Study Theme: Water, Sanitation, and Hygiene

Decoding WASH: from water to hygiene and sanitation in Rakai

Water, sanitation, and hygiene (WASH) falls under the sixth development goal as set forth by the United Nations to assure equal access to clean water and sanitation. The WASH team had the opportunity to meet with the National Water Service, the health inspector for the hospital in Kalisizo, and a town health inspector in Rakai to inquire about the real-time processes and problems faced in each aspect of WASH.

From spring to tap

The National Water Service (NWS) oversees many locations spread throughout districts in Uganda and is responsible for water treatment and sewage management. Boreholes are placed into underground water springs in order to tap into natural water sources. Pumps connected to the boreholes transport water from springs into collections of unprocessed water known as sumps which contain small stones to filter out any dirt/bacteria from the water. Water from the sumps is pumped into dosers, which help to automatically chlorinate the water and kill any bacteria that may be present. There is a worker on duty at all times to make sure that correct amounts of chlorine are being added to the water: when there is heavy rainfall, more chlorine may be added to account for extra bacteria and dirt found in the runoff. Chlorinated water from the dosers is then pumped to the filtration site, which utilizes the addition of more chemicals and sand in order to strain impurities out of the water.

Water from the natural springs is collected in a sump pictured above.

Filtered water is automatically pumped to the reservoirs, where water can then be distributed to communities of Rakai through underground piping systems. People without access to these piping systems may choose to have their own private water source, however, this is not recommended by the NWS. These people may choose to use chlorine tablets (1/2  tablet for every 1000 L of water) to clean their water source or pay  25 shillings for each jerrycan of water from a local water tap that is connected to the NWS. The NWS works together with the local electric company to power its automated pumps and also offers centralized sewage service. The system does not reach all people of Rakai, however, and many people choose to have their own private sewage tanks instead. In order to connect these people with the NWS sewage system, they would have to be temporarily displaced from their homes while the sewer lines are constructed. The NWS uses SMS messaging in order to communicate with customers and pays a boda boda (motorbike for hire) driver to provide important water announcements to the public who may not have access to cell phones.

Automated pumps transport water throughout the entire NWS water processing pipeline.

Chlorine is added to the water in containers known as “dosers”.

Sanitation within the Health facility

Regarding sanitation and waste management at the Kalisizo General Health Facility, solid waste is segregated according to different bin colors and liners: red bins for highly infectious material, black bins for general waste such as paper and plastics, yellow bins for infectious material, and brown bins for pharmaceutical waste. Some waste is incinerated, but wastes that cannot be incinerated are denoted by green labels and transported for proper disposal. Pharmaceutical wastes are taken by the National Medical Store for disposal.

Wards are cleaned every morning, while latrines are cleaned every morning and evening. Furthermore, there are separate latrines for inpatients and outpatients. Since there are no hand washing facilities provided near the latrines for patients in the health facility, there are also some health risks.

While further touring the health facility, we were also informed of a “placenta pit”, which is used to store placenta wastes from the maternity ward. This placenta pit at the time had a broken cover, which can pose a health risk to the Rakai community.

The lack of cover for the placenta pit creates a health risk for the community in Kalisizo.

Hygiene and Waste Management

The team also met with the health inspector for Kalisizo and interviewed him on hygiene and waste management within the region. He outlined the requirements necessary for the opening and maintenance of eating houses (restaurants) such as but not limited to an STI and sputum test in addition to a medical certification requirement which must be renewed every six months per employee. He described the challenges these eating houses face as a result of the high employee turnover rate—resulting in the need for recertification for new employees. When discussing solid waste management, the inspector reported that the primary means for waste removal in Kalisizo depends on its removal and transportation by a tender to a dumping site about 4km away from the town. Lack of funding, in turn, has resulted in routine dumping of rubbish and other solid waste by the townspeople into alleys and along streets. Despite these frustrations, the inspector mentioned efforts and potential solutions to the waste problem via fee collection of the townspeople as well as the current employment of about eight individuals responsible for sweeping the streets and collecting trash.