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

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

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

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

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

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

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

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

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

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

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

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

13. 13 The Objective: Healthier children