Uganda faces a significant economic burden from inadequate investment in the water, sanitation, and hygiene services. An EPRC analysis shows that the country loses as much as 2.9% of the economy (about Uganda shillings 5.9 trillion) annually.
Dr Ibrahim Kasirye, EPRC Director of Research, told a Water and Sanitation breakfast meeting organised by the Ministry of Water and Environment in Kampala recently that “the staggering cost is a clarion call for action”.
The costs come in the form of disease burden, premature deaths, productivity loss as one takes time off ill, and health care cost among others. For teen girls, studies have shown, some school dropouts are instigated by lack of or poor sanitary facilities.
“Premature deaths are the largest contributor of the costs, accounting for Shs3.2trn; this is followed by health care costs at Shs1.5tn, productivity losses and time access losses are around half a trillion each,” Kasirye said.
Dr. Ibrahim Kasirye sharing results of the analysis at a breakfast meeting in Kampala recently
Kasirye noted that the water, sanitation, and hygiene subsectors are underfunded, hampering life-saving interventions. In the 2022/23 budget year, WASH services were collectively allocated Shs 2.7tn, a figure that pales in comparison with the estimated annual requirement of UGX 5trillion. By 2030, the EPRC analysis shows, this requirement will have risen to at least Shs 10 trillion.
“This financial gap hinders the implementation of necessary interventions to improve WASH outcomes, particularly in sanitation,” notes the draft report abstract. “There is also a discrepancy between the allocated budget and the actual financial releases, which further exacerbates the financing challenge.”
“These financial discrepancies hinder the progress towards improved WASH outcomes,” said Kasirye, adding “This is the cost of not doing what is right. By investing relatively [insignificant amounts], we continue to lose substantial amounts of money in the cost of inadequacy.”
The disease burden from WASH services inadequacy, based on the 2024 population of Uganda, amount to 47.1million disease cases. At least 78% are in rural areas, partly because that is where most Ugandans live, and partly because rural areas have the largest WASH services deficits.
Uganda pays a heavy price for not investing adequately in WASH services. EPRC screengrab
OPEN DEFECATION
Of concern, Kasirye noted, is the vast number of Ugandans that still resort to open defecation to ease themselves. Two and a half million Ugandans, or 6% of the population practice open defecation.
Kasirye told the meeting that “it is one of the reasons why we have higher cost of inaction.” For some communities like Karamoja sub-region, it is “deeply embedded in the socio-cultural and economic landscape of the country.”
One of the highlighted impacts is child health where diarrhoea is the leading cause of deaths among children, accounting for 41% of all wash related deaths.
“About one in ten rural households do not have a sanitation facility. The lack of sanitation facilities in sub-regions such as Karamoja, Teso, and West Nile is not merely a matter of infrastructure deficit but is also a reflection of broader societal issues,” the report summary notes.
The cost of having a latrine or toilet is to be prohibitive, and a lack of awareness about the importance of sanitation.
Cultural practices further influence the prevalence of open defecation, with some communities viewing it as part of their traditional way of life. Agricultural livelihoods, which involve spending long hours in the field, often far from any permanent structures, contribute to the normalization of open defecation.
WATER ON THE PREMISES
Having water at the premises is one of the proven ways to cut the disease burden contracted on the way to and from collecting water.
“Having water on the premises reduces the risk of contracting these diseases. Most these diseases are captured or contracted on the way to the wells and back. Water on the premises is exceptionally low – even in urban areas. Only 15% of households have water on the premises. Nationally, it is around 10% of households. What does this mean? There is a remarkably high burden for collecting water,” Kasirye said. Adult females bear a substantial proportion of this burden – rural and urban areas – in terms of collecting water.
Officials in the WASH sector listen in to the EPRC presentation. Photo/EPRC