VURU Water Paper 2014 (1)

Water and Sanitation Report: First Phase Study, June 2014, Kanungu, Uganda

Volunteer Uganda: Research Uganda

In collabora*on with Great Lakes Regional College

An investigation into water access, quality and sanitation in primary and secondary

schools in Kanungu District

June 2014

Report prepared by Anthony Demetriou and Emma KreegerResearch Coordinators, Volunteer Uganda

Data collection conducted by Olivia Beale, Liam Davies, Jared Joseph-White, Fiona Lam, Adam Kee and Elena Suckling

In partnership with research interns at Great Lakes Regional College,Kanungu:

Taremwa Hanningtone, Muhumuza Jackness, Atire Jones, Amanya Macklin, Ankwasa Mercy, Musinguzi Paxtone, Kato Rachael, Oribariho Silver

With many thanks for the warm cooperation of the teachers working at the schools involved with this study.

Executive summaryWhilst developed countries have largely passed by the suffering and indignity that accompanies water and hygiene related sickness, for large swathes of the developing world it is a firmly entrenched feature of life. 780 million people lack access to an improved water source, over 10% of the global popula*on. While it is es*mated that 2.6 billion people lack access to adequate sanita*on, 38% of the global popula*on. As a result of this, more than 3.4 million people die each year from water, sanita*on and hygiene related causes.

Though the water and sanita*on sector in Uganda has shown improvements over the past 20 years, there is s*ll great need in these areas. One quarter of the Ugandan popula*on, 9.2 million people, lack access to safe water. Nearly two thirds of the popula*on, 24 million people, lack access to adequate sanita*on.

Consistent reports of typhoid and diarrhoeal disease in the Kanungu district have prompted a more thorough enquiry into the accessibility of safe drinking water, inves*ga*ng common methods of water treatment, sanita*on and hygiene prac*ces, and knowledge and awareness of waterborne diseases. Schools were chosen as our unit of analysis as it is children who are most vulnerable to water and hygiene related disease.

A mixed methods approach was applied to the design of this study allowing for the collec*on of both quan*ta*ve and qualita*ve data through ques*onnaire based interviews and focus group discussions.

A ques*onnaire was designed by Volunteer Uganda research co-‐ordinators. It was used as the basis of 30 structured interviews carried out with head teachers or senior staff in each school studied.

Focus group ques*ons were designed to correspond with the content of the ques*onnaire. The discussion consisted of respondents answering 9 open-‐ended ques*ons. Volunteer Uganda: Research Uganda (VURU) research interns moderated focus groups across 30 schools in Kanungu District.

Treated drinking water in each school studied was also tested for faecal contamina*on, the most common cause of microbial pathogens found in water.

It was discovered through ques*onnaire data that whilst most schools have access to a tap, 83% of respondents reported the need to use alterna*ve sources because of breakdowns. Over two thirds of respondents said that the last breakdown lasted for over a week. Addi*onally, less than 1 in 5 schools use an adequate amount of water according to government water usage targets. Almost two thirds of respondents said that they felt their school does not have enough water. Only two thirds of schools provide drinking water for students, despite all schools providing drinking water for staff. Sadly, 85% of the treated drinking water tested posi*ve for faecal contamina*on, showing that efforts at treatment are largely unsuccessful.

9 broad themes emerged in focus group discussions. Among these is the problem of school-‐community conflict which, focus groups revealed, is a problem contribu*ng to and arising from limited water access. This finding is in line with what was wri_en in a 2006 Ministry of Educa*on report and a 2013 WaterAid report on water and sanita*on in schools. Another prominent finding was how the use of water for hygiene and sanita*on oben sits at the bo_om of a hierarchy of perceived importance of water uses. Whilst a commonly expressed concern is that children do not see the significance of trea*ng water and that it is near impossible to prevent them from drinking untreated water. A discussion of our results and some recommended interven*ons can be found in the final chapter of this report.

Introduction1.1 The global context 7

1.2 Foundation stones of development 7

1.3 Reducing water and sanitation related disease: transforming health in developing countries 8

1.4 Freshwater: supply and demand 9

1.5 Water and sanitation in Uganda 10

1.6 Water and sanitation in Kanungu 11

Volunteer Uganda: previous research2.1 The Multidimensional Poverty Index (MPI): Pilot 2012 13

2.2 The Baseline study: Needs Assessment Report 2013 13

2.3 Malaria Report: First Phase Study 2014 14

The case for further research: Water 20143.1 Water and sanitation in Ugandan schools 15

3.2 Success of water, sanitation and hygiene programs in Ugandan schools 16

3.3 Water sanitation and hygiene programmes in Kanungu 16

Methods and research design4.1 Survey design 18

4.2 Focus Group design 18

4.3 Water quality Testing 18

4.4 Locations and Sampling 19

4.5 Respondents 19

4.6 Procedure 4.6.1 Questionnaire based interviews 20

4.7 Ethics 20

Questionnaire results5.1 Adequate Water Access 21

5.1.2 Tap ownership 21

5.1.3 Water collection time 22

5.1.3.1 Collection time from primary source 22

5.1.3.2 Collection time for schools without taps 22

5.1.4 Water Usage 23

5.1.5 Perceptions on water availability and usage 23

5.1.6 Access to treated drinking water for students 23

5.2 Adequate Water Quality 24

5.2.1.1 Proportion of schools with protected primary source 24

5.2.1.2 Proportion of schools with protected alternative source 24

5.2.2 Risk of further contamination 24

5.2.2.1 Transport 24

5.2.2.2 Storage 25

5.2.2.3 Distribution 25

5.2.3 Safe drinking water 26

5.2.3.1 Provision of safe drinking water for students 26

5.2.3.2 Provision of safe drinking water for staff 26

5.2.4. Coliform bacteria testing 26

5.2.4.1 Sample test results 26

5.3 Adequate Sanitation 27

5.3.1 Sanitation facilities 27

5.3.1.1 Student: stance ratio 27

5.3.1.2 Hand washing facilities 28

5.3.1.3 Availability of soap 28

5.3.2 Education 29

Focus group analysis6.1 Water access 34

6.1.1 Tap failure and consequences 34

6.1.2 Tensions in sharing water resources with the local community and inadequate supplies 35

6.1.3 Problems of topography 36

6.1.4 Consequences of child water collection 37

6.2 Drinking water quality 37

6.2.1 Insufficient storage and equipment impeding quality 37

6.2.2 The perception that piped water is safe to drink without treatment 38

6.2.3 The perceived unimportance of water treatment among students 38

6.3 Sanitation 40

6.3.1 The need to prioritise different uses of water 40

6.3.2 Water, hygiene and sanitation education in schools 40

Conclusions, limitations and recommendations 6 Conclusions and recommendations 42

6.1 Resource insufficiency, shared resources and community conflict 42

6.2 Recommendation 1: stakeholder meetings 43

6.3 Unsuccessful treatment of water 43

6.4 Recommendation 2: the introduction of a multi-barrier approach and further research 43

6.5 Poor quality water in ‘improved’ sources and the belief that this water is safe 44

6.6 Recommendation 3: a sensitisation programme 45

6.7 Insufficient drinking water supplied to students 45

6.8 Recommendation 4: further research into why drinking water is unavailable and the promotion of alternative treatment 45

Bibliography

Volunteer Uganda: Research Uganda 2014

1 Introduction

1.1 The global context

Inadequate access to clean water and sanita*on facili*es ‘claims more lives through disease than any war claims through guns.’' Whilst developed countries have largely passed by the suffering and indignity that accompanies water and hygiene related sickness, for large swathes of the developing world it is a firmly entrenched feature of life.

A joint study by the World Health Organisa*on (WHO) and UNICEF es*mates that 780 million people lack access to an improved water source, over 10% of the global popula*on. While it is es*mated that 2.6 billion people lack access to adequate sanita*on, 38% of the global popula*on. As a result of this, more than 3.4 million people die each year from water, sanita*on and hygiene related causes -‐ a figure almost equal to 1

the whole popula*on of Berlin and double the size of es*mates being made ten years ago. 2

These deaths are almost en*rely concentrated in the developing world at a propor*on of 99.8% according to the WHO. Beyond affec*ng the most vulnerable regions, within those it is the most vulnerable people 3

who suffer the most as 90% of such deaths occur among children. Indeed, for children under five years old, 4

the mortality rate is greater than the combined burden of HIV/AIDS and malaria. Further exacerba*ng this 5

problem is the fact that the outcomes of the kind of gastrointes*nal disease caused by poor water and sanita*on are more severe due to the under-‐nutri*on and lack of comprehensive interven*on strategies in the worst affected regions. 6

1.2 Founda:on stones of development

There is broad agreement in development discourse that access to enough safe drinking water and adequate hygiene and sanita*on facili*es are founda*onal building blocks without which development in other areas cannot meaningfully occur. Water, or its absence are central to poverty and the link between adequate water provision and poverty allevia*on is well established in the literature.

In rela*on to educa*on, for instance, it has been calculated by the United Na*ons Development Program (UNDP) in a report inves*ga*ng the effects of water scarcity on development that 443 million school days are lost each year due to water-‐related illness. If they could be reclaimed, there would be a tremendous 7

leap forward in the ability of future genera*ons in poorer regions to take the development of their na*ons into their own hands.

WHO, Safer Water, Better Health: Costs, benefits, and sustainability of interventions to protect and promote health, 20041

Ashbolt, M, Microbial contamination of drinking water and disease outcomes in developing regions, Toxicology, vol. 198, 2004, pp. 2

229-238

WHO, Safer Water, Better Health: Costs, benefits, and sustainability of interventions to protect and promote health, 20043

Ashbolt loc.cit4

Liu, L, Global, regional, and national causes of child mortality: an updated systematic analysis for 2010 with time trends since 2000, 5

Lancet, vol. 379, 2012, p. 2151–61

Ashbolt loc.cit6

UN-HABITAT/WHO, The Right to Water, Fact Sheet No. 35. United Nations, 20107

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It is es*mated by the WHO that for every $1 invested in water and sanita*on, there is an economic return of between $3 and $34 in terms of GDP. Whilst transposing the suffering caused by poor water, hygiene 8

and sanita*on into financial terms may appear to be a shallow reading of the problem, it is important to note that this limita*on on the ability of a developing economy to grow and on individuals to par*cipate in that economy plays a serious role in reinforcing the inequali*es between states reoccurring within current processes of global development. In short, if a person is constantly burdened by sickness they cannot work and therefore cannot contribute to their economy. In this sense sickness is a factor that detracts from the ability of poor countries to catch up to rich ones.

