrom T, Friel S, Dixon J, Corvalan C, Rehfuess E, Campbell-Lendrum D, Gore F, Bartram J: Urban environmental health hazards and health equity. J Urban Health. 2007, 84 (1): 86-97.CrossRefPubMedCentral
40.
go back to reference Nunan F, Satterthwaite D: The influence of governance on the provision of urban environmental infrastructure and services for low-income groups. Int Plan Stud. 2001, 6 (4): 409-426. 10.1080/13563470120103365.CrossRef Nunan F, Satterthwaite D: The influence of governance on the provision of urban environmental infrastructure and services for low-income groups. Int Plan Stud. 2001, 6 (4): 409-426. 10.1080/13563470120103365.CrossRef
41.
go back to reference Joshi A, Moore M: Institutionalized coproduction: unorthodox public service delivery in challenging environments. J Dev Stud. 2004, 40 (4): 31-49. 10.1080/00220380410001673184.CrossRef Joshi A, Moore M: Institutionalized coproduction: unorthodox public service delivery in challenging environments. J Dev Stud. 2004, 40 (4): 31-49. 10.1080/00220380410001673184.CrossRef
42.
go back to reference Hassan A: Orangi pilot project: the expansion of work beyond Orangi and the mapping of informal settlements and infrastructure. Environ Urban. 2006, 18 (2): 451-480. 10.1177/0956247806069626.CrossRef Hassan A: Orangi pilot project: the expansion of work beyond Orangi and the mapping of informal settlements and infrastructure. Environ Urban. 2006, 18 (2): 451-480. 10.1177/0956247806069626.CrossRef
43.
go back to reference Dreibelbis R, Winch P, Leontsini E, Hulland K, Ram P, Unicomb L, Luby S: The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health. 2013, 13 (1): 1015-10.1186/1471-2458-13-1015.CrossRefPubMedPubMedCentral Dreibelbis R, Winch P, Leontsini E, Hulland K, Ram P, Unicomb L, Luby S: The integrated behavioural model for water, sanitation, and hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings. BMC Public Health. 2013, 13 (1): 1015-10.1186/1471-2458-13-1015.CrossRefPubMedPubMedCentral
44.
go back to reference Schertenleib R, Morel A, Kalbermatten J, Saywell D: Guidelines for the Implementation of the Bellagio-Principles and the Household Centred Environmental Sanitation Approach (HCES). Proceedings of the 2nd International Ecosan Symposium. 2003, Germany: IWA, GTZ, Lübeck, 93-100. Schertenleib R, Morel A, Kalbermatten J, Saywell D: Guidelines for the Implementation of the Bellagio-Principles and the Household Centred Environmental Sanitation Approach (HCES). Proceedings of the 2nd International Ecosan Symposium. 2003, Germany: IWA, GTZ, Lübeck, 93-100.
45.
go back to reference Amuyunzu-Nyamongo M, Taffa N: The Triad of Poverty, Environment and Child Health in Nairobi Informal Settlements. 2003, Population council Amuyunzu-Nyamongo M, Taffa N: The Triad of Poverty, Environment and Child Health in Nairobi Informal Settlements. 2003, Population council
46.
go back to reference Fo B, Mitlin D, Mulholland C, Hardoy A, Stern R: Integrated approaches to address the social determinants of health for reducing health inequity. J Urban Health. 2007, 84 (1): 164-173. Fo B, Mitlin D, Mulholland C, Hardoy A, Stern R: Integrated approaches to address the social determinants of health for reducing health inequity. J Urban Health. 2007, 84 (1): 164-173.
47.
go back to reference Mikkelsen B: Methods for Development Work and Research. A new Guide for Practitioners. 2005, London: Sage Publications, 2 Mikkelsen B: Methods for Development Work and Research. A new Guide for Practitioners. 2005, London: Sage Publications, 2
Metadata
Title
Descending the sanitation ladder in urban Uganda: evidence from Kampala Slums
Authors
Japheth Kwiringira
Peter Atekyereza
Charles Niwagaba
Isabel Günther
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-624

Other articles of this Issue 1/2014

BMC Public Health 1/2014 Go to the issue