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Hygiene & Sanitation Strategies in Uganda How to Achieve Sustainable Behaviour Change?

This presentation explores new opportunities and strategies for hygiene and sanitation in Uganda, focusing on behavior change and the need to address the "faecal-oral" route of disease transmission. It discusses the importance of hygiene promotion, the role of community health clubs, and the success of demonstration models in improving sanitation. The presentation also emphasizes the need for holistic sanitation approaches and highlights the progress and lessons learned from test models for best practices in hygiene and sanitation. The objective is to create a healthier environment for children in Uganda.

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Hygiene & Sanitation Strategies in Uganda How to Achieve Sustainable Behaviour Change?

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  1. Hygiene & Sanitation Strategies in UgandaHow to Achieve Sustainable Behaviour Change? 31st WEDC Conference 31st October 2005, Kampala, Uganda Anthony Waterkeyn WSP / MoH (EHD)

  2. New Opportunities for HP&S An Enabling Environment • Poverty Eradication Action Plan (PEAP Revision) • Sector Wide Approach to Planning (SWAP) • National Concern over very high Infant & Maternal Mortality Rates (Ministry of Finance) • Health Sector Strategic Plan (2005 – 2010) • MoH emphasising PREVENTION ahead of CURE • Fiscal Decentralisation Strategy – More District autonomy for budget allocations • New Environmental Health Policy & Legislation • More concern to educate the Girl-Child and improve school sanitation

  3. New Opportunities for HP&S New Focus on Hygiene Promotion • Sanitation involves Behaviour Change • Hygiene Promotion is NOT just about building latrines • No point in building unwanted (mis-used) Toilets • Our Challenge:- How to break the faecal : oral routes of disease transmission? • Conversion vs Coercion (carrot or stick)?

  4. 56% Fluids Fields Faeces New Host Flies Fingers 4% ? Primary Prevention (The F diagram) Blocking the“Faecal Oral”Route Latrine/Toilet Water Quality Food Water Quantity Hand Washing

  5. Development Busia MoH District Leadership Integration of existing resources Carrot & Stick Regulation Emergency Gulu IDP Camps NGO (CARE / HIDO) Demonstration Model (Community Health Clubs) Peer Pressure Behaviour Change Best Practices in Uganda

  6. Competition Targets Prizes Fines Baseline survey Monitoring Key role of DDHS Health Assistants Coverage 40-90% Home Improvement Campaign in Busia

  7. 15 IDP Camps Gulu 4 months Dec – Mar 05 15,522 Health Club members (42% coverage) 116 CHCs Weekly Health Promotion sessions (20 topics) House to House monitoring Sanitation Committee Baseline survey & monitoring >120,000 direct beneficiaries Constr. 8,583 latrines (up from 1,700) Community Health Clubs in IDP Camps

  8. Holistic Sanitation in Busia and Gulu • Clean, hygienic latrine / toilet • Hand-washing facility with water & soap that is used • Clean, swept compound (all children’s faeces deposited in latrine) • Fenced rubbish pit • Pot drying rack • Clothes line • Fuel efficient stove • Safe drinking water in clean covered container with ladle • Properly ventilated rooms • Prevention measures against malaria • Control of rodents, flies & mosquitoes

  9. Way Forward • Treat HP&S holistically • “Total Sanitation” to break F-O route • Community Health Clubs build cohesion, peer pressure & positive behaviour change • Start with Model Homes and Model Villages… build on success • Demonstration Models :“seeing is believing” • Support health extension staff (ensure mobility and incentives)

  10. Revitalising HP&S : 1 Recent Progress • National Sanitation Working Group • Sanitation Best Practice Workshops (Busia Story) • Improved Advocacy for HP&S : e.g. AMCOW, some District Leaders, MoH Ministers and now, President Museveni • Improving Integration within some districts (Water, Health, Education, Gender, NGOs and CBOs) • Establishing District Water & Sanitation Co-ordination Committees (DWSCC) • “Total Sanitation” concept is beginning to spread

  11. Revitalising HP&S : 2 Lessons from Test Models for Best Practice in HP&S • Model Homes Model Villages Model Parish Model Parish Model Sub County Model S/County Model District (League Tables) • Concentrate on just ONE Sub-County per year and achieve Total Sanitation in that Sub-county • Within about 5-6 years a whole district can be completely changed • Model Village concept can influence advocacy and budgetary support from District (e.g.CAOs) • Seeing is Believing = Budgetary Support !

  12. Health & Water Sector UNDERTAKINGS • Annual Joint Sector Reviews • Past 3 years: Undertakings for Sanitation • Past week: President = major breakthrough “PHC Guidelines to be reviewed to encourage expenditure of up to 10% of the District PHC Grant on Hygiene Promotion and Sanitation Campaigns”. • Elections: “NO LATRINE – NO VOTE”!

  13. The Objective: Healthier children

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