There is also an important nexus between water and food security, however, it must be understood with reference to the scarcity of fresh water which is discussed in more detail below. Over 70% of the planet’s freshwater is used in agricultural irriga*on. The majority of food products have huge amounts of water 9

embedded into the process of their produc*on. If current trends in popula*on growth, economic growth and urbanisa*on con*nue, the strain on water supply could cause shormalls in global cereal produc*on of up 30% by 2025. A food shortage of this order, while it would cause a percep*ble shib in price in 10

developed countries, would cause a huge transforma*on in the accessibility of food in poorer ones causing more civil unrest in response to spikes in food prices. The World Bank reports that there have been 51 ‘food riots’ in 37 countries since 2007 and warns that more are likely to come. This kind of instability is hugely 11

inimical to development and intrinsically linked to fresh water supplies.

1.3 Reducing water and sanita:on related disease: transforming health in developing countries

In the 19th century, the outbreak of a cholera epidemic in Germany prompted the discovery by German microbiologist Robert Koch that water treatment methods such as chlorina*on and sand filtra*on greatly reduce pathogen levels in water, rendering it safe to drink. By the end of the century this became the norm in the treatment of piped water in Europe, the UK and North America. This innova*on ‘resulted in the largest reduc*on in the global disease burden of any interven*on since.’ With this history in mind it 12

becomes easier to appreciate the gravity of a comparable breakthrough in, say, the con*nent of Africa.

Improvements in water, sanita*on and hygiene could prevent at least 9.1% of the global disease burden and 6.3% of all deaths. The WHO and UNICEF es*mate that improved sanita*on could prevent the deaths of 13

1.5 million children each year who would otherwise be lost to diarrhoeal disease. The simple act of hand washing aber using the toilet and before ea*ng can reduce the number of cases of diarrhoea by 37%, improved water sources can reduce diarrhoea morbidity by 21% and improved sanita*on can reduce the figure by 37.5. 14

The importance of hygiene, water and sanita*on to development is manifested in agreements of collec*ve ac*on which reflect the values of the interna*onal community. In 2010 the United Na*ons General Assembly officially recognised access to clean water and sanita*on as inalienable human rights through Resolu*on 64/292, acknowledging them as necessary prerequisites for the realisa*on of all human rights. 15

WHO, Evaluation of the Costs and Benefits of Water and Sanitation Improvements at the Global Level, 20048

Food and Agriculture Organisation of the United Nations, Facts Brief on Water and Food Security, 20089

Brabeck-Letmathe, P, Water scarcity and food security: the role of ‘virtual water trade’, www.water-challenge.com, accessed 25 10

November 2014

Cuesta, J, No Food ,No Peace, World Bank Voices: Perspectives on Development, blogs.worldbank.org/voices/no-food-no-peace, 11

accessed 25 November 2014

Ashbolt loc.cit12

WaterAid Uganda, Status of Water, Sanitation and Hygiene in Primary Schools, 201313

WaterAid Uganda loc.cit14

United Nations General Assembly, Resolution A/RES/64/292, 201015

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http://www.water-challenge.com

http://www.who.int/water_sanitation_health/wsh0404.pdf

http://blogs.worldbank.org/voices/no-food-no-peace


It is also shown in the target to halve the number of people who do not have access to safe drinking water, set in 2000 as one of the Millennium Development Goals (MDGs). It has been widely reported that this 16

target has been met before the 2015 deadline. The WHO and UNICEF Joint Monitoring Programme (JMP) 17

has found that more than 2 billion people gained access to improved drinking water sources between 1990 and 2010. ‘Improved drinking water sources’ are defined by the JMP as public taps, protected dug wells, protected springs, or rainwater collec*on. That brings the total up to 6.1 billion people -‐ 89% of the global 18

popula*on. Yet the same progress has not been made with sanita*on, with around 2.6 billion people s*ll lacking basic facili*es. ‘Basic facili*es’ are defined by the JMP as those which ‘do not ensure hygienic 19

separa*on of human excreta from human contact’ -‐ including pit latrines or bucket latrines. 20

Though greater access to improved water sources such as protected wells or piped water is undoubtedly a step forward, it is worth men*oning here that water quality at these sources has not been tested. They protect from outside contamina*on but this protec*on is not complete and is not comparable to a comprehensive mul*-‐barrier treatment system -‐ one in which pathogen levels are minimised through mul*ple processes, such as sand filtra*on, solar disinfec*on or chlorina*on. It is unclear how safe the water that this addi*onal 2 billion people are drinking really is. Furthermore, very significant regional dispari*es have emerged. Nearly half of the 2 billion who have gained access to improved sources of water are in China and India, while Africa has been leb behind. Even within countries, there are grave inequali*es between rural and urban areas. 21

1.4 Freshwater: supply and demand

Though it is a renewable resource, with precipita*on renewing supplies, as the supply of water remains a constant, global demand is constantly increasing. One factor in this is the rapid urbanisa*on occurring in the developing world. As more and more people flock to ci*es in search of a be_er standard of living, their water consump*on increases, crea*ng a larger aggregate demand and need for sanita*on facili*es. Of the 60 million that move to urban areas annually, most move to informal se_lements with no sanita*on facili*es. Adding to this is the rapid rate at which the global popula*on is growing -‐ surging from 2.5 billion 22

in 1950 to 7 billion in 2011. United Na*ons projec*ons expect a popula*on of 8.9 billion by 2050. This 23

suggests that already strained water supplies and sanita*on facili*es will come under increasing pressure. A report by the Interna*onal Water Management Ins*tute (IWMI) projects that if water use is not made more efficient in terms of reducing waste, then there will be a 57% rise in global water demand by 2025. 24

With these facts in mind it becomes clear that compe**on for water is likely to intensify in coming decades as popula*on growth, urbanisa*on and industry demand greater quan**es. Sadly, it is those who have the least who stand to lose the most. The IWMI report men*oned above warns that it is likely that those ‘people with the weakest rights -‐ small farmers and women among them -‐ will see their en*tlements to water eroded by more powerful cons*tuencies.’ 25

www.un.org/millenniumgoals/environ16

United Nations, Millennium Development Goals Report 2012, 201217

WHO/UNICEF, Progress on Drinking Water and Sanitation 2012 Update, 201218

ibid19

ibid20

ibid21

UN Water, Tackling a Global Crisis: International Year of Sanitation, 200822

United Nations Population Division, World Population Prospects The 2012 Revision: Highlights and Advance Tables, 201223

International Water Management Institute, World Water Demand and Supply, 1990 to 2025: Scenarios and Issues, 199824

ibid25

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1.5 Water and sanita:on in Uganda

Though the water and sanita*on sector in Uganda has improved considerably over the past 20 years, there is s*ll great need in these areas. One quarter of the Ugandan popula*on, 9.2 million people, lack access to safe water. Nearly two thirds of the popula*on, 24 million people, lack access to adequate sanita*on. 26

Should Uganda meet the Mil lennium Development Goal on water and sanita*on, 72% of the total popula*on would need to have access to safe drinking water and 70% would need to have access to improved sanita*on. The Ugandan government’s own target is to increase access to improved water in rural areas to 77% and access in urban areas to 100%. It also aims to increase access to improved sanita*on in rural areas to 80% and to 100% in urban areas. 27

The Ministry for Water and Environment’s (MWE) Annual Water and Environment Sector Performance Report for 2014 states that as of June, the popula*on with access to safe water in urban areas amounted to 73%. The rural popula*on with access to safe water remained stagnant at 64%. Inadequate funding was reportedly the cause of this stagna*on. 28

The WHO/UNIFEC JMP for water and sanita*on, drawing on a mul*tude of datapoints, is more posi*ve. These figures state that 72% had access to safe water by 2010, 5 years ahead of the 2015 target. Yet it also notes a worrying rural/urban inequality in coverage at 68% and 95%. 29

The MWE 2014 Sector Performance Report states that 74.6% of the rural popula*on has access to sanita*on, up from 71% in the previous year. This puts Uganda on track to meet the na*onal target of 77% access to sanita*on by 2015. Sanita*on in urban areas is at 84% excluding Kampala (for which data does not exist) and is is unlikely to rise to the 100% target by 2015. 30

The WHO/UNIFEC JMP is less op*mis*c. According to their 2014 report, only 34% enjoy improved sanita*on in rural areas whilst in urban areas the figure is 33%. The total propor*on of the popula*on that enjoy improved sanita*on, according to the report is 34%. MWE na*onal es*mates include facili*es which are shared in its defini*on of improved sanita*on, where as the JMP does not. The discrepancy in the 31

sta*s*cs produced by the MWE and the JMP show that figures are not facts when it comes to assessing access to water and sanita*on and that precise measurement is difficult.

WaterAid, Where we work, www.wateraid.org/where-we-work/page/uganda, accessed 26 November 201426


Ugandan Ministry for Water and Environment, Annual Water and Environment Sector Performance Report for 2014, 201428


Ugandan Ministry for Water and Environment, op.cit30


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Figure 1. Map of Uganda showing Kanungu, Mapbox, www.mapbox.com retrieved 2 December 2014


Despite the clear need for investment in improved water and sanita*on infrastructure, government investment into the sector as a propor*on of total budget has been spiralling downward over the past 10 years. Budget alloca*on to the Ministry of Water and Environment has been reduced from 7.4% of the total budget in 2004 to 2.8% in 2014. These cuts have occurred whilst the popula*on of Uganda is swibly expanding and urbanising, crea*ng a demand for water and sanita*on facili*es which is grows.

