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Lessons from three East African cities on why sanitation is such a challenge

Residents of Kigali, the capital of Rwanda. Sanitation in the city is extremely poor. Reuters/Tobias Schwarz

More than half of people living in informal settlements in East Africa live in insanitary and overcrowded conditions. The number of people without adequate access to sanitation is around 55% in Kenya, 63% in Uganda and 68% in Rwanda.

Poor sanitation and unsanitary conditions pose a serious threat to health. Governments have failed to address the problem because they have not prioritised the provision of sanitation, particularly to poor people.

The question is: why has there been so little progress in delivering decent sanitation for millions on the continent?

In an attempt to answer this question, my colleagues and I conducted research to understand how supply and demand have affected both the provision of toilets, as well as their use, in Rwanda’s capital Kigali, the Ugandan capital Kampala and Kisumu in Kenya.

Our study compared the similarities and strong differences of the sanitation markets in the three East African cities.

There is clearly no constraint on the demand side. But on the supply side we found a host of problems that are preventing the provision of decent toilets.

What’s stopping toilets being built

We identified a number of key problems. These included:

  • Bricks and mortar: Materials needed for building toilets were very expensive because most building materials are imported.

  • Skilled labour: there is also a lack of skilled builders. Artisans are available in Rwanda, Uganda and Kenya to build latrines but they are general builders rather than specialists in sanitation.

  • Lack of training: Government’s and municipalities have not taken the initiative to train skilled builders.

  • Products and services: these are largely unavailable.

  • Cost: high cost was identified as the biggest factor preventing households from benefiting from improved sanitation.

  • Poor needs analysis: households are provided with sanitation products and services that they do not want.

  • Geography: the physical features of some informal settlements add to the struggle of sanitation. Settlements are geographically rugged and are built on difficult terrain. Many people are forced to settle for shallow pits. And lack of vehicle access to settlements makes it impossible for service providers to use trucks to empty latrines.


Addressing a range of constraints, rather than single ones, is likely to be more effective.

  • Awareness campaigns, communication and education programmes. Residents must be made aware of the availability of sanitation products and services and how they can access them. Changes to services must be accompanied by appropriate communication. And information centres can be used to teach people about what technologies are available, as well as financing programmes.

  • Long term national and local planning is necessary to overcome the constraints of limited infrastructure and lack of space. These also require a cross-sectoral approach.

  • Technologies need to be developed that take space and emptying difficulties into consideration. Examples of these are the MAPET and Gulper systems. These are manually operated systems which limit the amount of contact humans have with waste when emptying. They’re also cheaper and less time consuming.

  • Emptying services and waste disposal goes hand-in-hand. Setting up waste transfer stations in settlements has been recommended. They enhance resource recovery and the re-use of faecal sludge.

  • Training: the construction of various latrine technologies could be improved through training. But there is a lack of understanding and skills among informal providers, such as manual emptiers, about the appropriate way of disposing waste. Training is one way of rectifying this.

On their own the above solutions won’t ease the sanitation problems in East Africa. They need to be used together to achieve the required results.

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