By William Damulira, Re!gnite Africa Youth Leader
According to a 2012 study by the Water and Sanitation Program (WSP), poor sanitation costs Uganda 389 billion Ugandan Shillings each year equivalent to US$177 million. The poorest are the most affected with 13.5 times more likely to practice open defecation than the rich. In addition, 3.2 million Ugandans have no latrine at all and openly defecate while 13.8 million use unsanitary or shared latrines.
How bad is the problem?
The World Health Organization (WHO), through its 2015 Joint Monitoring Program (JMP) report, estimated that 801,000 children younger than 5 years of age perish from diarrhea each year, majority of the deaths happening in developing countries Uganda inclusive. This amounts to 11% of the 7.6 million deaths of children under the age of five and means that about 2,200 children are dying every day as a result of diarrheal diseases. It is important to note that unsafe drinking water, inadequate availability of water for hygiene, and lack of access to sanitation all together contribute to about 88% of deaths from the diarrheal diseases.
What are the financial implications of this?
Research conducted by the World Bank’s Water and Sanitation Program in 2008 revealed that five south Asian countries lose an estimated US $9 billion a year – 2% of their combined GDP – due to poor sanitation. A similar study conducted in Uganda in 2012 indicated that Uganda loses 389 billion Ugandan Shillings each year, equivalent to US$177 million.
Proposed way forward
Community-based approaches have proved a viable and feasible way toward achieving health promotion in developing countries. The approaches emphasize bottom-up capacity building to address the determinants of health, such as safe sanitation. According to a 2011 WaterAid report titled, The sanitation problem: What can and should the health sector do?, the benefits of community-based approaches have been investigated in several African countries.
Information gathered over 15 years of creation and tracking of pilot projects in several African countries by Juliet Waterkeyn has shown that the community health club (CHC) approach is a cost-effective model that creates a strong demand for sanitation and a culture of healthy behavior. Waterkeyn and her colleagues used hygiene promotion (in coordination with health agencies) to raise demand for sanitation. 
Data from Zimbabwe, Uganda, and South Africa showed high levels of community response through CHCs. For example, health workers provided six months of weekly low-cost hygiene promotion sessions resulting in latrine coverage rising to 43%. Although CHCs were successful elsewhere, Waterkeyn notes that there was limited involvement of the health sector in Uganda from 2003 to 2005 due to lack of sufficient staffing and transportation. At the district level, health workers attended workshops and then withdrew from their commitment to conduct community trainings if per diems were not provided.
Despite the unpopularity of the CHC approach in Uganda, the Village Health Team (VHT) approach has proved otherwise. In Uganda, village health teams (VHTs) comprising of volunteer community members have been used since 2003 to improve the health status of village members. Within the minimum healthcare package, VHTs provide services within a range of primary healthcare aspects, including diarrhea control and home-based management practices for safe sanitation. Although VHTs are not formally remunerated, local leaders and NGOs support them through training opportunities and provision of bicycles and some compensation.
There is also need for the government of Uganda to pay more attention to sanitation. Previously, there has been less appreciation for the role of good sanitation practices and policies in enhancing socio-economic development and environmental protection. The government has to address the loopholes in service delivery as well as targeting investments to the poorest. This will, in turn, make the financing more efficient. The government also has to allocate more investments to sanitation as this will not only help Uganda realize the health and welfare benefits of sanitation but also avert large economic losses.