This chronic underinvestment is ironically causing considerable economic losses. A 2012 report es*mated that Uganda loses UGX 386 or US$177 million per year due to poor sanita*on. 32

1.6 Water and sanita:on in Kanungu

Kanungu District is located in southwestern Uganda and is split into 9 sub-‐coun*es and 2 town-‐councils. It has a popula*on of 241,800 -‐ 90% of which, according to government figures, have access to safe water. 33

Safe water access rates, according to these government es*mates, vary from 72% in Kihihi sub-‐country to 95% in Kanyatorogo, Kayonza, Kirima, Kambuga, Mpungu, Nyamirama, Rugyeyo and Rutenga sub-‐coun*es as well as Kanungu Town Council. 34

The district has 1,669 water sources in total. 238 of these are non-‐func*onal, 31 of which have been so for more than 5 years and are considered by the MWE to be abandoned. The breakdown of source types can be seen in figure 2. 35

Technical breakdown, that is a breakdown where the physical equipment cons*tu*ng a water source becomes non-‐func*onal, accounts for the greatest propor*on of breakdowns at nearly a third (29%). According to the district assistant water officer this is because few people pay user fees for the maintenance of water facili*es -‐ when facili*es break down, there are insufficient funds to cover their repair. This is 36

perhaps a predictable outcome of the Government of Uganda’s 1999 Na*onal Water Policy which shibs the responsibility for maintaining and mee*ng the costs of water sources away from government and onto users. The second most significant reason, affec*ng over 1 in 5 sources (23.5%) is that they have become dry or low yielding. The third, affec*ng a similar propor*on (21.1%) is compromised water quality, showing that though a source may have all of the trappings of protec*on. this does not always ensure quality. 37

Figure 2 38

The district is equipped with 3 pumped water supply systems, 2 of which are surface water based whilst 1 is groundwater based. Surface water being that which collects on the surface of the ground: streams, rivers, lakes, swamps, puddles and so on. Whilst ground water is held underground in the soil or in the pores or crevices of rock. 39

WHO/UNICEF, op.cit32

Ugandan Ministry of Water and Environment, Water Supply Atlas 2010, 201033

Ibid34

Ibid35

N. Wesonga, Pulse Check for New Districts: Kanungu’s Case, The Daily Monitor, 27 July 2014, retrieved from www.monitor.co.ug 2 36

December 2014

Ugandan Ministry of Water and Environment, Water Supply Atlas 2010, 201037

Adapted from Ugandan Ministry of Water and Environment, Water Supply Atlas 2010, 201038

Ibid39

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http://www.monitor.co.ug


Rainfall is an important source of water and driver of agricultural produc*on in Kanungu, a district in which 73% of the working popula*on are employed in the agricultural sector, as irriga*on is rarely used. The 40

district enjoys a tropical climate, with far more rainfall in the summer. The average annual temperature in Kanungu is 18.9°C. The average annual rainfall is 1,222mm, double the received precipita*on of London which received 601mm and is seen as a ‘rainy city’. 41

Ugandan Bureau of Statistics, Uganda Population and Housing Census Analytical Report, 200240

www.en.climate-data.org/location/50845/41

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2 Volunteer Uganda: previous research2.1 The Multidimensional Poverty Index (MPI): Pilot 2012

The MPI research undertaken in 2012 tracked changes in poverty levels of participants from 2007 to 2012 using a multidimensional poverty index tool designed in collaboration with Makerere University, Kampala. An improvement was seen in how far participants had to travel from the household to collect water for consumption as the report shows that in 2007, 44% of participants accessed water from a distance over 500m and in 2012 this figure decreases to 32%. However, in 2012 only 10% had access to piped water in the household, 20% accessing water for consumption from streams and swamps and the remaining 70% from protected taps or communal springs, with little change from 2007.

2.2 The Baseline study: Needs Assessment Report 2013

The Needs Assessment Report conducted in September 2013 represents Volunteer Uganda’s most recent findings across multidimensional levels of poverty in Kanungu. Data was collected by mapping surveys conducted in structured household interviews in a range of sub-‐counties throughout the district. The report offers a baseline of statistics on water access, quality and sanitation which feature within the six dimensions of poverty the report covers: education and culture, organisation and participation, income and employment, interiority and motivation, health and environment, housing and infrastructure.

Indicators of poverty were classified into three categories according to responses from participants. In response to each question a participant was ranked as to whether their answer corresponded to being ‘in poverty’ (1) ‘at risk of poverty’ (2) or ‘not in poverty’ (3), following the Stoplight Approach to poverty measurement developed by Fundacion Paraguaya. 42

(i)Water access

Most importantly, the data highlights that access to water for consumption is among 1 of the top three most pressing needs within the Kanungu district. 93% of 551 households fall within category 1 and 2 responses when looking at adequate water for consumption as an indicator of poverty.

Furthermore it was recorded that only 7% of respondents have access to piped water in their homes, meaning that the remaining 93% fetch water or must travel a distance to collect water for consumption from outside the household in the form of communal protected springs or streams and swamps. 76% of respondents travelled over a distance of 30 minutes to collect water for the household.

(ii)Water quality and sanitation

Interestingly ‘water treatment’ and ‘hand hygiene, sanitation’ had the highest number of category 3 responses at 94% and 89% respectively. ‘Clean water consumption’ was also amongst the higher percentages at 67%.

As a means of treating water for consumption 94% of respondents boiled as their preferred method of treating water for consumption opposed to using other methods such as chlorination tablets, solar disinfection or water filtration.

However, 92% of respondents were sourcing water from communal protected and non-‐protected springs, rainwater, streams and swamps with high contamination risks making the water unsafe to consume without treating in some form. As income and employment is the dimension in which most respondents were in or at risk of poverty, it is a worrying

Burt, M, ’The “Poverty Stoplight” Approach to Eliminating Multidimensional Poverty: Business, Civil Society, and Government Working 42

Together in Paraguay’, Innovations, pp.53-75, 2013�13


factor that a lack of money for firewood or coal could cause a problem in water treatment for consumption and lead to many households drinking contaminated water.

2.3 Malaria Report: First Phase Study 2014

This report focuses primarily upon mosquito net possession, usage and malaria knowledge in the Kanungu district. Data was obtained through structured household interviews encompassing a sample size of 234 households.

It is important to note that, with respect to knowledge and awareness of transition of malaria, a high proportion of respondents were displayed inadequate of education on this topic. The second most popular response when asked what could be done to prevent malaria, was ‘to avoid drinking dirty water’, mentioned 94 times. This suggests a distinct lack of knowledge or perhaps misunderstanding of the difference between malaria and water borne disease.

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3 The case for further research: Water

2014Previous research conducted by Volunteer Uganda has highlighted access to safe water and knowledge of waterborne disease as inadequate in the district. The obtainability of safe drinking water, the common methods of water treatment and sanitation and hygiene practices in Kanungu District all warrant further investigation.

Education has arisen as an important behaviour change technique to reduce waterborne disease, based on the idea that raising knowledge and awareness of good and bad practices and their outcomes will help people to make the right choices to mitigate against risk of disease. 43

3.1 Water and sanitation in Ugandan schools

The pursuit of Universal Primary Education has been a key policy used by the Government of Uganda in the drive to reduce poverty. Through the UPE programme the Ugandan government abolished tuition fees and Parents and Teachers Association charges for primary education. Since the advent of this policy, enrolment in primary school increased from 3.1 million in 1996 to 7.6 million in 2003, a figure which has since been steadily increasing. This increase has put greater strain on already inadequate water and sanitation facilities in schools and has resulted in low hygiene and sanitation standards country-‐wide. 44

One aspect of inadequate sanitation in Ugandan primary schools which is particularly likely to cause school absence is inadequate hygienic facilities for girls. Toilet facilities, according to a report by the Ugandan Ministry of Education and Sports admits that ‘toilet facilities in primary schools remain inadequate for girls.’ 28% of schools had shared facilities, eradicating the possibility of privacy. Special washrooms were seen in only 36% of primary schools -‐ even of these, half functioned poorly and had no soap or basin. The study found that rural and government aided schools were especially ill-‐equipped and were less likely to make soap or a basin a priority, rendering hygiene facilities ineffectual. 16% of girls interviewed cited lack of privacy, 31% cited fear of soiling toilets and 51% cited poor toilet hygiene as factors which greatly contribute to discomfort during menstruation, potentially leading to school absence. 45

Overall, toilet hygiene was found to be poor. 80% of primary school floors were wet and dirty, whilst the figure for secondary schools is 79%. Faeces was smeared on the walls of 33% of primary schools and 25% of primary schools. The area surrounding toilets was soiled in 40% of primary schools and 20% of secondary schools -‐ indicating a desire to avoid the use of dirty facilities. 46

The national guidance for pupil: stance (a stance is a single cubicle of a latrine block) ratio is 40:1. Though the average ratio across Uganda has improved since 1997, in which it was 150:1, the proportion of primary schools achieving this benchmark ratio was reported to be only 25% in 2006 and a more recent WaterAid report claims that only 22% of their sample achieved it. 47

WHO, Combating Waterborne Disease at the Household Level, 200743

Bategeka, L and Okurut, N, Universal Primary Education Uganda, (Policy brief 10), 2005, retrieved from www.odi.org44

Ministry of Education and Sports, Sanitation and Hygiene in Primary Schools in Uganda, 200645

ibid46


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The same WaterAid report found that though all primary schools in their sample had ‘some kind of sanitary facility’, there was a real shortage of hand washing facilities. 57%, over half, lacked hand washing facilities. A significant deficit, especially in light of the fact that had washing can reduce the prevalence of diarrheal disease by 47%. 48

In the WaterAid study, resources, especially financial resources were highlighted as one of the main challenges to providing adequate facilities. Interviewees referred to NGO work as the main source of improvement for HWS standards, whilst government funding dwindles. Another was limited technical skills: appropriate technologies may be available, but there is a shortage of personnel with the expertise to construct these facilities. Beyond this, limited user awareness of the importance of and the proper use of water and hygiene facilities was considered to be a cause of improper use leading to degradation as well as non-‐use.

With regard to water accessibility, conditions were also found to be inadequate. The MWE recommends a minimum of 5 litres per day per student should be used in day schools, whilst the figure is higher at 25 litres per student per day in boarding schools. According to this threshold, less than 20% of primary schools use an adequate amount of water. Rural schools were more likely to meet the standard at 22%, whilst only 13% of urban schools did. 49

Distance to the main water source has also proven to be a problem in Ugandan schools. In their nation-‐wide study, the MWE found that most water sources were further than the recommended distance of 0.5km. In terms of the operation of these sources, government was the most common funder of water facilities, providing for 48% of primary schools. Next were parents and the community which fund water in 38%. 50

3.2 Success of water, sanitation and hygiene programs in Ugandan schools

In addition to the above projects there are many more initiatives that have been implemented throughout Uganda. These include many more WaterAid projects, a WES (water, environment and sanitation) programme run by UNICEF, the Government led – Global Sanitation Fund (committed to expanding to reach 30 districts from 2014), Water School 51

Uganda and The Water Project which provides communities with wells, are just but a few.

