Water and Sanitation Concerns in Jinja’s Slums

By Justin Silles, Alicia Brindisi, and Darcy Allen: People living in slums within Jinja encounter numerous health problems on a daily basis. The most ubiquitous and urgent concern is the lack of safe water and proper sanitation. In many of the settlements, residents do not have access to functioning toilets. In areas where public facilities do exit, they are inadequate and overburdened, with over 50 individuals sharing one toilet in many instances. The Rippon settlement, for example, is located on the banks of the river. Residents often resort to open defecation at the shore, which contributes to the spread of schistosomiasis (bilharzia), typhoid, and diarrhea. In addition to inadequate sanitation, slums also face challenges with their water supply. While some areas have standpipes, they are either no longer functioning, are in insufficient supply, or are unaffordable to individuals living in extreme poverty. As a result, community members resort to using contaminated water for cooking, cleaning, washing, and drinking. The lack of safe water sources, combined with inadequate sanitation, contribute to high rates of water borne disease.

Slum areas in Jinja also lack proper drainage, compounding the negative impact of poor sanitation. Settlements are often densely populated so in times of rain, water floods homes and walkways, often spreading water borne diseases. Water from outdoor bathrooms and rain combines with rubbish and collects in stagnant pools. The pools contribute to the spread of disease and provide a breeding ground for mosquitoes – increasing the risk of malaria. In areas such as Wanyama, where many of the homes have been built on swamps, residents face an even higher chance of contracting malaria due to the large mosquito populations. Without access to medication or comprehensive health care services, malaria is often undiagnosed, misdiagnosed, or untreated, often resulting in death, particularly among children under five.
In addition to health concerns caused by the living conditions of the settlements, poverty and lack of resources also contribute to serious health challenges that disproportionately affect women. For instance, pregnant women who are far from hospitals and clinics and who do not have money for transportation give birth at home, often without the assistance of a skilled attendant. Many women die during childbirth due from ectopic pregnancies or hemorrhaging because they were unable to access a medical facility. After giving birth, many women lack basic information on breast feeding and nutrition, resulting in malnourished babies. There is also little support for gynecological health and the prevention of gynecological cancers, an unmet need for contraceptives and family planning resources, and few health services for adolescent girls.

While the prevalence of HIV/AIDS in Uganda has decreased since the 1980s and 1990s, it is still a serious health concern, especially within slum settlements. Many people do not know their HIV status, whereas others who are HIV positive are not receiving sufficient care and treatment. In those settlements that have done testing activities, community members have found HIV infection rates to be much higher among women. However, women often do not have the information or resources to prevent the transmission of the virus to their unborn child.

Despite the many challenges within their communities, the Health and Hygiene (H&H) committees of the National Slum Dwellers Federation in Jinja are working to affect positive change. There are approximately 34 H&H committees in Jinja, and each committee has five members. H&H conducts various activities that aim to improve the health of fellow Federation and community members. In order to improve sanitation and access to hygienic toilets, H&H committees facilitate cleanup events, working alongside community members. In Lubaga, for example, H&H members sourced hoes, gum boots, and other materials to successfully clear the latrines of waste. They informed the local health inspector of the activity and its purpose, and he expressed his willingness to offer government assistance for future projects based on the success of the day’s activity. H&H has also implemented health education initiatives by gathering community members together to discuss certain issues and also going door-to-door to inform individuals about health topics. Members have reported a noticeable change within the settlements as a result of their sensitization efforts. For example, more individuals are boiling their water before use and some males expressed their willingness to be tested for HIV when they had previously been reluctant to do so. Furthermore, H&H has executed Voluntary Counseling and Testing (VCT) in Jinja’s settlements, in an effort to raise awareness about HIV/AIDS, empower individuals to know their status, and provide additional resources and support for those who are HIV positive.

H&H has had some achievements in improving the health conditions of Jinja’s settlements. However, the committees and the Federation are lacking the resources and funding needed to scale up their activities. Members have expressed the need for additional support, in the form of funds, regular and in-depth trainings, and identification badges. They also require tools to facilitate their activities, such as training materials to be used during sensitization exercises and supplies for cleanup events. In addition to improving awareness of health issues, there is a strong need within the communities for structural reinforcement. Additional toilets that are safe, clean, and accessible to everyone, regardless of age, sex, or ability, and sources of clean and affordable water are required to make lasting health improvements in the informal settlements.

As one member aptly stated, “You need a healthy body to have a healthy life. You cannot be a saver if you do not have a healthy life.”