House heads stumble over fallen logs while others hide behind bushes when they see big groups of people moving with Ms Betty Namusisi and Lucy Akoko. The sanitation promoter and health assistant have at times had to use an iron hand in a bid to improve sanitation in Kangulumira Subcounty, Kayunga District.

Formerly a member of a Village Health Team (VHT), Ms Namusisi has had her scope of work broadened after being enlisted as one of the people to champion the fight against poor sanitation aptly named Sanitation Promoters in the Market Based Sanitation Implementation Approach (MBSIA), a new sanitation network delivery model.

Developed by the Uganda Sanitation for Health Activity (USHA), a five-year project being implemented by Tetra Tech ARD Inc. in collaboration with key partners including SNV, BRAC, FSG and Sanitation Solutions Group (SSG), the MBSIA involves the recruitment, training and intentional linking of local actors to deliver desirable toilet models to households in target communities.

As a sanitation promoter, Ms Namusisi’s role is to sensitize residents on how they can improve their hygiene and sanitation in their homes. She also strives to interest residents in buying sanitation products like latrine upgrade pans and dust bins.

Her daily routine involves moving from household to household with pictures of products they could purchase and linking of possible buyers to distributors. She also advises people on how they can improve their home hygiene.

Ms Betty Namusisi, a Sanitation Promoter from Kangulumira sub county in Kayunga District.

“I feel proud that residents have picked up most of the products I have advised them to. Most of them have simply dug the pits and set up superstructures but have failed to roof them. It is not an ideal situation but it is step-up from the past where people were practicing open defecation,” Ms Namusisi says.

The mother of five strikes you as a friendly and calm woman but in her community she is feared by many residents – especially those without sanitation facilities in their homes.

Many are afraid that she will lead to their arrest or have their rental homes closed since she works closely with the authorities. She is however hopeful that the attitude will change with time once people understand that she means well.

“They all fear me and whenever they see me visit their homes, most of them run away. They think I will collude with the health inspectors to arrest them. But I mean no harm. At times I just want to know what sanitation challenges these homes are facing and see how I can help. In fact, I feel like throwing a party for each home that constructs a pit latrine. It makes me so happy,” she says.

She adds that the people have been very receptive of all the sanitation innovations like SaTo pans, SaTo stools and utensil racks but uptake has been slow due to the high poverty levels in the area. They therefore have to save for months or sell their agricultural produce to afford the even the smallest products usually costing less than shs.50,000 (approximately US$13).

Many say that the SaTo pans currently being sold at shs18,000 (approximately US$5) in the area should be sold at shs10,000 since they also have to pay the masons and also buy other materials required for the upgrade.

According to Ms Namusisi, a sizeable number of people now have latrines although these require upgrades as most are rustic with unwashable floors, poorly constructed, or have problems with flies and bad odor polluting the environment. She says that although Kangulumira has not yet achieved a desirable sanitation status, it is much better than neighboring villages.

A pit latrine in Kangulumira sub county. ALL PHOTOS BY JANE JUSTINE MIREMBE

“Since we have found that a good number of people have already constructed their latrines, we could help to upgrade them. If support is available for them then they should receive it,” Ms Namusisi, who was one of the trainees attending an MBSIA training in Kangulumira sub-county held recently, says.

Besides poor latrine hygiene, the sanitation promoter says Kangulumira faces a problem of garbage disposal, which has rendered the town’s streets a dumping ground. Rubbish is indiscriminately thrown wherever the locals please. The trenches and home compounds are filled with rubbish, with no regard to hygiene.

While open defecation has to a larger extent been eliminated from the town, water drainage is still lacking. The town is not yet connected to the national sewer line so bath water is mostly channeled in the many trenches and gullies. Due to the rubbish in the trenches, the water becomes stagnant turning into a breeding place for mosquitoes.

Like any other work assignment, sanitation promoters also face a number of challenges. For Ms Namusisi, the biggest challenge she has faced is a negative attitude from the public who do not understand her job. She is often ridiculed with some saying she is idle which is why she disturbs them about hygiene.

She also has to walk very long distances to visit different homes and is also often affected by harsh weather conditions. Seeing homes embrace sanitation products however gives her all the satisfaction she needs.

She requests that some low-income people in villages be helped either by constructing for them latrines or finishing construction for those whose latrine building stopped midway. This is because there are some people for whom there is no hope of them bringing them up to standard since they have no source of income. Expecting them to construct latrines or upgrade them is unrealistic, she says.

“If we identify such people and they are helped then it will increase the public’s confidence in sanitation promoters,” she notes.

She was grateful for the MBSIA training and says it has given her more zeal to work hard because she can see a good sanitation future for Kangulumira.

“I have been working but with no motivation. I am now working with vigor and happiness because we are going forward. We used to look at SaTo pans and wonder what they were but now people are using them. And they are so classy, it is as though you are using a waterborne toilet,” she concludes.


MBSIA training participants lay a precast slab on a pit latrine they constructed. With the new method, slabs can be precast from a different location and simply transferred to the latrine. SSG PHOTO

The MBSIA model is currently being rolled out in districts in Central East and Central West Uganda with the Busoga region being the first recipients of the training.

Some of the local actors involved in the model include masons, pit diggers, material suppliers/hardware stores, Sanitation Promoters and local financiers. Networks will be supported by SSG and USHA staff for an initial period of 12 months beginning in September 2019.

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