Dr Albert Rugumayo, a consultant for the Ministry of Education, has published a report in which he discusses the successes of sanitation programs in schools. He begins by acknowledging the virtual non-‐existence of water and 52

sanitation provision in the mid 1990’s and the clear improvement there has been since sanitation programs have been implemented to date, such as the building of latrines and improved access to drinking water. Importantly, he admits that less progress has been made in hygiene education. In evaluating the impact of WASH programs across Uganda he raises the issue of sustainability and highlights that whilst performance of NGO’s and Government action can be measured by infrastructure, there is little measuring actual change in practices. He calls for monitoring and evaluation systems to be in operation to ensure behavioural change in hygiene habits and life skills, such as the simple act of hand washing correctly with soap and water. As WASH projects currently stand, without real change in behavioural practices when initiatives end or funding stops, schools return to bad sanitation and hygiene habits and risk water related illness.

3.3 Water sanitation and hygiene programmes in Kanungu

As with the experience of WASH (water, sanitation and hygiene) programmes at the national level, in Kanungu there has been success in terms of the programs which ave been initiated but a gaping deficit in their coverage and a lack of monitoring and evaluation. There are several WASH projects currently running in the Kanungu District. In August 2012 the construction of the government backed Banyara Gravity Flow Scheme was completed. Supported by the Swarovski 53

jewellery company’s Waterschool Uganda project the scheme facilitated access to safe water for 24 schools in the

ibid48

ibid49

ibid50

Collaborative Council www.wsscc.org/countries/africa/uganda/global-sanitation-fund51

Rugumayo, A, Ministry of Education, Uganda - Scaling up School Sanitation Programmes at National Level, 200452

Magula, M, ‘Uganda: Mbabazi Hails Landmark Kanungu Water Scheme’, The Observer, 201453

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http://www.wsscc.org


Kayonza sub-‐county, 3 health units, the Kayonza tea factory and hundreds of households, as well as significantly reducing water collection time; which in turn has largely done away with the burden of an arduous journey collecting water for women and children.

The Swarovski Waterschool Uganda program also provides water boiling equipment and teaches sustainable water use. They operate in 20 local schools, have trained 80 teachers and impacted nearly 25,000 community members in Bwindi. Schools also benefit from WASH clubs where local residents are taught about the importance of sustainable water use, effective sanitation and good hygiene practices. All schools participating in the program are provided with rainwater 54

harvesting tanks and sanitary facilities.

In addition, 52 schools in Kanungu are benefiting from the WASH campaign run by Bwindi Community Hospital in collaboration with the Vision Group (a Ugandan publishing company) and WaterAid Uganda. This initiative gave 55

teachers in the selected schools training in how to improve hygiene and sanitation in their schools. Schools were also shown how to make and use ‘tippy taps’ (a plastic jerry can or water bottle, hung from a rope and releases water when tipped) to improve hygiene practices such as washing hands after using the toilet and before eating or preparing meals.

www.swarovskiwaterschool.com/uganda54

Bwindi Community Hospital, Annual Report 2011/2012, www.bwindihospital.com55

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4 Methods and research design

A mixed methods approach was applied to the design of this study allowing for both quantitative and qualitative data and a marriage of surveys and focus group discussions to improve on accuracy, reliability and depth of findings.

4.1 Survey design

The survey was designed by Volunteer Uganda research co-‐ordinators. It took into consideration VU: RU’s previous studies and recommendations for further research alongside information gathered across prominent water, sanitation and hygiene focused organisations, NGO’s and charities working in Uganda.

The survey consisted of 50 questions, set out in 8 sections: school demographics, water quantity and storage, water quality and usage, water source and collection, water reliability and dependence, health and wellbeing, treatment of water and toilets and sanitation.

The survey incorporated both open and closed questions to allow for the recording of both precise and concrete data alongside more detailed and opinion led responses. The majority of questions were coded for quantitative analysis and a selection left open to allow for more free-‐flowing answers to be later categorised and coded.

4.2 Focus Group design

Focus Group questions were designed to encourage discussion in line with the eight sections of the survey. The discussion consisted of 9 key questions.

4.3 Water quality Testing

In order to measure water quality within each school in the study it became apparent that water quality testing would play an essential role in the study’s design.

According to the World Health Organisation’s (WHO) Guideline for Drinking Water Quality, safe drinking water is defined as water that “does not represent any significant risk to health over a lifetime of consumption, including different sensitivities that may occur between life stages.” In order for drinking water to be potable it is important that it is free 56

from contamination of bacterial pathogens responsible for waterborne disease. The guidelines describe faecal contamination as “the greatest microbial risk” to drinking water as most disease causing pathogens found in water originate in the faeces of humans and warm blooded animals. 57

Volunteer Uganda research co-‐ordinators decided that the most effective method of testing for coliform bacteria (E-‐Coli) would be to use a water testing kit known as the total coliform bacteria test to test a sample of drinking water from each school. This test is ultimately a test of suitability for human consumption. It involves a simple colour indicator providing a positive or negative reading for the presence of coliform bacteria in the sample, a strain indicating faecal contamination. An example can be seen in the image below.

World Health Organisation, Guideline for Safe Drinking Water, 4th Ed, 201156

ibid57

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It was decided that within each school a sample of both treated and untreated water would be taken, and any water sample which was consumed as drinking water by members of the school would be tested for the coliform bacteria.

4.4 Locations and Sampling

Schools were chosen as the unit of analysis of the study. The sampling frame was based on a purposive sampling technique, operating on the principle that the best information can be obtained through deliberately focusing on a small number of instances selected on the basis of their known attributes. In this instance selecting 30 schools from across the district, 15 primary and 15 secondary, and within each of these groups allowing for a selection of both private and government schools, and boarding and non-‐boarding schools.

The study returned to sub-‐counties in which households were examined in the 2013 Needs Assessment Report: Kazuru, Kihihi, and Kanungu Town. In addition Kambuga, Kirima, Kanyantoroogo and Nyamerama were also visited. At least one primary and one secondary were sought in each of the sub-‐counties where possible, although limitations were met in that some sub-‐counties did not contain secondary schools.

4.5 Respondents

A total of 30 schools were visited, within each school one senior member of staff was selected for participation in the questionnaire. A total of 30 participants were interviewed; 26 males and 4 females.

Focus groups were held in 29 schools, of which 14 were primary and 15 were secondary. Focus group participants were selected across varying positions throughout the school to provide viewpoints across both genders and levels of responsibility to present a more accurate picture of the water situation within each school setting. A total of 146 people took part in focus group discussions, an average of 5 participants in each focus group; participants held positions such as teacher, matron, cook, cleaner, school advisor, security guard, groundskeeper, gatekeeper and director.

Involvement in the study was entirely voluntary for all participants. Each school was given a small facilitation towards lunch costs for research interns. Both survey and focus group questions focused on responses that represented the whole school as well as responses that focused on individual opinions. Representing a total population of 9,534 community members across 30 schools.

At each school both treated and non-‐treated water samples were collected. A total of 27 schools provided water samples, of which all were treated water samples. 3 schools did not have any water available for testing on the day of data collection. All samples were taken back to the Volunteer Uganda lodge where water quality testing was carried out on all samples confirmed as water used for consumption.

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4.6 Procedure4.6.1 Questionnaire based interviews

All interviews were conducted by research teams comprising of one or two field research interns from Volunteer Uganda and one or two research interns selected from Great Lakes Regional College (GLRC). On occasion, GLRC interns would 58

assist in translation when needed.

Each interview followed a standardised procedure. A formal brief outlining the purposes and objectives of the study were read out in both English and the local language, Rukiga. Consent forms were read and signed by the participant and then the interview proceeded with a series of structured questions. Each interview ended with a formal debriefing.

4.6.2 Focus groups

The focus group discussions were conducted by the same team of research interns from Volunteer Uganda and GLRC. In line with the format of the interview, a brief would be read in English and Rukiga to the participants and consent forms would then be read and signed. One volunteer would act as a facilitator, directing discussion, whilst another would transcribe and a third translate where necessary. Upon the conclusion of the focus group discussion a debrief would be read in English and Rukiga.

4.7 Ethics

All field researchers and GLRC students were issued with VU: RU’s research ethics guidelines prior to the start of the project, made aware of the responsibilities held within their roles and the ethical regulations they must commit to before entering the field.

A number of steps were taken to ensure that research integrity and validity was preserved at all times. Both survey and focus group respondents were required to be over the age of 18 years. All participants were required to have read a project brief in both English and Rukiga and signed a consent form before any formal interviewing took place.

All participants were made aware of their right to terminate the interview at any point before and have any data removed from the dataset and destroyed upon withdrawal. All respondents were made aware of the anonymity of their responses.

4.8 Data Analysis

All survey data was transferred into a Microsoft Excel spreadsheet. Any qualitative data was coded so as to make all responses quantitative. Data was split into subtopics within access, quality and sanitation, analysed using data analysis tools in Excel and presented as descriptive statistics.

The approach to the analysis of qualitative focus group data was based on the framework analysis approach developed by Richard A. Krueger. Analysis progressed through the stages of familiarisation, identifying a thematic framework, indexing, charting, and interpretation. In the familiarisation stage, all transcripts were read thoroughly and consecutively as major themes began to emerge. From here a thematic framework within which to organise the data was developed. Once the thematic framework was in place, researchers sifted through and indexed the data as passages relevant to particular themes were highlighted and sorted. In the charting stage, these passages were lifted from their original transcripts and grouped in terms of their relevant theme in order to facilitate comparison between focus groups and a view of what our data says about each theme on the whole, an important stage in the management and reduction of data. From there the data was interpreted, with the intention of identifying links between the passages and the data as a whole. The focus at this stage was on identifying larger trends and emerging ideas which cut across focus group discussions.

Local educational institution. GLRC alongside VU: RU offers research led internship programmes to students studying for diplomas 58

and degree level qualifications. �20


5 Questionnaire results

5.1 Adequate Water Access

This sec*on will analyse responses gathered in the ques*onnaire in an assessment of water access focusing on: water sources, tap ownership, collec*on *me, water usage, percep*ons of access to an adequate water supply, and drinking water availability.

5.1.1 Main water source used by schools

Figure 3: Main water source used by schools. Values refer to the number of schools in each category.

Data revealed that the majority of schools are accessing water from springs and wells. As demonstrated in figure 3.

5.1.2 Tap ownership

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Figure 4: 20 schools reported tap breakdowns, the dura*on of *me the tap was broken for (B) is displayed here. Values show the number of schools which fall into each category.


24 schools own taps on their premises, 5 are without and 1 school did not answer. 11 schools owning a tap are primary and 13 secondary, no differences were found between government and private schools in tap ownership.

Of those that had taps 83.33% of respondents reported tap breakdowns or taps ceasing to work, figure 4 displays how long taps were out of ac*on for. Respondents stated that it is common for schools to share taps with communi*es which can oben expose them to a higher risk of breakdown or sabotage. It was found that only 16.67% of school taps were recorded as having restricted access with a physical barrier in place, stopping students or community members having unlimited access.

5.1.3 Water collec:on :me

5.1.3.1 Collec:on :me from primary source

Respondents with taps were asked how long water collec*on took on a return journey (going to collect water and back again). 22 of 24 schools provided data. On average water collec*on *me for a school with a tap is 13.5 minutes (SD = 20.03) with a range of 70 minutes. The vast majority of schools collect water on foot, 1 school has use of a bicycle and 2 did not answer.

Time taken to collect water from the source for the 5 schools without taps varied. The average collec*on *me (going to collect water and back again) for a school without a tap is 34.79 minutes (SD =25.58) with a range of 56 minutes. All 5 schools collected water on foot.

5.1.3.2 Collec:on :me for schools without taps

24 schools use alternate water sources when access to their primary water source or tap is unavailable, of these 19 schools provided data; 16 with taps and 3 without taps.

The average collec*on *me (going to collect water and back again) from an alterna*ve source for schools without taps is 31.7 minutes (SD: 24.66) with a range of 35 minutes. Indica*ng here minimal change from the primary source collec*on *me.

Schools with taps are most affected. The average collec*on *me (going to collect water and back again) from an alterna*ve source, for a school with a tap is 76.3 minutes (SD 24.66) with a range of 35 minutes. This shows a very high increase in collec*on *me compared to when the taps are accessible. This is further displayed in figure 5 which shows only one school with a tap was not affected with a *me increase when using an alternate water source.

Figure 5: Data recorded from 16 schools, shows the minutes (m) added in collec*on *me for schools with taps when collec*ng water from an alterna*ve water source. Values show the number of schools which fall into each category.

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5.1.4 Water Usage

Ques*onnaire respondents were asked to es*mate their school’s daily water usage. Less than 1 in 5 schools use an adequate amount of water according to government water usage targets of 5 litres per pupil per day in non-‐boarding schools and 25 litres per pupil per day in boarding schools. This figure reflects every form of water use from consump*on and cooking to cleaning and personal hygiene. Water usage data for 7 of our 30 case sample is unknown. Results also show that the average amount of water used per student per day across all schools is just 2.98 (SD = 3.76) litres, well below the na*onal targets for both day and boarding schools.

Secondary schools tend to fare be_er than primary schools in providing adequate water as 3 of the 10 for which we have data meet the government minimum water usage threshold. On the other hand, only 1 primary school of the 13 for which we have data is mee*ng the target. Secondary schools also use well over double the amount of water per student per day than primary schools do. Secondary schools were found to use 4.67 litres on average whilst primary schools use only 1.67 litres.

5.1.5 Percep:ons on water availability and usage

Each respondent was asked whether or not they felt the school had enough water in which 63.33% of all schools responded ‘No’. The most common reasons for this were overconsump*on of water from others using the same source, the effects of dry season on supply and demand and mechanical breakdowns of taps.

In addi*on respondents were asked to rate the impact of dry season on their water supply according to the following scale:

1. Very severely

2. Severely

3. Moderately

4. Not very much

5. Not at all

All schools answered, one third of schools repor*ng a moderate effect, 27% of schools repor*ng not very much or none at all and the remaining 37% a severe or very severe effect.

5.1.6 Access to treated drinking water for students

Only 2 thirds of schools provide treated drinking water for students, despite all schools providing treated drinking water for staff. Secondary schools perform marginally be_er than primary schools here, with 73.33% of secondary schools providing treated drinking water for students and only 60.00% of primary. Results also showed that 75.00% of private schools were providing treated drinking water for students compared to just 50% of government schools.

5 schools could not provide data on how much treated water was made available to students for drinking on an average day. For the remaining 15 schools a child would receive 307ml of drinking water on average per day at school (SD: 171.24) with a range of 603ml. Only 11 schools are able to provide the equivalent of a 200ml glass of water or more, one of these schools is a government school. A full breakdown of this can be seen in table 2.

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5.2 Adequate Water Quality This sec*on will analyse data collected in rela*on to the quality of water within each school from collec*on at the source through to *me of consump*on. This process will be carried out by analysing data points in rela*on to; accessibility of water from a protected site, risks of further contamina*on through passage of collec*on, transport and storage, provision of safe drinking water, absence due to water related disease and results from coliform bacteria tes*ng.

5.2.1.1 Propor:on of schools with protected primary source

Respondents were asked to state which type of water source they normally use to draw water from (see figure 3). The vast majority of schools are obtaining water from either ground or surface sites, however only a limited number of these are protected. Of schools accessing water from a spring or well 57.14% of those sites were reported as protected and 9.52% were not known to be protected or not. Of the 12 schools accessing water from a protected site 7 were primary (2 government and 5 private) and were 5 secondary (all private).

4 schools answered rain as their main source of water and all responded ‘Yes’ when asked if their water source was protected, one respondent also claimed to have a protected bore hole. This suggests there may be some inaccuracy in the understanding of respondents to the criteria of a protected water site or a lack of knowledge regarding their water source.

5.2.1.2 Propor:on of schools with protected alterna:ve source

Many of the schools in the study stated that they use more than one site to source water. Focusing on the popula*on that use a protected well or spring as their main water source, 5 of the 12 schools use alternate sources such as rivers and rainfall which are non-‐protected sites. Therefore sugges*ng that only 7 of the 12 schools (23.33% of all schools) are accessing water solely from a protected site.

5.2.2 Risk of further contamina:on

5.2.2.1 Transport

The use of an uncapped container in transpor*ng water further increases the risk of contamina*on as it offers an open passage for bacteria to enter, whilst a capped container or commonly used ‘jerry can’ can reduce this risk. In transpor*ng water from the water source to the school 83.33% of schools are using jerry cans. The remaining 16.67% are using a mix of jerry cans, bo_les and uncapped containers.

When asked if these par*cular containers used for collec*ng water are used for any other purposes 3 schools answered ‘Yes’ and 1 school did not know. Despite these 4 schools using jerry cans they are increasing the risk of contamina*ng the water by using the containers for alternate purposes as the water is exposed to cross contamina*on. All schools that answered yes to this ques*on were government schools.

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5.2.2.2 Storage

The number of schools using shop bought or capped storage containers to store water used for consump*on in the school stands at 43.33%. Schools using either uncapped containers or a mix of capped and uncapped containers to store their water are at a higher risk of contamina*on.

Figure 6: Type of storage facility used for school water supply. Values show the number of schools that fall into each category.

Half of schools either admi_ed or did not know if storage containers were used for different purposes other than storing water. Three of these schools were using capped containers but increase their risk of water contamina*on when those containers are used for other purposes, these three schools are all government schools.

5.2.2.3 Distribu:on

Distribu*ng water using a dipping method can further increase the risk of contamina*on four schools are using this method. 4 schools are using this method. This can be seen in figure 7.

Figure 7: Water distribu*on risk. Data displays the number of schools that dip cups or vessels into the water compared to pouring when distribu*ng water. Values show the number of schools that fall into each category.

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5.2.3 Safe drinking water

5.2.3.1 Provision of safe drinking water for students

Of the 19 schools that provided treated drinking water for students the majority of schools are using firewood to boil water as their treatment method and 2 schools use water purifica*on or chlorine tablets. When the school that did not treat water before consump*on for students was asked why they responded “no facili*es”.

When respondents were asked whether or not to their knowledge students are drinking untreated water an alarming 83.33% responded ‘Yes’. The most cited reason was ‘insufficient boiled water available at school’, the second most recorded answer was an ‘ignorance or lack of knowledge’.

5.2.3.2 Provision of safe drinking water for staff

In contrast to students, 100% of schools in the survey provided drinking water for staff, 29 treated water before consump*on and one did not. 29 of the schools that treat water for staff are also using the boiling method (fuelled by firewood) and one school use chlorine tablets.

When respondents were asked whether to their knowledge staff ever drink untreated water only one school responded ‘Yes’ and three schools could not answer or did not know the answer.

5.2.4. Coliform bacteria tes:ng

5.2.4.1 Sample test results

27 schools provided a sample of water used for consump*on for tes*ng, all of the samples received were assured to be treated water samples. All samples were tested for coliform bacteria using a water safe colour indicator to test either yellow (posi*ve) or purple (nega*ve) for the presence of the pathogen. 85.18% turned yellow indica*ng the presence of coliform bacteria and 14.82% showed a nega*ve purple reading.

Figure 8: An example of a posi*ve (yellow) on the leb and nega*ve (purple) reading on the right, indica*ng the presence or absence of coliform bacteria.

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Figure 9: Number of schools indica*ng a posi*ve or nega*ve result for the presence of coliform bacteria in a treated water sample collected on day of data collec*on. Values correspond to the number of schools within each category.

5.3 Adequate Sanita:on

This sec*on will look at how we can measure adequate sanita*on facili*es and prac*ces within schools by assessing access to toilets, hand washing facili*es, good and bad hygiene and sanita*on prac*ces and hygiene educa*on. Where appropriate findings will be compared to na*onal approved standards.

5.3.1 Sanita:on facili:es

5.3.1.1 Student: stance ra:o

Interviewees were asked how many latrine stances (single cubicles within a latrine block) their school has available for students to use. Across our sample, 26 of 30 schools are mee*ng the government target of a student: stance ra*o of 40:1. The average ra*o across all schools is in-‐fact exceeding these targets at 30:1 (rounded to the nearest measure) with a standard devia*on of 16.94 and a range of 76.50. Figure 10 shows the number of schools mee*ng the government targets.

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Figure 10: Government student: stance ra*o is 40:1. Values show the number of schools within each category.


There is li_le to separate the performance of primary and secondary schools here. 13 of 15 primary schools are mee*ng the target of 40:1 whilst 12 of 15 secondary schools are. The average student: stance ra*o in primary schools is 28:1 (SD = 16.94) with a range of 48.18. In secondary schools the figure is 31:1 (SD = 19.31) with a range of 76.50.

5.3.1.2 Hand washing facili:es

Respondents were asked what type of hand washing facili*es were available for both staff and students to access throughout the school day. Only 1 school did not have any hand washing facili*es, over half of schools used water in jerry cans, and small number of schools had use of sinks or taps, displayed in figure 11 below.

13.33% primary schools have a tap or sink used as a hand washing facility compared to 53.33% of secondary schools. More government schools have a sink or a tap at 40.00% compared to 30.00% of private schools.

Figure 11: Type of hand washing facili*es available. Values show the number of schools within each category.

5.3.1.3 Availability of soap

Figure 12: Availability of soap at hand washing facility. Values show the number of schools within each category.

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Over a third of schools reported that there was never any soap available, one third assuring students find soap available most of the *me and a fibh of schools claiming soap is always present, shown in figure 12.

There was li_le dis*nc*on to be seen between primary and secondary schools here, however some surprising differences were seen between government and private schools. 40.00% of government schools reported to have soap provided at all *mes, compared to 25.00% of private schools, yet in contrast 50.00% of government schools never had soap available, compared to 25.00% of private schools.

Interviewees from the 29 schools that offered hand washing facili*es were asked if students have access to water for washing their hands before meals and 96.55% responded ‘Yes’, only one school said water was not available at this *me. All schools reported water was available for staff to wash their hands before meals.

When asked if water was made available for washing hands aber using the toilet only just over half of schools answered ‘Yes’ for students and 25 supplied water for staff use. There was minimal separa*on between primary and secondary schools here.

5.3.2 Educa:on

24 schools reported having hygiene educa*on programmes. The most common programmes incorporated topics in rela*on to ‘personal hygiene’ and ‘hand washing and sanita*on’. The majority of schools offer between 1 and 2 educa*on programmes.

There were only a handful of schools that offered hygiene educa*on specific to gender. 2 schools deliver WASH (water, sanita*on and hygiene) programs, three schools incorpora*ng girl’s health into the curriculum and only one school addressing boy’s health. 2 schools could not provide an answer or did not know what educa*on programmes were available. This data is displayed in figures 13 and 14.

Figure 13: Hygiene Educa*on programs available throughout all schools interviewed. Data according to the respondent are programs currently running as part of the school curriculum. Values correspond to the number of schools providing each program.

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Overall, primary schools offered more educa*on on sanita*on and hygiene than secondary schools with 14 of 15 primary schools offering at least 1 programme and 50% of those schools offering 2 or more. In comparison only 10 of 15 secondary schools offered any form of educa*on regarding sanita*on and hygiene and 50% of those offering 2 or more. There was li_le difference seen between government and private schools here.

Figure 14: Number of educa*on programmes per school. Values show the frequency of schools which fall within each category.

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Table 1. Water usage in schools


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Table 2. Treated water set aside for students


6Focus group analysis

VU:RU research interns moderated focus groups across 30 schools in Kanungu District looking into needs and prac*ces regarding access to water, drinking water quality and sanita*on. Each focus group was led by one VU:RU intern, whilst another transcribed and an intern from Great Lakes Regional College, a further educa*on ins*tu*on in Kanungu, acted as a translator where necessary. Discussions were conducted in English where par*cipants were comfortable to use it and otherwise conducted in Rukiga. Rukiga responses were translated into English before being transcribed. Focus group discussions were about 1 hour in length. 9 ques*ons were used to lead discussion.

Qualita*ve data analysis using the method outlined above revealed 9 themes within the categories of water access, drinking water quality and sanita*on. These broad themes are laid out in table 2.

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Focus group themes

Water access

Tap failure and consequences

Tensions in sharing water resources with the community

Problems of topography

Consequences of child water collection

Drinking water quality

Insufficient storage and equipment impeding quality

The perception that piped water is safe to drink without treatment

Perceived unimportance of water treatment among students

Sanitation

The need to prioritise water uses

Table 3. Focus group themes.


6.1 Water access

6.1.1 Tap failure and consequences

Our ques*onnaire data shows that the majority of schools (80%) have a tap on site, which is likely to be part of a gravity flow system direc*ng water from a spring along a course serving several communi*es and schools.

One of the significant barriers to adequate water access which cut across most focus group discussions was the tendency for these taps to become non-‐func*onal due to mechanical breakages or dry season.

1: …when the tap doesn’t work we suffer.

2: SomeNmes we have problems with the tap, when it is broken we have to walk 20 minutes to the source, which is only a stream. It is very difficult when we do not have water all day. In March the pipes were broken for 5 days.

One widely men*oned cause of taps becoming non-‐func*onal was uninten*onal destruc*on of water infrastructure. According to focus group par*cipants, this can occur through the construc*on of new roads where the gravity flow scheme piping cuts through the area in which a road is being built. In some discussions, the agricultural prac*ce of bush burning -‐ in which an area of land is burned in order to accumulate rapidly cycling nutrients -‐ was cited as a problem as farmers would unwiyngly burn through the plas*c pipes connec*ng a school to its water source.

4: Around here, when people are growing crops, they burn land to clear it. The fire can melt the pipes, which are plasNc.

Aside from these accidental causes of infrastructure destruc*on, some focus group par*cipants also referred to inten*onal sabotage as an occasional cause of taps ceasing to func*on. When discussing this, one par*cipant noted:

2: Some people are jealous.

R: Who? 2: Our neighbours. They think they should provide the area with water for the community.

Otherwise, dry season was men*oned in almost every focus group as a reason for reduced water supply and par*al or complete tap non-‐func*oning. As one respondent succinctly put it:

4: Drought is the driver of all our water problems at the school. The water level has gone so low that it was not possible to draw water from the source.

Whatever the cause, these episodes of tap breakdown have a range of knock-‐on effects. Respondents explained that infrastructure breakdowns resul*ng from road construc*on, bush burning, or inten*onal sabotage result in users incurring charges by the Na*onal Water and Sewage Corpora*on for repairs.

In periods of tap failure, an intervening factor which arose in focus groups as something which works against a school’s aim to provide enough water is a lack of storage.

Respondents explained that periods of *me in which their tap does not func*on can last from days to weeks -‐ with extended periods of non-‐use more common in dry season.

In discussions regarding tap failure, it was common for respondents to express that it results in longer journeys over hilly terrain to alterna*ve sources, which are protected from contamina*on to a lesser extent,

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if at all. Yet some respondents would go on to say that the accumula*on of costs related to tap failure in terms of extra *me spent collec*ng, labour, and some*mes money, incurred in overcoming the problem means that there is simply a greatly reduced amount of water available in schools. In these situa*ons, one respondent explains:

3: We just have to suffer and drink less water.

6.1.2 Tensions in sharing water resources with the local community and inadequate supplies

In many focus groups, par*cipants raised the issue of sharing water resources with the local community as well as other schools. This situa*on of sharing was always framed in nega*ve terms and discussed in rela*on to difficul*es which arose as a result of it. One of these difficul*es oben men*oned was long wai*ng *mes at the shared water source.

R: You also menNoned you share the well with community. Do you find there are many people waiNng queuing up for the water?

All: Yes

5: Many people

4: You have to line up.

5: Line up and wait.

R: How long have you had to wait for?

4: One hour.

3: One hour. Even more than one hour 2: SomeNmes even more than four hours.

Another nega*ve result of sharing water resources, according to focus group respondents, was overconsump*on. Although in places enough taps seem to have been installed to eliminate very long water collec*on journeys, the water within the systems which these taps are connected to is spread too thinly and is insufficient for its large user base, par*cipants explained. In some schools they discussed how one communal tank connected to many taps is filled daily but depleted very quickly, even by late morning for some.

4: Our water is supplied to a large area – there is not enough. We are not in control.

1: The number of students does not match up to the source available. We have one source for two hundred children.

Not only is the water infrastructure itself shared, focus groups revealed that the responsibility for paying for it and the consequences for missing payments are also shared. If one link in the chain of users does not pay, respondents explained, everybody suffers as the water supply is withdrawn.

1: It is not reliable because if we do not pay or one of our partners does not pay, the water supply is disconnected.

In other focus groups, another factor in producing tension between schools and other user groups in the community came up. Respondents complained that other users misuse the water infrastructure, leaving it damaged and unusable. Schools also blamed members of the community for stealing hygiene equipment,

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such as jerry cans used in *ppy-‐tap hand washing sta*ons. Inadequate fencing was men*oned as a factor worsening this situa*on.

3: We need a fence.

2: Outsiders do come and fetch water from the tap._

1: Outsiders destroy the tap. They do not know how to use it.

2: Outsiders come day and night.

R: Does the school tell the outsiders that they should not use the tap?

3: This is a community school so we do not stop people fetching water from the tap.

Whilst some respondents, when asked about problems that arise in sharing with the community, explained that it is the school which oben gets the blame when infrastructure is destroyed. This results in further financial costs being incurred in schools which oben have very limited resources.

R: Do you find any problem with the community scheme? 2: Yes, we find someNmes the tap may be broken. The school gets the blame most of the Nme and we end up having to pay to get it fixed.

Instead of collec*ve use and maintenance of water resources bringing communi*es together in coopera*on, in most focus groups, the rela*onship is framed instead in terms of compe**on resul*ng in disrup*on.

4: During dry season, in terms of operaNon, acNviNes in the school plan are affected. We compete for water in town, lessons are disrupted.

6.1.3 Problems of topography

Respondents from schools at par*cularly high al*tudes expressed that a weakness of the gravity flow system as it exists in Kanungu is that they get worse coverage than other members of the community at a lower al*tude.

4: The tank is not at the same level as the tap. So, the ones who live at a lower alNtude, they have access to water more of the Nme than we do

Par*cipants in one school even men*oned having to buy water from a prison at a lower al*tude when their tap does not func*on:

R: When was the last Nme you had access to water? 1: We had water in the morning, but now we no longer have it. R: Does that happen every day? 1: Water is available at 8 in the morning, but when it coms to 11AM it is no longer there. R: Why? 4: In the morning the community have not overused it, so the tank is sNll full. The later on in the day, the less water we have. R: When there is no water here, do you collect it anywhere else? 3: We go and buy it from our neighbours at the prison. The prison has taps. It is same water supply, but they are lower down the hill. It is 1000 UGX per 20 litre

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jerry can. If they also don’t have water, we have to pay someone further down the hill.

6.1.4 Consequences of child water collec:on

Sending children to collect water was found to be a commonly used prac*ce that researchers rou*nely observed whilst in the field. Though discussions on this theme did not open up very widely with par*cipants, some nega*ve consequences of this prac*ce emerged. In some discussions respondents men*oned children returning to class from water collec*on late and *red:

6: Even the students you find are adending class late. They go far to look for water and they become Nred.

In another focus group, par*cipants talked about how water collec*on can cause whole classes of students to miss out on lessons.

1: At Nmes when they are fetching water they disorganise the class acNviNes.

3: We stop lessons, then take the students for fetching.

Respondents in this focus group explain that water collec*on has been ins*tu*onalised into the school *metable at the cost of spending *me in class.

In other focus groups par*cipants report that the prac*ce of sending students to collect water encourages consump*on of untreated water as unsupervised students, aber a poten*ally long and *ring journey to a water source, will some*mes quench their thirst at the source itself instead of wai*ng for it to be treated.

Something that may help to explain why it is children who are lumbered with the job of water collec*on is that one par*cipant described his percep*on of the job as menial and boring, explaining that:

2: Water business is tedious. Fetching, carrying, boiling. It is all tedious.

6.2 Drinking water quality

6.2.1 Insufficient storage and equipment impeding quality

An idea that emerged across focus groups was that a lack of water storage facili*es put serious limita*ons in the amount of treated water available in schools. Respondents explained that the amount of water a school can treat is limited by the designated water storage facili*es it has. If these pots or tanks cannot be filled with enough treated water to provide for all students and staff, then treated water will be completely consumed whilst there is a gap in service as more water, if it is available, is being boiled. Though staff at a school may know very well that their water must be boiled, it is impossible to provide sufficient treated water if there is no where to put it and no money with which to purchase addi*onal storage. This could explain why so many schools treat water for their staff, but not their students

1: We don’t have the materials to store large amounts of treated water.

On the other hand, respondents at a school which is well resourced in terms of storage, explained that they are able to offer treated water without gaps in service:

R: I know there is a tank and tap for boiled water, is there always enough of that or does it run out?

5: We try hard from collecNon to get it filled, aeer cleaning it we fill again.

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2: We first clean the tank. In order to keep having safe water.

5: By the Nme the other one is used another will be cooling down so we can refill.

R: I understand. So you are saying that while the boiled water tank is used up, another is being boiled?

5: Yes so it cools in Nme to be refilled.

In terms of treatment equipment, many respondents men*oned that the absence of facili*es and materials including firewood was one reason that the amount of water which could be treated was limited. On the other hand, in a focus group discussion within a school which has an externally funded water treatment facility par*cipants expressed that having adequate treatment facili*es has changed the health of their students significantly.

1: Before we got this boiling facility, we suffered. Students would fall sick. Now we drink boiled water these cases are reduced. It helps when students wash their hands and use soap. We do not really get water related diseases anymore.

6.2.2 The percep:on that piped water is safe to drink without treatment

An idea expressed in many focus groups was that piped water -‐ water that is piped from a spring to the school’s tap through a gravity flow system -‐ is safe to drink. The essence of this problem is captured by par*cipants in one focus group in which it was said:

R: Is your water source ever polluted by humans or animals?

5: We assume the water is clean.

1: Because we have no tests we cannot tell with the naked eye if it is clean.

In one focus group a par*cipant said of others:

2: Many believe piped water is safe and therefore do not treat it.

Whilst in other discussions, par*cipants made this percep*on very clear:

R: Has your source ever become contaminated? 2: It has never been contaminated.

1: It is fenced at the source – there is no contaminaNon.

It another it was said:

3: They have no opinion because the water is clean.

1: We drink straight from the tap.

6.2.3 The perceived unimportance of water treatment among students

A theme which cut across many focus groups and was expressed by many par*cipants was the idea that the importance of drinking only treated water is not widely accepted among students. Par*cipants explained that many students do not like the taste of boiled water, which can have a smokey flavour. One way this

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plays out is in how children were said to drink untreated water on their way home or when collec*ng from the tap:

3: The staff no, but someNmes the children can [drink untreated water] on the way home and someNmes even when they are collecNng water from the tap.

This prac*ce was oben linked to incorrect tradi*onal views about the treatment of water. Par*cipants explained that children could pick up ideas about water from their family who may not have been exposed to sensi*sa*on on the danger of drinking untreated water. This results in students bringing in untreated water from their homes, even if they are being taught about its dangers within school.

R: Is water from home treated or untreated?

4: Some is treated, but not all of it. Some homes drink unboiled water and some do not. R: Why do you think that is?

4: Well, it depends on the level of understanding of contaminaNon. Different people have different levels of understanding and sensiNsaNon.

Other par*cipants have said:

2: You must have seen the children drinking untreated water at lunchNme.

1: Some people have tradiNonal views and do not believe in boiling water.

2: Many believe piped water is safe and therefore do not treat it. One nega*ve belief in par*cular is the view that drinking boiled water gives a person flu: R: What about the link of boiled water and flu?

2: The belief is there, but we try and discourage them.

R: How many students do you think believe this?

2: Around a third.

R: How many girls get sick from waterborne diseases per term?

2: Between 30-‐60, usually from typhoid.

The no*on of students picking up incorrect ideas about the importance of trea*ng drinking water at home as well as drinking untreated water there is reflected in the a focus group within a school with par*cularly good water and sanita*on prac*ces. Here it was stated that day-‐schoolers are much more likely to develop water-‐related diseases than boarders:

5: Most of the people who suffer from water borne diseases are the day schoolers, the people from the villages they are negligent. They are ignorant about boiling water, most people gejng illnesses are day schoolers. R: Does anyone else have an opinion? 2: As you have heard we only have the day schoolers, as they come from home during the course of the day some have suffered. We immediately take them to clinic to stop spread. it is very common for day schoolers. 6: It is not common for boarders.

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Par*cipants expressed that within this context of working with students who do not believe that consuming untreated water is harmful, a further problem arises from just how difficult it is to prevent large numbers of, oben very young, children from drinking untreated water. They explain that it is not possible to effec*vely impose external restraints that prevent this prac*ce, especially without a physical barrier protec*ng the tap.

1: Yes someNmes [students drink untreated water]. We can’t help it as the kids run off and drink untreated water straight from the taps. 3+4: Especially the younger ones.

1: Kids are stubborn and good at forgejng. We discourage children from doing it.

6.3 Sanita:on

6.3.1 The need to priori:se different uses of water

An important theme that can be seen across many focus groups, which casts the data on water use in a new light, is the need within schools to economise and priori*se different types of water use. A hierarchy of the perceived value of different uses of water emerges which tends to place drinking and cooking at the top and hygiene and sanita*on at the bo_om. When par*cipants were asked what they would do if they had more water, uses related to hygiene were almost always one of the last comments. One par*cipant actually ranked what he would like to use water for if there was more of it. Uses related to hygiene and sanita*on are both ranked beneath giving cows water to drink.

1: Number one, boiling and drinking. Number two, food preparaNon. Number three, giving the cows a drink. Number four, cleaning toilets and number five, bathing and washing.

Something that could help to explain this is that focus group par*cipants also expressed that it is impossible to iden*fy when sickness is or is not specifically related to hygiene. Beyond the fact that a medical diagnosis of sickness is rare because of either the cost or the distance to a medical centre, par*cipants said, it can be embarrassing to talk about common symptoms such as diarrhoea.

2: It is difficult to determine how frequent they get diarrhoea. R: Are records kept? 2: Because of diarrhoea?! It is difficult.

6.3.2 Water, hygiene and sanita:on educa:on in schools

Across focus groups a picture emerged of how schools approach educa*on related to hygiene and sanita*on. In many focus groups, when asked if the school offers any educa*on on hygiene and sanita*on, par*cipants referred to school assemblies.

Other par*cipants referred to more planned and structured mee*ngs in which boys and girls are separated and hygiene is discussed in an interac*ve way with a male or female teacher. Inspec*ons of students’ hair, nails, teeth and so on are also done here, with one respondent saying that if a child displays bad hygiene con*nuously, the school will work with the child’s family to encourage more sustained behavioural change.

2: We have meeNngs, boys meeNng and girls meeNng where this is discussed. R: What is discussed in these meeNngs? 3: We tell them how to care about themselves and how to use water to bathe and wash their hands.

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A focus group discussion within one school referred to par*cular staff members who are designated the role of being in charge of ma_ers related to health, including water, hygiene and sanita*on. Here there is a senior male staff member for boys and a senior female member of staff for girls.

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6Conclusions, limitations and

recommendations 6 Conclusions and recommenda:ons

6.1 Resource insufficiency, shared resources and community conflict

In the results of both ques*onnaire and focus group data, it is clear that water resources used by schools are inadequate and that this problem is amplified by the issues which surround sharing them. Less than 1 in 5 schools in our sample use an adequate amount of water per student per day when compared against the target threshold set by government, only 1 in 3 schools provide students with drinking water whilst 2 in 3 schools plainly asserted that they do not have enough water. Focus group discussions revealed that this insufficiency is very oben related to overconsump*on of limited resources spread thinly and widely used. The situa*on of sharing was always framed in nega*ve terms and discussed in rela*on to difficul*es which arose as a result of it. Specific problems which emerged were overconsump*on, resul*ng in water becoming inaccessible; long waits at the water source, some*mes las*ng hours; misuse of water infrastructure by the community or school children, resul*ng in breakdown and extra costs; shared financial responsibility, some*mes resul*ng in service disrup*on due to non-‐payment of other users; and theb of hygiene resources. Instead of communal use of and responsibility for resources bringing schools and communi*es together, the result has been compe**on resul*ng in disrup*on.

Government ini*a*ves and interven*on with respect to water service provision for the past 15 years have been underpinned by the Na*onal Water Policy enacted in 1999. The NWP outlined the plan to decentralise management of water sources, making local communi*es responsible for them. The presence of a Water User Group (WUG) and its execu*ve organ, the Water User Commi_ee (WUC), at every improved water point became a legal requirement. This policy brought a shib in the responsibility for a water source and associated costs from government to groups of end users as government documents explain that “actual users that are the most suitable people to manage and maintain their own water source.” The impact of 59

this policy has been unclear. Points of WUC inac*vity have been highlighted in reports by WaterAid and 60

the Nederlands Development Organisa*on. This also seems to be the experience of a few schools in our 61

sample in which this was men*oned in focus group discussions.

The same WaterAid report along with one by the Ugandan Ministry of Educa*on and Sports show that 62

school-‐community conflict over shared resources is not a new problem. In a water and sanita*on mapping exercise conducted across 5 districts, it was discovered that “the interac*on between the schools and their host communi*es play a key role in the sustainability of WASH services” as similar problems were 63

unearthed. Whist in the paper by the Ministry of Educa*on, it was found that communi*es “never contributed towards the repairing of boreholes, leaving the burden on schools”, that school facili*es are used without authorisa*on, are some*mes vandalised and that similar source misuse causes mutual

Ministry of Water, Land and Environment, A National Water Policy, 199959


Netherlands Development Organisation, Improving Water Supply to Rural Communities in Bundibugyo District by Strengthening 61

Water Management Structures, 2011

Ministry of Education and Sports, Sanitation and Hygiene in Primary Schools in Uganda, 200662

WaterAid Uganda, op.cit63

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annoyance between schools and communi*es. Tensions observed in this study may serve as a warning as 64

in 8 of the 20 districts examined they resulted in episodes of conflict in which tanks were pierced and taps or boreholes were broken by communi*es. These problems reflect an unforeseen issue arising as a result of the NWP. Localising the management of water resources and making them an issue of collec*ve ac*on requires formalised avenues of recourse and complaint with arbiters who have the authority to se_le disputes. Whilst a more formalised procedure of problem solving is also necessary to circumnavigate the poten*al problem of WUG and WUC inac*vity or the exclusion of other stakeholders.

6.2 Recommenda:on 1: stakeholder mee:ngs

A response to this problem must be found in opera*onalising the principle of school-‐community coopera*on. Groups of end users have been given the shared responsibility for taking care of their water source but there has been lack of coordina*on, leading to compe**on rather than coopera*on.

A solu*on could be found in organising mee*ngs of water and sanita*on stakeholders sharing the same resources. Certain key stakeholders would need to be present at each of these mee*ngs, such as WUC members, senior school staff and the PTA. Whilst other stakeholders, such as representa*ves of the district water office, the district educa*on office, the district health office would need to be involved with forming, organising and launching these mee*ngs, monitoring progress of resolu*ons made, and providing consulta*ve exper*se.

Roundtable type discussions would provide a forum in which problems can be discussed in the open to avoid the accumula*on of tension resul*ng in conflict. Possible solu*ons could be discussed and agreed upon by stakeholders whilst progress towards achieving them could be monitored by local officials.

6.3 Unsuccessful treatment of water

One of the most striking findings of this study is that staff in most schools are trea*ng water ineffec*vely as 85% of treated water samples tested posi*ve for faecal contamina*on. This libs the figure for the number of people in our sample who are being given drinking water contaminated with faeces and the associated microbial pathogens to 7,179.

Addi*onally, we found that the propor*on of staff and students who become ill from waterborne disease within schools which gave samples that tested posi*ve for faecal contamina*on are significantly higher than those schools whose samples tested nega*ve. The aggregate average of the propor*on of members of staff who fell sick in schools with contaminated water samples was 22% whereas the figure is just 6% in schools with samples which tested nega*ve. The figures for students are 8% and 3% respec*vely. This shows how this mistaken belief that treatment methods are effec*ve plays out in reality as it results in real sickness.

The ineffec*ve treatment of water in schools in Kanungu can be partly explained by the finding that a mul* barrier approach to the treatment of drinking water was shown to be taken in only 3 of the 30 schools in our sample. A mul* barrier approach to ensuring that drinking water is safe can be defined as an integrated system of procedures, processes and tools that collec*vely prevent or reduce the contamina*on of drinking water from source to tap in order to reduce risks to public health. This is not a process which has to be 65

done centrally, but is something which can be done at school level. The idea at the core of this approach is the need to follow a process, rather than relying on a single technology to improve water quality.

6.4 Recommenda:on 2: the introduc:on of a mul:-‐barrier approach and further research

A mul*-‐barrier approach begins with source protec*on. Ques*onnaire and focus group respondents in many schools explained that they had never visited their source. As this is a point at which it is very likely that microbial pathogens can be introduced, it is important that school staff are aware of the extent to

Ministry of Education and Sports, op.cit64

Federal-Provincial-Territorial Committee on Drinking Water & Water Quality Task Group, From Source To Tap - The Multi-Barrier 65

Approach To Safe Drinking Water, p. 4, 2002�43


which it is protected. At community level, some ac*ons which can be taken to protect the source are: regularly cleaning the area around the water source; moving latrines away from and downstream of water sources; building fences to prevent animals from geyng into open water sources; lining wells to prevent surface water from contamina*ng the ground water; building proper drainage for wastewater around taps and wells. Following this stage, sedimenta*on can be used to reduce the turbidity of water (the level of 66

par*culates like sand). This can be done by se_ling the water, for instance in a se_ling tank. Bacteria and viruses are oben a_ached to par*cle surfaces, therefore the removal of these par*cles will produce a reduc*on in their concentra*ons. Filtra*on can be used to further remove turbidity and pathogens from the water. Filtra*on is a process in which the water passes through some media, a filter. Through straining, the larger pathogens such as worms become trapped in the small spaces within the filter media. This process can be achieved through simple cloth filtering. Following this comes the process which many schools are already doing -‐ pasteurisa*on -‐ generally through boiling. Chemical disinfec*on can also be used at this point, but is less cost effec*ve and unlikely to become an a_rac*ve op*on in Kanungu. Finally, now the water has been made safe, it is necessary to ensure that it stays that way through safe storage as recontamina*on at this stage can be a huge problem. Safe storage means keeping the treated water away 67

from contamina*on sources, using a clean and covered container, and actually drinking water in a way that people do not make one another sick. The container should prevent cups, hands or dippers from touching the water. 68

Further research could examine more closely the methods by which each school treats their water, examining it at every stage journey from source to mouth. From this we would be able to determine to what extent a mul*-‐barrier approach is being employed, which could lead to a possible interven*on. This could be based on sensi*sa*on to the approach outlined above.

Another avenue for further research and possible interven*on could be found in an in depth study of the 15% of schools which are successfully trea*ng water. In these schools we have a system which is proven to work. Beyond its efficacy, the resources necessary to achieve the results are likely to be already within reach of schools currently trea*ng water ineffec*vely. An inves*ga*on of schools trea*ng water with success therefore provides the opportunity to discover a genuinely sustainable means by which this problem could be solved as schools would not become reliant on external actors and their resources, but on themselves and upon the resources that they already have.

6.5 Poor quality water in ‘improved’ sources and the belief that this water is safe

An improved water source is defined by the United Na*ons and Unicef Joint Monitoring Programme (JMP) for Water Supply and Sanita*on as one that, by nature of its construc*on or through ac*ve interven*on, is likely to be protected from outside contamina*on, in par*cular from contamina*on with faecal ma_er. As 69

men*oned in the introductory chapter, according to the JMP, Uganda met the millennium development goal for improving access to safe water in 2010, 5 years early, as 72% of the popula*on had access to safe water, that is, to a protected source. 70

We found that 14 of the 17 schools which access a protected source provided water samples that tested posi*ve for faecal contamina*on. It is worth no*ng here that these samples had also been boiled. This shows that what the United Na*ons, UNICEF, and the Government of Uganda call ‘safe water’ is not necessarily safe. Aside from throwing into ques*on the validity of the claims about succeeding in reaching this millennium development goal, this leaves the people of Kanungu in a situa*on where they are exposed to water which is more dangerous than they think it is.

www.sswm.info/content/hwts66

Ashbolt, op.cit67

http://www.sswm.info/content/hwts68

www.wssinfo.org/definitions-methods/69


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http://www.sswm.info/content/hwts

http://www.sswm.info/glossary/2/letterl#term2758


Another prominent result of this study, this one derived from focus group discussions, has revealed that it is a common concep*on to see water from an improved source as safe to drink without treatment. It is easy to understand why this is the case when the improved sources are considered by large interna*onal organisa*ons to be safe.

6.6 Recommenda:on 3: a sensi:sa:on programme

In response to this misconcep*on, along with the ineffec*ve treatment of water and the absence of water and hygiene related outreach in many schools in Kanungu, we suggest working in coopera*on with Bwindi Community Hospital (BCH), who already run a successful water and hygiene outreach programme, to introduce educa*onal outreach to schools in Kanungu. Perhaps a good start would be introducing a WASH (water, sanita*on and hygiene) educa*onal outreach day comparable to the HIV day that Volunteer Uganda is already commi_ed to. We would rely on the exper*se and prac*cal knowledge of what works of BCH in design of programme content.

There are a significant number of schools which answered in the affirma*ve when asked if they have any hygiene educa*on programmes. However, when asked about details it seems that many of these are limited to assemblies. We know nothing of their content and it would certainly add something to the knowledge of students and staff to engage in a programme designed with the help of experts at BCH.

Further research could look into the details of exactly what kind of water, sanita*on ad hygiene educa*on is already in place, its content, and could poll sa*sfac*on rates.

6.7 Insufficient drinking water supplied to students

100% of schools provide staff with treated drinking water but only two thirds of schools are able to provide drinking water for students. In addi*on, respondents stated that staff could drink as much as they wanted throughout the day but students were limited to the amount set aside for drinking each day and it was revealed in some focus groups that frequently there is not enough water for students and they go thirsty. Not only is it a concern that 85% of water samples tested posi*ve for coliform bacteria, but that the students are drinking so li_le throughout an average school day of 7 hours.

According to the Bri*sh Na*onal Hydra*on Council, a child should drink on an average day the equivalent of 6-‐8 200ml glasses of water, a child of 14 years is considered an adult and should drink 8-‐10 glasses and small children 6 glasses of 150ml. Of course it must be considered that varia*on in ac*vity and climate 71

may also alter supply of water needed to maintain hydrated. This strikes alarming concerns with the data collected on drinking water provision for students in the sample. Only two thirds of schools provide any water at all, and an average of only 307ml per day for those that could. Taking into account an average school day of 7 hours, 300ml is not even close to being enough to keep students hydrated, not to men*on most students also walk long distances to and from school in addi*on to this.

6.8 Recommenda:on 4: further research into why drinking water is unavailable and the promo:on of alterna:ve treatment

Further research could inves*gate why so li_le water is available for students, whether or not students are affected in class by dehydra*on or low concentra*on levels

Some schools revealed in focus groups that they could not supply children with any water at all because cost of firewood or charcoal to boil the water for safe drinking was too expensive. An organisa*on called ‘Water school Uganda’ are currently opera*ng in 100 schools throughout Uganda aiming to improve many aspects of water sanita*on and hygiene. One successful project they are implemen*ng is the ‘Solar Disinfec*on Technology’ which they are using to treat drinking water. Partnering with BCH to educate on

National hydration council, www.naturalhydrationcouncil.org.uk/hydration-facts/faqs-on-hydration71

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alternate water treatment methods for safe drinking water and learning from water school Uganda could be a great way overcoming problems of water treatment in schools.

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Documents

VURU Water Paper 2014 (1)